have often focused on the history of childbirth in one country or on one continent, thereby pointing to national or regional specificities in the modernization of birth.38
In the most recent edition of Jordan’s Birth in Four Cultures, published in 1993, however, she tends to depict a modern biomedical model of birth as a kind of monolithic structure which she refers to as “cosmopolitical obstetrics” and defines as “a system that enforces a particular distribution of power across cultural and social divisions.”39 Jordan argues that the export of this “cosmopolitical” model to the Third World is a form of “biomedical colonization” and “imperialism.”40 She depicts a scenario in which modernity, and biomedicine in particular, does not emerge locally throughout the globe, but is transplanted around the globe. But biomedicine is not a monolithic entity.41 And the biomedicalization of reproduction is not a uniform process either within or across national boundaries.
Somewhat like Jordan, Faye Ginsburg and Rayna Rapp are also concerned with how unequal power relations manifested in the globalization process impact control over reproduction and lead to what they describe as the “stratification of reproduction on a global scale.”42 Yet at the same time, they caution against unidirectional models of the relationship between power and knowledge in the context of globalization. They write, “While our work calls attention to the impact of global processes on everyday reproductive experiences, it does not assume that the power to define reproduction is unidirectional. People everywhere actively use their local cultural logics and social relations to incorporate, revise, or resist the influence of seemingly distant political and economic forces.”43 In addition to the contributors to Ginsburg and Rapp’s (1995) edited volume, other anthropologists have begun to examine the diverse and uneven ways that childbirth is being biomedicalized throughout the world.44
This perspective can help dispel the misconceptions embedded in those feminist studies that view all the controlling aspects of biomedicalized births as derived from a Western historical legacy of the Enlightenment and Industrial Revolution and that present a romanticized vision of holistic “indigenous” birth, or “ethno-obstetrics,” as egalitarian, “woman-centered,” and noninterventionist. Janice Boddy’s study of childbirth in postcolonial Sudan, for example, shows that due to the practice of infibulation and the need to open and restitch the scars from infibulation during delivery, midwifery there can hardly be viewed as noninterventionist.45 In this book, I am not engaging in a debate about whether hospital deliveries are fundamentally controlling or liberating. They may of course be both, just as home deliveries may be experienced as repressive, comforting, or both. Rather, my interest is in demonstrating the historical and cultural specificity of the transformations in the experience of childbirth for working-class women of Tamil Nadu in the late twentieth century.
It is important to underscore the fact that just as the nature of modern birth is unique, forms of resistance will, of course, also be distinct. Due to international and local political-economic structures and cultural processes, biomedical births have not become hegemonic in Tamil Nadu, even in urban areas such as Madras, where almost all births take place in the hospital. And obstetrics has never been the domain of medical men in India as it is in the United States. Following Jean and John Comaroff’s interpretation of Gramsci, I use the term “hegemony” to mean those systems of knowledge, symbols, and practices which are culturally constructed in the context of relations of power and which “come to be taken for granted as the natural and received shape of the world and everything that inhabits it.”46 It is the apparent “natural” quality of hegemony which gives it its profound power. Although allopathy may indeed be the dominant form of maternal and child health care in urban India, it is not taken for granted as the only naturally legitimate form of care. Its apparent superiority must still be publicly articulated. It, therefore, cannot be viewed as hegemonic. Unlike the woman-centered, natural, home-birth movement in America, resistance to biomedical birth in Tamil Nadu is not counterhegemonic; it is based on a critique of the discriminatory ways in which allopathic services are (or are not) provided rather than on a critique of allopathy itself. Resistance to the biomedicalization of birth among the poor of Tamil Nadu, therefore, reflects an effort at bricolage rather than an effort to replace one system of birth with another, wholesale.
Recalling the opening story of Mumtaz, who says she gave birth to her child right on the threshold of her home, we can, following James Scott, view her action and inaction as one of those partial, everyday forms of resistance that are the “weapons of the weak.”47 But a far more interesting and significant form of resistance is taking shape in Tamil Nadu today. Some women want new technologies offered by allopathy but they want to avoid forms of discrimination which they face in public hospitals. Increasingly, these women are opting to bring allopathy and allopathic practitioners back across the threshold into their homes. In some ways, this appears to be a creative and positive solution to their predicament. But, as we see in the coming chapters, there are also potentially serious health risks involved in partially administering biomedical technologies at home without immediate access to full-fledged biomedical emergency care.
TAMIL NADU: URBAN AND SEMIRURAL FIELD SITES
The state of Tamil Nadu, in the southeast corner of India (see Map 1), is often considered one of India’s model states with respect to the provision and use of allopathic maternal-child health (MCH) care. A 1994 government of Tamil Nadu publication showed that 60.6 percent of all reported deliveries in the state were institutionalized; the remainder took place in homes.48 A separate 1993 government of Tamil Nadu report stated that hospital deliveries accounted for “more than 90 percent” of all deliveries in urban areas and “about 50 percent” of all deliveries in rural areas.49 In 1993 the World Bank reported that in the capital city of Madras 99 percent of all deliveries were in hospitals.50 And, by the beginning of 1995, the director of the World Bank–funded India Population Project-V (IPP-V) for Madras reported that 99.9 percent of all deliveries in Madras were conducted in hospitals.51 Because a number of home deliveries go unreported, these figures reflect a somewhat unrealistically high percentage of hospital deliveries. Nevertheless, they demonstrate that the rates of hospital deliveries in Tamil Nadu are significantly greater than those for India as a whole, for which it was reported in 1995 that no more than 20 percent of all deliveries took place in hospitals.52 Yet very little scholarly attention has been given to the cultural and political processes by which MCH care, specifically for childbirth, is being incorporated into allopathic systems of knowledge and institutions in this region or to the quality of that care.53
Map 1. The states of India, 2001.
My initial decision to carry out this research in Tamil Nadu, however, had more to do with my own personal history in the state than with a purely scholarly interest in filling a lacuna in academic research. As a child, I spent three and a half impressionable years, from the ages of eight to twelve, living in Sri Lanka, where my father was posted with the Foreign Service. During much of that time, my older brother and sister were attending an international boarding school in what had once been a colonial hill station in Kodaikanal, Tamil Nadu. I remember spending many vacations with my mother visiting my brother and sister on Kodai Lake and sightseeing in the temple towns and wildlife preserves in the plains and jungles of Tamil Nadu. And I, too, attended the same school briefly in 1976 before our family was posted back to Washington, D.C. During that time, I was captivated by the hustle and bustle of even this small bazaar, by the crispy texture of dosais and the sweetness of the sesame seed candies, and by the thrill of sneaking off to the mist-covered slope of Coaker’s Walk to smoke beedis while contemplating the vast spread of the plains, barely visible below.
Ten years later, I found myself returning to the plains of Tamil Nadu in 1986 as a college senior participating
