Anthropology of Pregnancy Loss

Comparative Studies in Miscarriage, Stillbirth and Neo-natal Death

Rosanne Cecil, Rosanne Cecil

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000323849
• Edition: 1
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

How much influence does culture have on a mother's reactions to pregnancy loss? At what stage is a fetus attributed with human status? How does this affect the mother's reactions to the loss of a baby?Contemporary, historical and oral-history accounts from regions as diverse as rural North India, urban America, South Africa and Northern Ireland, provide a fascinating insight into the experience and management of miscarriage across a number of different cultures. The authors explore how the social, technological and medical context in which miscarriages occur can affect the ways in which women experience such an event. In the West, advances in medical technology, a low infant-mortality rate and a low birth rate have raised expectations as to the successful outcome of each pregnancy. In addition, the early confirmation of pregnancy makes consequent pregnancy loss -- which might have gone unnoticed or unconfirmed in the past -- all the more difficult for mothers in the West. Yet, mourning rituals and behaviour at a pregnancy loss, which may be elaborate in some societies, are generally considered to be inappropriate in many Western societies. Differing social beliefs regarding the causes of miscarriage, preventative measures and curative treatments are also examined. Medical anthropologists, sociologists and health professionals will all find this book fascinating reading.

Part I
Ethnographies

1
Delayed Periods and Falling Babies: The Ethnophysiology and Politics of Pregnancy Loss in Rural North India

Patricia Jeffery and Roger Jeffery

Throughout rural north India, a child-bearing career is an essential part of an adult woman’s life. Fertility is very important to men and women alike. Perhaps the most compelling reason for this is the necessity of having a new generation of workers who will support their parents in old age. Not to want children is unthinkable. Infertility or the failure to bear children who survive is usually calamitous for a woman, since these are acceptable reasons for a man to repudiate his wife or take a second woman into his home. Moreover, most village women are poorly nourished. This means that pregnancy is a risky business, both for the mother and the baby. Indeed, the generally high fertility rates, the low birth weights and the high rates of infant and maternal deaths that are prevalent in the region are indicative (at least in part) of this situation. Thus, a high incidence of pregnancy loss would not be in the least surprising, and we might expect pregnancy loss to be a major concern for women, their families and the local medical services.

During our research on women’s experiences of child-bearing in rural Bijnor District, in North India, we asked women to recount all their pregnancies, asking specifically about ‘delayed periods’, ‘falling babies’, and ‘babies bom dead’ or described as dying after just a couple of breaths.¹ Certainly, local understandings of pregnancy and the factors that can contribute to its untimely or unsuccessful end were matters that concerned women. Yet, the numbers of mishaps reported were far below any expectations based on Western medical views of pregnancy loss.² Taking those figures that relate to the period 1980 to 1989, for instance, the ever-married women in the four villages where we worked reported 1366 conceptions. Of these, we were told of just forty-five that ended before time, mainly in the middle and last trimesters (about 33 per 1000 conceptions). There were another forty-one babies delivered in the last trimester who were bom dead or died almost immediately (about 30 per 1000 conceptions).

In order to tease out the ramifications of such low levels of reported pregnancy loss, we need to explore the wider setting in which pregnancy and pregnancy loss are diagnosed and experienced. In the Bijnor case, this includes local understandings of pregnancy as both a condition that normally requires no formal medical intervention and as a ‘matter of shame’ that should not be publicized. In contrast to the medicalization of pregnancy and pregnancy loss in the West, for instance, women in Bijnor experience scarcely any antenatal medical care.

Issues beyond the immediate confines of the health services also have crucial implications for how pregnancy loss is handled. In particular, the situation of the child-bearing woman in her in-laws’ home impacts on her daily life, including her experiences of pregnancy and pregnancy loss. Briefly, child-bearing women in Bijnor are usually married in their teens to a man of their parents’ choice, and generally in a village some distance from their natal village. A married woman is entitled to be supported by her husband and his relatives, though she herself is a vital (though usually unpaid) worker for the family. Her own lack of independent income, whether from employment or from ownership of productive resources such as land, places her in a position of relative weakness within her husband’s household.

Being somewhat distant from her parents compromises her ability to obtain support from that quarter. And this is most acutely the case in relation to her child-bearing experiences, for it is inappropriate for a daughter to have close contact with her natal kin during pregnancy, childbirth and the immediate post-partum period. Crucially, these features of women’s daily lives underpin the local demographic regime, which is characterized by high levels of fertility and child mortality. Only within this broader context can we unravel women’s experiences of pregnancy loss in rural Bijnor.³

Conception and Ethno-embryology

Pregnancies are usually understood within a framework provided by the ethno-physiological theories of becoming and remaining pregnant to full term and their associated ‘country’ or ‘home’ remedies. Such taken-for-granted understandings of bodily processes and how they relate to diet and life-style can provide a route into understanding how a woman comes to know that she is pregnant and, by the same token, that her pregnancy has terminated before its due time.

Sexuality and reproduction are closely linked with a pair of opposites commonly used in local medical models, garmi (heat, activity, stimulation) and thand (coldness, calmness, pacification).⁴ The effect (tasir) of climate, people’s temperaments, individuals’ bodies, medicines and foods can all be described in these terms. Good health both requires and reflects a balance between these qualities, a balance unique to each individual and one which can be upset by their diet or the climate. A naturally garm (hot, active) person (as displayed in hot temper or skin rashes) suffers during hot weather or after taking garm food, but a thanda (cold, tranquil) person is less severely affected. In terms of this framework, an ailment may indicate an internal imbalance: diagnosis discerns its cause, and dietary and other avoidances (parhez) are prescribed to remedy the problem.

Women often described the female body as a black hole (kali-kothri) in which the belly or abdomen (pet) is a conglomeration of tubes (nas or nali, the nerves, intestines and blood vessels). Women were generally unclear about how the tubes interconnect with one another and are linked to the liver, kidneys, stomach and other organs such as the uterus (bacha-dani or baby-receptacle). Most women referred to one uterus which is normally closed by the cervix (munh, mouth or orifice). The vagina (bacha-ka-rasta or baby’s path) and rectum are thought to connect with the tubes inside, but most women were unclear about urination.

For a girl, puberty marks the start of fluctuations in her bodily state. Heat gradually accumulates in her body until it precipitates a menstrual flow which prevents the heat concentrating in her head and making her crazed. Since blood is hot, women are anxious if menstruation is delayed or light, although an excessively heavy menstrual flow is considered weakening. Menstrual blood is also regarded as defiling, and a complete and rapid ‘cleansing’ (safai) is necessary to prevent the poison from accumulating dangerously in the body. A menstruating woman is unclean until her cleansing bath after the flow ends.⁵ Physical maturity is also linked with sexual ‘heat’ or passion, and parents are generally keen to marry their adolescent daughters quickly for fear that they will engage in inappropriate sexual relationships.

At puberty, a boy’s body begins to produce semen (pani, or water), a highly concentrated distillation from blood.⁶ Semen is even hotter than blood, and accumulating semen could result in excessive heat and (if it goes to the head) madness. This can be averted through moderately frequent sexual intercourse.⁷ People use a variety of terms when talking about sexual intercourse, some suggesting that intercourse is like farming, referring to work or even ploughing. Semen contains the seeds (bij) that a man plants in his wife and which develop into a baby. Like crops, the children belong to whoever ploughs and owns the field.

During sexual intercourse, the heat generated opens the woman’s cervix and permits the man’s seeds to enter the fertile environment that her uterus provides. A woman is considered capable of conceiving at any time in the menstrual cycle, provided that she is hot enough to receive sexual advances and to nourish a man’s seeds. The woman who is too cold will be infertile (banj), the word also used to describe a barren field.⁸ If conception occurs, the cervix is believed to close to prevent another conception, and it should open again only during labour to permit the baby to pass along the vagina. Just as the soil nourishes the seed planted in it, so too is the pregnant woman’s role essentially a nurturant one, in which the growing baby is enabled to grow and is prevented from drying out by the ‘dirty’ or defiling blood (ganda khun) that would otherwise flow if the mother continued to menstruate.⁹

The diagnosis of both pregnancy and pregnancy loss, however, does not take place in a medicalized setting. Of the various practitioners (Government and private), none is engaged in any substantial outreach or systematic surveillance of the local populace for any condition, including pregnancy. Formally, the ANMs (Auxiliary Nurse-Midwives) posted in clinics in most sizeable villages should give pregnant women regular medical checks, distribute iron and folic acid tablets (to combat anaemia, which is presumed universal), monitor fetal development (for example, by weighing the mother), give a course of free injections of tetanus toxoid (to avert neonatal tetanus caused by cutting the cord with an infected instrument), identify women at risk, and attend such women’s deliveries or refer them to the Government women’s hospital in Bijnor. However, the Government antenatal service relies on women seeking out their advice, and many women do not consult the ANM at all during pregnancy. Those who do are unlikely to seek confirmation that they are pregnant. The ANM should also maintain a network of traditional birth attendants (dais) to identify pregnant women and register them with her. Some dais claimed that they could diagnose pregnancy after two missed periods, for an internal examination indicates if the cervix is closed or if the amenorrhoea has some other cause. But, in fact, women seldom consult dais during pregnancy either, and they do not systematically receive medical care from them. Pregnancies, then, are not officially registered through the medical services or the traditional birth attendants.¹⁰

In practice, the diagnosis of pregnancy depends on the woman herself, perhaps along with another woman in her husband’s village such as his mother or the wife of his brother or paternal cousin. The cessation of menstruation is considered to be a key sign of pregnancy, connected with which the woman becomes increasingly hot because of the accumulating menstrual blood. Thus the pregnant woman will almost certainly experience some symptoms of heat, such as skin rashes or nausea and vomiting.¹¹ Generally, women note the start of their menstruation according to a lunar calendar and, if their next period does not begin, they say that ‘one month is completed’.¹² Using this calculation, women consider that pregnancies should last between nine and ten lunar months.

Pregnancy and Shame

Even though a woman’s child-bearing abilities are an important element in her in-laws’ expectations of her, pregnancy is not something about which she should be openly proud. Moreover, despite the importance of fertility, pregnancy is not formally marked through any celebratory and supportive customs.¹³

Shame or embarrassment (.sharm) are important components of many aspects of women’s lives.¹⁴ In the course of their child-bearing, women undergo several physiological processes which are regarded as shameful, and many of them also as polluting. Pregnancy is considered a ‘matter of shame’ (sharm-ki-bat) because it draws attention to the pregnant woman’s sexual activity, but it is not polluting. In general, though, pregnancy is couched around in circumlocutions. While women do talk about a pregnancy taking up residence (garbh rahna) or becoming with-pregnancy (garbh-se), with-belly (pet-se) or heavy-legged (panw bhdri hona), there are also several popular euphemisms. Older women delight in embarrassing recently married women by asking if they have acquired any ‘earnings’ (kamai) yet. People also talk of expectation, of waiting for the purpose to emerge, or, more graphically, of something suspicious (dal-me kuch kala, literally, something black in the pulses).

The young married woman herself, however, is unlikely to make an explicit statement that she believes she is pregnant. Rather, the pregnant woman should display more ‘shame’ than usual in the way she dresses and moves. Her mother-in-law may guess that she is pregnant only by noting when she last had the purifying bath signifying the end of menstruation, though some women regularly interrogate their daughters-in-law to check if they are menstruating normally.

Ethno-physiology of Pregnancy Loss and its Prevention

Although women reported fewer pregnancy losses than we expected, they were indeed concerned about the possibility of pregnancy loss. While harbouring the baby during pregnancy, the pregnant woman is like a field nourishing her husband’s seeds. Consequently, her general bodily state and her behaviour affect not only her own well-being but also the baby’s development and the chances that the pregnancy wil...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• Notes on Contributors
• Introduction: An Insignificant Event? Literary and Anthropological Perspectives on Pregnancy Loss
• Part I Ethnographies
• Part II Other Studies
• Index