Birth on the Threshold. Cecilia Van Hollen
and causes which gave rise to such problems. Like this process of mystification, the medicalization of childbirth is an extension of the power of professionalized medical institutions.22 Yet the process of the medicalization of childbirth is different because “non-medicalized” birth is not necessarily a symptom of inequality. Rather, the medicalization of birth entails a pathologizing of the “normal” by placing birth under the domain of the professional doctor. State-regulated institutions have gained a foothold in the domain of birth through this pathologizing process. From a Foucauldian perspective, however, Margaret Lock and Patricia Kaufert point out, “an account limited to the interests of the medical profession and of the state is inadequate because medicalization cannot proceed unless a cooperative population of patients exists on whom techniques can be performed.”23 Yet, to speak of a “cooperative population” does not negate the possibility of resistance. Furthermore, the medicalization of childbirth can be viewed as a mystification of social ills when it comes to be touted as the only and most essential means of reducing risks of infant and maternal mortality and morbidity, thereby erasing the critical role that malnutrition and a wide range of other diseases associated with poverty may have on maternal and infant health.24
A “non-medicalized” birth does not mean that no medical care or treatment is given if by “medicine” we mean all forms of healing, of promoting and maintaining a healthy, “mindful body.”25 In many communities throughout the world, and certainly in India, there are a wide variety of non-biomedical practices used to attempt to ensure a risk-free delivery and the birth of a healthy baby. And in India, as in many other parts of the world, there are “indigenous” midwives with specialized knowledge regarding childbirth. Therefore, rather than using the term “medicalization,” I use the more specific term “biomedicalization” to refer to this process.
Since the 1970s, feminist-inspired anthropological and sociological studies of birth have critically examined the cultural and political underpinnings of modern biomedical approaches to birth in the United States and Europe. This literature is vast, and I do not intend to review the field here.26 I elaborate more on these various scholars’ approaches in the context of specific debates and discussions in the following chapters. In a nutshell, however, most of these studies argue that the roots of modern, biomedical approaches to birth in Europe and the United States lie in Enlightenment thinking. According to these scholars, the modernization of medicine has entailed a shift from viewing reproductive processes, such as childbirth, as tied to natural and cosmological processes, which could be facilitated through some degree of human intervention but which ultimately lay beyond human control, to viewing childbirth as something which can and should be improved upon through the application of new, scientific practices based on the study of the laws of nature.27 This Enlightenment thinking and the drive to control and harness nature for human, capitalist interests laid the groundwork for the Industrial Revolution. The Industrial Revolution brought with it an increasing reliance on machine-driven production and placed a premium on efficiency for the sake of enhanced capitalist profits. Scholars have pointed out that in the context of the Industrial Revolution, women’s reproductive bodies came to be viewed as machines which should operate in uniform and “efficient” ways to facilitate (re)productivity.28 These studies have focused on the shift from home births attended by female midwives to hospitalized births overseen by a cadre of biomedical professionals with male obstetricians in charge, and have demonstrated how women’s reproductive bodies became the object of the “medical gaze.”29
Many have emphasized the ways in which birthing women and female midwives have been disempowered by the rise of the male biomedical establishment. And they demonstrate that this control is legitimized and naturalized by the “authoritative knowledge” of the biomedical establishment, which puts its faith in and derives authority from increasingly complex and costly technological interventions during conception, pregnancy, and delivery.30 Some scholars, however, have highlighted the ways that women were themselves active agents in shaping the development of obstetrics, and reproductive technologies more generally, and have shown how women have both gained and lost control in this process.31
A cadre of feminist activists who have resisted the biomedicalization of childbirth in the United States and Europe have advocated for a return to “natural childbirth” and to “woman-centered” home births attended by female midwives with as little technological intervention as possible, unless intervention is deemed medically necessary.32 Some anthropologists have become advocates for midwifery and the natural childbirth movement.33 And ever since the early work of Mead and Newton in 1967, anthropologists have found it useful to study childbirth practices in non-biomedical contexts in other parts of the world in order to learn alternative birthing techniques which can be applied to birthing practices in the West.34
Anthropologists have not only been interested in considering how non-Western approaches could be applied in the West; they have also studied the impact of Western obstetrics on childbirth practices and therapeutic selection in non-Western societies.35 Such studies often focus on the social, political, and cultural barriers to the acceptance of Western obstetrics in non-Western societies and make recommendations for changes in the manner in which Western obstetrics are delivered in such settings. Conjoining both these approaches in her seminal book, Birth in Four Cultures (1978), Brigitte Jordan calls for “mutual accommodation” between non-biomedical, in her case Mayan, and biomedical, in this case American, practices.36
One of the important contributions of Jordan’s original work was the fact that she not only looked at differences between highly biomedicalized and non-biomedicalized birth practices, but she also revealed variation among biomedical models of birth in three different countries: the United States, Sweden, and Holland. Some anthropologists and sociologists have continued to reveal variations in how biomedical models of birth are constructed and acted upon across class, ethnicity, and race within the United States and among different Western nations.37 And historians 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