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Reproductive Health, Fertility Control, and Childbirth  

Susanne M. Klausen

Fertility has long been highly prized in Africa, especially in societies where economic production depended mainly on human labor power. In addition to their role as future workers, children were crucial for, inter alia, securing lineages, providing social security, and ensuring spiritual safekeeping. Women were therefore expected to produce offspring. For them, bearing children was elemental to their social identity, security, and status; failing to reproduce could be calamitous. For both women and their husbands, infertility was often stigmatizing, but women usually bore the brunt of blame for involuntary childlessness and therefore could suffer especially devastating social consequences, such as divorce and ostracism. Managing fertility involved a wide range of reproductive practices. Africans believed infertility was caused by supernatural forces; consequently they sought assistance from spirit mediums and traditional healers to help women achieve or maintain fecundity. Postpartum women practiced birth spacing to ensure infants’ health, achieved through sexual abstinence and prolonged breastfeeding. Because premarital pregnancy was often a serious violation of social norms, youth were typically taught ways to avoid conception while engaging in premarital sex play. Women procured abortions using a variety of methods, including ingestion of plant-based concoctions and extreme manual pressure to kill the fetus. Childbirth, though feared for the risk involved, was typically a welcomed event although the social context for birth varied according to culture and social organization. In some societies, midwives attended women, whereas in others, solitary birth was the ideal. The reproductive politics and practices of precolonial societies informed those of the colonial era, which in turn helped shape postcolonial Africa. Western incursions into African societies had uneven effects on indigenous practices related to reproductive health, fertility control, and childbirth. While some indigenous ideas and practices persist, others, such as post-partum sexual abstinence, have been severely undermined.


Women and Medicine in Early America  

Rebecca Tannenbaum

Women from all cultural groups in British North America—European, African, and Indigenous American—played a central role in medicine in early America. They acted as midwives, healers, and apothecaries and drew on a variety of cultural traditions in doing so, even as they shared many beliefs about the workings of the human body. Healing gave women a route to authority and autonomy within their social groups. As the 18th century opened, women healers were able to enter the expanding world of capitalist commerce. Anglo-American women parlayed their knowledge of herbal medicine into successful businesses, and even enslaved midwives were sometimes able to be paid in cash for their skills. However, as academic medicine took more of an interest in topics such as childbirth, women practitioners faced increasingly bitter competition from professionalizing male physicians.


The Politics and Culture of Medicine and Disease in Central America  

David Carey Jr.

With its diverse ecological zones and varied public health threats that ranged from lowland epidemic to highland endemic diseases, Central America is a challenging place to practice healthcare. In addition to topography and geography, social relations have also influenced the dynamic, contested, and negotiated process of healthcare in developing countries. Adversarial relations among indigenous people, African immigrants and slaves, and the state marked the region’s pasts. After the Spanish conquest established racist structures that favored Hispanic citizens by instituting forced labor mechanisms and limiting access to political, economic, and social power, colonists extracted land and labor from indigenous communities. Although most countries assumed that adopting Hispanic customs would improve the lives of indigenous and Afro-Central Americans, many elites felt such workers’ health was important only insofar as it did not impede their ability to labor. Characterized by holistic approaches to health that took into account psychological, emotional, and physical well-being, indigenous and other traditional healing practices flourished even after states embraced the fields of bacteriology and parasitology in the late 19th and early 20th centuries. Primarily served by curanderos, midwives, bonesetters, and other traditional healers for generations, some remote rural communities were isolated from schooled medicine and its practitioners. In other rural communities and cities, hybrid healthcare offered patients palatable and efficacious healing options. As doctors became politicians and states embraced science to modernize their nations, politics and public health became inextricably linked. Often with the assistance of multinational companies and nongovernmental organizations, governments deployed scientific medicine and public health campaigns to undergird assimilationist projects. Based on assumptions that traditional medicine was impotent and indigenous people and African descendants were vectors of disease, public health campaigns often discounted, rejected, or persecuted the healing practices of such peoples. When authorities embraced rather than problematized the confluences of race and health, they enjoyed some success. Yet neither authoritarian nor democratic governments could establish a medical monopoly.


How Primary Maternal-Child Healthcare Reduces Mortality among Mothers and Children throughout the World: A Historical and Personal Reflection on Progress and Missed Opportunities  

Nicholas Cunningham

In the first decades of the 21st century, despite major medical advances, women in the least developed parts of the world are dying in childbirth far more often than women in wealthier nations, and their children are far more likely to die before reaching age 5. The major reason for this is that healthcare in these areas lacks its foundation: basic primary maternal and child healthcare (MCH). Two early examples of primary MCH care showed that the high death rates for mothers and children could be reduced substantially at low cost: David Morley’s Under-Fives Clinic in Western Nigeria, which began in the 1960s, and the Aroles’ Jamkhed Project in Maharashtra State in India, which began in the early 1970s. The lessons learned from these two early projects were also highlighted as principles at the Alma Ata International Primary Care Conference in 1978. They included: 1. Integration of basic curative care with the various aspects of promotive/preventive care, the former building the trust required for full acceptance of the less-understood aspects of the latter, such as immunizations, family planning, and exclusive breastfeeding during the first six months of life. 2. Heavy reliance on well-supervised lower-level health workers (including community health workers) to reach entire target populations. 3. Reliable delivery of a limited formulary of common, low-cost medical supplies and medications. 4. Partnerships among government ministries of health, education, and finance with communities and with local, national and international non-governmental organizations, and, 5. Gradual buildup as the health system and the communities enhance their capacity to support the work, so that success builds on success. It is past time for building primary MCH and eventually total population-based care systems everywhere. The first and biggest benefit will be in least developed societies, where the present rate of preventable mother and child deaths is unconscionable.