Maternity, Medicine and Power: Reproductive Decisions in Urban Benin. Carolyn Fishel Sargent. Comparative Studies of Health Systems and Medical Care, Vol. 22 (John M. Janzen, series ed.). Berkeley: University of California Press, 1989. 256 pp. $36.00 (cloth).
This book constitutes a major step forward in the understanding of a process that is affecting every Third World nation: the wholesale adoption of an imported Western model of birth. The deplorable lack in the ethnographic literature of good cross-cultural studies of women and reproduction will soon be eliminated if more studies like this one are forthcoming.
Sargent's study primarily concerns the factors that influence birth decisions made by the women of one particular ethnic group in northern Benin, the Bariba. Much of the value of this research lies in her skillful comparison of urban Bariba women in the city of Parakou with their rural counterparts and predecessors in the town of Pehunko, where Sargent conducted an earlier project in 1976-77. The understanding of "pure" Bariba culture she gained in this earlier research gave Sargent a baseline for comparison of the changes that have accompanied the urbanization and modernization of Benin, and most especially of the significance of these changes for women's reproductive choices.
Two cultural idiosyncracies characterized the birthing styles of rural Bariba women, both reflections of core values and beliefs of the wider Bariba culture. Stalwart stoicism in the face of pain is one of these. Bariba men found many opportunities for gaining honor and prestige by not showing pain; birth provided the only such avenue for most Bariba women. The ideal pattern for birth had the woman going about normal activities around the house without any indication to her husband that she was in labor (other women present seemed usually to have known), then, when she could no longer stand, retiring alone to a room and giving birth without making a sound. Ideally, the husband would know of his offspring's birth only when the baby's own cry was heard; at that point, maternal relatives and friends would enter to offer assistance and support.
According to the author's painstaking survey work, most rural Pehunko women did succeed in living up to or approximating this ideal, thereby gaining considerable and lasting prestige and community respect. Moreover, the indigenous midwives whose skills were often called upon in complicated deliveries also often gained high community status. Unfortunately, no statistics are available on the outcomes of these births, nor is Sargent explicit in detailing traditional procedures. But many modern studies have established the efficacy of walking during labor as opposed to lying down, and the kneeling position Bariba women apparently used for delivery is certainly physiologically more effective for pushing than the flat-on-the-back position of the American hospital. I was frustrated by the lack of specific detail about birth position, manner of delivery, and indigenous midwifery techniques, as this sort of information might prove useful in working out practical alternatives to standard hospital routines. I also wished for inclusion of personal narratives describing women's thoughts, emotions, and actions during these private deliveries. But since pain is a taboo topic among the Bariba, privacy highly valued, and shame an ever-present danger, perhaps such stories are simply never narrated.
The other basic tenet of Bariba culture reflected in rural birth patterns is a strong belief in the reality of witch babies. Being born in certain positions or with certain physical characteristics categorizes a child as a witch who, if allowed to live, will grow up to do harm to his or her family. Delivering alone or with only other women present often enabled the mother to determine the fate of her child, as she (in consultation with any female attendants) could choose whether or not to disclose significant information that could lead to the baby's execution by a ritual specialist. …