African Medical Pluralism

By William C. Olsen; Carolyn Sargent | Go to book overview

12
Legitimate Care, Dangerous Care,
and Childbirth in an Urban African
Community

Claire Wendland

IN A MILIEU OF THERAPEUTIC pluralism, sources of legitimation are also plural and contested. In this essay, I draw on ethnographic observations and interviews with people who attend women at birth in an urban Malawian community—both in health centers and hospitals, and outside of the spaces labeled medical—to explore the ways in which legitimation of expertise depends upon presumptions about the dangers of care.

Birth attendance is commonly understood in southeastern Africa to be dangerous to the person who provides it. Some forms of it are legally ambiguous. More importantly, according to both nurses and azamba (traditional birth attendants, or TBAs, who work outside of biomedical settings), exposure to the blood of childbirth renders caregivers vulnerable to both bloodborne and spirit-borne illnesses. Birth can “kill the eyes” of the attendant and can incite jealousies that erupt into potentially lethal witchcraft accusations.

Care can also be dangerous to the cared-for. Women in labor may be exposed to negligent care, to abuse, to iatrogenic injury. They may learn what they do not want to know, knowledge that is dangerous to them. They are also subject to blame. Maternity workers inside and outside the formal biomedical sector often blame pregnant women themselves—whom they characterize variously as ignorant, fearful, backward, promiscuous, willful, or simply poor—for dangerous birth.

Biomedically trained caregivers, working in places recognized by the state as healthcare facilities, and the informal-sector birth attendants, who work in what is often called “the village” even when it is within city limits, often level blame at one another for the dangers involved in contemporary childbirth. In so doing, each group seeks to bolster its own authority. Contests over authority and legitimation, some waged in the public domain through newspapers and radio announcements or community meetings with traditional authorities, risk exacerbating the maternal health problems they are ostensibly intended to mitigate.

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