Postcolonial midwifery: Midwives, territories and human rights in development
Midwives, territories and human rights in development1
In recent decades, there has been an increasing debate over the entrance of the issue of human rights into development discourse (Cornwall and Nyamu-Musembi 2004; Spivak 2004; Cornwall and Molyneux 2006; Uvin 2007; Lettinga and Van Troost 2014; Gabay 20152). Some authors argue that its entrance has benefited non-governmental activism, participation and the accountability of development projects, which, thanks to this new focus, now place more emphasis on the obligations of donors than on charity. Simultaneously, however, there have been critical accounts about the potential neoliberal project behind such transformation, including aspects of new colonization combined with a fear that human rights will inevitably lose their political edge and become co-opted empty slogans. Postcolonial scholarship in particular has viewed human rights as a problematic Western or Eurocentric intervention lacking legitimacy among the masses in the Global South.
However, some postcolonial perspectives differ in how they conceptualize human rights in the Global South. For example, Grovogui (2006) argues that it is Eurocentric to consider human rights only as a European invention, when claims to different kinds of human rights have historically been and currently are made at local and regional levels in different parts of the developing world. Several authors have analyzed how local claims concerning human rights have become globally visible, such as Indigenous rights in Latin America (Brysk 2000, 2013; Speed 2008; Engle 2010). Others have demonstrated how many global human rights are being vernacularized at local levels to achieve political change (Levitt and Merry 2009).
Ackerly (2008) argues that feminists have for a long time shown how human rights can be thought of as local, universal and contested terrains. She maintains that human rights can be a critical tool of micro-political forces and used against oppression by revealing previously hidden wrongdoings (see also Spivak 2004). A focus on human rights issues can imply an attempt to make the invisible visible.
This chapter builds on this timely debate by analyzing a to-date less explored case related to the fields of development and human rights: the
Latin American mobilization for the humanization of birth and against obstetric violence, which is fundamentally linked to the defense of midwifery in these regions and most especially in Mexico. This campaign is radical in many senses: by insisting on honoring the reproductive rights of women in the Global South, it challenges some dominant, core perceptions of reproductive rights in childbirth in development by arguing that the clinical-medical view, which has been focused merely on access to medical services as the main component of ensuring reproductive rights, does not necessarily safeguard the rights of women but, in fact, may jeopardize these rights by exposing women to obstetric violence.
The campaign for the humanization of birth and against obstetric violence, as shown in this chapter, is tied to particular criticisms of development and historically complicated links between demographic policies and reproductive rights in Latin America (see also Chapters 1,2 and 3). The latter implies that, although activisms against the predominant biomedical techno-births, among others, can be found globally, there are elements in this Latin American campaign that are distinct, for example, to North America.
As was already discussed in Chapter 2 of this book, this mobilization is intimately linked to the defense of midwifery. Midwives, who until now have mostly been the underdogs of the official medical systems in Latin America in general and Mexico in particular, have emerged not only to defend their vocation and to improve the situation of midwifery in their countries, but also to speak for the reproductive rights of women. Many of these midwives may be considered as part of the more global movement for human rights in childbirth. By challenging the dominating perceptions of reproductive rights, this campaign might achieve a shift in development policies to favor midwives (UNFPA 2014).
Internationally, a midwife is defined as a government-recognized professional. According to the International Confederation of Midwives, and as endorsed by the World Health Organization (WHO):
A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.
As noted in the Introduction to this book, this international definition of the midwife has caused much trouble in Global South and Indigenous territories, since most midwives fall outside this “academic” category. In many Latin American countries, midwifery is not licensed, leaving even some professional midwives outside this official definition. Second, to recap from Chapters 1 and 2, midwifery training differs considerably from medical training, as the midwifery body of knowledge—while it does overlap with
Post colonial midwifery 177 obstetric knowledge—is (or should be) much more focused on facilitating the normal physiology of birth.
Additionally, much midwifery knowledge is based on empirical and apprenticeship learning, especially in the case of the so-called traditional and Indigenous midwives, most of whom who do not meet the international definition. Most professional midwives who do meet the international definition are trained in university-based programs legally recognized in their jurisdictions. This leaves most empirically trained midwives outside legal recognition and protection. Historically, their different philosophy and form of caring based on empirical hands-on knowledge and community service for women have been under attack, as this particular vocation is positioned in a highly contested international terrain. Contestations also divide midwifery itself between academic- and empirical-favoring approaches. Traditional midwives, who still constitute possibly the majority of midwives in the world, are coded by the International Confederation of Midwives (ICM), WHO and other international development agencies as “traditional birth attendants” (TBAs). They generally do not qualify as professional midwives as they are empirically trained: they have gained their knowledge as apprentices, through dreams or simply as family heritage (Sarelin 2014a). In the case of Latin America, as elsewhere, TBAs include Indigenous midwives who are embedded in Indigenous communities and cultures, and are recognized in their own communities as midwives. Due to this divided and divisive international midwifery context, this age-old vocation has become deeply politicized.
The mobilization for human rights in childbirth globally and for the humanization of birth and against obstetric violence in Latin America can be perceived as a “transnational advocacy network,” as described by Keck and Sikkink (2000). These authors define a transnational advocacy network as consisting of actors and activists (who may include members of social movements and non-governmental organizations) who work transnational^ toward a particular set of goals, are united by shared values and a common discourse and who share information and services extensively. These authors note that activists in the networks not only seek to influence formal politics but also to transform the terms and nature of the debate within the nationstates and international organizations. According to these authors, transnational advocacy campaigns have been particularly successful when focused on topics related to human rights, nature, women and the health of children and Indigenous peoples.
For this chapter, I have relied on multiple sources and the results of my ethnographic fieldwork as described in Chapter 2. This chapter is structured as follows. I first look at the general developments related to reproductive health and rights, explaining what I mean by the dominant clinical perception of reproductive rights and noting a shift toward benefiting professional midwives at the expense of traditional midwives. In addition to bringing up the dominant “right to access to medical care” approach of reproductive rights,
I briefly discuss the origins of reproductive health policies in coercive population control.
Next 1 trace the origins and development of global human rights in the childbirth campaign and its Latin American counterpart, the campaign for the humanization of birth and against obstetric violence. I discuss the nascent human rights discourse within these campaigns. Finally, as in other chapters, I provide two herstories: the narratives of two autonomous midwives in Mexico who recount their experiences in rural, Indigenous Mexico, which illustrate both their links to broader Latin American mobilizations in terms of humanized birth and midwifery, and complex postcolonial relations and rights in terms of traditional, Indigenous midwiferies. I then retake the postcolonial approach to discuss and deepen the viewpoints of Indigenous and Native midwives at global levels with particular emphasis on Indigenous territories and motherlands. I also touch on the ethnic tensions within midwifery.
In conclusion, I touch on the situation of traditional/Indigenous midwives, who might challenge reproductive rights discourse with their focus on Indigenous rights. Thus, by using the term “postcolonial midwifery” in this chapter, I shed light on the complex, situated relations and rights among women in the Global South and Indigenous territories—in this case, from the perspective of autonomous midwives in the midst of Indigeneity in Mexico. I conclude by outlining some important pending issues for further postcolonial analysis of midwiferies.