Contraception Across Cultures: Technologies, Choices, Constraints (review)

Contraception Across Cultures: Technologies, Choices, Constraints. Edited by Andrew Russell, Elisa J. Sobo, and Mary S. Thompson. Oxford: Berg, 2000; distributed by New York University Press. Pp. xiii+252. $65/$19.50.

Contraception Across Cultures is a selection of essays that stem from papers presented at a two-day international conference held at University College Stockton (now University of Durham, Stockton Campus) in 1996. The authors investigate the impact of contraception on society and vice versa from a cross-cultural anthropological perspective. There are case studies from Mexico, Haiti, Israel, Uzbekistan, Bangladesh, Rhodesia/Zimbabwe, and Tonga. The book is divided into sections on approaches and methods, political and economic contexts, policy and practice from a user perspective, and policy and practice from a provider perspective. Authors rely on traditional quantitative methodology and also present data collected using a qualitative method called "participant-observation," which seeks to achieve an in-depth, holistic understanding of a particular group. Although birth-control technologies are mentioned in every chapter, they are not a major focus. Rather, the authors are primarily concerned with cultural issues.

In their analysis of psychosocial data, Mary S. Willis and Marion Pratt maintain that "developing effective, safe and practical contraceptive methods requires an understanding of subjective feelings and sexual behaviors amongst different cultural or ethnic groups" (p. 27). New technologies are needed, especially to counter the African AIDS epidemic, but first we must understand peoples' past history and current sexual practice. Joshua Levene notes that a symptom of ignoring cultural issues is the failure of efforts at birth control in some countries. In India, for example, efforts to introduce the Lippes intrauterine device, an effective technology in the West, failed because the side effect of irregular and increased menstrual bleeding exceeded a threshold perceived as tolerable by Indian women. Amy Kaler points out in her essay on Rhodesia/Zimbabwe that contraceptive policies are also constrained by politics and history. How can anthropologists help resolve these issues? According to M. Catherine Maternowska, one method is to focus on the relationship between clients and clinics. In her study of a family-planning clinic in Haiti, Maternowska describes fascinating encounters between elitist doctors and residents of Cité Soleil, a slum community.

Focusing on the user perspective, Jennifer Phillips Davids and Rhoda Kanaaneh tell similar stories in their description of cultural influences on contraceptive use among Ethiopian Jewish immigrants in Israel and Palestinians in the Galilee. In both instances, the assumptions of family planners conflict with qualitative anthropological data. Nancy Stark examines contraceptive methods used by rural Bangladeshi women during a twelve-month study at two villages. She warns that contraceptive policy must account for the "restrictive influence of society and culture on women's ability to independently control their fertility" (p. 179).

Providers' perspectives are covered in essays on contraception in Uzbekistan and Chiapas, Mexico. Monika Krengel and Katarina Greifeld examine Uzbek contraceptive policy in light of cultural influences such as the high status accruing to large families, lack of information on side effects, sex education taboos, and identification with the state. Mary S. Thompson examines Mexico's policy following the decision to abandon pronatalist policy during the 1970s. In Chiapas, contraceptive policy is linked to economic development and modernization. Not surprisingly, with the state mired in political and military strife and economic instability, contraception policy faces an uncertain future.

Contraception Across Cultures addresses contemporary cases in a number of different countries and yet much of the data is almost identical to that from Western nations during the early part of the century. The clinics formed by Marie C. Stopes and Margaret Sanger in Britain and the United States were specifically designed to meet a need that the medical community failed to address. Widespread inability of medical doctors to dispense sound contraceptive advice was due largely to governmental unwillingness or inability to address cultural issues. Stopes's and Sanger's pioneering clinics relied on extensive qualitative and quantitative anthropological data taken by nurses employed at the...