Cover

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Frontmatter

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Contents

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pp. vii-vii

List of Tables

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pp. ix-xii

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Preface

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pp. xiii-xvi

My decision to structure this book on motherhood and risk in the way that I have has its genesis in an incident that occurred during my first visit to Tanzania in the summer of 1990. I was a doctoral student in anthropology at the time and had traveled to Tanzania to explore the possibility of conducting an ethnographic study of maternal health there at some point in the future. ...

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Acknowledgments

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pp. xvii-xx

This book, which is a revision of my dissertation thesis, has had a long gestation. The list of people and institutions who helped in the process and to whom I owe many thanks is also long. The initial research on which this book is based was funded by a grant from the Joint Committee on African Studies of the Social Science Research Council and the American Council of Learned Societies ...

List of Abbreviations

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pp. xxi-xxiv

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1. Motherhood as a Category of Risk

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pp. 1-18

I first heard the story of Mrs. X in February 1988 during an afternoon talk in the School of Public Health at the University of California, Los Angeles. The guest speaker, a senior medical officer from the World Health Organization (WHO), had come to speak to graduate students about the recently launched Safe Motherhood Initiative, an international effort to address the problem of maternal mortality in the “developing” world.1 ...

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2. The Colonial Community: Managing Native Motherhood

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pp. 19-34

A comparison of colonial and contemporary documents that have addressed motherhood and maternal health risk in the Third World reveals similarities in the language used and solutions proposed despite the passage of time. In 1937, for example, a reprint of the article “Certain Aspects of the Welfare of Women and Children in the Colonies” was sent out to colonial administrators throughout the British Empire. ...

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3. The International Community: Making Motherhood Safe from Afar

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pp. 35-52

Since the mid-1980s, international attention has increasingly focused on the high levels of maternal mortality in the Third World. This new attention to maternal health was itself an outcome of the United Nations’ “Decade for Women 1976–1985,” a decade in which women’s issues were made visible through the volume of research generated about women during that period (Escobar 1995; Kabeer 1994; Ong 1988; Royston and Armstrong 1989).1 ...

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4. The National Community: Making Motherhood Safe in Tanzania

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pp. 53-63

In February 1989, Dr. M. Kaisi, a Tanzanian obstetrician and gynecologist, was asked by Tanzanian Ministry of Health officials to prepare proposals for the development of a Tanzania-specific Safe Motherhood Initiative. That initial request resulted in The Safe Motherhood Initiative in Tanzania: Role of the Health Sector, which, according to its descriptive subtitle, was an assessment ...

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5. Situating the Fieldwork Setting: The Shinyanga Region in Historical Perspective

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pp. 64-82

When I originally selected the Shinyanga Region as the site for my fieldwork, my decision was based on two main factors. First, maternal mortality in the Shinyanga Region during the 1980s was quite high: for every 100,000 live births, approximately 300 women died from complications associated with pregnancy, childbirth, or the postpartum period (Kaisi 1989; Mandara and Msamanga 1988). ...

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6. The Community of Bulangwa

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pp. 83-106

Despite a puzzling lack of reference to the presence of any people, the above description of the physical landscape of southern Sukumaland is still somewhat recognizable over a century later, although the cattle and the grassiness of the rolling plains are no longer as abundant as this entry in Stanley’s journal for February 17, 1875, suggests.1 ...

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7. Risk and Tradition

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pp. 107-118

Tradition is an ambiguous concept. It has been invoked both to stigmatize as well as to celebrate African cultural practices. In chapter 2, we saw how native practices were often portrayed as “backward” and “harmful.” Such perceptions led government officials to implement policies that sought to transform traditional native cultural practices into those seen in the more developed parts of the world. ...

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8. The Prenatal Period, Part 1: The Risk of Infertility

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pp. 119-149

The provision of prenatal care was one of the four essential elements of the global Safe Motherhood strategy to improve maternal health outcomes (Mahler 1987). Prenatal care also figured significantly in national-level discussions in Tanzania. The result of those discussions, the Safe Motherhood Strategy for Tanzania, recognized, among other things, the benefits of prenatal care and the need for health education campaigns to encourage women to seek care during their pregnancies. ...

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9. The Prenatal Period, Part 2: Risks during Pregnancy

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pp. 150-186

Although many women in Bulangwa place a positive value on fertility and motherhood, in this chapter we will see that pregnancy also appears to be a period of increased stress for women, as evidenced by the negative emotions many admit to feeling while pregnant, their concerns with preventing or counteracting a variety of physical and spiritual prenatal risks, and the hassles many encounter while trying to obtain care in clinic and hospital settings. ...

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10. Risks during Childbirth

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pp. 187-211

One of the things that struck me most about the majority of births I observed in Tanzania was the overall stoicism of the birthing women. Although childbirth in no way appeared to be pain-free, it nevertheless was not characterized by a lot of noise. Very rarely did a woman yell out loudly in pain, and if she did, she was quickly admonished either by midwives or nurse assistants on the labor ward or by Mwana Nyanzanga in the village setting. ...

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11. Risks during the Postpartum Period

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pp. 212-225

Women in Bulangwa spoke about the hours and days immediately following birth as a period fraught with danger. In some cases, the dangers associated with this final stage of the birth process were directly attributed to the physical act of giving birth. In other cases, the risks were described as being spiritual in nature and associated with the by-products of birth. ...

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12. Risk and Maternal Health

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pp. 226-232

I bring this account of women’s pregnancy-related experiences to a close by returning once again to the story of Mrs. X. In light of the other women’s stories we have examined in the preceding pages, how well does her story capture the complexity of maternal health issues in the community of Bulangwa? ...

Notes

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pp. 233-268

References

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pp. 269-294

Index

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pp. 295-303