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When Marisol (a pseudonym) was pregnant with her first child in her hometown , a rural hamlet outside the state capital of Puebla, Mexico, she suffered frequently from morning sickness. Her mother-in-law, with whom she and her husband lived, knew a solution. When the nausea was too much for her daughter-in-law to bear, she would prepare caldo de gallina, chicken soup. She wrung an older, egg-laying hen’s neck, plucked it, and over several hours cooked a rich broth laden with vegetables picked from the fields surrounding their home.1 When Marisol sipped the soup, served with fresh, hand-made corn tortillas, her nausea subsided. During her second pregnancy, having migrated to New York City with her husband and child, Marisol again suffered from morning sickness. Because her mother-in-law’s soup could not bridge the distance , Marisol asked her obstetrician at her monthly visit to a public prenatal clinic what she should do. He responded that she should buy a box of crackers and keep it handy, eating a few before getting out of bed and whenever she felt queasy. I asked her what she thought of that advice. She replied, “It’s so practical ! The box of crackers costs a dollar. I can find them at any corner store, and I can keep them next to my bed or in my purse when I’m out of the house. It’s much easier than cooking soup all day!” This vignette illustrates how one woman cared for herself and the ways the advice and care she was given by others differed between two pregnancies. Marisol does not say that the chicken soup was not effective for combating nausea ; she was clear that it was. However, for her second pregnancy, she shifted her practices (and, by extension, her nutritional intake) to adapt to the advice she was given by a physician, whom she described as being more knowledgeable Paradoxes and Patients Immigrants and Prenatal Care Chapter 1 1 than her mother-in-law. She also adapted to a changed set of circumstances in which crackers—convenient, inexpensive, and easily accessible—seemed preferable and more suited to her new life in New York City. Meanwhile, her physician never asked her how she combated nausea in her previous pregnancy . Had she been asked, she might have mentioned the caldo de gallina, and it is possible her provider might have suggested she try chicken soup again rather than recommend a nutritionally inferior, processed food. This book is based on an ethnographic study that sought answers to the following questions: How are conflicting approaches to pregnancy care reconciled by Mexican immigrant women? How do they decide which aspects of self-care to adopt and which to reject? What impact do the attitudes of prenatal care providers in public clinics toward immigrant patients have on their experiences of pregnancy and childbirth and on the outcomes? The Birth-Weight Paradox In 2003, at a conference on Mexican immigration to New York City at City College, a Columbia Presbyterian Medical Center surgeon, Carlos Navarro, said, “Mexican immigrant women have healthy babies. They have some sort of cultural advantage, but we [doctors] don’t know what it is.” With this statement, Navarro implicitly issued a powerful call for ethnography. Historically, that which is “cultural,” as opposed to that which is psychological or biological, has been the terrain of inquiry for cultural anthropologists and the object of their preferred methodology, ethnography. This methodology opts for an inductive approach that seeks to solve research questions by examining the everyday experiences, discourses, and practices of individuals and groups. Anthropologist Aihwa Ong argues for ethnography: “As anthropologists, we are skeptical of grand theories. We pose big questions through the prism of situated ethnographic research on disparate situations of contemporary living” (2006, 12). This book examines the purported cultural advantage of Mexican immigrant women in pregnancy and childbirth and the puzzle identified by epidemiologists as the “birth-weight paradox.” This is a subset of the “immigrant paradox,” in which first-generation immigrants have more favorable health indicators, by some measures, than their U.S.-born counterparts (Forbes and Frisbie 1991; Landale, Oropesa, and Gorman 1999; Rumbaut and Weeks 1996), and of the “Latino health paradox,” in which Latinos demonstrate an advantage over other groups on a number of health indicators (Alegría et al. 2008; Escobar and Vega 2006; Fuller et al. 2009; Taningco 2007; Vega, Rodríguez, and Gruskin 2009). The birth-weight paradox, also...

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