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46 It had been a chaotic week at the family doctor clinic where I observed weekly prenatal and neonatal consultations. Dr. Tatiana Medina, one of the two clinic physicians, had taken a month-long medical leave, and Janet was struggling to absorb her colleague’s patients as well as her own. When Janet called in Tatiana ’s next patient she frowned immediately at the sight of this very thin young woman in her sixth month of pregnancy, who handed over a plastic bag that contained her clinical history from previous prenatal visits and her most recent ultrasound report. Absorbed in the handwritten notes, Janet noted, “The ultrasound says that the baby’s weight is normal, on the low side, but normal. But you’re very thin, how much have you gained?” She made a quick calculation and then looked up with horror, exclaiming, “You’ve only gained 2.5 kilograms [about 5.5 pounds] in your whole pregnancy? This can’t be!” Aghast, she continued , “This is awful! I have to admit you to a maternity home, because this can’t be—the home right here, a hospital, it doesn’t matter where, because you’ve only gained 2.5 kilograms in your whole pregnancy and you were thin, maybe malnourished, to start with!” I immediately thought of Gisela Navarro, the pregnant patient whose poor weight gain had also caused Janet consternation, and who had just given birth to a daughter with healthy birth weight without requiring admittance to a maternity home. By contrast, the relative severity of this woman’s case set in motion a number of interventions, making explicit the omnipresent anxieties surrounding the birth of low-weight babies for both doctors and the state. Attracted by Janet’s uncharacteristic outburst, two of the nurses walked into the room. Assessing the situation, one added reprovingly, “You have to rest, my dear, because your child is going to be born low birth weight.” Still flustered by her discovery, Janet added, “Yes, you have to have complete rest, I have to admit 3 Reproducing Citizens and Socialism in Prenatal Care REPRODUCING CITIZENS AND SOCIALISM IN PRENATAL CARE 47 you at least until your weight stabilizes, you have to get all the tests done—this is awful!” The young woman’s face registered some displeasure at this prospect, but when she suggested that she could just visit the maternity home on an outpatient basis, Janet quietly informed her that that was unlikely to be permitted. As she left, a waiting patient commented on her thinness. Shaking her head, Janet concurred: If she gives birth to a low-weight [baby], it’s a huge mess for us, because they send [the results] through the hospital, through the Ministry of Public Health, they analyze everything, what happened, why a low-weight [baby] was born . . . [because if the baby is born low birth-weight] it will raise the rate of low-weights in the country, and it could raise the [neonatal ] mortality rate as well. Just this year, in this polyclinic zone we’ve had two neonatal deaths, one from congenital malformations and the other, I don’t remember . . . anyway, they counted them as two neonatal deaths. And with these two deaths, because we have so few births, the rate in this municipality is now so high that it raises the rate in the whole country, just with this municipality. We’ve got problems! Slipping between her anxiety for the welfare of her patient and that of national reproductive health statistics, Janet’s dense commentary neatly illustrates the simultaneous functioning of reproductive health statistics as “technologies of scientific knowledge, of government administration, and of symbolic representation” (Urla 1993, 819). Situating this potentially problematic pregnancy within the context of the neighborhood’s troubling recent birth outcomes, Janet’s concern reflected not only the deaths of two infants, but that those deaths were categorized as neonatal mortalities (rather than fetal deaths) and would thus be entered into the reproductive health statistics for the municipality. Given Cuba’s below-replacement birth rate, particularly in urban areas like Havana, the death of each newborn assumes additional statistical weight with greater potential to affect the national record. In this context, the prospect of a child who might be born low-weight—and whose mother’s own poor weight gain had somehow slipped through the cracks—would reflect poorly on Janet and Tatiana’s own performance . Should the infant not survive, it would also add another black...

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