Family Secrets: Risking Reproduction in Central Mozambique

Notes

253 Notes Chapter 1 1. Shortly after Mozambique won independence from Portugal in 1975 through a thirteenyear war, fighting broke out again. FRELIMO, the political party formed to fight for independence from Portugal, had won the support of many Mozambicans by forming agricultural cooperatives and improving access to and quality of education and health care. Interested in Mozambique’s natural resources, and alarmed by FRELIMO’s compliance with UN sanctions against Rhodesia, the white minority regime of South Rhodesia, later joined by the apartheid regime of South Africa, set out to destabilize the young country, an effort that led to sixteen more years of warfare. In 1982, South Africa increased its involvement to block Mozambique’s support for resistance against apartheid in South Africa, targeting and maiming civilians, including children, and the social infrastructure (c-r.org/our-work/accord/mozambique/historical-context.php). 2. A bairro, Portuguese for“residential neighborhood,” in Mozambique refers to an informal peri-urban sprawl, with houses constructed of wood, reeds, mud, tin, or cement. 3. An around-the-corner woman is a girlfriend, mistress, or prostitute who waits for her boyfriend in an out-of-the-way location, thus around the corner. 4. Useful for health workers, clinicians, and others involved in primary health care delivery and health promotion programs, Werner’s manual provides practical, easy-to-understand information on how to diagnose, treat, and prevent common diseases. Special attention is focused on nutrition, infection and disease prevention, and diagnostic techniques as primary ways to prevent and treat health problems. 5. During follow-up research in 1998, women in Mucessua made even more accusations that the underpaid nurses at the maternity clinic demanded under-the-table fees to ensure attentive treatment during delivery and postpartum. Women who could not pay were left to give birth alone or mistreated. Informants reported that a particular nurse had been summoned three times before the district tribunal but acquitted of accusations of killing infants of women who could not pay the bribe demanded. Not enough data were gathered to substantiate these rumors; however, their persistence suggested that the commodification of childbirth extended to the formal sector and that women without any access to cash would be trapped between these two potentially predatory systems, leading to the emergence of new birthing practices. Preliminary data collected during the follow-up year suggests that Pentecostal and African Independent churches offering maternity services may attract women who feel unsafe with both home and hospital childbirth. Also see Pfeiffer, Gimbel-Sherr, and Augusto 2007. 6. The names of these nurses are pseudonyms. I refer to all other health personnel by their real names. 7. Abortion is illegal in Mozambique, except in extreme cases when the mother’s life is endangered. However, the interpretation of the law has become less restrictive, and 254 Notes to Pages 17–51 abortions are available on request in a number of hospitals, where doctors have encouraged women to seek medical help rather than use clandestine methods (see Agadjanian 1998; see also Machungo et al. 1997). 8. The SMI strategy adopted in Mozambique encompasses short- and long-term goals of upgrading all levels of care within maternal health services, including: domiciliary deliveries by traditional birth attendants; primary care—family planning, postpartum consultations, maternity deliveries; secondary care—communication and transport, waiting hostels, surgically equipped hospitals; and epidemiologic monitoring (Povey 1990). 9. Although the scope of benefits accrued by routine prenatal care for all women is currently being debated, both researchers and health care providers agree that various components of prenatal care services have been associated with positive pregnancy outcomes for both mother and infant. No prenatal care, as well as late initiation and inadequate number of prenatal care visits, are associated with negative pregnancy outcomes in some cases, including increased maternal and infant mortality. 10. This core element of the Mozambican Safe Motherhood Program is based on WHO’s risk approach (WHO 1978a; WHO/UNICEF 1980). Beginning in 1980, a pregnancy control form for health personnel to fill out during initial prenatal examinations was introduced in prenatal clinics throughout the country“to monitor pregnancies and to help direct specialist care to mothers at greatest risk” (Jelley and Madeley 1983: 111). 11. The discussion that follows relies heavily on Crehan’s Fractured Community (1997); page numbers in parentheses in the text that follows refer to this work unless otherwise noted. 12. I use the term“reproductive loss” to refer to miscarriage, perinatal deaths (stillbirth to seven days postpartum), and infant deaths...