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ChAPTER 11 A Competition over Reproductive Authority Prenatal Risk Assessment in Southern Belize Amínata Maraesa By six o’clock on Wednesday mornings the market in the town of Punta Gorda is already buzzing with distant villagers and local townspeople. While there are a few Garinagu merchants selling cassava sweets and Mestizo-owned dry-goods storefronts, most of the vendors are rural-dwelling Kekchi- and Mopan-speaking Maya—primarily women—who come into town to sell a variety of harvested items such as root vegetables, beans, and culantro leaves. Meanwhile, their children are dispersed throughout town selling vegetables from plastic buckets they carry doorto -door for the townspeople who might not get to the market to shop. “You no wan’ buy?” is a familiar query heard through the house windows, which at 6:30 a.m. are just beginning to open to the day’s sun and the fresh breeze blowing off the Bay of Honduras that borders this anything-but-sleepy town in the Toledo District of southern Belize. Although the rural communities of Toledo are seemingly isolated from town life—scattered throughout a mountainous and water-logged topography, separated by long stretches of dirt road where few vehicles pass—the population of this relatively small geographic region is connected within itself and to the urban center in various multistranded relationships of blood, marriage, and commerce (Williams 1973). All roads lead to town, where villagers use the early-morning shopping time to make some money, obtain goods, and catch up on the latest news and gossip from within the region and beyond. After making their initial purchases and marking larger items to be picked up by the bus driver for their return trip, many of the pregnant women who have come to town on this day head away from the market commotion in the direction of the local hospital. Swaying under the weight of their protruding bellies, the women trickle into the faded yellow public health building, which opens every Wednesday morning at eight o’clock to serve the thirty or so women who come in from the surrounding villages for prenatal care each week. This chapter looks at the interplay between nurse-midwives and pregnant women concerning reproductive risk, as the prenatal examination room becomes an arena for competing knowledge systems where nurse-midwives and pregnant women often negotiate opposing viewpoints concerning maternal and child health. Although they represent a purportedly acultural biomedical authority, the rural and public health nurse-midwives in charge of administering the Ministry of Health 211 prenatal care services in the Toledo District are part of the local cultural matrix, adjusting the administration of standardized protocols to try to accommodate a local reality. Nonetheless, pregnant women in this area continue to make their reproductive decisions based on their preexisting beliefs—incorporating only the advice that is feasible given the concrete realities of their daily lives (cf. Markens, Browner, and Press 1999). As nurse-midwives struggle to convey and maintain the authority of international biomedical standards and a discourse of risk that relies on a constructed objectivity to validate its superiority, pregnant women have their own perception of risk and interpret the health of their pregnancies through a reliance on an embodied understanding of their previous and current reproductive conditions as well as their social and environmental realities. Usually these contrasting perspectives result in disregard by the pregnant women for the information relayed to them by the Ministry of Health nurses during the prenatal examination. At times, these divergent understandings erupt into heated—yet respectful—competition for authority. Some Notes on Language Because of its unique history, Belize is the only English-speaking country in Central America. Despite the increasing influx of Spanish-speaking immigrants from neighboring Latin America, English remains the national language. More commonly heard, however, is Belize Creole, an English-based language that contains words derived from Amerindian and African languages, as well as words and phrases from Spanish and American English (Young 1995). Despite the frequency of Garifuna linguistic communication among the Garinagu residents of Toledo and the prevalence of Kekchi and Mopan as the first languages of these Maya populations , Belize Creole is the lingua franca of social life and a common communicative thread that binds the multiethnic and multilingual populations in the Toledo District. In this chapter, I have transcribed the words of individuals speaking Belize Creole, including those speaking Belize Creole as a second language, as they were uttered to include grammatical structures that do not conform to...

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