Risk, Reproduction, and Narratives of Experience

Afterword

Afterword Rayna Rapp The chapters of Risk, Reproduction, and Narratives of Experience that you have just read all operate in an existential gap: in this gap, each woman’s pregnancy is in deep, abstract conversation with every woman’s pregnancy as experts aggregate and analyze them, whether in urban Los Angeles and Puebla, Mexico, or rural Belize, Ghana, and China. In this existential gap, the twinned concepts of risk and responsibility compress each woman’s pregnancy story into the statistics by which experts come to know and intervene in what they consider high-risk pregnancy and birth practices. Expert discourse then shapes, bullies, or disciplines against such risky business. Some of our authors invoke the contemporary Foucauldian concept of “responsibilization ” as an optical technology of the neoliberal state, suggesting how individual maternal citizens are made to dutifully care for themselves and their growing fetuses in the terms of governmentality that they have ostensibly internalized . Yet in the existential gap, these very notions of responsibility/responsibilization may be quite experience-far, as the anthropological accounts collected in this book tell us. Experts rarely recognize the gap, as they consolidate their powerful, authoritative knowledge by articulating local variants of its universal dictates. Thus, physicians in Puebla, Mexico, tell their resident anthropologist that midwives are “very good . . . at attending the birth,” while cautioning that midwives don’t have “actual knowledge.” The gap is present when obstetricians express frustration as Haitian patients in Florida refuse “the gift of knowledge” that a recommended amniocentesis might bring, without inquiring about the women’s reasoned refusals; or when they label Guatemalan midwives the biggest risk to Guatemalan pregnant women’s birthing experiences. The gap is widened and manipulated as health planners , policy makers, and government statisticians aggregate maternal/child morbidity and mortality knowledge at a distance. Classically, they peer over the gap, pondering birth outcomes by region, claiming that “ignorant Indians” (Guatemala) or “dirty tribal practices” (Tanzania) or “backward ethnicities” (China) are responsible for birthing under conditions they denounce. Rarely do they traverse the gap to investigate the washed-out mountainous or tropical roads of rural Belize or Oaxaca or the Shangri-la northwest Yunnan region of China, where money and transport to bring a laboring woman to clinic is sorely lacking, and barriers are physical and sometimes punitive as well as social-structural. In the gap, there is a logic used 231 by many experts who blame pregnant women themselves for the structural violence which shadows poor women’s reproduction. Sometimes, even the well-meaning addition of standardized risk discourse serves only to increase risky practices, as Alicia Gálvez’s analysis of Mexican women giving birth as new immigrants in the United States shows us. Policy strategies and debates have long circulated across international gaps. Sometimes, policy experts dictate that, for example, local empirical birth attendants be trained and empowered outside their hometowns and villages, while at other times that they be left in place but provisioned with discrete tools and hierarchies of command and oversight. For more than half a century, WHO and UNICEF have conversed with ministries of health in poor countries, sometimes approving, sometimes disapproving local midwives, always already agglomerated into TBAs, traditional birth attendants, a concept which may itself increase the gap between what local female curers, parteras, and iyom know in situ, and what their standardization is intended to produce. This ping-pong game of labeling birth attendants as competent/incompetent without attending to the specifics of their gender and training itself too often produces costly abstractions rather than teamwork in the interest of medical service, as these multiple Mexican and Guatemalan examples show us. And Qingyan Ma’s analysis of shifting policy aimed to reduce maternal mortality in one mountainous, multiethnic region of the countryside illustrates the irrationality of rational governmental and NGO changes as they systematically ignore the effects of the existing market socialism in China. Pregnant women, of course, often have their own local and deep-seated understandings of the dangers of their liminal, birthing state and the real possibilities of miscarriage, stillbirth, and infant death, which shadow their lives. For them, risk can operate in the existential gap, as well: these essays show us how drug-addicted Los Angeles women feel acutely the risk of being without their illegal highs, unable to imagine the risks that intravenous drug use might bring to their blood-tethered fetuses; and Guatemalan pregnant women and their attendants speak of “angel pacts” by which empirical midwives have been called to their...