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112 I n 1929 university-trained midwife Consuelo Rueda Sáenz proposed to the director of the Servicio de Sanidad (Public Health Service) that an outreach program for maternal and infant medical care be established in the poor neighborhoods of Quito. Just as the state employed physicians to serve the poor, she wrote, it should also pay for the services of professional midwives. To ensure that poor women took advantage of such a program, it should be required that all birth certificates be signed by a registered midwife or physician . Rueda explained that her proposal “is aimed at serving those women who cannot, because of their poverty, go to clinics or pay for the services of physicians or licensed midwives, and who therefore prefer to die alone, or entrust their terrible moments to untrained hands that for a small fee present themselves as knowledgeable but that are ignorant of the difficulties of the issue and the consequences of their actions.” Indeed, Rueda argued that infant mortality was caused solely by empiricismo (unlicensed practitioners) and that “obstetrics [midwifery] is one of the most interesting branches of medicine, and is a beautiful and dangerous science. As the mother of lives that should multiply, it should be practiced only by scientific hands.”1 Six years later, in 1935, an outreach program of maternal-infant care, much like the one that Rueda outlined, was established by the Ecuadorian state. Rueda’s letter emphasized many of the points that would later be highlighted in this state project: the need to reduce infant mortality, the effort to displace empirics with professionally trained and licensed midwives, and the notion of • 4 Midwifery,Morality,andtheState MIDWIFERY, MORALITY, AND THE STATE • 113 childbirth as requiring scientific management. Her letter also underlines how women themselves sought to broaden the arena of professional work available to them and to promote the state’s goals in the area of public health. What she did not anticipate, perhaps, were some of the challenges that women like her would face once this project was established, particularly in their relations with other employees of the Sanidad. Rueda was not a traditional midwife who had upgraded her skills at the university. Rather, she was part of a new generation of scientific midwives who had studied at the Universidad Central in Quito in the early twentieth century. Soon after the 1899 opening of the new Maternidad (lying-in hospital) in Quito, Rueda registered at the university in 1900 to study midwifery. She had been born in Quito in 1882, and at eighteen was the youngest of the three women who began university study that year in the only field open to women. She was a paternal orphan and lived with her mother during her studies. One of her two classmates was also an orphan (having lost both mother and father), and these were the two students who completed the program most quickly. They both graduated in July 1903, following three years of study; it took their classmate some seventeen additional months to graduate. Rueda clearly had some intellectual inclinations, since she then formed part of the first female cohort admitted to the second field of university study opened to women, registering with five others in a preparatory year of study for pharmacy in 1904. She went on to study three more years of pharmacy, although for unknown reasons she did not graduate in this field; four of her classmates, however, did become the first group of female pharmacists in 1909. Further evidence of Rueda ’s scientific inclinations appeared in her notes on her work as a Sanidad midwife in the late-1930s, where she described interesting cases she had attended and the challenges of childbirth conditions in the Andean towns and cities where she was posted. While she apparently shared with policy makers a series of notions regarding both childbirth and state responsibility, and indeed professional midwives can themselves be seen as the products of a state project to modernize childbirth, nonetheless the record of conflict over the work of government-funded midwives shows that they were not simply mechanical representatives of state goals in the towns and cities where they worked. Maternal and infant health was an important topic in Ecuador at the turn of the twentieth century. Women of all social classes began their reproductive lives early and had numerous pregnancies. Infant mortality was high. From infancy to adulthood, mortality rates declined for every subsequent age group. The only exception to this rule was, notably...


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MARC Record
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