I find the Rachel R. Chapman ethnography intriguing because it gives very interesting insights in a global health initiative on maternal health care and how maternal mortality rates in Southern Africa, particularly in Central Mozambique, can be improved. Reading on, I find some of the things addressed in the book weird and absurd; it doesn’t make sense to me that pregnancies are actually, for the longest time possible, hidden from others, or how they expose someone to social threats, envy and ill will. I think pregnancy is supposed bring joy to the pregnant woman and the community at large and the news should be shared and spread as much as possible and not kept a secret. Chapman opens my eyes to a lot of new information; it is news to me that there are people who don’t subscribe to modern maternal health care. It draws a sensitive image of the women from Central Mozambique whose reproductive and maternal healthcare choices are affected by fears and extremely difficult conditions. The book is generally engaging, for instance in the vivid passage where it does evoke a local market place and sex workers. However, a reader with no knowledge in African studies could find it difficult to plunge in debates of naturalistic disease causation. (Even though Chapman, in the end, explains the concepts)
Chapman fuses cultural anthropology with political economy while brilliantly demonstrating ways in which neo-liberalism and its increased importance to the market has led to changes in sexual and reproductive avenues for women to use. She discovered that social practices in Central Mozambique and Western Biomedical treatments are both vital when it comes to ladies’ maternal healthcare choices. The book focuses deeply on secrets of mothers in Central Mozambique, highlighting the pregnancy fears they have and reasons as to why maternity healthcare services are underutilized, these reasons are family expectations and the cost of traditional healing. Chapman aims to give her readers an understanding of the cultural and global factors influencing Mozambican women’s reproductive experiences. She does highlight the fact that, ties that rely on mutuality present people the utmost security; it also suggests that, a person’s break out from paucity can make deeper the poverty of others. Rachel Chapman draws us a picture of what it is to be pregnant in 1990s to 2000s in Mozambique.
The role of Rachel Chapman as an ethnographer in the work is to make the reader and the relevant stakeholders recognize how the increase in social tension and economic pressure are dangers to pregnancies in central Mozambique. By understanding that, stakeholders have a better chance of coming up with ways and methods to address the situation. She broadens the reader’s perspective on matters such as Mozambican women’s approach to their layered vulnerability and gives them an understandable sense of the implication of the political economy of Mozambique. Chapman’s work also influences the present public health avenues used to solve the problem of underutilized maternity and reproductive health service. She aims at pointing and rectifying the letdown of public health approach to be held accountable for the conditions in which women make choices regarding their reproductive susceptibility.
One of the strengths of this work is that, before she talks about maternal healthcare in Mozambique, she gives a ethnographic and historical background that actually does prepare the reader to get an understanding Mozambique’s state of reproduction. The other strength is in the author’s research methods; she interviewed 83 women during their pregnancy and postpartum, this coupled up with the fact that she used pregnant state during her field work and had access to some women’s secrets. The other strength of Chapman’s ethnography is that it brings out other social issue that woman from Mozambique face. The said issues include gender inequality which constrains women; she points out that they have lower education levels, fewer possibility of mobility and more household responsibility. Weaknesses in her work include the fact that she dwells so much on the difficult situations facing Mozambican women , forgetting to mention or suggest ways through which these women can be helped or hw these women’s perspectives can be molded so that they take up hospital based prenatal and maternal care.
Through this work, the depiction it paints on the Mozambican women is that of a naive, traditional and rural group. It shows the community as one that sticks to its cultural beliefs even in the face of modern maternal healthcare, which is proven to be safer. The voices and perspectives shown in the work are those of the Mozambican women on how the see biomedical hazards that affect where or not they’ll take up hospital based maternal care. This ethnography can be used to get under the skin of the design problem in underutilized maternity health services. The ethnography can also be used to truly understand the underlying problem and therefore design a far better and workable reproductive and maternal health system for Mozambican women.
The issue addressed in this ethnography is global and affects women in most parts of Africa and third world countries across the world. Despite progress in other countries, child birth and maternal healthcare is still an issue. According to research, Africa amounts to a big portion of world’s maternal health. According to World Health Organization, in 2003, out of the 289,000 childbirth deaths reported, 62% occurred in Africa (WHO 14). World Bank and the United Nations in their “Trends in Maternal Mortality: 1990 – 2013”, stated that in third world countries the mortality ratio was 230 women per 100,000 births compared to 16 women per 100,000 in first world countries. Globally, around 3 million newborn babies die each year (WHO 24). Chapman’s ethnography can help address this issue since her work has equipped global health leaders and donors with information that can help them commit to strengthening healthcare awareness not only in Mozambique but internationally. Her ethnography is also uniquely suited to understand how global health programs can interact with Mozambicans in the rural areas to critically change their experiences (WHO 10).
Chapman’s main point relates to Muslim women in Northern Ghana who also don’t use modern maternal healthcare despite it being free. The findings done in Northern Ghana suggest that, Muslim women have challenges accessing modern healthcare facilities due to difficulties conditioned by religious beliefs, which maintain that they have to observe bodily sacredness through reserved dressing and to steer clear of illegitimate physically contact with men (Mills 56). There isn’t a framework that might clearly provide an explanation to the situation that prevents one from seeking maternal healthcare service amongst Muslim women in Northern Ghana and women in rural Mozambique. Studies done in Ghana showed that Muslim women were less likely to use antenatal care services or deliver in a healthcare facility or use postnatal care services (Mills 87). This also relates to the maternal healthcare issue in Mozambique in that just like in rural Mozambique, there is a need for change and this includes cultural capability exercise for healthcare providers to match the cultural and religious needs of a Muslim woman, which in the long run enhances their care experience. In both cases, maternal healthcare services, particularly skilled attendance during delivery is very vital and is mandatory in reducing maternal mortality in third world countries.
The main point in Chapman’s ethnography is linked the book “Birthing a Slave” by Marie Jenkins Schwartz, where we see Doctor’s trying to manage the reproductive health of enslaved women. These women however are distrustful of their doctors and prove to be unruly by taking charge of their own health systems using traditional healing methods (roots and herbs). “Birthing a slave” just like Chapman’s “Family Secrets” depicts competing approaches to maternal and reproductive health. The two authors – Schwartz and Chapman – addressed quite similar problems but their hypotheses are different because each one is an ethnography based which involved lots of research from actual people while the other might be based on an integration of social history and medicine.
The issue I would like to raise is that of civic education, seeing as it has worked in the past, what steps are relevant and responsible stake holder taking to ensure a decrease in maternal mortality? And what other ways and methods can be employed to ensure mothers in developing countries fully adopt modern maternal healthcare systems? Have the relevant and responsible stakeholders thought of breaking some of these traditional barriers by proving to women in rural areas that modern maternal healthcare is really safe?
Work Cited
Chapman, Rachel Rebekah. Family secrets: risking reproduction in Central Mozambique. Vanderbilt University Press, 2010.
Schwartz, Marie Jenkins. Birthing a slave: Motherhood and medicine in the antebellum South. Harvard University Press, 2006.
World Health Organization. "The World health report: 2005: make every mother and child count: overview." (2005).
Mills, Samuel. "Use of health professionals for delivery following the availability of free obstetric care in northern Ghana." Maternal and child health journal 12.4 (2008): 509-518.
