RESUMO
Mexico's indigenous communities continue to experience higher levels of mortality and poorer access to health care services than non-indigenous regions, a pattern that is repeated across the globe. We conducted a two-year ethnographic study of pregnancies and childbirth in an indigenous Wixárika community to explore the structural causes of this excess mortality. In the process we also identified major differences between official infant mortality rates, and the numbers of infants born to women in our sample who did not survive. We interviewed 67 women during pregnancy and followed-up after the birth of their child. At baseline, socio-demographic data was collected as well as information regarding birthing intentions. In depth-interviews and semi-structured interviews were conducted with 62 of these women after the birth of their child, using a checklist of questions. Women were asked about choices regarding, and experiences of childbirth. Of the 62 women we interviewed at follow-up 33 gave birth at home without skilled attendance and five gave birth completely alone in their homes. Five neonates died during labour or the perinatal period. Concerns about human resources, the structure of service delivery and unwanted interventions during childbirth all appear to contribute to the low institutional childbirth rate. Our data also suggests a low rate of death registration, with the custom of burying infants where they die. This excess mortality, occurring in the context of unnecessary lone and unassisted childbirth are structurally generated forms of violence.
Assuntos
Povos Indígenas/estatística & dados numéricos , Mortalidade Infantil , Parto , Adulto , Antropologia Cultural , Colonialismo , Feminino , Humanos , Lactente , Morte do Lactente , Recém-Nascido , Entrevistas como Assunto , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , México/epidemiologia , Gravidez , Sistema de Registros , Adulto JovemRESUMO
BACKGROUND: Preventable maternal and infant mortality continues to be significantly higher in Latin American indigenous regions compared to non-indigenous, with inequalities of race, gender and poverty exacerbated by deficiencies in service provision. Standard programmes aimed at improving perinatal health have had a limited impact on mortality rates in these populations, and state and national statistical data and evaluations of services are of little relevance to the environments that most indigenous ethnicities inhabit. This study sought a novel perspective on causes and solutions by considering how structural, cultural and relational factors intersect to make indigenous women and babies more vulnerable to morbidity and mortality. METHODS: We explored how structural inequalities and interpersonal relationships impact decision-making about care seeking during pregnancy and childbirth in Wixarika communities in Northwestern Mexico. Sixty-two women were interviewed while pregnant and followed-up after the birth of their child. Observational data was collected over 18 months, producing more than five hundred pages of field notes. RESULTS: Of the 62 women interviewed, 33 gave birth at home without skilled attendance, including 5 who delivered completely alone. Five babies died during labour or shortly thereafter, we present here 3 of these events as case studies. We identified that the structure of service provision, in which providers have several contiguous days off, combined with a poor patient-provider dynamic and the sometimes non-consensual imposition of biomedical practices acted as deterrents to institutional delivery. Data also suggested that men have important roles to play supporting their partners during labour and birth. CONCLUSIONS: Stillbirths and neonatal deaths occurring in a context of unnecessary lone and unassisted deliveries are structurally generated forms of violence: preventable morbidities or mortalities that are the result of systematic inequalities and health system weaknesses. These results counter the common assumption that the choices of indigenous women to avoid institutional delivery are irrational, cultural or due to a lack of education. Rather, our data indicate that institutional arrangements and interpersonal interactions in the health system contribute to preventable deaths. Addressing these issues requires important, but achievable, changes in service provision and resource allocation in addition to long term, culturally-appropriate strategies.
Assuntos
Atitude Frente a Saúde/etnologia , Parto/etnologia , Morte Perinatal/prevenção & controle , Qualidade da Assistência à Saúde/estatística & dados numéricos , Violência/etnologia , Adolescente , Adulto , Antropologia Cultural , Tomada de Decisões , Etnicidade , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Relações Interpessoais , México , Assistência Perinatal/estatística & dados numéricos , Morte Perinatal/etiologia , Gravidez , Fatores Socioeconômicos , Adulto JovemRESUMO
Every year, around two thousand Huichol families migrate from their homelands in the highlands of northwestern Mexico to the coastal region of Nayarit State, where they are employed on small plantations to pick and thread tobacco leaves. During their four-month stay, they live, work, eat, and sleep in the open air next to the tobacco fields, exposing themselves to an unknown cocktail of pesticides all day, every day. In this article, I describe how these indigenous migrants are more at risk to pesticides because historical and contemporary structural factors ensure that they live and work in the way of harm. I discuss the economic, social, political, and racial inequalities that exist in their every-day environment and how these forms of structural violence are mitigated by their intersection with local cultural contexts and their specific indigenous lifeworld.
Assuntos
Exposição Ambiental , Praguicidas , Migrantes , Adulto , Agricultura , Fazendeiros , Feminino , Humanos , Lactente , Masculino , México/etnologia , Gravidez , Condições Sociais , Fatores Socioeconômicos , Nicotiana , ViolênciaRESUMO
Mexico's indigenous regions are characterised by socio-economic marginalisation and poor health outcomes and the Maternal Mortality Rate in indigenous communities continues to be around six times higher than the national rate. Using as a case study the Huichol community of North-Western Mexico we will discuss how institutional health and welfare programmes which aim to address accepted risk factors for maternal health are undermined by a series of structural barriers which put indigenous women especially in harm's way. Semi-structured interviews and observational data were gathered between 2009 and 2011 in highland communities and on coastal tobacco plantations to where a large number of this ethnic group migrate. Many Huichol women birth alone, and to facilitate this process they maintain a low nutritional intake to reduce their infant's growth and seek spiritual guidance during pregnancy from a shaman. These practices are reinforced by feelings of shame and humiliation encountered when using institutional health provision. These are some of the structural barriers to care that need to be addressed. Effective interventions could include addressing the training of health professionals, focusing on educational inequalities and the structural determinants of poverty whilst designing locally specific programmes that encourage acceptance of available health care.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Indígenas Norte-Americanos , Serviços de Saúde Materna/estatística & dados numéricos , Saúde Materna/etnologia , Parto/etnologia , Gravidez/etnologia , Feminino , Política de Saúde , Disparidades nos Níveis de Saúde , Humanos , Mortalidade Materna/etnologia , México , Pesquisa Qualitativa , Vergonha , ViolênciaRESUMO
Understanding the coloniality of gendered lives, family dynamics, social arrangements, and political structures in Indigenous communities begins with confronting and interrogating a history written largely by and for men in positions of power. The archives are limited in terms of what can be gleaned about gender equality and what existed before the proliferation of European patriarchy. Indigenous Wixárika people tread a delicate balance between a lifeworld that is organised around a ritual-agricultural cycle, and the accelerating incorporation of the imperial mode of living and the coloniality of being, into their communities and culture. The 'coloniality of gender' explains how Indigenous women and men have been drawn into and shaped through contact zones, these sites of imperial intervention that have brought social, cultural, and structural changes to gender. Problematically, this concept assumes a one-way process of domination, whereby modern European power structures were imposed on Indigenous people. A critical exploration reveals how gender dynamics and equality were influenced by a much messier process, entangled with Wixárika's cultural and religious systems as well as the leveraging of political collateral. This paper will draw on findings from a historical and ethnographic study of the coloniality of gender in Indigenous Wixárika communities. We will critically examine archival evidence alongside oral histories to suggest how social, development, and political interventions from the late 20th century challenge the idea of the 'coloniality of gender', and discuss how past and present actants collide and dialogue to bring about social change and greater gender equality.
Pour comprendre la colonialité des vies, des dynamiques familiales, des arrangements sociaux et des structures politiques axés sur le genre au sein des communautés autochtones, il faut d'abord confronter et interroger une histoire écrite en grande partie par et pour des hommes en position de pouvoir. Les archives sont limitées quant à ce que l'on peut apprendre sur l'égalité des genres et ce qui existait avant la prolifération du patriarcat européen. Le peuple autochtone des Wixárikas repose sur un équilibre délicat entre un « monde vécu ¼ organisé autour d'un cycle rituel-agricole, et l'incorporation accélérée du mode de vie impérial (Brand et Wissen, 2021) et de la colonialité de l'être dans ses communautés et sa culture. La « colonialité du genre ¼ explique comment les femmes et les hommes autochtones ont été attirés dans des zones de contact - ces sites d'intervention impériale qui ont entraîné des changements sociaux, culturels et structurels en matière de genre - et façonnés par elles. Le problème est que ce concept suppose un processus de domination à sens unique, par lequel les structures de pouvoir de l'Europe moderne ont été imposées aux populations autochtones. Une exploration critique révèle comment la dynamique et l'égalité des genres ont été influencées par un processus beaucoup plus désordonné, enchevêtré avec les systèmes culturels et religieux wixárikas, ainsi qu'à l'exploitation des garanties politiques. Cet article s'appuie sur les résultats d'une étude historique et ethnographique de la colonialité du genre dans les communautés autochtones wixárikas. Nous jetterons un regard critique sur les archives et les récits oraux afin de montrer comment les interventions sociales, politiques et de développement de la fin du XXe siècle remettent en question l'idée de la « colonialité du genre ¼, et aborderons la manière dont les acteurs passés et présents se heurtent et dialoguent pour donner lieu à des changements sociaux et à une égalité accrue entre les genres.
Entender la colonialidad de género, las dinámicas familiares, arreglos sociales y estructuras políticas en comunidades indígenas comienza con confrontar e interrogar la historia largamente escrita por y para hombres en posiciones de poder. Los archivos están limitados en términos de lo que puede vislumbrarse sobre igualdad de género antes de la proliferación del patriarcado europeo. Los indígenas Wixárika tejen un delicado balance entre la vida organizada en torno a los ciclos de rituales agrícolas, la acelerada incorporación de un modo imperial de vida y la colonialidad de ser en sus comunidades. La 'colonialidad de género' explica cómo mujeres y hombres indígenas han sido arrastrados y moldeados a través de zonas de contacto, sitios de intervención imperial que conllevan cambios estructurales, culturales y de género. Problemáticamente, este concepto asume una vía en el proceso de dominación, donde las estructuras de poder europeas fueron impuestas en los pueblos indígenas. Una exploración crítica revela cómo las dinámicas de género y la igualdad fueron influenciadas por un proceso mucho más turbulento, vinculado con los sistemas culturales y religiosos de los Wixárika y por una influencia política colateral. Mostramos hallazgos desde un estudio histórico y etnográfico de la colonialidad de género en comunidades indígenas Wixárika. Examinamos críticamente evidencia de archivo e historia oral para mostrar cómo las intervenciones sociales y de desarrollo, desde finales del siglo XX, desafiaron la idea de la 'colonialidad de género' y discutimos cómo personas del pasado y el presente dialogan para provocar un cambio social y mayor igualdad de género.
RESUMO
The manner in which urban locations are drawn into the global economy defines their spatial organisation, distribution and utilisation. The relationships that are generated by this process include economic exchanges, racialised dynamics between workers and owners, gendered divisions of labour and the use and abuse of natural resources and infrastructure. These encounters of globalisation are often unequal or awkward and mediated by varying forms of violence, from structural to interpersonal, as these are used to rebalance the terms on which they meet. Using coloniality as an analytical tool, this article discusses the delicate balance of these Western-led encounters. Globalisation has become colonial by embedding hierarchical relationships in the foundations of the modern political economy. Gender identities, whiteness and non-whiteness, developed and underdeveloped are continually redefined, stigmatising certain groups and locations while elevating others on the basis of colonial power dynamics. Through a case study of the US-Mexico border city of Juárez, this article examines ethnographic work in its global context to explore how shame has become attached to male identities in locations of urban marginality. Theorising around the coloniality of urban space production, I discuss how Juárez's border location has shaped its development though gendered and racialised frictions that are kept in check with violence. A coloniality perspective enables the unpicking of dominant conceptions of industrial cities in the Global South as metonyms for underdevelopment. Using the concept of edgework, I draw out how violence oils the wheels of globalisation to renegotiate damaged identities in contexts of territorial stigma.
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Saúde Global , Homicídio/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Saúde Pública , Violência/estatística & dados numéricos , Adulto , Distribuição por Idade , Escolaridade , Feminino , Humanos , Masculino , México/epidemiologia , Distribuição por Sexo , Fatores Socioeconômicos , Adulto JovemRESUMO
How women make decisions about care-seeking during pregnancy and childbirth, is a key determinant of maternal and child health (MCH) outcomes. Indigenous communities continue to display the highest levels of maternal and infant mortality in Mexico, a fact often accounted for by reference to inadequate access to quality services. A growing body of research has identified gender inequality as a major determinant of MCH, although this has rarely been situated historically in the context of major social and epistemological shifts, that occurred under colonialism. I used a feminist ethnography to understand the structural determinants of Indigenous maternal health. I drew on research about the colonial and post-colonial origins of ethnic and gender inequality in Mexico and specifically the Wixárika Indigenous region, in order to identify the different ways in which women have historically been disadvantaged, and the processes, situations and interaction dynamics that emerged from this. Sixty-four Wixárika women were interviewed while pregnant, and followed up after the birth of their child between January 2015 and April 2017. These data were triangulated with structured observations and key informant interviews with healthcare providers, teachers, community representatives and family members. The findings suggest that gender inequalities were introduced with the colonial system for governing Indigenous regions, and became naturalised as Wixárika communities were increasingly integrated into the Mexican nation. The associated structures of marriage, community and interpersonal relationships now operate as forms of institutionalised gender oppression, to increase Indigenous women's vulnerability, and influence decisions made about care and childbirth. Ethnographic data analysed in historical context evidence the continuity of colonial forms of inequality, and their impact on wellbeing. While welfare and health programmes increasingly aim to address gender inequality on social and relational levels, by rebalancing gendered household dynamics or empowering women, the historical and colonial roots of these inequalities remain unchallenged.
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Antropologia Cultural , Identidade de Gênero , Parto , Criança , Feminino , Humanos , Lactente , México , Grupos Populacionais , GravidezRESUMO
Through the theoretical lens of a "violence continuum" we explore how, in many of the most marginalized areas of Mexico, global and regional historical and contemporary structures have shaped and constrained men's ability to achieve the hegemonic masculinity of neoliberal Mexico. An analysis of statistics and local research studies on male homicide is used to understand how impoverishment and extreme inequality can undermine men's capacity to access a dignified standard of living and exercise their masculinity, in the process of which many draw on interpersonal violence as a resource for respect and manhood.
RESUMO
This article discusses the manner in which social and historical factors impact upon indigenous conceptions of health and health-seeking behaviour, reinforcing their authoritative knowledge about birth and wellbeing. It explores how Mexican indigenous Huichol migrant labourers experience structural, everyday and symbolic violence while away working, and in their home communities. The study was based on semi-structured interviews and observations with 33 Huichol migrant labourers and 12 key informants from the community (traditional healthcare providers), health sector (medical doctors based in the highlands) and tobacco industry (farmers, tobacco union leader and pesticide sellers) during 2010-11. Findings show how the continuum of violence is experienced by these migrants as shame, timidity and humiliation, expressions of symbolic violence that have helped define their tradition of birthing alone and their feeling of entitlement to the conditional welfare payments which sustain their marginalised subsistence lifestyle. This paper proposes that there is a cyclical relationship between structural violence and authoritative knowledge as the former reinforces their adherence to a set of cultural beliefs and practices which are the basis of racial discrimination against them.
Assuntos
Acessibilidade aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Vergonha , Migrantes/psicologia , Adulto , Características Culturais , Emprego , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Pesquisa Qualitativa , Racismo , Migrantes/estatística & dados numéricos , Violência/estatística & dados numéricosRESUMO
The aim of the study was to explore the effects of domestic employment on the well-being of child domestic workers (CDWs) in India and the Philippines. A questionnaire was administered to 700 CDWs and 700 school-attending controls in the two countries. In India, 36% of CDWs started work before age 12, 48% worked because of poverty or to repay loans, 46% worked >10 h per day, and 31% were physically punished by employers. Filipino CDWs were mainly migrants from rural areas, 47% were working to continue their studies and 87% were attending school, compared with 35% of Indians. In India, 67% of CDWs and 25% of controls scored in the lowest tertile (p<0.001) compared with 36% and 30%, respectively, in the Philippines (p=02). Key significant correlates of low psychosocial scores were non-attendance at school, long working hours, physical punishment, limited support networks and poor health. This study shows that it is not domestic work that is intrinsically harmful, but rather the circumstances and conditions of work, which could be improved through pragmatic regulatory measures.