WUNRN
GHANA - MOTHERS & DUALITY OF
SAFE HEALTH VS. TRADITIONS WITH RISKS
Aaron R. Denham writes in this excerpted essay from "Risk, Reproduction, and Narratives of Experience." The result is double-whammy pressure.
(WOMENSENEWS)-- One afternoon early in my
fieldwork in the Upper East Region of Ghana, I accompanied a local nongovernmental
worker and a community health nurse to visit a sick 3-year-old girl named
Azuma, her mother, Abiiro, and their extended family.
The nongovernmental worker had
concerns not only about Azuma's poor health, but also about circulating rumors
that the family suspected her of being a "spirit child," a malicious
spirit from the bush with a grave intention of destroying the family.
From the nongovernmental worker's
perspective, Azuma was at risk because of her medical condition and the chance
that family members would administer to her a deadly poisonous concoction.
From the family's perspective,
Azuma represented a risk to her mother, the family's livelihood and its
continued existence in this and in the ancestral world.
Upon
arriving at the family's compound we sat in the shade of a baobab tree with
eight slight children under the watchful eye of the family elder and waited for
Abiiro. She soon emerged from her near-collapsing mud home, limping from a
filariasis infection and carrying Azuma, to sit on a bench across from us with
Azuma on her lap.
Azuma, arms around her mother,
regarded us with concern from an askew right eye as she breathed uneasily,
mouth open. After we exchanged customary greetings with the family, the nurse
examined Azuma and talked with Abiiro.
As we spoke about her condition,
Azuma made repeated attempts to breastfeed. Abiiro pushed Azuma away,
mentioning that she had stopped producing milk several months earlier. Azuma's
medical card, issued by the Ministry of Health at its free postnatal care
clinic, indicated that the 3-year-old was consistently underweight, never
exceeding 11 pounds. The nurse tried, to no avail, to get Azuma to stand
unaided. Her lean legs bowed outward with each unsuccessful attempt.
Constant Crying, Rarely Sleeping
Abiiro estimated she was 34 years old, although she appeared much older. She had given birth four times and had three surviving children, including Azuma, the youngest. Abiiro's most significant complaint was that Azuma cried day and night, rarely slept and insisted on being carried in her arms, which interfered with her work.
At subsequent visits with the
family, it became apparent that she was greatly concerned about the disruption
and impact of Azuma's condition on the larger family. Also, the family
described an increase in interpersonal family conflict that coincided with
Azuma's birth. These complaints were indicative of potential spiritual danger
and ancestral displeasure. Other than her frailty, Azuma's most noticeable
feature was a strabismus in her right eye. This "look" troubled
family members. Wandering eyes are perceived as evidence that a child or adult
is up to something spiritual and cannot be trusted.
I was surprised that the nurse,
after a brief examination, quickly pronounced Azuma fine and said Abiiro simply
needed to provide her with "proper nutrition" and vitamins to
stimulate her appetite. She prescribed vitamins, antibiotics for Azuma's
respiratory infection and medication for a suspected malaria infection.
"That wandering eye is
caused by the child failing to get the proper eye drops during birth," the
nurse explained. "The mother must have had gonorrhea when she gave birth.
If she would have gone to the hospital to deliver, none of this would have
happened."
The nurse questioned Abiiro about
Azuma's birth, stressing that all women should give birth in hospital.
"Why didn't you call the midwife or go to the hospital to give
birth?" the nurse asked. "You even had complications and still did
not go."
Abiiro said she was unable to
send for the local midwife because she went into labor at night and lived a
five-hour minibus ride away from the nearest hospital.
Complex Set of Unofficial
Risks
While hospital and clinic births represent the Ministry of Health's official position aimed at reducing maternal risk, my subsequent visits with Abiiro and other community members revealed a complex set of unofficial risks that overshadowed sanctioned safe-motherhood messages.
First, Abiiro had gone into labor
after sunset. Although midwives employed by the Ministry of Health encourage
families to contact them at all hours, Abiiro later revealed that she did not
want to bother the midwife at night. Community members, particularly expectant
mothers, rarely travel along paths at night because of the increased presence
of dangers such as witchcraft, sorcery and various spiritual beings. Giving
birth in the family compound is often preferred, since babies born along a road
or path--a liminal, ambiguous and potentially dangerous place--may never fully
integrate into the social/earthly world. Moreover, the local interventions for
difficult delivery require the woman to be in the family compound connected to
the uterine or agnatic kin, rather than in a depersonalized clinic.
Several women also equated home
birth with a valued ethic of endurance and strength. Finally, rumors of birth
experiences in hospitals or clinics warned of nurses beating women who labor
too slowly and of medical staff mishandling or dropping and thus injuring or
killing infants.
Abiiro's notion of responsibility
for Azuma's condition was understood within an epistemology that emphasized the
local social, ancestral and spiritually based perceptions of risk. The nurse
redirected and focused on Abiiro's individual responsibilities as a mother
disconnected from the social and economic realities of the kin system, a
biomedical risk discourse that emphasized the importance of regular antenatal
clinic attendance, family planning and birth spacing and improved nutrition.
In this and other encounters I
observed, it was apparent that biomedical health providers regarded mothers as
individual agents who are responsible to make the choices, as communicated by
health professionals and educators, that are in their best interests.
During my research among the
Nankani, the local ethnic group, I became interested in the disjuncture between
and integration of traditional ways of knowing in relation to the transnational
models incorporated in Safe Motherhood campaigns and biomedical programs.
Cases like Azuma's spurred my
interest in local subjective understandings of maternal risk and blame. Based
on my early impressions, mothers appeared subject to a double burden of blame
ensuing from both the biomedical and the traditional models. However, upon
viewing blame from a processual framework--resulting from long-term
relationships and ongoing case studies--a difference between biomedical and
traditional models of blame emerged.
Excerpted from Chapter 9,
"Shifting Maternal Responsibilities and the Trajectory of Blame in
Northern Ghana" by Aaron Denham, from the new book, "Risk,
Reproduction, and Narratives of Experience," edited by Lauren Fordyce and
Amínata Maraesa, published by Vanderbilt University Press, 2012. Reprinted with
permission. For more information:www.VanderbiltUniversityPress.com.