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In Managing Motherhood, Managing Risk, Denise Roth Allen persuasively argues that development interventions in the Third World often have unintended and unacknowledged consequences. Based on twenty-two months of fieldwork in the Shinyanga Region of west central Tanzania, this rich and engaging ethnography of women's fertility-related experiences highlights the processes by which a set of seemingly well-intentioned international maternal health policy recommendations go awry when implemented at the local level.
An exploration of how threats to maternal health have been defined and addressed at the global, national, and local levels, Managing Motherhood, Managing Risk presents two contrasting, and oftentimes competing, definitions of risk: those that form the basis of international recommendations and national maternal health policies and those that do not. The effect that these contrasting definitions of risk have on women's fertility-related experiences at the local level are explored throughout the book.
This study employs an innovative approach to the analysis of maternal health risk, one that situates rural Tanzanian women's fertility-related experiences within a broader historical and sociocultural context. Beginning with an examination of how maternal health risk was defined and addressed during the early years of British colonial rule in Tanganyika and moving to a discussion of an internationally conceived maternal health initiative that was launched on the world stage in the late 1980s, the author explores the similarities in the language used and solutions proposed by health development experts over time.
This set of "official" maternal health risks is then compared to an alternative set of risks that emerge when attention is focused on women's experiences of pregnancy and childbirth at the local level. Although some of these latter risks are often spoken about as deriving from spiritual or supernatural causes, the case studies presented throughout the second half of the book reveal that the concept of risk in the context of pregnancy and childbirth is much more complex, involving the interplay of spiritual, physical, and economic aspects of everyday life.
Denise Roth Allen is currently working in the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention.
"A searing critique of the first ten years of the Safe Motherhood Initiative based on candid observations and survey data from a rural Tanzanian community. Managing Motherhood, Managing Risk is an important contribution to the emerging genre of medical anthropologies of reproduction and risk. It is unusual in that it manages to be simultaneously critical of the homogenized and generic nature of development discourses and interventions, while being practical and eminently accessible in orientation. Clear and urgent reading for doctors, public health specialists, and students concerned with how to reduce maternal mortality on a global scale, the book traces the discrepancies between official (expert, international, national) and unofficial (lay and local Tanzanian) definitions of risk as they relate to pregnancy, childbirth, fertility, and infertility--and shows the implications of these discrepancies for the quality of maternity care in a local, rural Tanzanian setting."
—Nancy Rose Hunt, Assistant Professor of History and Obstetrics/Gynecology, University of Michigan
"In a compelling ethnographic account of pregnancy, birth, and motherhood in Tanzania, Allen provides a powerful analysis of the political, economic, and cultural contexts for maternal health risks, and offers insights into why international campaigns for 'safe motherhood' have had less than optimal success."
—Carolyn Sargent, Southern Methodist University
"Allen's careful and systematic fieldwork sets standards that others would do well to follow. Especially valuable is the dialectic she sets up between global initiatives, national discourse, and local realties--this dialectic permeates the book and will make it immensely valuable to social scientists and to policy and development planners alike. Women emerge as real individuals adapting a multitude of strategies to interface with their local health care systems. Allen explodes the myth that uneducated women don't utilize medical services, showing precisely what goes wrong inside clinics and hospitals that can drive women to reject the clinic and seek the services of traditional midwives. Through specific and engaging ethnographic examples, we see how smoothly things work when the biomedical practitioner is willing to work with the indigenous system, and how problematic they are for women when biomedical practitioners treat them badly or refuse to interface with traditional care providers. This book makes a major contribution to the anthropology of reproduction, to the field of women's studies, and to the international literature on maternal-child health and the Safe Motherhood Initiative. In this latter arena, the book will be especially welcome, as it sheds new and clarifying light on the pressing contemporary debates about the causes of and the cures for the high rates of maternal mortality in the too-often generically faceless 'Third World.'"
—Robbie Davis-Floyd, Author of Birth as an American Rite of Passage
"The 1987 global Safe Motherhood Initiative drew attention to women's risks of reproducing in difficult circumstances. The risks to women throughout much of the world of NOT reproducing, however, have hardly been recognized at all. Based on a wealth of original anthropological and demographic data, as well as her practical training in lay midwifery, Denise Roth Allen explores the tensions between these two positions in rural Tanzania. Her insights will mark a major turning point in studies of reproduction in Africa."
—Caroline Bledsoe, Northwestern University
". . . an important contribution both to studies of women's health and to critiques of development. . . . [Allen's] work among the Sukuma of Shinyanga provides a rich and vivid picture of the circumstances women face from pregnancy through childbirth. . . . Weaving together first-hand observations with personal stories, and systematically examining the risks associated with childbirth, Allen constructs a very powerful and often-harrowing account of the experiences of childbearing women. . . . Allen's work does much to challenge the assumptions embedded in international development interventions aimed at 'Third World' women."
—Journal of the Royal Anthropological Institute
". . . .make[s] an important contribution to the critique of biomedical interventions in the global South. . . . In examining the complex array of social and cultural factors that define maternal risk in one community, it challenges continued support for the prevailing public health model. . . "
Copyright © 2002, University of Michigan. All rights reserved. Posted February 2003 and November 2004.
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