Shifting cultures

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In these different and shifting contexts, the available cultural knowledges

and practices that shape pregnancy and childbirth ensure that birth is

always more than a biological event. As noted earlier, cultural scripts

provide individuals with the ideas and practices of a particular culture

so that members of a culture can be ‘guided’ through life events and

transitions (Willard, 1988). Yet confusion may be experienced if women

physically move between cultures and find that their ways of knowing,

and related practices, do not resonate with the expectations of the culture

in which they come to reside. On my return from living and working in

Bangladesh I carried out a small piece of research. This explored the

influence of cultural traditions and religious beliefs on British

Bangladeshi women and their use of antenatal services (Miller, 1995).

The rationale for this piece of exploratory research was that ‘Asian’

women living in Britain had been found to have higher perinatal mortality

rates than other mothers. One explanation for this had focused on their

(lack of) use of antenatal services. The research findings brought into

relief the ways in which different cultural ways of knowing exist in relation

to childbirth. It also showed that what counts (and who says what

counts), varies greatly between different cultures, and as societies become

more culturally diverse, within cultures. Women becoming mothers in

cultures into which they have moved can find that their expectations and

experiences are not easily accommodated or recognised within the dominant

culture. The form of authoritative knowledge that underpins expectations

and practicesmay also be differently constructed. My own decision

to return to the UK from Bangladesh for the birth of my first daughter is

an example of this. According to my own culturally inscribed ways of

knowing about childbirth, I had at that time accepted (or at least did not

question) that hospital was the safest place to give birth, especially for a

first birth.

My research on Bangladeshi women living in England was carried out

in a city in the south of the country. Whilst hierarchical forms of authoritative

knowledge dominate in the West, the findings from this research

showed that some aspects of authoritative knowledge that did not fit with

other, culturally inscribed ways of knowing, could be resisted. Resistance,

however, could lead to those in whom cultural authority had been vested,

the health and medical professionals, to be critical of cultural practices

they saw as different. A dominant theme in the qualitative interviews

revolved around the difficulty of maintaining cultural and religious practices,

for those who had moved from Bangladesh to live in England. As

Munia commented:

Actually when we are living in England we can’t keep everything like we would in

Bangladesh . . . when you step out from your home everything is different.

The women interviewed in the study had all attended antenatal clinics

during their pregnancies in Britain. However, those who had also had

children in Bangladesh had not previously had any formalised antenatal

care. The women spoke of having attended antenatal classes in Britain

because they thought they had to. This suggests a partial acceptance of the

dominant culture, an acceptance of one aspect of pregnancy and childbearing

which has traditionally been located within the private sphere

shifting into the public sphere. However, an area in which resistance was

discernible was in relation to parent-craft classes. At the time the research

was carried out (the early 1990s) there were attempts by various health

authorities across England to encourage Asian mothers (including

Bangladeshi women) to attend parent-craft classes (Jain, 1985; Munro,

1988). But the women in the study had resisted these attempts and said

they could not see the relevance of ‘practising’. Munia spoke passionately

on the subject of attendance at parent-craft classes:

That is what most mothers-in-law doesn’t like, they said ‘why so much bothering

. . . you have to go and practice?’ . . . I think that’s not necessary because our

culture is so different, we do learn so much from our Mum. A lot of like English

girls they’re away from their Mum, and I think for them it’s good. But for us it’s

not because we do listen to our Mum . . . our culture is totally different.

The ways in which cultural differences play out in relation to the expectations

and practices that surround and shape preparation for childbearing

are clear in the above extract. Cultural authority was traditionally seen to

reside in Bangladeshi women’s mothers, mother-in-laws and other

female relatives, and in relation to preparing for motherhood traditional

practices were maintained. However, to be seen to resist aspects of

antenatal care could lead to women being perceived as not preparing

‘appropriately’ by the medical and health professionals in whom cultural

authority has been vested by the dominant culture. Another of the

Bangladeshi mothers in the study spoke of cultural assumptions being

made by the health professionals with whom she had contact:

Well, I think I give the image of being an Asian woman and people have their

barriers . . . it’s difficult to be assertive even when you have the language, I feel

I was bossed around and I feel quite resentful about that . . . and then the health

visitor who came to see me before my child was born was making all sorts of wild

assumptions too. She was all right once she got to know me, but she was being

patronising at first.

Cultural practices may also be further challenged for those who do not

‘have the language’. Language difficulties, combined in some cases with

the break-up of extended family units, have led to changes in traditional

practices amongst some British Bangladeshis. Because many women do

not speak English they must take a relative with them to the antenatal

clinic to translate for them. As seen earlier, in Bangladesh matters relating

to pregnancy and childbirth are the domain of women alone; mothers,

mother-in-laws or other female relatives, give any advice thought necessary.

The break-up of large extended family units brought about by

migration to Britain means that in many cases there is no mother or

mother-in-law living in Britain. Increasingly, husbands are becoming

involved in this traditionally female area, acting as interpreters for their

wives when they make clinic and hospital visits. As Munia commented:

The husband goes because they [the women] feel scared to death, they don’t

speak the language and everything is so strange. For a woman from the village they

feel strange.

Problems of access to, and/or any potential for sharing of, authoritative

knowledge may be heightened, then, where the dominant language is

also a second language. Sargent and Bascope have observed that ‘the

production, possession and display of knowledge of any sort is a product

of the capacity to participate in interactions with doctors and nursing

staff ’ (1997:197) . In the Banglade shi study it was found that language

difficulties had increasingly led to men becoming chaperones and interpreters

for their wives. In so doing, this new practice further distanced the

women from the cultural processes they associated with childbearing. In

turn, this practice led to complaints from doctors to the local Bangladeshi

language group that husbands and wives never seemed to have discussed

anything before they went to the clinic. Clearly, the doctors were making

assumptions based on particular cultural understandings of marital relationships

which were not appropriate in this context. But this observation

also shows that whilst men may have become involved in one area of

childbearing, chaperoning and translating for their wives in the public

sphere, in the private sphere of the home matters relating to pregnancy

and childbirth remained within the control of women and were not

openly discussed with male partners.

The interplay between different ways of knowing and cultural scripts

was demonstrated in this piece of research. The findings illustrate the

ways in which script-based knowledge can be challenged in different

cultural contexts. They also show the power of hierarchical models of

authoritative knowledge that dominate in the West. There is little ‘cultural

space’ available for alternative ways of knowing. Practices that do

not appear to fit with the dominant cultural model may be dismissed as

inappropriate, or worse, ‘feckless’ (Miller, 1995; Davis-Floyd and

Sargent, 1997). As Jordan has observed, the ‘consequence of the legitimation

of one kind of knowing as authoritative is the devaluation, often

the dismissal, of all other kinds of knowing’ and associated practices

(1997:56). Resistance to different, alien cultural practices may offer the

possibility for women to retain some control in their journeys into

motherhood, but simultaneously risks condemnation from those in positions

of power. For example, other research carried out during this period

showed the ways in which Asian mothers living in theUKwere stereotyped

and labelled as poor mothers. This was because those in whom cultural

authority was invested, the health professionals, thought the mothers

lacked ‘normal maternal instinct and feelings’ (Bowler, 1993:13).

The ways in which cultural contexts shape expectations and practices

has implications for how we make sense of life events and transitions

through narrative construction. Yet, as in the previous chapter, we must

once again consider how far the need to actively make sense of these

events is a Western phenomenon and what part different models of

authoritative knowledge play in the process. As noted earlier, in the

context of the UK and America hierarchical forms of knowledge permeate

and shape notions of reproduction and childbearing. Little space is

left for other ways of knowing. Legitimacy is given to medical knowledge,

and health and medical professionals and many women accept this as

normal and (ironically) natural. In contrast, in Bangladesh and the

Solomon Islands different, more horizontal forms of authoritative knowledge

have shaped the practices that surround childbearing. In these

different cultural contexts the interplay between knowledges, practices

and the contours of the available cultural scripts reflect pre-existing

patterns of authority. They serve to demonstrate ‘the extreme cross

cultural variation in the kinds of care available to pregnant and birthing

women’ (Davis-Floyd and Sargent, 1997:14).

Yet the contours of cultural scripts can and do shift over time. Also,

some aspects of ways of thinking about reproduction and childbearing

may be shared across seemingly very different cultures, but result in

different practices. An example of this is apparent in relation to the

accounts of childbearing collected from new mothers in the UK and the

cultural beliefs that underpin practices in Bangladesh (Miller, 2000). As

we have seen, in Bangladesh women’s bodies are closely associated with

pollution whether during menstruation, childbirth, or whilst breastfeeding.

Cultural practices exist which serve to protect those around these

women from contamination, which is thought to accompany these

aspects of women’s lives. In the very different cultural context of the

UK, the accounts of women collected in a study of transition to motherhood

(see previous chapter) also included references to cleanliness and

smell in relation to childbirth. In these accounts, decisions to give birth in

a hospital were partly justified on the grounds that birth was both smelly

and messy and something to be contained and kept away from the home.

The comments from Felicity and Philippa below illustrate this:

The one thing about birth that really worries me is the mess. The mess and the

smell . . . (Felicity)

I mean, partly because I don’t know what to expect. I think I’d rather have

everything on tap at the hospital if necessary because you don’t really know the

shape . . . or anything, so I just think I’d rather, especially for a first baby, I’d

rather have the care on hand if I need it . . . I do think I’d rather come back to my

house as something that is kind of sorted out, to some extent quite clean and what

have you, rather than where this kind of event takes place . . . I can’t see the benefit

of having it at home. I just think I’d rather go away, do it somewhere else and then

come back. (Philippa)

Although smell and mess are associated with childbirth in both cultures,

the ways and places in which these dimensions of childbirth are

managed differ according to the form of authoritative knowledge that

shape cultural practices. In Bangladesh ‘pollution’ following childbirth is

eliminated through ‘the cleansing of the woman, her clothes, the environment

and all the equipment’ following delivery (McConville,

1988:183). Clothes worn by the labouring mother together with the

placenta will usually be burned or buried in order to avoid contaminating

anyone or anything around the childbearing woman. The ‘dirty event’ of

birth for most women takes place on either the earth floor or on a mat in

the home (McConville, 1988). In the UK a clear distinction is made

between the hospital in which ‘this kind of event takes place’ and the

home, which for the majority of women is no longer regarded as the

normal or natural place to give birth. The mess is also regarded as

‘worrying’ in a society where practices around both birth and death are

in place to sanitise and depersonalise these events. For example, for the

most part, these events have been removed from the home and placed in

other settings where they can be controlled, managed and contained. In

societies where individual control is highly prized, the risk of losing

control, especially control of our sometimes leaky bodies, is particularly

worrying (Douglas, 1966; Jackson and Scott, 2001).