Progress, authoritative knowledge and women’s lives

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Earlier in this book the question of how we can move towards a more

collaborative, consensual model of authoritative knowledge, in which

different types of knowledge can be accommodated and shared, was

posed. This question arose in chapter 2 in the context of mapping different

cultural practices in relation to childbearing and motherhood.

According to Jordan this was, and remains, ‘the challenge for the future

of childbirth in the technologized western world, as well as in the developing

countries of the third world’ (1997:73). As noted at the time, this

quest is particularly challenging because of the complex interplay

between technology, perceptions of progress and different ways of knowing,

all of which are set within an increasingly globalised world, where

boundaries are more fluid than at any time before. It requires us to discern

between liberating and oppressive dimensions of what constitutes progress,

and importantly, whose voices are heard and/or count in the discussions.

It also requires us to once again note the problems explored

earlier in this chapter in relation to reflexivity and priorities in lives, to take

account of how lives are differently affected by material and structural

circumstances, and intersected by class and caste position and gendered

inequalities. Inmany ways here the discussions do not hinge on constructions

of maternal responsibilities and good mothering but on the more

profound concerns of maternal and child mortality rates and supporting

women’s reproductive (and human) rights. But there are huge challenges

in trying to achieve this, not least assuming that Western notions

of individuality, selfhood and personhood – the Western modernist subject

– can be translated, or have relevance to the lives of others in different

parts of the world. Similarly, there are dangers inherent in translating

 ‘basic rights across society and culture, even when as seemingly blameless

as promoting the citizenship rights of women and children’ and clearly

reproductive rights and associated practices are equally difficult terrain

(Scheper-Hughes and Sargent, 1998:7). Yet many developing countries

aspire to patterns of development and progress they discern in the West.

To return to a section from much earlier in the book, where I described the

birth of my first daughter and interpreting for the ‘bewildered’ Bangladeshi

woman in the next bed (chapter 2), what to me seemed culturally baffling

and bewildering for her, might for her have been regarded as progress,

although still bewildering and far removed from the very different experiences

she would have had giving birth in Bangladesh. For her husband and

family, a hospital birth would almost certainly have been regarded as

progress, largely because it would be perceived to be safe. Yet in the

West wholesale hospitalisation for childbirth has mostly led to increased

interventions, including rapidly increasing caesarean rates and a ‘mistaken

hypothesis’ that caesarean rates are responsible for a decrease in perinatal

mortality rates (Tew, 1998:171).

Clearly we need to be ‘suspicious of a simple universal solution’ in

relation to improving the lives of women and their children in developing

countries. It is important to caution against development in terms of

reproductive rights and childbirth being unquestioningly equated with

increasing numbers of hospital births (Scheper-Hughes and Sargent,

1998:4). But the question remains of how we move to more consensual

forms of authoritative knowledge in relation to reproduction and childbirth,

how we avoid the medicalisation and pathologising of childbirth

and motherhood and provide all women with real choices in relation to

their reproductive health. Certainly in those societies characterised by

more horizontal forms of authoritative knowledge, and where technology

has not largely replaced more embodied, experiential ways of knowing,

there remains the opportunity to build more collaborative and inclusive

models of authoritative knowledge. But, ironically, whilst we question

how we can ‘conceptually put back together that which medicine has

rendered asunder’ in the West, in other parts of the world, much more

fundamental concerns exist for many women related to survival. Which is

not to say our quest in the West is wrong or misplaced, but both to point

to the differences in concerns between developing countries and those in

the West, and to highlight the difficulties of translating concerns from,

and between, countries (see chapter 2). In many ways there has never

been a more urgent need to try to tread a pathway between such polarised

positions, to seek more consensual models of authoritative knowledge

that relate to women’s lives in meaningful, culturally and locally relevant

ways. Certainly, it is not the case that the West has all the answers, indeed

far from it; we only need look to patterns of Western behaviours and their

associated problems now adopted and discernible in many developing

countries to confirm this. For example, reproductive health problems

recently documented in the Solomon Islands note an increasing incidence

of sexually transmitted diseases, teenage pregnancies and problems

of HIV/AIDS. They also note an increase in unprotected sexual activity

among young people together with more alcohol and substance abuse

and the emergence of organised prostitution rings. Is this the price of

progress? When I lived in the Solomon Islands more than twenty years

ago betel nut was the locally grown and harvested ‘narcotic’ of choice,

resulting in red and numb lips and teeth but not organised prostitution

rings. In particular, the emergence of organised prostitution rings implies

oppression in some form, or at the very least a lack of choices in women’s

lives. For me it invokes a view, long held amongst feminists in the West,

that ‘patriarchal (and racist and classist) societies have devalued, controlled,

or appropriated women’s reproductive capacities’, which is not a

description I would have used to describe the Solomon Islands when I

lived there all those years ago (Chase and Rogers, 2001:11). Indeed, as

noted earlier in chapter 2, at that time patriarchy was not a dominant,

organising feature in the society. In contrast, patriarchy was identified as,

and continues to be, a defining feature of society in Bangladesh.

In the intervening years since I lived and worked in Bangladesh, ‘makingmotherhood

safer’ has been a declared aim ofmany aid organisations.

Yet maternal mortality continues to be high. According to recent UN

figures three women die every hour due to pregnancy-related complications.

These figures provide a sobering indicator and reminder of the

continued inequity in women’s lives in Bangladesh. And indeed, figures

may actually be higher, as not all incidences of maternal mortality are

reported. For example, the families of unmarried teenage girls who might

die as a result of an abortion are unlikely to report the death because of the

associated shame. Clearly, these untimely deaths are not just a consequence

of a lack of available health care, but rather the result of the

coming together of social, cultural and economic factors. As we saw in

chapter 2, childbearing has been one area in the lives of Bangladeshi

women from which men are largely excluded and in which women have

‘control’. But ‘control’ is always limited by the conditions and circumstances

in which it is experienced. In this highly patriarchal society,

deeply ingrained religious and cultural ideas of male and female difference

circumscribe women’s lives and ‘choices’ in particularly unequal

ways. An example of this is the poor levels of literacy that continue

amongst women. Only one third of school-age girls attend school, and

it is estimated that half of all girls will marry and begin having children

before they reach the age of eighteen years. For Bangladeshi women,

then, choices remain very limited and stand in stark contrast to those

we have seen utilised by the women in the previous three chapters. Yet

mapping the different cultural terrains of reproduction, childbirth and

motherhood enables us to see the cultural differences and sometimes the

similarities. It has become even more important as the processes of

globalisation increasingly influence individual lives and spread across

and between cultures and countries. Such work enables us to learn from

the practices in other cultures, for example, in relation to the ways in

which childrearing practices are differently organised, and maternal

responsibilities differently conceived. The scripts and discourses drawn

upon by the women in the previous chapters stand in contrast to

those available to Bangladeshi women. There is also a need to urge

caution in relation to the ways in which legitimacy can be given to

particular practices, which then become accepted as ‘natural’. That is,

we need to learn from our own experiences of medicalisation in the West

to reflect on how particular practices have come to be unquestioningly

accepted whilst others have been relinquished. Moving on from these

important global concerns, it is now to the lives of individuals in the West

we return, focusing on the debates around narratives and subjectivity.