Negotiating the intersections of pre-natal health and medical cultures

Staying healthy while pregnant can be quite challenging, and it's often also an exercise in the cultural relativity of medical information. As a medical anthropologist, I've always been interested in the similarities and differences in societies' healing and health maintenance practices. India is a particularly interesting place to explore these issues (and yes, I am biased), in part because of its well-developed traditions of concurrent and complementary medicine. Most people I know here rely on at least two of the following types of providers: allopathic physicians, Ayurvedic doctors, homeopaths, practitioners of Unani medicine, or providers of other therapies such as yogic breathing, reiki, and acupuncture.

Recently, a persistent chest infection and some general GI problems convinced me to consult two friends who serve as lay-health advisers, and eventually, three allopathic doctors. From the two friends, I received a bag filled with various Ayurvedic tonics. From the medical doctors, I was given a bevy of prescriptions for complex mixtures of antibiotics and palliatives (symptom-relieving treatments and medicines).



Life in Delhi presents various health concerns, ranging from black snot to persistent Delhi-belly. It also offers a much wider variety of treatment options than one finds in the U.S.


Figuring out what to take was really complicated. We couldn't find reputable information on the safety of the Ayurvedic tonics during pregnancy (i.e. from a source other than the online store that was selling them), but our friends swore that they were much safer than any antibiotic I could take. When I checked the safety of the allopathic drugs perscribed by the physicians, I found that several of them were strongly contraindicated during pregnancy because in animals they were associated with birth defects (this is category C, for those of you who are familiar with drug categorizations and pregnancy). The prescription in question came from our family physician here in metropolitan Delhi, who's been seeing patients for 40 years. This woman knows what she's doing. And the friends I consulted about the Ayurvedic treatments are former study abroad program leaders, who've been taking care of sick Americans in India for decades.

For us, this brings up a variety of questions related to epistemology and objectivity. At the most basic: how does one know what is "safe," and conversely what is not safe? Who does one trust when it comes to medical knowledge--particularly with sensitive conditions like pregnancy and pre-natal health? What makes us invest trust in one kind of practitioner or treatment over another?

Let's return to the Ayurvedic treatments, for example. They've been used for thousands of years here in India, and chemical analyses of many common ingredients in Ayurvedic medicines have demonstrated their beneficiality. However, very few studies have been done on Ayurvedic drugs and pregnancy. Without research specifically on pregnancy and Ayurveda, how can their safety be verified? Then again, is it even useful to apply a positivistic, biomedical definition of "drug safety" (usually established by a clinical trial or a retrospective cohort study) to a non-biomedical system?

According to our pregnancy books, the best policy when one is unsure about a treatment is not to take it. But I was really sick, and I had to do something. At some point, as with all medical interventions during pregnancy, it came down to the bottom line: which is more dangerous for me and the fetus, an ongoing health problem or the potential side effects of the treatment? In the end, I went with the familiar. After having Dave check the safety of each ingredient online, I took the antibiotics, the painkillers, the decongestants, and the cough syrup. We gave the Ayurvedic medicines away to Indian friends.