In Sickness and In...Sickness.

Travels in India are invariably filled, for us, with intermittent, unpleasant, but usually non-serious digestive problems. Travel in Brazil, as it turns out, has been filled with unexpected respiratory problems and topical infections. I say "unexpected" because, having lived in New Delhi's thick smog for a year, we were looking forward to the pure, clean air of rural Brazil. As I write, we are in the heart of the dry season, and the air is anything but pure and clean. The dirt roads have become dust roads, everyone is burning their lots and their yards and their trash, and the result is respiratory havoc. In Dancing Skeletons: Life and Death in West Africa, nutritional anthropologist Katherine Dettwyler chronicles the trials and tribulations of fieldwork in Mali with a child. Having left her husband and their son, who has Down's Syndrome, in the States, Dettwyler takes her older daughter along. Already racked with guilt about leaving her husband and son, Dettwyler describes with great poignancy the crisis she faces when her daughter contracts malaria and nearly dies. This book has been coming to mind a lot lately. In our 6 months in Brazil, Annabelle has been on more than 6 courses of antibiotics, for everything ranging from a stubborn sinus infection, to an ear infection, to impetigo covering half her body, to what she has now--a serious kidney infection. Had we had better access to a pediatrician and a laboratory for a urine test, we could have caught the UTI before it progressed to her kidneys. I'm going to recount at length the process we engaged in to get diagnosis and treatment. My purpose is not to complain, but to illustrate how high the barriers to medical care are here, and how in learning to adapt we’ve gained additional insight into some of the daily struggles faced by those in our research community.

We first noticed symptoms but waited for several days, hesitating because the doctor who visits the settlement twice a week is not a pediatrician, usually prescribes Annie a course of antibiotics without any alternative treatment suggestions, and has intimated in previous conversations that he thinks we're a little crazy for always bringing her to the doctor. Then Dave was out of town for a couple of days on a research trip. Then her symptoms seemed to disappear. Then the doctor wasn't visiting the settlement. Then it was the weekend. By this time, Annie was beginning to run a fever. We fought heatedly about whether or not this was serious enough to take her on the long trip to a pediatrician. Finally, we got worried and took her on an hour-long truck ride to the nearest bus station in the small town near the settlement, then got on a 2-hour bus to the nearest town big enough to have a pediatrician. Unsurprisingly, the doc wanted a pee test, but all labs are closed on Saturdays and Sundays. With a prescription in hand, the next day we made the three-hour trip home and began to try to figure out how to get a pee test done from rural Brazil. First we had to make the hour-long trip into town by motorcycle on a dirt road to get the collection bags. Then we were only able to collect a tiny bit, but the lab told us to bring it anyway. It wasn’t enough. We had to try for two more mornings to collect enough pee for the test, not an easy feat. We dropped it off one day and had to go back the next to pick up the results. Then we had to call the pediatrician in the city, and visit the consulting doctor who just happened to be in the settlement that day, to make sure we were going to proceed with the correct treatment. He was the one who finally took a careful look at the report and informed us that this was a serious kidney infection, not just a UTI. By this time, Annie had had symptoms for two weeks. The total cost for all the transport, consults, tests, stays in a hotel, and medicines was around $300—more than most people here make in several months.

The barriers here are clear, and high. One key problem is the remoteness of the place we live. As I mentioned, there is a general practitioner who visits the settlement twice a week for a few hours in the morning. He is good at what he does, but is limited by the poverty of most people here and by the fact that there are no testing or diagnostic facilities nearby. Any test, imaging, etc, must be done in town, which is the hour-long truck or motorcycle ride. If it's anything beyond a routine blood or urine test, you have to undertake the much longer bus ride.

A second major barrier is the lack of infrastructure in this region of Amazonia. As one of the poorest parts of one of Brazil's least-populated states, this region's roadways are pitted with pot holes that could swallow a car if given the chance. The distance between the towns I've mentioned is actually quite small, but the state of the roads makes it impossible to move quickly.

A third major barrier is the cost. Medical care in the settlement is free, but if one needs to consult a specialist (in this case, that's anything other than the GP), one must choose to either go through a long certification process to get government-sponsored access to free care, or to pay out of pocket for private care. We opted for the latter since we're not entitled to government care anyway, and the expenses were high.

Unfortunately, the stakes here are also clear, and high. The health of one's child--and the responsibility one feels for putting that child in a situation not particularly conducive to good health--is an onerous burden. We feel racked with guilt about the near-miss we had with this kidney infection, especially juxtaposed against the background of the many other illnesses Annabelle has had since we arrived here. I am always quizzing mothers in the settlement about what they do to keep their children healthy, and their responses differ little from what we do. Why, then, does Annie get sick so much more than other children here? Why, for example, does a cold go away within a few days for most children here, while for Annie, it almost invariably turns into a sinus infection requiring treatment? Do they get just as sick, but people view symptoms differently (e.g., green snot and a fever are not viewed as worthy of a medical consultation and a course of antibiotics, while in the US, those are considered red flags)? What does a parent do when faced with the tough choice between family togetherness and good health?  And what insights do these experiences yield into the daily lives and struggles of those in our field site?

Last week, the settlement inaugurated a gleaming new health post. While still quite modest by hospital standards, it is lauded as the state’s most advanced for a rural area. Its recent construction was the result of a long political struggle between members of the community and the state, requiring various forms of lobbying and protest. Yet, most of its rooms stand empty, and it is only staffed by trained medical personnel two days a week. Perhaps as a hold-over from earlier days when absolutely no medical care was available, people here maintain a palpable lack of emotionality to both sickness, and it turns out, death (something Nancy Scheper-Hughes wrote about at length in Death without Weeping). We’ve lost count of the number of times a woman has nonchalantly mentioned in passing that she lost a child at an early age from a preventable illness, injury, or choking accident. Nearly every woman we know over the age of 35 has lost at least one. We feel scared by the  “What can you do?” expression we encounter as we worriedly scurry about, asking how to get lab tests, or whether it is abnormal that our child get sick with such frequency. But we also are beginning to understand, feeling our own measure of resignation that sometimes, unfortunately, there's very little that one can do.

We Can't Do This- We Can Do This

About a year and a half ago, we found ourselves standing on the side of a 6-lane divided road in central Delhi, jetlagged and having just learned that Jo was pregnant. We each stood there, silent for a few minutes, watching morning rush hour traffic crawl by and breathing bus fumes. Finally we looked at each other, saw our own panic reflected in the other's eyes, and freaked out. What followed was a veritable smorgasboard of catastrophizing. The general gist of the conversation was, “Oh God, we can't do this.”

 Flash forward to about two weeks ago. We're sitting in the cab of an ancient pickup truck retrofitted with bench seats and a metal cage on top for cargo. We join approximately 10 people and heave a year's worth of our suitcases, stroller, and other accoutrements onto the groaning roof. The truck bumps and squeaks its way slowly along a rutted dirt road, taking us to the rural Brazilian settlement where we will be living for the next year. Annie is crying, Jo is getting sunburned, David is getting irritated, we're all dripping sweat. This time, there's only a single terse exchange: “Honey, you can't do this kind of thing with a family. This is ridiculous.” Same idea—we can't do this.

  We've both reflected quite a bit on the similarities between these two memories, and on the very real feelings of panic that choked us both at one point or another as we've traveled around while pregnant, giving birth, and with our (now) 8-month-old. We've realized that there have been many times when we thought we couldn't do it, but we did, and quite a few times when we thought we could do it, but we couldn't. In this post we discuss some of the challenges of doing fieldwork with a family. What happens when reality is really too much, and how can compromises be negotiated? It is neither solely about rising above the challenges of doing fieldwork with a family and riding off into the sunset, nor about retreating with one's proverbial tail between the legs. It's about negotiating the professional and personal juxtapositions that are kids in the field.

We'll draw another example from our first days as a family in Brazil. To provide a little background, David's research is about the potential linkages between political participation and environmental education in the Brazilian Landless Workers Movement (MST). In 1996, 21 MST members were massacred while marching as part of their struggle for agrarian land reform. Survivors of the community have created an annual 10-day educational event leading up to the anniversary of the massacre.

 Group discussion following debate on agroecology

 Che: "To be young and not a revolutionary is a genetic contradiction." Who knew?

  Discussion group on gender with monument to those massacred--made from burned Brazil nut trees-in background

 The daily protest, closing the highway for 21 minutes in memory of the deceased.

This encampment on the side of a rural Amazonian highway was a key event for David's research. However, sleeping under black plastic tarps on the side of the highway, in the rainy season, with unspeakable heat indices and little shade made the chances of encamping for 10 days with an 8-month old pretty much nil.

 Home sweet home?

 Turns out black plastic is actually fairly waterproof. Emphasis on fairly.

 The 2000 liter open shower

First, we both acknowledged that there were the things we HAD to do to keep everyone safe and comfortable. For example, avoiding heat-stroke, dengue, and dehydration. The onus is greater when only one member of the group speaks the language, as was the case for us in India and now in Brazil. Then, there are the things you WANT to do. Oh, man, it would be so nice just to skip taking an hour-long motorcycle ride tomorrow in the heat of the day to the encampment and instead hang out in the river with my daughter. Similarly, I think I'll go to the encampment another night so I can have dinner at home and not wake up in a mud pit. Or the reverse: I'd really like to participate to the fullest extent in this 10-day encampment, and get that sought-after 'emic' perspective. Early on we decided that David would go each day to the encampment, and at some point we would try to spend two nights there as a family. This seemed realistic in principle, but the day that we tried to encamp as a family turned out to be the hottest of the entire event, and Annie started getting diarrhea. Not a good combination for any involved. Annie was clearly not happy, and as a result nor was Jo; David was trying to conduct interviews with little success as it became increasingly clear that this family encampment was just not going to work out after all. A marital skirmish ensued and we re-evaluated and compromised again: David would continue to commute to the encampment during the days, and would spend two separate nights encamping with his research community. We think this example illustrates the fact that combining fieldwork and families is a lesson in tradeoffs: we can't do this— we can do this. Situations that you would be comfortable in, e.g., sweating it out on the side of a highway for 10 days, are sometimes not fair to ask of your family, particularly when they can't answer back. But at the same time, having Jo and Annie at the encampment during the day was incredibly rewarding, both personally as well as professionally as a multitude of people wanted to hold her, bathe her, and watch her during the day (Annie, not Jo, although Jo wished someone wanted to dunk her in a big tub of cool water). We realized that it wasn't only the MST members that had been learning during the week at the encampment; we had as well. And importantly, although David's style and depth of participation in the event did not turn out as he had originally envisioned it, he came away feeling he had collected enough material in those 10 days to write an entire MA thesis, or at least a dissertation chapter. We can't do this—We can do this.

Happy Annie=Happy Us

The look that froze my heart, or, parenting across cultures

Parenthood is a strange beast, a strange and apparently public-access beast. Everyone gets unsolicited parenting advice. It’s hard to know what to do with that advice sometimes, and when that advice comes from a cultural context that differs from the one you were brought up in, it gets even more interesting. There are surely lessons in these encounters. Consider:

“Hat! Hat! Where is the baby’s hat?” –shopkeeper in Kerala, where the average daily temperature was 95 with abundant sunshine and high humidity

“Don’t hold the baby that way! You’ll break its neck!” –male bureaucrats at the Foreigners’ Regional Registration Office in Delhi, when we were holding the baby vertically so she could look over our shoulders and see what was going on

“You’re going to give her a bath now?! But she’ll get too cold!” –my research assistant; just after a massive baby poop at 5:00 in the evening

“See, babies’ collar bones get out of place because we pick them up by their arms all the time. Then they get pain in their shoulders and won’t drink milk. You just have to push them back down [she proceeds to push on the baby's shoulder while baby screams hysterically].” –the lady who comes to clean, and moonlights as a baby and child masseuse in several homes

My usual tactic when I got advice that didn’t match my model of parenting was to either nod seriously and say I’d make sure to take care of that, or to say something to lighten the mood like, “Oh, she’s fine. Don’t worry!” People didn’t like the latter response at all. Sometimes I got scathing looks that implied in not-so-subtle terms that I must be a horrifically irresponsible parent.

Since I was still working on my research after the baby’s birth, Dave would often look after her for several hours at a time while I went out to do an interview. He’d frequently take her on walks in the Baby Bjorn around our neighborhood, and sometimes when we went out together he would carry her this way too. This drew a lot of stares.


Stares abound: Especially when Dave is getting his feet eaten by fish at the pedispa!

Now, it’s not as if men in India don’t carry babies. They do! But they usually carry them wrapped in a blanket and held cradle-style. I’m unsure if the stares came because we’re foreigners with a small baby (not something one sees a lot in India), because of the baby-carrying contraption itself, because Dave was carrying her and not me, or perhaps because Dave is just so tall. Surely, it was a combination of the above. The looks were usually curious, amused, and sometimes a little good-naturedly shocked.

Sometimes the interest in our division of parenting labor was more concerned than curious, however. Before becoming a parent, I imagined that people in India might find it odd and somewhat amusing that Dave was going to be so actively involved in our baby’s care. I knew this wasn't typical, but I thought to myself in a horribly culturally imperialistic way that this would create excellent opportunities for intercultural understanding, and might help my oppressed Indian sisters see that they don’t have to bear the brunt of childcare all alone. Girl power! Alas, this was not to be.

One day, I was getting ready to leave for an interview when the cleaning lady was at our flat. As I was about to walk out the door, she exclaimed, “You’re leaving the baby? With HIM?! Won’t she cry? Won’t she miss you?” Her facial expression froze like a DVD that had skipped: sheer incomprehension, utter disbelief, and outraged accusation. I’ve never been looked at that way before, by anyone, ever. That look went straight to my heart and made me feel, for a few seconds, that I must indeed be the worst parent in the world. It was totally paralyzing.

I falteringly explained that I was leaving milk behind so that he could feed her, and that I’d only be gone for a few hours. I felt like a kid making excuses for my bad behavior in school. She said, “But what will he do with her?” When I explained that he would sambhalna her [a general verb meaning to look after or take care of], her expression changed from horror to doubt. It took several minutes of explanation from my Indian research assistant, who enthusiastically vouched for my acceptability as a parent, before she relaxed. This was one situation where any amount of explanation by my foreigner self wasn’t going to bridge the cultural divide.

A few days later, I decided to bring it up again and see if I could get more insight into that unforgettable facial expression of hers. I casually asked her if she had been really surprised about Dave taking care of the baby, and why. She said, “My husband—I mean, he comes home from work, sits down in front of the TV, and youn [mimics a stern, angry facial expression and an imposing posture]. The children say, ‘Papa, papa,’ and he ugggh [mimics a disinterested grunt and a hand pushing the kids out of the way of the TV]. ‘Give me some water! Where’s dinner?’”

I was really surprised by this response. India does have a heavily patriarchal culture where women frequently stay home and take care of all child- and household-related responsibilities, but what she was describing sounded so extreme, like a caricature of all the worst aspects of patriarchy. If a foreigner had described this situation to me, I would have dismissed it, thinking skeptically, “Oh, she’s just vilifying North Indian cultural norms because she doesn’t understand them. She should be more of a cultural relativisit.” It’s important to keep in mind that this woman comes from a traditional family who only recently migrated to the city from a rural part of Uttar Pradesh, but at the same time, the situation she described probably wouldn’t sound unfamiliar to many other women in Delhi. She herself is working and bringing much-needed income to their impoverished family, but judging from her description of her husband’s behavior, this hasn’t brought her a lot of respect or status in the family.

…All of which is to say, cultures differ. As an anthropologist, I don’t expect to be surprised by cultural differences anymore, especially in North India, where I’ve spent so much time. Parenthood, however, has opened a new door onto an entirely new set of cultural beliefs, practices, and values that I’d never been exposed to before. There’s always more to learn.

Damned if you do-Damned if you don't: Or does it even matter? (our birth story)

It's unbelievable that it's been a month (ok, six weeks now; 2 weeks since we started writing this post!) since Annabelle was born! That it has taken us this long to write this post about her birth is a testament to the realities of life as new parents doing field work. In our case, it's also a testament to the complicated emotions surrounding the birth itself.

Whether the birth would've gone differently had we been living in the United States is unclear, and that in itself is quite interesting from the perspective of a medical anthropologist. Living in India, Jo had a late-term ultrasound at 37 weeks. This late stage ultrasound is not routinely done in the United States, and we aren't quite sure as to why it's not done at that stage here. The ultrasound showed that the umbilical cord was wrapped twice around Annabelle's neck. When the ultrasound tech told us this in a matter-of-fact sort of way, we were kind of in shock..."What does this mean"..."What will this mean for the birth, for the birthing options, for our unborn child?". There were so many questions. While Jo's next doctor's appointment wasn't for several days, we did know immediately that this information was going to what we had envisioned to be the birthing process.

Upon returning home, we did did what any obsessive and anxiety ridden parents-to-be would do (but shouldn't): we consulted the Pandora's box that is the Internet. For the next several hours, we uncovered countless contradictory accounts of how the cord wrapped around the neck doesn't matter, as opposed to those that claimed it caused a child's death or serious impairment. This conflicting information was quickly compounded by the conversations we had with our friends and relatives, who have very different perspectives on medical culture.

After two days of stewing in information and misinformation we went to see Jo's OB. She told us, whether or not this is true, that there was a 95% chance that Jo would require an emergency c-section if she tried to go for a natural delivery. In short, she strongly, strongly recommended "electing" to have a c-section as opposed to a normal delivery. With this advice, what we had envisioned about the birth (natural, quiet, and most importantly, not characterized by medical intervention) evaporated. As Jo was only 37 weeks along, the doctor said we had a few days to decide, but that she would like to do the "procedure" in the next week if we "decided" to go that route.

Over the next few days, I think we walked around the little park in our neighborhood enough times to wear a track in the cement. As academics, we couldn't help but see this decision as being fraught with incredibly complicated epistemological issues. At a first glance, this seemed like the embodiment (pun not intended) of the classic Foucauldian knowledge/power couplet. To paraphrase, Foucault wrote that knowledge is indeed power, but power allows those in control to determine what counts as knowledge. The knowledge/power complex dictates what can be said, and by whom, and through cultural institutions becomes embodied in our everyday lives through action, interaction, and social structure. Foucault wrote about these concepts extensively in The Birth of the Clinic. What counts as knowledge in this situation? Was the "information" we found on the Internet "credible"? Was it sanctioned by the medical establishment? No. And was it credible? Even if they cited peer-reviewed journal articles, many of the accounts we read were on online bulletin boards, and thus seemed devoid of power because they weren't from a medical authority figure. On the other hand, the information dispensed by our OB and medically-trained family members felt official, sanctioned, and wielded a lot of power.

This was a first-hand introduction to the ways in which questions of knowledge and power dovetail with the new responsibilities of parenting. This wasn't an abstract academic exercise for us; it was very real and soon to become embodied in Jo's own body based upon which decision we made. We have a relative who is pretty severely disabled with cerebral palsy, a result of...well, it depends who you talk to, but a cord being wrapped around his neck, oxygen deprivation, and a difficult birth. And that was without a late-term ultrasound to indicate that a difficult labor would be a strong possibility.

So after much ruminating, the "decision" boiled down to the age-old axiom, "You're damned if you do, damned if you don't". "You're damned if you do" amounting to the fact that going with the c-section meant that we were "caving in" (or so it felt) to the medical establishment and its interventionist ethos. "You're damned if you don't" amounting to the life-long guilt we'd feel if we went forward with a natural birth and something went wrong (however unlikely that scenario might be). I've been writing "decision" in quotations because from the moment we had the information about the cord, we felt to a large extent that the decision had been made for us by the biomedical establishment.

In the end, we chose to go through with the c-section. Looking back now, it hardly seems important, but at the time it felt like a life-and-death decision. We'll never know if it actually was life-and-death, but we ended up with a healthy and happy little girl, and an even happier set of new parents.

Welcome Annabelle Winifred Meek, born August 18th, 2011

Sex Determination and Cultural Constraints

Blue or pink...or taupe?

Depending on where one is conducting fieldwork, learning the biological sex of one's baby before it is born can be illegal. This has been the case for us here in India. Our baby is set to arrive next week, but we still have no idea if it's a boy or a girl. Although once a source of major frustration for us--as we were curious to learn all we could about our little one--now that the birth is imminent it doesn't seem like such a big deal. Still, it's an important social and political issue, so this post is devoted to our experiences with sex determination in India.


Why is prenatal sex determination illegal in some places? The basic reason is that in some populations, males are preferentially desired over female children, and as a result females may be selectively aborted before birth, or neglected and/or killed thereafter. Although this sounds grisly and improbable, in some cases, the numbers are quite staggering. The secondary sex ratio, which is the ratio between sexes at birth (as opposed to at the time of conception) and is the statistic most frequently cited to talk about population sex ratios, should be around 105 boys to 100 girls in a "natural" (i.e., un-tampered-with) situation. In some places, this ratio is highly skewed, with numbers as high as 130 boys to 100 girls.


Why is sex selection considered a problem? Sex selection is a problem not just because it creates population imbalances that have significant social, economic, and reproductive consequences. More importantly, it is a symptom of systematic social inequalities that constitute a violation of women's human rights. Rarely, if ever, does sex selection work in the opposite direction (in favor of girls) at a population-level scale.

This year (2011), India's new census data were released. Since the previous census in 2001, sex ratios have worsened in many parts of the country, especially in the more prosperous and educated states. This is somewhat surprising because typically, as populations become more educated, women's social equality increases. At the same time, India's 2011 census shows that the country's overall infant mortality rate--the number of infant deaths per 1,000 live births--has decreased 30% in the past 10 years. Population growth has also decelerated. The fact that the sex ratio is getting worse in the face of these otherwise positive population trends is alarming. Even among Indian diasporas living in the US and the UK (two countries where prenatal sex determination is legal), the sex ratio is significantly skewed toward males.

To me, this information suggests that it's not India's within-country conditions (such as climate, geography, other demographic trends) that are causing girl babies to die more frequently than boys; it's a sociocultural reason. The pressure to have a boy in India is so intense that, according to recent newspaper reports we've been reading, people who can afford to do so will fly to Dubai and get a sex determination ultrasound or amniocentesis. Some even go so far as to have the sex of their baby surgically altered shortly after birth. Now, of course, there are bright spots--villages or towns with remarkably healthy sex ratios in the midst of a larger region of unfavorable ones, or entire states where the sex ratio resembles what one would expect--but the problem doesn't seem to be going away for India.

India's pervasive sex selection in favor of boys becomes more understandable when one considers the dominant social structure and its concomitant social pressures. In fact, I've spoken with so many women about it that while I can't sympathize, I can certainly empathize. First of all, India's dominant social systems are highly male-biased. Men in most households are still the primary breadwinners. When a woman marries, she moves into her husband's family's household, often bringing along a significant dowry which is usually negotiated in advance as part of the marriage arrangement. Even if no dowry is there (it is technically illegal), the bride's parents transfer a lot of wealth to the groom's family by paying for a lavish multi-day wedding ceremony and gifting their daughter gold jewelry. Because of social pressures to communicate status by displaying wealth (something we Americans also do a lot of, too), parents feel compelled to host ceremonies that stretch the limits of their means. They often save money for years and/or go into serious debt to pay for these ceremonies, much as American parents save and take out loans for their children's college expenses. This means that daughters constitute a financial liability, and this is one reason why a family might not be thrilled about the birth of a daughter, especially if she's not the first daughter.

On the other hand, sons are, in many ways, a form of social and financial security for their parents, at least in the traditional systems. A son brings a bride into the household, who takes over her mother-in-law's domestic responsibilities and allows her to retire. Likewise, good sons traditionally contribute most of their earnings to the family, lessening the financial responsibility of the father and allowing him to retire as well. India has no social security system and very few older-age homes, so this kind of in-built family support continues to be important for aging parents even in urban, wealthy families with access to good health care. Although many scholars claim that the joint family is dying out in India, just a little over half of the women I work with on a regular basis live in joint families, and I find that it's still the pervasive ideal communicated in popular media like blockbuster Bollywood films. This trend may be changing, but it's not gone yet.

Because boys are so important to the integrity of family structure, married women are often pressured by their in-laws to bear sons. If they fail to do so, they may be abused or threatened. In many cases of female infanticide, it's not the birth mother but another family member who kills the baby. Naturally, under this kind of pressure, women want to have sons. I would, too, if I lived with and worked for my mother-in-law and she was always breathing down my neck and punishing me and making my home-bound life miserable. In this way, the woman-oppressive system gets perpetuated by women.

Since starting my research, I've met several women who have something like 6 or 7 daughters and one son (he's usually the youngest of the bunch). I've met others who have 6 or 7 daughters and no sons. These women are always financially very strained and emotionally very stressed. Women's number-one stressor across the board, at least in my research, is getting their daughters married. Wealthy or not, this is a big social responsibility for a parent, and other family members will exert significant pressure on him or her to get the daughter settled and married earlier rather than later. This means that in many cases, women don't complete a high-school level education. And we all know that less education means less empowerment means less capability to stand up for one's rights in oppressive scenarios. Once again, the family perpetuates the system.

So given this context, for us the choice was pretty clear.

No choice--in terms of knowing that is.

Well, no legal choice. As the above discussion should illustrate, plenty of people choose to pursue illegal means of sex determination through bribing technicians or traveling to countries where it remains legal. But laws are there for a reason.

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.

Taking the Plunge

The decision to have a child (or children), while different for everyone, is always a personal one. How does such a fundamentally personal choice fit in with the academic professions? Although it's different for everyone, we believe there are some common concerns shared by many folks considering parenthood: Are we ready? Is this a "good" time? Would there be a "better" time? Do we have the resources (financial, social, time-wise)?...The list goes on. We set up this blog because we know we're not the first ones to ask these questions; many of our friends and colleagues are dealing with similar issues. We're hoping that this blog will be a resource, and perhaps even a source of social support, for people going through these tough decisions.

For us, two healthy, young-ish doctoral students with supportive families, our primary concern revolved around timing. In short: was this a "good" time to have a baby? Jo was just about to begin a year of fieldwork in India after which we would be living in the Amazon for another year for Dave's fieldwork. Would there be a "better" time...perhaps one in which our first child would not be born in a foreign country, would not live the first year of its life in an Amazonian agrarian settlement, far away from its grandparents and other resources? Would our lives "calm down" after field work? Would dissertation writing, applying for jobs, or tenure track positions provide any respite? After a lot of hemming and hawing, we started to think that perhaps not. While life as an academic certainly has its perks, neither of us saw a stress-free, deadline-free point on the horizon.

With this realization, we began to wonder: Was this, perhaps, the "perfect" time, one in which we would be more "around" (i.e. not in an office or on a campus) and would be able to be an all-day part of our baby's life? Would living the first two years in India and Brazil imbue our baby with appreciation for cultural diversity, tolerance of adversity, patience, or perhaps lead to the easier acquisition of a second or third language?

As we spent three months awaiting our research visas to India, living in limbo, we pondered these questions incessantly. Our various graduate-school friends with children provided their insights and shared their experiences. But again, everyone's situation is different, and the decision was squarely ours. Deciding that "no time is a good time", that starting life with feet in diverse cultures couldn't be a bad thing, and that remaining committed to the challenge of integrating family life with that of academics...we took the plunge.