Medical Anthropology Cross-Cultural Studies in Health and Illness
ISSN: 0145-9740 (Print) 1545-5882 (Online) Journal homepage: http://www.tandfonline.com/loi/gmea20
Extending Theory, Rupturing Boundaries: Reproduction, Health, and Medicine Beyond North-South Binaries Nayantara Sheoran, Daisy Deomampo & Cecilia Van Hollen To cite this article: Nayantara Sheoran, Daisy Deomampo & Cecilia Van Hollen (2015) Extending Theory, Rupturing Boundaries: Reproduction, Health, and Medicine Beyond NorthSouth Binaries, Medical Anthropology, 34:3, 185-191, DOI: 10.1080/01459740.2014.981263 To link to this article: http://dx.doi.org/10.1080/01459740.2014.981263
Accepted author version posted online: 06 Nov 2014. Published online: 09 Dec 2014. Submit your article to this journal
Article views: 135
View related articles
View Crossmark data
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=gmea20 Download by: [Chinese University of Hong Kong]
Date: 12 November 2015, At: 13:46
Medical Anthropology, 34: 185–191, 2015 Copyright © 2014 Taylor & Francis Group, LLC ISSN: 0145-9740 print/1545-5882 online DOI: 10.1080/01459740.2014.981263
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
INTRODUCTION
Extending Theory, Rupturing Boundaries: Reproduction, Health, and Medicine Beyond North-South Binaries Nayantara Sheoran Department of Anthropology and Sociology, Graduate Institute, Geneva, Switzerland
Daisy Deomampo Department of Anthropology, Fordham University, Bronx, New York, USA
Cecilia Van Hollen Department of Anthropology, Syracuse University, Syracuse, New York, USA
In his 1930 short story “Mantra” (Premchand 2012), Indian writer Munshi Premchand tells the story of Dr. Chadha, a medical doctor, and Bhagat, a poor old man revered locally as a shaman who can cure snakebites. Tragically, Bhagat’s only son dies after Dr. Chadha, on his way to golf, refuses to see the young patient. Premchand’s narrative establishes Dr. Chadha as a privileged physician, trying to make it to tee off in time and callously disregarding a poor illiterate villager. NAYANTARA SHEORAN is postdoctoral fellow in the Department of Anthropology and Sociology at the Graduate Institute, Geneva. As a postdoctoral research fellow, she is extending her engagement with biomedicine and burgeoning biotechnologies in India. She is conducting extended fieldwork in India on the sociocultural and ethical implications of the emergence of stem cell biotechnologies (both embryonic and adult), while also elaborating on parts of her dissertation research, which critically analyzes pharmaceutical contraceptives. DAISY DEOMAMPO is assistant professor of Anthropology at Fordham University, New York. She is a medical and cultural anthropologist whose current research focuses on the globalization of assisted reproductive technologies and its implications for gender relations, family formation, and social stratification. CECILIA VAN HOLLEN is associate professor of Anthropology at Syracuse University, New York. She is a cultural and medical anthropologist, specializing in analyses of global health, international development, reproduction, HIV/AIDS, and gender in South Asia. She is the author of Birth in the Age of AIDS: Women, Reproduction, and HIV/AIDS in India (Stanford University Press 2013) and Birth on the Threshold: Childbirth and Modernity in South India (University of California Press 2003). She is currently conducting research on cervical and breast cancer in India. Address correspondence to Nayantara Sheoran, Anthropology and Sociology, Graduate Institute of International and Development Studies, 2 Chemin Eugéne-Rigot, P.O. Box 136, Geneva CH 1211, Switzerland. E-mail: nayantara. [email protected]
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
186
N. SHEORAN, D. DEOMAMPO, AND C. VAN HOLLEN
Bhagat has lost his son, and is now in debt, although he derives small pleasure from smoking hookah in the evening in the company of his wife. As the story develops, a snake bites Dr. Chadha’s only son at the son’s lavish birthday celebration; no one can save him at this gathering, not even his own physician father. Word gets to Bhagat of the dire situation in the Chadha household, but he refuses to offer help, recalling the doctor’s lack of attention to his own son’s need. However, unable to fall asleep and in anguish about the situation, Bhagat finally goes to the Chadha home, cures the young boy, and leaves without any reward or recognition, even refusing a bit of tobacco from the household. While the Chadhas wanted to offer him everything they can financially, Bhagat wants no reward. Dr. Chadha finally remembers who this old man was and, duly shamed by his behavior, promises to be more benevolent in the future with his time and care. This short story, familiar to generations of Indians, exemplifies popular depictions of the benevolence of the ‘poor’ and their ability to hold up mirrors to the ‘rich.’ Such depictions use a simple dichotomy that represents the ‘poor’ as always and already superior moral beings because of their self-sacrificing ability as providers; in contrast the ‘rich’ are cast as inferior, placing their own personal interests and comforts above any concern for the human condition. Similarly, historical tropes draw on the facile dichotomy between the global North and global South, with countries from the South represented as benevolent providers of raw material to the North, exotic spaces on the receiving end of colonial subjugation or modernization. The North, in contrast, is characterized as driven by individualistic, capitalistic, and ‘modernist’ goals based on extraction and exploitation. Just as Bhagat holds up the moral mirror to Chadha, scholarly tropes exist whereby the South is expected to hold up the moral mirror to the North. In their recent collection of essays, Theory from the South, Jean Comaroff and John Comaroff call into question these tropes, arguing that “old margins are becoming new frontiers,” sites at which “radically new assemblages of capital and labor are taking shape, thus to prefigure the future of the global north” (2012: 12, 13). They hold up the South not as a mirror to the North in its current condition, but rather as a future condition. Their provocative work thus complicates the narrative of the South as simply providing raw material to the North, and instead, challenging the linear, teleological perspectives of development and modernization, they present the South as a set of relations, a space of nonlinear global flows that sheds new light on debates about states, citizens, rights, justice, and capital. The various articles in this special issue of Medical Anthropology draw on the Comaroffs’ argument that the global South is not simply a space onto which theoretical frameworks from the North are mapped, but rather a location from which new theoretical understandings emerge (and have emerged for some time). In a rapidly liberalizing world, an increasing number of consumers of medical technologies and health care services either travel to or are situated in the global South. At the same time, the South has also emerged as a major hub for the production and distribution of new medical technologies and pharmaceuticals— such as generic biomedical therapies and herbal therapies—flowing in South-to-North and Southto-South directions. Within this context, our focus is on the spatial, embodied, linguistic, and cultural boundaries crossed by state and nonstate actors. In this issue, the contributing authors examine such boundary crossings in order to identify new directions of theory, and to elucidate how this approach shapes our contemporary understandings of health and medicine, reproduction and contraception. We view such crossings as temporal moments from which new theory can emerge to challenge discourses that have thus far been situated in localities. Following the Comaroffs, we do not aim
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
INTRODUCTION
187
to take theory from the South and map it onto the North; rather we ask how we might understand health, medicine, and reproduction in new ways using theory developed in the South. In doing so, our view of theory from the South is not merely about the origin of the ethnography. Rather than prioritize the ethnographic location, we also are concerned with the positionality of the author. That is, following the Comaroffs, theory from the South is not only about the South or about theories of people who may be from the South. Rather, acknowledging the multiplicity of our identities and positionalities, we are concerned with the ways in which the South affects theory. Thus, while Connell (2007) has productively examined the ways in which Northern theory fails or does not apply in the South, the Comaroffs have highlighted the ways in which the future is emergent not solely in the North, but also in the South. Ideas and events emerging from the South shed light not only on the South but on our understanding of the world at large. The authors’ positionality in this issue becomes evident as each turns to their long-term engagement with their research site and interlocutors to understand and articulate the nuanced complexity of the South and theory that may emerge therein. Some of the interlocutors in Centella’s research, for instance, have been friends and colleagues since her early work in 2001 (this issue). Hughes Rinker, who has conducted field research in one area, intermittently, since 2008, conducted the interviews without interpreters in multiple languages (Moroccan Arabic, French, and English) (this issue). All the authors have lived for extended parts of time in both the global North and South. Their fluidity in navigating spaces and languages enables them to put forward a theory from the South that is neither solely dependent on their subjectivity, nor their presence in the South or North, to explicate health realities. Sheoran, who grew up in India before moving to the United States when she was 19 years, like the other authors in this special issue, articulates the ability to negotiate different North-South spaces when she writes in her article in this issue: Sometimes, I am an ‘objective’ social scientist, working on collecting data to arrange conversations and observations in patterns. At other times, though, I am present as more than just the neutral observer, as I feel my own position helps explain better some conversations with my respondents about ECPs [Emergency Contraceptive Pills] in particular and their social reality in general.
This ability to navigate these ethnographic spaces, which themselves are shifting based on the border crossings of not only the researcher but also the respondents is made vividly clearly in Deomampo’s article (this issue). For example, of the parents who traveled to India for surrogacy, 19 traveled from the United States and 9 from Australia, with the remaining parents traveling from Norway, France, Canada, Israel, and the Netherlands. Deomampo’s work, like other articles in this issue, makes clear that the theory emerging here is a condition of the location of the ethnography, and the position of the researcher and the interlocutors, evolving because of these shifting boundaries being negotiated at multiple levels. Our goal in this introduction is to briefly explore how scholarship emerging from the global South inverts prior assumptions of how medicine operates there, by focusing on the border crossing not only of ethnographic data or researcher but also of ideas and theories. From examining the ways in which contemporary biomedicine exists alongside ‘traditional’ medicine (Halliburton 2009; Naraindas and Bastos 2011) to the pervasive pharmaceuticalization of everyday life in the South (Ecks 2005, 2008; Das and Das 2006), these works ask us to reexamine not only how medicine operates in the South but also the implications of this for medicine in the North.
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
188
N. SHEORAN, D. DEOMAMPO, AND C. VAN HOLLEN
The realities of the South provide a lens through which to examine the conditions of health and well-being in the North. Within the realm of reproductive justice, scholars have explored how women choose birthing options and the medicalization of fertility and reproduction (Bridges 2011; Davis-Floyd 2005). Cecilia Van Hollen (2003) complicates this narrative in her book, Birth on the Threshold, on birthing practices in South India; in this she elucidates how socioeconomic and cultural factors contribute to how women choose to give birth, and argues that in addition to culture, the discourse on modernity has affected how poor women in South India participate in reproductive choices. She suggests that these decisions are not made in a “power vacuum by totally ‘free’ individuals” (Van Hollen 2003:208). Rather, women practice multiple levels of agency. Van Hollen (2003:213) wrote that her women respondents chose to participate in biomedical birthing options because it gave them a sense of being ‘educated’ and ‘modern.’ Women in South India sought what some women in the United States have referred to as hegemonic birthing practices that denied them a so-called natural experience. While biomedical interventions have indeed saved lives, the social implications of such interventions are not universal. Whereas some feminist scholars and activists in the North have critiqued biomedical interventions as invasive and inhumane and sometimes causing rather than preventing negative health outcomes, low-income women in South India, like the majority of mainstream middle-class women in the United States (Davis-Floyd 1992), viewed the same interventions as essential for healthy outcomes. For the South Indian women, however, these technological interventions were equally desired for the sense of power (as shakti) and the developed, modern status they could confer. Although women articulate their options differently in the North and South, it is also important to note the similarities. Women in the North might choose not to participate in ‘hospital births,’ but they do so in response to problematic power structures within hospitals. Similarly, the poor women of Tamil Nadu in Van Hollen’s study resisted the power structures in hospital settings by searching for viable options that allowed them access to modern birth practices in conjunction with cultural practices they saw as valuable. While recent scholarship avoids the trap of representing the experiences of privileged Northern women as representative of women across global boundaries (Ginsburg and Rapp 1995; Narayan and Harding 2000), we must remain wary of overlooking similarities in how women organize and deal with the same formations of power. As Saba Mahmood suggests in Politics of Piety (2005), we need to re-examine the framework under which we articulate women’s experiences. Mahmood explores how the revival of a particular Islamic piety for women depends on their participation in rituals that were explicitly forbidden in some forms of Islam (like women preachers and women attending mosques). This participation in the mosque movement perplexes liberals and Westerners, who view Muslim women as subjugating themselves to a doctrine that supposedly supports their oppression. In focusing on women’s identity, Mahmood provides an engaging critique of what is always taken for granted within Western philosophical and liberal thought, questioning the very tools of analysis used by liberal and Western feminists. She extends the work of Lila Abu Lughod (2005), who has identified practices of power as more than a binary between resistance and domination. She suggests that we question the very act of resistance and analyze it within a framework that is not entrenched in Western liberal thought (Mahmood 2005:9). Using the Foucauldian notion of power as productive (Foucault 1979), whereby through discourse power creates the subjects, and combining with this with Butler’s questioning of the “emancipatory model of agency” (cf.
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
INTRODUCTION
189
Mahmood 2005:20), Mahmood proposes that we reject binary notions of power when analyzing acts that some view as subversive to an Islamic ideology. Similarly, Indian feminists like Chandra Talpade Mohanty (2003a, 2003b) have suggested that women from the South (‘third world’) are not monolithic subjects who only came to exist in relational terms to women from the North (‘first world’) (Mohanty 2003b). The constructs of Third World women by First World feminists depended on assumptions of Western women as “secular, liberated, and in control of their own lives” (Mohanty 2003b:81) and Third World women as a universal category of the oppressed object. According to these constructs, First World women had agency while Third World women were not capable of moving beyond oppression. Mohanty’s cautionary note in 1988 is still relevant today: not only First World feminists, but also activists, Third World scholars, and policymakers, might be tempted to ignore the historical materiality of their own ‘culture(s)’ as they try to imagine and articulate an ‘empowering’ future for women’s local lives. Responding to this concern, scholars have taken on the challenge of rethinking key concepts of subjectivity, agency, and culture. The articles in this special issue contribute to this literature by illustrating the diversity of women’s lives, even those living in the same spaces, while paying credence to the similar power structures that women operate within and against. Studies that have historically grouped all women of the global South (or the ‘East’) are problematic not only because they ignore women’s individual agency but also because they situate women’s lives within a static historical moment. Review articles by Naomi Quinn (1977) and Carol C. Mukhopadhyay and Patricia J. Higgins (1988) illustrated some decades ago the tendencies of cross-culturally located studies to group women’s experiences as monolithic. According to Uma Narayan (1997), such research is another form of colonization. Extending this, Mahmood (2005) suggests that Western feminists look at women’s participation in the Islamic revival as a form of agency, rather than self-subjugation to particular doctrines. Yet because of Western feminists’ own locations within a particular Western rational tradition, until recently such analyses have been foreclosed. Next, the authors work to avoid the tendency toward cultural essentialism and universalism in their investigations of how theory from the South lends a more nuanced reading of North-South relations. As feminist medical anthropologists concerned with reproductive and global health, we often ask ourselves the ‘so what?’ question about our research. We ask: what are the implications of our work? Why does it matter that we unpack certain phenomena, highlight complexities, and allow our work to tell narratives of those often unheard? In this special issue, we attempt to answer what is at stake and why we should care to ‘extend theory and rupture boundaries’ when looking at health and reproduction. The articles included in this special issue engage with the Comaroffs’ challenge to move beyond North-South binaries, to reflect on themes of health and medicine in different ways. In doing so, however, we acknowledge the multiple connotations that the South holds. The global South is not an object in itself but rather bespeaks a relation, reflecting new perspectives from which to imagine the world we live in and enabling fresh imaginings of its current and future state. The boundary between North and South is porous and unstable, with sightings of the South in the North, and North in South, as the two fields share intertwined trajectories in the contemporary global order. Yet scholars have much to gain from turning the analytic lens to an ‘ex-centric’ location, an alternative to hegemonic Euro-American hubs. Such an approach, as the Comaroffs suggests, requires a return to theory of a specific kind: a grounded theory that
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
190
N. SHEORAN, D. DEOMAMPO, AND C. VAN HOLLEN
investigates the relationship between empirical observation and theoretical formation, between the world in which we live, and the ways in which we experience and inhabit that world. The four articles in this issue take up this challenge, seeking to explain events and ideas through empirically driven, historically contextualized critical observations; in other words, a theory grounded in the ordinary, in sites that trouble our assumptions about the usual centers for theory-making and compel us to turn toward new fonts of knowledge in the South. While situating their work ethnographically within the realm of reproductive health, medicine, and science in the global South, the authors of the four articles presented below interrogate complex regimes of power that move beyond North-South binaries to reveal a much more complex, nuanced view of the impact of globalization on reproductive bodies, policies, and practices. The authors address a range of relevant topics, including how access to and use of emergency contraceptives in India mobilizes neoliberal ideologies as they travel from North to South; how reproductive health practice and policy in Morocco problematize neoliberal ideologies of selfgovernance and responsibility; Bolivian-Iranian collaboration in health care and its challenges to hegemonic forms of health care delivery, development aid, and geopolitical cartographies; and the ways that struggles to define parenthood and gain citizenship (for children born via transnational surrogacy in India) engender new ways of thinking about kinship and nationhood in transnational contexts. A dominant theme cross-cutting these essays is anthropology’s hallmark agenda to highlight variation where many assume homogeneity. Medical anthropology has been at the forefront of the study of the cultural politics of biomedicine on a global scale. As these articles reflect on new articulations of health care, biotechnology, medicine, and reproductive/contraceptive technology throughout distinct locations in the global South, so, too, they demonstrate how North-South representations are inadequate in revealing the complex terrain from which new theory might emerge. By moving beyond North-South binaries, this special issue allows us to apprehend new ways of thinking about health and medicine around the globe. The articles that follow are a clear indication that medical anthropologists continue to lead the way in extending the boundaries—both literal and theoretical—of this line of inquiry, as they keep pace with rapidly shifting terrains of both biomedical technologies and geopolitics.
REFERENCES Abu-Lughod, L. 2005 Dramas of Nationhood: The Politics of Television in Egypt. The Lewis Henry Morgan Lectures, 2001. Chicago, IL: University of Chicago Press. Bridges, K. 2011 Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization. Berkeley: University of California Press. Comaroff, J., and J. L. Comaroff 2012 Theory from the South: Or, How Euro-America Is Evolving Toward Africa. Boulder, CO: Paradigm Publishers. Connell, R. 2007 Southern Theory: The Global Dynamics of Knowledge in Social Science. Cambridge, UK: Polity. Das, V. and R. K. Das 2006 Pharmaceuticals in urban ecologies: The register of the local. In Global Pharmaceuticals: Ethics, Markets, Practices. Adriana Petryna, Andrew Lakoff, and Arthur Kleinman, eds. Pp. 171–205. Durham, NC: Duke University Press.
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
INTRODUCTION
191
Davis-Floyd, R. 1992 Birth as an American Rite of Passage. Berkeley: University of California Press. ———. 2005 Anthropology and birth activism: What do we know? Anthropology News 46(5):37–38. Ecks, S. 2005 Pharmaceutical citizenship: Antidepressant marketing and the promise of demarginalization in India. Anthropology & Medicine 12(3):239–254. ———. 2008 Global pharmaceutical markets and corporate citizenship: The case of Novartis’ Anti-Cancer Drug Glivec. BioSocieties 3(2):165–181. Foucault, M. 1979 Discipline and Punish: The Birth of the Prison. New York: Vintage Books. Ginsburg, F. and R. Rapp, eds. 1995 Conceiving the New World Order: The Global Politics of Reproduction. Berkeley: University of California Press. Halliburton, M. 2009 Mudpacks and Prozac: Experiencing Ayurvedic, Biomedical and Religious Healing. Walnut Creek, CA: Left Coast Press. Mahmood, S. 2005 Politics of Piety: The Islamic Revival and the Feminist Subject. Princeton, NJ: Princeton University Press. Mohanty, C. T. 2003a Feminism without Borders: Decolonizing Theory, Practicing Solidarity. Durham, NC: Duke University Press. ———. 2003b “Under Western eyes” revisited: Feminist solidarity through anticapitalist struggles. Signs 28(2):499–535. Mukhopadhyay, C. C. and P. J. Higgins 1988 Anthropological studies of women’s status revisited: 1977–1987. Annual Review of Anthropology 17:461–495. Naraindas, H. and C. Bastos 2011 Healing holidays? Itinerant patients, therapeutic locales and the quest for health. Anthropology & Medicine 18(1):1–6. Narayan, U. 1997 Dislocating Cultures: Identities, Traditions, and Third-World Feminism. Thinking Gender. New York: Routledge. Narayan, U. and S. Harding, eds. 2000 Decentering the Center: Philosophy for a Multicultural, Postcolonial, and Feminist World. A Hypatia Book. Bloomington: Indiana University Press. Premchand, M. 2012 Mantra. In A Hundred Lamps: Classic Stories About the World of Medicine. Yatish Agarwal, ed. Pp. 55–72. New Delhi, India: Rupa Publications. Quinn, N. 1977 Anthropological studies on women’s status. Annual Review of Anthropology 6(1):181–225. Van Hollen, C. 2003 Birth on the Threshold: Childbirth and Modernity in South India. Berkeley: University of California Press.
ISSN: 0145-9740 (Print) 1545-5882 (Online) Journal homepage: http://www.tandfonline.com/loi/gmea20
Extending Theory, Rupturing Boundaries: Reproduction, Health, and Medicine Beyond North-South Binaries Nayantara Sheoran, Daisy Deomampo & Cecilia Van Hollen To cite this article: Nayantara Sheoran, Daisy Deomampo & Cecilia Van Hollen (2015) Extending Theory, Rupturing Boundaries: Reproduction, Health, and Medicine Beyond NorthSouth Binaries, Medical Anthropology, 34:3, 185-191, DOI: 10.1080/01459740.2014.981263 To link to this article: http://dx.doi.org/10.1080/01459740.2014.981263
Accepted author version posted online: 06 Nov 2014. Published online: 09 Dec 2014. Submit your article to this journal
Article views: 135
View related articles
View Crossmark data
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=gmea20 Download by: [Chinese University of Hong Kong]
Date: 12 November 2015, At: 13:46
Medical Anthropology, 34: 185–191, 2015 Copyright © 2014 Taylor & Francis Group, LLC ISSN: 0145-9740 print/1545-5882 online DOI: 10.1080/01459740.2014.981263
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
INTRODUCTION
Extending Theory, Rupturing Boundaries: Reproduction, Health, and Medicine Beyond North-South Binaries Nayantara Sheoran Department of Anthropology and Sociology, Graduate Institute, Geneva, Switzerland
Daisy Deomampo Department of Anthropology, Fordham University, Bronx, New York, USA
Cecilia Van Hollen Department of Anthropology, Syracuse University, Syracuse, New York, USA
In his 1930 short story “Mantra” (Premchand 2012), Indian writer Munshi Premchand tells the story of Dr. Chadha, a medical doctor, and Bhagat, a poor old man revered locally as a shaman who can cure snakebites. Tragically, Bhagat’s only son dies after Dr. Chadha, on his way to golf, refuses to see the young patient. Premchand’s narrative establishes Dr. Chadha as a privileged physician, trying to make it to tee off in time and callously disregarding a poor illiterate villager. NAYANTARA SHEORAN is postdoctoral fellow in the Department of Anthropology and Sociology at the Graduate Institute, Geneva. As a postdoctoral research fellow, she is extending her engagement with biomedicine and burgeoning biotechnologies in India. She is conducting extended fieldwork in India on the sociocultural and ethical implications of the emergence of stem cell biotechnologies (both embryonic and adult), while also elaborating on parts of her dissertation research, which critically analyzes pharmaceutical contraceptives. DAISY DEOMAMPO is assistant professor of Anthropology at Fordham University, New York. She is a medical and cultural anthropologist whose current research focuses on the globalization of assisted reproductive technologies and its implications for gender relations, family formation, and social stratification. CECILIA VAN HOLLEN is associate professor of Anthropology at Syracuse University, New York. She is a cultural and medical anthropologist, specializing in analyses of global health, international development, reproduction, HIV/AIDS, and gender in South Asia. She is the author of Birth in the Age of AIDS: Women, Reproduction, and HIV/AIDS in India (Stanford University Press 2013) and Birth on the Threshold: Childbirth and Modernity in South India (University of California Press 2003). She is currently conducting research on cervical and breast cancer in India. Address correspondence to Nayantara Sheoran, Anthropology and Sociology, Graduate Institute of International and Development Studies, 2 Chemin Eugéne-Rigot, P.O. Box 136, Geneva CH 1211, Switzerland. E-mail: nayantara. [email protected]
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
186
N. SHEORAN, D. DEOMAMPO, AND C. VAN HOLLEN
Bhagat has lost his son, and is now in debt, although he derives small pleasure from smoking hookah in the evening in the company of his wife. As the story develops, a snake bites Dr. Chadha’s only son at the son’s lavish birthday celebration; no one can save him at this gathering, not even his own physician father. Word gets to Bhagat of the dire situation in the Chadha household, but he refuses to offer help, recalling the doctor’s lack of attention to his own son’s need. However, unable to fall asleep and in anguish about the situation, Bhagat finally goes to the Chadha home, cures the young boy, and leaves without any reward or recognition, even refusing a bit of tobacco from the household. While the Chadhas wanted to offer him everything they can financially, Bhagat wants no reward. Dr. Chadha finally remembers who this old man was and, duly shamed by his behavior, promises to be more benevolent in the future with his time and care. This short story, familiar to generations of Indians, exemplifies popular depictions of the benevolence of the ‘poor’ and their ability to hold up mirrors to the ‘rich.’ Such depictions use a simple dichotomy that represents the ‘poor’ as always and already superior moral beings because of their self-sacrificing ability as providers; in contrast the ‘rich’ are cast as inferior, placing their own personal interests and comforts above any concern for the human condition. Similarly, historical tropes draw on the facile dichotomy between the global North and global South, with countries from the South represented as benevolent providers of raw material to the North, exotic spaces on the receiving end of colonial subjugation or modernization. The North, in contrast, is characterized as driven by individualistic, capitalistic, and ‘modernist’ goals based on extraction and exploitation. Just as Bhagat holds up the moral mirror to Chadha, scholarly tropes exist whereby the South is expected to hold up the moral mirror to the North. In their recent collection of essays, Theory from the South, Jean Comaroff and John Comaroff call into question these tropes, arguing that “old margins are becoming new frontiers,” sites at which “radically new assemblages of capital and labor are taking shape, thus to prefigure the future of the global north” (2012: 12, 13). They hold up the South not as a mirror to the North in its current condition, but rather as a future condition. Their provocative work thus complicates the narrative of the South as simply providing raw material to the North, and instead, challenging the linear, teleological perspectives of development and modernization, they present the South as a set of relations, a space of nonlinear global flows that sheds new light on debates about states, citizens, rights, justice, and capital. The various articles in this special issue of Medical Anthropology draw on the Comaroffs’ argument that the global South is not simply a space onto which theoretical frameworks from the North are mapped, but rather a location from which new theoretical understandings emerge (and have emerged for some time). In a rapidly liberalizing world, an increasing number of consumers of medical technologies and health care services either travel to or are situated in the global South. At the same time, the South has also emerged as a major hub for the production and distribution of new medical technologies and pharmaceuticals— such as generic biomedical therapies and herbal therapies—flowing in South-to-North and Southto-South directions. Within this context, our focus is on the spatial, embodied, linguistic, and cultural boundaries crossed by state and nonstate actors. In this issue, the contributing authors examine such boundary crossings in order to identify new directions of theory, and to elucidate how this approach shapes our contemporary understandings of health and medicine, reproduction and contraception. We view such crossings as temporal moments from which new theory can emerge to challenge discourses that have thus far been situated in localities. Following the Comaroffs, we do not aim
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
INTRODUCTION
187
to take theory from the South and map it onto the North; rather we ask how we might understand health, medicine, and reproduction in new ways using theory developed in the South. In doing so, our view of theory from the South is not merely about the origin of the ethnography. Rather than prioritize the ethnographic location, we also are concerned with the positionality of the author. That is, following the Comaroffs, theory from the South is not only about the South or about theories of people who may be from the South. Rather, acknowledging the multiplicity of our identities and positionalities, we are concerned with the ways in which the South affects theory. Thus, while Connell (2007) has productively examined the ways in which Northern theory fails or does not apply in the South, the Comaroffs have highlighted the ways in which the future is emergent not solely in the North, but also in the South. Ideas and events emerging from the South shed light not only on the South but on our understanding of the world at large. The authors’ positionality in this issue becomes evident as each turns to their long-term engagement with their research site and interlocutors to understand and articulate the nuanced complexity of the South and theory that may emerge therein. Some of the interlocutors in Centella’s research, for instance, have been friends and colleagues since her early work in 2001 (this issue). Hughes Rinker, who has conducted field research in one area, intermittently, since 2008, conducted the interviews without interpreters in multiple languages (Moroccan Arabic, French, and English) (this issue). All the authors have lived for extended parts of time in both the global North and South. Their fluidity in navigating spaces and languages enables them to put forward a theory from the South that is neither solely dependent on their subjectivity, nor their presence in the South or North, to explicate health realities. Sheoran, who grew up in India before moving to the United States when she was 19 years, like the other authors in this special issue, articulates the ability to negotiate different North-South spaces when she writes in her article in this issue: Sometimes, I am an ‘objective’ social scientist, working on collecting data to arrange conversations and observations in patterns. At other times, though, I am present as more than just the neutral observer, as I feel my own position helps explain better some conversations with my respondents about ECPs [Emergency Contraceptive Pills] in particular and their social reality in general.
This ability to navigate these ethnographic spaces, which themselves are shifting based on the border crossings of not only the researcher but also the respondents is made vividly clearly in Deomampo’s article (this issue). For example, of the parents who traveled to India for surrogacy, 19 traveled from the United States and 9 from Australia, with the remaining parents traveling from Norway, France, Canada, Israel, and the Netherlands. Deomampo’s work, like other articles in this issue, makes clear that the theory emerging here is a condition of the location of the ethnography, and the position of the researcher and the interlocutors, evolving because of these shifting boundaries being negotiated at multiple levels. Our goal in this introduction is to briefly explore how scholarship emerging from the global South inverts prior assumptions of how medicine operates there, by focusing on the border crossing not only of ethnographic data or researcher but also of ideas and theories. From examining the ways in which contemporary biomedicine exists alongside ‘traditional’ medicine (Halliburton 2009; Naraindas and Bastos 2011) to the pervasive pharmaceuticalization of everyday life in the South (Ecks 2005, 2008; Das and Das 2006), these works ask us to reexamine not only how medicine operates in the South but also the implications of this for medicine in the North.
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
188
N. SHEORAN, D. DEOMAMPO, AND C. VAN HOLLEN
The realities of the South provide a lens through which to examine the conditions of health and well-being in the North. Within the realm of reproductive justice, scholars have explored how women choose birthing options and the medicalization of fertility and reproduction (Bridges 2011; Davis-Floyd 2005). Cecilia Van Hollen (2003) complicates this narrative in her book, Birth on the Threshold, on birthing practices in South India; in this she elucidates how socioeconomic and cultural factors contribute to how women choose to give birth, and argues that in addition to culture, the discourse on modernity has affected how poor women in South India participate in reproductive choices. She suggests that these decisions are not made in a “power vacuum by totally ‘free’ individuals” (Van Hollen 2003:208). Rather, women practice multiple levels of agency. Van Hollen (2003:213) wrote that her women respondents chose to participate in biomedical birthing options because it gave them a sense of being ‘educated’ and ‘modern.’ Women in South India sought what some women in the United States have referred to as hegemonic birthing practices that denied them a so-called natural experience. While biomedical interventions have indeed saved lives, the social implications of such interventions are not universal. Whereas some feminist scholars and activists in the North have critiqued biomedical interventions as invasive and inhumane and sometimes causing rather than preventing negative health outcomes, low-income women in South India, like the majority of mainstream middle-class women in the United States (Davis-Floyd 1992), viewed the same interventions as essential for healthy outcomes. For the South Indian women, however, these technological interventions were equally desired for the sense of power (as shakti) and the developed, modern status they could confer. Although women articulate their options differently in the North and South, it is also important to note the similarities. Women in the North might choose not to participate in ‘hospital births,’ but they do so in response to problematic power structures within hospitals. Similarly, the poor women of Tamil Nadu in Van Hollen’s study resisted the power structures in hospital settings by searching for viable options that allowed them access to modern birth practices in conjunction with cultural practices they saw as valuable. While recent scholarship avoids the trap of representing the experiences of privileged Northern women as representative of women across global boundaries (Ginsburg and Rapp 1995; Narayan and Harding 2000), we must remain wary of overlooking similarities in how women organize and deal with the same formations of power. As Saba Mahmood suggests in Politics of Piety (2005), we need to re-examine the framework under which we articulate women’s experiences. Mahmood explores how the revival of a particular Islamic piety for women depends on their participation in rituals that were explicitly forbidden in some forms of Islam (like women preachers and women attending mosques). This participation in the mosque movement perplexes liberals and Westerners, who view Muslim women as subjugating themselves to a doctrine that supposedly supports their oppression. In focusing on women’s identity, Mahmood provides an engaging critique of what is always taken for granted within Western philosophical and liberal thought, questioning the very tools of analysis used by liberal and Western feminists. She extends the work of Lila Abu Lughod (2005), who has identified practices of power as more than a binary between resistance and domination. She suggests that we question the very act of resistance and analyze it within a framework that is not entrenched in Western liberal thought (Mahmood 2005:9). Using the Foucauldian notion of power as productive (Foucault 1979), whereby through discourse power creates the subjects, and combining with this with Butler’s questioning of the “emancipatory model of agency” (cf.
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
INTRODUCTION
189
Mahmood 2005:20), Mahmood proposes that we reject binary notions of power when analyzing acts that some view as subversive to an Islamic ideology. Similarly, Indian feminists like Chandra Talpade Mohanty (2003a, 2003b) have suggested that women from the South (‘third world’) are not monolithic subjects who only came to exist in relational terms to women from the North (‘first world’) (Mohanty 2003b). The constructs of Third World women by First World feminists depended on assumptions of Western women as “secular, liberated, and in control of their own lives” (Mohanty 2003b:81) and Third World women as a universal category of the oppressed object. According to these constructs, First World women had agency while Third World women were not capable of moving beyond oppression. Mohanty’s cautionary note in 1988 is still relevant today: not only First World feminists, but also activists, Third World scholars, and policymakers, might be tempted to ignore the historical materiality of their own ‘culture(s)’ as they try to imagine and articulate an ‘empowering’ future for women’s local lives. Responding to this concern, scholars have taken on the challenge of rethinking key concepts of subjectivity, agency, and culture. The articles in this special issue contribute to this literature by illustrating the diversity of women’s lives, even those living in the same spaces, while paying credence to the similar power structures that women operate within and against. Studies that have historically grouped all women of the global South (or the ‘East’) are problematic not only because they ignore women’s individual agency but also because they situate women’s lives within a static historical moment. Review articles by Naomi Quinn (1977) and Carol C. Mukhopadhyay and Patricia J. Higgins (1988) illustrated some decades ago the tendencies of cross-culturally located studies to group women’s experiences as monolithic. According to Uma Narayan (1997), such research is another form of colonization. Extending this, Mahmood (2005) suggests that Western feminists look at women’s participation in the Islamic revival as a form of agency, rather than self-subjugation to particular doctrines. Yet because of Western feminists’ own locations within a particular Western rational tradition, until recently such analyses have been foreclosed. Next, the authors work to avoid the tendency toward cultural essentialism and universalism in their investigations of how theory from the South lends a more nuanced reading of North-South relations. As feminist medical anthropologists concerned with reproductive and global health, we often ask ourselves the ‘so what?’ question about our research. We ask: what are the implications of our work? Why does it matter that we unpack certain phenomena, highlight complexities, and allow our work to tell narratives of those often unheard? In this special issue, we attempt to answer what is at stake and why we should care to ‘extend theory and rupture boundaries’ when looking at health and reproduction. The articles included in this special issue engage with the Comaroffs’ challenge to move beyond North-South binaries, to reflect on themes of health and medicine in different ways. In doing so, however, we acknowledge the multiple connotations that the South holds. The global South is not an object in itself but rather bespeaks a relation, reflecting new perspectives from which to imagine the world we live in and enabling fresh imaginings of its current and future state. The boundary between North and South is porous and unstable, with sightings of the South in the North, and North in South, as the two fields share intertwined trajectories in the contemporary global order. Yet scholars have much to gain from turning the analytic lens to an ‘ex-centric’ location, an alternative to hegemonic Euro-American hubs. Such an approach, as the Comaroffs suggests, requires a return to theory of a specific kind: a grounded theory that
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
190
N. SHEORAN, D. DEOMAMPO, AND C. VAN HOLLEN
investigates the relationship between empirical observation and theoretical formation, between the world in which we live, and the ways in which we experience and inhabit that world. The four articles in this issue take up this challenge, seeking to explain events and ideas through empirically driven, historically contextualized critical observations; in other words, a theory grounded in the ordinary, in sites that trouble our assumptions about the usual centers for theory-making and compel us to turn toward new fonts of knowledge in the South. While situating their work ethnographically within the realm of reproductive health, medicine, and science in the global South, the authors of the four articles presented below interrogate complex regimes of power that move beyond North-South binaries to reveal a much more complex, nuanced view of the impact of globalization on reproductive bodies, policies, and practices. The authors address a range of relevant topics, including how access to and use of emergency contraceptives in India mobilizes neoliberal ideologies as they travel from North to South; how reproductive health practice and policy in Morocco problematize neoliberal ideologies of selfgovernance and responsibility; Bolivian-Iranian collaboration in health care and its challenges to hegemonic forms of health care delivery, development aid, and geopolitical cartographies; and the ways that struggles to define parenthood and gain citizenship (for children born via transnational surrogacy in India) engender new ways of thinking about kinship and nationhood in transnational contexts. A dominant theme cross-cutting these essays is anthropology’s hallmark agenda to highlight variation where many assume homogeneity. Medical anthropology has been at the forefront of the study of the cultural politics of biomedicine on a global scale. As these articles reflect on new articulations of health care, biotechnology, medicine, and reproductive/contraceptive technology throughout distinct locations in the global South, so, too, they demonstrate how North-South representations are inadequate in revealing the complex terrain from which new theory might emerge. By moving beyond North-South binaries, this special issue allows us to apprehend new ways of thinking about health and medicine around the globe. The articles that follow are a clear indication that medical anthropologists continue to lead the way in extending the boundaries—both literal and theoretical—of this line of inquiry, as they keep pace with rapidly shifting terrains of both biomedical technologies and geopolitics.
REFERENCES Abu-Lughod, L. 2005 Dramas of Nationhood: The Politics of Television in Egypt. The Lewis Henry Morgan Lectures, 2001. Chicago, IL: University of Chicago Press. Bridges, K. 2011 Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization. Berkeley: University of California Press. Comaroff, J., and J. L. Comaroff 2012 Theory from the South: Or, How Euro-America Is Evolving Toward Africa. Boulder, CO: Paradigm Publishers. Connell, R. 2007 Southern Theory: The Global Dynamics of Knowledge in Social Science. Cambridge, UK: Polity. Das, V. and R. K. Das 2006 Pharmaceuticals in urban ecologies: The register of the local. In Global Pharmaceuticals: Ethics, Markets, Practices. Adriana Petryna, Andrew Lakoff, and Arthur Kleinman, eds. Pp. 171–205. Durham, NC: Duke University Press.
Downloaded by [Chinese University of Hong Kong] at 13:46 12 November 2015
INTRODUCTION
191
Davis-Floyd, R. 1992 Birth as an American Rite of Passage. Berkeley: University of California Press. ———. 2005 Anthropology and birth activism: What do we know? Anthropology News 46(5):37–38. Ecks, S. 2005 Pharmaceutical citizenship: Antidepressant marketing and the promise of demarginalization in India. Anthropology & Medicine 12(3):239–254. ———. 2008 Global pharmaceutical markets and corporate citizenship: The case of Novartis’ Anti-Cancer Drug Glivec. BioSocieties 3(2):165–181. Foucault, M. 1979 Discipline and Punish: The Birth of the Prison. New York: Vintage Books. Ginsburg, F. and R. Rapp, eds. 1995 Conceiving the New World Order: The Global Politics of Reproduction. Berkeley: University of California Press. Halliburton, M. 2009 Mudpacks and Prozac: Experiencing Ayurvedic, Biomedical and Religious Healing. Walnut Creek, CA: Left Coast Press. Mahmood, S. 2005 Politics of Piety: The Islamic Revival and the Feminist Subject. Princeton, NJ: Princeton University Press. Mohanty, C. T. 2003a Feminism without Borders: Decolonizing Theory, Practicing Solidarity. Durham, NC: Duke University Press. ———. 2003b “Under Western eyes” revisited: Feminist solidarity through anticapitalist struggles. Signs 28(2):499–535. Mukhopadhyay, C. C. and P. J. Higgins 1988 Anthropological studies of women’s status revisited: 1977–1987. Annual Review of Anthropology 17:461–495. Naraindas, H. and C. Bastos 2011 Healing holidays? Itinerant patients, therapeutic locales and the quest for health. Anthropology & Medicine 18(1):1–6. Narayan, U. 1997 Dislocating Cultures: Identities, Traditions, and Third-World Feminism. Thinking Gender. New York: Routledge. Narayan, U. and S. Harding, eds. 2000 Decentering the Center: Philosophy for a Multicultural, Postcolonial, and Feminist World. A Hypatia Book. Bloomington: Indiana University Press. Premchand, M. 2012 Mantra. In A Hundred Lamps: Classic Stories About the World of Medicine. Yatish Agarwal, ed. Pp. 55–72. New Delhi, India: Rupa Publications. Quinn, N. 1977 Anthropological studies on women’s status. Annual Review of Anthropology 6(1):181–225. Van Hollen, C. 2003 Birth on the Threshold: Childbirth and Modernity in South India. Berkeley: University of California Press.
