Gender, Childbirth and the "Indian Problem" in Bolivia's Obstetric Movement, 1900-1982
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Delivering the Nation, Raising the State: Gender, Childbirth and the "Indian Problem" in Bolivia's Obstetric Movement, 1900-1982 Item Type text; Electronic Dissertation Authors Gallien, Kathryn N. Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 29/09/2021 10:28:44 Link to Item http://hdl.handle.net/10150/560827 DELIVERING THE NATION, RAISING THE STATE: GENDER, CHILDBIRTH AND THE “INDIAN PROBLEM” IN BOLIVIA’S OBSTETRIC MOVEMENT, 1900-1982 by Kathryn N. Gallien __________________________ Copyright © Kathryn N. Gallien 2015 A Dissertation Submitted to the Faculty of the DEPARTMENT OF HISTORY In Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY In the Graduate College THE UNIVERSITY OF ARIZONA 2015 THE UNIVERSITY OF ARIZONA GRADUATE COLLEGE As members of the Dissertation Committee, we certify that we have read the dissertation prepared by Kathryn N. Gallien titled Delivering the Nation, Raising the State: Gender, Childbirth and the “Indian Problem” in Bolivia’s Obstetric Movement, 1900-1982 and recommend that it be accepted as fulfilling the dissertation requirement for the Degree of Doctor of Philosophy. ______________________________________________________________________________ Jadwiga E. Pieper Mooney Date ______________________________________________________________________________ Bert J. Barickman Date ______________________________________________________________________________ Martha Few Date ______________________________________________________________________________ Douglas Weiner Date Final approval and acceptance of this dissertation is contingent upon the candidate’s submission of the final copies of the dissertation to the Graduate College. I hereby certify that I have read this dissertation prepared under my direction and recommend that it be accepted as fulfilling the dissertation requirement. ______________________________________________________________________________ Dissertation Director: Jadwiga E. Pieper Mooney Date STATEMENT BY AUTHOR This dissertation has been submitted in partial fulfillment of the requirements for an advanced degree at the University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations from this dissertation are allowable without special permission, provided that an accurate acknowledgement of the source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the copyright holder. SIGNED: Kathryn N. Gallien ACKNOWLEDGEMENTS This project would not have been possible without the guidance and support of several women in Bolivia who took me under their wings, despite of their own busy schedules. In La Paz, Marcela Barragán made me feel at home in her city, spent hours discussing my approach to this project, and introduced me to obstetricians and parteras around the country. In Sucre, Nancy Manjón and María Esther Santos Parraga, at the Universidad San Xavier de Chuquisaca, introduced me to their colleagues and to graduates of the midwifery-nursing programs of the 1950s and ‘60s. In Tarija, Miriam Vargas Vargas drove me around Tarija late into the evenings in search of retired physicians and nurses. I am indebted to everyone who took the time to talk to me about their lives. My advisor, Jadwiga E. Pieper-Mooney, tirelessly gave me feedback on drafts, from the ragged first attempts to this “final” product. Her advice improved this work immeasurably. Bert J. Barickman, Doug Weiner, and Martha Few offered their support, inspiration, and encouragement at every step in the process. The friends who came into my life while I was working on this project kept me sane and smiling through all of the challenges and joys of research and major life transitions. Karina Juaregui Garafulic y Silvia Muñoz: ¿Vamos a Diesel, amigas? Anne Sofie Scherrebeck: ¿Recibiste la carta del Ministerio de Relaciones Interiores? Alissandra Stoyan: Do you smell something burning? Lisa Munro: Thank you for improving my writing! Let’s keep ruminating about life, love, and work together. Big thanks also go to Sara J. Edel, Tyler Ralston, Jill Hadap, and 梁晨 for the many different ways you made my life better over the course of my graduate career. Thanks to my German family, especially Ulrich Dribusch, for your unwavering support and encouragement. Finally, I am grateful for my parents, sisters, and brothers—Nadine, Dick, Kirstin, Pam, Wendy, John, and Glenn. All of you taught me to listen, explore, work hard, and persevere. My father used to tell me to find work I enjoyed so much I would do for free. I am certain I have taken that advice a lot farther than he intended. For my mother, Nadine R. Bayer, and grandmother, Nadine S. Bayer CONTENTS LIST OF FIGURES ...................................................................................................7 LIST OF TABLES.....................................................................................................8 ABSTRACT...............................................................................................................9 INTRODUCTION: The Obstetric Movement in Bolivia: Gender, Race, Birth and the Nation-State........................................................................................................10 CHAPTER ONE: The Dawn of Bolivia’s Obstetric Movement: Midwives, Mothers, Nurses, and Nation, 1900-1930s ..............................................................41 CHAPTER TWO: Nurses, Midwives, and Mestizaje: Shifting Professional Boundaries and the Limits of Medical Hegemony, 1940s-1950s ...........................88 CHAPTER THREE: Matronas, Miners, and Medical Knowledge: The Transnational Politics of Health and the Rise and Fall of University-Educated Midwives in Bolivia, 1950s-1970s ........................................................................132 CHAPTER FOUR: Inclusion and Control: USAID, Hugo Banzer, and the Promotion of Parteras and Primary Care ...............................................................177 EPILOGUE AND CONCLUSION: The Obstetric Movement from Eugenics to Interculturality........................................................................................................220 APPENDICES .......................................................................................................230 BIBLIOGRAPHY..................................................................................................262 LIST OF FIGURES Figure 1. Bolivian Population Categorized by Race in 1900........................................................ 17 Figure 2. Linguistic Map of Bolivia ............................................................................................. 29 Figure 3. Miraflores General Hospital.......................................................................................... 56 Figure 4. The “Maternity Post” building under construction.. .................................................... 56 Figure 5. SCISP Maternal-Infant Care Programs.. ....................................................................... 99 Figure 6. Nurses and Nuns in Tarija. .......................................................................................... 108 Figure 7. Mery Gallo de Machicado Leading Her Midwifery-Nursing Classmates................... 151 LIST OF TABLES Table 1. Total USAID Expenditures on “Family Wellbeing” Projects, 1968-1974 ..................................................190 ABSTRACT In Bolivia, indigenous women’s desires to give birth in an atmosphere of respect and cultural autonomy, as well as physicians’ and politicians’ attempts to mold the nation along racial lines, shaped the development of obstetric medicine. Based on oral histories of midwives, nurses and obstetricians, this study uses midwifery as a lens to examine the connections between nation- state formation and the development of obstetric medicine in Bolivia between 1900 and 1982. Putting midwives at the center of a study about nation-state formation reveals complexities that many male-centered studies miss: indigenous, mixed-race, and white Bolivian women played central roles in state projects and, through their embodiment of different forms of womanhood, influenced debates about Bolivian national identity. This study also engages groundbreaking feminist studies of the 1970s and ‘80s which showed that U.S. and European male physicians created obstetric medicine by pushing female midwives out of the practice. These physicians typically accused midwives of ineptitude and defined childbirth assistance as a scientific medical procedure that should not be practiced by women. While that pattern holds true in Bolivia to some extent, it does not explain the power dynamics that shaped childbirth assistance in Bolivia. Over the course of the twentieth century, Bolivian physician’s desires to modernize childbirth assistance and childrearing practices intertwined with the efforts of Bolivia’s elite to overcome what they considered the country’s “Indian Problem.” INTRODUCTION The Obstetric Movement in Bolivia: Gender, Race, Birth and the Nation-State My mother was a midwife [partera] and I learned to attend births from her. We have