TIMES ARE CHANGING: THE ROLE OF BIOMEDICINE AND

CHILDBIRTH PRACTICES IN RURAL OAXACA

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A Thesis

Presented to the

Faculty of

San Diego State University

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In Partial Fulfillment

of the Requirements for the Degree

Master of Arts

in

Anthropology

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by

Nadia Merino-Chavez

Summer 2012

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Copyright © 2012 by Nadia Merino-Chavez All Rights Reserved

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DEDICATION

This Master’s thesis is dedicated to my parents, Pedro Merino and Patricia Chávez, who have dedicated their lives so that my sisters and I can have a life filled with opportunities and live in a world where we can accomplish our dreams. In particular, I want to dedicate this thesis to my husband, Ramon Hernández, who has encouraged me through every step of this journey and continues to be my source of strength. In addition, I want to dedicate this thesis to my loved ones, my sisters Nayeli and Nidia Merino, and my grandmother, Austreberta Dirzo. Thank you for all of your continued guidance and support. Without your help, patience, and endless encouragement, I would have not been able to embark on this academic journey of higher learning as a first-generation graduate student. Most of all, I would like to dedicate this thesis to all the Mixtec women who participated in the study and my mother-in-law who were invaluable to the completion of this thesis. I want to thank them for allowing me to be a part of their world and learn about their knowledge of life and birth. This project was conducted in hopes that the wisdom imparted from these Mixtec women regarding childbirth and maternal care inspires younger generation to preserve traditional forms of knowledge and care.

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ABSTRACT OF THE THESIS

Times are Changing: The Role of Biomedicine and Childbirth Practices in Rural Oaxaca by Nadia Merino-Chavez Master of Arts in Anthropology San Diego State University, 2012

With the introduction of biomedical models in rural Mexican communities over the past years, traditional child birthing practices are slowly being abandoned and the use of traditional midwives is declining. This study explores the management of childbirth practices in the rural Mixtec community of Santiago Juxtlahuaca, Oaxaca, México. This project seeks to examine the implications caused by the reorganization of obstetric care and the changing birthing practices among Mixtec women. The project also assesses the ways in which the introduction of biomedical care is transforming the birthing practices of the indigenous women in rural Oaxaca.

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TABLE OF CONTENTS

PAGE

ABSTRACT ...... v LIST OF TABLES ...... viii LIST OF FIGURES ...... ix ACKNOWLEDGEMENTS ...... x CHAPTER 1 INTRODUCTION ...... 1 2 RESEARCH SETTING ...... 7 3 THE ÑUU SAVI PEOPLE ...... 16 History...... 16 Demographics ...... 18 Indigenous People of Oaxaca...... 19 Language ...... 20 Subsistence ...... 23 Infant Mortality and Maternal Mortality...... 25 Social Inequality and Health ...... 25 Sociocultural Context...... 26 4 RESEARCH METHODS ...... 33 Research Questions ...... 36 Profile of Mixtec Women in the Study ...... 37 Distribution by Age...... 37 Language ...... 37 Marriage and First Pregnancies ...... 40 Place of Birth ...... 42 Protection of Informants ...... 43 5 AUTHORITATIVE KNOWLEDGE AND BIOMEDICINE ...... 45 6 MIXTEC HEALING: HEALTH BELIEFS AND TRADITIONAL CARE ...... 52 Nature and Environment ...... 54

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Hot and Cold Equilibrium ...... 56 Illness ...... 59 Medicinal Plants and Food...... 61 La Partera (The Midwife) ...... 66 Management of Birth ...... 70 Baños de Vapor— Steam Baths ...... 76 Maternal and Infant Care ...... 80 7 “ANTES NO HABIA MEDICOS”: CHANGING BIRTHING PRACTICES ...... 83 8 TRANSNATIONAL MIGRATION AND CHANGING HEALTH BELIEFS ...... 94 REFERENCES ...... 103 APPENDIX LIST OF MEDICINAL PLANTS ...... 112

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LIST OF TABLES

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Table 1. Profile of the 25 Mixtec Women in Study ...... 38 Table 2. Distribution of the Languages Spoken by the Mixtec Women ...... 40 Table 3. Distribution of Age at First Pregnancy for the Mixtec Women in the Study ...... 41 Table 4. Type of Birth Assistance Sought by the Women in the Study ...... 42 Table 5. Distribution of Number of Children for the Women in the Study ...... 42 Table 6. Distribution of Birth Place ...... 43

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LIST OF FIGURES

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Figure 1. Map of Oaxaca, México and the district of Juxtlahuaca, which contains 7 Municipios (municipalities)...... 8 Figure 2. Santiago Juxtlahuaca, Oaxaca...... 10 Figure 3. Mixtec traditional dances of the Chilolos, Diablos, and Chareos...... 11 Figure 4. Distribution of women by age...... 40 Figure 5. This rebozo is used during delivery...... 73 Figure 6. A structure of an old Baño de Vapor made out of stone rocks...... 77 Figure 7. A model of the structure representing a baño de torito or temezcal...... 77 Figure 8. Jarrilla de Rio is a flower used to perform steam baths...... 114 Figure 9. Ilite is a plant utilized by Mixtec women to perform steam baths after childbirth...... 115 Figure 10. Salva Real is another plant used for curative purposes...... 116 Figure 11. Pirrul, this plant is used for several medicinal purposes and also used for steam baths...... 117 Figure 12. The plant known to Mixtecs as Hierba de Burro and found in San Martin Durazno is used by Mixtec women for steam baths...... 118 Figure 13. Borrega is another plant utilized to perform steam baths by Mixtec women...... 119 Figure 14. Flor blanca is a another plant used to perform steam baths in combination with other plants...... 120 Figure 15. Ocotoe is used to ease pain after delivery...... 121 Figure 16. Mixtec women have knowledge of medicinal plants that are used to induce labor pain to quicken childbirth...... 122

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ACKNOWLEDGEMENTS

This research was supported by the Foreign Language and Area Studies (FLAS) Fellowship during the academic year of 2008 and the summer of 2010. This fellowship allowed me the opportunity to study the Mixtec language and become immersed into the Mixtec culture. I want to thank my committee members— Dr. Ramona L. Perez, Dr. Frederick Conway, and Dr. Patricia Geist-Martin for their insightful comments and contributions to the completion of this thesis project.

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CHAPTER 1

INTRODUCTION

Childbirth is an important cultural event that tends to incorporate the beliefs, values, and traditions of the mother and her culture group. Birthing practices mirror the culturally defined notions of childbirth, where rituals are patterned and defined by the values structured by the social organization of a society (Kay 1982). Understanding the social context of birth, local customs, traditional knowledge, and care offers an understanding of how cultures manage and conceptualize their world around them. In recent decades, traditional childbirth practices, along with other medical practices in rural indigenous communities have undergone significant changes partly due to the introduction of biomedicine. This has produced a conflictive acceptance of the integration of biomedical care in rural areas throughout the world that clashes with long established and socially accepted beliefs and practices about the human body, reproductive health, and indigenous care associated with childbirth. This issue can be seen among the Hmong who have found themselves disbursed across the globe. During the 1960s and 1970s, thousands of Hmongs were displaced from their farming communities in the highlands of Laos and were forced to relocate to Thai refugee camps; they were subsequently relocated to cities throughout the Americas, with a significant number relocated to the U.S. Among Hmong refugees in the United States, Hickman (2007) has documented the tension between the Hmong folk health system based on spirituality and non-physiological etiologies and their immersion into Western health care practices. In response to this tension, the Hmong have accommodated to the biomedical system by integrating their own health beliefs and traditional health practices with medical care. The Hmongs revert back to their traditional care whenever they feel dissatisfied with biomedical treatment. This has evolved into a syncretic relationship where the Hmong practice both medical and folk healing traditions. Due to changes in the health belief system, Hickman (2007) concludes that, “[t]his syncretism has lead to an intricate system of combined physical and spiritual diagnoses that significantly affects the way health care

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decision are made within the Hmong Community” (176). Prior to their displacement and relocation to other parts of the world, the Hmong had little contact with the biomedical care system due to the remoteness of their villages with nearby cities where medical services were offered. With the limited contact they had with the outside world, notions of illness within the biomedical model did not interfere or influence the traditional health beliefs held by the Hmong. Based on his work among the Hmong in Alaska, Hickman (2007) notes that once the Hmong were relocated to Anchorage, Alaska, they were introduced to biomedicine where patterns emerged among community members that suggested a syncretism of practices derived from both the traditional notions of health care and new ideas from the biomedicine. In Herskovits’ (1937) work, the concept of syncretism serves as an analytical tool and theoretical construct to analyze how subaltern agents gain empowerment as they reconcile the conflictive relationship between traditional beliefs with the dominant doctrine that aims to assimilate them into the wider society. Syncretism can offer an analysis of both agency and resistance on the part of individuals and help explain changing dynamic processes and phenomena in a given culture. In this case, Mixtec women’s inclusion of biomedical practices with traditional health beliefs can be best understood within the context of syncretism as it helps explain how certain particular beliefs and practices emerge, why other practices are abandoned, while new ones are created. Hickman (2007) defines syncretism as “a dynamic aggregation of elements from two or more philosophically unique systems of belief or practice, which becomes generally accepted as an integrated and unitary (although not homogenous) system” (182). As has been the case of the Hmong in Alaska, they have not completely abandoned their traditional systems and health beliefs but have rather created a system that combines traditional cosmology with western explanations of certain illnesses (Hickman 2007). It has been argued that in México, traditional health concepts and medicinal practices by indigenous communities are being replaced with the biomedical model (Aguirre Beltrán 1986; Lipp 1991; Rubel and Browner 1999). According to Rubel and Browner (1999), the increased contact of peasant communities with biomedical practices in Oaxaca is a result of important innovations put forth by the federal government. Such innovations include the continuous construction of roads that permit rural communities greater access to health centers in urbanized cities (Hunt, 1992). Increased contact with the biomedical system has

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also been the result of medical students traveling to rural communities to complete their medical service. Within the Mexican medical system, medical students must complete a year of social service work in rural areas or cities around the country (Rubel and Browner 1999). In the discussion of the Mixtec people and the introduction of biomedicine in the rural areas of Oaxaca, the biomedical model is disrupting traditional health care and affecting what type of care Mixtec women seek for childbirth and maternal care. While older women are preserving long-held beliefs and traditional forms of healing, younger generations of Mixtec women are opting to utilize more biomedical approaches to childbirth. The older Mixtec people have adopted several health care beliefs and health-seeking behaviors yet traditional health practices are still present within their culture (Bade 1994). Based on my interviews with the Mixtec women, older women are maintaining long held-beliefs of how illness occurs, what remedies and traditional care can be sought out after biomedical care fails, and how to prevent illnesses or ailments to the body. However, younger Mixtec women are resisting in continuing with these traditional indigenous practices and are conforming to the established biomedical system as legitimate. As is true with culture, health practices do not remain static over time and people accommodate and adapt to the exigencies of the times. In México, the biomedical model is accepted as the legitimate form of medical treatment that forms part of the larger national discourse that promotes modernity. This discourse furthers the perception developed in the 1920s that indigenous medicinal practices are invalid and illogical. Traditional indigenous practices have been characterized as backward, dangerous, ill-prepared, and superfluous (Cragin et al. 2007). While indigenous medicinal practices are tolerated, they are prohibited by the law in México and considered dangerous practices (Rubel and Browner 1999). The federal and state governments have implemented policies and programs to diminish and eradicate the use of traditional medicinal practices by advancing the biomedical system throughout the country. Beginning in the 1970s, there was an initiative by the federal government to incorporate midwives into the biomedical system through a series of training courses on the biomedical system of birthing. However, evidence suggests that these training certification programs were ineffective in fully incorporating biomedical care into the practice of traditional midwives once they returned to their communities (Davis-Floyd 2001). Davis-Floyd (2001) has found that the programs to incorporate midwifery in conjunction with obstetric biomedical care have not

4 been fully incorporated, leaving large areas of rural Mexico in various states of synthesis between the two practices. This is reflected in Miranda’s (2009) thesis project where she discusses the medical pluralism found among Yucatecan Maya midwifes and the biomedical system in two rural communities along the Central Yucatán Peninsula. In compliance with the Mexican government, biomedicine is promoted as the authority in providing obstetric care for Maya women. The Maya women in these communities have been caught in a conflictive situation where they hold midwifery as the authoritative knowledge for childbirth practices while simultaneously acknowledging the benefits of biomedicine. This has created a complex issue where the two practices clash together while working in sync with each other to produce a hybrid form of health care. Miranda (2009) further examines how “Yucatec Maya women navigate and negotiate between biomedical and traditional health care systems in order to receive the health care that best suits their needs” (v). Miranda (2009) concludes that for the Yucatec Maya women, it was not a matter of choosing over the traditional versus the modern practices but rather exercising their agency to determine the best approach for childbirth and maternal health care specific to their needs. In this study, I will examine the childbirth practices in Juxtlahuaca, Oaxaca and what is the response of Mixtec women are regarding the integration of biomedicine in maternal health. This study explores the changes occurring within traditional practices as a result of migration and state-based interventions, current conceptions of birthing as a cultural phenomenon, and management of childbirth practices by women and other members of the community in the rural Mixtec town of Santiago Juxtlahuaca, Oaxaca, México. The research is grounded in the narratives of Mixtec women obtained through semi-structured interviews and informal discussions focused on their childbirth practices and experiences of childbirth and maternal care. Local parteras (midwives) were also interviewed to learn about their knowledge of birthing and maternal care within local cultural frameworks as well as how they perceive integration, or rejection, of biomedical practices into their own knowledge base and practice. Ultimately, this project seeks to examine the implications caused by the reorganizing of obstetric care and the changing birthing practices and maternal care among Mixtec women. While the anthropology of human birth has grown over the years, there are sparse ethnographies on different cultures for cross-cultural comparison.

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Studies such as this one can “improve and broaden our appreciation of the organization of female networks, interests, and strategies” (Jordan 1993: 5). Moreover, there is relatively little ethnographic data and anthropological literature available on Mixtec women and their knowledge regarding the process and practices of childbirth, particularly the changes within birthing practices and maternal care, and a loss of traditional practices. As Davis-Floyd and Sargent (1997) note, “Almost everywhere one looks, indigenous systems of birth knowledge are being replaced by, competing with, or acceding to second-tier status under technomedical imports… a process that needs anthropological analysis and could be greatly ameliorated by anthropological input” (12). In that vein, this study seeks to obtain narratives from Mixtec women and learn about their childbirth practices, experiences, and maternal care. As directions for new research, Kay (1982) proposes not only to document variation in birthing systems but also “chart the determinants and consequences of social and cultural change in birthing systems” (40). Examining childbirth as a cultural subsystem can be useful in advancing knowledge in the areas of maternal and child health. This information can also be imperative when using the knowledge in an applied context. As a culturally framed event, birthing in a society reflects cultural ideology; an important component in the analysis obstetrical events (Kirsis 1996). In turn, studies on birthing can broaden cross- cultural and anthropological understandings of gender roles, social relations, power relations, the formation of ritual behavior, and organizations of ethnomedical systems (Browner and Sargent 1990: 221). I have organized this thesis with an outline of the Mixtec people followed by the specific issue of birthing as it takes place today. In Chapter two, I discuss the research setting of the study. The study was conducted in Santiago, Juxtlahuaca located in the Mixteca Baja region of Oaxaca, México among indigenous Mixtec women. Chapter three provides a historical background on the Mixtec indigenous group, the demographics, and the sociocultural context that define the Ñuu Savi, the People of the Rain. The fourth chapter details the research methodology employed as part of this research project and the procedures followed to ensure confidentiality and anonymity to the participants. Twenty-five Mixtec women were interviewed on their experiences with childbirth practices, maternal care, and infant care. Traditional treatment, post-partum care, and healing practices were also documented. In chapter five, the concept of authoritative knowledge is explored along with

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the intersection of the biomedical model transforming the birthing practices of the Mixtec women in Juxtlahuaca. Authoritative knowledge is considered as the acquired knowledge of the parteras (midwives) that “counts” (Jordan 1992) and which is produced and reproduced among the Mixtec women. Chapter six explores the concept of health beliefs and traditional care practiced by the Mixtec people. Ideologies regarding the balance of nature and the hot and cold equilibrium are examined to understand the worldview of the Mixtec people and how they conceptualize illness and its subsequent treatment. In addition, I discuss the role of the parteras (midwives) in the community, the management of labor and birth, as well as maternal and infant care. After childbirth, it is customary for Mixtec women to recuperate and heal through baños de vapor (steam baths) as it helps the new mother restore the heat lost during childbirth. Chapter 7 discusses the changing birthing practices by analyzing data obtained during fieldwork in Juxtlahuaca among Mixtec women. With the introduction of biomedical care in the birthing system, more Mixtec women opt for obstetric are at the local IMSS hospital than use a partera (midwife). Mixtec women still maintain traditional practices of care when the biomedical care fails or they simply do not agree with the care or treatment. In the past, Mixtec women did not have access to medical care at a hospital due to the unavailability of a nearby hospital or limited resources. With the health reform during the 1970s, health care in México began to reach rural indigenous areas of the country. In Chapter 8, transnational migration and its effects on the changing health beliefs of the Mixtec are addressed. As more Mixtec people engage in transnational migration, their notions of health, illness, and treatment are changing as they acquire new beliefs about health and care available.

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CHAPTER 2

RESEARCH SETTING

In the Mixtec language, Juxtlahuaca is known as Yosucuiya (Yosu means flat and Cuiya means year), which translates into flat valley or Yosocuii which means green valley (Enciclopedia de los Municipios de México 2009). At an elevation of 1,690 meters about sea level, the town of Santiago Juxtlahuaca lies in the southwest part of Oaxaca in the Mixteca Baja region and is the cabecera (head town) of the distrito (district) of Juxtlahuaca. Throughout the thesis when I mention the actual name of Juxtlahuaca, I am referring to the cabecera and not the district unless otherwise stated. The district of Juxtlahuaca has 7 municipalities with Santiago Juxtlahuaca as the largest town followed by San Sebastián Tecomaxtlahuaca, a neighboring town in close proximity (see Figure 1). The remaining municipalities of the district of Juxtlahuaca include San Martin Peras, Coicoyan de la Flores, San Miguel Tlacotepec, Santos Reyes Tepejillo, and San Juan Mixtepec. Juxtlahuaca is one of the oldest towns in the Mixteca region founded by Mixtec kings before the pre-Hispanic era. With the arrival of the Spanish conquistadores, the name of the town was changed from Xiuxtlahuaca to Juxtlahuaca. With the arrival of Friar Dominici Domingo de Santa Maria and Friar Benito Hernandez, the district of Juxtlahuaca was bound to colonial rule on September 13, 1542. Juxtlahuaca is situated in a valley separated by a large river, the Rio Grande that is also known as Juxtlahuaca River, which splits into two small rivers, Rio Santo Domingo and Rio de Santa Catarina. The climate in Juxtlahuaca is partly sub-humid with coastal temperatures. Because of Juxtlahuaca’s climate, bananas, peaches, lemons, tomatoes, beans, and garlic are grown among other important crops. Traveling through Juxtlahuaca, fields of corn (milpa) are visible and remain an important staple in the life and diet of the Mixtec people. Juxtlahuaca is easily accessible and is off the main road from Huajuapan de León— this road is part of the Panamerican highway that connects Huajuapan de León to México City (Distrito Federal), Oaxaca City, and to the coast of the Pacific Ocean to Pinotepa

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Figure 1. Map of Oaxaca, México and the district of Juxtlahuaca, which contains 7 Municipios (municipalities). Source: Oeidrus Oaxaca N.d. Map of Oaxaca. Oeidrus Oaxaca. http://www.oeidrus-oaxaca.gob.mx, accessed August 24, 2011.

(Mindek 2003:25). The construction of these paved roads and highways have been central in opening the Mixtec region to other parts of México. Particularly in Juxtlahuaca, the construction of these roads also has been instrumental in enabling the out migration of residents in these Mixtec communities. With the development of regional infrastructure, Juxtlahuaca and other indigenous communities in Oaxaca became a link for migration. These developments allowed for people to travel outside of the region to urban cities such as México and eventually to the United States. At the entrance of the town of Juxtlahuaca is a military base hidden in the mountain tops. The military has a strong presence in this area and regular military checks are conducted at the entrance of the town. Juxtlahuaca has become a principal town in the Mixteca Baja region where many people from neighboring towns travel to conduct business, for tourism, or to relocate. A number or residents in Juxtlahuaca have moved in from nearby towns and villages to provide a higher education for their children. Juxtlahuaca has a number

9 of schools and levels accommodating to its growing population. There are three elementary schools, two high schools, and one college called Colegio de Bachillerato Agrupecuario. Following the main road into Juxtlahuaca, the next visible site is the local hospital, the Hospital Rural de Solidaridad No. 66 from the Instituto Mexicano del Seguro Social (IMSS) health system. This federally funded hospital was recently built, providing free services that cover general medicine as well as different specialties. There also are a number of private clinics, pharmacies, dental and vision services available to residents in Juxtlahuaca. To the east of Juxtlahuaca lies a valley of mountains and to the west is the Juxtlahuaca River. With a population of approximately 33,401inhabitants based on the 2005 census, Juxtlahuaca is one of the biggest municipalities in the district of Juxtlahuaca (see Figure 2). Juxtlahuaca has grown significantly over the years with inadequate infrastructure to meet the demands of a growing population. Juxtlahuaca has become urbanized, resembling cities like Huajuapan de León, which is located in the district of Silacayoapan. Walking through the streets of Juxtlahuaca, the image of a growing city is apparent. Turning every corner are a number of stores and services including a veterinary for animals, a local hotel for travelers, bakeries, wineries, miscellaneous stores, tortilla factories, restaurants, grocery supermarkets, video rental stores, furniture stores, shoe stores, clothing stores, internet services, mail services, and bus terminals traveling to different destinations around México. Currently, there are three main banks in the country operating in Juxtlahuaca: Banamex, HSB, and Banco Azteca. As with many urban centers that grow too quickly, Juxtlahuaca lacks potable water to every household, many streets are not paved, and gang graffiti marks the sides of buildings. The main center of the town is known as El Centro, which is one of the oldest barrios in Juxtlahuaca. Surrounding the Centro are the other main barrios— Santa Cruz, San Felipe, Guadalupe, San Pedro, and Santo Domingo. These are the oldest and more established barrios in Juxtlahuaca. The Centro is mostly populated by Spanish speaking mestizos who have been known to “consider themselves superior to the other residents of the town” (Romney and Romney 1966:7), while the Mixtecs and Triqui (another indigenous group) occupy the outer parts of the town. The residents of the Centro do not consider it as a barrio but as a central part of Juxtlahuaca where political and economic power is concentrated:

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Figure 2. Santiago Juxtlahuaca, Oaxaca.

Economically, El Centro is the hub of, the regional market system, the site where both permanent shops and weekly commercial market stalls are located. El Centro is also the seat of regional power. All state, federal, and district offices are housed within the barrio. El Centro’s concentration of political and economic power has made the barrio the focal point of the city, if not the entire district. (Gonzalez 1996:168) Adjacent to the Centro is one of the biggest barrios in the town known as the Barrio Santo Domingo. The Barrio of Santo Domingo is mostly occupied by Mixtec indigenous people. Mixtecs are centered in Santo Domingo and in the outskirts of the town, where they are forming many unofficial barrios across the river but the ethnic identity of the Barrio continues to pride itself in its Mixtec indigenous heritage. Many of Juxtlahuaca’s Mixtec elders live in the Barrio where the Mixtec language continues to be spoken on a daily basis. One important characteristic of Barrio Santo Domingo has been its annual patron saint celebration, displaying the traditional dances of the Chilolos, Chareos, and Diablos (see Figure 3). These are the main dances that still persist in Juxtlahuaca and other Mixtec communities in the region. Dressed with feathered hats, red masks, and women’s clothing the chilolos are dancers posing as women.The Diablos are among the favorite dancers in the

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Figure 3. Mixtec traditional dances of the Chilolos, Diablos, and Chareos.

region. Their clothing is composed of a jacket, leather pants with goat hair chaps, boots, a scarf tied around their neck, and a wooden devil mask with horns as they dance to Mixtec music. Another element to the dance of the Diablos is their use of the chicote (whip) made out of leather and wire rope at the end to create a thunder. The chareos are the Christians and the Moors and every year during the festivities they reenact the battles of the Moors against Christians and the battle of Santiago Apóstol who helped defeat the Moors. The patron saints celebration is experienced as a community event where everyone participates in the celebrations. In preparation for the patron saints festivities, an individual or several families are named to take responsibility for sponsoring the event, called the mayordomos. The mayordomos are responsible for hosting the festivities and providing the meals for the community. Two of the most important celebrations in Juxtlahuaca occur on December 25th, celebrating Catholic religious festivities and on July 25th, honoring the patron saint Santiago Apóstol. The celebration draws local community residents and family members living in the United States. Located in El Centro is the church, Parroquia de Santiago Apóstol, built in 1633 and was later reinforced due to age. The Barrio of Santo Domingo also has its own church named Parroquia Santo Domingo. For several decades now, a conflict exists between El Centro and the Barrio of Santo Domingo regarding the official patron saints festivities

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celebrated during the beginning of July 25th and lasting for a week. As Gonzalez (1996) documents of the ethnic and identity politics surrounding the patron saints celebration, both barrios celebrated the patron saint’s celebrations jointly but after the 1960s, a change occurred where the residents of El Centro established their separate and independent patron saint celebration from the Barrio Santo Domingo (166). This tension was evident as I attended both celebrations in El Centro and at Barrio Santo Domingo. By many Mixtec people, the celebrations held at the Barrio are considered as official, traditional, and authentic whereas at El Centro, the festivities are concentrated more on the fiesta than on the religious aspects. Gonzalez (1996) asserts that this issue points to the class and ethnic stratification present among the Mixtec indigenous and mestizos living in Juxthlahuaca which is further heightened by migration, The decision by the mestizo community to organize their own fiesta was motivated by early regional development and later transnational migration, which sparked Juxtlahuaca’s growing influence in and outside of the region. Modernzation and transnational migration opened up new avenues of wealth and power. Modernization brought regional infrastructure development, which allowed for greater access to industrialized material goods. (Gonzalez 1996:173) In the main street and adjacent to the zocalo are located the food stands packed with people waiting to eat mole, pozole, memelitas, tacos, tamales or any other specialty dish of the day. Juxtlahuaca becomes a picturesque image of Mixtec women carrying tenates (palm baskets) filled with groceries, women making memelitas (tortillas filled with beans), and Mixtec women selling tortillas and totopos (traditional big tortilla) or tamales. This vivid image includes the picture of Triqui indigenous women wearing their bright red huipil— an important cultural marker of this group. Walking around the market place, the Triqui women are usually found in groups talking and socializing among themselves. Much social and political conflict has surrounded this cultural group who have endured years of marginalized by the government. Juxtlahuaca is populated by several cultural groups interacting with each other— the mestizos, who moved to the area from other parts of Oaxaca; the Triquis, another ethnolinguistic cultural group; and the Mixtecs who comprise the majority of the populace. Both the Mixtec and the Triquis belong to the Oto-Manguean language family, possessing distinctive variants and tonalities (Katz 1993:100). Language and dress, as cultural markers, are important and distinguishable features among the people in Juxtlahuaca. Older Mixtec

13 women are characterized by their rebozo (pani- in Mixtec), or shawl, and for their palm woven baskets called tenate (ndo’o- in Mixtec). Younger generations of Mixtec girls, however, are not continuing with the traditional dress and conform to more modern wear, caused by migration and the pressure to assimilate into the Mexican identity. Another cultural group distinguished in Juxtlahuaca are the Triquis. Women are distinguished by their traditional hand woven red huipil, a red woven tunic that is worn daily. In Juxtlahuaca, the Triquis hold an image of being violent people who are easily angered. While the interaction between the Mixtec and Triquis are limited, both indigenous groups have found a shared social space to avoid conflict. Market day in Juxtlahuaca begins as early as Thursday, but the official market day is on Friday when people from neighboring towns travel to Juxtlahuaca to sell their products or make their weekly purchases. Beginning very early on Thursdays, Juxtlahuaca becomes a bustling city with merchants setting their stands of food products, clothing, shoes, kitchenware, and electronics. The market is located adjacent to the municipal governmental building and extends several streets over. Walking through the market, vendors have strategically separated the streets by products and services available to customers. One street will have piles of chiles lined up in rows, other streets are exclusively designated for clothing and shoes, while others are for groceries, dishware, and other commodities. The market becomes an important space for social interactions among Mixtec people. Bargaining is a customary practice still observed in the Mixtec region and other parts of México. Mixtec people will bargain for the best prices or they will trade products, known as trueque. To this day, sellers and buyers continue to engage in trueque (barter), sometimes exchanging products grown or prepared as well as negotiating over prices to procure the basic necessities at affordable prices. A separate market for the sale of animals is located across the town, creating its own unique social space. Mixtec men can be seen negotiating with other men, bargaining in Mixtec for the best price as they inspect the animals. Similarly, the areas are separated by animal type, keeping the cattle and horses at one end and the chickens, goats, and pigs on the other end. While indigenous cultural traits, customs, and traditions are very much a part of the mundane life of the people in Juxtlahuaca, the community has experienced westernization through contact by outsiders and migration. The building of paved roads has opened the way

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for Mixtec people to migrate to different parts of México and the United States, increasing the contact with Western ideologies and commodities. Unlike nearby villages in the district, Juxtlahuaca receives a great deal of outside contact from travelers backpacking through the region or mestizos who have moved into the community from other parts of Oaxaca. As a result, Juxtlahuaca continues to urbanize, offering more services and products to people each year. During my stay, I would hear comments by members of the community on how much Juxtlahuaca has changed over the years; it was no longer a small Mixtec village but a growing place bustling with people coming into Juxtlahuaca on a daily basis. Yearning for the past, people would comment that the village is heading in a bad direction. There is an increase of violence and people have become more distrustful of each other. The anonymity resulting from population density coupled with increased violence experienced in the village is usually blamed on foreigners traveling to the community, people in neighboring communities, or other outsiders changing the demographic landscape of this Mixtec village. A local private doctor in Juxtlahuaca talked to me about the direction the village is headed. He recounted the tragic story of two teenagers who were murdered and that has created distrust and uneasiness among the people in Juxtlahuaca. Additionally, Juxtlahuaca has become a transnational community with families split between the community and the US; members will come back to the village for the patron saints celebration, family events, or other festivities in the community. The influence of outside contact and migrants bringing back different ideas has created to the ambience of distrust and uneasiness. With the growing transnational migration, urbanization of Juxtlahuaca in the recent years, and the biomedical services in the area, this has contributed to the changing perspectives on different aspects of Mixtec life, including health care. With the building of the IMSS hospital, this has opened the accessibility of community members to medical treatment— something they did not have in the past. The Mexican Institute of Social Security or Instituto Mexicano del Seguro Social (IMSS) is a governmental organization that provides public health, pension, and social security services to worker and their families (IMSS 2011). Based on modifications made to the Mexican social security institute, IMSS-oportunidades became an extension to the program covering marginalized and impoverished populations, encompassing “19 states and cares for nearly 11 million marginalized people, primarily those found in the country’s rural zones” (IMSS 2011). Several factors have contributed to the

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accessibility of IMSS to the Mixtec people that centers on inclusionary practices. For instance, a doctor at the IMSS hospital informed me that nurses must be bilingual in Spanish and Mixtec to provide better services. A woman I interviewed explained that there is a midwife who works in conjunction with the IMSS hospital that incorporates Mixtec traditions with biomedical practices, including offering an epidural to relieve the pain of women during labor for those who would give birth at home. However, this woman expressed her desire to use the medical system instead of a partera because she felt more secure and safe giving birth in a hospital setting. In this thesis, I argue that migration and the growing urbanization of Oaxaca in general and Juxtlahuaca in particular, have contributed to the changing perspectives on various aspects of Mixtec life, including health and what mediums they seek for treatment and care. I sought, in particular, to determine the degree to which traditional forms of life and ways of care were being negotiated based on these outside influences. As will become evident, I found that many ways of life, including perceptions of health, the body, and care are gradually being abandoned for more medicalized approaches. In particular, the construction of the IMSS hospital in Juxtlahuaca has opened the accessibility of community members to medical treatment— something they did not have in the past.

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CHAPTER 3

THE ÑUU SAVI PEOPLE

In this section I will briefly contextualize the Mixtec people in by providing sociocultural background of then Mixtec culture, the people, and the history as imperative to understanding how they perceive the body, health, and traditional healing practices.

HISTORY Known as the “People of the Rain” or the “Cloud People”, the Mixtec are an indigenous group located in the northwestern part of México. In their native language, they call themselves the Ñuu Savi 1. The Mixtec name comes from the Nahuatl language, which means “the place of clouds” 2 According to the Academy of the Mixtec Language, the name Ñuu Savi defines the sacredness of nature and all that surrounds the Mixtec people including humans, animals, plants, and the earth (Academia de la Lenguage Mixteca 2007:xi-xii).3 The Mixtec are the fourth largest ethnolinguistic and indigenous group in México following the Nahualt who are the first and largest indigenous group in Central México, followed by the Maya who live in Southern México, and the third largest are the Zapotec who are also located in Central Valleys of Oaxaca. Archaeological evidence suggests that the Mixtecs have inhabited Oaxaca for more than 2,800 years with a remarkable cultural development (Romney and Romney 1966:1). Agriculture allowed the Mixtec to evolve into a complex civilization becoming one of the greatest civilizations in Mesoamerica. Their civilization was based on an agricultural

1 This word is in the Mixtec language which translates into Spanish as Pueblo de la Lluvia (People of the Rain). This is how the Mixtec refer themselves as in their language, Tu’un Savi. 2 The Nahualt people named them as Mixtli because of where they were located in the highland mountains near the clouds. The Mixtec lived in a region of much rain and where clouds characterize the scenery. 3 Translated from the book Bases para la escritura de tu’un savi (2007) “Ñuu Savi define a un espacio sacralizado y humanizado que engloba todo (seres humanos, animales, plantas, piedras, la tierra misma). A las personas que habitan en el territorio se le nombrara de acuerdo con la variante que se habla en cada comunidad” (xi-xii).

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economy that involved long-distance trade with other groups in the region and sophisticated culture with different forms of art, literature, religion, architecture, cosmology, and mathematics (Bade 1994:61; Joyce 2010:283; Mindek 2003:10). The Mixtec civilization left one of the most beautiful forms of cultural patrimony of the preContact civilizations known as the codices. These are pictorial essays that contain the rich and varied history, architecture, culture including social structure, dress, rituals, cosmovision, history of kings and nobility and linguistic heritage of the Mixtecs before and after the conquest as well as post-conquest relations (Katz 1992: 45). An important figure in the Mixtec Codices was Eight Deer Tiger Claw of Tilantongo (Ocho Venado Garra de Jaguar), a King who ruled the Mixtec Empire for two centuries during the 11th and 12th century, uniting all three Mixtec regions—Tilantongo (Alta region), Teozacualco (Baja region), and Tutepec (Coastal region)— through military expansion. The codices also indicate that the place of origin for the Mixtec people originated in Apoala, located in the northeast of the Mixteca region. In the origin myth, the Mixtec believe they are the descendants of the first Mixtecs that originated in the village of Apoala (Mindek 2003:10). The Mixtec codices also provide knowledge of the complex Mixtec civilization; they were used as pedagogy for rituals and captured their own distinct sacred calendar, which was used to name individuals after their birth dates and describes the social positions of Mixtec people in general. Archaeology indicates that what is now considered the Mixteca region was first inhabited by the Mixtec, “during its highest point, approximately 7,000 years before the Christian era” (Mindek 2003:9).4 Archaeological evidence suggests that between 400 and 300 BC demographic growth is evident both in the Mixteca Alta and Mixteca Baja. Before being conquered, there existed no division between men and women. Mixtec women were also caciques5 who conquered and ruled entire regions. During this period, women also inherited lands. By 1520 and with the arrival of the Spaniards, the Mixtec civilization was internally divided by conflict among the nobility and was found in a weakened state and

4 Translated from Mixtecos: Pueblos Indígenas del México Contemporáneo (Mindek 2003) “Los arqueólogos afirman que la ocupación humana en la Mixteca inicio en su parte alta, aproximadamente 7,000 años antes de la era cristiana” (9). 5 Queen/Ruler

18 conquest was immediate. The Spaniards took away the land from the Mixtec people, their language, their religion, and codices. The Mixtec were coerced into conversion to Catholicism and to the Spanish language. During this period, the Mixtec population suffered a drastic population reduction due to forced labor, illnesses brought by the Spaniards, religious repression, and social and economic changes imposed by the Spanish rule. As Joyce (2010) illustrates of the arrival of the Spaniards to the Tututepec of the Mixtec region in 1522, Oppression and epidemics rapidly decimated rapidly decimated the coastal population. A major smallpox epidemic swept through the region in 1534, followed by measles in 1544. The population of the Tututepec Empire at the time of the conquest has been estimated at more than 250,000, yet only an estimated 4,500 people were recorded at Tututepec in the census of 1544. (3) With the onset of the Spanish colonial rule in Oaxaca, the indigenous people of Oaxaca were devastated by the various epidemics and imposition of the colonial institutions.

DEMOGRAPHICS Before being conquered, there was no boundary dividing the Mixtec region. With the delineation of the Mexican states, the Mixtec region became divided by three separate states, dividing the Mixtec group into different regions, Oaxaca, Guerrero, and Puebla,. In Oaxaca, the Mixtecs are located in three regions—the Mixteca Alta (its Mixtec name, Ñudzahui nuhu, means “a divine and highly esteemed thing”), the Mixteca Baja, which they call Ñuine, referring to the higher temperatures and the Mixteca de la Costa, which bears the name Ñundaa because it reflects flatness (Velasco Ortiz 2007:29). Located in the northeastern part of Oaxaca, the Mixtec region covers an approximate surface of 40,000 km under a variety of ecological settings, geographical landscapes, and microclimates (Mindek 2003:5). Oaxaca reflects a diverse landscape that extends from the Sierra Madre Mountains, to the cloudy tropical forests, and stretches all the way to the hot and humid Isthmus of Tehuantepec. The climatic conditions of the Mixteca regions vary between rainy and dry seasons with hot, semi-humid, and semi-arid temperatures (Katz 1993:100). At an elevation of 1,700 meters, the Mixteca Alta region is located along the mountainous terrain, bordering the states of Puebla and Oaxaca. With a dry, cold climate, the Mixteca Alta has adequate conditions to “graze sheep and goats as well as to cultivate corn, beans, squash and some fruits such as

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apple and peach” (Mindek 2003:6)6 The Mixteca Baja region, which includes part of Oaxaca and Guerrero, is moderate in climate and is located along extensive hills and wide valleys. The Mixtec of the Coast exhibits warm and tropical temperatures. Its climatic temperatures and ecological setting allow for the growth of a variety of vegetation including “tropical fruits, vegetables and cocoa, and, ascending the mountains, coffee “(Mindek 2003:6).7 Oaxaca is divided into 30 districts and the Mixtec region comprises eight of these districts. The Mixteca Alta, covering 38 Municipios, is the most populated region. The Mixteca Baja covers another 31 Municipios in northwestern part of Oaxaca including Huajuapan de Leon, Juxtlahuaca, Teposcolula, and Silacayoapan as well as some districts in Mexican states of Puebla and Guerrero.

Indigenous People of Oaxaca Oaxaca is one of the states in Mexico with a total of 17 indigenous groups including Mixtec, Zapotec, Chatino, Triqui, Mixe, Amuzgo, Chocho, Chontales, Cuicateco, and Huave, as well as several other ethnic groups such as the ixcatecos, popolocas, chocholtecas and afromestizos from the Costa (Mindek 2003). With diverse cultural and linguistic backgrounds, indigenous groups in Oaxaca identify more with their village town and particular ethnolinguistic groups than with the Mexican national identity. Up until the 1980s, the Mixtec comprised the second largest ethnolinguistic group in the state of Oaxaca following the Zapotec (Velasco Ortiz 2007). Mixtec is part of the Oto-Manguean language family that includes other languages such as the Cuicateco and Triqui, groups of whom also live in the region (Mindek 2003). At the present, the Mixteca continue to be one of the largest indigenous groups in Oaxaca with a significant number of native speakers of the language. According to the 1990 census, In Juxtlahuaca approximately 16,000 individuals speak the Mixtec language while 5,500 are monolingual in Mixtec (Lewis 2009). Data from the 2002 Census indicates that 350,151 individuals speak the Mixtec language in Mexico, of

6 Translated from Mixtecos: Pueblos Indígenas del México Contemporáneo (Mindek 2003) “…apacentar ganado ovino y caprino, y también para sembrar maíz, frijol y calabaza, y algunos frutales como manzano y durazno” (6) 7 Translated from Mixtecos: Pueblos Indígenas del México Contemporáneo (Mindek 2003) “frutas tropicales, vegetales y cacao, y, subiendo los montes, café” (6).

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which 244,029 are in Oaxaca; 100,544 in Guerrero; and 5,578 in Puebla (Academia de la Lengua Mixteca 2007:11). These figures, however, do not include the numbers of Mixtec speaking people in other areas of México and the United Sates.

Language Tu’un Savi 8 is the language spoken by the Mixtec people but it is commonly known as Mixtec. Its literal translation means Palabra de la Lluvia or the Language of the Rain. Tu’un Savi is part of the Oto-Manguean language family along with the Triqui, Amuzgos, Chatinos, and Cuicatec which are also spoken in the state of Oaxaca (Lewis 2009; Mindek 2003). Moreover, the Mixtec language is very tonal with similar words containing a different meaning depending on the tone, with much nasalization (some vowels are nasalized), and makes use of the glottal stop (which indicates a pause in between vowels) (Academia de la Lengua Mixteca 2007; Cruz Ortiz 1998). An accent mark is used to indicate a high tone, it is left blank to indicate a medium tone, and an underline is used to indicate a low tone. For example: Ko’ó means let’s go Koo means snake Koo means sit down Yáá means tongue Ya’a means chile Yaa means ashes Also within the complex structure of the Mixtec language, certain prepositions and nouns are used as metaphorical extensions of body parts as well as to define spatial domain and temporal events. Many variants of the Mixtec language are spoken throughout the Mixtec region, varying with each village (Austin 2008:200). Traveling to different villages in the same region, each village will speak a different variant with certain features that distinguish it from other neighboring communities. The variants from the Mixteca Alta and Mixteca Baja demonstrate great difference and are unintelligible. This is also the case of the Mixtec

8 Also referred to as Tu’un Da’vi (Language of the Poor). Tu’un Da’vi is more commonly utilized by the Mixtec people. Due to the marginalization and forced conversion to the Spanish language (referred to as Tu’un Jan’an, which translates as the rich language) their language was perceived as poor with no value.

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language spoken in Guerrero, Puebla, and on the Coast. Despite these variations, the language remains an important cultural marker and identity of the Mixtec people. As with most culture groups, the conceptualization and worldview of the Mixtecs is informed by their environment, climate, and natural landscape. The Mixtec people utilize nature around them for sustainability from food, households, and clothing. In addition, as part of their legends and oral traditions, the Mixtec speak of originating from nature. Cruz Ortiz (1998) documents an oral tradition of Mixtecs in Pinotepa, which is located in the Mixteca Costa region of Oaxaca, of their origin myths of the first Mixtecs, The first parents of the Mixtec civilization were born of a thorny tree call Ceiba Blanca… The first Mixtec woman was born from this tree, sprouted from its center in the shape of bud. It grew until it became a large worm and then descended from the tree; when it was on the ground it began to swirl and the worm remained halfway in the swirl, turning in circles. As it was swirling it was growing and, suddenly, as by art of magic, it transformed into a beautiful woman… The man was born from the leaves of the same tree. (31)9 Tu’un Savi is an oral language with no standard written form. Oral tradition was an important practice in passing down knowledge to their children about the culture, traditions, moral teaching, history, and ancestors. According to Cruz Ortiz (1998), “Before, Mixtec oral tradition played a very important role in their daily life. It was used as a base for moral teachings that a boy or young person should possess in society. It was one of the forms that the elderly Mixtecs utilized as a method to educate their children; also it was related to the nature of their work” (14).10 It would be customary for the Mixtec people to meet and gather around to listen to the elders relate stories about their ancestors, their origin myths, and legends; however, this tradition is gradually being lost by younger generations who are no

9 Translated from Yakua Kuia El Nudo del Tiempo: Mitos y Legendas de la Tradiction Oral Mixteca (Cruz Ortiz 1998), “ Los primeros padres de los Mixtecos nacieon de un árbol espinoso llamado Ceiba Blanca… La primera mujer mixteca nació del árbol, brotó de su centro en forma de capullo. Fue creciendo hasta ser un gusano grande y luego bajó del árbol; cuando ya estaba en el suelo empezó un remolino y el gusano quedó a la mitad del remolino, dando vueltas. Conforme iba girando iba creciendo y, de repente, como por arte de magia, se transformó en una hermosa mujer… El hombre nació en las hojas del mismo árbol (31). 10 Translated from Yakua Kuia El Nudo del Tiempo: Mitos y Legendas de la Tradiction Oral Mixteca (Cruz Ortiz 1998), “Antes, la tradición oral mixteca jugó un papel muy importante en la vida diaria. Se usó como base de la enseñanza moral que debe tener un niño o joven en la sociedad. Era una de las formas que los ancianos mixtecos utilizaron como método para educar a sus hijos; también estaba ligada a su trabajo” (14).

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longer interested in continuing with the practices, interrupted by out-migration of many young Mixtecs, and the advancements due to technology (Cruz Ortiz 1998). In the recent years, the Mixtec language, specifically some variants, have become classified as endangered. During the 1980s, the Mexican government pushed for a more neoliberal multicultural framework, moving away from indigenismo and consequently, stigmatizing the use of indigenous linguistic and cultural practices (Perry 2009). In many ways, this transition has discouraged many Mixtec people from continuing to speak or teach children their native language. As Cruz Ortiz (1998) relates, “Many Mixtecs do not feel proud of this inheritance neither do they want to appropriate it since to be indigenous it has meant to be exploited; they try to pretend something that are not, even rejecting to speak our native tongue. These attitudes are moreover understandable due to the centuries of exploitation that we have suffered” (13).11 While Tu’un Savi is still spoken in a number of rural communities, the Mixtec language is gradually being abandoned in favor of the Spanish language. Mindek (2003) maintains that in municipal towns, the Mixtec language is in the process of being abandoned by younger generations as a result of urbanization while in smaller nearby villages, the Mixtec language continues to be spoken and is being maintained as the everyday language (9). This seems to be the case in Juxtlahuaca where the language is spoken less by younger generations and is only spoken by a few elders in the community. During the period following the Mexican Revolution, the Mixtec experienced similar forms of forced integration as other indigenous groups in the nation where they were subjected to forced Castilianization. Based on testimonials during this period, “going to school meant torment for children, the teachers would hit anyone who dared speak Mixtec; likewise they also demanded for the parents to follow suit at home” (Mindek 2003: 9).12 Migration has also

11 Translated from Yakua Kuia El Nudo del Tiempo: Mitos y Legendas de la Tradiction Oral Mixteca (Cruz Ortiz 1998), “Muchos Mixtecos no se sienten orgullosos de esta herencia ni quieren apropiarse de ella, ya que ser indígena ha significado ser mas explotado; de aquí que traten de aparentar algo que no son, inclusive hasta desechan hablar nuestra lengua. Estas actitudes son por demás entendibles ante los siglos de explotación que hemos padecido” (13). 12 Translated from Mixtecos: Pueblos Indígenas del México Contemporáneo (Mindek 2003) “Los testimonios afirman que en una época, ir a la escuela significaba para los niños un martirio, pues los maestros le pegaban a todo aquel que se atrevía hablar en mixteco; asimismo, exigían a los padres que siguieran su ejemplo en el hogar (8).

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affected the usage of the Mixtec language. The language is not being passed down to younger generations of Mixtec children once they move to the United States, affecting the rates and use of this indigenous language. While it is an oral language, efforts by scholars, the Academia de Lengua Mixteca (Mixtec Language Academy which was started in 1990 by Mixtec community members), other organizations, and linguists have been able to develop a standardized form or system or writing for the Tu’un Savi language to ensure its preservation and dissemination to younger generations. The standardized form allows for variation with a few of the letters that reflect different sounds, thus preventing any one dialect or variant as representing the diverse whole of the Mixtec language.

Subsistence As in the past, the Mixtec people in Oaxaca continue to depend on subsistence agriculture based on cultivating the principal crops of the region – corn, beans, and squash. As Mindek (2003) describes, the cultivation of maize, beans, squash and chile, the basic diet of the Mixtec, is practiced in small units on eroded soils and depends on the rainy season, which is why their yields are low: the average familial harvest only ensures food for six or eight months out of the year (20) 13 The harvest of these main crops is insufficient in providing sustainability in a full year cycle for family consumption or for commercial sale. It is approximated that in the entire Mixteca region, only 7% of the land can be utilized for cultivation of agricultural products (Krause 1994). A number of factors contribute to the lack of economic sustainability today for the Mixtec; some are the result of the exploitation of natural resources and the destruction of local economic structures by the colonial imposition in the region. These include deforestation, the introduction of certain livestock in the region, the destruction of the terrace system, and the introduction of new cultivation techniques (Krause 1994:1; Mindek 2003:10). All of these conditions caused soil erosion and devastated the form of agricultural cultivation that the Mixtec depended on and continue to depend

13 Translated from Mixtecos: Pueblos Indígenas del México Contemporáneo (Mindek 2003) “El cultivo de maíz, frijol, calabaza y chile, base de la alimentación mixteca, se practica en pequeñas unidades de suelos erosionados y depende del temporal de lluvias, razón por la que sus rendimientos son bajos: la cosecha familiar solo asegura la alimentación durante seis u ocho meses del año” (20).

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today for sustainability. The Spanish conquistadores viewed the Mixtec as an economic asset, exploiting the gold and silver mines in the region, controlling the production and commerce of the grana cochinilla,14 and using the Mixtec as slave labor (Mindek 2003:10). At present, the Mixteca region does not have a single economy, agricultural crop, or tourist enterprise like other parts of Oaxaca, nor does it have a commercial agriculture that would allow them to compete in the international markets. The Mixtec, however, have been known for their intricate work with palm weaving. While this practice is being lost and only known by some elders in the communities, the Mixtec weave hats (ixiñi in Mixtec; sombreros in Spanish), petates (yivi in Mixtec; mat made of palm in English) and tenates (ndo’o in Mixtec; palm baskets in English). The role of the women is confined to the realms of domesticity but Mixtec women also contribute to the income of the household by selling tortillas or other products in the local market. This effort is limited in providing the necessary income to support a whole family. The lack of employment opportunities available and rising poverty have prompted much of the transnational migration of both Mixtec men and women since the 1980s to the United States or other parts of México to work in the agricultural fields or in the service sector (Bade 2004). Since the twentieth century, the Mixtec have participated in seasonal migration to different parts of México including Veracruz, Chiapas, Morelos, Mexico City, Sinaloa, Sonora, Baja California as well as to different areas of the United States (Velasco Ortiz 2007:343). Mixtec typically engage in agricultural or service work; in Mexico City, men “tend to work in services and masonry and women in domestic services…Veracruz and Morelos are principal destinations for harvesting sugar care; Obregón, Sonora, for picking cotton; Culiacán, Sinaloa, for tomato picking; and Baja California and the United States, for the horticultural fields” (Velasco Ortiz 2007:343). This transnational migration has become imperative for families left behind. The remittances sent by relatives who have emigrated have allowed families back in their home of origin to rely on a new source of income (Krause 1994: 3). Without the remittances sent by family members working and living abroad, the

14 The production of the grana cochinilla is the cultivation of the cactus plant where insect grows. From the dry insect, the blood becomes a coloring used to dye clothing or other objects. The red dye coloring was popular and of great demand in the European market during the colonial period (Mindek 2003:11).

25 survival and reproduction of entire communities would not be possible. Hence, many village towns in the Mixteca have been built and sustained by the remittances sent by Mixtec immigrants.

Infant Mortality and Maternal Mortality Oaxaca is one of the states in México with the highest rates of poverty, malnutrition, unsanitary conditions, lack of infrastructure, and insufficient preventive medical care to address the high infant mortality and maternal mortality rates. The high infant and maternal mortality in Oaxaca is reflective of the social inequality, the lack of prenatal care provided to women, and the malnutrition present in the country as a whole. During their study of Mixtecs in Juxtlahuaca, Romney and Romney (1966) documented the high infant mortality rate through genealogical data. According to the study, “women in the barrio [had] borne twice as many children as [were] surviving” (95). While infant mortality has decreased over the years, there is a prevalence of diverse illnesses still affecting children (Krause 1994:3). Also prevalent in the state of Oaxaca are a high number of preventable infectious ailments and chronic illnesses such as anemia and parasitic diseases, acute respiratory diseases, and intestinal infections (Rubel and Browner 1999:91). Rural communities in the Mixteca region continue to be economically underdeveloped, lacking basic services such as potable water, paved roads, and electricity. Access to health care facilities is limited in rural areas and existing facilities are located in urban areas making it difficult for families in rural areas to access health care services.

Social Inequality and Health Part of the increased social inequality that exists in Oaxaca originates from the rural migration of people into the cities, which lack the necessary infrastructure to maintain a growing population. The forced migration of many rural villages results from the inability of this sector of the population to sustain a livelihood in their lands through agriculture. This has contributed to the growth of the informal industry in Oaxaca. The lack of infrastructure has also contributed to the quality of health among urban Oaxaqueños who suffer from chronic intestinal infections, high rates of amoebic infections, and dysentery (Murphy and Stepick 1991). Over one-third of households in the state of Oaxaca still lack potable water in their

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households. The population of Oaxaca continues to grow and has grown tenfold in the recent years. With the growth of the Oaxacan population and rural-to-urban migration, Oaxaca has increased significantly, resulting in a lack of available land for new rural-to-urban migrants. Murphy and Stepick (1991) noted in the late 1980s and early 1990s that this resulted in the growth of squatter settlements outside the city, referred to as colonias populares (64). Oaxaca is one of the poorest states in Mexico and inequality is apparent, especially between the wealthy mestizo population and impoverished indigenous groups. In Oaxaca, the distribution of services and income inequality reflects the asymmetry that exists between the various ethnic groups populating this region (Mindek 2003). Various socio-economic and political factors contribute to the inequality among indigenous groups. For contemporary Mixtec people, life is marked by extreme poverty and families lack the basic necessities, creating harsh living conditions. Added to this is severe soil degradation that has devastated the cultivable land, making it hard for people to sustain a livelihood (Bade 1994:62). The Mixtec are one of the most marginalized people in México and in the United States. A number of households in the Mixteca region still have dirt floors and lack a drainage system, running potable water, roads, natural gas, electricity, sanitation, and medical care. In Juxtlahuaca, a large number of Mixtec households continue to have dirt floors and only a few have access to potable water. While most households have electricity, many continue to cook with firewood.

SOCIOCULTURAL CONTEXT The Mixtec people are characterized by their native language, their music, cultural heritage, community cooperation, and respect for the land and their past ancestors (Dahl- Bredine and Hicken 2008). The Mixtecs value a life filled with family, children, and healthy lives. Most scholars hold that the Mixtec people today have a culture that is interpreted by outsiders as quiet, humble, respectful, and hardworking. Greetings are honorific and important displays of respect are presented to the elders in their families, fictive kinship, and communities, “Among the members of the community, dialogs are common in Mixtec; first they greet each other with the customary greetings of ‘good morning’ or ‘good afternoon’.

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Obedience and respect are important; they avoid problems or conflicts with others, but above all these must exist toward the father of the family” (Anguiano 1997:29).15 Even within the language, honorific pronouns are utilized to denote respect to others. The issue of respect and humility can be seen in the standard greetings that are an important aspect of their culture and a way to establish relationships and unity among themselves. In addition, trust, sense of community, and solidarity are important social and moral principles within the Mixtec indigenous communities (Cruz Ortiz 1998; Dahl-Bredine and Hicken 2008). Community belonging remains important for many Mixtecs in maintaining membership, status, and respect. During celebrations such as baptisms, weddings, funerals, and patron saints celebrations, various members of the community or sometimes entire communities will assist or provide monetary assistance for the festivities. Many Mixtec communities are governed through usos y costumbres, a civic-religious system which is an important element in the cultural reproduction of the Mixtec communities by organizing under the principle of service and mutual aid for the collective benefit of the community (Velasco Ortiz 2007:32). This form of local government is based on the election of municipal authorities by the community to ensure political and social organization as well as the sustainability and reproduction of the community. The practice of usos y costumbres was validated within the Mexican constitution during the Salinas administration. Part of this local form of government is the requirement of Tequio, a form of community service, performed usually by the males aged 18 years and under the age of 60 years old for the benefit of the community participating in town projects such as construction and maintenance of basic infrastructure in the town (Kearney and Besserer 2002). The tequio is a Nahualt word which means “collective work”. As a whole, collective work comprises a vital element and is the basis of the economy for many indigenous communities. Members of the community are also elected annually to serve cargos, which is the “voluntary service in one of the community’s many cargos or committees” (Cohen 1999:2). The cargo system includes taking

15 Translated from the book, Los Mixtecos en Nuevo Leon, (Anguiano 1997), “Entre los miembros de la comunidad son communes los dialogos en Mixteco; posteriormente se saludan, acostumbrando para esto darse los bueno días o buenas tardes. La obediencia y el respeto son factores importantes, ya que evitan problemas o conflictos con los demás, pero sobre todo deben existir hacia el padre de la familia” (Anguiano 1997:29).

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governmental or religious positions within the community such as mayordomias, cofradias, and civic cargos for the cabildo, or town council. Community members are selected to fill public offices as a requirement of their membership within the community. Such positions include the Presidente Municipal (the President or mayor of the town), Comandante de Policia (Chief of police), Secretary, and Treasurer within the cabildo, or town council. These cooperative structures construct alliances between individuals, families, and the community (Cohen 1999:110). The networks of kinship are extensive which facilitates the support and assistance of families and the community as a whole, particularly during festivities, weddings, and patron saints celebrations. Changes within the system of usos y costumbres are also occurring as a result of the increase of out migration. Kearney and Besserer (2002) discuss the changes occurring in the Mixtec town of San Jerónimo Progresso with community governance and how migrants are fulfilling their civic and ceremonial obligations. In recent years, many Oaxacan communities have become transnational communities with Mixtecs living abroad. This has affected the conditions and customs in which civic duty is conducted. Even while living abroad, Mixtec must fulfill their civic duties. The appointments of cargos require citizens to relocate back to their hometowns forcing them to leave their work and families behind. According to Kearney and Besserer (2002), “This pattern of governance represents a new moment in the history of Oaxacan communities in which municipal governance and citizenship is increasingly dependent on the service of return migrants and the taxes of immigrants living ‘in the North’” (9). Increasingly, remittances and the cargos held by migrants has become a source of economic development for many Mixtec communities. Ventura Luna (2010) also examines the changes occurring in the municipal governance in the Mixtec town of San Miguel Cuevas. Ventura Luna discusses the difficulties and economic hardships that Mixtec migrants have encountered while trying to fulfill their civic duties and attempting to preserve their membership within their hometown. Since the cargos are unpaid services performed for the betterment of the community, many migrants are forced to move back to their hometown for a period of time and endure loss of normal income. The cargo system is being maintained by Mixtec migrants who contribute monetarily to the hometown. More importantly, this new pattern has allowed Mixtec communities to rely on greater financial resources by Mixtecs migrants working abroad. As a result, “Harsh sanctions such as fines, confiscation of

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property, and expulsion from the community are increasingly being imposed to encourage compliance” (Kearney and Besserer 2002). While changes within the governance of the communities continue to occur due to migration, usos y costumbres remains an important part of the Mixtec life. Moreover, Mixtec customs, religious beliefs, and way of life are also informed by the forces of nature and religion (Anguiano 1997). Mixtec mythology is surrounded by the elements of life, death, and afterlife which are all celebrated in the Mixtec culture. Religion is an important aspect of Mixtec life dictating the rituals and traditions practiced by the Mixtecs. Religious customs incorporate rituals honoring the Mother Earth and the Saints introduced to them by the Spanish. Towns are named after patron saints and people celebrate them with festivities that span over the course of a few days or a week. Ceremonial life is also centered on religion and the most important events in an individual’s life including baptism, marriage, and death. It is customary for the Mixtecs to have compadres (godparents) for these events. During a funeral, the family is accompanied by a procession of music followed by relatives carrying candles and flowers to bury the deceased (Anguiano 1997). On Dia de los Muertos (Day of the Dead), deceased relatives are remembered and honored by building alters with cempasúchil (marigold) flowers and food that they most enjoyed. Mixtec life revolves around nature and seasons to inform them about work and when to cultivate their crops which typically involved the participation and labor of the entire family. Farming continues to be a main form of subsistence for the Mixtec people in Juxtlahuaca despite the growth of the service sector. Many Mixtec in Juxtlahuaca continue cultivating maize, beans, and squash continues to be practiced by the Mixtecs. In Dahl- Bredine and Hicken’s (2008) work, The Other Game: Lessons from How Life is Played in Mexican Villages, a Mixtec man conveys, “We are campesinos because it is our vocation, an important vocation, one of the most important in the world since we all depend on food. And we have thousands of years of knowledge about the land that has been passed down to us as our heritage by our ancestors” (25). The Mixtec are resourceful and utilize nature for the practicalities of life including the cultivation of food, the making of clothing such as the palm hats (sombreros) used by men or palm mates (tenates), and using their craftsmanship to create instruments for music to name a few (Mindek 2003). The traditional palm weaving serves as a central part of the tourist industry in Oaxaca where local families have carved a

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niche for preserving their traditions of palm weaving while at the same time structuring a marketing strategy to be part of the informal market of the tourism industry. In conjunction with the harmonious relationship the Mixtecs maintain with nature, they also make use of the natural resources for medicinal practices. The Mixtec have an extensive knowledge of a variety of plants and animals that possess curative purposes. Through oral tradition, the Mixtec have passed down knowledge and beliefs regarding traditional medicinal practices to their children. Diez-Urdanivia and Pérez-Gil (1996) affirm that, “The traditional or indigenous medicine, including the cause of illness, becomes a process of integration of the medical values of the group, reaffirming its ideology and contributing to the consistency and solidarity of its social system through the re- establishment of the harmony and emotional equilibrium with its own group” (211).16 The use of traditional forms of care provides an insight into what a group or culture value and how they conceptualize the world around them. In all, the concept of illness and healing as understood by the Mixtecs is molded by their relationship with nature and their religion. Traditional Mixtec healing and their health system are further explained in Chapter 6. In Mexico, gender plays an important role in dictating the social roles of both men and women. In all, gender becomes a social organizing category that codifies social as well as sexual behavior (Stephen 2002:47). These gender roles dictate the role of women inside the realms of the household and in the public sphere. According to Norget (1999) a woman in Mexico, and Latin America at large, is relegated to the private and domestic sphere of a household performing a number of concomitant tasks. These tasks are confined to the maintenance of the household and include cooking, cleaning, washing, and the care of their children and husband (6). In Oaxaca and all around Mexico, the case of Mixtec women in rural Oaxaca where women perform the mundane housework of grinding corn, cooking, cleaning, washing, and caring for children (Katz 1993:100). In many Mixtec communities, women also partake in rigorous and painstaking work, often tending to work cultivating

16 Translated from the article, “Practicas de Salud Reproductiva en Zonas Indígenas del Estado de Oaxaca” (Díez-Urdanivia & Pérez-Gil 1996 In Sexualidad y Reproducción Humana en México), “La medicina tradicional o indígena, desde la misma causa de la enfermedad, va procurando un proceso de integración de los valores médicos del grupo, reafirmando su ideología y contribuyendo a la consistencia y solidez dentro de su sistema social a través del restablecimiento de la armonía y equilibrio emocional con su propio grupo” (211).

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family land plots, household domestic work, and care of their children while male counterparts migrate to different part of México or the United States to generate new sources of income. For Mixtec migrant communities, however, these ascribed gender roles for Mixtec women have transcended, modified or reaffirmed their established roles. In some instances, the role of the Mixtec women will transcend and move beyond the established role, others are modified to move elevated status, while in other cases the established roles are reaffirmed and remain the same. With the increase in out-migration from Mixtec people, a number of scholars (Hondagneu-Sotelo 1994; Ibarra 2003; Menjívar 2003; Pedraza, 1991; Stephen 2007; Velasco Ortiz 2007) have focused on gender and migration. In a study on indigenous immigrant women in Baja California, Mexico and the U.S. State of California, Elizabeth Maier (2006) found that immigration has allowed indigenous women to achieve more personal autonomy and an elevated position within their families and communities as well as enhanced access to more educational and job opportunities. Migration can signify economic and personal autonomy from patriarchal and gender roles for some women; however, for other women, it may represent an increased workload, more hardships, or reinforced patriarchy. Unable to support a family in the United States with one income, some immigrant women are forced to work and contribute to the family income. Thus, migrant women have been able to renegotiate their patriarchal and gender roles by becoming active agents within their households after they enter the work force (Ramírez et al. 2005). Moreover, Mixtec women in México are characterized as being passive and submissive wives confined to the realms of domesticity and the exigencies of the dominant macho husbands (Murphy and Stepick 1991). The Catholic Church and the Mexican nation have played an important role in framing acceptable gender and social roles, thus dictating how women should behave and act in public and at home. Particularly in Oaxaca, traditional gender roles for indigenous women are attached to the images of the Virgin Mary. Notions of gender attached to indigenous women become embodied in the image of devoted mothers and wives while their sexual image and premarital virginity are solely focused on reproduction and monogamy (Stephen 2002). The social roles of indigenous women are also associated with marriage and motherhood as the natural roles for Oaxacan women while men are linked with machismo, aggressiveness and dominance. Women are expected to be domestically oriented, be faithful to their husbands, maintain the household and take care of

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their husbands and children (Murphy and Stepick 1991:145). It is the norm for rural women in the state of Oaxaca to attend school only for the first years, subsequently get married at a young age, and then become a devoted wife and mother (Howell 1999:99). Typically, it is not typical for an indigenous woman to receive a high school education. In their communities, pregnancy and childbirth are a natural part of a Mixtec woman’s life. The ideal scenario for a young married couple is to have as many children of both sexes. Children comprise an important part of Mixtec families. Children are also viewed as important economic contributors in the household (Krause 1994:7). They are perceived as economic assets, who will become economic providers for parents in their old age. The more children a couple bears, the lesser the burden will not be for the parents in later years. As well, adult children who emigrate become sources of additional income for households and communities that alleviate economic pressures. Under the assigned gender roles, girls help their mothers taking care of younger siblings or helping out with household chores such as cooking or washing clothes. On the other hand, boys go out into the fields with their fathers taking care of the animals or helping with the agriculture.

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CHAPTER 4

RESEARCH METHODS

This study explores the perspectives and management of childbirth practices of a rural Mixtec community in the Mixteca Baja region of Oaxaca in the village of Santiago Juxtlahuaca, located in the district of Juxtlahuaca. This project seeks to examine the implications caused by the reorganization of obstetric care and the changing birthing practices and maternal care among Mixtec women. Particularly, it seeks to examine how the biomedical system is transforming the use of parteras (local midwives); preference today is for biomedical obstetric care during childbirth including maternal care. In conducting my research, I was also privy to shifts in overall healthcare preferences. As a result, I also will discuss the consequences migration has had on the type of health care people decide to utilize. For years, people from the state of Oaxaca have engaged in an increasing transnational migration to and from the United States and México. This phenomenon begs the question: how is migration transforming the beliefs and perspectives of Mixtecos in relation to the type of health care they seek, specifically regarding maternal care for Mixtec women? This thesis employs ethnographic and qualitative methods, emphasizing the value and importance of understanding and articulating the participants’ lived experiences. To gather quality, meaningful, rich narratives and lived experiences from Mixtec women, semi- structured interviews were conducted. These interviews offered firsthand accounts and personal experiences of the beliefs and practices of childbirth. I also engaged in active participant observation to obtain more concrete in-depth knowledge from the Mixtec women and parteras in the community. I lived with a family in barrio Santa Cecilia, a new barrio created in the outskirts of Juxtlahuaca, across the Juxtlahuaca River. The household compound included another family, a sister-in-law with her six children. I cooked with the Mixtec women; I learned how to wash laundry with them; I went to the market on market days and learned how to effectively bargain and purchase products based on the local

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bargaining system; I learned how to use traditional household remedies for common illnesses. I attended community events including the patron saint’s celebration of the town, participated in the social gender roles while in a mayordomia, and attended a local high school graduation. I went to the cemetery and learned how to participate in the rituals of honoring the deceased relatives, and participated in the daily activities of the Mixtec women. In addition, I immersed myself in the Mixtec language after having studied it for several years at SDSU. Language embodies the values, traditions, and perceptions considered important in a particular culture. In relation to language and culture, Sapir (1933) writes, “The content of every culture is expressible in its language and there are no linguistic materials whether as to content of form which are not felt to symbolize actual meanings, whatever may be the attitude of those who belong to other culture” (156). Bloch (1991) further notes of the linkage between culture and language where “culture is thought and transmitted as a text through language” (184). Language is fundamental in understanding the worldview of a culture; it allows us to obtain insights into how people create meaning, understand their beliefs, discern what they value, and begin to learn how they interpret the world around them. Moreover, the Sapir-Whorf hypothesis holds that language “constitutes the means with which individuals think and therefore, especially as stated in its strongest form, language conditions or determines cultural thought, perception, and world view” (Sherzer 1987:295). Language becomes a reflection of the way people see their world around them and is uniquely to that cultural group. In all, language is the reflection of a culture. Therefore, as Moore and Sanders (2006) convey, “…language is central to social life, that it is what defines us as humans, and thus we must analyze social life as the creation and negotiation of meaning within which actors interpret their experience and order their actions” (xiv). As such, it became important for me to learn the language, the structure, and how Mixtec people conceptualize their world around them. Since 2007, I immersed myself in learning the Mixtec language. For the past four years, I have diligently learned the linguistic variant of Mixtec spoken in the town of Ixpantepec Nieves located in the Mixteca Baja region in the district of Silacayoapan, a 40 minute drive to Juxtlahuaca. This variant is intelligible with the Mixtec variant spoken in Juxtlahuaca, my research site. During the summer of 2010, I participated in the Mixtec

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Language Summer Program through San Diego State University. This opportunity allowed me to obtain a better understanding of the Mixtec culture, language, customs, traditions, and visit a number of communities with distinct linguistic variants. Staying with a family in the Mixtec community of Ixpantepec Nieves allowed me to observe the gender roles among families, the work women perform, how families interact, and form part of the community traditions as well as the mundane practices of the Mixtec people. For the study, participants were recruited via the use of the “snowball” technique (Bernard 2002). In my previous visits to the community, I created rapport with key primary informants, which facilitated the recruitment of additional participants within their immediate social networks (Bernard 2002). In the summer of 2009, I visited the town of Santiago Juxtlahuaca. I was able to build a rapport with several of the women in the community who were willing to talk to me about their experiences. I came across several obstacles during my study due to the traditional gender roles that men and women follow within rural indigenous communities in Oaxaca where women are primarily restricted from participating in public spaces (Murphy and Stepick 1991). Women are expected to adhere to traditional gender roles that confine them to the private spaces. Because women are confined to the private realms of their households, the snowball technique served as a viable recruitment method for locating additional participants in my study. Snowball sampling is a technique where “each person interviewed leads the researcher to the next person, based on a designated set of criteria. The result is the continuous accrual of related research respondents. It is an important instance of chain analysis” (Diaz et al. 1992). This technique allows the researcher to build a sample of individuals with one or more common characteristics within a larger known or unknown universe of individuals, not all of whom may, as a group, share the behavior and cultural element in question” (Bernard 1998:705; Bieleman et al. 1993). The snowball technique enabled me to identify and locate potential participants who were interested in talking about their experiences regarding childbirth practices and maternal care. In addition, the snowball technique allowed me to gain access to women in the community and parteras (midwives). Through the use of the snowball technique, I adhered to social and cultural understandings of traditional gender roles established in the communities, minimizing the risks to potential participants.

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The interviews for both Mixtec women and midwives were conducted in Spanish and Mixtec languages. While I have spent several years studying the Mixtec language, at the time of the study, I did not possess an advanced understanding of the language sufficient to conduct the interviews by myself. My mother-in-law, a native of San Martin Durazno, a nearby Mixtec town located 20 minutes away from Juxtlahuaca, accompanied me during my interviews and served as my interpreter during my interviews with Mixtec women. As a respected elder in the community her assistance allowed me to establish rapport and create a network of Mixtec women in the community who felt comfortable talking to me about their experiences. My mother-in-law married into a family from Juxtlahuaca, establishing her own rapport with the community, becoming familiar with the ways of living, and building social relationships with Mixtecs families in this community.

RESEARCH QUESTIONS Birthing practices among Mixtec women reflect how cultural values and knowledge are expressed and transmitted. These practices also reveal an instance where women’s sense of agency emerges. This project seeks to understand the beliefs and practices surrounding maternal care and birthing practices of Mixtec women. The research questions included: 1. How do the beliefs, practices, and knowledge surrounding traditional birth among Mixtec women shape their cultural practices about birth and maternal health care? 2. How has this knowledge been negotiated among Mixtec women since the introduction of biomedicine and obstetric practices? 3. What is the role of midwifery and ethno-obstetrics in the Mixtec communities? 4. How has biomedical maternal care transformed the birthing practices of the indigenous women? 5. Have the infant mortality rates decreased with the introduction of biomedical models? 6. What is the role of Mixtec men within the maternal care and birthing practices of their wives? During the interviews, the participants were asked a series of questions regarding their childbirth practices and experiences, and their decision for either seeking medical care or using a local midwife to assist them during the delivery of their children. The Mixtec women were asked specifically about maternal and child care during and after childbirth. I was appreciative of the women who shared their knowledge about the herbal plants utilized during childbirth and those used for treatment post-birth. I documented the ways traditional

37 herbal plants were utilized. Many were used as herbal teas to ease the pain during and after childbirth including their use during baños de vapor (steam baths).

PROFILE OF MIXTEC WOMEN IN THE STUDY In addition to the qualitative data gathered through the semi-structured interviews, quantitative data was also collected to present a thorough analysis and depiction of the Mixtec women. The descriptive statistics included in the data analysis complements the responses provided by the participants in the interviews. The descriptive statistics provide a profile of the Mixtec women through their demographic data as well as standard practices. Although the sample size of 25 is small, preliminary findings from this study offer important demographic trends in relation to the role of biomedicine and childbirth practices in rural Oaxaca. Fieldwork and data were gathered during the summer of 2010. I interviewed 25 Mixtec women who had given birth to at least one child at the time of the study (see Table 1).

Distribution by Age Based on the age of the participants (N=25), the mean age of the women in the study was 48 years old (see Figure 4). The minimum age of the participants was 23 years old and the maximum was 80 years old. Six of the participants fell under the age between 20 to 30 years old, while 7 participants fell under the age of 31years to 40 years old. Eleven of the participants were under the age of 50 to 70 years old. The oldest participant was 80 years old at the time of the interview.

Language Among the women interviewed, 32% (N=8) of the participants only spoke Mixtec and another 36% (N=9) only spoke Spanish. Another 32% (N=8) of the women spoke both Mixtec and Spanish (see Table 2). In accommodating to the language barrier, the IMSS hospital in Juxtlahuaca has bilingual nurses to assist both Mixtec and Spanish speakers. As noted earlier in the thesis, the physician at the IMSS hospital noted that nurses must be bilingual in Spanish and Mixtec since the majority of people using the services speak either Spanish or Mixtec.

Table 1. Profile of the 25 Mixtec Women in Study Pseudonym Age Place of Children Breastfeeding Birth Assistance First Language Birth Pregnancy Guadalupe 23 Santa 2 8 months Doctor 17 Mixtec/Spanish Catarina Vanessa 24 Juxtlahuaca 4 3 months; then Doctor 17 years Spanish gives food María 26 Santa 4 8 months to 1 2 doctors; 2 midwives 18 Mixtec/Spanish Catarina year Yolanda 28 San Martin 1 6-8 months Doctor 26 Spanish Peras Laura 30 Juxtlahuaca 6 Doctor 22 years Spanish Paulina 30 Santa María 2 1 year Doctor 18 years Spanish Asunción *doctor recommended 6 months Juana 33 Santa María 3 1 year Doctor 22 years Spanish Natividad *Lost a baby Beatriz 40 Santa María 4 6 to 8 months Doctor 18 years Spanish Asunción Francisca 42 San Martin 9 total: 7 1 ½ years Only one midwife 16 years Mixtec and Durazno live 2 dead Spanish Norma 44 Juxtlahuaca 10 1 year Midwife for all births 16 years/ Both except used doctor for married at 14 last birth years Cecilia 48 Juxtlahuaca 10 1 year Mother-in-law 20 Spanish Silvia 50 Juxtlahuaca 6 total; 5 2 years Doctor 18 years Spanish live (table continues) 38

Table 1. (continued) Pseudonym Age Place of Children Breastfeeding Birth Assistance First Language Birth Pregnancy Carmen 50 Santa 4; 1 1-2 years 2 at home; 1 doctor in 14 Mixtec Catarina deceased the U.S. Maricruz 53 Santa 5 1 year Midwife and alone at Married- 16; Mixtec Catarina home children -18 Margarita 55 San Martin 6 1 year Midwife 16 years Mixtec Durazno Consuelo 55 San Martin 19 1 ½ years Mother-in- 18 years Mixtec and Durazno Law/Grandmother Spanish Amelia 57 Juxtlahuaca 2 1 year Mother-in-law 18 Spanish Flor 59 San Martin 14 1 ½ - 2 years At home 15 years Mixtec and Durazno Spanish Julia 60 San Martin 8 8 months to 1 Midwife and Mother-in- Mixtec/ little Birth Durazno year law Spanish attendant Julieta 60 Juxtlahuaca 10 1-1 ½ years Alone, used midwife for 19 Mixtec first pregnancy Rosa 62 Juxtlahuaca 10 2 years Midwife 15 years Mixtec Lorena 64 Juxtlahuaca 12 1 ½ - 2 years Midwife or alone 15 years Mixtec Leticia 65 San Martin 5 1 year Mom and Midwife 17 years. Mixtec/little Peras (mother-in-law) Spanish Sofia 67 San Martin 9 total: 3 2 years Midwife 16 years Mixtec Durazno men/3 women died Olga 80 Santa 8 1-2 years Alone at home and Married - Mixtec Catarina doctors 13yrs; children - 14yrs

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Figure 4. Distribution of women by age.

Table 2. Distribution of the Languages Spoken by the Mixtec Women Language Frequency Percent Mixtec 8 32.0 Spanish 9 36.0 Both 8 32.0 Total 25 100.0

Marriage and First Pregnancies Among the participants interviewed, thirteen or 52% (N=25) of the women had their first pregnancies at the ages between 14 to 17 years old, while 9 or 36% of the participants became pregnant for the first time between the ages of 18 years to 21 years old (see Table 3). Three of the women were 22 years to 26 years old during their first pregnancies. In general, Mixtec women married at a young age and a number of older women interviewed had married into arranged marriages by their parents. In all, the older women were more inclined

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Table 3. Distribution of Age at First Pregnancy for the Mixtec Women in the Study Age at First Pregnancy Frequency Percent 14-17 Years 13 52.0 18-21 Years 9 36.0 22-26 Years 3 12.0 N 25 100.0

towards arranged marriages than the younger generations of women. In the past, arranged marriages were customary since women were not allowed to have boyfriends or be involved in relationships. Anguiano (1997) explains, “Dating relationships hardly exist, and if they become present, they last at the most a month, then they have to ask the hand of the woman to date her. Parents do not let the daughter have boyfriends” (27).17 Arranged marriages are less customary, since most Mixtec women now have the option to marry the person they choose. In the interviews, the participants recalled the type of birth assistance they sought or the only assistance they had access to during the time of their pregnancies (see Table 4). Nine of the women indicated that their primary birth assistants were midwives, while 40% or 10 of the participants sought the birth assistance of doctors. Only 2 participants indicated that during their pregnancies, they sought the assistance of midwives for their first pregnancies and later sought the assistance of doctors for other pregnancies. Three women indicated being assisted by relatives such as their mothers and/or mother in-laws during the delivery of their babies. Only one of the participants stated that she did not have any assistance during her pregnancy and delivered her child alone. Based on the responses, there was fairly equal amount of women seeking the assistance of midwives and doctors, with a slightly greater number of women choosing the assistance of doctors. Among the women interviewed, 36% had one to four children, while another 36% of the women had five to eight children. Only one of the participants had 14 children, while

17 Translated from the book, Los Mixtecos en Nuevo Leon (Anguiano 1997:27), “Las relaciones de noviazgo casi no se dan, y si llegan a presentarse duran a lo mucho un mes, pues se tiene que pedir la mano de la mujer para poder salir con ella. Los padres no dejan a la hija tener novios.”

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Table 4. Type of Birth Assistance Sought by the Women in the Study Frequency Percent Midwives 9 36.0 Doctors 10 40.0 Both 2 8.0 Relatives 3 12.0 Alone 1 4.0 N 25 100.0 another participant had 19 children. Another 20% of the women had between nine to 12 children (see Table 5).

Table 5. Distribution of Number of Children for the Women in the Study Number of Children Frequency Percent 1-4 Children 9 36.0 5-8 Children 9 36.0 9-12 Children 5 20.0 13-16 Children 1 4.0 17-20 Children 1 4.0 N 25 100.0

Place of Birth Twenty-five women participated in the interview process. Thirty-six percent (N=9) of the women were born in Juxtlahuaca. Six or 24% of the women were born in San Martin Durazno. Another 20% (N=5) of the women were born in Santa Catarina. Among those women 8% (N=2) were born in San Martin Peras and another 8% were born in Santa María Asunción. Only one participant was born in Santa María Natividad (see Table 6). Three generations are present within the data— these include young women, middle aged women, and postmenopausal women. The age range of the Mixtec women is disbursed across these generations which allows for change to be observed in the childbirth practices and perspective of Mixtec women over time. The age of the participants affects the decisions each woman has made based on the availability of medical service and due to out-migration by the Mixtec people. In the past, the Mixtec women did not have the services now available through the IMSS hospital. Older women did not have the pressures of society to move

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Table 6. Distribution of Birth Place

Hometown Frequency Percent Juxtlahuaca 9 36.0 San Martin Durazno 6 24.0 San Martin Peras 2 8.0 Santa María Natividad 1 4.0 Santa María Asunción 2 8.0 Santa Catarina 5 20.0 Total 25 100.0

toward biomedical birthing whereas the younger women are more inclined toward biomedical services. In addition, the rate of out-migration from Mixtec communities is transforming the attitudes and perspectives health with younger Mixtec women more accepting of biomedicine and perceiving traditional healing as a practice of the past. In Chapter 7, I discuss the response of Mixtec women in Juxtlahuaca regarding the introduction of biomedicine within birthing practices.

PROTECTION OF INFORMANTS Approval from the Institutional Review Board for this thesis research was granted on July 21, 2010. In accordance with the IRB, potential participants were given a consent form in Spanish that explained the purpose and objectives of the study, confidentiality, the extent of their participation, and provided them with researcher’s contact information so that they can direct any questions or concerns in the future. I verbally explained to the participants the purpose of the consent form as well as explained the measures taken to protect the identity of the participants. Since the Mixtec language does not have standard alphabet and each community speaks a different variant, I did not provide the consent forms in Mixtec but sought the verbal authorization and recorded it along with the interview. In addition, the participants were informed of their right to cease their participation at any time. The safeguards implemented to protect the participants included providing pseudonyms in reports and field notes to protect the identity of the women and maintain confidentiality and anonymity. The names and identities of the participants will remain protected through their assigned pseudonym. In the research, and elsewhere, the informants

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will be referred to by their pseudonym. The potential risks are associated with privacy violations or disclosing the name of the participants. To reduce the risk, women were explained that a pseudonym will be assigned to them or they have the choice of using their real name, if they choose to do so. At public presentations and published work, the interviewees will be identified by pseudonyms and by demographic characteristics.

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CHAPTER 5

AUTHORITATIVE KNOWLEDGE AND BIOMEDICINE

Research on shifts in ideologies and practices among indigenous and rural people has been greatly influenced by the concept of authoritative knowledge (Jordan 1993; Sesia 1996). Authoritative knowledge is best described as an “interactionally grounded notion” and not knowledge that is embedded in positions of authority (Jordan 1992:4). Systems of authoritative knowledge are “socially constituted, displayed, and reinforced” by the people themselves (Sargent and Bascope 1996). It is knowledge that is transmitted and reproduced through social interactions and recreated through discourse. The examination of authoritative knowledge allows us to understand how knowledge is produced and reproduced in communities or societies as well as who gets to dominate such systems. Jordan’s (1992) analysis of authoritative knowledge explains the unequal relationship found between biomedicine and ethno-obstetrics particularly in high and low technological settings of birthing systems. Jordan (1992) argues that in “technological[ly] sophisticated social settings, such as the delivery room in a U.S. hospital, unequal access to information and to technology works to exclude laboring women from generating knowledge that ‘counts’”(Sesia 1996:131). This produces an unequal distribution of knowledge where biomedicine becomes validated and legitimized over other systems of knowledge thereby negating the value of accrued or experiential knowledge such as that of parteras (traditional midwives). Through the production of scientifically and technologically based knowledge, biomedicine has been validated as an authoritative form of care. It has been legitimized as an objectively valid form of knowledge and has held a privileged position from other forms of traditional health care. Moreover, Jordan argues that once the production and transmission of biomedical obstetric care in an institutional setting is perceived as authoritative and legitimized, this “not only devalues indigenous ethno-obstetric wisdom and skills, they disallow the very methods of indigenous knowledge and skill acquisition” (1989:935). This authoritative knowledge

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held by midwives, known as ethno-obstetric, is authoritative at the local level with the people and communities they serve. This form of knowledge is more evenly and broadly distributed among the people in the communities than is the medical knowledge which is knowledge only held by the few physicians and nurses. The authoritative knowledge of midwives then, becomes knowledge that ‘counts’ for the people because it is knowledge they understand, it is the standard care that they perceive as normal or correct, and it is knowledge they can reproduce (Sargent and Bascope 1996:218). In the growing medicalization of birth, primacy is given to the expertise and practice of physicians, “control of technology is linked to the decision-making authority surrounding birth” (Sargent and Bascope 1996:222). In the three cultures where Jordan (1978, 1993) examined the interplay between the biomedical system and traditional midwives, both practices and forms of knowledge competed with each other. The construction of biomedicine as authoritative in a birthing setting becomes problematic when “competing kinds of knowledge that are held by women or by other participants are judged irrelevant” (Jordan 1993: 152; Sargent and Bascope 1996:215). The contextualization of biomedicine as authoritative then becomes knowledge upon which decisions are made (Sargent and Bascope 1996) in the management, delivery, and care of childbirth and becomes accepted as the only form of care. Davis-Floyd (2001) argues that the decrease of midwifery in México is changing with the biomedicalization of birth, a practice regarded by a modernized society “as a premodern vestige of a more backward time that must necessarily vanish as modernization progresses” (4). In part, Kay (1982) argues, rapid westernization of the health sector, in particular, has played a significant role in redefining childbirth as an exclusive domain of professionally trained obstetrics (25). The decline in the use of traditional midwifery is evident as fewer midwives attend births in México. These traditional midwives, often in their old age, are not imparting their knowledge onto younger generations, resulting in an important cultural loss. Various studies have documented the changing birth practices in several indigenous cultures as the result of the increase in the application of biomedicine practiced in rural regions of México. Among notable studies documenting the changing birthing practices include Cosminsky’s (1977) ethnographic work among traditional midwives in Guatemala and Middle America; Jordan’s (1978, 1992) extensive cross-cultural comparison of birthing systems in four different cultures which includes the Mayan

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traditional midwives in the Yucatán region, and medicalization of birthing in the United States, Sweden, and Holland (Kay 1982) and Browner’s (1988, 1989b) work on the medicalization of pregnancy and prenatal care. Several anthropologists have acknowledged the shifting of birthing knowledge between traditional midwives and biomedical practitioners (Davis-Floyd and Sargent 1997; Jordan 1993; Kay 1982). This has been most succinctly documented by Jordan (1993) who notes that, “[a]t the present time, traditional birthing systems are undergoing tremendous change under the influence of Western medicine, while Western obstetric practices themselves have been under pressure to adjust to changing views of the position and competencies of the women and couples involved in birth” (5). Past ethnographies (Browner 1983, 1985, 1986, 1989a; Cosminsky 1977, 1982; Laderman 1983; MacCormack 1982) have explored how indigenous systems have been or are currently in danger of being disrupted by the importation of biomedical systems that often replace traditional birthing practices with a type of birth ‘management’ that relies heavily on machines, such as sonograms that are poorly understood, difficult or impossible to fix in rural areas, too costly to be widely offered, and that even in the West have not been shown to improve birth outcome in a variety of large-scale studies (Davis-Floyd and Sargent 1997:5). Further guided by the rhetoric of extending health and maternity care to the poor through biomedical practices, government officials and MDs refute the practices of midwives by arguing that with the increased availability of doctors and nurses in México, low income households are entitled to the same care and access as the middle class to hospitals and doctors to a larger population (Davis-Floyd 2001). Good Maust (2000) documents the increase of cesarean deliveries in Mérida, Yucatán. According to Mexican physicians, they believe that following technological interventions in the management of birthing such as cesareans are the safest approach for the health and well-being of both the mother and newborn child. Midwives are “a hangover from the undeveloped past” which must be replaced promptly by the “vanguard of the future—modern health care” (Davis-Floyd 2001). Within the medical field, physicians give continuity to the discourse of traditional midwifery as a “backward” practice. This notion is furthered in México despite the fact that in most cases, many clinics in rural communities continue to be understaffed and under-served (Davis-Floyd 2001:6).

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Kay argues that over two-thirds of babies in the developing world are delivered by traditional indigenous midwives who are regarded by their clients as having the knowledge and ability to handle and interpret their bodily manifestations (1982). Official medical personnel often believe that increasing the midwives’ knowledge through the application of western medicine in their practice would serve as an important factor in lowering death rates in societies where high infant mortality rates exist (Kay 1982:233). The White Ribbon Alliance is an international grassroots organization that focuses on improving the maternal mortalities and making childbirths safer for women around the world by building alliances and affecting policy (White Ribbon Alliance 2010). According to a 2010 report put forth by White Ribbon Alliance, “63% of the births in developing world attended by skilled health— including midwives as well as doctors and nurses with midwifery skills— up from 53 percent in 1990” (White Ribbon Alliance 2010). According to reports by the World Health Organization and United Nations, about 75% or maternal deaths around the world occur during childbirth or postpartum (World Health Organization 2005). Thus, White Ribbon Alliance suggests as a solution a cost effective approach that allows for the training and increase in skilled birth assistants combined with family planning and improvements to the health system, these can all aid in the prevention of maternal mortality, unintended pregnancies, and infant mortality. This organization advises that with the aid of skilled health workers, this would significantly improve the outcomes of deliveries, Increasing the availability of skilled health workers means more women survive childbirth and more children live through early infancy. A 10% increase in skilled health workers corresponds to a 5% reduction in maternal deaths. By increasing the number of midwives, Malaysia, Sri Lanka, and Thailand halved their maternal mortality ratios within 10 years between the 1950s and 1960s, and Egypt halved its maternal mortality ration between 1983 and 2000. (White Ribbon Alliance 2010) In Guatemala, such training programs have been implemented among Guatemalan midwives but because they are based on western biomedical models of birth, childbirth is perceived “as a disease rather than a normal process” (Kay 1982:250). This holds cultural implications in delivering an effective training program since they do not consider the cultural relevancy or cultural conceptualizations needed for women to implement practices that lead towards healthy pregnancies and in turn help reduce child and maternal mortality. In Mexico, traditional childbirth practices are gradually changing through the implementation of

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medical health care and midwifery training programs designed within the western notions of biomedicine. However, these training programs have been ineffective in their approach as they abandon the knowledge of existing practices in midwifery, their rationale, and their relationship to cultural understandings of birth (Kay 1982). In the interface between the biomedical and indigenous systems, rural and indigenous communities remain distrustful of the care provided to them by the medical system. In part, there is a lack of cultural relevance offered in the maternal care proposed in the biomedical model. The increased medicalization of birthing in rural and indigenous communities as well as in places with low technological systems of birthing, has disallowed women to be involved in the decision-making process or have any type of management over their births. This essentially disrupts women’s agentive relationship within their pregnancy and birthing process. There is a kind of agency attached to the relationship between a partera and an expectant mother. As Sesia (1996) explains, This is especially true with older and multiparous clients, whose experience with multiple pregnancies and birth are highly regarded and valued by parteras. Midwifery does not bring with it the imposition of vertical authority. Within the ethno-obstetric model of care, the women—not the midwife—is still the active agent. As we have seen, pregnant women decide when and how many times to visit their parteras. (133) This is true of the relationship with the parteras and Mixtec women I interviewed. The parteras possess an expertise acquired through their experiences with assisting, providing advice, and facilitating the process during birth deliveries (Sesia 1996:133); a knowledge which is being denied as authoritative by the biomedical system of birthing. The Mexican national health system is composed of two types of institutions that provide medical care to the citizenry— public and private. There are a number of public institutions, which include the Ministry of Health (SSA), Institute of Social Services and Security for Civil Servants (ISSSTE), Social Security for Oil Workers (Pemex), Social Security for Army Forces, Social Security for Navy Forces, Department of Federal District (DDF), individual State Services, and the Mexican Institute of Social Security (IMSS). The Mexican Institute of Social Security (IMSS) was created in Mexico City. Since its inception, Mexican hospitals and clinics have followed a medical system based on the IMSS model (Ortiz 2003). It is one of the largest public providers of health services that are

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considered as an affordable alternative for medical care, offering health care to approximately 50 million Mexicans, particularly private workers, their family dependants, and poor families in rural communities. Figures from1995 and 1996 estimate that IMSS covered a total of 41% of the population while the Ministry of Health (SSA) covered 30% of the total population (Reyes-Frausto 2001). In the six decades since the IMSS was founded, it extended their system of health care facilities, medical care, and health benefits throughout the country. Medical care and health benefits include: 1. Community Health 2. Reproductive and Maternal and Child Care 3. Occupational Health 4. Medical Care 5. Medical Education 6. Medical Research 7. Planning and Medical Infrastructure (Reyes-Frausto 2001:87) The medical care facilities that operate under IMSS range from small family clinics and general hospitals to rehabilitation units and specialty hospitals. In 2000, the Mexican Institute of Social Security (IMSS) was comprised of 1,450 family medicine clinics, 14,000 family physicians, 240 secondary care hospitals, and 10 tertiary care medical centers (Perez et al. 2000:1295). IMSS has continued to grow over the years. Covering almost half of the country’s population, however, it has been ineffective in providing and ensuring quality care due to its size and complexity. By the end of the 1970s, IMSS embarked on a new task— to provide medical health care to the peasant communities in México and create medical infrastructures in rural areas (Ortiz 2003:88). In recent years, the health care system in México has been influenced by the hegemonic system of the biomedical model favoring the more scientific based practices of health care. Through federal policies and implementation of public health initiatives, the intent has been to introduce biomedical services in communities where concepts and practices of traditional medicine persist. An important change came during the mid-1970s when the Mexican government initiated programs with the objective of transforming traditional midwifery practices by introducing biomedical approaches and modern technology (Davis-Floyd and Sargent 1997:398; Sesia 1996:122). In part, this change gave

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way to the recognition and acceptance of traditional medicine in México, and in particular the role of midwifery (Sesia 1996:122). In the Mexican culture, parteras have played an important role in the birthing practices of rural peasants in México. In the southern state of Oaxaca, for example, it is characterized by a predominately rural and low-income peasant population. Most deliveries and maternal health care were and continue to be offered by traditional midwives. Beginning in 1974 and throughout the early 1980s, more than 15,000 midwives in México were incorporated into the institutional health system through a series of training courses based on the biomedical system in prenatal care (Sesia 1996:123). In this effort, training in Oaxaca began in 1979 and continued through1985 where approximately 779 traditional parteras underwent training and became certified by the Mexican Institute for Social Security (Sesia 1996:123). These parteras were incorporated into the local institutional health care service with the objective of upgrading “‘midwives’ skills in prenatal care, to teach them to identify and refer out high-risk pregnancies and deliveries, and to enroll them in family planning campaigns” (Castaneda et al. 1992:268; Davis-Floyd and Sargent 1997:399; Sesia 1996:123). Sesia (1996) documents in her work with midwives in Southern Oaxaca that nothing changed substantially in the practice, care, or belief of childbearing by midwives after returning to their villages from these certification courses (Sesia 1996:126-127). Sesia (1996) explores the interplay between the authoritative knowledge practiced by traditional midwives and the implementation of the biomedical system in the birthing practices and prenatal care in the southeastern part of Oaxaca. As I will argue, what has affected the practice of the midwives was not the authoritative knowledge itself as a result of the training programs, but the services sought after by their clients.

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CHAPTER 6

MIXTEC HEALING: HEALTH BELIEFS AND TRADITIONAL CARE

It was a cold morning in Juxtlahuaca. The dew was setting in on the land under the overcast sky of Juxtlahuaca. The cold winds that covered the mountainous regions were slowly dissipating as the early morning sun began to shine and roosters reminded us that it was time to get up. My host mother was already at work gathering wood to build the firewood to begin preparing the first meal of the day. In the adjacent household, the sister-in- law, Norma, was also busy at work. Norma is a 44 year old Mixtec woman whose husband had died from an illness a year ago. She was left to take care of her four young children; her two older sons, who often migrated back and forth to the United States, had recently migrated to San Diego, California where they knew relatives to work in agriculture. I was amazed by Norma’s strength and fortitude to provide a living for her children. Without a male in the household, she would go out to her fields and perform the agricultural work that her husband would do. Despite her hardships, she always had a great attitude and was excited to talk to me about my research. She was fluent in both Mixtec and Spanish; however, the main language she regularly spoke was Spanish since she did not teach the Mixtec language to her children. Like most of the Mixtec households I visited, her house consisted of a small room made out of wood that served both as the kitchen and bedroom. As I walked into the kitchen, Norma greeted me with Chaa, a hello in Mixtec. She knew I was trying to learn Mixtec and with every opportunity she had, she tried to teach me a new word. Her mother, Doña Julia, was visiting her that morning. Doña Julia is a 60 year old Mixtec woman who used to be a birth attendant years ago. Now she only provides assistance to women who seek her guidance during their pregnancy or delivery. Doña Julia spoke very little Spanish while Mixtec is the main language she uses to communicate with. Norma was conversing with Doña Julia in Mixtec of her experiences as a birth assistant. Norma translated to me what Doña Julia recounted.

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Sitting down I took up balls of masa (flour) and put forth my best attempt at making tortillas with Norma. Doña Julia talked while we worked, recalling the difficulties she encountered while helping to deliver Norma’s first child. Norma had complications and trouble giving birth due to the contamination of mal aire (bad air) or espanto (fright). On the afternoon of that day, her daughter began to feel intense pains and was in labor for many hours. As Doña Julia explained, El niño no quería nacer. Ella tenía días con el dolor y el niño no quería nacer. No sabíamos porque estaba tomando mucho tiempo. Decidí hacerle una limpia porque tenía mal aire. Se acordó que cuando ella era más joven agarro un susto muy fuerte. There were complications with the baby being born. She had been in pain for days and she could not go into labor. We did not know why it was taking a long time. I decided to do a spiritual cleansing because we believed that she had been exposed to bad air. She remembered that when she was younger she had a big fright.18 Intertwined with ideas of spiritualism, religion, and traditional practices, Doña Julia decided to cleanse her daughter of any bad spirits she had or from any bad air that might have entered her body. Doña Julia recounted, Norma tenía como cinco o seis años cuando tuvo un susto. Norma estaba afuera jugando con sus hermanos cuando un perro de la calle llego y empezó a corretear a Norma. Estaba chiquita y no sabía qué hacer. El susto fue mal para ella cuando quería tener a su hijo. No lo podía tener hasta que le hice una limpia para quitarle el espanto. El bebé no nació hasta el otro día en la mañana. Por eso uno tiene que tener mucho cuidado cuando uno está embarazada y cuidarse. Norma was about five or six years when she had a scare. Norma was out playing with her brothers when a stray dog came and started to chase Norma. She was little and did not know what to do. The scare was bad for her when she was trying to give birth. She could not give birth until I did a spiritual cleanse to remove the fear. The baby was not born until the next day in the morning. That is why we must be careful when we are pregnant and take care of ourselves.19 As with other Mixtec women I spoke with, Doña Julia believes that evil spirits can intercept on the well-being of human beings. Like with any illness, pregnancy can also be affected by these forces. Midwives call on the help of spiritual powers to facilitate childbirth if they believe evil forces are present.

18 Interview with author, July 31, 2010. 19 Interview with author, July 31, 2010.

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Mixtec women conceptualize maternal care differently from the notions and paradigms found within the Western model of biomedicine. Concepts and terminology in biomedicine are often not translatable into the Mixtec language. In addition, the practices of birth and maternal care carried out by traditional midwives are often perceived as incomprehensible in the field of biomedicine. In many instances, the intersection of traditional ethno-obstetric knowledge practiced by parteras acts in contradiction with the biomedical system of care. The type of knowledge provided by traditional midwives is considered as ethno-obstetrics— “obstetric knowledge is collectively valued as the result of long years of practice and accrued hands-on experience” (McClain 1975; Sesia 1996:122).The prenatal care provided by traditional parteras is focused on the authoritative knowledge accrued by the women from the number of births they have participated in and knowledge acquired about birthing over time. In this chapter, I attempt to document various traditional practices and techniques involving maternal and infant care within the Mixtec culture.

NATURE AND ENVIRONMENT Approaches to Mixtec medicine, treatment, and healing are a syncretism of two distinct medical systems. The Mixtec are inheritors of the Pre-Columbian and the 15th century Spanish medicinal practices that encompass a blend of humoral, indigenous, and western medicine (Bade 1994). The syncretized medical concepts and ideas presently found within the rural Mixtec communities diverge from those central to contemporary biomedicine, differing in etiology, therapy, and concepts of prevention (Bade 1994). Within the Mixtec health system, the causation and origin of illness is based on witchcraft, evil spirits, and an imbalance with nature, differing greatly from the medical system. Treatment is also based on indigenous practices that encompass beliefs on a hot and cold complex and through the cleansing to the body of evil spirits to cure ailments where contemporary medicine calls for more scientifically based approaches. As Bade (1994) explains, “Non- medical health-care treatment in the Mixteca generally involves healing ceremonies with a strong religious content in which divine intervention is sought” (66). The Mixtec people use either type traditional or medical practices, depending on the type of illnesses diagnosed and tend to seek care based on their conceptualization of illnesses and the most effective

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treatment. The Mixtec people will usually first seek treatment from people in their community that possess traditional curative knowledge such as the yerberos (individuals who know about herbal remedies), hueseros (individuals who know how to relocate bones; bone- setters), and parteras (local traditional midwives). As a second option, Mixtec families seek medical care at the hospital or clinics but this type of care is often inaccessible to them or is too costly. The Mixtec have a close relationship with nature that has been maintained for generations, primarily because of their rural isolation and dependency on the natural environment. As a result, the worldview of the Mixtec people is conceptualized around notions of nature and the environment surrounding them, which also dictates their daily behavior and lifestyle. To maintain a balance between natures, they eat certain food at certain seasons, take into account hot and cold properties to remain in a healthy state, and try to avoid emotional stresses on their bodies that can cause illness. According to Rubel and Browner (1999), the Mixtec characterize health as a balance between nature that must be maintained in equilibrium with constant monitoring and adjustment over time (86). Therefore, the Mixtec people believe that: Causal explanations of illnesses, whether physical, emotional or mental, are attributed to a variety of imbalances suffered by the body. That is why it is believed that when an individual feels the loss of this balance due to a shock, a strong anger, to interpersonal conflict… or cold currents, these factors can cause a disease and, consequently, the indigenous person employs an important time to try to avoid circumstances that exposes to imbalances, fearing that it will affects his health. (Rubel and Browner 1999:86) The Mixtec people understand a good state of health as found in equilibrium with nature and the environment. This involves following certain rules that apply to what type of food is consumed at different seasons, controlling strong emotions, and abiding by principles of behavior and interaction that create equilibrium with their world; this in turn maintain a healthy state of being. Mixtec believe that hot and cold properties are important in maintaining equilibrium. However, these properties are not always related to temperature but rather on how something causes the body to respond. In the case of their environment Katz (1992) maintains that “The Mixtec consider the combination of heat and humidity as

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necessary for life and for fertility; the ideal moment for the sowing of the maize as in human procreation are dependent upon such conditions” (103)20 The Mixtec people conceive of the qualities found in the hot/cold and dry/humid duality as important and considered vital for determining appropriate times for the agriculture and procreation.

HOT AND COLD EQUILIBRIUM The hot and cold principle is part of the Mixtec health system where nature and supernatural forces are attached to notions of illness. The belief is that illness can occur as a result of mixing the categories hot/cold and dry/humid temperatures in distinct ways which can affect an individual’s state of health. These concepts as understood by the Mixtecs are also applied to their knowledge of life cycles, food consumptions, medicinal practices, and health, among other practices (Katz 1993). Foster (1976) and Currier (1966) argue that this principle of a hot and cold dichotomy practiced in the Mixtec culture has origins in the concepts of Greek humoral pathology, which were adopted in the Americas with the arrival of the Spaniards. Foster (1976) holds that this type of health system is better understood as a personalistic etiology where “the belief that all misfortune, disease included, is explained in the same way; illness, religion, and magic are inseparable; the most powerful curers have supernatural and magical powers, and their primary role is diagnostic” (773). On the other hand, Lopez Austin (1988) contends that the system of hot and cold principle as practiced in the Americas is unique and native to the region and it was practiced even before the conquest. Lopez Austin (1988) extensively documents the ideological system of the Nahuas including the health system and practices of the hot and cold polarity. The pathology of the Mixtec is one based on hot/cold properties where diseases or illnesses arise as a result of a disturbance of these conditions or the occurrence of an imbalance between these hot and cold elements. The hot and cold imbalances as well as other folk illnesses such as susto, evil eye, and bad spirits that have been documented among other indigenous groups in México are also found among Mixtec ideology (Kearney 1972; Rubel et al. 1984) and among other

20 Translated from “Del frio al exceso de calor: dieta alimenticia y salud en la Mixteca” (Katz 1992) “Los mixtecos consideran la combinación de calor y de humedad como necesaria a la vida y a la fertilidad; el momento ideal tanto para la siembras del maíz como para la procreación humana se ubica en tales condiciones” (103).

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people throughout Latin America and around the world (Turnbull 1987) that stem from the concepts of Hippocratic medicine. Glick (1967) notes that “it is common knowledge that in many cultures, ideas and practices relating to illness are for the most part inseparable from the domain of religious beliefs and practices” (32). In many cultures, religion, illness, and the supernatural are interwoven together which formulates the conceptualization of illness and healing rituals of a given culture. This is true of the Mixtecs who believe that the causation and prevention of illness are related to religious and supernatural forces. In depicting the world view of Zapotecs in the town of Ixtepeji in the state of Oaxaca, Kearney (1972) explains that,“Ixtepejanos believe that the world, including the air around them, is threatening and filled with dangerous beings, and that one’s intimates are also potentially dangerous… It is a basic tenet that humans are susceptible to frustration and envy, which in turn make them wish to harm others” (x). In the cosmology of the Zapotecs, they believe in omnipresent natural and supernatural entities that threaten the well being of people. These are in the form evil spirits, envy, deceit and frustration. People become susceptible to these forces causing them to fall ill. This is also true of the worldview of the Mixtec people who believe that supernatural aggression such as acts of jealousy, anger, bad spirits, and imbalance with nature threaten the wellbeing of an individual. In addition, the Mixtec people are wary of social interactions and interpersonal relationships that can manifest into evil spirits cast upon them. In their cosmology or way of interpreting their world around them, the Mixtec believe in witchcraft, the evil eye, Susto (fright), indigestion, the effects of 'hot' or 'cold' food and bad airs that cause children to become ‘chipil’ (gloomy or sad) which affects their health. Such illnesses are cured through the help of a spiritual healer (curandero) or through divination rituals also employed to cure ailments to the body (Anguiano 1997; Bade 1994).21 Susto is a common folk illness that has been documented in a number of cultures (Bolton 1981; Kearney 1972; Logan 1979; Rubel et

21 Translated from the book, Los Mixtecos en Nuevo Leon (Anguiano 1997:27), “embrujos, el mal de ojo, los sustos, los malos aires, el empacho, los efectos de las comida ‘caliente’ o frías’ y en el hecho de que los niños de ponen ‘chipil’ en ciertos momentos. Todo esto se cura con adivinación y desembrujamientos, por curanderos.”

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al. 1984; Salby Rosas 1958; Turnbull 1987). Rubel et al. (1984) examine susto among three populations in the region of Oaxaca—Mestizo, Zapotec, and Chinantec. Within the ideological framework of health and illness, the lack of well-being is associated with the loss of certain elements in the body such as blood, heat, or alma (the soul), powerful emotions, and an imbalance in the body (Rubel et al. 1984). As Rubel et al. (1984) explain, “Good health is equated with systemic harmony, or homeostasis. In a healthy body, balance is characterized by the even distribution of ‘hot’ and ‘cold’ humors. Anything that would disturb that distribution should be avoided” (31). In accordance with the Mixtec, the good health of individuals is found in a state of harmony or equilibrium. Healing practices are dictated by the illness and how it was obtained. If there is an imbalance, necessary procedures need to be taken to restore balance back to the body in the form of administration of certain foods, cleansing of the body of evil spirits, or avoiding strong emotions. In understanding the ideological framework of health and illness within the Mixtec community, religion, nature, and supernatural forces comprise important elements that inform the causation of illness and how it is subsequently treated and prevented. The hot and cold principle is embedded in the daily practices and beliefs of the Mixtec. According to Katz (1993) and Romney and Romney (1966), Mixtecs understand life cycles in terms of varying temperatures found in individuals throughout their lifetime. For instance, at birth, babies are considered to be in a cold, tender and delicate state. As the individual grows up, they progressively become hotter and again lose heat in old age (Katz 1993). During a person’s life, however, the hot temperatures can be altered as a consequence of illness or unstable health conditions. While individuals maintain a normal heat temperature through their life, it is believed that this can be altered by a disease or illness. In the case of women, menstruation and pregnancy can alter their normal heat temperature (Katz 1993). A common belief is that menstruating women are not supposed to be in the fields during sowing as their coldness can cause the crops to fail by affecting the soil and seed. After a mother gives birth, she is considered to be in a cold state after the loss of heat produced by the delivery. Thus, both the mother and the baby are considered to be in a cold, delicate, and unbalanced state. To recuperate and regain the necessary heat in their bodies, it is customary for women to complete steam baths using medicinal plants to reach normal temperatures. During the management of childbirth and postpartum, care is given considering the hot and cold

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dichotomy as well as maintaining an equilibrium with nature such as avoiding emotional disruptions to the body such as susto or anger, eating appropriate foods considering the hot and cold properties, and protecting against evil spirits.

ILLNESS Culture provides a window into meanings that are specific to a people. It can provide insights into how people conceive of health and the management of illnesses. In the etiology of the Mixtec medicine, sickness can result from various sources but is usually understood as conditions or phenomena that attack the psychological or physical well-being of an individual; this can include strong emotion (such as fear, anger, and jealousy), external agents, and evil spirits (Bade 1994:62). Some examples of ethnospecific illnesses include susto (strong fright), empacho (indigestion or intestinal blockage), mal de ojo (evil eye), and caida de mollera (sunken fontanelle on a baby’s skull). Romney and Romney (1966) list a number of factors that Mixtec people believe contribute to the attainment of illness including the following: 1. The disruption of emotional states such as fear and anger 2. The contamination of rituals 3. The magical strike by sorcery 4. Improper diet According to the Mixtec belief system, the evil eye, considered a form of magic or sorcery, can cause severe illness to an individual and is diagnosed by examining the inside of an egg. The evil eye is the result of an individual staring at an individual, such as a child, who may be in a weakened state or who lacks the ability to fend off the intended evil. This illness is attributed to the intentional or unintentional look of admiration or appraisal from an adult, “whose spirit is believed to be stronger and more willful, posing a danger to the welfare of the child’s weaker spirit” (Bade 1994:63). Particularly for Mixtec children, they are seen as more susceptible to malicious forces or the evil eye and they need to be protected from jealousy, fear and anger to prevent them from contracting an illness (Bade 1994). Specific rituals are performed to avoid or cure babies and young children from the evil eye or other malevolent forces. One such ritual requires a red string or a red-colored amulet to be tied on the child to protect them from the evil eye. If a child becomes ill as a result of the evil

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eye, it can be cured “only by the touch of the person who caused the contamination” (Romney and Romney 1966:76). The individual must touch the child to avoid transferring any other bad spirits and ease the weakened spirit of the child. Another way to avoid forms of evil spirits causing illness to children is to place a mirror next to the child to ward off any bad spirits when they are sleeping. Other sources of illness or ailments to the body are caused by the cold entering the body— an attack to the physical well-being. Mixtec people believe that digestive problems such as empacho occur as a result of an imbalance in the consumption of cold and hot foods. It is believed that in order to avoid certain ailments to the body that disrupt the equilibrium, individuals need to maintain a diet that avoids cold foods in favor of the consumption of hot foods (Katz 1992:105). For instance, digestive problems such as diarrhea are perceived as illnesses produced by poor digestion and the cold entering the body. Consuelo, a 55 year-old Mixtec woman, explained during our conversation on illnesses that diarrhea is caused by the cold foods and constipation is caused by drinking too much water or consuming food that is too hot. Besides the consumption of cold foods, other eating behaviors can cause bad indigestion including, “drinking too much water, eating too much, eating too fast, not eating at the right time, eating with dirty hands, and in the case of children, eating dirty things” (Katz 1992:105).22 Thus, a diet consisting of warm food is recommended to ease and cure digestive problems. Herbal teas and massages to the stomach are also recommended for treating digestive problems. The Mixtec people believe that bad health or illness can occur through the loss of one’s soul where is it believed that the soul detaches from the body. This occurs when an individual has a strong susto (strong fright or shocking experience) or strong emotions of anger or jealousy. The belief in espanto or susto (fright) is common among Mixtec people and among other groups in Latin America. For example, espanto or susto revolves around the belief that a child or an adult has lost his or her soul and therefore, it needs to be retrieved from the spot where it was lost (Romney and Romney 1966). The common effects that young

22 Translated from “Del frio al exceso de calor: dieta alimenticia y salud en la Mixteca” (Katz 1992) “por el hecho de tomar demasiada agua, de comer demasiado, de comer demasiado rápido, de ‘no comer a su hora’, de comer con las manos sucias y, en el caso de los niños, de comer cosas sucias” (105).

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children experience as result of an espanto or susto involve becoming listless, incessantly crying, and experiencing a loss of appetite. Special rituals are employed to cure illness in young children caused by espanto or susto. To cure espanto, the child needs to be taken to the location where he or she lost their spirit and retrieve it by performing a limpia (spiritual cleaning) to the body. This is done to restore the lost spirit back into the body. During this ritual, herbal plants are used to perform the limpia. The common herbal plants utilized are the pirul, el chicastle, el chamizo blanco, and an egg that is rubbed all over the affected person’s body. Subsequently, the name of the child is summoned so that the soul may return to the body. In the event that individuals contract an illness, they commonly refer to empirical healers such as curanderos (tyii kixi tata in Mixtec; traditional folk healer or shaman), parteras (traditional midwives), sobadoras (massage therapists), and yerberos (herbalists) who provided spiritual healing, health care, and traditional treatments. There is a distinction between each form of healer and the community perceives them differently. As Rubel and Browner (1999) explain, “In part, parteras, yerberos, and sobadoras learned their trade primarily through empirical practice by observing other family members. In contrast, the curanderos acquire their practice through various methods such as through dreams, study, or learned knowledge brought by another curandero who is better prepared and older” (89). There is often caution by community members when seeking the help of curanderos due to their association with witchcraft and sorcery that can be used to inflict evil or bad health unto people. In the diagnosis of an illness, healers focus on the circumstances or conditions which may have disturbed the physical or spiritual well-being of the individual, an approach that differs from biomedicine.

MEDICINAL PLANTS AND FOOD The botany of Oaxaca is rich and diverse and provides an abundance of flora for consumption, healing, and worship. The Mixtec, as with many other indigenous groups in Latin America, combine plants for medicinal purposes with ritual practices. As other studies have documented (Browner 1985; De la Fuente 1941; Sesia 1992), several linguistic groups in Oaxaca have adapted to different ecological niches. The cultural adaptations to their environment have shaped their conceptualizations of illness, knowledge of medicinal plants,

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traditional medicinal practices, health care, and responses to common illnesses (Rubel and Browner 1999). Understanding the ecological settings of the different linguistic groups in Oaxaca has contributed to the understanding of how each group explains the causations of illness and the development of different responses to healing. Katz (1997) affirms that these groups respond distinctively to health and illnesses based on their adaptations to their ecological environment. Some plants grow wild and only need to be collected while others are cultivated for domestic use. The hot and cold dichotomy is also considered important in medicinal forms of treatment. Some medicinal plants utilized for healing are classified as hot while others are classified as cold. The classification of food or plants as hot or cold is formulated through the association with their place of origin; for example, if they originate from tierras frias (cold lands) such as in the highland mountains of the Mixtec region, they are designated as a cold plants; likewise, if they originate from tierras calientes (hot lands), places such as the coast, they are classified as hot plants. A proper mixing of both hot and cold medicinal plants is believed to provide the necessary remedy for healing. The improper use of either hot or cold plants can be harmful. Medicinal plants are an important element for women during the management of childbirth and postpartum care. Midwives and Mixtec women, in general, make use of medicinal plants on a daily basis for home remedies and general uses for the treatment of illnesses. During my interviews, older Mixtec women, some of who had been midwives or birth attendants, showed me some of the medicinal plants they use for the steam baths during the delivery. An important collaborator was Consuelo. Consuelo is a 55 year old Mixtec woman born in San Martin Durazno. She still wears the traditional Mixtec clothing comprised of the traditional rebozo and floral dress. Her hair is tightly braided in two strands and is neatly tied up in a bun. When I first met her she was arriving to her house from the field. She was using the traditional basket with a tumpline, called ndo’o, around her forehead. She explained that she was growing some milpa and had just come from looking after them. She has a calm demeanor and spoke in a strong voice that exhibits her years of experiences and wisdom. She kindly greeted my mother-in-law and me and invited us into her house. She spoke while she made a mushroom soup for us. All three of us sat down on the hardened dirt floor inside Consuelo’s wooden kitchen as she began her

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preparation of the mushroom soup by taking a handful of mushrooms she found on her way from her cornfield. She rips the mushrooms piece by piece as she begins telling us the remedies and medicinal plants she has used over the years for the management of her own pregnancies and childbirth. A useful medicinal plant that Consuelo recommends using for women before going into labor to ease the pain of contractions is herba buena or also known as heirbita. As she explains, Para el dolor, me dieron un té de hierba buena (hierbita). Te tomas el té para el dolor. Es bueno también caminar mucho cuando los dolores empiezan. For the pain, they gave me a tea made out of hierba buena (mint leaves). You drink this tea for the pain. Lots of walking is also good when the pains begin.23 I was surprised to learn that Consuelo gave birth to 19 children, one of whom was deceased. Consuelo married at a young age and had her first baby at the age of 18 years old. She never sought the medical attention at a hospital setting for her deliveries. Much of the care provided to her during her childbirth was from her mother-in-law and grandmother. Flor is a 50 year old Mixtec woman from San Martin Durazno who also recommends a tea composed of poleo and hierba buena for the pain. Flor affirms that this tea also helps to quicken the pain for labor. As she states, También para el dolor es bueno tomar hierba buena y poleo, otra hierba para el dolor cuando va a nacer el bebé. El poleo también se puede usar para dar el baño Also for the pain is good to take hierba buena and poleo, another herb for the pain when the baby is about to be born. The poleo can also be used to give the steam bath.24 Margarita is a 50 year old Mixtec woman also from San Martin Durazno. For labor pains she recommends the mixture of two medicinal plants, cebo de chivo and romero, These are ground down then boiled and left to drink once it is cooled. Besides medicinal plants, Mixtec women also use other home remedies to ease any discomfort or pain. For instance, Consuelo offers another advice to ease any discomfort or pain after delivery,

23 Interview with author, August 1, 2010. 24 Interview with author, August 1, 2010.

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Cuando hay complicaciones después del parto, es bueno tomar aguardiente con sal costeña, que se remuelen bien, y se toma para que se corte la sangre. When there are complications after a delivery, it is good to drink aguardiente with salt, mix them well, as it helps to thin the blood.25 After birth, medicinal plants are also an important element in the management of health care for women. Mixtec women also make use of medicinal plants for the care of women in the postpartum stage to help them adjust to the changes in their bodies. For the most part, Mixtec women breastfeed their babies and they also utilize herbal plants to ensure that their bodies produce the necessary milk for their children. Consuelo comments on the usefulness of a flower used to aid milk production, Otro hierba que es bueno es la flor truenador. Es una flor blanca que se hace en té. Con agua caliente se echa en los pecho para que baje la leche Another herb that is good is the flower truenador. It is a white flower that is made into tea. With hot water, it is placed on top of the breast so the milk can flow.26 Ruda and romero are two medicinal plants typically used for steam baths after childbirth. Throughout my stay in Juxtlahuaca and my many conversations with Mixtec women, they would not only give me advice on what medicinal plants to use and how I should perform healing rituals but also how to cure common illnesses. The knowledge they provided me was invaluable and they were appreciative that I wanted to learn about their traditional practices. As some would comment, many of the younger Mixtec people believed that such practices are from the past and would reinforce the importance in medical treatment. Here, I document some of the home remedies and healing rituals that many of the Mixtec women kindly shared with me. One plant that was commonly named among the Mixtec women and is frequently used for common illnesses is Ruda (yuku lota- in Mixtec). Among some of the practical uses for Ruda is the cleansing of people of bad spirits as well as their use in healing an open wound on the skin. Ruda and aguardiente, a strong distilled alcoholic beverage, are used together for the treatment of mal aire (bad air) or mal de ojo (evil eye). Symptoms arising from these can be cured by blowing aguardiente all over the patient’s body and then

25 Interview with author, August 1, 2010. 26 Interview with author, August 1, 2010.

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sweeping the patient’s body with ruda. Consuelo recommends using a blend of ruda with another medicinal plant, “Para el mal de ojo es bueno usar una hierba que se llama barba de viejo con ruda” (For the evil eye it is good to use an herb that is called with barba de viejo with ruda). Doña Rosa, a 62 year old Mixtec woman, uses Ita Pila, a plant that grows near fresh water springs, as a useful curative plant utilized to help people with depression. Among the many plants the Mixtec women shared with me was the use of avocado leaves, which help heal bumps and bruises (golpes y moretones). Digestive and intestinal illnesses are usually common in rural communities due to the lack of potable water and unsanitary conditions. Indigestion can be cured by giving the person a cup of lemon juice with coastal salt (which is brought from the Mixteca Costa region) or household salt. Garlic is also used by the Mixtec people to cure people from bad spirits. A strand of garlic is hung at the entry way of a household to deflect bad spirits (See Appendix for a list of medicinal plants and their uses). Food is another important area of concern for Mixtec people since they believe this is where some illnesses are derived and are directly related to notions of hot and cold as previously mentioned. Food must also be understood within the frame of the seasons that are also correlated to time. The Mixtec people distinguish time by two seasons, the rainy season and the time of drought. Humidity, common during the hot rainy season, is associated with notions of vegetation and fertility while the drought or dry season that occurs in the winter is related to notions of infertility. This influences the perceptions carried by the Mixtec people regarding the proper food that can be consumed during particular times. Thus, their diet revolves around categories of cold and hot, dry and wet, raw and cooked (Katz and Vargas 1990:20). The dichotomy of hot and cold is also attributed to food and more specifically in relation to how certain ailments are acquired. Romney and Romney (1966) documented this cultural phenomenon, explaining this belief among Mixtec people in Juxtlahuaca, “The hot- cold complex is important, then, not only in diagnosis but also in the treatment of illness. Avoidance of the type of food which caused the illness is one aspect of curing. Another is the administration of cooling or refreshing foods or herb baths, when the illness is regarded as a hot one.” (75) This duality is important in associating foods and the proper time to consume them to successfully heal any ailment or cure specific illnesses. Certain types of foods such as milk, avocado, cheese, and beans are considered cold and should not be consumed during

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cold seasons as they can upset the stomach which can lead to diarrhea or digestive problems. In addition, people need to avoid eating food that is excessively hot.

LA PARTERA (THE MIDWIFE) In Oaxaca, and among many Mesoamerican indigenous groups, the partera has played a vital role in their communities delivering babies and providing maternal and reproductive health care. Most indigenous midwives inherited their knowledge from their mothers or mothers-in-law— a form of authoritative knowledge derived from community knowledge. Knowledge is conveyed through direct observation and gained from their own experiences with their pregnancies and deliveries. Other midwives acquire their knowledge from other midwives in the community or are encouraged to follow the practice of midwifery as a ‘calling’ derived from a dream or vision. As members of the same community, midwives are essential for providing maternal and childbirth care to women as they share parallel perspectives and beliefs about the body, how it functions, and share similar belief and knowledge of traditional medicinal plants. Their cultural background facilitates the relationship between the parteras and the women seeking their services. Women in the community adhere to the practices of the parteras, as these comply with the symbolic order and norms accepted in the social organization of their community (Cosminsky 1977). The familiarity that local women have with the practices of the parteras, including the herbs they use, provides them with a space where they feel comfortable with the maternal and child care they receive. While the biomedical system recognizes the usefulness of the empirical knowledge and traditional practices of midwives, and the fundamental role they play in providing ethno- obstetrics and gynecology care to indigenous women who do not have access to medical care, they are nevertheless in a relation of inequality “where the midwives represent a subordinate attention model set against the hegemony of the official system of health” (Diez- Urdanivia and Pérez-Gil 1996:212).27 As in the past, the role of midwives remains of

27 Translated from the article, “Practicas de Salud Reproductiva en Zonas Indígenas del Estado de Oaxaca” (Díez-Urdanivia & Pérez-Gil 1996 In Sexualidad y Reproducción Humana en México) “…sin embargo, se mantiene una relación de desigualdad en donde las parteras representan un modelo de atención subalterna frente a la hegemonía del sistema oficial de salud (212).

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fundamental importance in México, especially in rural and indigenous regions where medical care is limited, and at times, inaccessible. Working with midwives in the Isthmus of Tehuantepec, Sesia et al. (1988) document the importance of their roles in the community and the services they provide to rural and indigenous communities. In this region, they observe that the indigenous empirical midwives maintain their dominant positions providing their services to pregnant women and babies in spite of the increasing presence of institutional services in the community. As discussed earlier, during the 1970s, there was an attempt to integrate traditional midwives into the health care system through training courses offered by the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social, IMSS). The training courses had specific aims and objectives in improving the maternal and child care offered by traditional midwives. These courses intended to: (1) improve the attention provided by the midwife especially in terms of hygiene, the advice on prenatal care and post-natal care, the identification of high risk pregnancies and channeling them to institutional medical services; (2) Using midwives in the introduction and promotion of family planning practices; (3) Train them in basic primary health care, environmental sanitation, hygiene and nutrition in order to utilize them as promoters of low-cost community health; and lastly, (4) register all the empirical midwives operating in the region. (Sesia et al. 1988:72) 28 Despite the integration and attempt of the national government to address the type of maternal and child care provided by traditional midwives, the institutional programs have had little impact in modifying the practices and treatment followed by midwives besides an improvement in the hygienic conditions during childbirth. A number of components in the training courses offered by the biomedical model for traditional midwives have been criticized and viewed as problematic. One component seen as problematic is the insistence on adopting the obstetric horizontal positioning of women

28 Translated from the article, “Las parteras en el Istmo de Tehuantepec: reflexiones de trabajo” (Sesia, Galange, and Alejandre 1988) "1) Mejorar la atención proporcionada por la partera en lo que se refiere en especial a la higiene, los consejos sobre el cuidado pre-natal y post-natal, la identificación de embarazos de alto riesgo y la canalización de los mismos a los servicios médicos institucionales; 2) Utilizar a la partera en la introducción y promoción de prácticas de planificación familiar; 3) Entrenar a la misma en conocimientos básico de atención primaria, saneamiento ambiental, higiene y nutrición con el fin de utilizarla como promotora de salud comunitaria de bajo costo; 4) registrar a todas las parteras empíricas operantes en la región "

68 during labor. As one Mixtec women in the study comments, the best position for the woman to be in during labor is kneeling down. This is the most natural position for women during labor because they can receive the care they need to ease the pain. The midwife or husband can massage the back or hips of the woman as well as help her when she is pushing the baby out by being her physical support. Outside of the Western model of obstetric care, this practice is perceived as an unnatural position which only privileges the commodity of the doctor rather than the mother (Sesia et al. 1988). Another criticism for the training program has been the insistence for midwives to abandon their traditional knowledge as an acknowledgement of the perceived risks involved in their practice, and favor the biomedical form of care. In consequence, this has resulted in the underestimation of the midwives’ own cultural knowledge by the medical field further rendering these practices as illogical and unconventional. In addition, the inefficiency of the health training programs also revolves around the relationship established by medical personnel, a relationship based on a paternalistic and authoritative tone. The unreciprocated relationship materialized in a distrust of the medical model among midwives (Sesia et al. 1988). In the Isthmus of Tehuantepec, the programs became problematic for the midwives due to the structure of the program. The courses for the program were designed “centrally, outside the context of application…[imposing an] uncritical learning of practices and knowledge beyond their reality and worldview, trying at the same time to incorporate them into a system of sanitary medical health care whose aims are to them incomprehensible” (Sesia et al., 1988:75).29 The ethno-obstetric model of maternal care provided by local midwives has been sustained by the continuous production of knowledge. This has become the basis for the effectiveness of this shared model followed by midwives in their local communities. It is a knowledge that is socially constructed and reproduced, and most importantly, reinforced by members in the community at the local level (Sesia 1996). However, what happens when this knowledge is not actively being reproduced within the community? The cultural loss when such knowledge

29 Translated from the article, “Las parteras en el Istmo de Tehuantepec: reflexiones de trabajo” (Sesia, Galange, and Alejandre 1988), “Los programas y los cursos se idean a nivel central, afuera de su contexto de aplicación; a las parteras se les impone el aprendizaje acrítico de prácticas y conocimientos ajenos a su realidad y cosmovisión; tratando al mismo tiempo de incorporarlas en un sistema de atención medica sanitaria cuyas finalidades son para ellas incomprensibles” (75).

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is not shared among the younger generations will be difficult to reinvent or recreate in the future. Sesia’s findings in the Isthmus also are the case for parteras in Juxtlahuaca. The reproduction of traditional practices and knowledge about pregnancy, childbirth, and reproductive health is gradually dissipating among the younger generations of Mixtec women. One explanation for the decline in the reproduction of ethno-obstetric traditional knowledge is the increased availability of obstetric care at the local IMSS hospital in Juxtlahuaca. As Francisca, a 42 year old Mixtec woman in the study explains, the IMSS and the Oportunidades program promotes reproductive health in Juxtlahuaca and nearby communities by holding several workshops regarding women’s health. Francisca talked about her enrollment in the program called Oportunidades, which began in 1997. Opprtunidades is a program funded by the Mexican government which offers maternal and infant healthcare, provides a small stipend to families who have children in school, and promotes health and nutritional education among other resources to low-income, rural, and most marginalized sectors of society (Oportunidades 2011). In addition, nurses in Juxtlahuaca travel to nearby communities to perform maternal care for expectant mothers who are unable to travel to Juxtlahuaca. Secondly, the influence of the biomedical care in the community has led younger Mixtec people to associate traditional care as something of the past and of indigenous heritage. Some of the Mixtec women in the study expressed the common stereotypes associated with midwifery and traditional practices. They stated that some of the common misconceptions people hold of the traditional practices are that they are backward, superstitious, and ignorant— a legacy of the discourse fomented by the government-led training programs negating the value of indigenous ethno-obstetric knowledge. In essence, these misconceptions have prevented many of the younger generations of Mixtec women from seeking traditional forms of care and instead opting for medicalized care. Younger generations of Mixtec people have begun to conceptualize treatment through different points of view. This was indicative from the younger Mixtec women I interviewed whose notions of health are changing as a result of the increasing acceptance of misconceptions regarding indigenous care, new perspectives about health brought to the community through migration, and the availability of medical care at the local

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IMSS hospital. These factors have all provided obstacles in continuing the reproduction of Mixtec traditional practices (See Chapter 7 for further discussion). Many of the parteras or birth attendants interviewed in this study received no prior training and acquired their skills while assisting other women giving birth in their families. The older Mixtec women I interviewed informed me that they would share any experiential knowledge they had about the management of pregnancy, childbirth, and postpartum recovery period particularly the baños de vapor or steam baths. Presently, few Mixtec women possess traditional curative knowledge or continue with such practices. The documentation of the birthing practices, management of birth, and knowledge of parteras has been limited by both the national health care system and new ideas on health obtained through migration. As I talked to more Mixtec women, most would address the issue of the small remaining number of midwives left to serve in the communities. Because of old age or death, the number of midwives in Juxtlahuaca is very few and most women could only name one or two left in the community.

MANAGEMENT OF BIRTH There is an understanding that childbirth and mothering are important albeit normal occurrences in a Mixtec woman’s lifetime. During pregnancy, Mixtec women are expected to continue with their daily activities and perform their normal chores inside the household (Kirsis 1996:68). Even at the last stages of their pregnancies, Mixtec women still gather wood, cook, wash clothes, and if they have other children, they take care of them. Based on the local notions of pregnancy and childbirth, there are no taboos that prevent Mixtec women from performing their daily tasks with the exception of refraining from carrying heavy objects (Romney and Romney 1966:89). Pregnancy and childbirth are not medicalized in the Mixtec culture as they have become in other countries, particularly in developed countries. Based on the medical model in western societies, the state of being pregnant carries both social and medical implications where the meaning of pregnancy is embedded with meaning of illness and categorized as a ‘potentially pathological’ that needs to be treated accordingly (Arney 1982; Oakley 1984). Thus, western societies have medicalized the management of labor or birth and treat it as an illness (Comaroff 1977; Teijlingen 2005). In the medicalization of pregnancy and childbirth, pregnancies are only perceived normal in

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retrospect (Teijlingen 2005). The medical model emphasizes risk reduction. Statistical models are utilized to reduce the risks in childbirth; these risks are measured in morbidity and mortality statistics. Women undergo a standard medical process throughout their pregnancies and are treated as passive patients that must be cared for by obstetricians. In the medical model, pregnancy is doctor-centered and medical intervention is necessary while the midwifery model adheres to the notions that pregnancy is a normal physiological process (Teijlingen 2005). As a local practice, mothers and mothers-in-law are present at the time of delivery. The norm requires both families be present and assist during the delivery of a child to ensure that if something may go wrong or complications may occur, both families are present and blame shall not be placed upon a specific person or family. Husbands are allowed to be present during labor assisting “with the mother off her feet during a contraction” or assist when the mother begins to push (Kirsis 1996:71). However, not all husbands are present at birth, either because they do not want to be present or because at the moment of the delivery they are working. Expectant mothers commonly seek the services of midwives for prenatal and postnatal care only when needed in circumstances that the medical option is not viable. Midwives provide various services including sobadas or massages to reposition the baby when it was found in a bad position by massaging the abdomen of the woman, assist during the delivery of the baby, and after childbirth, they assist with steam baths. During my conversations with the Mixtec women and local midwives in Juxtlahuaca, they imparted their knowledge of several techniques they utilized during and after labor. They also rely on several techniques to facilitate the process of expel the placenta afterwards. During the delivery of the baby, the partera is always attentive to the mother providing her with warm water to drink, massaging her, keeping her calm and company during the long hours of labor. Special herbal preparations may be required to help induce labor. One preparation requires the use of fresh pine resin with roots from a corn plant. The fresh pine resin is boiled with three roots and is consumed while warm. For the care of labor pains, a Mixtec woman affirmed that midwives administer teas made of peppermint, hierba buena, or valeriana among other plants. Another herbal preparation involves a type of brew made with sage as documented by Romney and Romney (1966:90). When the child begins to emerge, the midwife positions herself in front of the mother to receive the child, another woman or

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sometimes the husband, holds the mother down strongly by the waist. A practice noted by a Mixtec woman is the use of a wide sash made out of palm30 that is placed around the woman’s waist tightly to help with the contractions (see Figure 5). The sash is tied at the top of the woman’s stomach and it is believed to help push the baby down during labor while preventing the placenta from rising after birth. The Mixtec woman also claims that another value of using the sash is its use in expelling the placenta more rapidly. In recent years, the sash has been replaced with the use of a rebozo (shawl) that is tied around the mother’s stomach. Doña Julia, a 60 year old widow and Mixtec woman born in San Martin Durazno used to be a birth attendant for people in the community who sought her help. She gained her knowledge from her own childbirths and from assisting her relatives with their deliveries. Women began seeking her help after people recommended her and she became recognized for her knowledge. As Doña Julia (60 years) explains, Primero te incas encima del petate, te pones fuerte, no nos vamos a tener miedo. Cuando uno tiene miedo es mal para uno. El rebozo se usa durante el parto. Se amara alrededor de la boca del estomago para ayudar a la mamá empujar” First, you kneel down on top of the palm mat. You have to be strong, you must not be afraid. The rebozo is used during delivery. It is tied around the top of the stomach to help the mother push during delivery.31 After the child is born, the midwife continues the delivery process by helping the mother expel the placenta. The midwives I interviewed discussed several techniques to extract the placenta. A technique used by the midwife to help exert the placenta is to provoke nausea, giving the women the strength necessary to continue pushing. For the removal of the placenta, the women would devise several measures to extract the placenta. Some midwives would give tés amargos (bitter teas) that would make the women keep pushing until the placenta was extracted. One woman suggested that some midwives would make a tea out of the tail of a tlacuache (opossum) to provoke nausea and that would help the women to extract the placenta. In addition, Romney and Romney (1966) documented several techniques among the Mixtec women in Juxtlahuaca. One technique involves the consumption of two

30 Ordinarily, the sash is utilized as a belt by Mixtec women. Its palm material wraps around the waist and it then tied with the rebozo. Now, Mixtec women rarely use this sash. 31 Interview with author, July 31, 2010.

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Figure 5. This rebozo is used during delivery. It is tied around the top of the waist of the mother to help during contractions and pushing. raw eggs and a tea. In their ethnography, Romney and Romney (1966) detail, “To help [a woman] make sufficient exertion, she is given two raw eggs to eat. These are broken directly into her mouth by the midwife or one of the other women present. When the pain begins, she is given a bitter tea made from artemisa, which is supposed to help expel the child” (Romney and Romney 1966:93). However, this technique was not mentions as practiced by any of the midwives I interviewed or used on any of the Mixtec women during childbirth. As I spoke with, Doña Julia, she noted the importance of knowing how to extract the placenta and taking care of the umbilical cord. Birth attendants or midwives must be experienced in this area since it can lead to complications or even death for the mothers. She spoke of an incident at the local clinic where a nurse was assisting a Mixtec woman in childbirth. Once the baby was born, the nurse was not careful and let go of the umbilical cord and instantly caused death to the mother. Many of the women in the study recommended that after giving birth, women should not bathe soon after birth to help the blood circulate completely; however, in medical

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settings, women are recommended otherwise. Women are allowed to take a bath the next day after birth (Kirsis 1996). Days after giving birth, midwives recommend that new mothers take a bath with medicinal plants in a baño de temezcal and rest for forty days. This postpartum rest is called la cuarentena, which is a forty day period where the women recuperates from childbirth and takes the time to breastfeed and take care of her newborn. This tradition is practiced in many Latin American countries, Mexico, and the Unites States. However, in the recent years, the forty-day rest period is not practiced as it was in the past. As Diez-Urdanivia and Pérez-Gil (1996) affirm, “the quarantine has been falling into disuse, since women have the need to enter the field and domestic work” (217).32 The Mixtec women in this study also noted the growing disuse of la cuarentena. Most noted that because of the exigencies of household chores and taking care of their families, they begin their daily routine of chores only a few days after giving birth. As Consuelo explained, Uno tiene que seguir trabajando en la casa después de que uno da a luz. No hay nadien que nos cuide o cuide a nuestros niños o nos haga de comer You have to keep working in the house after one gives birth. There is no one to care for us or take care of our children or who can cook for us.33 Many of the women I interviewed discussed the problematic situation they found after they gave birth. They talk about continuing their daily household work after giving childbirth a few days after and even work during their pregnancy. Women also commented on the absence of care they would receive after childbirth. They explain that no one would care for them. Flor (59 years old) describes, Uno tiene que seguir trabajando. Cuando yo estaba embarazada, yo tenía que seguir trabajando. Ponía el nixtamal para hacer las tortillas, yo hacia los quehaceres de la casa One has to continue working. When I was pregnant, I had to continue working. I put the nixtamal to make tortillas; I would do the chores of the house.34

32 Translated from the article, “Practicas de Salud Reproductiva en Zonas Indígenas del Estado de Oaxaca” (Díez-Urdanivia & Pérez-Gil 1996 In Sexualidad y Reproducción Humana en México) “la cuarentena ha ido quedando en desuso, ya que las mujeres tienen la necesidad de incorporarse a los trabajos de campo y domésticos” (Diez-Urdanivia & Pérez-Gil 2006:217). 33 Interview with author, August 1, 2010. 34 Interview with author, August 1, 2010.

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As Rosa (62 years old) further states, there was no one to take care of her when she gave birth and needed to prepare in advance to not burden herself or her husband with more work. A day or two in advance, Rosa would make tortillas so there would be enough to consume while she recovered. Rosa is a 62 year old Mixtec woman who had 10 children. As she made tortillas for the family, she recounted her experiences with childbirth. When I asked her about the care provided for woman during pregnancy and after childbirth, she explained that they take care of themselves. Rosa explains, Mientras que estaba embarazada, yo todavía trabajaría. Aquí, las mujeres trabajan si estén embarazadas porque no hay nadie que nos cuide a nosotros o a nuestra familia cuando damos a luz. Yo todavía trabajaba, cocinaba, limpiaba, y cuidaba a mis otros niños. Trabajaba mientras estaba embarazada hasta que tuve a mi bebé. While I was pregnant, I would still work. Here, women work even if they are pregnant because there is no one to take care of us or our family when we give birth. I would still work, cook, clean, and take care of my other children. I would work while I was pregnant until I had my baby.35 Standing up, Rosa demonstrates how a pregnant women would carry a basket on one side and an infant on the other side, Cuando yo iba al campo para llevar comida a mi esposo o buscar leña, yo cargaba a mi bebé a un lado y el tenate en el otro lado. Uno no es delicada When I would go to the campo (mountain) to take food to my husband or get wood, I would carry one baby on one side, and a tenate on the other side. One is not delicate.36 Even while pregnant, women are not considered to be ill and can still perform their normal duties. Women continue to cook, clean, gather wood and water, wash clothes, and take care of their other children. After childbirth, it is important for the new mothers to stay healthy to regain their strength and for the mothers to produce breast milk. In addition to steam baths, Mixtec women also recommend new mothers to add vapor to the breast with medicinal plants to help them produce breast milk. The majority of the Mixtec women in the study breastfeed their child for more than a year and it was important that they take care of their bodies to supply

35 Interview with author, August 1, 2010. 36 Interview with author, August 1, 2010.

76 the necessary milk for their children. Despite that doctors at the local IMSS hospital recommend Mixtec women to breastfeed for 6 to 8 months, women continue to breastfeed up to one year or more.

BAÑOS DE VAPOR— STEAM BATHS Ethnographic and archaeological records indicate the existence of steam baths used throughout Mesoamerica. These served various functions including therapeutic use, hygienic purposes, and for ritual practices (Katz 1997). Archaeological records show several types and constructions of steam baths throughout the Americas. One type of structure is built with adobe and is a permanent structure known as baño de refresco (Romney and Romney 1966:75) or the temezcal (Katz 1997:157). In the Mixtec region and Juxtlahuaca, these structures are commonly recognized as the temezcal (see Figure 6). More temporary structures are known as baño de torito, made out of wooden sticks (Katz 1997:157; Romney and Romney 1966:75). The framework of the baño de torito is constructed out of sticks arched in a rectangular shape. The structure is covered with several layers of mats to preserve the heat inside (see Figure 7). A fireplace made out of stone rocks is located at one end which is used to create the steam. Throughout the bath, water is poured inside the rocks to maintain the steam and heat. At the other end lies the entrance way. A woman with the experience and knowledge of how to conduct steam baths will go inside with the recent mother and stroke her gently with herbal plants all around her body. As Katz (1997) details, “the recent mother lies down in the steam bath; the person that ‘knows how to bathe,’ will lie down next to her and browse her gently with leaves… from head to toe” (158)37. Before and during the steam bath, women are given a warm tea to drink made out of herbal plants to avoid dehydration from the heat, before and after the steam baths. In the Mixteca Region and throughout Mesoamerican indigenous cultures, baños de vapor (steam baths) are important cultural practices also used for curative and postpartum care (Katz 1997). The baños de vapor are herbal curative baths that function to restore the

37 Translated from “Baños terapéuticos y postparto entre los indígenas de la Mixteca Alta (México) (Katz 1997) “La recién parida se acuesta en el bano; la persona que ‘sabe banar’ se acuesta a su lado y la fustiga con hojas… desde la cabeza hasta los pies…” (158).

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Figure 6. A structure of an old Baño de Vapor made out of stone rocks.

Figure 7. A model of the structure representing a baño de torito or temezcal.

78 heat and hot temperatures in individuals. Steam baths are conceived as cooking the ill- stricken body to eliminate ailments caused by the cold entering the body (Katz 1997:60). For mothers and newborns, steam baths are conceptualized as cooking the women’s tender bodies to recuperate the heat lost during the delivery and return to a healthy state. According to Katz (1997) a steam bath, “purifies through fire and water, are used to cure various diseases and to heal new mothers; and, in some cases, steams baths were used before and during labor, in rituals of birth and death” (154)38. In addition, certain diseases such as measles, malaria, swellings, and skin diseases are said to be cured through steam baths. In the Mixteca region, a primary use of the steam baths is for postpartum care. After women give birth, they are cured with baños de vapor (steam baths) to help their bodies regain a balanced state and help the healing process after postpartum. According to Mixtec belief, women’s bodies become cold and their wombs are believed to become dry. In order to recover the normal moisture of heat and humidity in the body, women need to be ‘cooked’ in the steam bath (Katz 1997). Steam baths are believed to restore the lost heat from their bodies and restore the moisture conditions essential for their continued fertility. The Mixtec women also believe that the new mother cannot heal if her body is not cooked and heat is not restored to her body. Bathing with cold water will be harmful to her health (Katz 1997:158). Mixtec women advise a woman not to bathe with cold water following the days after giving birth because it can be harmful for her recovering body and it also can stop the flow of milk. Baños de vapor are given to mothers and the newborn child to restore the heat and humidity after childbirth, as the high temperatures serve to disinfect the mother’s scars and help her heal faster (Katz 1997). It is customary for the mother and sometimes the newborn baby, for a few minutes and at a low temperature, to be bathed in the steam baths every three days during the twenty to forty days of postpartum care (Katz 1997). Usually, the baby is bathed in the steam bath for a shorter time than the mother and little steam is used. As well, the baby is browsed gently with herbal plants. This ritual must be performed by someone who is

38 Translated from “Baños terapéuticos y postparto entre los indígenas de la Mixteca Alta (México)” (Katz 1997) “el baño purifica por medio del fuego y del agua, sirve para curar varias enfermedades y para que sanen las recién paridas; en algunos casos, se ocupa antes y durante el parto, en ritos de nacimiento y de muerte” (154).

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experienced in giving sweat baths. Bade, acknowledging the research of Cresson and Mason argues, “Sweat baths spirits are especially dangerous and easily offended. Failure to properly perform a sweat bath childbirth ceremony or failure to placate the spirit of a disused sweatbath with a ceremonial soil ritual will expose one to the wrath of these spirits” (Bade 1994:62). An important element of the steam baths is the use of herbal plants. Mixtec people categorize certain herbal plants as cold and hot based on their specific functions. Katz (1997) has documented the use of herbal plants during steam baths among the Mixtecs in the highlands of the Mixteca Alta region and asserts that Mixtecs blend a combination of hot and cold herbal plants for curative purposes. Equilibrium must also be found between the herbal plants utilized to perform the steam baths to find a combination of hot and cold plants and not use an excess of either plant. The Mixtec women shared their experiences and knowledge, explaining the process and procedures of how steam baths are performed. Doña Julia describes the process of creating a baño de temezcal, Primero se pone unos palos en forma de casita. A un lado se escarba un pozo donde se va a poner la lumbre. El pozo se cubre con piedras. En las piedras se va echar agua para que pueda salir el vapor. La casita se tapa con cobijas y petates para que el vapor no se escape. Luego la señora que va a dar el baño y la mamá entra al baño de temezcal pero antes tienen que tomar agua hervida para que no se desmallen cuando entren Ahora hay más doctores que parteras. Las jóvenes ya no quieren hacer los baños como antes se hacía. First some sticks are made into the shape of little house. On one side a well is dug where a fire place will be made. The well is covered with stones. Water is thrown into the stones to create the steam. The little house is covered with blankets and palm mats so the vapor does not escape. Then the mom enters baño de temezcal but before she has to drink boiled water so she does not faint when she going inside. Now there are more doctors than midwives. The youths no longer want to do the steam baths as it was done in the past.39 Some women also noted the importance that steam baths can provide. As Flor (59 years) further asserts, Después de tres a cuatro días, se les da a las mamás el baño de vapor. Se necesita una señora que sepa hacer los baños. Tiene que ser despacito y uno tiene que sudar para que uno se sienta mejor

39 Interview with author, July 31, 2010.

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After three to four days, moms are given a steam bath. It is necessary to find a woman that knows how to take the baths. It must be done slowly and one has to sweat to feel better.40 With the use of steam baths, women would be able to heal faster from childbirth, the heat from the steam baths would allow the women to fill their breast with milk, and some women would even take the newborn baby for a few seconds into the steam bath to prevent them from getting sick. As Consuelo (55 years) affirms of the importance of steam baths, Ahora muchas jóvenes ya no hacen el baño después de dar a luz. El baño es importante para que la leche nazca. Yo hice los baños para todos mis hijos” Many young people do not take part in the steam baths after giving birth. The steam baths are important for make breast milk. I did the steam baths for all my children.41 This was true for some of the Mixtec women in the study, a small number used the steam bath after giving birth but did not complete the whole process. Some explained that they only did the steam bath for one or two times and did not continue further while a majority did not do the steam baths at all.

MATERNAL AND INFANT CARE While Mixtec pregnant women are not cared for by other members of the family, certain precautions and beliefs are considered important. For instance, Mixtec women are recommended to adhere to notions about food that comply with the hot/cold dichotomy and are encouraged to eat foods they crave. Pregnant women do not change their dietary habits, in fact it is believed that “food craving must be satisfied to avoid miscarriage” (Katz 1993:101). To prevent a miscarriage or premature birth women are encouraged to eats foods they crave and their husbands play a central role in fulfilling these cravings by providing the expectant mothers with the foods they desire. However, women are cautioned that eating too much food may result in a painful childbirth (Romney and Romney 1966:91). Along with the management of postpartum care, women also need to follow a diet that involves only hot foods since it is believed that women loss heat during childbirth that

40 Interview with author, August 1, 2010. 41 Interview with author, August 1, 2010.

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must be regained. Various taboos transpire in the postpartum care of Mixtec women. It is not advised for recent mothers to consume cold foods or hacer coraje (become angry). As Katz (1992) explains, “women should not get extremely angry (a state too hot), if you eat cold foods at the same time, you can die, because you cannot combine the cold and excessive heat” (Katz 1992:107-108).42 After childbirth, women are restricted from eating certain foods regarded as cold. During the first few days of giving birth, the new mother is given a diet of hot foods that commonly include hot chocolate or chicken soup. Additional restrictions are placed on the foods new mothers are prohibited from eating such as spicy or greasy foods, pork, black beans or any food considered cold. In accordance with the food regulations that abide by the cold/hot dichotomy, A new mother must take good care of [her] diet. It is conceived that she loses her ‘heat’ upon giving birth; thus becomes ‘cold’, 'tender' and ‘delicate’, she is left injured, ‘she is thought of as sick’. To ‘heal’ she should not eat ‘cold’, raw or not well cooked foods (such as soft tortillas) the ‘cold’ food commonly mentioned are the pork meat, beans, potatoes, avocado, cactus, several quelites, lemon; the diet of predilection of the new mother is composed of chicken soup with tortilla and warm boiled water; she can also eat steak. (Katz 1992:107) 43 Special precautions are followed and certain taboos are considered in the care of infant and newborn babies. At birth, children are considered to be in a cold, delicate, and tender state (Katz 1992). Katz (1997) documented that infant care among Mixtecs in the highlands primarily revolves around their diets. For the first couple of months, a newborn baby is only breastfed. After five to eight months, mothers begin to feed their babies other foods while continuing to breastfeed them until the age of one and a half years. As babies enter the stage of weaning, they begin to consume solid foods; however, because they are still considered to be in a state of being ‘cold’ and thus have delicate stomachs, they are not

42 Translated from “Del frio al exceso del calor: dieta alimenticia y salud en la Mixteca” (Katz 1992) “Además, la mujer no debe de hacer coraje (un estado demasiado caliente); si come cosas frías al mismo tiempo, se puede morir, puesto que no se puede combinar el frio y el exceso del calor” (107-108). 43 Translated from “Del frio al exceso de calor: dieta alimenticia y salud en la Mixteca” (Katz 1992) “una recién partida debe cuidar mucho su dieta. Se concibe que ella pierde su ‘calor’ al dar a luz; así queda ‘fría’, ‘tierna’ y ‘delicada’, ‘queda como herida’, ‘está enferma’. Para ‘sanar’ no debe comer alimentos ‘fríos’, crudos o no bien cocidos (tal como tortillas blandas), es decir ‘frios’ también; los alimentos ‘frios’ comúnmente mencionados son la carne de puerco, los frijoles, las papas, el aguacate, el nopal, varios quelites, el limón; la dieta de predilección de la recién parida se compone de caldo de gallina con tortillas tostadas y agua hervida y tibia; ella puede comer también carne asada” (Katz 1992:107)

82 given cold foods for consumption that may upset their stomach and cause diarrhea (Katz 1997).44 Another precaution taken by mothers is avoiding burping new infants over their shoulders. According to Romney and Romney (1966), mothers preclude from burping new infants over the shoulder until they reach four months old, as it is thought to be “dangerous to hold the child up over the shoulder before he can hold up his own head [and] the backbone of the new infant is also considered to be very weak, and one has to handle the infant very carefully to avoid injuring it” (98). Special care on the diet is considered as babies become toddlers. The hot and cold quality becomes central in the diet of toddlers. After the weaning period, small infants are given similar food consumed by the adults. The foods, however, are made out of softer consistencies and are more watery in substance such as chicken soup, boiled eggs, rice, and grated apple or banana (Katz 1992:109).

44 “Baños terapéuticos y postparto entre los indígenas de la Mixteca Alta (México)” (Katz 1997) “En los primeros meses, el bebe se nutre únicamente de la leche de su madre. Entre los cinco y ocho meses, el niño empieza a tomar otros alimentos; sin embargo, sigue mamando hasta la edad de un año y medio. Hasta la edad del destete, el bebe es ‘frio’ y ‘tiene el estomago delicado’; entonces no come alimentos ‘frios’ que podrían causar una diarrea” (160).

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CHAPTER 7

“ANTES NO HABIA MEDICOS”: CHANGING BIRTHING PRACTICES

As outlined earlier, in1995, a number of health sector reforms were established in México. Proposals delineated in the health reforms aimed at expanding the coverage of health care to the high proportion of uninsured population. This included the proposal to increase the delivery of basic services (i.e. immunization and family planning) offered to a larger sector of the population and to “promote equity within the financing and delivery of services,” particularly to the poorest who have “more health needs and less access to health services” (Reyes-Frausto 2001:82-84). However, cultural, economic, and geographical barriers and availability of resources and services have made it difficult for health services to reach the distant and rural areas of México. With the increase in emerging health care policies in México to rural regions, a growing number of births in México are attended by physicians and skilled birth attendants rather than midwives (Cragin et al. 2007:50). Particularly in the area of obstetric and maternal care, the objectives of the new health programs were to begin modernizing the medical care of women and to leave behind their indigenous traditional practices of childbirth. This was intended to address the high rates of maternal deaths and infant mortality in the country. According to reproductive health indicators and databases on mortality in México, “The principal causes of maternal deaths in México are toxaemia and hypertensive disorders of pregnancy (32%), hemorrhage (22%), complications of the puerperium (10%) and abortion (8%). Since 1990, maternal mortality has decreased in rural area, but increased in urban areas” (Cragin et al. 2007:51). By the 1970s and into the 1980s, the continued improvements to maternal care, through an emergent biomedical system, enabled an increase in the percentage of indigenous women attended by physicians during childbirth in rural regions of México. In the subsequent years following the changes in the health care system

84 and obstetric care for women, more deliveries have became attended by physicians and less by traditional midwives, In 1974, 55% of births were attended by physicians and 40% by traditional midwives and nurses. By 1997, 82% of all deliveries in México were attended by physicians and 15% by nurses or midwives” and in poor rural states “[t]hirty-three per cent of deliveries in rural areas were attended by nurses or traditional midwives from 1994-97, compared with 15% for the country as a whole.” (Cragin et al. 2007:51) Along with the new health initiatives implemented, traditional midwives were included through training programs that would teach biomedical care to midwives who could then become certified. Several scholars and organizations have disputed the efficiency of these training programs arguing that despite the certification of midwives, they continue with their authoritative knowledge and traditional practices, only taking what they believe is necessary knowledge. While midwifes and Mixtec women continue employing their authoritative knowledge with certain birthing practices and maternal care, there is a general acceptance of biomedicine in Santiago Juxtlahuaca and many rural communities in Oaxaca. More women opt to deliver their babies at the hospital and in some cases; however, some women rely on the expertise of midwives in situations where biomedicine does not meet their needs. In Santiago Juxtlahuaca, biomedicine is gradually replacing traditional practices. Younger generations are more accepting of biomedical care and believe that traditional indigenous practices are from the past and “backward”. More Mixtec women are willing to submit themselves to the authority of medical treatment, to the new technologies available to them, and to the new medical procedures. This has reaffirmed the authority of medical care over traditional practices. Over the years, the growing medicalization of childbirth has contributed to the cultural loss of indigenous birthing practices in México. The availability and accessibility of medical care has gradually increased in rural places like Santiago Juxtlahuaca, allowing Mixtec indigenous women to give birth at hospitals. There seems to be an increase in the number of Mixtec women in Juxtlahuaca seeking the medical services instead of the assistance from local midwives. The women in the study attribute these growing transformations to the changes that they are experiencing. Juxtlahuaca is undergoing a number of changes in different aspects of the economic, social,

85 and political landscape. Within the political realm, usos y costumbres are gradually dissipating from the political sphere of this growing urbanized municipal town. The Mixtec language and dress are being lost by new generations of Mixtec men and women who are adapting to contemporary styles of the time. With the construction of the local IMSS hospital, Mixtec women do not find the necessity of seeking midwives for their childbirths as in the past. The Mixtec women also affirm that women are no longer having normal childbirths, are now have become more complicated and require medical assistance. The availability of doctors and medical services has enabled Mixtec women to have safer, less at- risk pregnancies and childbirths. Mixtec women also discussed the faster recovery period offered with medical care. They conveyed that having their children in hospital settings has allowed women to heal faster so they can go back to their daily chores sooner. Furthermore, the increase in transnational migration has also contributed to the social changes regarding the conceptualization of healthcare. Below I document the responses of the Mixtec women regarding their perceptions to biomedicine and childbirth. The Mixtec women provide an interesting perspective on the transformations they are experiencing and provide reasons for why they believe times are changing. As we sat in small stools watching Doña Rosa (62 years old) prepare freshly made tortillas for dinner, my mother-in-law and I sit attentively listening to the stories, the struggles, and experiences in Doña Rosa’s life. I was impressed with the wisdom found in the years of Doña Rosa, which helped shape her perspectives on life. She has a way of sharing her beliefs and feelings without imposing them, but rather sharing her life experiences so young women like myself can learn about the value found in the traditional knowledge in every aspect of life. From the many conversations I had with the Mixtec women, the topic of the dwindling number of midwives available in the community would come up. Doña Rosa talked of the decrease in the use of midwives in the community, Antes la gente grande eran parteras, ahora hay puros doctores. Se están acabando las mujeres mayores que saben sobre el cuidado tradicional. La gente joven ya no quiere usar parteras y mejor van al hospital para tener sus hijos. Como ya hay doctor, la gente piensa que ya no hay la necesidad de haber parteras. Las jóvenes no están aprendiendo del cuidado como antes. Before, the elderly women would become midwives, now there are doctors. We are running out of the elderly women who know about the traditional care. Young people do not want to use midwives and prefer to go to the hospital to have their

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children. Since there are doctors now, people believe that there is no longer the need for midwives. The younger women are not learning of the tradition care like before.45 Another Mixtec woman, Consuelo, also asserts, Pues aquí ya no hay muchas parteras como antes. Si has una partera que conozco. Hay algunas personas que todavía van con ella. Well, here, there are not many midwives as before. There is a midwife I know. There are some people who still go with her.46 Flor (59 years old) further comments, De las parteras que yo iba para tener mis hijos, ya no están. Ahora, las jóvenes les gustan ir con el doctor. No sé más de muchas parteras aquí. Algunos se encuentran en su vejez y otros han muerto. Hay una en San Martín Durazno que es buena. Ella es reconocida por la clínica. En caso de que las mujeres no pueden ir al hospital a ver al doctor, ella va a verlas y las atienden. Of the midwives that I would visit to have my children, they are gone. Now, the younger women like go to the doctor. I don’t know of many midwives here anymore. Some are in their old age and others have died. There is one in San Martin Durazno that is good. She is recognized by the clinic. In case where women cannot go to the hospital to see the doctor, she goes out to see them and provide care for them.47 Like Doña Rosa and the other Mixtec women in the study, they expressed the idea that midwives are sought out less and less by the new generations of Mixtec women. The new generations are not learning about the traditional care and the knowledge and care are gradually being lost. A number of reasons that most women offered for the lack of midwives available in Juxtlahuaca was old age, most of the midwives are deceased, and younger Mixtec women are not seeking the services of midwives as in the past. Norma is a 44 year old Mixtec woman who has given birth to 10 children. She was married at the age of 14 years old and had had her first baby at the age of 16 years. She is a talkative and very friendly person. She is tall and slender and has adapted some of the traditional clothing but has kept the use of the traditional rebozo (shawl) and palm basket (ndo’o), which I occasionally would see her wear

45 Interview with author, July 31, 2010. 46 Interview with author, August 1, 2010. 47 Interview with author, August 1, 2010.

87 for market days. Her husband recently passed away and she was left to take care of the younger children. While there is no other income coming into the household, she often finds short time jobs that come up. She had just finished working at a corn field (milpa) for another community member and was paid 200 pesos ($20) for the day. She used a midwife for all her childbirths except for the last birth where she sought medical care with a doctor at the IMSS hospital in Juxtlahuaca. When I asked her about the decisions of women using a midwife or a doctor for their deliveries, she replied, Ya no hay tantas parteras disponibles aquí en Juxtlahuaca para dar sus servicios There are not many midwifes available here in Juxtlahuaca to provide their services.48 As Norma further expresses, Los tiempos están cambiando, las mujeres no pueden tener partos normales como lo hacían en el pasado. Las mujeres más jóvenes prefieren ir al médico porque piensan que es peligroso ir con la partera. Ahora las mujeres sólo quieren usar doctores, ellas ya no quieren usar parteras. Ya no hay muchas parteras, hay algunas pero la gente ya no las usa para sus partos. Los jóvenes prefieren ir al médico. En el hospital, las enfermeras nos dan pláticas sobre cómo cuidar nuestros hijos y cómo cuidarnos cuando estamos embarazadas. Times are changing; women are no longer having normal births as they did in the past. Younger women prefer to go to the doctor because they think that it is dangerous to go to the midwife. Now women only want to use doctors, they don’t want to use midwives anymore. There are not many midwives, there are some but people no longer use them for their deliveries. Young people prefer to go to the doctor. In the hospital, nurses will give talks on how to care of our children and how to take care of ourselves when we are pregnant.49 Most of the Mixtec women in the study agreed on the benefits of seeking a doctor for their deliveries, affirming that more care is now available for indigenous women than in the past. Paulina (30 years old) affirms, Ahora la mujeres puede ir al médico porque ya hay un hospital, antes no había un hospital para que podamos ir. Ya no es muy difícil tener a nuestros hijos Now woman can go to the doctor because there is a hospital, before there was not a hospital we could go too. It is no longer too difficult to have to our children.50

48 Interview with author, July 28, 2010. 49 Interview with author, July 28, 2010. 50 Interview with author, August 1, 2010.

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Women can now have their children at a hospital setting that involves less risk, less pain, and avoids long hours of labor. Several Mixtec women also voiced a sentiment of being forgotten and thus suffered from the lack of medical attention in the past. As Norma maintains, …Porque somos indígenas y pobres, nosotros no teníamos los servicios médicos que ahora tenemos, aunque poco pero es algo. Antes las mujeres no eran cuidadas como ahora. No había atención para nosotros. Nadie me cuidó a mí. No había educación en cómo cuidar de nosotras mismas; nosotros no éramos valorados. Ahora hay más cuidado, ahora tienen más cuidado de nosotros. …Because we are indigenous and poor, we would not get the medical services that we do now, although little but it is something. In the past women were not taken care of as we are now. There was no attention for us. No one ever took care of me. There was no education in how to care of ourselves; we were not valued. Now there is more care; now they have more care for us.51 In essence, these Mixtec women view the availability of medical services as an opportunity they did not have in the past. The availability of medical services in Juxtlahuaca has also facilitated childbirth for Mixtec women. Particularly, some Mixtec women discuss the necessity of medical services for at-risk pregnancies and infant and maternal mortality. In essence, they affirm that the increase in medical services has allowed women to have safer and shorter labors without too many complications or pain. Beatriz, a 40 year old Mixtec woman from Santa María Asunción, was the most outspoken on the advantages of using medical services to give birth. Beatriz was part of the IMSS oportunidades program which provides workshops on women’s health including maternal care. She only speaks Spanish and her children are in their teenage years. Her husband is in the United States and often sends money but has been away for several years. As Beatriz expresses, …antes no había médicos; bebés y mamás morían porque no había ayuda para uno. Ahora es mejor para nosotros porque ahora uno puede ir con el doctor y tener a nuestros hijos. Antes mujeres y recién nacidos morían cuando había complicaciones. Uno no podía ir al doctor o al hospital porque estaba muy lejos y uno no llegaba a tiempo. Con los doctores uno puede tener cesarías y es más rápido el parto. Uno no sufre mucho como antes. Los dolores son menos y es más rápido. Uno también se puede recuperar más rápido y no es tanta preocupación para la mujer porque uno puede cuidar a sus hijos y poder hacer los quehaceres de la casa después de unos días.

51 Interview with author, July 28, 2010.

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... before there were no doctors, moms and babies would die because there was no help for us. Now it is better for us because now we can go to the doctor and have our children. Before women and newborns would die when there were complications. We could not go to the doctor or hospital because it was too far and would not arrive on time. With the doctors we can have cesareans and faster deliveries. One does not suffer much as before. The pain is less and it is faster. One can also recover faster and it is not too much worry for women because we can look after our children and take care of the household chores after a few days.52 During my interviews, the need for medical attention was addressed for Mixtec women who are having children at later ages than is customary. For these women, the necessity for medical services was favored over traditional birthing practices. Yolanda is a 28 year old Mixtec woman from the town of San Martin Durazno, which is 45 minutes away from Juxtlahuaca. She is quiet and soft spoken but friendly, always with a smile. We did the interview as she breastfed her baby girl. She had her first baby a year ago. She married at the age of 26 years old and had trouble conceiving. Yolanda sat down on a small wooden stool next to the entryway of the kitchen door trying to get warmth from the sun as she carried her baby on her lap who was wrapped in a blanket. The baby had a red hat to fend off the mal ojo, according to Yolanda. Her husband is a recent migrant who came back from California. When I would ask her some questions her mother would often respond before Yolanda could answer or add to a response. When I asked about her decision of using a midwife or a doctor for the delivery of her baby she responded that her husband did not want her to use a midwife. The mother quickly responded they did not want her to have any complications during childbirth considering the age of Yolanda. She explains, Con el médico, hay menos peligro y riesgo. Porque ella es mayor de edad, su marido tenía miedo de que ella tuviera el bebé en casa o con una partera. Pensó que sería tan peligroso y es por eso que ella tuvo el bebé en el hospital con un médico. With the doctor, there is less danger and risk involved. Because she is older, her husband was scared of her having the baby at home or with a midwife. He thought that it would be dangerous so that is why she had the baby at the hospital with a doctor.53

52 Interview with author, August 1, 2010. 53 Interview with author, August 3, 2010.

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Yolanda also comments on the response by the doctor when she told him that she had seen a midwife during the first months of her pregnancy. He scolded her instructing her that it was dangerous and should not see the midwife anymore. Juana, another Mixtec woman, also shared a similar experience. Juana is 33 years old who lives in a new barrio on the outskirts of Juxtlahuaca. She is quiet and does not speak unless spoken too. Juana has three small children ranging from 3 to 7 years old. Even though they have a small concrete house built with remittance money, the family prefers to live in a wooden house on the side. The husband had immigrated to the United States and was gone for a few years and once he came back to Juxtlahuaca, he married Juana. Since they live in a new barrio, they do not receive potable water or electricity. Juana had lost a baby last year ago. While her pain was reflected when she spoke of her loss, she remained strong. When I asked her about her decision about using a midwife or a doctor for her previous childbirths, she responded that her husband believed that with a doctor she would get better care. As Juana explains, Porque tenía 22 años en aquel tiempo, mi marido pensó que sería mejor y más seguro ver al médico. Pensó que sería peligroso ir con una partera. Si fui a ver una partera al principio para que me haga sobadas o cuando yo no me sentia bien pero para el parto, yo tuve a todos mis niños en el hospital con un médico. Because I was 22 years old at the time, my husband thought that it would be better and safer to see the doctor. He thought it would be dangerous to see a midwife for the delivery. I did go see a midwife to massage my stomach at the beginning or when I would not feel well but for the delivery, I had all of my children at the hospital with a doctor.54 For other women such as Paulina (30 years old) her decision to use a doctor for her childbirths includes the security and form of care provided to her. At a hospital setting she felt more secure giving birth with advanced technology; she explains that she was able to give birth faster and with less pain. For some of the Mixtec women who preferred to use a doctor for their delivery instead of a midwife, they stated that with a doctor their deliveries were quicker and less painful. The doctor would give them an epidural for the pain or do a C- section if there were complications. Laura is a 30 year old Mixtec woman who decided to have her children with the assistance of a doctor. Laura has six children. Her husband has

54 Interview with author, July 31, 2010.

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immigrated back and forth to the United States for several years. Laura only speaks Spanish and is very strong in her opinions. She had adopted modern dress with clothes brought back by her husband from the United States. Her household reflects her economic stability brought by the frequent trips made by her husband to the United States. They live in the Centro of Juxtlahuaca and have started a small business. When I asked her about her decision to use a doctor for her childbirths and why she believed that people do not seek the assistance of midwifes as they did in the past she responded, No es como antes que uno tenía que aguantar el dolor. Ya hay doctores para que uno no sufra mucho y pueda tener sus niños con más seguridad y menos riesgo. El doctor nada mas te da la inyección y en unas horas ya tienes tu niño. Yo creo que los doctores so mejores porque pueden salvarle a uno la vida y la del bebé si algo va mal. It is not like before when one had to endure the pain. There are doctors now so that one does not suffer as much and we can have our children with more security and less risk. The doctor only gives an injection and in a few hours I can have my baby. I believe that the doctors are better because they can save our life and that of the baby if something goes wrong.55 In the same household, I interviewed Laura’s sister-in-law, Vanessa who is 24 years old. Also from an immigrant household, Vanessa’s husband has migrated to the United States and at the time of the interview, he was in California. Laura reflects similar experiences and views on their option to use a doctor and medical care for their childbirths. Even more, Vanessa was firm in her beliefs about the opportunities to give birth with the assistance of a doctor. Vanessa explains that the services at the IMSS hospital are free for child birth; it involves less risk and danger, and provides a faster recovery. In accordance, other women spoke about the benefits of going to the hospital rather than seeking help from a midwife. Women would heal faster from their childbirth so they could more quickly begin to take care of the household, their daily chores, cook, and take care of their other children. As Doña Rosa states, En el pasado y como ahora, no hay nadie que se ocupe de nosotros después de tener a nuestros hijos. La pobreza es mucha que nos preocupamos de quien va a cuidar de nuestros hijos, quien va a recoger la leña o agua, o quien va hacer la

55 Interview with author, July 31, 2010.

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comida para nuestras familias. Una mujer puede ir al hospital, tener a su bebé y comenzar su trabajo más rápido. In the past and like now, there is no one to take care of us after we have our children. Poverty is great, that we would worry of who is going to take care of our children, who is going to gather wood or water, or who is going to make the food for our families. A woman can go to the hospital, have their baby, and begin their work faster.56 Francisca, a 42 year old Mixtec woman who used midwives for all her childbirths comments further on the issue about money factoring in women’s decision to use the doctor or a midwife. She states, En el hospital, los servicios son gratis, pero con las parteras uno tiene que pagar dependiendo de cuanto uno tiene. Cobran de acuerdo a la cantidad que puede pagar uno, pero todavía uno tiene que pagar. El hospital es mejor porque ahora es gratis, antes uno tenía que pagar para tener una partera y a veces uno no tiene el dinero para pagar. At the hospital, the services are free but with midwives you have to pay depending on how much they charge. They charge according to how much you can pay but still you have to pay them. The hospital is better because right now it is free, before one had to pay to have a midwife and sometimes one did not have the money to pay.57 While the Mixtec women in the study perceived the introduction of biomedicine as positive, they also expressed their discontent with certain practices and procedures that disrupt their own traditional beliefs regarding childbirth practices and maternal health. Some women who delivered their babies at a hospital voiced their discomfort at the absence of allowing family members to be present during childbirth and at the feeling of being alone. At their deliveries, only doctors and nurses were allowed to be present, according to the Mixtec women who had their deliveries at the IMSS hospital. As is the case with Koyukon women, the Mixtec women also rely upon the support of family members, providing a sense of comfort for women giving birth. As Kirsis (1996) relates of Koyukon women, “After their first birth women sometimes delivered alone, by necessity or desire. But the presence of other women to physically tough a parturient and to ‘support’ her contractions was as source of comfort for birthing women, especially during the first birth experience” (70). Another

56 Interview with author, July 31, 2010. 57 Interview with author, August 1, 2010.

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Mixtec woman imparted her experience of having a baby at the local hospital articulating her dissatisfaction with the care they provided. The food they were given was not enough and they were not well attended as they would be with a midwife. The women continue to use authoritative knowledge when they feel it is appropriate for the care they are seeking such as relying on traditional practices when medicinal procedures does not work. The birthing practices and maternal health provided to Mixtec women is changing. There seems to be a decrease in the reproduction of Mixtec traditional knowledge and practices in Juxtlahuaca. Traditional healing and authoritative knowledge are being lost where the knowledge is not being transmitted to younger generations and is being replaced by biomedical practices. There are fewer traditional midwives in the community and even fewer young women who are continuing such practices, resulting in a cultural loss of traditional birthing practices and important medicinal practices. For instance, fewer Mixtec women are using the accustomed baños de vapor (steam baths) to heal their bodies after childbirth or following traditional ways of care. The younger generations are opting for biomedical obstetric services instead of seeking the care of midwives due to the accessibility to prenatal care and free delivery at the local IMMS hospital. When before, the access to medical services was remote for many communities and continues to be for some rural and indigenous communities in Oaxaca and throughout México, now Mixtec women in Juxtlahuaca have access to such services. Fear of “indigenous” or outdated practices have also factored in the decision of younger Mixtec women to seek medical attention for their pregnancy where delivery will be less painful.

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CHAPTER 8

TRANSNATIONAL MIGRATION AND CHANGING HEALTH BELIEFS

Migration for the Mixtec region can be identified in different periods. The Mixtec people first migrated to the northern parts of México including Veracruz, Mexico City, Sinaloa, Sonora, and Baja California, seeking agricultural work. As Velasco Ortiz (2007) identifies, the first stage of Mixtec migration began in 1940 until 1960 which is characterized by migration to other places in Mexico. This period is also identified by the migration of Mixtec people into the United States through the Bracero Program. By the 1940s, the Mixtec engaged in a new migratory route when México signed an agreement, the Bracero Program, with the United States to cover the labor shortage as a result of World War II and was provide an amount of Mexican labor for the U.S. agricultural sector (Mindek 2003:12). Initiated in 1942, the Bracero Program brought the first flow of indigenous Mexicans to the United States. During this period 1942 to 1964, “7,000 agricultural workers left the Mixteca Alta and Baja as braceros (Velasco Ortiz 2007:37). Another stage identified in the migration of Mixtecs is during the 1960s up to the 1980s which is identified by an increase in economic development in the United States. By this time Mixtecs migrated to new areas including the Sinaloa, Sonora, and San Quintín Valley, Tijuana working as agricultural workers. As Velasco Ortiz (2007) explains, “Contractors or labor brokers recruited workers in the villages and transported them to agricultural fields” (38). During the 1960s, Mixtec migration also extended to new destinations in the United States. Mixtecs began migrating to Washington, Oregon, Alaska, and Canada. This period is also characterized by the increased migration of entire Mixtec families, creating important communities of destination and migratory routes. By the 1970s and 1980s, the number of indigenous migrants expanded greatly when many families were able to regularize their status through the 1986 Immigration and Control Act (IRCA). By the 1980s and early 2000, these communities grew and became defined settlements for many Mixtec migrants on both sides of the Mexican and U.S. border. As

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Velasco Ortiz (2007) discusses, “The Immigration and Reform and Control Act (IRCA) of 1986 launched a process of legalization that enabled migrants to move freely across the border. Under the family reunification program of the IRCA amnesty, many Mixtecos brought their wives and children to the United States” (39). All over the United States, the Mixtecs are concentrated in the most labor-intensive agricultural areas particularly in the strawberries, tomatoes, grapes, citrus, and flower fields. The Mixtec made their way to the United States where they began to disperse into various states, forming new migratory destinations and ethnic enclaves (Clark Alfaro 2003:10). In the case of migrants from México, literature reveals that networks are essential in their migration (Cohen 2004). Social networks were an essential aspect of early migration. These played an important role in solidifying Mixtec enclaves in the U.S. These new migratory destinations include California, New York, and Washington among others. Labor migration became a necessity and a primary economic decision for numerous young Mixtec males. In addition, Clark Alfaro (2003) cites various reasons for the migration of many Mixtecs including , “the precarious availability of productive resources, to the erosion of the land, the scarce rains, lack of work, conditions that, as migrants, convert them into economic refugees” (Clark Alfaro 2003:9).58 The mass migration of Mixtecs to other parts of México and to the United States has created a phenomenon of transnational migration resulting in the creation of transnational communities. A number of Oaxacan communities have become deterritorialized transnational communities, with community members operating in both the community of origin and community of destination (Kearney and Nagengast 1989). Recent migratory studies have focused on the emergence of transnational communities to further understand how these new communities develop, how action is conducted on a transnational level, and how political transnational communities are formed in the United States and México (Glick Schiller 1995; Kearney 1995; Rivera-Salgado 1999:1441; Smith 2006; Stephen 2007).

58 Translated from Los mixtecos en la frontera (Baja California) (Clark Alfaro 2003) “Estos indígenas salen de sus pueblos, entre otras razones, debido a la precaria disponibilidad de recursos productivos, a la erosión de la tierra, las lluvias escasas, falta de trabajo, condiciones que, como migrantes, los convierten en refugiados económicos”

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Different conceptualizations and definitions of transnationalism have emerged within the field without a consensus on a definite definition. Basch et al. (1994) define transnationalism as “the process by which immigrants forge and sustain multi-stranded social relations that link together their societies of origin and settlement” (7). Examining the complexity of the lives of the immigrants across borders, Glick Schiller (2003) defines transmigrant as, those persons, who having migrated from one nation-state to another, live their lives across borders, participating simultaneously in social relations that embed them in more than one nation state. Activities and identity claims in the political domain are a particular form of transmigrant activity that is best understood as long-distance nationalism. (105) The term transnationalism is a concept that depicts the lives of migrants as maintaining cultural practices and ties with relatives and their communities of origin while residing in the United States. For Smith (2006), who studied the transnational lives of a Mixtec indigenous community in Ticuani, Puebla and the U.S. state of New York, the conception of transnationality arose as a “result of a failure of older dominant theories on immigrant assimilation to explain the growing trend of close ties between migrants and their home countries” (6). As an example of the governance of a Mixtec town displaced abroad, Smith (1995) describes this Mixtec community as effectively governed by town authorities living in New York City. Hondagneu-Sotelo (1994) defines transnationality as the “ongoing attachments that immigrants maintain with people and institutions in their places of origin” (16). Contemporary migrants do not break ties with their communities but in fact, many continue to participate actively in the social, political, and economical components of their home communities either directly or indirectly. Smith (2006) explains that the emergence of transnationalism is a state of living that has enabled migrants and subsequently, their children, to retain cultural values and practices from their home communities in an effort to “live meaningful lives, gain respect and recognition” within the context of assimilation into the United States. Moreover, this notion set forth a new understanding of migration and the linkages that most migrants maintain with their families and their communities. Hence, recent migration has come to be understood as a transnational or circular process. In the process of maintaining close ties with their communities, “migrants expand their relationships across geographical, political, economic, and cultural boundaries, creating

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transnational families and communities” (Ramírez et al. 2005). Many migrants maintain contact with relatives back home, often sending money, or returning to visit their relatives. Lynn Stephen (2007) characterizes the transnational lives of Mixtec migrants living in Mexico, California, and Oregon as transborder. This concept portrays the lives of Mixtec migrants as transborder rather than transnational because they travel across “ethnic, class, cultural, colonial, and state borders within Mexico as well as at the U.S.-Mexico border and in different regions of the United States” (6). Not only do they migrate across national borders, they transcend across social, political, and cultural boundaries that make their migratory experiences unique as indigenous people. Moreover, Stephen (2007) conceptualizes the transborder lives of Mixtec immigrants as the “simultaneity of connections that transborder migrants have in more than one physical location at once and how the social, economic, political, and religious activities of one community stretch across space and borders” (15). The term also includes those immigrants who actively participate in community organizations which promote human rights for the indigenous population living in México and the United States. Other immigrants become active participants in public organizations often formed by Mixtec people living in the United States for the improvement of their communities in Oaxaca. These transborder immigrants become social, political, and economic actors in their communities affecting changes in Oaxaca while living in the United States. Gonzalez (1996) further comments, Transnational migration also resulted in the expansion of the social network well beyond former Mixteca migration focal areas in México (Puebla, Cuatla, Mexico City, Sinaloa, and Tijuana) to areas with the United States (San Diego, Vista, Santa Maria, and Madera, California; Salem, Oregon; and Yakima, Washington. (Gonzalez 1996:171). Migration has impacted different spheres of the Mixtec people affecting social change and perpetuating new cultural manifestations. Migration has enabled relatives to send money to their communities in the form of remittances (remesas59), vital for the subsistence of families and entire communities. The remittances have also been important in the improvement of various communities in the Mixtec region, the “money is utilized, among others things, to pave roads, to build public buildings and schools, to reconstruct dwellings, for the installation

59 Remittances are money earned by migrants working abroad that is sent back home.

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of telephones and telegraphs, and also to defray the expenses of the festivities for the patron saint celebrations” (Mindek 2003:22-23).60 Immigrants also transmit or carry home social remittances in the form of new skills, attitudes, and knowledge which convey new ideas and perspectives. With migration and globalization, new ideas and technology have transformed the experiences of migrants. In particular, the experiences that indigenous migrants encounter while living abroad alter the notions and perspectives they hold about themselves and the communities they left behind (Gonzalez 1996). Grieshop (1997) and Bade (1994) have studied the impact of transnational migration in relation to beliefs and behaviors linked to health. Grieshop (1997) argues that transnational migration, particularly Mixtec migration from Oaxaca has transformed their health belief system. In his analysis, Grieshop (1997) explains that “those individuals who live external to Oaxaca in California expressed a distinct (or transformed) pattern of belief in relation to health/illness in comparison to the belief pattern of the Mexican respondents” (403). Migration and time dimension contribute to the new perceptions of health and the appropriate form of care. Mixtec migrants bring back new notions about health, altering the perspectives of the people on how and what type of treatment to seek. Dismissing indigenous practices as invalid and something of the past, they see the validation of what technology and biomedicine can offer. While traditional healing practices continue to be an important characteristic of the Mixtec culture, I observed changing concepts of health and healing in Juxtlahuaca. Much of this is attributed to the Mixtec migrants returning to Juxtlahuaca for patron saints celebrations, Christmas, family celebrations, or other festivities in the community. Over the years, these influences have brought into conflict the traditional with the modern, offering new alternatives for health practices and behaviors. This is exemplified by the efforts of the IMSS institution and other health organizations in México toward the promotion of healthier practices, good health, and ways of curing, treating, and preventing diseases.

60 Translated from Mixtecos: Pueblos Indígenas del México Contemporáneo (Mindek 2003) “Ese dinero se utiliza, entre otras cosas, para pavimentar caminos, construir edificios públicos y escuelas, reconstruir viviendas, para la instalación de teléfonos y telégrafos, y también para costear los gastos de las fiestas patronales” (22-23).

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From the perspectives of the Mixtec women, the institutionalization of medical services in Juxtlahuaca has meant an opportunity to access services they did not have in the past. A growing number of expectant mothers have embraced the new services offered and have taken advantage of the services while still referring to traditional practices and beliefs when they disagree with certain biomedical care or, in extreme cases, where they become distrustful of such services. Unfortunately, the limited use of midwifery has resulted in the cultural loss of valuable traditional ethno-obstetric knowledge, beliefs, and practices. Contrary to the argument made by Sesia (1996), who states that “under present circumstances reliance on traditional midwifery in poor and isolated regions of the state is likely to continue— if not increase— in years to come” (134). This is a result of a decrease in the reproduction of traditional knowledge and practices where younger generations are choosing biomedical obstetric care at the local IMMS hospital. In recent years, the value and efforts in studying indigenous practices has been important in preserving the traditional forms of curing and healing. This became important to me when I embarked on this project and attempted to document these for future generations. Before entering the field, my hypothesis stated that Mixtec women were trying to prevent the cultural loss of traditional birthing practices by embracing authoritative knowledge. To the contrary, this was not the case. Mixtec women perceive the introduction of biomedicine in obstetric care as an opportunity to have safer birth deliveries, endure less pain, and have quicker labors, and most importantly, lessen the rates of infant and mortality rates. During a conversation with a Mixtec migrant women living in the United States, she expressed her dissatisfaction with the cultural loss occurring in her community with regards to birthing practices occurring as a result of migration and new ideas about health entering the communities. She had migrated from her community several years ago and was recently regaining her membership in her community. She felt that traditional knowledge and practices were being disregarded and more precarious of all, they were being forgotten. During my stay in Juxtlahuaca and talking to the Mixtec women, I encountered an acceptance for the biomedical model over the use of midwives for childbirth. In actuality, both older and newer generation of Mixtec women embraced the availability of biomedicine. In Juxtlahuaca, traditional healing and authoritative knowledge is gradually being lost where the knowledge is not being transmitted to younger generations and instead is being replaced

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by biomedical practices. The Mixtec women I interviewed saw the acceptance of biomedicine in the community as part changing times. They willingly accepted the replacement of new birthing practices as a way of life, something that inevitably occurs through changing times. Several scholars have focused on the necessity of understanding local practices, the role of the birth attendants, and the social context of birth to implement more effective health programs (Kay 1982:250). The ongoing discussion has continued with the prospect of designing a program ideal for both ethno-obstetric and biomedical models where maternal health care is offered by both professional midwives and doctors. An appropriate model would incorporate authoritative knowledge with biomedicine. Measures should include steps to employ “professional midwives and obstetric nurses in rural health clinics and marginalized urban clinics with a maternal death ratio above the national average” as well as opening more professional midwifery schools (Cragin et al. 2007). As Cragin et al. (2007) recommend, the formal integration of more professional midwives and obstetric nurses into the public health system can provide a quality of maternal and child care for vulnerable populations (59). Moreover, according to Cragin et al. (2007), the integration of midwives into the medical realm has faced several obstacles that involve the resistance of the medical establishment itself in providing credibility to midwifery and the limited options midwives encounter while seeking long-term steady employment in public hospitals. Midwives can offer a range of services that are both culturally sensitive and medically sound yet the national discourse discredits their practices and knowledge. Yet, it is more imperative that professional midwives and obstetric nurses practice their profession and legitimize themselves in the health care system. While the national discourse needs to be redirected, legislation is needed to effectively define the scope of practice associated with professional midwives and obstetric nurses and provide them with licenses to put into practice their skills (Cragin et al. 2007). The services offered by midwives may serve as an additional strategy that addresses the issue of maternal mortality in rural areas. By tailoring the use of professional midwives in rural settings that efficiently reflect the needs of rural communities and with the available resources, this can help reduce maternal mortality rates (Cragin et al. 2007). Among the leading causes of maternal mortality are post-partum hemorrhage and eclampsia. In Mexico, the high rates of maternal mortality

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are attributed to the inability of local infrastructures to provide rural women with more efficient access to medical care. Over the decades, México has engaged in and encouraged programs to advance their agenda of ‘modernizing’ the country; in particular, government institutions have insisted that indigenous groups abandon their traditional practice and fully assimilate, as is the case with the full acceptance of ‘modern’ medicine despite the growing presence of the scientific medical care in rural areas (Diez-Urdanivia and Pérez-Gil 1996). Traditional medicinal practices are an inherent part of their culture and what informs their worldview. However, I argue that in recent years the introduction of biomedicine within obstetrics is gradually replacing the way Mixtec indigenous women are seeking childbirth and maternal care in Juxtlahuaca. Access to new forms of care now available through the IMSS local hospital and new ideas emerging from migration has affected the way Mixtec people think about health and how they seek health care. There are new ideas about health and health care that do not support the continuation of traditional practices among the younger generations. While in the past, Mixtec women did not enjoy the medical services, younger generations are opting for this approach that involves less pain and faster recovery. In addition, notions of medicinal care, traditional practices, and rituals in traditional midwifery have failed to be passed down to younger generations who maintain that midwifery is a practice of the past. New generations are not finding the same value in local knowledge but this could be changed if parteras and other local healers were respected and incorporated into the clinics and outreach programs. In her work among curanderas in Oaxaca, Mexico, and two communities in Peru, (2005) discusses how parteras, curanderas, and traditional healer are no longer being used in the Mixteca region. (2005) explains, “While curanderismo previously served a source of respect and community power for women, it now appears to negatively challenge the health, economic structure, and social status of the female curanderas in Oaxaca (vi). With the nationalization of the health care, local healers are not held with the same respect and status as in the past. According to ndez (2005), the nationalization of health affected the way people perceive health and the manner in which people seek health care. Curanderismo and indigenous forms of healings stigmatized and marginalized as backward and some people have become distrustful of their practices. Not being able to practice healthcare as a recognized form and being effectively incorporated into

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Mexico’s health system has devoid curanderas, parteras, and local healers from economic advancement and have suffered exploitation from clients that do not repay them for their services or feeling underpaid for their services. As with midwifery in Juxtlahuaca, this has been detrimental to the continuation of traditions and practices held by Mixtec women and traditional midwives who do not reproduce and pass down their knowledge to younger generations. As a resolution, (2005) argues that, Rather than dismissing or alienating indigenous medicine in Latin America and elsewhere, public health workers and other concerned groups should build on curanderismo’s essentially rational, empirically based healing methods… Health campains could better serve isolated communities and increase the status of curanderas by embracing the customs, notions, and language of these indigenous communities to create meaningful and acceptable messages that are better understood and executred by people who practice and rely on traditional medicine. (72) If parteras were trained as promotoras for maternal and infant care, there might be a return to respect and trust for local knowledge. The birthing practices and maternal health offered to Mixtec women are changing. There is a general acceptance of biomedicine. In the past, access to medical services for many rural communities was limited, now Mixtec women in Juxtlahuaca have greater access to medical services. While certain practices are being maintained, some are lost or abandoned in favor of medical care which they view as a faster recovery for them. The Mixtec women in the study do not perceive the loss of traditional birthing practices as a cultural loss but rather as an opportunity and embracing changes that occur through time.

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REFERENCES

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APPENDIX

LIST OF MEDICINAL PLANTS

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List of Medicinal Plants and Usage

1. Jarrilla de Rio— This flower is used to perform steam baths. It is also known as Jarillo de Montez (see Figure 8).

2. Ilite— This plant is used to perform steam baths (see Figure 9).

3. Pixixi— This plant is used as a tea for children when they have diarrhea.

4. Zapote (fruit)— makes babies sleep when they do not want to go to sleep.

5. Salva Real— This medicinal plant is made into a tea and it is used to cleanse the uterus after giving birth (see Figure 10).

6. Pirrul— This plant is used to cure from bad spirits and also used to perform steam baths (see Figure 11).

7. Hierba de Burro— This plant is used to perform steam baths. This plant is made into a tea (see Figure 12).

8. Borrega— This plant is used to perform steam baths (see Figure 13).

9. Flor blanca— This plant is made into a tea. It is given to women when they are having complications giving birth (see Figure 14).

10. Ocotoe— This is used to ease pain after delivery. It is made into a tea to be consumed by the mother (see Figure 15).

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Figure 8. Jarrilla de Rio is a flower used to perform steam baths. This plant is also known as Jarillo de Montez. These flowers grow near riverbeds.

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Figure 9. Ilite is a plant utilized by Mixtec women to perform steam baths after childbirth.

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Figure 10. Salva Real is another plant used for curative purposes. It is made into a tea and it is believed by the Mixtec women to cleanse the uterus after giving birth.

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Figure 11. Pirrul, this plant is used for several medicinal purposes and also used for steam baths. More commonly, this plant is also used for other traditional forms of healing such as limpias (cleaning) of evil spirits.

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Figure 12. The plant known to Mixtecs as Hierba de Burro and found in San Martin Durazno is used by Mixtec women for steam baths. This plant is made into a tea to be consumed by the mother after childbirth.

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Figure 13. Borrega is another plant utilized to perform steam baths by Mixtec women.

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Figure 14. Flor blanca is a another plant used to perform steam baths in combination with other plants.

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Figure 15. Ocotoe is used to ease pain after delivery. It is made into a tea to be consumed by the mother. Ocotoe is also used to make fire.

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Figure 16. Mixtec women have knowledge of medicinal plants that are used to induce labor pain to quicken childbirth. These particular flowers are used to induce pains to help women into labor. These can be bought on market day from an herbalist in Juxtlahuaca, Oaxaca.