Negotiating Modernity in the Margins of the State: the Cultural Politics of Reproduction in Southwest China
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NEGOTIATING MODERNITY IN THE MARGINS OF THE STATE: THE CULTURAL POLITICS OF REPRODUCTION IN SOUTHWEST CHINA A Dissertation Submitted to the Temple University Graduate Board In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY by Qingyan Ma January 2014 Examining Committee Members: Sydney White, Anthropology Judith Goode, Anthropology Jayasinhji Jhala, Anthropology Jessica Winegar, Northwestern University © Copyright 2014 by Qingyan Ma All Rights Reserved ABSTRACT This dissertation examines how globalized biomedical definitions of reproduction are being adopted by the Chinese state and interpreted at the local level in Yunnan. It provides an anthropological perspective on how to provide affordable health care for the mass population, a question that most nation states have to contend with in the current neoliberal economy. In the dissertation, I present a critical view of the state through a medical lens (Kleinman 1995) so as to reengage anthropological theory and social theory. The following chapters of the dissertation investigate how the local people articulate their understanding of medicine, science, the body, and ethnicity in relation with the state and in the everyday life of medical practice and consumption. In particular, this dissertation examines the relationship between different narratives of modernity and ethnicity as embodied in the transformation of the public health system in Weixi Lisu Autonomous County in Southwest China, the so-called “margin of the state” (Das and Poole 2004). As a historical ethnography, I contextualize the transformation of public health policy in this area within the nexus of shifting political and economic policies from 1) the Maoist period from 1958 to 1981, during which “cooperative medicine” backed by the commune provided basic health care for the peasants; 2) 1981 to 2006, the transitional period from the command economy to the post-Mao market economy, during which most rural peasants had been left out of post-decollectivization health care; and 3) 2007 until now, the period in which the New Cooperative Medicine has been implemented in rural China. By historicizing the transformation of public health policy in the ethnic minority area, this dissertation not only intends to illuminate how the changing public health ii policy has been embedded in the state’s pursuit of modernity, development agenda, and nation-building strategy in the borderland, it also attempts to portray how its multi-ethnic residents maneuver their ethnic minority identity within the changing historical periods by taking on, reconfiguring, or resisting public health policies in their daily life so as to achieve the maximum benefit of state policies and their citizenship status. In this way, this dissertation will shed light on how the ethnic minority residents articulate different narratives of modernity and how their articulation contests and reconfigures the contours and constitution of modernity. iii This dissertation is dedicated to my parents, Jiayi Qiu and Guangzu Ma. iv ACKNOWLEDGEMENT This dissertation was supported at various stages by the Department of Anthropology, the Graduate School and the Center for the Humanities at Temple University. My graduate study and fieldwork was supported by the Presidential Fellowship from Temple University. The final completion of this dissertation was made possible by funding from the Dissertation Completion Grant from Temple University. First, I would like to extend my appreciation to the people who gave me tremendous assistance during my fieldwork in China. Dr. He Ming at the National Research Center for the Studies of the Ethnic Groups of China’s South-Western Borderlands of Yunnan University invited me to be the researcher in residence at the center and assisted me in my fieldwork. Dr. Zhang Kaining and Dr. Gui Baokun from the Yunnan Health and Development Research Association were wonderful informants as well as excellent aids, as they introduced me to doctors in Weixi. The doctors of Weixi Mothers and Children’s Hospital—Zhao Shuying, Yang Runying, Qian Junchun and many others—gave me the opportunity to observe their clinical practice, invited me into their homes and accepted my request for interviews. The doctors of Tacheng Township Clinic and Baijixun Township Clinic accompanied me visiting the villages and introduced me to the village doctors. At the village level, my deepest gratitude extends to the village doctor He Xiuzheng and her family for their generosity—not only for allowing me stay with them, but also for opening their hearts to me. I particularly wish to thank Yulian Mama, who was my key informant, local guide, interpreter and best friend v in the village. She accompanied me walking the most difficult mountain road at night and supported me as I lived through sickness, loneliness and helplessness in the field. In the United States, I would like to thank Dr. Sydney D. White for steering me into the field of medical anthropology and China studies, for her consistent advice and support during my years at Temple University, and particularly for her encouragement during my fieldwork. Dr. White has put tremendous amount of effort into shaping my research attitude and guiding me throughout my doctoral study. I am also deeply grateful to Dr. Judith Goode for serving on my exam committee and giving me advice along with my study in the program. I would like to express my gratitude to other faculty member in the anthropology department. Dr. Jessica Winegar and Dr. Raquel Romberg markedly informed my theoretical and methodological innovations through the coursework I took with them. Dr. Anastasia Hudgins helped me shape my initial research project through numerous discussions and editing my research proposal. Dr. Jayasinhji Jhala, and Dr. Paul Garrett gave me meaningful advice throughout my graduate study. I am also thankful for Ms. Yvonne Davis for her invaluable administrative support. Upon completion of my dissertation, I cannot stop thinking about the wonderful cohort I have developed at Temple. Brooke Bocast, Shu-fan Wen, Brendan Tuttle, Diane Garbow, Aisha Rios, and Brittany Webb—without their mutual encouragement and help, I could not have made it through our program. I also want to express my appreciation to my friends in the field of anthropology in other parts of the world—Zhang Jingjing, Ouyang Jie, Mu Wei, and Zeng Guohua, gave me continuous support and encouragement throughout this project. My roommate in Philadelphia, Zhan Tingting, was also always a good listener to my initial thoughts on the project. vi And finally, last but not least, I would like to thank my husband, Feng Gao and my son, Harry Haiwen Gao, for their unwavering love and support throughout my doctoral studies. vii TABLE OF CONTENTS Page ABSTRACT........................................................................................................................ ii DEDICATION……………………………………………………………………............vi ACKNOWLEDGMENTS ...................................................................................................v LIST OF TABLES...............................................................................................................x LIST OF FIGURES ........................................................................................................... xi PROLOGUE......................................................................................................................xii CHAPTER 1. INTRODUCTION……………………………………………………......................1 1.1 Research Questions…………………………………………………………..1 1.2 Theoretical Relevance………………………………………………………..4 1.3 Methodology and Fieldwork…………………………………………………10 1.4 Dissertation Outline………………………………………………………….14 2. LOCATING WEIXI…………………………………………………………………18 2.1 In the Margins of the State…………………………………………………...18 2.2 The History of Political Changes in Weixi…………………………………..22 2.3 Ethnicity in the “Spatial Division” in Weixi……………………………...27 2.4 The Coexistence of Religions: Tibetan Buddhism, Christianity, and Catholicism…………………………………………………………………..32 2.5 Conclusion…………………………………………………………………...35 3. CHASING THE PUBLIC HEALTH POLICY MOVES IN WEIXI………………..37 3.1 The Cooperative Medicine Era: the Maoist Period (1958 - 1981)…..…….....39 3.2 Rural Public Health in the Market Economy (1981-2006)…………………..44 3.3 New Cooperative Medicine and the Creation of Peasants’ Hygiene Consultants (2007 - 2013)……………………………………………………49 3.4 Conclusion…………………………………………………………………...54 4. THE TRANSFORMATION OF EVERYDAY REPRODUCTIVE PRACTICES IN DACUN………………………………………………………...................................56 viii 4.1 Introduction…………………………………………………………………..56 4.2 An Overview of Dacun………………………………………………………58 4.3 Zheng He’s family…………………………………………………………...59 4.4 The Reproductive Practices of Women in Three Age Groups in Dacun…….63 4.5 Conclusion…………………………………………………………………...77 5. THE DISCOURSES OF RISK IN THE PROMOTION OF HOSPITAL BIRTH………………………………………………………………………………..79 5.1 Introduction…………………………………………………………………..79 5.2 Situating the Larger Shangri-la Project (LSP)……………………………….80 5.3 The Discourses of Risk in the Larger Shangri-la Project (LSP)……………..83 5.4 Conclusion………………………………………………………………….95 6. FROM MEDICAL PLURALISM TO MEDICAL CONSUMERISM……………96 6.1 The Questions of Medical Consumption…………………………………...96 6.2 Theoretical Engagement……………………………………………………98 6.3 The Medicines………………………………………………………………102 6.4 Conclusion………………………………………………………………….113 7. CONCLUSION………………………………………………………......................116 BIBLIOGRAPHY………………………………………………………………………119