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Maternal Health As a Cultural ‘Problem’

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Maternal Health As a Cultural ‘Problem’ INTERCULTURALITY FROM BELOW: A STUDY OF MATERNAL HEALTH ENCOUNTERS IN THE PERUVIAN ANDES Thesis submitted in accordance with the requirements of the University of Liverpool for the degree of Doctor in Philosophy Maria-Anne Moore March 2018 Table of Contents Table of Figures ............................................................................................................. v Abstract ......................................................................................................................... vi Declaration .................................................................................................................. vii Acknowledgements .................................................................................................... viii Dedication ..................................................................................................................... ix Glossary ......................................................................................................................... x Abbreviations ......................................................................................................................... x Spanish and Quechua Terms ................................................................................................ xii Map of Peru ................................................................................................................. 15 Introduction: Turning Maternal Health into an Intercultural Problem ........................ 17 Mariacha va a ser mamá: Maria is going to be a mum ....................................................... 17 Maternal Mortality: A Global Concern ................................................................................ 22 MMR in Peru ....................................................................................................................... 24 History of Reproductive Health in the Andes ...................................................................... 25 Maternal health as a cultural ‘problem’ ............................................................................... 29 Chapter One: Literature Review: Maternal Health and Maternal Mortality in Peru ... 32 Introduction .......................................................................................................................... 32 Epidemiological contributions to understandings of maternal health and MMR in Peru .... 34 Health and social policy contributions to understanding maternal health and MMR in Peru .............................................................................................................................................. 41 Plan Estratégico de Salud Sexual y Reproductiva 2009-2015 ........................................ 41 Casas de Espera Materna and Parto Institucional .......................................................... 42 ‘Interculturality in Health’ ............................................................................................... 46 Parto Vertical ................................................................................................................... 48 Juntos .............................................................................................................................. 50 Qualitative health research: the individual’s experience of maternal health ....................... 53 Ethnographic Perspectives on providing and accessing Maternal Health ........................... 59 Lived experiences of maternity in cross cultural contexts ............................................... 61 Structural Violence, Social and Reproductive Justice ..................................................... 65 Biopolitics, ‘Stratified Reproduction’ and ‘Reproductive Governance’ ......................... 68 Conclusion ........................................................................................................................... 72 Chapter Two: Methods and methodology ................................................................... 77 Introduction .......................................................................................................................... 77 Page | ii Research aim ........................................................................................................................ 77 Ethnography as a research method ....................................................................................... 78 Theoretical Perspective ........................................................................................................ 80 Fieldwork and field sites: Chiara and Izcuchaca ................................................................. 81 The comunidad campesina and district of Chiara ............................................................ 82 Izcuchaca, District of Anta ............................................................................................... 85 Ethnographic observation and participation .................................................................... 89 Participants and cases ....................................................................................................... 91 Interviews ......................................................................................................................... 94 Secondary sources ............................................................................................................ 96 Data analysis ........................................................................................................................ 98 Ethical considerations .......................................................................................................... 99 Reflexivity .......................................................................................................................... 103 Chapter Outlines ................................................................................................................ 105 Chapter Three: Maternal Health as an Object of Governance and Monitoring ......... 108 Introduction ........................................................................................................................ 108 Promoting maternal health in Chiara ................................................................................. 109 Rewards, Sanctions and Rights .......................................................................................... 111 Surveillance and Monitoring .............................................................................................. 120 Community Responsibilisation .......................................................................................... 124 Milagros’s story ................................................................................................................. 131 Conclusion ......................................................................................................................... 134 Chapter Four: Maternal Health as ‘Moral Experience’ ............................................. 137 Introduction ........................................................................................................................ 137 Rosalinda’s Story ............................................................................................................... 138 A Pregnancy Confirmed ..................................................................................................... 139 Risk and vigilance: the obstetrician’s viewpoint ............................................................... 141 Moderating ‘bad behaviour’ ............................................................................................... 142 ‘Good’ and ‘Bad’ Mothering: chiarina women’s perspectives ......................................... 149 Mariana’s Birth: reinforcing the punitive message ............................................................ 154 Conclusion ......................................................................................................................... 159 Chapter Five: Ties that bind: Family and Parto Institucional ................................... 162 Introduction ........................................................................................................................ 162 Jessamyne: A model gestante ............................................................................................ 163 Promoting familial involvement in Parto Institucional ..................................................... 171 Violeta’s story: Obstetric Violence and Invisible Bodies .................................................. 175 Milagros’s Story: Fear, embodiment and post partum illness ........................................... 182 Page | iii Conclusion ......................................................................................................................... 188 Chapter Six: Landscapes of Failure: Geography, Logistics and State Legibility ...... 192 Introduction ........................................................................................................................ 192 A new ‘Multi-sectorial approach’ to maternal health ........................................................ 192 Disciplinary Consequences for Health Practitioners ......................................................... 198 Reaching Out: Delivering Healthcare ‘in the field” ........................................................... 201 Contracting Health Services in Rural Areas .....................................................................
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