Dissertation FINAL

Distribution Agreement In presenting this thesis or dissertation as a partial fulfillment of the requirements for an advanced degree from Emory University, I hereby grant to Emory University and its agents the non-exclusive license to archive, make accessible, and display my thesis or dissertation in whole or in part in all forms of media, now or hereafter known, including display on the world wide web. I understand that I may select some access restrictions as part of the online submission of this thesis or dissertation. I retain all ownership rights to the copyright of the thesis or dissertation. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. Signature: _____________________________ ______________ Matthew R. Dudgeon Date Birth after Death: Men and Reproduction in Two K’iche’ Maya Communities By Matthew R. Dudgeon Doctor of Philosophy James T. Laney School of Graduate Studies Department of Anthropology _________________________________________ Carol M. Worthman, Ph.D. Advisor _________________________________________ Peggy F. Barlett, Ph.D. Committee Member _________________________________________ Peter J. Brown, Ph.D. Committee Member Accepted: _________________________________________ Lisa A. Tedesco, Ph.D. Dean of the James T. Laney School of Graduate Studies ______________ Date Birth after Death: Men and Reproduction in Two K’iche’ Maya Communities By Matthew R. Dudgeon B.A., Vanderbilt University, 1996 M.A., Emory University, 2001 M.P.H., Emory University, 2005 M.D., Emory University, 2011 Advisor: Carol M. Worthman, Ph.D. An abstract of A dissertation submitted to the Faculty of the James T. Laney School of Graduate Studies of Emory University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Anthropology 2013 Abstract Birth after Death: Men and Reproduction in two K’iche’ Maya Communities By Matthew R. Dudgeon In the late 20th century, ethnic and economic inequalities in Guatemala led to a guerilla insurgency that was met by state military counterinsurgent forces. The genocidal violence of the civil war disrupted the reproductive trajectories of many western highland indigenous Maya communities. In this dissertation, I explore patterns of reproduction and reproductive loss in Maya communities after the Guatemalan civil war. I focus on an aspect of reproduction often left unaddressed in demographic as well as anthropological approaches: men. Working with predominantly K’iche’ Maya communities, I investigate ways men influence decisions about family size and reproductive complications. I interrogate men’s own experiences of reproduction as an integral part of their masculinity and an area of risk that lies outside the domains defined as masculine. To accomplish an ethnography of reproduction and masculinity in the context of genocide, I worked in two K’iche’ Maya communities: one peri-urban community relatively less affected by the civil war, and another rural community the war had forced into hiding as a Community of Populations in Resistance. I examine men’s attitudes toward marriage, pregnancy, childbirth, and contraception. I trace four important elements of K’iche’ Maya masculinity: productivity, growth, control, and respect. I argue that these elements inform men’s reproductive experiences and decisions and aid in explaining the profound ambivalence many men feel about their roles in reproduction. I tie this ambivalence to broader narratives of risk associated with reproduction that implicate men and women as well as care providers such as local traditional birth attendants. I examine patterns of contraceptive use, demonstrating that men may actively collaborate with partners in contraceptive decision making even as they confront conflicts that arise from the consequences of those decisions. Using quantitative data, I explore the impact of variables accounting for men’s influences on epidemiologic models of reproductive health outcomes such as initiation of prenatal care, complications during pregnancy, contraceptive knowledge and use, and neonatal and infant mortality. I conclude with a discussion of K’iche’ Maya reproductive resilience and men’s changing reproductive roles in the context of that resilience. Birth after Death: Men and Reproduction in Two K’iche’ Maya Communities By Matthew R. Dudgeon B.A., Vanderbilt University, 1996 M.A., Emory University, 2001 M.P.H., Emory University, 2005 M.D., Emory University, 2011 Advisor: Carol M. Worthman, Ph.D. A dissertation submitted to the Faculty of the James T. Laney School of Graduate Studies of Emory University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Anthropology 2013 Acknowledgements This dissertation was produced with the help of many people, including faculty, students, and staff in the Emory University Department of Anthropology, the Rollins School of Public Health, and the Emory School of Medicine. Research support was provided by grants from the National Science Foundation, Fulbright- Hays/Department of Education, and the Wenner-Gren Foundation. Emory has provided an amazing environment for my training as an anthropologist, epidemiologist, and physician. My committee has provided me with unmatched support and mentorship during my coursework, fieldwork, and dissertation writing. I am forever indebted to Dr. Carol Worthman, whose keen intellect is surpassed only by her warmth and kindness, but only just. Dr. Peter Brown has been a constant guide through the vast uncharted territory of medical anthropology, and I look forward to joining him on the frontier. Dr. Peggy Barlett has been an unflagging champion as well as a rigorous reader, challenging me always to take the next critical steps toward a viable thesis. Dr. Marcia Inhorn was an early influence on my work, and our writing together was a true pleasure as well as an accomplishment I was proud to share. Dr. Bruce Knauft is an intellectual dynamo, and Dr. Ivan Karp and Dr. Bobby Paul taught me Marx, Freud, foxes and hedgehogs. Thanks to the epidemiology professors at Rollins that allowed me to operate in the quantitative as well as the qualitative worlds, especially my MPH thesis advisor Dr. Carol Hogue. The faculty and staff at the Emory School of Medicine helped me to transition to anthropologist-physician, and I must thank Dr. Bill Eley and Dr. Ira Schwartz, who together inspire not only me but also hundreds of physicians to be great doctors. Anthropological fieldwork is a daunting piece of work, perhaps doubly so when working in two communities. I owe a debt of gratitude to the men and women of Jun and Keb’, who let me into their homes, onto their soccer fields, and into their lives for almost three years of mine. I only hope I have done some justice to the richness of their experiences that they shared. In particular, I thank my field assistants who so tirelessly helped me to interview so many. Maltiox cha we. My fieldwork would not have been possible without the cooperation of many men and women in the Guatemalan Ministry of Health, who helped me to frame the questions about reproductive health that would undergird my project. I am particularly thankful to the friendship and guidance of Dr. Gustavo Barrios and his family, who really were a second family to me during my time in Guatemala. I am ecstatic to return as a physician to Guatemala and join him in his relentless struggle against illness in that country. I hardly know where to begin in thanking fellow graduate students, having met and worked with so many along the way. I am so grateful to have shared a few steps on a long intellectual journey. Special thanks to Ben Junge, Sarah Lyons, Sarah Willen, Julie Solomon, Joanna Davidson, Brandon Kohrt, Ryan Brown, Dan Hrushka, and Lara Deeb for their support, intellectual and moral. Dan Smith and Holly Wardlow have been older intellectual siblings in the field of gender studies, and I have benefited immensely following the blazes on their trail. Thanks to Nicole Berry for being an amazing contact while in the field, it has been so amazing to see our work progress after sharing thoughts over coffee in Quetzaltenango. Lauren Fordyce, Liz Roberts, Aminata Maraesa, and Meg McCullough all provided incredible conceptual support, reading drafts of conference papers and submissions, and I am thrilled to continue working with them on the anthropology of health. Finally, I want to thank my family. My mother, Jean Dudgeon, has always been my inspiration as a teacher and as a compassionate human being, and she is the source of both my intellectual curiosity as well as my desire to make the world a better place. My sister, Amy Dudgeon, has chosen an even more difficult path than mine as a Hollywood actress, and I am continuously amazed by her courage and creativity. My father, Wayne Dudgeon, died before I finished my dissertation, but his memory informs and infuses every sentence I write about what it means to be a man. Finally, my partner Elissa Meites has been a constant source of care and support, and I love her more every day for it. I dedicate this dissertation to them. Table of contents List of figures and tables List of male informants Map of Guatemala Map of the departments of Quetzaltenango and Quiché, Guatemala Map of the municipality of Cantel, Quetzaltenango, Guatemala Map of the municipality of Chajul, Quiché, Guatemala Chapter 1: Introduction Chapter 2: Ethnographic Context and Methods Chapter 3: Gender, Masculinity, and Reproductive Health Chapter

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