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“We Are Strong Women”: a Focused Ethnography Of “WE ARE STRONG WOMEN”: A FOCUSED ETHNOGRAPHY OF THE REPRODUCTIVE LIVES OF WOMEN IN BELIZE Carrie S. Klima, Ph.D. University of Connecticut, 2002 Belize is a small country in Central America with a unique heritage. The cultural pluralism found in Belize provides an opportunity to explore the cultures of the Maya, Mestizo and the Caribbean. Women in Belize share this cultural heritage as well as the reproductive health issues common to women throughout the developing world. The experiences of unintended pregnancy, contraceptive use and abortion were explored with women using a feminist ethnographic framework. Key informants, participant observations, secondary data sources and individual interviews provided rich sources of data to examine the impact of culture in Belize upon the reproductive lives of women. Data were collected over a two-year period and analyzed using QSRNudist qualitative data analysis software. Analysis revealed that regardless of age, ethnicity or educational background, women who found themselves pregnant prior to marriage experienced marriage as a fundamental cultural norm in Belize. Adolescent pregnancy often resulted in girls’ expulsion from school and an inability to continue with educational goals. Within marriage, unintended pregnancy was accepted but often resulted in more committed use of contraception. All women had some knowledge and experience with contraception, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Carrie S. Klima-University of Connecticut, 2002 although some were more successful than others in planning their families. Couples usually made decisions together regarding when to use contraception, however misinformation regarding safety and efficacy was prevalent. While abortion is illegal, most women had knowledge of abortion practices and some had personal experiences with self induced abortions using traditional healing practices common in Belize. Belizean culture is evolving as Belize grows and tries to find its place in the global marketplace. Education and employment have created new opportunities for women in Belize. However, these opportunities have resulted in challenges to the traditional roles and culture of families in Belize. Women in Belize enjoy somewhat better health than their geographic and cultural neighbors yet share many of the same concerns for their health and their families. Women strive to obtain quality health services and equality in employment and relationships, and share these struggles with women throughout the developing world. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. “WE ARE STRONG WOMEN”: A FOCUSED ETHNOGRAPHY OF THE REPRODUCTIVE LIVES OF WOMEN IN BELIZE Carrie S. Klima B.S.N, Loyola University of Chicago M.S. University of Illinois at Chicago A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy at the University of Connecticut 2002 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Copyright by Carrie S. Klima 2002 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPROVAL PAGE Doctor of Philosophy Dissertation “WE ARE STRONG WOMEN”: A FOCUSED ETHNOGRAPHY OF THE REPRODUCTIVE LIVES OF WOMEN IN Belize Presented by Carrie S. Klima, B.S.N., M.S. Major Advisor /O lga Maranjian ChurcQ ____ Associate Advisor Cheryl Tatano Beck Associate Advisor Henrietta Bernal University of Connecticut 2002 ii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Acknowledgements I would like to thank my committee, Olga, Cheryl and Henrietta for their support and guidance with this research. They allowed me to follow my heart, face the challenges of ethnography and were always there when I needed reassurance and direction. I wish to thank my colleagues in the nurse-midwifery program at the Yale School of Nursing. They were my support during coursework, willing research subjects and understood my absences throughout my program of study. My new colleagues at the University of Illinois have supported me through the writing process and had the faith I would finish. Thank you. I also wish to thank Judi, my teacher and friend with whom I began my relationship with the women of Belize. Her support and guidance from the beginning of my nursing education have been instrumental in allowing me to reach this goal. Judi, I promise this is REALLY the last thing I will ask you to do. My family and friends have been patient and understanding of my time and my absences. I look forward to rejoining them ail soon. Lastly, I wish to thank my friends and colleagues in Belize for their help, their homes and their time. Without the help of Florene Olgadez, Ediberta Chan Bausta, Nurse G. Heredia, Lorna Perez and Marie Chavarria, I would never have successfully finished this research. My profound gratitude belongs to the women of Belize, who gave me their time and shared their valuable experiences. My hope is that I have done justice to their stories. in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table of Contents CHAPTER 1 ........................................................................................................................... 1 Introduction ............................................................................................................................ 1 Belize...............................................................................................................................3 Reproductive Health Care in Belize .......................................................................4 CHAPTER 2 ........................................................................................................................... 7 Review of the Literature................................................................................................... 7 The Evolution of Reproductive Health Care .................................................................7 Education .................................................................................................................... 14 Employment................................................................................................................14 Poverty........................................................................................................................15 Role of culture .......................................................................................... ..................16 Unintended pregnancy ............................................................................................. 21 Contraception and Unintended Pregnancy ............................................................ 22 Contraceptive Challenges ........................................................................................ 23 Abortion and Reproductive Health .........................................................................25 The Availability and Legal Status of Abortion ...................................................... 27 Reproductive Health in the Caribbean and Latin America ..................................... 29 CHAPTER 3 ..........................................................................................................................35 Setting.................................................................................................................................35 Belize.............................................................................................................................. 35 History.........................................................................................................................35 Demographics ............................................................................................................ 44 Education ....................................................................................................................46 Water and Sanitation ............................................................................................... 48 Health .............................................................................................................................. 49 Communicable Diseases ........................................................................................ 49 Adult and Child Health .............................................................................................50 Reproductive health care .............................................................................................52 Fertility........................................................................................................................ 52 Contraception and Family Planning ......................................................................53 Pregnancy Intendedness........................................................................................57 Maternal and Child Health .......................................................................................57 Health Care System ................................................................................................. 60 Allopathic Health .......................................................................................................66 Traditional Medicine .................................................................................................68
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