This week I chose to take a look at childbirth in Ghana. I suppose I chose the topic of birth over that of death due to the high maternal mortality rate in this country – an unsettling 350 maternal deaths out of every 100,000 births (UNICEF 2013).
In her piece Technology and Social Interaction: Note on the Achievement of Authoritative Knowledge In Complex Settings, Brigitte Jordan examines physical video footage of a woman’s birth and an Airline Operations Room to discuss the implications and development of authoritative power in both of these settings. In this piece she argues that the ownership of materials required to fulfill a certain task define and display the authoritative knowledge in the given situation (Jordan 1992). She notes that authoritative knowledge is a participatory effort with the participants of culture and society granting the authority to, in this case the physician and medical professionals. In America, this is potentially due to the increasingly medicalized understanding of existence and health – this way of thinking creating a hierarchy of knowledge as medical knowledge or expertise is not seen to be available to everyone.
Jordan makes many interesting observations regarding the relationship between the woman in labor, physician and nurse technician throughout labor. She notes that the woman’s urges, feelings, and inherent inclinations of how to understand and treat her body in the extreme stress of childbirth are ignored – she becomes a patient, an object. Jordan notes that the woman is controlled repeatedly throughout labor first by the nurse technician who speaks directly to her and tells her not to push, and well as Lamaze breathing, which implies that a women in “in control” of her body and urges. Further, the woman is not allowed to push until the physician is present, this action therefore removing her bodily experience for the business of birth and granting a professional the knowledge and authority to choose when the business will be taken care of.
In Ghana, most births are preformed in a woman’s home with the assistance of a midwife. In an ethnographic article titled Well-Being and Birth in Rural Ghana: Local Realities and Global Mandates, Kathryn Linn Geurts describes an at-home birth that took place in an Ewe speaking community in the Volta region of Ghana. In this village, there was a growing tension between midwifery, and the “Traditional Birthing Assistants” – women, and occasionally men, who received training in a medical clinic to advocate for change in the birth process of Ghana – particularly to save women’s lives from birth complications (Geurts 1998). The goal of the TBA seems to be similar to the goal of Ying in the documentary we watched this week regarding Hmong birth.
In this article, Geurts describes that a woman went into labor and remained at home throughout the process, though she wanted to go to the hospital and called out many times to be taken there. The midwife and family, however, would not let her leave (1998). By denying her wishes to give birth in a hospital, it seems that the woman becomes, in this situation, someone who does not have the final authoritative knowledge of the situation. The tension and cultural tradition in this region appears to be playing a large part of why the midwife would not let her go. It appears that the midwife, a trained professional, though not trained in a biomedical framework, holds the highest authoritative knowledge when it comes to childbirth.
Geurts describes that the woman was allowed to walk around, cry out, take or deny food, thus advocate certain choices for her body throughout the process, giving her perhaps more “freedom” and agency in understanding and working through the feelings of labor in comparison to a woman in labor at a hospital in the United States. In this way, the process and inherent feeling or urges of a women’s body are respected and understood, though her power to choose where the birth takes place is not granted. This is possibly because the women in rural Ghana are held in a society that gives the authority of life decisions to men (Mantey 2013). In Geurts’ case the husband is not mentioned, not even present during the birth. However in an article from Voices of America, a woman’s husband is able to grant or deny a woman’s wishes to have her child at home or in a hospital after, for example, consulting ancestors, etc (Mantey 2013).
Lastly, in Ghana, specifically among the Ewe speaking people, birth is a community endeavor. Women and children of the community often come to the woman’s house to see how she is doing and to provide herbs, food and drink through her struggle. Due to the high Maternal and child mortality rates, it is understood the child birth is a joyous experience, but also very dangerous (Geurts 1998). Childbirth, in this way, appears to unite the community both in joy and sorrow in a way the remains different from the community atmosphere of an US delivery room.
Geurts, K. (1998). Well-Being and Birth in Rural Ghana: Local Realities and Global Mandates. Fifth Annual African Studies Workshop “Cross-Currents in Africa.” Retrieved from http://www.africa.upenn.edu/Workshop/geurts.html
Jordan, B. (1992). Technology and Social Interaction: Note on the Achievement of Authoritative Knowledge In Complex Settings. Institute for Research on Learning.
Mantey, J. (2013). Maternity Mortality Remains High In Ghana. Voices of America. Retrieved from http://www.voanews.com/content/maternity-mortality-remains-high-in-ghana/1589459.html