Throughout the course, I decided to focus on the African country of Ethiopia. I chose this country because of the prior knowledge I had about this country, including its cultural practices, the history of the country, and the lack of medical help, especially that for women. I felt that it would be very important for me to focus on this country because Ethiopia has one of the highest maternal mortality rates in the world, with 2,000 women dying during labor per 100,000 births (Kwast, Rochat, Kidane-Mariam, 1986). You do not have to be a future or current health care professional to realize that this is a horrifying statistic that needs to be changed. As I have analyzed maternal mortality throughout the course, as well as had analyzed the anthropological theories that can be used to evaluate maternal death, critical medical anthropology was the theory that seemed the most logical to discuss my health problem. Critical medical anthropology is the outcome of the realization that anthropology and epidemiology have similar interest. It focuses on the improvements of human behavior, health, and research that can help the human life cycle. Epidemiology is “the study of the distribution and detrminants of diseases and injuries in human populations” (Inhorn, 1995).This theory focuses on understanding and responding to pressing health issues and problems around the world as they are influenced and shaped by human social organization, culture, and context (Singer, 2004). From an anthropological perspective, it can focus on behavioral aspects, such as why people accept certain cultural ideologies and cultural social norms. From an epidemiological perspective, it focuses on how certain behaviors and cultural norms can lead to health problems or how certain behaviors lead to health improvements. Using the critical medical anthropology theory is the effective to analyze maternal mortality because from an anthropological perspective, I can analyze the cultural differences, such as birthing traditions or how women behave during their pregnancy to understand why the rates of maternal mortality are so high. From an epidemiological perspective, I can analyze the socioeconomic or the inconsistency of health care based on race.
It is pretty obvious that compared to Western societies, Ethiopia is culturally different. With that being said, westernized medical standards may be a huge priority to Westerners, but to other countries, such as Ethiopia, it may not be. In fact, In Ethiopia up to 80% of the population uses traditional medicine due to the cultural acceptability of healers (Kassaye, Amberbir, Getachew, and Mussema, 2006). Traditional medicine can include natural healing and community healers. This can impact the number of women who die during birth because although these healers’ methods are respected, it may not be the safest route for giving birth. Many of these healers’ have methods that include eating certain foods before birth to ensure that the mother and baby are safe and culturally, this a helpful practice, due to their cultural beliefs and practices, but medically, it is not effective. Critical medical anthropology can help this issue by allowing traditional healers’ to still practice these traditions but doing it in a space where the woman and child will be safe. This will be a challenge culturally because Ethiopians have gone about these practices and traditions for years. Introducing medicalized labor and delivery standards can make Ethiopians feel that they are being disconnected from their culture and may not be as effective. To help with the change, it will be effective for the traditional healers’ and for the community to understand that their practices are respected, but with more knowledge about the woman’s body will impact the number of women who die per year and can change the fact that Ethiopia has one of the highest maternal mortality rates in the world.
With cultural differences, it is expected that women view their bodies differently while pregnant. For example, in the United States, pregnancy for the first half is typically viewed as an exciting time, where the mother will still work and do typical things like working out or other physically active things. At about the sixth month of pregnancy, many expectant mothers will begin to slow down at work and stop doing such strenuous activities due to being extremely pregnant and feeling fatigued or tired. Then at about the eighth month of pregnancy, expectant mothers will take maternity leave, as well as some men. These events do not occur the same way in Ethiopia. Ethiopian expectant mothers view pregnancy as a “normal state” that requires no medical attention, and blame pregnancy outcomes to factors that are beyond the purview of medical science, such as good and evil spirits, food, and weather (Granot, Spitzer, Aroian, Ravid, Tamir, Batya, Noam, 1996). This occurs due to the way that their cultural practices are instilled in them, not because they simply do not care about being pregnant. It is important to respect their ideals about pregnancy, but it is also very important to note that many women in general avoid going to seek medical help. In fact, many women do not visit health care professionals until they are rushing to the center while in labor. It is also important to link their beliefs about pregnancy to a reason why this country faces such a high rate of maternal mortality. Many of the reasons why expectant mothers’ die are linked to underlying diseases that these women had gotten in the early stages of pregnancy or even in the later stages, such as preeclampsia or pregnancy diabetes. These diseases could have been discovered sooner, and ultimately have saved many women from dying. It is important to respect their cultural differences when finding ways to prevent maternal mortality.
From an anthropological perspective, an issue to research that ties into maternal mortality is the socioeconomic status of the women who are impacted by this epidemic. Socioeconomic status is essentially how the amount of money you make impacts your status among your peers or the people who live near you. This status can impact you positively, if you have a higher income and negatively if you have a lower income. In Ethiopia, 80 percent of the population lives in the rural areas, while 20 percent of the population live in urban areas. Most of the people who live in these rural areas work in the field of agriculture, and quite frankly, this does not bring in a lot of income to support their family, let alone enough to allow them to access the proper health care that is necessary. In the rural areas, there aren’t enough health care centers that are available for pregnant women to access in case of an antenatal emergency. There is an obvious discrepancy in Ethiopia when it comes down to who receives top priority medical attention. Because of the fact that there are not many medical care centers in the rural areas of Ethiopia, in comparison to the abundance of health care and physicians who are easily accessible for the people who live in the Addis Ababa region, it is apparent that the socioeconomic status of these people plays a huge factor in the quality of their health(Boulton, Carlson, Wagner, Porth, Gebremeskel. 2019). This is important to note for the sake of pregnant women, because to get to these centers in case of an emergency, the women would have to travel far distances to receive medical care and prolonging the amount of time that they are seen for their emergency can be fatal. Many women are also discouraged of going to these centers because they do not have the coverage needed to see a health care physician. Because of this, not attempting to get seen by health care professionals is not something that a decent percentage of Ethiopians have on their daily agendas. To fix this problem, I believe that there needs to be an increase of the amount of health care centers, so that there is a center that is accessible to everybody, especially the population of people who live in rural Ethiopia. To get proper medical care should not be a burden on the patient in an emergency, rather it should be easily accessible and a calm experience.
In Ethiopia, there are plenty ethnic groups who either high in the racial hierarchy or people who are considered to be low in the hierarchy, as this is true in almost every country. This idea can also be expressed religiously, as there are religions that are deemed unacceptable and evil and there are other religions that are celebrated and widely accepted. With this being said, how you identify can impact the type of medical experience you can expect to receive. Racism in medicine is a topic that is rarely discussed but is a huge problem in many countries. There is an abundance of people who live in Ethiopia who are Black as most of the population is Black, but in most of Africa, the presence of different ethnic groups causes racist acts towards one another. This creates racial tension and also medical racism in the very few health centers. People who identify as a certain race are turned away from medical centers and find it very hard to receive help in an emergency. This is unsafe for mothers who are having health care emergencies and need assistance in giving birth. One of the main reasons many women die from giving birth is from hemorrhage, and this occurs when there is nobody around to give women proper instructions on how to safely and effectively deliver the baby. This can be changed if there is a raise of awareness about racial medicine, and not just in Ethiopia, but everywhere. It can be extremely unsafe and even fatal if this trend continues and pregnant women are being turned away due to how they identify.
Using critical medical anthropology is to examine many of the health care issues in the world is critical. It can help people examine and analyze all of the different impacts that social determinants have on the impact of the way humans experience medical care. It can also bring awareness to how we communicate through physician and doctor interactions and can help us realize how intertwined that anthropology and epidemiology are and how we can use this understanding to efficiently discover the causes and reasoning behind why certain people have certain medical issues and others do not. The use of critical medical anthropology urges examplary interventions and ethnographic researches are introduced and wider usage is advocated of such works and methods by bureaucrats and medical staff for understanding the patients’ behavior, and the influence of social, economic and political factors on the workings of particular health systems (Witeska, 2015). Critical medical anthropology can be used to improve the conditions of the ongoing epidemic of high rates of maternal mortality in Ethiopia and the rest of the world.
Boulton ML, Carlson BF, Wagner AL, Porth JM, Gebremeskel B, et al. (2019) Vaccination timeliness among newborns and infants in Ethiopia. PLOS ONE 14(2): e0212408. https://doi.org/10.1371/journal.pone.0212408
Granot, Michal & Spitzer, Ada & Aroian, Karen & Ravid, Carol & Tamir, Batya & Noam, Revka. (1996). Pregnancy and Delivery Practices and Beliefs of Ethiopian Immigrant Women in Israel. Western journal of nursing research. 18. 299-313. 10.1177/019394599601800306.
Inhorn, M.(1995). Medical Anthropology and Epidemiology: Divergences or Convergences? Soc. Sci. Medical Journal, Vol 40, No.3 pp.285-290
Merrill Singer. (2004). The coming of age of critical medical anthropology, Social Science & Medicine, Volume 28, Issue 11, 1989, Pages 1193-1203
Kassaye, K., Amberbir, A., Getachew, B., Mussema, Y. (2006) A historical overview of traditional medicine practices and policy in Ethiopia. Ethiopian Journal of Health Development, Vol 20, No.2 pp. 129-134
Kwast, B, Rochat, R, Kidane-Mariam, W. (1986) Maternal Mortality in Addis Ababa, Ethiopia. Studies in Family Planning, Vol 17 No. 6. Pp. 288-301
Witeska, M. (2015) Critical Medical Anthropology— a voice for just and equitable healthcare. Ann Agric Environ Med. 2015;22(2):385-9. doi: 10.5604/12321966.1152099.