Old World Sexism

Last year I wrote about a bylaw requiring women and TBAs to pay a fine of a goat to the chief of their village each time they have a home birth. The other day I found out that when a young girl “falls pregnant*” her family also owes a fine to the chief as a penalty. I couldn’t help but ask “what about the boy or man’s family?” even though I knew the answer was that there is no accountability on the male’s part.

*So often the language alone says so much.

It’s bad enough when you know a culture facilitates victim blaming and double standards, but when the policies enforce them so blatantly, it gets to me. Don’t get me wrong—I’m aware of reproductive rights issues we have around the world including at home, but at least our policymakers have to try working a little more discreetly to write sexist legislation.

I also learned that medical students are taught just two categories for induced abortions: “inevitable” or “criminal.” The physicians had a dynamic conversation* about the appropriateness of putting that kind of language on a medical record. Their job is to treat people, not to get involved in legal disputes and criminal cases. The truth is abortions are still illegal here (pretty comprehensively), so technically calling it criminal is accurate. But the fact that stigmatizing language can even be found on your hospital chart demonstrates how pervasive the oppression of women really is.

*I was proud of the clinic leadership for even having the conversation—it was not easy or comfortable, as the Christian faith is a big part of this hospital. Ultimately, they were clear about wanting to do right by their patients.

Working on a research team connected to a clinic means it’s easy to see how these systemic issues touch individual lives.

The founder of CLI, Jeff, told me about a 12 year-old who was raped and impregnated by a local boy and ran away from her parents (no surprise given the environment I just described). She sought refuge with her uncle but was turned away, so was on her own until she came to deliver at CLI hospital. She is one of many cases to inspire the clinic’s new teen motherhood program. They’re working to offer nutritional and parenting support for the mother including a stipend for someone in her family to take time off of work so she can return to school.

It’s a needed service but it’s hard not to think ‘upstream’ about how we can prevent the pregnancies in the first place. Motivating cultural change is so complicated, resource- and time-intensive, so I’m happy to hear that the clinic staff is interested in using the community volunteers organized through my surveillance project as advocates for other initiatives driven by the clinic. These volunteers seem to really believe there is opportunity to improve their villages, and they are one thousand percent critical to driving sensitization efforts. You can’t be a mzungu running around insulting someone’s culture, but a respected champion who shares your vision (maybe an army of them) actually has a chance to incite change.

So, this is where the ‘less data, more doing’ pressure comes from. But evidence has shown time and time again that empowering girls and women promotes growth in all areas (econ/edu/health), arguably with more efficience than any other type of intervention. I hope CLI can learn from those cases and leverage data from Malawi and around the world to move the needle for girls and women right here.

Yes, You Can Help

plush uterus

I’m leaving for Peru in less than a week! If you’re still looking for ways to help, consider these:

Education materials on sexual and reproductive health
( in Spanish would be the most helpful )

  • educational boards of reproductive systems,
  • menstrual cycle visual aids,
  • pregnancy process materials,
  • demo kit of birth control methods, etc.judy blume book

Judy Blume’s “Are You There God? It’s Me Margaret” (in English and/or Spanish)

  • This book will  be used as an educational/discussion tool around menstruation for pre-teen and teen girls at Shilla primary and secondary school, and in the context of English classes. It allows for  participatory discussion about menstrual popular culture with an intercultural approach and in a fun context.

Kale seeds

  • for community organic garden and school garden

English Language Learning materials

  • to donate to the primary and secondary schools in Shilla

If you live in Columbus and want to donate something, let me know! I’ll pick them up from you this weekend.

and Cash, of course

Some of these are pretty specific so another option, for dwellers of Columbus or any city, is to donate money. Project needs will undoubtably arise once we are on site. Also, some things make sense to buy there, due to travel limitations, and also because learning materials obtained locally will have better cultural relevance to the learners than something we might bring over. Any donations collected will go straight to the community, not the volunteers’ expenses. So pitch in and help us boost our effectiveness.

Solpayki (thank you)!

Connecting the Dots

So I’ve shared a lot about national public health policy in Peru. You might be wondering what this could possibly have to do with my work on the ground, in an indigenous community, up in the mountains.

Policy decisions have remained regressive and are causing harm to the traditional practice of the Quechua. A few examples how:

  • A fine against home delivery
    • both the family and the midwife are subjected to such fines
    • this policy is causing the practice of midwifery to fade, as young people passionate about maternal health are studying obstetrics over midwifery because of the government’s ‘harassment’ of midwives.
    • meanwhile, practicing midwives are taking their operations ‘underground’
  • Refusal of birth certificates unless the fine for home birth is paid
    • There are serious implications associated with not having proper documentation. It restrict’s the child’s eligibility for necessary social services.
    • The internationally recognized right to personhood is violated with this practice.
  • An abortion ban, even in cases of rape or incest
    • though less severe punishments are prescribed for these situations
    • no reference to term, so the traditional beliefs of early term abortion as ‘menstrual cycle regulation’ are disregarded
  • Lacking adequate accommodations for Andean communities
    • Women hours from a facility are required to deliver in one, but they cannot come early to ensure that their transportation is covered
    • Attending in Quechua is not a routinely practiced standard of care, causing obvious communication barriers and further dividing the biomedical world from the indigenous community
    • Some facilities allow for vertical delivery, a method that’s shown to ease the birthing process and is seen as critical in the ritual of giving birth as recognized by the Quechua.
Natural birth in a vertical position is promoted, because the baby should be received close to Pachamama or Mother Earth. Other rituals take place, such as burying or burning the placenta. This event takes place in a horizontal relation between the midwife and the birthing woman.
    • Many facilities do not allow for vertical delivery, as it is a more difficult position for the doctor. It seems as though traditional handling of the placenta is even less accommodated.


The volunteer group had dinner at my house a couple of weekends ago and I shared the following Haikudeck. I covered repro history as my last entry recounts. Then I shared cultural barriers to biomedical health settings, and suggested solutions to making care more culturally appropriate. Explore my notes if you’d like, or leave a comment below if you have any questions.


Peru reproductive health policy (1990s)

I’ve been doing research on the policy around reproductive health in Peru. With some significant political instability in the last few decades came a huge shift in contraceptive policy, from neoliberalism to extreme conservatism.

In the 1990s the Fujimori government addressed reproductive health from a population control angle. Making contraceptives more widely available, legally, was highly controversial since Roman Catholicism is the dominant religion in Peru. Feminists celebrated increased options for Peruvian women to exercise reproductive health autonomy. 

In time, though, this campaign became infamous for performing sterilizations without informed consent; aggressive recruitment practices targeted at individuals in poor communities (such as the indigenous); and extremely poor quality of care in delivering those procedures.

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