Abstract
In this paper I look onto the experiences of immigrant African women with the western maternity system. I start with a short exploration on the difference between the Western and the African maternity care system. I use the papers of Berggren et al. (2006) and Brown et al. (2010) as primary references and I back up their findings with other research results. In particular, I focus on the beliefs that African women have about common western obstetric practices. Then, I examine the experience of Somali immigrant women who have been circumcised when they receive maternity care in Sweden. Finally, I look into the female body through a feminist perceptive.
Key words: Africa, West, maternity care, immigrant women, female body
Introduction
The dramatic demographic changes that occurred during the 21st century led to a more cultural diverse background of women being treated by medical professionals in western countries. Diversity is a reality, since many pregnant, immigrant African women, who have been circumcised or infibulated, who have different religious beliefs, and perceive their bodies in a culturally diverse way, come face to face with an over – medicalized (in comparison to their home countries), culturally western, health care system (see, for example Essen, et al., 2000). This means that the medical stuff need to perform a culturally sensitive perinatal surveillance and to understand the difference between the Western medical system and the African one. It is essential that the unique sociocultural context of the origin country is properly recognized and a more holistic approach to treatment is being into practice. The outcomes of a culturally competent care are positive (Willis, 1999).
According to the WHO more than 80% of the population in Africa use traditional medical practices (Shewamene et al., 2017); “Isihlambezo is a mixture given to pregnant women to help them with the birth process to make it easier and painless. . . . All healing power comes from God and the ancestors. A pregnant woman is supposed to follow certain things. She is not supposed to go out at night or attend funerals, as this attracts unfamiliar spirits which may harm the unborn baby.” (Naidu, 2014, pp. 150). African traditional medicine plays a dominant role in maternity health care. While the western medical system is physically and biologically focused, the traditional medicine focuses on the metaphysical, healing power of the nature, the religious spirits and narratives, the spiritual power of the ancestors and the healing power of the sacred, people of the tribe. “We say everything will come at the time when God will plan it” (Brown, et al., 2010, pp. 223).
Herbal medicine, such as garlic, ginger, eucalypt, ruta rue, bitter leaf, palm kernel, neem leaves, jute leaves, vervain, cresson, madder, fenugreek, cinnamon, etc., is used in many African countries [Ethiopia; (Bayisa et al., 2014), Morocco (Elkhoudri et al., 2016), Nigeria (Fakeye et al., 2009) etc.], to pregnant women in order to cure common pregnancy health issues of the first trimester, such as nausea and morning sickness (Bayisa et al., 2014), to help the postpartum women get back into shape (Elkhoudri et al., 2016), to cause abortion (Rasch et al., 2014) and to provide assistance during childbirth (Sarmiento et al., 2016; Mureyi et al., 2012). The providers of these herbs are usually people of the community, such as family members, neighbors, traditional healers, grandmothers and mothers-in-law, that help the women and her newborn from the first 40 days postpatrum until over three months after childbirth. Many women described the importance of an affectionate female community after delivery. This along with the use of traditional medicine herbs was something that immigrant women wanted to preserve in the western residence countries (Berggren et al. 2006).
Traditional medicine is something that western medicine practices have abolished many years ago. The over-medicalization of the obstetric procedure can be recognized by the rising rates of C-sections (e.g. Boerma et al., 2018), the increase of pharmaceutical drugs prior, during and after pregnancy (e.g. Ματσανιώτης, 1999 in Κατσίκη, 2006) the ignorance of the women’s needs into labor due to the unquestionable authority of the medical stuff; “. . .the majority of women believed that their experiences and bodily perceptions were not listened to until the attending doctor confirmed that their symptoms were “real”.” (Bellón Sánchez, 2014, pp. 30).
The fear of common western obstetric practices
“They say that when they have a normal delivery the doctor is paid little but if they cut them quickly they get more money. That is why they cut them. Some of them . . . they practice on them.” (Brown, et al., 2010, pp. 224). African women in labor experience a feeling of frustration during their encounter with the western medical system. A rush need by the clinicians to finish the procedure along with the common recommendation of performing cesarean section comes into contradiction with the cultural and very religious background of the African women. The belief on religious determination of things meant to happen, leads African women to refuse cesarean section, because if they accept it, it represents an unwillingness to accept help from God. The fear of cesarean section is common, due to other described experiences of resulting to death, belief of future reproductive disability and risk of anesthesia (Brown, et al., 2010).
The findings of Brown et al. (2010) research are backed up by other studies as well; Herrel et al., (2004), Beine (1995), Ameresekere et al., (2011) also showed the fear of Somali women on C-section and the experienced frustration on rushing labor. This fear of C-section can be justifiable since cesarean sections are less frequent in Africa and are performed mostly on emergencies (Dumont et al., 2001).
The case of Somali women, who have been circumcised, with the Swedish maternity care system
“Now I have to become a victim again after delivery, when the midwives refuse to resuture me ” (Berggren et al., 2006, pp. 53). African women who have been circumcised describe their experience with the western maternity care as being twice shameful; they feel exposed to their cultural practices as being the only ones to still practice female genital mutilation, and shameful when they ask for a re-suture after giving birth. In their research Berggren et al. (2006) showed that many women considered the Swedish law on forbidding re-suturation too strict and described that they had to suffer again, this time because they were being “open” and didn’t confront to the cultural norms either of their home country nor to the residence country.
Women may also feel exposed to the medical personnel, which can perceive them as powerless in front of the cultural peer pressure and the patriarchal beliefs about female sexuality. The medical personnel can also create an image of a woman who doesn’t have the ability to decide over her reproductive rights (Leval et al., 2004). In the interviews contacted by Berggren et al. (2006), the women expressed a feeling of being the study object, a new medical case that is not happening in the West and they have the opportunity to examine. Doctors, nurses and midwives were there without the explicit consent of the laboring woman and they were referring to what has happened to them without talking direct to them.
The fact that midwives are not always familiar with what should happen when a woman who is circumcised is coming into labor, is depicted, by the African women, in the feelings of fear, stress, helplessness and vulnerability about their bodies and a intuitive need for guiding the medical personnel; “We need to have help because we are sutured. We can’t become like Swedes, and we can’t deliver like Swedes. . . . I and other women who have not been opened before delivery suffer most. We need to be opened at delivery, but the midwives don’t know how to cut.” (Berggren, et al., 2006, pp. 54).
Another study in Sweden showed that circumcised women felt a lack of emotional support and a frustration regarding the adequacy of the midwives’ knowledge in handling their labor (Essen, et al., 2000). It is important to mention that the health care services in Sweden were described as much better than in Africa, in both studies (Berggren, et al., 2006; Essen, et al., 2000).
The female body
The cultural norms seem to be very persistence on the women’s perceptions on what must happen to their bodies and how much power these practices have in regards to their socialization and religious subsistence (Brown et al., 2010). To be circumcised is considered to be a rite from girlhood to womanhood. Many interviewed women in the research of Berggren et al. (2006) described that they had to protect their daughters from the social shameful outcry, by putting them through FGM, in order to be just like the other girls. In some African tribes the fear of an “untamed” female sexuality lies in the belief that if the clitoris is not cut off, it will continue to grow into a penis-like, gruesome organ and the girl will loose her femininity (Abusharaf, 1998).
FGM, as a powerful patriarchal forced procedure in women’s bodies, is usually performed by women towards women, and in most cases without anesthetics, antiseptics, analgesics or antibiotics, using any available sharp tool, such as rocks, broken glasses, even the teeth of the performer (Barstow, 1999). This sadistic act is interpreted by some scholars as a psychological defense mechanism of the women to accept their inevitable, submissive role in their society, to internalize the physical and psychological pain they came through, and through their numb, emotionally dissociating attitude to live the catharsis by projecting the pain onto the bodies of their own children (Williams & Sobieszczyk, 1997). Therefore, the female body can be seen as a tool to confront the patriarchal norms, that lead to an internalized misogyny, since it is associated with the female identity.
The female body is perceived in the patriarchal society as a “naturally” weak, disabled, handicapped, dependent female body (Young, 1980) that needs to be tamed “if it challenges its femininity, its condition as object, through a loud and subversive embodied subjectivity” (Cohen Shabot, 2015, pp. 234). The female body challenges its pure “femininity” by desiring sexual pleasure, by feeling powerful and adequate during labor, and by demanding its needs to be fulfilled. The intersectional identities of gender and nationality shows that the female body is still being left out, since the common practices of one culture are not recognized by the other, and it is viewed, with much curiosity, as alien, objectified, and fragile encumbrance.
Bibliography:
Abusharaf, R. M. (1998). Unmasking Tradition. The Sciences, 38(2), 22–27. https://doi.org/10.1002/j.2326-1951.1998.tb03367.x
Ameresekere, M., Borg, R., Frederick, J., Vragovic, O., Saia, K., & Raj, A. (2011). Somali immigrant women’s perceptions of cesarean delivery and patient-provider communication surrounding female circumcision and childbirth in the USA. International Journal of Gynecology & Obstetrics, 115(3), 227–230. https://doi.org/10.1016/j.ijgo.2011.07.019
Barstow, D.G. (1999). Female genital mutilation: the penultimate gender abuse. Child Abuse and Neglect, 23, 501–510.
Bayisa, B., Tatiparthi, R., & Mulisa, E. (2014). Use of Herbal Medicine Among Pregnant Women on Antenatal Care at Nekemte Hospital, Western Ethiopia. Jundishapur Journal of Natural Pharmaceutical Products, 9(4). https://doi.org/10.17795/jjnpp-17368
Beine, K. (1995). Conceptions of prenatal care among Somali women in San Diego. Journal of Nurse-Midwifery, 40(4), 376–381. https://doi.org/10.1016/0091-2182(95)00024-e
Berggren, V., Bergström, S., & Edberg, A. K. (2006). Being Different and Vulnerable: Experiences of Immigrant African Women Who Have Been Circumcised and Sought Maternity Care in Sweden. Journal of Transcultural Nursing, 17(1), 50–57. https://doi.org/10.1177/1043659605281981
Boerma, T., Ronsmans, C., Melesse, D. Y., Barros, A. J. D., Barros, F. C., Juan, L., Moller, A. B., Say, L., Hosseinpoor, A. R., Yi, M., de Lyra Rabello Neto, D., & Temmerman, M. (2018). Global epidemiology of use of and disparities in caesarean sections. The Lancet, 392(10155), 1341–1348. https://doi.org/10.1016/s0140-6736(18)31928-7
Brown, E., Carroll, J., Fogarty, C., & Holt, C. (2010). “They Get a C-Section . . . They Gonna Die”: Somali Women’s Fears of Obstetrical Interventions in the United States. Journal of Transcultural Nursing, 21(3), 220–227. https://doi.org/10.1177/1043659609358780
Cohen Shabot, S. (2015). Making Loud Bodies “Feminine”: A Feminist-Phenomenological Analysis of Obstetric Violence. Human Studies, 39(2), 231–247. https://doi.org/10.1007/s10746-015-9369-x
Dumont, A., de Bernis, L., Bouvier-olle, M. H., & Bréart, G. (2001). Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. The Lancet, 358(9290), 1328–1333. https://doi.org/10.1016/s0140-6736(01)06414-5
Elkhoudri, N., Abdellatif, B., & Amor, H. (2016). Maternal morbidity and the use of medicinal herbs in the city of Marrakech, Morocco. Indian journal of traditional knowledge. 15, 79-85.
Essen, B., Johnsdotter, S., Hovelius, B., Gudmundsson, S., Sjoberg, N., Friedman, J., & Ostergren, P. O. (2000). Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden. BJOG: An International Journal of Obstetrics and Gynecology, 107, 1507-1512.
Fakeye, T. O., Adisa, R., & Musa, I. E. (2009). Attitude and use of herbal medicines among pregnant women in Nigeria. BMC Complementary and Alternative Medicine, 9(1). https://doi.org/10.1186/1472-6882-9-53
Herrel, N., Olevitch, L., DuBois, D. K., Terry, P., Thorp, D., Kind, E., & Said, A. (2004). Somali Refugee Women Speak Out About Their Needs for Care During Pregnancy and Delivery. Journal of Midwifery & Women’s Health, 49(4), 345–349. https://doi.org/10.1016/j.jmwh.2004.02.008
Leval, A., Widmark, C., Tishelman, C., & Maina Ahlberg, B. (2004). THE ENCOUNTERS THAT RUPTURE THE MYTH: CONTRADICTIONS IN MIDWIVES’ DESCRIPTIONS AND EXPLANATIONS OF CIRCUMCISED WOMEN IMMIGRANTS’ SEXUALITY. Health Care for Women International, 25(8), 743–760. https://doi.org/10.1080/07399330490475593
Mureyi, D. D., Monera, T. G., & Maponga, C. C. (2012). Prevalence and patterns of prenatal use of traditional medicine among women at selected harare clinics: a cross-sectional study. BMC Complementary and Alternative Medicine, 12(1). https://doi.org/10.1186/1472-6882-12-164
Naidu, M. (2014). Understanding African Indigenous Approaches to Reproductive Health: Beliefs around Traditional Medicine. Studies on Ethno-Medicine, 8(2), 147–156. https://doi.org/10.1080/09735070.2014.11917629
Rasch, V., Sørensen, P. H., Wang, A. R., Tibazarwa, F., & Jäger, A. K. (2014). Unsafe abortion in rural Tanzania – the use of traditional medicine from a patient and a provider perspective. BMC Pregnancy and Childbirth, 14(1). https://doi.org/10.1186/s12884-014-0419-6
Sarmiento, I., Zuluaga, G., & Andersson, N. (2016). Traditional medicine used in childbirth and for childhood diarrhoea in Nigeria’s Cross River State: interviews with traditional practitioners and a statewide cross-sectional study. BMJ Open, 6(4), e010417. https://doi.org/10.1136/bmjopen-2015-010417
Shewamene, Z., Dune, T., & Smith, C. A. (2017). The use of traditional medicine in maternity care among African women in Africa and the diaspora: a systematic review. BMC Complementary and Alternative Medicine, 17(1).
https://doi.org/10.1186/s12906-017-1886-x
Williams, L. & Sobieszczyk, T. (1997). Attitudes surrounding the continuation of female circumcision in the Sudan: passing the tradition to the next generation. Journal of Marriage and the Family, 59, 966–981
Willis, W. 0. (1999). Culturally competent nursing care during the perinatal period. Journal of Perinatal and Neonatal Nursing, 23(3), 45-59.
Young, I. M. (1980). Throwing like a girl: A phenomenology of feminine body comportment motility and spatiality. Human Studies, 3, 137–156.
Κατσίκη, Γ. (2006). Το κοινωνικο-πολιτισμικό πλαίσιο της γέννησης και η συμβουλευτική εγκύων και νέων μητέρων. In Μ. Μαλικιώση-Λοΐζου, Δ. Σιδηροπούλου-Δημακάκου, & Γ. Κλεφταράς (Eds.), Η συμβουλευτική στις γυναίκες (pp. 113–135). ΕΛΛΗΝΙΚΑ ΓΡΑΜΜΑΤΑ.
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