The Construction of Risk in Childbirth in Rural Zimbabwe: The Case of Traditional Midwifery

Abstract

This thesis is based on a study that was conducted in the Manicaland Province of Zimbabwe during the period 1996-1997. The main objective of the study was to identify factors in traditional midwifery that facilitate the vulnerability of both the birthing woman and the traditional birth attendant (TBA) to risks in childbirth. Traditional birth attendants in Zimbabwe, though for a long time a shunned and ridiculed cadre, have always been the custodians of maternal health in the rural areas. TBAs have traditionally relied on intuition and hands-on-experience in their day-to-day practice. With the government's adoption of the upgrading programme for TBAs as a Primary Health Care initiative to reduce infant and maternal mortality, TBAs in Zimbabwe have since incorporated some of the modern obstetric methods into their own traditional practices. There is yet another group of TBAs, who regardless of the training programme, have continued dependence on their experiential and intuitive knowledge for delivery of health. Traditional Birth Attendants, as well as the rural women with whom they share an explanatory model of birthing, were consulted in this study in order to get an emic understanding of risk construction, which in turn would inform intervention strategies. It was hoped that the fusion of these conceptual categories (indigenous with biomedical), would contribute to a body of knowledge which would be a foundation for culturally compelling interventions to reduce risks in traditional birthing practices. As this study unfolded, it became apparent that not only was the women's preference for the TBA determined by cultural forces, but that there were a myriad of additional, contextual forces at play. Macro-processes affecting TBA practices are noted, and issues analyzed from the broader perspective of critical medical anthropology (CMA).