[ PUBLICATION ] La place du consentement dans les expériences de violences obstétricales au Mexique

paru dans Autrepart 85 « Les violences de genre » 2018/1: 39-55. Disponible sur https://www.cairn.info/revue-autrepart-2018-1-page-39.htm


Au Mexique, le Chiapas fait partie des rares États où les violences obstétricales peuvent être sanctionnées pénalement. Ces violences, qui peuvent inclure des épisiotomies systématiques, des césariennes sans consentement ou encore de la contraception forcée pendant le postpartum, s’exercent à l’intersection de plusieurs rapports de pouvoir entre patientes et personnel soignant. Pour les femmes pauvres ou indigènes, ces violences représentent une continuité de la violence systémique vécue au quotidien. À partir des récits de trois femmes mexicaines, collectés lors de 13 mois d’enquête ethnographique dans le Chiapas entre 2013 et 2015, ce travail met à jour les difficultés d’application de la loi sur les violences obstétricales, et interroge les conditions d’expression d’un consentement libre et éclairé des patientes dans les hôpitaux publics mexicains.


Chiapas is one of the few Mexican states where obstetric violence can be sanctioned in criminal court. Obstetric violence ­ which can include, but is not limited to, routine episiotomies, coerced Cesarean sections or forced contraception at childbirth ­ happens at the intersection of several power relations between patients and health personnel. For poor women and indigenous women, obstetric violence is another expression of the structural violence they experience on a daily basis. In this article, based on 13 months of ethnographic fieldwork in Chiapas between 2013 and 2015, I analyze the difficult application of the obstetric violence law in practice. Based on the account of three women, I interrogate the conditions of expression of informed consent in Mexican public maternity wards.

[ PUBLICATION ] Politiques de santé materno-infantile au Brésil et au Mexique

avec Alfonsina Faya Robles, Cahiers des Amériques Latines 88-89, 2018, pp.61-78.

Au Mexique et au Brésil, les femmes pauvres sont la cible privilégiée de politiques de santé materno-infantiles. Dans le premier contexte, elles bénéficient d’une aide financière en échange de leur participation à des ateliers de santé et à des visites médicales. Dans le second, elles sont inscrites dans des programmes de santé pendant leur grossesse, accouchement et post-partum. L’analyse croisée des données d’enquêtes menées auprès de femmes de quartiers populaires, de sages-femmes traditionnelles, d’agent.e.s communautaires de santé et de personnel médical met en avant deux processus connexes de régulation des choix reproductifs : la médicalisation de la santé reproductive et la sanitarisation des corps féminins. Nous montrons comment le développement de l’assistance médicale et sanitaire dans ces deux pays, au-delà des changements positifs, soumet les décisions reproductives au contrôle d’agents étatiques de santé, renforçant les mécanismes de régulation et de domination des (corps des) femmes pauvres.

La suite sur https://journals.openedition.org/cal/8837

[ PUBLICATION ] Socio-Cultural Approaches to the Anthropology of Reproduction

An edited bibliography curated by Elise Andaya and Mounia El Kotni, available at http://www.oxfordbibliographies.com/abstract/document/obo-9780199766567/obo-9780199766567-0197.xml


Attention to reproduction within anthropology emerged in early cross-cultural studies, largely descriptive and ethnomedical in nature, that examined reproduction in the context of cultural and religious beliefs around conception, childbirth and postpartum taboos, and knowledge about fertility regulation. However, the topic was given a new theoretical framing and disciplinary significance beginning in the 1980s when feminist scholars built on prior work on gender and kinship to articulate a new field of analysis that firmly situated reproduction at the nexus of power and politics. As Faye Ginsburg and Rayna Rapp argued in their article, “The Politics of Reproduction” (Ginsburg and Rapp 1991, cited under Early Conceptual Frameworks and Edited Volumes) that demarcated this new field that they called the “politics of reproduction,” biological and social reproduction are inextricably intertwined.

[REVIEW] Midwives and Mothers: The Medicalization of Childbirth on a Guatemalan Plantation

[Originally published on August 8, 2018 on the Association for Feminist Anthropology website]

Midwives and Mothers: The Medicalization of Childbirth on a Guatemalan Plantation, Sheila Cosminsky, University of Texas Press, 2016, 303 p.

Midwives and Mothers builds on Sheila Cosminsky’s decades-long involvement with midwives in Guatemala, where she has been conducting research since 1974. This thoroughly documented monograph provides a rich account of the changes and continuities in women’s reproductive care preferences and midwives’ practices in rural Guatemala. Cosminsky analyzes the shifting roles of midwives across generations by contrasting midwife Maria’s work in the 1970s to her daughter Siriaca’s, also a midwife on the coffee and sugar plantation where she grew up.

As indicated in the Acknowledgements, it is a feeling of urgency that led the author to publish this monograph, an urgency fueled by the ongoing criticism and attacks by biomedical personnel and international organizations towards traditional midwives’ knowledge and practices. The increased pressure to medicalize pregnancy and birth deeply impact women’s experiences and midwives’ practices, as described in the nine chapters of this monograph.

Each chapter contains rich ethnographic descriptions, details on international and national health policies, and theoretical analysis from the fields of medical anthropology, the anthropology of reproduction and midwifery studies. The first three chapters provide information on the context of the study: Chapter 1 introduces the reader to midwives’ role in Maya communities, Chapter 2 describes the Finca and María’s work, and Chapter 3 contrasts María and Siriaca’s practices and relations to their patients. The following three chapters dive deep into describing midwives’ work in prenatal care (Chapter 4), pregnancy (Chapter 5) and postpartum (Chapter 6), contrasting the changes between mother and daughter’s practices, and in the relations between midwives and health institutions. Chapter 7 focuses on the role of the midwife, whose scope of practices range far beyond pregnancy and birth, while Chapter 8 and 9 respectively interrogate national midwifery policies and one of their consequences, the medicalization of childbirth.

The changing role of midwives

Across Guatemala, midwives attend two third of births, a rate reaching 80 percent in rural areas. Cosminsky analyzes midwives’ daily practices in relation to various socio-political spheres, including local cultural norms, political relations between midwives and Finca owners, national midwifery training programs and international policies aiming at diminishing Guatemala’s high maternal mortality rates. This ethnography also highlights how, on their end, Maya women’s reproductive health decisions are made at the nexus of various structural factors, personal decisions, family preferences and public health messages.

Taken together, the chapters provide a large overview of midwives’ diverse scope of practices, from prenatal care, labor and delivery to infant care and family counselors, leading the author to describe these women as “doctors to the family.” While previous ethnographies on and with midwives in Mexico and Guatemala also describe the many roles midwives undertake (Berry 2010, Freyermuth 2003, Jordan 1993), Cosminsky devotes entire chapters to one or the other aspect of midwives’ work, providing a comprehensive description of midwives’ large scope of practice. The fruitful comparison of midwives-as-family-doctors grounds these women’s work in the everyday life of Maya men and women and provides a glimpse both at their material living conditions and the health challenges they face.

Cosminisky’s long-standing involvement with midwives appears through detailed ethnographic vignettes, providing an intimate view on the relations between midwives and their patients, as well as in the detailed list of diseases—ethnocultural and biomedical alike—these women cure. While I appreciate the level of detail provided by the vignettes, my work with the Organization of Indigenous Doctors of Chiapas (OMIECH)—at the forefront of political opposition to biopiracy in Southern Mexico—lead me to be wary of listing medicinal plants and recipes as they are presented in the Appendices. Debates on plant knowledge property are strong in both research and activist communities, and this monograph, published in English, is directed towards non-community members, raising concern on the use of such knowledge. Providing a translation of the Appendices and sharing it with community members might be one way of returning the knowledge to those who provided it, as OMIECH has done in Chiapas.

The medicalization of childbirth in Guatemala

Cosminsky’s ethnography is also a political analysis of the medicalization of childbirth in Guatemala, and the everyday consequences of midwifery training programs on midwives’ medical practices and women’s birth experiences. Descriptions of midwifery trainings highlight how international guidelines impact relations between medical staff and midwives, and change the way midwives manage birth. The author expresses concern for the continuous attacks on midwives’ practices by biomedical personnel. For example, midwives are not allowed to attend primiparous women, which restricts midwives’ scope of practices and can come into conflict with cultural expectations and women’s desires. Despite such regulations, women resist giving birth in hospitals, for fear of mistreatment and abuse – a fear shared by several women throughout the book.

Broader impact

The moral dilemmas Guatemalan midwives face, between biomedical recommendations and their empirical knowledge resonate with midwives’ situation across the world. The medicalization of reproductive health is of growing concern by scholars, activists and international organizations. This ethnography provides a case study of the rapid changes in midwives’ practices, and their far-reaching consequences not only for women but for entire communities. It is a valuable resource for teaching undergraduate and graduate courses alike, in Anthropology, Nursing and Midwifery, Latin American Studies and Public Health. The different chapters can be used separately or as a whole, providing an excellent example of ethnographic research and writing.



Berry, Nicole S. 2010 Unsafe Motherhood: Mayan Maternal Mortality and Subjectivity in Post-War Guatemala. Reprint edition. New York: Berghahn Books.

Freyermuth, Graciela 2003      Las mujeres de humo: morir en Chenalho : género, etnia y generación, factores constitutivos del riesgo durante la maternidad. México, D.F: CIESAS, INM, Comité por una Maternidad Voluntaria y sin Riesgos en Chiapas.

Jordan, Brigitte 1993 Birth in Four Cultures : A Crosscultural Investigation of Childbirth in Yucatan, Holland, Sweden, and the United States. 4th edition. Prospect Heights, Ill: Waveland Pr Inc.