[ PUBLICATION ] A Tale of Three Midwives: Inconsistent Policies and the Marginalization of Midwifery in Mexico

Un article co-écrit avec Lydia Zacher Dixon et Veronica Miranda, disponible sur le site du Journal of Latin American and Caribbean Anthropology.

ABSTRACT

This article uses collective ethnographic research to provide a multifaceted and multisited understanding of how current issues facing midwifery and women’s health in Mexico reflect a historically fraught relationship between marginalized populations and the state. We argue that midwives have been hindered in their ability to systematically improve maternal health care as a result of their uneven and changeable relationship with the Mexican state. We present case studies of three Mexican midwives who have different backgrounds, access to training and certification, and relationships with the local health systems that structure how they interpret and negotiate their relationships with state institutions and policies. As we examine these negotiations, we do not lose sight of the ways that midwives’ opportunities, experiences, and challenges are often interwoven with those of the women they serve. Both exist at the margins of the Mexican state—a space where dreams of modernity and legacies of inequality collide. [gender, health, Mexico, midwifery, social anthropology]

RESUMEN

Este artículo utiliza la investigación etnográfica colectiva para proporcionar una comprensión multifacética y multilocal de cómo los problemas actuales que enfrentan la partería y la salud de las mujeres en México reflejan una relación históricamente tensa entre las poblaciones marginadas y el Estado. Sostenemos que las parteras han sido obstaculizadas en su capacidad de mejorar sistemáticamente la salud materna como resultado de su relación desigual y cambiante con el estado Mexicano. Presentamos estudios de casos de tres parteras Mexicanas con diferentes antecedentes, acceso a capacitación y certificación, y relaciones con los sistemas de salud locales que estructuran cómo interpretan y negocian sus relaciones con las instituciones y políticas estatales. A medida que examinamos estas negociaciones, no perdemos de vista las formas en que las oportunidades, experiencias y desafíos de las parteras se entrelazan con las de las mujeres a las que sirven. Ambos existen en los márgenes del estado Mexicano, un espacio donde chocan sueños de modernidad y legados de desigualdad. [antropología social, género, partería, México, salud]

[ BLOG ] Chiapas health workers strike against reforms

[Article originally published in ROAR Magazine]

Workers of the Chiapas Health Jurisdiction have been on strike for one month, in protest against the structural reforms the government intends to pass.

It isis 8:30 pm and the nurses are just starting their 12-hour shift. “There are three teams. Now we have a 12-hour shift, until 8 am tomorrow morning, and then we come back 24 hours later,” one of them explains. Workers from different health institutions of the city of San Cristóbal de las Casas have organized the distribution of supplies in the tents blocking the road to the Woman´s Hospital and the Health Jurisdiction. During the long shifts, “some bring coffee, some bring food, and others come with hunger,” says another nurse, laughing.

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Nurses on strike

Workers of the Health Jurisdiction of Highlands Chiapas, which is comprised of workers from 18 municipalities have been on strike for over one month, in protest against the eleven structural reforms the government has been trying to pass. In particular, they explain that the so-called “universalization of healthcare” which would merge the different public healthcare institutions of the country would have disastrous consequences in Chiapas, one of Mexico’s poorest states.

The current universal healthcare (Seguro Popular) covers about 300 procedures. The previous program covered over 3,000. “And with this reform, there will be barely a hundred procedures covered, leaving out chronic illness such as diabetes and acute conditions like cancer,” a union representative explains. And in a country with vast income disparities, universal healthcare’s unique cost for uncovered procedures would not be accessible to poor peasants living in the states of Oaxaca (where the police repression led to 12 dead, a hundred wounded and 25 disappeared in Nochixtlan a few weeks ago),Guerrero (where 43 students were disappeared in September 2014) and Chiapas. The biggest health costs will thus be shouldered by patients themselves, and not by the state.

The privatization of healthcare is in line with international reforms promoted by lending agencies, such as the World Bank and the Inter-American Development Bank, and will benefit those already in the business of health, like the Mexican telecom magnate Carlos Slim. “This is a model that does not fit with the reality of Mexico, and what we as workers are starting to implement are local consultations with lawyers, researchers, and activists to find a new health model” decries another union leader at a press conference on June 30. Protesters are also calling out to the state’s lack of knowledge and interest in the operating conditions of the health institutions. “In the hospitals here, we lack medicine and even machines. Sometimes there are not even syringes. The only thing doctors can do is fill out prescriptions and send patients to buy out-of-pocket medications in pharmacies”. In the face of such shortages, staff members often help out their poorest patients by paying the costs out of their own pocket.

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Sign of protest outside of the Health Jurisdiction.

The discontent with the law is plenty: “For those of us who will be retiring, we would only be getting 1,080 pesos a month (about 60 USD)” explains one healthcare worker. “Our colleagues working in laboratories will be judged on their productivity, not on the number of hours; in order to comply with their goals they will have to either work more hours or increase the number of patients per hour,” describes another.

Even though the Highlands’ Jurisdiction is the only union on strike in the state so far, health workers from all over the country marched in protest on June 22. In Chiapas, teachers, families, students and residents of different districts of the city have shown solidarity with the movement: “Night after night, people from the barrios bring us coffee and show their support.”

Twenty-two days after declaring a “Permanent Assembly,” the 2,500 workers stand firm. So far, the health reform has been paused, “but this does not mean that it will not be reactivated,” cautions the union representative, “we will not dismantle our Permanent Assembly.” The health workers say they have learned a lot from the teachers, who have been mobilizing against radical changes in the education system as well. “We are barely learning how to walk. But we will walk together with the teachers and peasants.”