Nutritional Epigenetics and Prenatal Diets

Nutritional Epigenetics and Prenatal Diets: “I’ve been eating this way for years”

by Natali Valdez

Between 2012 and 2014 I completed participant observations and interviews at two clinical
trials, one in the United States and one in the United Kingdom. These trials tested nutritional
interventions on ethnically diverse pregnant women who were deemed obese. The recent trend to
test nutritional interventions on pregnant populations is related to the emergence of postgenomic
science. Scientists believe that a woman’s weight and diet during pregnancy can influence the
health risks of her developing fetus, and of future generations. Moreover, theories in nutritional
epigenetics claim that food can act as an environmental factor, which can modify genetic regulation
and expression. Therefore, the nutritional interventions targeting obese pregnant women are
intended to provide a healthy nutritional environment for the developing fetus.

In my ethnographic work at the clinical trials I found that food or nutrition came to mean
many different things to the scientists designing the intervention and the participants receiving the
intervention. For instance, based on the design manuals I read and interviews I had with the
principal investigators and collaborators at the StandUP trial, nutrition was framed through the notion of glycemic control. Glycemic control aims at minimizing foods that are high on the glycemic index. The glycemic index is a tool that categorizes foods based on how they will affect blood sugar levels. Therefore, the intervention focused on controlling or limiting foods that are high in sugar, saturated fats, and carbohydrates. At the trial the women in the experimental group would receive the nutritional intervention, which consisted of meeting with a health trainer at least eight times to learn how to change their diet through glycemic control.

The justification of the nutritional intervention based on glycemic control was explained to me in the following way: if a pregnant woman eats a donut, she will experience a spike in her blood
sugar levels, which will cause a cascade of reactions related to glucose metabolism. Eating a donut
will also expose the fetus to metabolic and hormonal reactions. In this case, the donut is an
environmental factor that stimulates metabolic and hormonal reactions that affect the fetus. In the
trials that I examined, pregnant women are not explicitly told that their diet is an environmental
factor. However, the scientists at the StandUP trial drew from nutritional epigenetics to justify the
significance of nutritional interventions during pregnancy precisely because food can act as an environmental factor. From my observations, the explicit framing of food as environment remained
in the realm of the scientists and not necessarily in common conversations among pregnant
participants in the trial.

From the perspective of pregnant participants enrolled in the experimental group, nutritional
epigenetics disappeared from view and what came into focus were the women’s cultural and
emotional entanglements with food. On a sunny afternoon in April Mary came in for her last
intervention visit with Diana, the health trainer for the StandUP trial. Mary was the first generation
born in England whose parents and family were all from Senegal. She self identified as African and
was studying for her masters in computer engineering in the UK. Diana identified as Afro-Caribbean since her parents migrated to England from Jamaica. Diana was one of the few women of color working on the StandUP trial.

During the session, Diana asked Mary, “what are the main staple foods in Senegal?” Mary
replied, rice, okra, and palm oil. Diana then reminded her that some of those foods were high on the
glycemic index. She then proposed that when Mary goes back to Senegal to visit her family, she
will need to focus on portion control. Mary responds, “portion, portion, portion, I do not want to
share a house with you [Diana], too much portion, I just put a plate of food down and as long as you
want to eat you just mix, eat, tummy is full.” Mary states this with a huge smile and both women
started laughing. The session continues and Diana walks Mary through a few different
questionnaires. Diana then asked Mary, “what’s been your biggest achievement and challenge?”

Mary responds by stating that her biggest achievement was how the intervention had “changed the
way I eat, the way I think about food – I behave myself more,” she says this again with a big cheeky
smile. To address the second part of the question, Mary goes on to say that one of her biggest challenges was having to always be “aware of everything, like portions and liquid beverages, I’m
not used to it, it will be hard because I’ve been eating this way for years.”

Although Diana and Mary have a warm jovial dynamic during the intervention delivery,
Mary was sincere in expressing how the intervention affected her. Take the example of portion
control. Controlling one’s portion was at first a foreign concept to Mary. The idea that one would
measure a “serving” of food calculated by grams of sugar, carbohydrates, and fat is a different
epistemological approach to food, eating, and sharing. As Mary mentioned here and in other conversations she usually just put a big plate of different kinds of food in the middle of the table and
everyone would take what they wanted. In this way encouraging the idea of portion control
intervenes not strictly in the nutritional aspect, but it also intervenes in a cultural and social way of
relating and sharing foods with others. Mary also recognizes that the intervention has “made her
behave more,” which indexes how the nutritional intervention intended to change her existing
eating habits. In addition, the idea that the intervention makes her “behave more” reflects the
underlying notion that prior to the intervention she was not “behaving” when it came to her food
and diet choices.

This snap shot of a nutritional intervention during pregnancy illustrates how different
approaches to food and nutrition are conceptualized at different levels and spaces within the same
clinical trial. On the one hand the scientific discourse and approach to the intervention focused on
nutrition as an environmental factor affecting fetal development, and glycemic control – a method
to intervene spikes in blood sugar levels. On the other hand nutrition or diet from the intervention
delivery was seen as a fundamental change in Mary’s life. A change in how she eats, shares, and
thinks about food. The juxtaposition of both these narratives exposes how a scientific tool like a
nutritional intervention is not a neutral object, but one that is rendered meaningful in different ways
based on how people engage with it.

Since returning from the field, it is clearer to me why a critical feminist perspective within
science studies and reproductive anthropology is fundamental in the examination of epigenetics.
Reproduction and pregnancy are at the center of epigenetic knowledge production, and as Rayna
Rapp reminds us, reproduction is also at the center of social theory. I appreciated the opportunity to
write this short reflection for CAR newsletter because it pushed me to think through material I have
not examined since completing the dissertation.


Natali Valdez completed her PhD in June 2016 in the Department of Anthropology at the University
of California, Irvine. She is currently a Postdoctoral Fellow in the Center for the Study of Women,
Gender, and Sexuality at Rice University. At Rice she will be working on her book manuscript titled
“Weighing the Future: An Ethnographic Examination of Epigenetics and Prenatal Interventions.”

A Very Informative Video on Circumcision

So, I've just recently discovered Ryan McAllister, PhD and his videos on birth and circumcision, and I highly recommend you view his video on Child Circumcision (aka genital cutting). It is a lecture to a room of anthropology students, and he comes at the topic from an accessible academic perspective.

If you're ever wanted to know more about why you should think about or question circumcision or no, this is a great overview video (with a brief hard-to-watch clip of male genital cutting near the beginning).

He makes a number of excellent points. He covers culture, medicalization, the biology of the penis and the procedure, informed consent issues, ethics, the science behind common reasons for removing the foreskin, and more.

I love the comedic clip's quote... "so you can have this chopped off or you could wash it?"

The whole video really makes you question, do the supposed pros outweigh the known cons?




Note that this presentation includes graphic material to convey more complete information about the topic.

One thing he doesn't really touch on is the fact that the obstetricians who perform this procedure are also keen to have parents circumcise because it is a relatively quick and easy surgery that they make money from.

Ryan is the director of NotJustSkin.org.

One of NotJustSkin's primary missions is to educate the public about violations of informed consent or bodily integrity. In the U.S., male genital cutting, more often called circumcision, is commonly practiced even though parents rarely receive the information that would be required to give informed consent to any other procedure. Circumcision is the only procedure where a doctor can legally amputate part of a non-consenting child without any medical reason.


I was not an intactivist before viewing this video, but I may be one now...


To add, being a feminist from a Jewish background, I also encourage a perusal of an article called "Circumcision: a Jewish Feminist Perspective."

This is the first of Ryan's videos that I came across, but I plan to post on his other content, as well.

New Ricki Lake & Abby Epstein Documentary on Birth Control

Ricki Lake and Abby Epstein, the duo who brought us the ever popular Business of Being Born, are back together. They are planning a new documentary called Sweetening the Pill (based on a book of the same name) which aims to open our eyes the way that BoBB did, but this time, about birth control.

BoBB questioned the "one size fits all" and over-medicalized approach to childbirth, showing women that there are more options out there for birth. Sweetening the Pill hopes to do exactly the same thing, questioning the ubiquity of hormonal contraceptives (including the pill and hormonal IUDs, rings, implants).

They are probably assuming that the same audience who cheered at their questioning of the assumption that hospital birth or cesareans are right for everyone would also cheer at their questioning of the assumption that hormonal birth control is right for everyone.

I find the concept of this film fascinating from a medical anthropology perspective. Reproductive anthropologists examine phenomena like menstruation, menopause, and birth control from a cross-cultural and biological perspective, often finding that ideas we hold true are not always universal.

If you look at a the history of medicine, you find that men's bodies were considered the ideal, while women's bodies were thought to be defective machines. Men's bodies were the basis for a normal, healthy functioning body, without the confusing aspects of menstruation, pregnancy, and menopause. Female bodies were seen as problems that needed to be solved.

Controlling our bodies' menstrual cycles allows the female body to be more like a man's, as we can control our "out-of-whack" hormones, keep from getting pregnant at any unknown time, and even cease bleeding. It created a freedom for women who were somewhat enslaved by their bodies making decisions for them, consequences that kept some from living a life they wanted or working outside of the home.

These days, the white Western body is seen as the norm, while women of color or women from other nations are to us what women used to be to men. Hormonal birth control was developed based on what would be appropriate for the European/American body, not for the Asian, African, or Latina body. Standard hormone dosages, or any hormones at all, may not be right in all bodies, similar to how not everyone's body can process lactose.

Many women find they have side effects from taking The Pill that they do not like, like feeling sick or uncomfortable, and often stop taking the pill. There has been some research on biological side effects, and we know that the pill does increase your risk of blood clots. Unfortunately, so does being pregnant! Other serious issues are rare, and it is up to women to make the right choice for themselves. Many think that choosing when to be pregnant (or never being pregnant) is the right choice for them, so taking the pill is worth the small medical risks.

There is research that has found that hormonal birth control can affect sexual desire. We know that it affects hormones, and studies have found that it might affect who we find attractive. Women might wonder "Would I be different if I wasn't on this birth control?" It is a valid question to ask.

Sweetening the Pill doesn't say that hormonal birth control isn't great, they just wonder why its the only one that is usually recommended to women when they talk to their doctors about birth control. Are there other options? What's right for me? Maybe a lot of women don't even know there are non-hormonal birth control options, other than condoms. Maybe their doctors don't even tell them the side effects.

I think that this is a valid perspective. I think that women deserve to know that there are non-hormonal options, such as the diaphragm and a non-hormonal copper IUD (Paragard).  Other examples include cervical caps, spermicide and sponges, the pull-out method (withdrawal), and natural family planning (also called fertility awareness).

The main method that the film seems to focus in on is Fertility Awareness (Natural Family Planning). They argue that though we felt empowered by The Pill, being aware of your own body's processes is even more empowering. You don't need a medication or "unnatural" hormones messing up your own natural processes, you just need to get in tune with your body.

Fertility Awareness Method: a mathematical calculation of a woman’s cycle in order to determine periods of fertility and is only effective if a woman has regular 28-day periods. Fertility Awareness requires that the woman daily monitor cervical fluid, temperature and other factors to determine fertile days. In either case, either abstinence or use of a barrier method during fertile times is required in order to prevent pregnancy. 

Fertility Awareness is a great thing to learn to do, especially if you're trying to get pregnant, but it is not a highly reliable form of birth control if you are really super trying NOT to get pregnant. If people used it perfectly, it would be as effective as people perfectly using the pill or the patch, but people don't use these things perfectly. In typical use, you take the pill at different times each day, and you might mess up or forget your tracking.

Typical use of Fertility Awareness methods (including cervical mucus methods, body temperature, methods and periodic abstinence) has a 24% "failure rate," which means it is about 76% effective. That is quite close to the effectiveness of Withdrawal (pulling out), which people often refer to as a ridiculous method to use to prevent pregnancy. The success rate for withdrawal is 78% (surprisingly effective, all things considered)! I've seen other website cite Fertility Awareness as 80% effective and pulling out as 73% effective, but I trust the data from the Guttmacher Institute, a highly respected reproductive health research organization:

So, the public health side of me thinks that it is not wise for Sweetening the Pill to get too many people moving away from their hormonal birth control, which has quite a few benefits for women, especially low income women and marginalized women and women of color. Birth control that is highly effective, like the pill (91% effective with typical use) and the hormonal IUD (99% effective), is not something we should step away from lightly. It allows women control over their lives, it helps women who truly shouldn't (medical reasons, youth, or otherwise) get pregnant, and it avoids abortions. The Natural Family Planning method really doesn't have the efficacy that these methods do.

I'm not vehemently against starting the conversation that this documentary is starting, the way some articles on the internet have been -- see the infamous Amy Tuteur's post on Time.com and Slate.com's articles to hear some outrageously unbalanced reviews. I think that this is a valuable conversation to have. I recognize that I am of a class privileged enough to be able to afford all types of birth control and have the time to track fertility, if we want to. Not everyone actually has the financial and temporal freedom to actually choose what is right for them, so we need true open and honest information on all of the options.

You can find more information on the film Sweetening the Pill at the Kickstarter site (which has been fully backed).




I think a great part of this conversation, from an academic viewpoint, is whether the Pill or Natural Family Planning is more empowering, more feminist. The film's preview implies that though the Pill was the ultimate female empowerment 55 years ago, being one with your body's processes and not relying on pharmaceuticals is more empowering. Others might think that by rejecting the pill, we are undoing the work that was done to become less enslaved by our biology.

 Best Daily's post quotes Ricki Lake/Abby Epstein:

"The progression of mainstream feminism is founded in part on women overcoming and controlling their biology", they explained. "This is because for a long time women's biology or difference has been used against us as justification for our mistreatment and oppression. Women have come to feel that they must overcome their biology in order to have equality and freedom."

To enjoy the same privileges as men, do we feel we must we be more like them, not just in our attitudes, but in our biology? Lake and Epstein think so: "The male body is held up as the "ideal" in the medical industry and the female body is seen as inherently faulty and problematic. Women have had to make sacrifices to be allowed to work alongside men in a patriarchal society. The fear is that if we stop making those sacrifices we will lose that ground."

I don't think Ricki Lake and Abby Epstein are "anti-choice" or "anti-feminist" as the Time and Slate articles call them, but I do hope that they present their information in a balanced way. I do hope they talk about the pros of hormonal birth control for so many women, and the potential cons of fertility awareness methods. I hope they talk about other methods that aren't usually talked about in the mainstream.

We will have to wait for its release to find out!

Notes from the Field: Learning with Indigenous Midwives in Chiapas, Mexico

Mounia during the Day of the Dead fiesta
November 2014

Today's post is a guest article from anthropologist Mounia El Kotni. Mounia's "Notes from the Field" appeared in the most recent Council on Anthropology and Reproduction newsletter, and she has kindly allowed its reproduction here. In this post, she describes her participant-observation experience with midwives in Chiapas.


Learning with Indigenous Midwives in Chiapas, Mexico

“Oh, I see, so you want to be a partera (midwife)” is the typical response I hear after explaining the purpose of my visit; that I am doing dissertation research to document how midwives live and work. Although I try to explain my research goal in terms of “helping raise awareness on the difficulties parteras are facing,” I am always met with this same response “so you want to learn how to become a midwife?” And as I have gotten to meet parteras and aspiring midwives, I must admit that there is not always a clear difference between what I do and how I act and what they do and how they act: asking questions about pregnancy care, sitting in on prenatal consults, taking notes on almost everything the partera says... There is a thin line between participant-observation and midwives’ apprenticeship model. And indeed, I have been learning a lot about how parteras work and live, but also a hell of a lot about plants given in pregnancy care and massage techniques.

Since October 2014, I have been in San Cristóbal de Las Casas, Chiapas, conducting dissertation fieldwork and volunteering for the Women and Midwives’ Section of the Organization of Indigenous Doctors of Chiapas (OMIECH). As a volunteer, my work consists mainly of two tasks: administrative tasks (aka looking for funding) and logistical support during events and workshops. Since 1985, OMIECH has been strengthening Mayan medical knowledge and organizing health workshops in indigenous Tseltal and Tsotsil communities of Chiapas. Even though I am in Chiapas, some of my notes echo those of Kara E. Miller (Fall 2014 Newsletter). Here too, the parteras - who are referred to as Traditional Birth Attendants in international documents - are frustrated with the lack of possibilities to transfer their skills to the next generation. This is why the Women and Midwives’ section organizes workshops focused on reproductive health, and care during pregnancy, birth, and postpartum. These workshops are open to all members of the community where they take place, and aim to perpetuate botanical and medical knowledge by transmitting it to younger generations.

Micaela giving a workshop at the meeting of OMIECH parteras
February 2014. credit: OMIECH

The loss of knowledge is accelerated by various factors: young people’s migration, midwifery not being an attractive profession economically, and also the increasing medicalization of birth. The push to send women to birth in hospitals comes with a delegitimation of indigenous parteras’ knowledge as “not-modern”. Through conditional cash-transfer programs (documented by Vania Smith-Oka in the state of Veracruz), women are pushed to have their prenatal visits and give birth in hospitals. Parteras, on their end, have to attend trainings given by the Health Secretary. These trainings emerged in the 1980s, and intensified in Chiapas under the pressure of reducing maternal mortality rate to comply with the Millennium Development Goal (Chiapas has one of the highest maternal mortality rates in Mexico). Indigenous traditional midwives either have to follow the trainings or stop practicing. This can have dramatic consequences in places where they are often the only health care provider in their communities.

Micaela during a community workshop with parteras.
May 2014. credit:Alice Bafoin

As I jot down notes during an interview or observation within these different settings, I feel a thrill of delight when their words echo one another. But then I realize this means that these state policies are really achieving great changes for parteras. And like Sisyphus, tirelessly, my colleagues at OMIECH reweave what is being unwoven: traditional medical knowledge, but also, and as important, pride in it and trust within the community.

While “in the field”, my notes are scribbly at times, crystal clear at others, but rarely absent. I try to type them regularly, as a good apprentice-anthropologist, but have stopped feeling guilty when I could not do so. It took me a few months to be able to “let go” and admit there will always be an event I will miss, a trip I cannot make... At my mid-point in the field (already), I have just started to take drawing classes, which helps me expand the range of my notes, when words fail to describe a hand gesture, or when I do not know the terminology for this exact point on the belly that needs to be massaged. These classes have made the familiar look different, and made me look at people in a new way, which in turns adds more depth to my notes. Life in the field intertwines professional, political and personal spheres. The friendships I have built through this research promise to impact both my career and personal life. As we were searching for plants in the garden of the organization for an upcoming booklet publication, my colleague Micaela corrected me as I got the name of the plant wrong, once again. I could sense, for the first time, an impatient tone in her voice. I pause and I suddenly realized that although I am not studying to become a midwife, every one of the parteras I have met has been a teacher to me, training me a little bit, sharing their story, their tortilla and their endless knowledge. I am looking forward to learning a lot more in the next five months I will be spending with them and I hope my dissertation will bring them knowledge they can use in their struggle.

Mounia El Kotni is a French-Moroccan doctoral candidate at the State University of New York at Albany. Her dissertation documents the impact of Mexican health laws on the practice of indigenous midwives. She is currently conducting fieldwork with the Women and Midwives Section of the Organization of Indigenous Doctors of Chiapas (OMIECH). Since 2012, Mounia is also a member of the French organization Association Mâ, which promotes respected childbirth. She can be reached at melkotni@albany.edu

Notes from the Field: When Breastmilk Isn’t Enough

Veronica and 4 month old Paulo

Today's post is a guest article from anthropologist Veronica Miranda. Veronica's "Notes from the Field" appeared in the most recent Council on Anthropology and Reproduction newsletter, and she has kindly allowed its reproduction here. In this post, she reflects on her time spent in the Yucatan while she was breastfeeding and conducting field research.


When Breastmilk Isn’t Enough

It was a hot and humid late July afternoon when I decided to pay a visit to one of the village midwives. I gathered my already-packed research bag and on the way out I said good-bye to my husband (a.k.a. field assistant and nanny) and kissed our three month old son. It was around three o’clock when I left. The heat was still unbearable as I walked through the rural Yucatec Maya pueblo of Saban, located in the southern interior of the peninsula.

When I arrived to the midwife’s house I was hot, sweaty, and thirsty. I was escorted by the midwife’s daughter to the large newly built thatched roof kitchen located behind the house. Elda, the midwife, was cooking lunch when I got there. She invited me to sit down and eat with her family. We had a simple but delicious lunch.

Elda served a thin soup of boiled Chaya (a dark leafy green high in calcium and folic acid) that was mixed with ground-up pumpkin seeds, sea salt, and a generous squeeze of fresh lemon juice. Her son had picked some avocados from the tree outside and made a big bowl of guacamole. And like all meals in the pueblo, our lunch was accompanied by fresh, handmade corn tortillas. It was one of my favorite meals. I ate two servings and savored every bite.

Elda was happy that I liked her cooking and she said I must always be hungry because I am breastfeeding. She told me she ate often when she breastfed her children many years ago. I asked her if she exclusively breastfed her three children—two girls and a boy. She said yes. In fact her son, the youngest, was the largest of all her babies. He was so big that many people thought he was a year old when he was only six months. We had already had many conversations in the past about the importance of breastfeeding for both baby and mother. Yet at that moment, I had to ask her a question that had been bothering me for some time. I asked, “Elda if I am exclusively breastfeeding my infant son and he is visibly a large and healthy baby, why are so many people in the community telling me I needed to supplement with formula? Why are they saying he needs more than breastmilk”?

Elda took a moment to think about what I had just said and then asked if my son cried a lot. As a young first-time mother away from my own familial support system, I was not really sure the average amount a baby cried. My son did cry often throughout the day and night but I was usually able to sooth him by breastfeeding. From the day he was born I nursed my son on demand—even at eight months he was still adamant about having breastmilk every two to four hours. In the end, I answered Elda’s question by saying “Yes, he does cry a little”. Her teenage son was intrigued by our conversation and asked me if my son had air in his belly? Assuming this was similar to colic I explained that this used to be an issue, but not anymore. Elda suggested that he could have mal de ojo. But she was leaning more to the idea that maybe I was not producing enough milk. She asked if my milk was soft or hard when it leaked through my shirt. I paused for a moment—I had never been asked this question before. Was she referring to my milk flow or the thickness of my milk? I probably will never know since I did not ask her to explain. Not completely understanding the question I said I think it comes out soft.  

She said that was it. My son cried a lot because he was hungry, she explained. My milk was too thin and he was not getting his fill. I asked her what I could do to fix this, and she responded by saying, “Usually if the mother has thin milk, about a month after the baby is born, she is told to drink a lot of agua de Chaya and follow a local remedy of placing boiled orange leaves over the her breast and taking a warm bath with the tea water. The mother must stay inside for three days, especially if it is cloudy outside. This will help increase the milk supply and make it thicker”. Unfortunately, I had missed my chance. My son was almost four months old and my best option now was to supplement with formula.

I thought about this conversation with Elda the rest of the time I was in the field. Just a generation ago, women in the community exclusively breastfed. The older and middle aged women who told me I needed to supplement with formula had exclusively breastfed their own children. Women have always breastfed. Breastfeeding continues to be widely practiced throughout the community. As Elda pointed out, local healers and midwives have used traditional remedies passed down from older generations to help a mother increase her milk supply and sooth a crying baby. But times have changed; today, breastmilk is no longer seen as enough. Many women firmly believe that infants need to be supplemented with formula. The idea that traditional medicine is no longer able to help women produce enough milk to feed their babies is relatively new. Formula, for many women, provides the necessary nutrients infants need to thrive. These beliefs are instilled through the advice of local doctors and nurses, and reinforced by widespread media and public health campaigns. Today the majority of new mothers believed that their infants would be healthier and happier if they had both breastmilk and formula.  

There is a wide array of literature that explains why indigenous and/or poor women choose to use infant formula. Some reasons include 1) the belief in corporate media messages proclaiming the superior health benefits of formula; 2) indigenous women’s internalization of the idea that their bodies are inadequate; 3) a rise in social status with the use of expensive formula; and 4) the adoption of the idea by indigenous and/or poor women that they are better mothers by offering formula to their children. I knew all of this going into my fieldwork. I have read the literature, and studied the political economic histories that have affected and shaped rural women’s choices. Yet, it was not until I personally experienced in the field the issue of supplementing with formula that I had a greater appreciation for the many ways in which women address on a daily basis the health of their children. As a young researcher eager to apply the scholarly knowledge I had gained I chose to focus heavily on the issue of breastmilk verses infant formula. But I was wrong. After many conversations with women in the community I was finally able to listen to them and understand that they did not see the two as a binary. It was until much later that I realized the women suggesting I supplement with formula were trying to help me deal with a situation and address a specific symptom—a crying baby. These rural Yucatec Maya women are bombarded with constant messages by doctors and from the media that their bodies are insufficient at meeting the needs of their unborn and infant children. As with childbirth, these women have not addressed their health and that of their children through an either/or dichotomy. Women are trying to make the most of all the resources they have and mixing practices allows them to ensure the wellbeing of their children. It was shocking to see how strong the outside messages of the inadequacy of women’s bodies had affected their beliefs, yes, but even within that these women are trying to find the best ways to raise healthy and happy children.


Veronica Miranda is a doctoral candidate in medical anthropology at the University of Kentucky. Her dissertation research focuses on how rural Yucatec Maya women, midwives, and state health care workers participate in the production of childbirth practices in relation to federal health policies and programs.

Weekend Movie: From Womb to Womb

Biological Anthropologist Julienne Rutherford has a fascinating talk available online that is a short but nice overview of the effect of epigenetics from womb to womb. Essentially she discusses the effects on the intrauterine environment, and whether the womb that we develop in affects the womb that our female offspring produce when they reproduce. The purpose is to understand how we pass down, generation to generation, the effects of our socio-ecological environment. Put another way, how our grandmother's life affects our life, and the lives of ensuing generations.

Her talk covers how placentas play a role, how Life Course Theory is part of it, but isn't the whole picture, and how studying primates can help us get an idea of the impact of intrauterine environments on the health and lives of future offspring.

"We are more than our genes. Genes get switched on and off constantly. All the DNA in our bodies in all the cells is essentially identical, but some get turned on, some get turned off...

But even more subtley, gene expression can be affected by our environment in the now, in the lived experience. Molecules attach to the DNA, which sort of locks it down, so its inexpressible - can't get turned on. This phenomenon is called epigenetics. Epi = beyond, above. Something beyond just the molecule themselves. How are the molecules regulated.

We know from a variety of experiments and observations in humans and other animals that the lived experience of an organism can have enormous impacts on how the genes are regulated. We also know that some of these molecular locks can be inherited along with the DNA itself. So, for ex, some genes in the stress pathway of maternal ,fetal, and placental tissues are regulated differently in people who have experienced poor nutrition, poor rearing behavior... high levels of psychosocial stress, institutional racism and discrimination, and the experience of war..."

It's one more argument for improving social and economic environments in order to improve a population's health and future potential. People often think that a poor or unhealthy person can just "do better" to make themselves healthier or more wealthy, but so much depends on our socio-ecological environments, and that of our ancestors.

"The placenta contains the mysteries of the past and predictions for the future..."

You can view Dr. Rutherford's 23 minute presentation on the website for the Cusp Conference 2014.

https://www.cuspconference.com/videos/julienne-rutherford-2014/

Public Health Ryan Gosling

...I just can't help myself. I am cracking up at these!

Do you know about the Ryan Gosling meme? (If not, read all about it at Know Your Meme)

Have you all seen Home Birth Ryan Gosling?  

Or what about Feminist Ryan Gosling? 

Well now there is Public Health Ryan Gosling!   

Here are a few of my favorites:

Get it? Hehe. Do you have a favorite Ryan Gosling meme?

Mass Media Childbirth

While I'm working on finishing up my anthropology Master's thesis, I thought perhaps you'd be interested in perusing another.

Have you heard of the film "Laboring Under an Illusion: Mass Media Childbirth vs. The Real Thing"?  It is made by filmmaker, childbirth educator, anthropologist Vicky Elson. I had a chance to view this film a couple of years ago. It is a quick film, and available to watch online at Amazon for $1.99. If you're interested in a review of the film, there is one at Stand and Deliver.




Turns out the author's thesis on this topic is online! I haven't had a chance to read through it, but it sounds great. Here is the abstract:


Childbirth in American Movies and Television Patterns of Portrayal and Audience Impact
by Victoria L Elson

The author, an independent childbirth educator, systematically analyzed sixty-two American television and motion picture portrayals of human childbirth. She found that many of these portrayals included extreme distortions of time and danger. Comic and dramatic embellishments detracted further from the accuracy of these portrayals.

She also collected ethnographic data on cumulative lifetime effects of such portrayals on viewers, especially as those effects personal beliefs about childbirth. She found that many viewers reported being able to maintain conceptual distance, due to their media literacy. But she also found that a substantial number of viewers self-reported susceptibility to beliefs fostered by media consumption. In many of those viewers, anxiety about giving birth ran deep, in ways that could arguably make those viewers more susceptible to complications, interventions, and inappropriate choices in childbirth.

The paper also includes background information on media literacy, a discussion of present-day American birth, and suggestions for neutralizing the potentially negative effects of mass media birth imagery.


You can read the entire thing online here!

Traditional Societies

Not having much time lately for blog writing, I've just been sharing as much as I have time to read via my Facebook and Twitter pages. But this article had too many great things to pull out of it not to put them on my blog.

The article "The World Until Yesterday by Jared Diamond - Review" is a review by Wade Davis of Diamond's new book. But it is also a great article on Anthropology. As the article is somewhat long, I've pasted some excellent parts of it below (but I encourage you to click over and read the entire thing!)

Wade begins by giving a short historical background on anthropological thinking in the early part of the last century. One of these theories, that of cultural evolution, envisioned "societies as stages in a linear progression of advancement, leading, as they conceived it, from from savagery to barbarism to civilisation." Or, that there was an evolution that all societies went through, advancing over time from savage to civilized in the same sequence, and clearly the civilized peoples were the ideal goal.

Franz Boas was the first to posit that cultural variation is produced by diverse mechanisms and "that all cultures share essentially the same mental acuity."

From the article:

This ethnographic orientation, distilled in the concept of cultural relativism, was a radical departure, as unique in its way as was Einstein's theory of relativity in the field of physics. It became the central revelation of modern anthropology. Cultures do not exist in some absolute sense; each is but a model of reality, the consequence of one particular set of intellectual and spiritual choices made, however successfully, many generations before. The goal of the anthropologist is not just to decipher the exotic other, but also to embrace the wonder of distinct and novel cultural possibilities, that we might enrich our understanding of human nature and just possibly liberate ourselves from cultural myopia, the parochial tyranny that has haunted humanity since the birth of memory.

Whether this intellectual capacity and potential is exercised in stunning works of technological innovation, as has been the great historical achievement of the West, or through the untangling of the complex threads of memory inherent in a myth – a primary concern, for example, of the Aborigines of Australia – is simply a matter of choice and orientation, adaptive insights and cultural priorities. There is no hierarchy of progress in the history of culture, no Social Darwinian ladder to success. The Victorian notion of the savage and the civilised, with European industrial society sitting proudly at the apex of a pyramid of advancement that widens at the base to the so-called primitives of the world, has been thoroughly discredited – indeed, scientifically ridiculed for the racial and colonial notion that it was, as relevant to our lives today as the belief of 19th-century clergymen that the Earth was but 6,000 years old.

Franz Boas

In his reflection on Diamond's works, Wade writes:

The other peoples of the world are not failed attempts at modernity, let alone failed attempts to be us. They are unique expressions of the human imagination and heart, unique answers to a fundamental question: what does it mean to be human and alive? When asked this question, the cultures of the world respond in 7000 different voices, and these answers collectively comprise our human repertoire for dealing with all the challenges that will confront us as a species as we continue this never-ending journey.

Traditional societies do not exist to help us tweak our lives as we emulate a few of their cultural practices. They remind us that our way is not the only way.

The voices of traditional societies ultimately matter because they can still remind us that there are indeed alternatives, other ways of orienting human beings in social, spiritual and ecological space. This is not to suggest naively that we abandon everything and attempt to mimic the ways of non-industrial societies, or that any culture be asked to forfeit its right to benefit from the genius of technology. 

By their very existence the diverse cultures of the world bear witness to the folly of those who say that we cannot change, as we all know we must, the fundamental manner in which we inhabit this planet. This is a sentiment that Jared Diamond, a deeply humane and committed conservationist, would surely endorse.

Jared Diamond

And if you're super into Anthropological theory, read through the comments on the article and jump in on the arguments about whether this is a fair review of Diamond, or if IQ can measure intelligence in every culture. 

Mother Nature

When I was an anthropology undergraduate student, I read and reviewed the book Mother Nature: Maternal Instincts and How They Shape the Human Species by anthropologist Sarah Blaffer Hrdy. This book, along with Birth in Four Cultures, was a book that began the shaping of my interest in maternal health and anthropology of reproduction.

Hrdy writes this book from a primatology, biology, women's studies, feminist, history, sociology, and evolutionary psychology perspective. It covers an enormous range of topics, from animal behavior to european history, all providing perspective on the assumption that maternal instinct is a defining element of a woman's nature. As the book's description notes, "Hrdy strips away stereotypes and gender-biased myths" and shows that mothers "deal nimbly with competing demands and conflicting strategies."

I have gone back to this book many times since I first read it. It presented a lot of ideas to me for the first time; For example, placentophagia, the grandmother hypothesis, reasons behind wet-nursing and infanticide, and more.

Below is my review of the book (c) 2006:

         What do langurs, prolactin, and an infant’s appearance have to do with being a loving mother? Everything, according to Sarah Blaffer Hrdy. Mother Nature: Maternal Instincts and How they Shape the Human Species is a book that, in no less than 700 pages combines biology, psychology, history, and anthropology to present a new argument in regards to the image of motherhood. Hrdy writes there is no such thing as maternal instinct. In actuality, there is such thing as maternal instinct, just not in the way that we usually think of it. Society assumes that all mothers have intrinsic caring behavior towards their offspring. Hrdy’s book presents the idea that a mother’s natural instinct is to make decisions about whether or not to birth and raise a child -based on personal situation – and then decide between their needs and that of their offspring.

The idea of the self-sacrificing mother is a product of human cultural ideas, not the dominant reality. This idea is based on our ideas of morality (not nature or biology), which vary across cultures. We believe in our society that it is immoral and unnatural for a mother to not raise every child that she conceives. Hrdy deftly challenges this notion. She calls attention to the fact that in many cultures mothers practice infanticide regularly, and women throughout history and all of evolution have done so as well. She also points out that mothers do not instantly bond with their children, and not all mothers love every child unconditionally.

There exist in our society some very serious conflicts for women: to be good mothers, but also to be women who need to work in order to help raise the children, or to follow personal ambition. Or, to not use birth control or abortion (in other words, to have every child), but not have enough daycare provided. Hrdy writes that life is hard and mothers cannot be blamed for the choices they sometimes have to make. She is a proponent of the idea that being pro-life is being pro-choice. I think that this is one the most interesting ideas that this book presents. A child will only survive if the mother or caretaker wants the child to live. Thus, the mother should be given the opportunity to decide when is the right time in her life for her to be able to successfully raise a child. Then that child will live a healthy and cared-for life, and not succumb to the uncertainties that go along with abandonment or not being fully cared for.

There is a great deal of variety and complexity of behavior among mothers. A mother decides whether or not she can successfully raise a child based on her health, environment, and personal ambitions. Would the child die if she were to let it live? Would its life be hard? Does the mother have the money and resources to raise the child to be healthy and successful? Would raising the child harm the mother? Or keep the mother from pursuing her own goals? Would the investment made in one child at one point in time be better at another time for another child? Hrdy advocates the notion that since our society believes that every single human being deserves the right to live, and to kill an infant is bad, then something needs to be done to help mothers. In order for children not to be abandoned or killed mothers need help. More than euphoric hormones or an adorable infant to help a mother attach, she needs some form of help in order to make sure each child is cared for – such as allomothering. This is an important point, but it also makes it seem that Mother Nature is a long-winded endorsement of day care.

Sarah Blaffer Hrdy uses many animals and primates as biological examples for types of mothering, such as langurs, spiders, mice, bees, and more. These animal mothers make certain logical choices about having and raising children. For instance, mice automatically abort a fetus by absorbing it whenever an infanticidal male is around and harm to the baby is inevitable. Here, maternal investment in the child would be a waste of resources that can be reserved for a more successful time later. These explanations are fascinating, and show great insight into the biological workings of motherhood. In the case of primate examples this can be relevant, however, with other animals it can have its drawbacks. Even if the explanations are interesting and make sense, do they have to do with us? Moreover, with all the seemingly relevant examples of primates which are supposed to tell us something about our own evolution as human mothers, she then writes that the two percent genetic difference between humans and apes is actually quite significant because of culture, language, and so on. Thus, if this difference is that significant, what do all her examples of them mean for us?

Hrdy is very selective about what she uses to back up her argument. For instance, when she gives human examples most of them are of indigenous peoples. She is coming from a biology background, so this makes sense. The indigenous people probably live closer to how original humans lived when we were evolving, especially maternally (although its hard to say how things were evolutionarily because we were not there and cannot know for sure). Yet using these people as an example causes a problem because our societies now are so different from these original human societies. And culture, which plays a huge part, varies greatly. We no longer live in societies where allomothers are easy to find. Also, investment in children lasts a much longer time now that parents also save money to send children to school. Humans cannot catch up biologically with the advances we have made culturally, and it has a huge impact on childrearing.

             These days, with the option of birth control, mothers choose to terminate investment in offspring if the conditions are not right for child raising. They choose to have fewer children with more chance of success. It is a question of quality vs. quantity. Wanting quality over quantity is healthier for the mother (though it may be the opposite of what males may desire). Hrdy has proven that this scenario is not unnatural, it just is not in harmony with society’s expectations, which wants a completely selfless mother full of love for every single child. By changing the way we think about motherhood, Mother Nature has an important impact on our society’s thinking. Mothers, fathers, scientists and politicians can all benefit from taking a look at maternal instinct in this way. Hrdy successfully refutes many female gender myths and assumptions. She does a great job at making the subject matter interesting not only to scientists but also to laypeople. She incorporates biology, psychology, history, and anthropology. Although it lacks a discussion about what adoption and love mean for evolution, Mother Nature covers a great deal of information.

*Note: This review was written more than 6 years ago, and well before this topic became my passion. This review would probably turn out somewhat differently if I read and wrote about the book today.

This is Anthropology

Last year Florida Gov. Rick Scott said on a radio show,

We don’t need a lot more anthropologists in the state. It’s a great degree if people want to get it, but we don’t need them here. I want to spend our dollars giving people science, technology, engineering, and math degrees.

The Anthropology community responded swiftly with local and national attacks on blogs, newspapers, websites, and radio. To see an all-inclusive overview over the reactions to this attack on anthropology and the social sciences, click over to Neuroanthropology blog. It sparked major discussions on university listserves and on twitter and facebook.

Several students decided to create a campaign like "This is Public Health" for Anthropology. Then a graduate student at the University of South Florida, took her fellow students and colleagues’ statements on This Is Anthropology and made them into a Prezi presentation

I posted about this last year when it was going on, but I never posted the awesome Prezi on this blog! So here it is, THIS IS ANTHROPOLOGY:

This is Anthropology on Prezi

You can either click through, or set it to Autoplay.


By the way, a few days after all the responses, and the fact that everyone pointed out that his daughter has an anthropolgoy degree, Rick Scott said "I love Anthropology."

It's also worth pointing out that, as the first slide in this presentation notes, "The statistics Rick Scott used to extol the virtues of STEM [science technology engineering math) education at the expense of other disciplines are brought to you by anthropologists."

Once Upon a Birth

Have you heard about Merck's Campaign to improve maternal health and save women from dying for giving life - Merck for Mothers?

Their new effort, "Once Upon a Birth," is a campaign to raise awareness about maternal health and help prevent the deaths of some 800 women around the world who die during pregnancy and childbirth every day. Melissa Joan Hart is the spokeswoman for this campaign, and shared her birth story on the Merck for Mother's Facebook page.

For every person who shares their birth story, a monetary donation will be made to Join My Village, which is a charitable initiative that helps women and girls through education, and supports safe pregnancies and deliveries. These deaths are preventable - family planning, access to health care that can recognize preeclampsia, or timely treatment for postpartum hemorrhage!

All you have to do is share your birth story! Or, if you don't want to go through Merck, there are ways to help Join My Village directly. 



This video is our way of highlighting the urgent issue of maternal mortality and demonstrating how we hope to improve the health of women during pregnancy and childbirth.

I think this is a great video, but I disagree with one aspect... I don't think research into more technologies is what is needed to save the lives of these mothers. I think it's access to quality care, reduction in structural violence, improvement in the lives of the poor and the marginalized. Gender equality, improved transportation, food, etc. Health policies that improve the social and ecological factors that keep people in poor health.

Are Doulas a Form of Complementary and Alternative Medicine?

Last week we discussed medical pluralism and complementary and alternative medicine (CAM) in an anthropology course. CAM is hard to define, but basically brings to mind chiropractors, acupuncture, massage therapy, homepathy, Reiki, dietary supplements, yoga, meditation, traditional chinese medicine, etc. The 2007 National Health Interview survey found that approximately 38% of adults use CAM. Alternative medicine is used instead of conventional medicine, while Complementary medicine (or therapies, treatments, etc) are used in conjunction with conventional (bio) medicine.

Kaptchuck (2001) writes “any therapy deemed unacceptable by the mainstream can find a receptive home in CAM,” all that is required is that they can be described as alternative (202).  Harvey (2011) builds on this point, also emphasizing that “it gathers or is granted meaning from what it is not (Western) as if having no meaning-making, capabilities or significance of its own” (48).

As we were discussing CAM, one of my classmates asked me to talk about being a doula. When asked, I was a little bit thrown off. Is a doula really a CAM practitioner? Doulas are non-medical. I don't consider myself "medical" but could certainly fit into a form of "therapy," as I provide psychosocial support. After all, is yoga and massage medical? They're definitely therapeutic. And am I "alternative" or am I "complementary"? Well, no one really uses a doula INSTEAD of biomedicine, generally in addition to it, so perhaps doulas are complementary.

So, I agreed to speak about these thoughts I was having about being a doula and perhaps being complementary medicine. It's true that many people who hire doulas do so because they feel they haven't received appropriate care from biomedicine/conventional medicine. Often, CAM is sought because biomedicine is not meeting some health need. Alternative therapies attempt to “address what orthodox biomedicine seems both unable and unwilling to address” (Nairandas 2011:69). Also true is the fact that people who hire doulas also tend to be into massage, yoga, acupuncture, chiropracty, and other forms of CAM.

I struggled with this topic, though, because I had never considered myself a CAM practitioner before. This was what my professor found the most interesting. Perhaps I hadn't thought of myself that way because I do get hired mainly by people who, even if they desire a natural birth, are still birthing in the hospital and are not the hippie crunchy granola new age people one associates with users of CAM.

I think after considering this for a while I have come to the conclusion that yes, a doula is a form of complementary medicine. It is a form of mind-body therapy. Like acupuncture, for example, it doulas are seeking legitimacy by proving their worth and efficacy through randomized control trials. Further, doulas can on occasion be paid by health insurance, also a fight that CAM undergoes.

The only place I could find a clue about doulas as CAM was at this Integrative Medicine blog where the blogger mentions doulas and health insurance.

To many, it might seem obvious that doulas are CAM, especially if they've never heard of them. But to me, because I work in biomedical settings, it seems hard to separate what I do from conventional medicine. Perhaps a midwife and/or doula at a home birth seems more alternative.


What do you think? Is a doula a complementary and alternative health practitioner?



Our CAM and medical pluralism readings:

Baer, H. A., C. Beale, R. Canaway, and G. Connolly 2012 A Dialogue between Naturopathy and Critical Medical Anthropology: What Constitutes Holistic Health? Medical Anthropology Quarterly 26(2): 241–256.
Baer, H. A. 2002 The Growing Interest of Biomedicine in Complementary and Alternative Medicine: A Critical Perspective. Medical Anthropology Quarterly 16(4): 403-405.
Harvey, T. S. 2011 Maya Mobile Medicine in Guatemala: The “Other” Public Health. Medical Anthropology Quarterly, 25: 47– 69.
Kaptchuk, T. J. and D. M. Eisenberg 2001a Varieties of Healing. 1: Medical Pluralism in the United States. Ann Intern Med 135(3): 189-195.
Kaptchuk, T. J. and D. M. Eisenberg 2001b Varieties of Healing. 2: A Taxonomy of Unconventional Healing Practices. Annals Of Internal Medicine 135(3): 196-204
Micozzi, M. S. 2002 Culture, Anthropology, and the Return of "Complementary Medicine". Medical Anthropology Quarterly 16(4): 398-403.
Thompson, J. J. and M. Nichter 2012 Complementary & Alternative Medicine in the US Health Insurance Reform Debate: An Anthropological Assessment is Warranted. Topic paper prepared for the SMA 'Take A Stand' Initiative on Health Insurance Reform.
Barnes, L. L. 2005 American Acupuncture and Efficacy: Meanings and Their Points of Insertion. Medical Anthropology Quarterly, 19: 239–266.
Green, G., H. Bradby, A. Chan, M. Lee 2006 “We are Not Completely Westernised”: Dual Medical Systems and Pathways to Health Care among Chinese Migrant Women in England. Social Science & Medicine 62(6): 1498-1509.
Kaptchuk, T. J. 2011 Placebo Studies and Ritual Theory: A Comparative Analysis of Navajo, Acupuncture and Biomedical Healing." Philosophical Transactions of the Royal Society B: Biological Sciences 366(1572): 1849-1858.
Langwick, S. 2010 From Non-Aligned Medicines to Market-Based Herbals: China's Relationship to the Shifting Politics of
Traditional Medicine in Tanzania. Medical Anthropology 29(1): 15-43.
Naraindas, H. 2011 Of Relics, Body Parts and Laser Beams: The German Heilpraktiker and his Ayurvedic Spa. Anthropology & Medicine 18(1):67-86.
Thompson, JJ, and M Nichter 2007 The Compliance Paradox: What We Need to Know About "Real World" Dietary Supplement Use in the United States. Alt Ther Health Med 13(2):48-55.
Yuehong Zhang, E. 2007 Switching between Traditional Chinese Medicine and Viagra: Cosmopolitanism and Medical Pluralism Today. Medical Anthropology 26(1):53-96.

Anthropological Perspectives on Health Care Professional Training

So grad school is kicking my butt this semester, and I have not had as much time as I would like to blog! I feel sad that it has fallen by the wayside.

I'm taking a really great anthropology class this semester on health systems and medical systems. One of our first class sessions we read and discussed articles on the topic of medical provider training, and the making of the modern health care professional, from an anthropological perspective. I find this topic really interesting in its own right (especially because of Robbie Davis-Floyd's analysis of the way OB/Gyns are trained in Birth as an American Rite of Passage), but also because I know two people in medical school right now. So as I read these articles I imagine them being shaped and molded into new kinds of people.

Readings covered the education and creation of the modern health care professional, or the formation of the individual undergoing biomedical training, and aspects of training that contribute to their subjectivation. A lot of really great discussion points came out of these articles (see below for bibliography), such as the socialization of medical students, how students come to patient-blame and ignore social context, the perpetuation of inequalities, and the issue of the market-driven health care system.

Most interesting was the way health care professionals are socialized in their training, learning how to fit in as a clinician. Students learn things like "detached concern," and how to appropriately "present" patients. Unfortunately, these students often come to engage in victim-blaming, blaming the patients for their poor health rather than larger forces like power inequalities, poverty, racism, social status, etc. Because medical students are often taught how to standardize and be objective, they fail to take into account the unique, situated experiences of each individual patient. In fact, these future health care providers repeatedly come to preserve social inequality and reproduce power inequalities created by biomedicine instead of working to solve the broader political and economic issues that contribute to poor health.

Anthropological study of the way in which clinicians and physicians become modern health care professionals enables us to understand “what kinds of people are formed” through medical training. This is a topic I find particularly fascinating because of the enormous effect that health care professionals have on all our lives. I found it interesting to read the ways that clinical training affects the not only the kind of doctors these students become, but also the kinds of people they become. Moreover, these readings illuminated the important ways in which their biomedical training preserves the production the biomedical model, power differentials, and the widening health disparities in our health care system.

I would have liked to have learned more about what these researchers and authors feel would make medical training more efficient at teaching these future health care providers to recognize and address social and power inequalities, rather than perpetuating them. If medical training continues produce health care professionals who ignore the social context of each patient’s health and suffering, what is a better way to train them? These are not issues that will be easily solved. 


Articles:

Adams, V. and S. R. Kaufman 2011 Ethnography and the Making of Modern Health Professionals. Culture, Medicine and Psychiatry 35(2):313-320.

Holmes, S. M., A. C. Jenks and S. Stonington 2011 Clinical Subjectivation: Anthropologies of Contemporary Biomedical Training. Culture, Medicine and Psychiatry 35(2):105-112.

Holmes SM and Ponte M. 2011 En-case-ing the Patient: Disciplining Uncertainty in Medical Student Patient Presentations. Culture, Medicine and Psychiatry. 35(2):163-82.

Jaye, C., T. Egan, and K. Smith-Han 2010 Communities of Clinical Practice and Normalising Technologies of Self: Learning to Fit In on the Surgical Ward. Anthropology & Medicine 17 (1): 59-73.

Rivkin-Fish, M. 2011 Learning the Moral Economy of Commodified Health Care: ‘‘Community Education,’’ Failed Consumers, and the Shaping of Ethical Clinician-Citizens Cult Med Psychiatry (2011) 35:183-208.

The Summer I Ate Clay because I am a Birth Junkie

I ATE CLAY. Literally.

Curse my Anthropological curiosity!

This summer has been a whirlwind for my graduate program. I completed my IRB and began my research for my master's thesis on breastfeeding. I am also interning for the community organization who provides women with breastfeeding assistance. Doing participant observation has been harder to arrange than I thought, and recruitment for interviews wasn't able to begin until much later than I had wanted. But I am in the full swing of things! I am learning a lot about women's breastfeeding experiences. More on this project down the line :)


So why did I ate clay? Well, here is the story:
I interviewed a woman who was from Africa, and she told me all about the postpartum practices of her country. She was explaining that after women give birth there is a huge celebration, people whistle, and the children make these things that they bring to the woman. I asked her if it was food and she said "No. it's... mud. Is that the right word? It's edible." I thought perhaps there was a language barrier... how could mud be edible? Then she pulled a bag out of her kitchen pantry and said, "Here I have some that someone brought for me after I had my baby." And asked me if I wanted to try it.

Now you would think that since she had described it as "mud," that perhaps I would hesitate. And perhaps a normal person would. But being obsessed with all things birth and culture-related, I was fascinated by this different postpartum practice. What was this food that the women of her culture eat postpartum? I had to experience it.

It looked like a dark colored ball with white powder. I asked her if it was sugary and she said No. Then she broke one into pieces, picked up a small piece, and put it in her mouth. So, I picked up a piece, put it in my mouth, and started chewing. And quickly realized I was eating CLAY. And she said, "oh! you're not supposed to chew it!" And I'm trying not to be all, "AHHH Get this out my mouth its dirt!" Thankfully she said, would you like a paper towel? And I spit out as much as I could, rinsed my mouth out at the sink, and was still given a toothpick and a bottle of water on my way out so that I could continue to pick the mud out of my teeth. BLECH!

It wasn't until later that I realized that someone probably brought it to her from her home country, meaning I most likely ate the dirt of another country. And am now probably going to get all sorts of diseases. But I feel fine so far! :) In case you're curious, this is called geophagy, which is a condition where people crave and eat non-food items like clay, chalk, etc. Pregnant and postpartum women are known to crave clay. It is tradition in Africa, maybe because of cravings caused by dietary deficiency (lack of nutrients). It also helps you feel full.

Really interesting radio story about this here.

There has been a lot going on since I last did a "personal doula update" of sorts!

In biggest news, this blog was reviewed in this summer's SQUAT magazine! So cool!
Sarah wrote, "Overall, I've found that Emily's sharp, thorough intellect and clear writing style makes each blog post a learning experience, which keeps me (this non-blogger) coming back again and again." Thanks, Sarah and SQUAT!

I am also taking a course this summer on global women's health. We have focused on a lot of the topics that were covered in my anthropology reproductive health class, with a few others thrown in that are not related to reproduction (chronic diseases, violence, and so forth). This is the first time this course is being taught, and I really like how interdisciplinary it is, and how we talk a lot about human rights (and even feminism!) As part of this course, we are traveling to Panama to explore these health issues in this particular country. I am very excited to visit a new country! And to reflect more on women's health issues from an international perspective.


I had a few doula clients have their babies. I mentioned in my last update that one doula client was going to attempt a red raspberry leaf tea chugging method to make her labor super short. Well, her labor was very fast and intense! Of course, we'll have no idea if that is because of the red raspberry leaf tea, or the chiropractor/acupuncture she tried when her water broke and contractions didn't start, or just if that's how her labor would have been anyway. Once her contractions actually started in earnest, she was dilated at super lightning speed. I honestly didn't even believe that it was possible for her to be ready to go to the hospital when I got the call that went, "actually, don't come to the house, just meet us at the hospital!" But when we checked in she was fully dilated. The urge to push took longer to come, and the actual pushing phase was also longer than my average, which is interesting. I'm not sure what that means, but it was interesting to note. Every birth is so different! This birth had a fabulous in-hospital midwife attending, and I was so incredibly pleased to see that.


I had another new experience with another doula birth this summer. Client had a beautiful and relaxing birth center birth, labor not too long, and pushed her baby out into the water. I even had a doula-in-training friend working with me for that birth, which was fun! Unfortunately, she had the toughest postpartum period I've ever seen. The baby was the most frustrated baby I have ever seen. Would not stop crying, even when she had the breast in her mouth. Baby was not latching, and mom's milk didn't come in for a week. And then the poor mama felt she couldn't take it easy, didn't have a lot of help at home, and she had a lot of trouble with her perineal stitches. Apparently in my state, midwives aren't supposed to touch you 48 hours after the birth, so she was simply told to "go to the emergency room." With a newborn! My heart really went out to her :( I don't have a lot of practice with the postpartum end of things; I was never trained as a postpartum doula, and my newborn knowledge is really centered around breastfeeding.

Also, it has been a while since I talked about the objects from my doula bag that I use, so here is what I have realized that I use most:

- A fan. I realized the battery-operated one was just too intense (and loud) for moms, so I carry an old fashioned hand-held one (that I actually bought in China). I use it at every birth. Most moms have temperature swings, and get very hot during pushing.
- Wet wash cloth. Either my own or the birth center/hospital ones. For the same reasons as above!
- Breath mints. I eat a lot of these during a labor. Long hours without teeth brushing, or I just ate and want to clear that food scent away, or because I'm doing a lot of breathing and my breath probably just stinks. I offer to dad, too. 
- iPod and speaker. You would not believe how many times mom and dad don't bring their own (forget it at home or don't think of it). All my clients have liked either the classical music or the guided visualization tracks. I have a ton of ocean and nature music sounds, too, but these end up sounding annoying and weird in a hospital room.
- Birth ball. For laboring at home. Most of the birth locations in my area have some of their own.

Things I use often, but not every time:
- Rice sock to heat up
- Straws for mom to drink with
- Peppermint oil on a cotton ball for nausea.
- Preggie pop or other lollipop to keep mom going (sugar, anti-nausea, something good tasting)
- Lanolin ointment for when mom's forget their lip balm
- Tennis ball for back massage


I'll update you on Panama and women's health later!