This ethnographically informed dissertation focuses on the ways rural Yucatec Maya women, midwives and state health care workers participate in the production of childbirth and maternal health care practices. It further addresses how state health programs influence the relationships and interactions between these groups. Although childbirth practices in Yucatan have always been characterized by contestation, negotiation and change, their intensity and speed have significantly increased over the last decade. Drastic changes in the maternal health of rural indigenous communities in Mexico and throughout the world are directly connected to intensified state interventions that favor biomedicine over traditional health systems. In rural Yucatan, state health programs such as Oportunidades and Seguro Popular support a biomedical approach to birth by distributing medical resources to government clinics/hospitals and encouraging program participation of poor women through conditional cash incentives. This dissertation seeks to interrogate changing childbirth practices in a rural indigenous community in Quintana Roo, MX to gain a deeper understanding of the complex politics that shape local understandings and approaches to childbirth. It further explores how shifting social relations and political alliances are created within the context of reproductive health. This ethnography highlights how Yucatec Maya women envision a productive, yet negotiated, relationship with the state that allows them control of their prenatal and maternal health while engaging with state health programs. Focusing on the cultural production of childbirth in a rural community in southwestern Quintana Roo, this research seeks to explore the dynamic ways in which indigenous communities are reproduced over time through moments of engagement and contestation with the state. The Maya women in this dissertation exist at the margins of the Mexican government’s concerns, policies, and resources. Yet, even at the margins the influence and power of state ideology and policies intimately affect the lives of rural indigenous women. The core argument of this dissertation is that these women, who rely on traditional and historical experience, create strategies for survival and social reproduction despite their marginalized position within the Mexican state. This research draws from over a decade of fieldwork. Predissertation fieldwork took place during the summer months of 2002, 2003, 2004, 2007, 2008, and 2010. I completed my dissertation fieldwork from January to October of 2013. During that time, I conducted 60 formal and informal interviews and a small survey. Additionally, a large portion of my research took place with a local family that consisted of female healers and health educators, whom I extensively interviewed and conducted hundreds of hours of participant observation. The family was the locus of authoritative knowledge in the community and they provided vital insights into community life and local understandings and approaches to reproductive health. This dissertation follows the Latin American tradition of using testimonios to articulate—and reflexively examine—the layered meanings and intersecting politics that shape changing childbirth practices in rural Yucatan.

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). / Thesis / Master of Arts (MA)