What can we,
anthropologists, criticize against global health?
Mitzub'ixi Quq Chi'j - Mitsuho
IKEDA, Osaka University
Keie SOU describes how postpartum care is marketed differently in Japan and Taiwan. Wealthier women in Taiwan seek traditional postpartum care, such as dietary therapy and hotels, for healing, whereas Japanese women find satisfaction in honing their newborn care skills through public services. Through observations of Japanese and Laotian pregnant women's behaviors, Kyoko SIMAZAWA examines what determines the differences in women's behaviors. In contrast, Laotian women's behavior is less medicalized and more self-determined and diverse. Etsuko MATSUOKA uses the example of Universal Health Coverage, UHC, in Indonesia to illustrate the national health insurance system (BPJS) and how it can be applied to the doctor-midwife clinic at the time of childbirth. She examines how the universal health coverage system in Indonesian BPJS and its impact on the clinics of doctors and midwives at the time of birth. The reality is the subordination of a cleverly shaped midwifery system to that of the physician. As a result, she predicts that the case for natural childbirth will become a medium- to long-term phenomenon. Mitsuho IKEDA draws from his experience teaching Critical Medical Anthropology, CMA, at the university level to emphasize a focus on the historicity of this scholarly tradition. Just as the three previous presentations have exposed perinatal women to waves of commercialization, marketization, medicalization, delegitimization, and disempowerment in the era of global health, CMA argues for the introduction of respect for the people's perspective and consideration for the people's right to self-determination in public health policy. We share and emphasize the need for equitable public health policies as the most important thing in the era of global health, and the need to support professional critical perspectives and the raising of people's awareness and self-determination in the field of any health phenomenon.
| Postpartum Care in Urban Taiwan and Japan: Expert Practices Keie SOU, Nara Women's University In this presentation, I will explore postpartum care in urban Taiwan and Japan, and attempt to elucidate the understanding of the content of postpartum care, as well as the role and purpose of 'experts' in it, by describing the practices of postpartum care 'specialists' in urban areas of Taiwan and Japan. In recent years, with the trend of marketization and medicalization of the postpartum period, Taiwan has emphasized traditional postpartum care as an important means of caring for the body, while Japan has promoted postpartum care as a part of well-being, offering a different type of care to women. One of the reasons why postpartum care has become so popular is because of the rhetoric around 'healing'. Women can spend quality time in a place of their choosing, enjoy lavish meals, leave the care of their baby to specialists, and get plenty of rest. However, this "cure" can sometimes be distressing and even painful. In Taiwan, postpartum care is provided by specialists in obstetrics and gynecology, pediatrics, and Chinese medicine, who provide guidance to mothers and babies. In Japan, the guidance is provided by midwives or nurse practitioners. In other words, the fundamental difference between Western doctors and midwives becomes more obvious. Overall, Taiwan and Japan hold similar values regarding the importance of postpartum care. Postpartum care is viewed as an important rite of passage/well-being, and the "healing" that women receive during this time will be an issue of concern in the future. In addition, although the postpartum period has not been associated with medical care in the past, the close relationship with medical care will be further strengthened through the purchase of expensive 'healing'. Postpartum Care, Healing, Experience, Taiwan, Japan |
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| Who controls childbirth? Insights from the behavior of women in Laos and Japan. Kyoko SHIMAZAWA, Otemae University Childbirth is a physiological phenomenon. However recently, there has been much emphasis on improving the maternal mortality rate, which is one of the global health issues, seems to be prioritizing safety through childbirth in medical facilities and active medical intervention. For women, childbirth fulfills personal and sociocultural beliefs and expectations, so-called psychosocial well-being, which seem to take a backseat, even though they are just as important as safety. This carries the risk of forcing women to give up control over their own bodies. Childbirth, which is supposed to be a physiological phenomenon, is classified as a disease because only safety is prioritized. After volunteering as a midwife in Laos, the presenter also became involved in research and is currently involved in midwifery education in Japan. In this presentation, we will focus on women's behavior during childbirth in Laos and Japan, and examine who controls the body during childbirth and the background behind this. In Laos, even during facility births, women's behavior seem to respond to their bodily sensations. They exhibit the power of their bodies during childbirth. On the other hand, in Japan, upon admission, women are implicitly coerced into changing into hospital gowns and lying on the bed for examination and tests. At this point, women's bodies cease to be subject to their control. The current trend in Global Health undeniably promotes childbirth in medical facilities. However, within this context, it is crucial for women to maintain a sense of self-control over their bodies during childbirth and to actively engage in childbirth and childcare, thereby demonstrating the power of their bodies. This not only contributes to women's health but also significantly influences the superiority of specialized professions and gender disparities. Childbirth, Midwife, Bodies Control, Laos |
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| How does UHC (Universal Health Coverage) change the landscape of childbirth in Indonesia? Etsuko Matsuoka (Emeritus professor of Nara Women’s University) Universal Health Coverage is one of the top agendas of global health in recent years. UHC, with its aim of health for all, is intended to improve overall health situations of people by providing easy access to healthcare. However, if UHC actually achieves its aim needs to be verified. This presentation looks at the ongoing effect of UHC in Indonesia, known as BPJS that started in 2014, on childbirth and women’s health. Until the implementation of BPJS the mainstay of childbirth in Indonesia was midwives. They provided care to the majority of women from pregnancy to postnatal period in independent midwifery clinics which were small scale but located throughout Indonesia. However, BPJS made a decision that small midwifery clinics would not be covered by health insurance unless they either become upgraded to primary care clinics or they become incorporated into a doctor’s clinic which will collectively receive insurance reimbursement. Since the introduction of BPJS increasing number of normal births have moved from midwifery clinics to hospitals and has brought up the rate of cesarean section, a prospect that will increase a risk of future birth for women. When more births are delivered in hospitals by doctors, the number of normal births without medical intervention decreases. To conclude, it is important to incorporate women’s viewpoints into policy making to verify if UHC actually improves women’s health as well as children’s health. I suggest that anthropology can play a big part in presenting people’s viewpoints with the help of ethnographic approach even among the grand wave of global health. Universal Health Coverage, Global Health, Childbirth, Indonesia, Midwife |
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| To Students of Critical Anthropology: A Letter from Osaka, Japan Mitsuho IKEDA, Osaka University This presentation proposes a Critical Medical Anthropology (CMA) for the era of global health, drawing on my experience of introducing CMA in a university educational context. Before emerging CMA, Japanese already had the name Social Medicine (Sozialmedizin) from the 1920s, which was influenced by R. Virchow; the shift from German-style Hygiene to American-style Public Health after 1945 was not due to an independent decision by the Japanese medical society, but to a post-war change in the ruling regime. CMA was more influenced by Marx than Virchow, which is manifested in the term 'Political Economy of Health' as its antecedent form. I studied medical anthropology via social medicine after volunteering for a Primary Health Care programs in rural Central America in the mid-1980s. This has given me a critical view of public health and a bottom-up way of thinking about constructing people's health. While Global Health policy expands the perspective and scope of what public health has captured from above by operating the WHO, international NGOs or governments, the ethnographers of CMA seek construct local health from the bottom. Both sides are required to dialogue on how to intervene with local people and respect their self-determination. Critical Medical Anthropology, Political Economy of Health, Virchow, Marx |
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