Hospital Births and Frontier Obstetrics in Urban West Papua

Abstract

Drawing on ethnographic research and interviews with 60 urban Indigenous Papuan parents, we investigate how a frontier context shapes childbirth and maternity care. Building on arguments about how medical care may perpetuate violence and inequalities, we show tensions and contestations between Papuans and the Indonesian medical system over what care Papuans want and what is made available to them. Urban Papuans embraced medical advice and hospital assistance. They valued preserving the mother’s strength and fertility through vaginal childbirth or avoiding caesarean sections, which some described as part of a larger agenda of Papuan persistence amid Indonesian colonialism. But they often encountered what we call ‘frontier obstetrics’: invasive technological interventions in hospital births that display Indonesian power and authoritative knowledge, with little consideration for consent or culture in medical encounters. Challenging authoritative knowledge and contesting c-sections are ways some Papuans may disrupt and exceed the care that they are offered.

Keywords:

• Birth
• Reproductive Abandonment
• Caesarean Sections
• West Papua
• Frontier Obstetrics

Acknowledgements

The authors would like to acknowledge and thank the research participants for sharing their time and experiences. We thank discussants and colleagues at the Australian Anthropology Society conference in Cairns, 2018, and the Association for Social Anthropology in Oceania conference, in Hilo, Hawai'i, in 2020 where we presented earlier versions of this article. We acknowledge research funding from the University of Queensland and local logistical support from the University of Papua. We also thank TAPJA reviewers and editorial team.

Notes

1 Because data are not disaggregated by Indigenous heritage or cultural identity, these dire statistics do not reflect maternal mortality among Indigenous Papuans, a common tactic for disappearing inequities.

2 The earlier interviews were conducted by Munro in the course of health services evaluations in Wamena and Manokwari sponsored by local NGOs and funded by the Canadian International Development Agency and the Canadian Institutes for Health Research Knowledge Translation initiative. These were conducted in line with ethics approval from the University of Calgary and vetted locally in consultation with scholars from Cenderawasih University, the University of Papua, and community elders. Interviews by Katmo and Wetipo received ethics approval from the Australian National University and the University of Queensland, and were vetted by their respective institutions. They received government approval from district and village authorities. Research funding was provided by the University of Queensland.

3 Until 2017, the Indonesian government mandated that specialists had to take up appointments in remote areas for two years (Efendi 2012). This has been replaced by an incentive system.

4 For example, a recent study (Haya et al. 2014), facilitated by World Vision Indonesia, actually investigated whether Papuan highlanders give birth in animal pens or in the forest alone, and while it found that they do not, it argued that ‘the subjects did not understand the concept of date and time, and they recognized their pregnancy only after their abdomen looked larger’ (64).

Additional information

Funding

This work was supported by the Australian National University and the University of Queensland.