Cutting Inoperable Bodies: Particularizing Rural Sociality to Normalize Hysterectomies in Balochistan, Pakistan

Abstract

Drawing on 15 months of ethnographic research in Balochistan, Pakistan (2005–2006), I explore Panjguri midwives’ (dïnabogs, kawwās, or balloks) narrative links between routine injections of prostaglandins around childbirth and the increasing number of hysterectomies. These techno-medical interventions reflect the postcolonial biomedicalization of women's bodies and reproductive health care, and are reinforced by shifts in Pakistan's public health policy against maternal mortality in a context where about 90 percent of births occur outside of hospitals. Transnational campaigns against maternal mortality further biomedicalize women's lives. Interviews with doctors, midwives, and women, and analysis of women's experiences, illustrate the practical considerations that were used to normalize radical hysterectomies over less invasive procedures.

Keywords:

• Balochistan
• biomedicalization
• hysterectomy
• injections
• midwives
• rural bodies

ACKNOWLEDGMENTS

Many people have contributed to the writing of this article. I am grateful to the Panjguris and all the people participating in my research in Pakistan, for their time, generosity, and patience. I thank Lawrence Cohen and Adele Clarke for their critical insights. Shalini Randeria provided timely guidance. Many others provided thoughtful comments on earlier versions including Sharon Kaufman, Vincanne Adams, Janice Boddy, Roshnak Kheshti, Huma Dar, Anju Gurnani, Malek Towghi, Lucinda Ramberg, Laura Hubbard, Cristina Giordano, Mel Chen, Rebekah Edwards, and Carlo Caduff. This article has also benefited from Lenore Manderson's editorship, discussion with Hasineh Towghi, and draws from my doctoral research supported by University of California, San Francisco and Berkeley, the Woodrow Wilson and Johnson and Johnson Women's Health Fellowship, and the American Association of University Women.

Notes

Studies on the “social creation” of routine have focused on this process predominately in the United States (Koenig 1988). See also Thompson (2005) on the effects of routine practice in US fertility clinics.

In Laderman's (1983) study, Malaysian rural women also viewed their indigenous medicine superior to biomedicine.

See Pigg (1997) for an eloquent account of how Nepalese “TBAs” are reductively produced and homogenized in health development policy and intervention projects. See Towghi (2004) on the instrumental uses of the TBA in Pakistan.

Panjguri dïnabogs had acquired these Balochi diagnostic terms over years of experience with women seeking their services. Medical doctors and LHV instead employed English language medical diagnostic categories to describe symptoms and diseases (e.g., fibroid or irregular bleeding). Balochi usage of zakhm overlaps with Urdu lay and medical usages, generally referring to any bodily wound, but could also indicate emotional pain, often found in Urdu poetry to express sorrow, pain of the heart, deep sadness, and longing for the beloved.

I thank Lawrence Cohen for helping me formulate “biomedicalization failure,” which reflects my observations of contradictory and nonhegemonic responses to the heavy-handed imposition of biomedicine on Panjguri midwives and women.

Scholars have noted the misuse of oxytocin in clinical and home deliveries in India (Brhlikova et al. 2009; Jeffery et al. 2007).

A study of infertile women in five different hospitals in Karachi found that though both physicians and TBAs were commonly sought as providers for their infertility concerns, 75 percent of the women had first sought a physician (Tahir et al. 2003).

The sleeves of Baloch women's outfit are typically long, wide, heavily embroidered, and the chemise is worn over loose fitting shalwar or pant. The sleeves serve important and multiple functions, especially in the daily lives of rural Baloch women, such as for grabbing a hot pan, fanning oneself or children on hot days, or as a wrapping around a child on cool days.

Although, generally, symptomatic fibroids require treatment in the form of hormones or surgery, hysterectomy has been considered the traditional and definitive treatment of symptomatic fibroids (Christiansen 1993; Al-Taher and Farquharson 1993; Garcia 1993).

Additional information

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Fouzieyha Towghi

FOUZIEYHA TOWGHI is a research fellow in the Department of Social and Cultural Anthropology, University of Zurich, and the Swiss Forum for Migration and Population Studies, University of Neuchatel. Her current research in India, United States, and Switzerland explores the effects on South Asian women's bodies and lifeworlds of the global circulation of biomedical research, and the diagnostic and therapeutic norms for reproductive cancers.