An aspect of Chapter 3 which I found quite interesting was Lydia Dixon’s identification of infrastructure as a limiting and discriminating factor for widespread healthcare access in Mexico. Although Mexican programs such as Seguro Popular increased “access” to healthcare for a large portion of the population previously uncovered, the possession of a healthcare program in rural/underserved areas does not guarantee that care services can tangibly be reached. As this ethnography focuses on midwifery, Dixon explains how programs like Seguro Popular “conditioned” women to choose hospitals rather than local midwives. By pressuring pregnant women to utilize the facilities with which they were granted, hospitals then faced issues of overcrowding which led to poor conditions, understaffing, or even rejection of care. The lack of adequate infrastructure for patients to reach, and for doctors to provide, adequate healthcare led Dixon to coin the term “infrastructural violence” to explain barriers to labor care.
The most intriguing piece to me was Dixon’s distinction between active and passive infrastructural violence. Active violence could be the construction of delivery rooms without enough space for a partner to be present during birth, whereas passive violence could be poor roads leading from a rural community to healthcare centers. Whichever form of violence, or combination of forms, is present, what results is an inequitable distribution of healthcare services, discriminating against Indigenous, rural, and/or poorer communities based on race or economic status.
Hi Michael. Your point about Dixon’s identification of infrastructure is interesting! I think the way she develops this in the chapter is very thoughtful in the different levels of infrastructure that lack. Under the larger umbrella of inequality in reproductive health and pregnancy and delivery, she includes those who have “physical” access to care but do not receive it, those who receive care but suffer from mistreatment, and those who do not have access to care at all. I thought this was a really interesting way to frame her point about infrastructure because it encompasses all access to care and shows that the problem is not necessarily limited to just access or care individually. She further frames this in the cultural context of Mexico and Indigenous peoples by accounting for historical and social influences. I thought this was an excellent way to frame her ethnography because it gives insight into the deeper foundation of pregnancy and delivery in terms of conceptions and current issues.
Dixon also mentioned that “how women give birth” tells us a lot about the behind-the-scenes in the community and country. I thought this was interesting because it reminded me of something I learned in my global health class that maternal and child mortality is a large indicator of a country’s progress in health. Although this comes from a different background of reasoning in that children health is indicative of disease prevalence and maternal health is indicative of quality care, I thought that Dixon’s point about the highlighting of priorities could also be true in this case. It is cool to see how anthropology and ethnography can intersect with the field of global health in thought when the backgrounds of these concepts are very different!
Hello Michael! I like how you framed your post. I also found it interesting to think about how Seguro Popular “conditioned” women away from local midwives, resulting in inadequate resources in hospitals. Something that stood out to me in this book was the multidimensionality of injustice, as the unintentional – or at least secondary – consequences of specific health care systems result in especially poor treatment of marginalized people from rural areas in Mexico. Even recent years have resulted in increased access to prenatal care and maternal mortality has decreased, some indigenous regions are more disproportionately advantaged than others due to economic, social, landscape, and distance-related factors (93). I also found it interesting how negative experiences in Seguro Popular labor wards were not immediately apparent because “patients [with]… terrible… experiences… felt the need to perform the role of the ‘good patient’ by appearing thankful” (97). The underlying cultural norms of certain regions also play a role in what kinds of treatment people with withstand, especially if they are expected to prescribe to formal systems.