As one who didn’t initially know too much about the Mexican healthcare system, let alone the practice of midwifery in general, I found this week’s reading Midwifery & Development in Mexico: Delivering Health particularly interesting. To start, I appreciated how Dixon laid the foundation for an adequate understanding of how the healthcare system in modern day Mexico is set up. She explains how the privatization of healthcare in the country has led to a fragmentation in care, and how this has placed certain marginalized groups, particularly the indigenous groups. This helps to explain the remaining prevalence of midwifery in Mexico– given the lack of access to care and already existing discrimination within it, indigneous mothers oftentimes turn to professional midwives to help them deliver their children safely. This infrastructural inequity is outlined in Dixon’s research as she asserts that many of the midwives she spoke with claimed that “social inequality underlies the infrastructural violence that makes rural, Indigenous women more likely to die in childbirth” (Ch 3, pg 104). In using in-depth interviews as a core part of her methodologies in studying midwifery in Mexico, Dixon is able to acquire first hand testimony, such as the one above, of how the healthcare system is perpetuating legacies of racism and colonialism, placing indigenous women in particular at a signficant, systemic disadvantage.
A second theme noted from the reading is the relationship between midwives and the system itself, and how this represents a push/pull relationship. Essentially, Dixon outlined how midwives have been resisting the existing structure of the medical system, but how they have also been a part of it for the better part of its existence. Dixon directly references this push/pull relationship when she says, “the midwives need the state– they depend on state institutions for licensure, salaries in some cases, certificaes, and occasional opportunities for work– but they are also some of the strongest critics of the practices employed in state facilities” (intro, pg 44). Here Dixon describes one of the most interesting parts of the reading– the juxtaposition of the midwives’ dependence on the Mexican healthcare system but also how they openly critique it given all of the infrastructural violence that contributes to inequity as it pertains to indigeneity, rurality, and gender.
Overall, some questions I might ask to continue the discussions and points brought up in the reading: how has the midwives’ relationship with the state changed over time? Have they always been critics? How is this reflected in Midwife education (CASA, etc.)?