IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v56y2003i9p1893-1909.html
   My bibliography  Save this article

Burning bridges: policy, practice, and the destruction of midwifery in rural Costa Rica

Author

Listed:
  • Jenkins, Gwynne L.

Abstract

The trend toward hospitalization of birth has a long history in Costa Rica and currently approximately 98% of births take place in the clinical setting. Impoverished rural areas, like the town of Buenos Aires, lag behind national trends and only recently has birth moved from the home to the hospital. Costa Rica's midwife certification program co-opted rural midwives as bridges to biomedicalization, responsible for both pushing women into the biomedical setting and filling the gaps left by a limited national health care system. Despite the eventual illegalization of key practices and of home birth itself, local use of midwives' services continues, albeit with local demands that have transformed midwives into bridges to biomedical care in ways unanticipated by and invisible to national programmers. Midwives provide key services like prenatal massage, treatment of pregnancy crises, and attending unforeseen home births and women unable to afford the modest costs of hospitalization. Yet, midwives report increasing dissatisfaction and the desire to stop providing services in their communities. Practices like prenatal massage are in demand, but are no longer embedded in a system of local exchange that is socially and economically meaningful. Midwives blame their clientele for their dissatisfaction, but directly link these changes to the notions of professionalism, compensation, and changing community values. Thus, the social relationship between midwives and their clients must also be understood as a destructive force burning midwifery as a bridge to safe birth. In this essay, I argue that the process of both remodeling and subsequently destroying midwifery practices begun in the formal health care sector at the national level continues at the local level through changing values and meanings associated with midwives' practices.

Suggested Citation

  • Jenkins, Gwynne L., 2003. "Burning bridges: policy, practice, and the destruction of midwifery in rural Costa Rica," Social Science & Medicine, Elsevier, vol. 56(9), pages 1893-1909, May.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:9:p:1893-1909
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(02)00212-5
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Vani Borooah, 2000. "The Welfare of Children in Central India: Econometric Analysis and Policy Simulation," Oxford Development Studies, Taylor & Francis Journals, vol. 28(3), pages 263-287.
    2. Geeta Gandhi Kingdon & Jeemol Unni, 2001. "Education and Women's Labour Market Outcomes in India," Education Economics, Taylor & Francis Journals, vol. 9(2), pages 173-195.
    3. Cowell, Frank A & Jenkins, Stephen P, 1995. "How Much Inequality Can We Explain? A Methodology and an Application to the United States," Economic Journal, Royal Economic Society, vol. 105(429), pages 421-430, March.
    4. Basu, Kaushik & Foster, James E, 1998. "On Measuring Literacy," Economic Journal, Royal Economic Society, vol. 108(451), pages 1733-1749, November.
    5. Lavy, Victor & Strauss, John & Thomas, Duncan & de Vreyer, Philippe, 1996. "Quality of health care, survival and health outcomes in Ghana," Journal of Health Economics, Elsevier, vol. 15(3), pages 333-357, June.
    6. Oaxaca, Ronald, 1973. "Male-Female Wage Differentials in Urban Labor Markets," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 14(3), pages 693-709, October.
    7. Borooah, Vani, 2003. "Births, Infants and Children: an Econometric Portrait of Women and Children in India," MPRA Paper 19620, University Library of Munich, Germany.
    8. Klasen, Stephan, 1994. ""Missing women" reconsidered," World Development, Elsevier, vol. 22(7), pages 1061-1071, July.
    9. Mark Rosenzweig & Andrew D. Foster, "undated". "Technical Change and Human Capital Returns and Investments: Evidence from the Green Revolution," Home Pages _065, University of Pennsylvania.
    10. Behrman, Jere R & Wolfe, Barbara L, 1984. "The Socioeconomic Impact of Schooling in a Developing Country," The Review of Economics and Statistics, MIT Press, vol. 66(2), pages 296-303, May.
    11. Gibson, John, 2001. "Literacy and Intrahousehold Externalities," World Development, Elsevier, vol. 29(1), pages 155-166, January.
    12. Ravallion, Martin & Wodon, Quentin, 2000. "Does Child Labour Displace Schooling? Evidence on Behavioural Responses to an Enrollment Subsidy," Economic Journal, Royal Economic Society, vol. 110(462), pages 158-175, March.
    13. Caldwell, John C., 1993. "Health transition: The cultural, social and behavioural determinants of health in the Third World," Social Science & Medicine, Elsevier, pages 125-135.
    14. Nielsen, Helena Skyt, 1998. "Discrimination and detailed decomposition in a logit model," Economics Letters, Elsevier, vol. 61(1), pages 115-120, October.
    15. Foster, Andrew D & Rosenzweig, Mark R, 1996. "Technical Change and Human-Capital Returns and Investments: Evidence from the Green Revolution," American Economic Review, American Economic Association, vol. 86(4), pages 931-953, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Giacaman, Rita & Wick, Laura & Abdul-Rahim, Hanan & Wick, Livia, 2005. "The politics of childbirth in the context of conflict: policies or de facto practices?," Health Policy, Elsevier, vol. 72(2), pages 129-139, May.
    2. El-Nemer, Amina & Downe, Soo & Small, Neil, 2006. "'She would help me from the heart': An ethnography of Egyptian women in labour," Social Science & Medicine, Elsevier, vol. 62(1), pages 81-92, January.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:56:y:2003:i:9:p:1893-1909. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.