Health, reproduction and identity : indigenous women of Chiapas, Mexico
Women are central to Primary Health Care strategies because of their social reproductive roles as family health carers, the health implications of biological reproduction, and the focus on family planning within related services. Such factors ensure that women have a close relationship with health policy and institutions. This thesis analyses the negotiation of differing paradigms of health and reproduction by indigenous women in the community of Amatenango del Valle in the southern Mexican state of Chiapas in relation to their ethnic and gender identities and to the context of social, economic and political marginalisation. The analysis reflects upon the divergence and convergence between this negotiation and the formulation of policy and service provision. The conceptual framework of pluralism and subjectivity is applied both to understandings of "Western" and "traditional" health paradigms as fluid and intersecting, rather than fixed and oppositional, as well as to the multiple and unfixed nature of indigenous women's identities. Concepts of pluralistic health and hybridity drawn from post-colonial and postmodern feminist theories allow space for envisioning women's agency to negotiate different health services and reproductive decisions, albeit in ways strongly mediated by the context of poverty and marginalisation. The discussion of policy formulation and the case study data reveal how pluralism is often accommodated at the level of the individual, rather than being recognised in policy and provision of services. The findings also illustrate how the historical and contemporary marginalisation of indigenous peoples affects the health status of women and their families and their utilisation of services, including family planning services. The thesis concludes that learning from the ways in which women negotiate services, particularly those multiplistic services of traditional providers, could result in the formulation of policy and the implementation of programmes which more effectively meet health and reproductive needs and better respect cultural diversity.