‘They are more careful’

This chapter analyses a poorly understood health practice: transnational caring for infants and children. A reproductive paradox provides the point of departure. A majority of births were registered to foreign women in Prato, Italy, yet many parents sent their babies back to China. The chapter focuses on decisions among transnational migrants, particularly Chinese parents working in the Made in Italy fashion industry, that result in the formation of global households. The chapter draws on hospital ethnography in the intimate space of a paediatric exam room and interviews with migrant parents and health-care workers. Qualitative data analysis reveals parents’ privileging of quality care. Findings challenge health-care professionals’ critical gaze and shed light on how migrant parents cope with transnational lives as non-citizen entrepreneurs and workers. Finally, understanding parental decision making may improve how practitioners approach health problems, particularly in a context of intensified migration and mobility.

Making measures

This chapter discusses the production of demographic measures as a kind of translation. Most demographic data come from surveys or documents produced for administrative purposes, particularly censuses and vital registration. In each case, the production of the document requires that people translate what they understand about the world into demographic categories. As translation, the production of demographic data necessarily entails interpretation; as a translation into a less rich medium, it also involves reduction. The various kinds of demographic data vary considerably in how much they differ from the lived experiences that they translate and partially represent; translations performed mostly by researchers also differ from those performed exclusively by untrained respondents. When done well, there are substantial gains to demographic translation, as a joint result of quantification and aggregation.

Reporting statistics on undernutrition and obesity

The epidemiologies of undernutrition and obesity are conducted using standardized metrics in very regulated ways. Bodies are physical entities with economic, social, and medical correlates, and the standardization of bodily measures of undernutrition and obesity have political and economic implications. Most recently, their use has been mostly as proxies for health and mortality risk. This chapter describes the now historical process of bodily standardization through public health anthropometry at both extremes of body size, and examines how public health reporting of undernutrition and obesity informs the discourse of both of them at governmental level, once such measures are given the status of national statistics.

Medical topography as an instrument of colonial management in French Algeria, 1830–71

The role played by medicine in colonial history has been underestimated, and even misunderstood. This chapter shows that, contrary to some prevailing assumptions, the main impact of medicine in the colonization process was perhaps not so much at the level of bodies as at another level: space. A different, population-based historiography is therefore necessary. This chapter proposes that because of its fundamental interest in the environment and space, Western medicine—contemporary with the colonial imperative—contributed to the domination of the European powers by making it possible to think of the fundamental spatial continuity of the world and therefore its conquest. Medical topographies, in the context of the conquest of Algeria by French armies from 1830, provide an exemplary source in which to explore this proposition. Algeria occupied a prominent place in French medico-topographical production: forty-one topographies were devoted to it, amounting to 7 per cent of all medical topographies handwritten and printed following the conquest, more than any other area of French territory. Medical topographers first began in those areas for which they were specialists, and which seemed reserved particularly for them: water and air. They then turned to mortality. Finally, I demonstrate that topographies were an ideological and legitimizing instrument. They demonstrate a marked imbalance between their concern with the health of the French soldiers and later of the colonists, and the health of the local population.

Introduction

Anthropological demography in recent decades has expanded beyond a focus on fertility regulation shared initially with demography, taking on a much wider range of health issues, and locating them in the context of inequalities that have frequently given rise to major differentials of health and well-being. Key problems involve collaborative research with genetics, epidemiology, gerontology, clinical practice, linguistics, social and medical history, and also with historical and contemporary demography. This work prioritizes bottom-up inquiry, in which ethnography is combined with quantitative and historical methods. The approach provides more than substantive knowledge of the role of cultural and social formations in health variation; it enables examination of how local institutions and experience are translated into the demographic and health measures on which survey and clinical programmes rely. We are then in a position to consider the empirical adequacy of such translation, what happens when models and measures become standardized evaluations of health statuses, and what this implies for governance. The five principal parts of the book chart components of the current agenda, drawing on recent conceptual and methodological advances, with each section providing detailed case studies. Main themes include: the historical background to demographic governance and its continuing influence on health interventions in the global South; demographic translation—the analysis of whether conventional research and administrative instruments render people’s health experience accurately; compositional demography—the identification of local population units and structures that track people’s agency in health-seeking behaviour; and the reconceptualization of reproductive and related risks that this approach enables.

Concealed pregnancies and protected postpartum periods

This chapter analyses the delineation of what counts as a critical period for action and intervention in improving maternal health. Using ethnographic interviews alongside descriptive data from the Nepal Demographic and Health Survey, it analyses two critical junctures for maternal health, the antepartum and postpartum periods, in the context of a particular peri-urban community of Nepal. The postpartum period is socially recognized as sutkeri for Hindu Nepalis, a forty-day period in which a woman who gave birth is considered ritually polluted, but also particularly susceptible to long-term health problems if proper care is not taken for her body in its vulnerable state. This perception of bodily vulnerability and mandated care while sutkeri exists in stark contrast to the absence of such notions and protective practices for the period of pregnancy. Pregnancy, an outwardly visible sign of sexual activity, is a state that one should hide or minimize in order to maintain one’s reputation and honour as a woman. Women worked to conceal their pregnancies, and typically no or little extra care was provided to women to meet their nutritional needs or to enable them to avoid hard physical labour. However, intersecting statuses, such as caste and class, and contexts, such as agricultural households and multi-generational households, crosscut any simple characterizations of the pregnancy and postpartum periods—even within the confines of a subgroup of the Nepali population (Parbatiya) in a single community and place.

Body symbolics, obstetric practices, and the improvement of maternal health in Cambodia

Cambodia is one of the nine countries worldwide to have reduced its maternal mortality rate by more than 75 per cent between 1990 and 2015. Whilst prior to the 2000s, childbirth in Cambodia used to be a private event, it has now become a biomedical event for women and their families. This chapter describes the findings of mixed-method research challenging the idealized vision of the United Nations regarding maternal health in Cambodia by describing obstetrical practices on the ground, from an empirical study led in several clinical settings in Phnom Penh, through participant observation, semi-structured interviews with health-care professionals and patients, questionnaires with pregnant women, to the examination of medical records from four Phnom Penh maternity wards. The findings demonstrate that the biomedicalization of childbirth in Cambodia has been accompanied by technologized delivery with extremely frequent use of surgical practices. In order to understand the population’s adherence to these practices, the chapter draws out a number of anthropological and demographic arguments. These biomedical practices are part of a symbolism of the body where the body is conceived as a receptacle, where the body humours must be able to circulate appropriately, and where the hot/cold balance must be respected. Childbirth as an opening of the body represents a danger for women because it threatens this equilibrium.

Population ageing and conjunctural action

One of the most promising conceptual and empirical breakthroughs to emerge from combined anthropological and demographic thinking is the theory of conjunctural action. Developed in a sequence of articles and books by Jennifer Johnson-Hanks, this approach provides an effective alternative to rationalist decision-making models that have prevailed in population studies over the whole post-War period. Observation and analysis of vital conjunctures show how social, economic, and political differences between groups in society are manifested in individual agency at specific points across the life course, and how people’s behaviour in this way differentiates the many subpopulations making up a society. The approach thus addresses directly two major shortcomings in population research: the need to explain mechanisms underlying the evolution of population heterogeneity, and the dynamics that entrench inequalities. To date, the study of conjunctural action has been addressed chiefly to fertility. In this chapter, we explore how health issues facing older people, their families, and communities are illuminated by this approach, drawing on multi-site, longitudinal ethnographic and demographic research in Indonesia. We begin with the nature of uncertainty and vulnerability at older ages, and how it can be modelled across the life course. This leads to consideration of the dynamic relation between individual action and subpopulation memberships, and how it articulates the compositional demography of status, network, ethnic, and related subpopulation memberships.

Beyond the government document

In response to global initiatives, Indonesia has increased efforts to register all children at birth. Birth registration has a core goal to transform the act of childbirth into a legal statement about the obligations and entitlements of belonging to a nation-state. Drawing upon a multi-method exploratory study conducted in 2014 in four low-income, high out-migration Sasak communities in East Lombok, this chapter discusses childbirth and birth registration practices in families where the mother or father leave the island for extended periods of low-skill, temporary work. Migration, Sasak pregnancy practices, state childbirth management, and the meaning of documents become bound up with procedures by which the state seeks to align kin and other local relatedness in conformity with membership in the state. Despite the institutionalization of midwives as agents of birth registration, the limited success of state efforts to register children is evident in the ways that migrant families navigate, circumvent, ignore, and selectively exploit the official system, thereby supporting their priorities around work and family. The implications of these patterns for Indonesian birth registration goals are noted.

An anthropological demography of mental health in Senegal

This chapter stems from ongoing field research on mental health in Senegal, an African country in the midst of an epidemiological transition. While mental health has been integrated into global health and sustainable development objectives, it is not a priority in sub-Saharan Africa. Few states have a mental health policy, nor specific programmes and data on the situation of mentally ill people and their families. From the time of the French colonization, Senegal has developed an original strand of psychiatric intervention, the Fann School of Cultural Psychiatry. The current supply of psychiatric care takes place in the multi-therapeutic context of this ethnically and religiously diverse society. The therapeutic pathways of patients are analysed in terms of stigmatization, relationships between patients and healers, socio-economic inequalities, poverty, and the absence of universal medical coverage for the entire population. To understand adherence to psychiatric treatment, one must take into account the family and social dynamics at work in a society increasingly marked by individuation processes and globalization through international migration. In attending to the subtleties of care as conceived by sufferers’ families and social networks, the chapter points to multiple layers of the demographic governance of mental ill health, from the state to local kin and social groups.