Work, Reproduction, and Health in Two Andean Communities

By Anne Larme, 1993.

Chapter 8 - Reproducing Illness or Reproductive Illnesses? Women's Work and Health in Cuyo Cuyo

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sponsorship. Throughout her pregnancy and in the months following the birth, T2 continued to be bothered by sobreparto. Its symptoms were headaches, and pain and itching over her entire body.

T2's major problem in the months following the birth, however, was madre, including bleeding and cramping, back pain, and swollen feet. Although ultimately caused by childbirth, it was brought on by "cold," carrying heavy loads, hard work in the chakra, and general exhaustion.

As these examples portray, some of the symptoms of reproductive illnesses clearly relate to reproductive events and to reproductive physiology, as defined and recognized by Western biomedical practitioners. The interpretation of other dimensions of these illnesses, however, requires knowledge of the Andean context in which they are found, including Andean body concepts, the daily lives of Andean women, and the interrelationship of work and reproduction in the Andes. These examples illustrate that, although childbirth is discussed as the principal cause, the meaning of madre, sobreparto, and sopla to Cuyo Cuyo women goes far beyond the physical event.

Sometimes the physical "trauma" of childbirth is a direct cause of these illnesses (I2, J2, L2, T2), although the effects may come years later (C2, D2, N2, S2). Most of the other causes of reproductive illnesses are less direct. Also contributing are general pregnancy symptoms (J2, L2, T2), especially during unwanted pregnancies (F2, J2, T2), the stress of miscarriage (L2), and the general effects of a life of repeated pregnancies and births (C2, I2, J2, N2, T2). Reproductive illnesses are also intertwined with women's work lives, because childbirth permanently damages women's bodies, and the stress of work movements constantly recalls and exacerbates this damage (C2, D2, F2, J2, N2, S2, T2). Women often manage their multiple roles alone -- including childbearing -- which causes them great difficulty. This is another stressful experience expressed through these illnesses (F2, I2, L2). Obligations to care for other family members and to fulfill social roles in the community provide further stress to women and add to their reproductive complaints (I2, L2, N2, T2). Another cause is social discord with other comuneros, represented by the suspicion of sorcery (S2). Through reproductive illnesses, women also complain about their subordination to husbands, which frequently results in wife-beating (D2, I2, T2). It is also possible that some of these symptoms relate to menstruation and menopause, although women did not express this directly.

In summary, reproductive illnesses explain -- or are used to complain about -- any symptoms women connect to their reproductive physiology or to reproduction itself. Cuyo Cuyo women perceive the damage from childbirth, and therefore their susceptibility to these illnesses, to increase with each birth. In their perception, they become more and more débil as they lose blood and as their madre, or lower body area, is exposed to the trauma of childbirth. Work movements further damage a woman's weakened body. Symptoms recur at any time in a woman's life as she carries out her typical daily activities within the temperature and weather extremes of Cuyo Cuyo, and as she performs her normal social roles in family and community. Thus, repeated childbirth, combined with years of hard work and social subordination, creates chronic reproductive illness in Cuyo Cuyo women.

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Reproductive Illness and Three Bodies

Why do Cuyo Cuyo women emphasize childbearing as a source of symptoms? Why is the image, vocabulary, and bodily experience of childbirth the main idiom through which women communicate their distress?

Scheper-Hughes and Lock (1987) propose that human health and illness can only be understood when the body is considered to be "simultaneously...[a] physical and symbolic artifact...both naturally and culturally produced, and...securely anchored in a particular historical moment" (p. 7). In contrast to Western science and biomedicine, which focus on one body, the physical body, Scheper-Hughes and Lock talk about three bodies that are central to human health: 1) the individual body -- however the body is conceived in a particular culture, including its phenomenological, biological, spiritual, and mental components, and their interrelationships; 2) the social body -- the body as a natural symbol with which to think about nature, society, and culture (in the Durkheimian-Mary Douglas sense); and, 3) the body politic -- referring to the regulation, surveillance, and control of bodies, both individual and collective, to fulfill some definition of collective stability, health, and social well-being. A focus on any one body, to the exclusion of the others, clearly misses essential parts of the picture.

Recent anthropological work on biological reproduction reflects this multidimensional perspective of the body (e.g. Browner and Sargent 1990; Handwerker 1990). These authors point out, for example, that, while the basic biological difference between men and women has been used historically and cross-culturally to limit women's roles and status, conversely, reproduction has also served as women's main access to power and status. As Browner and Sargent note, "...reproductive studies can provide a particularly powerful lens through which to view broader social processes...[for reproduction] articulates with a society's patterns of gender role organization and its associated ideological and sociopolitical dynamics." (p. 215)

In Cuyo Cuyo, women's individual (biological and phenomenological) bodies, sociocultural conceptions of women's bodies, and the control of women's bodies by the Andean body politic, are all important features of madre, sobreparto, and sopla.

The Individual Body

Women everywhere experience the biological events of menstruation, pregnancy, miscarriage, childbirth, menopause, and various symptoms in their reproductive organs. These account for many of the symptoms Cuyo Cuyo women group into the illnesses of madre, sobreparto, and sopla.

In Cuyo Cuyo, we must consider an additional biological factor that contributes to women's experience of their bodies and reproduction, the effects of high altitude hypoxia. Although Andeans are physiologically adapted to high altitude, hypoxia contributes to high rates of miscarriage and infant mortality. These undoubtedly have both physiological and psychological effects on women, adding to the cultural construction of reproductive illness in the Andes. The higher amount of energy it takes to work and reproduce in a hypoxic environment may make the assignment of lighter, more sedentary, tasks to women biologically adaptive, as this may enhance reproductive capabilities. However, within the present Andean context, performing housework and light subsistence tasks (as opposed to

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income-generating activities) is contributing to the devaluation of women's roles. This is an additional factor in reproductive illnesses.

Andean body concepts add another dimension to women's bodily experience. Women's bodies -- especially those of married women -- are considered to be more débil than men's bodies. They have an extra orifice where illnesses can enter, the vagina, and they regularly lose blood, which is thought to be irreplaceable, through menstruation and childbirth. Because of this debilidad, women are thought to be more susceptible to soul-grabbing. Their frequent negative emotions, such as sadness and worry, also leave them susceptible to grabbing, as punishment by the Pachamama. Women generally perform lighter tasks and sweat less than men, so they are less able to maintain their health through sweating. Further, all components of a woman's lower body are thought to be damaged and weakened by childbirth, a condition that worsens with age and hard work. With these images of women's bodies, it is easy to understand why both men and women in Cuyo Cuyo consider women to be weak and sickly. In the Andean conception, women's bodies are inherently inferior.

The broad interconnection of women's bodies, physical work, and reproduction in Cuyo Cuyo, leads me to suggest that many, if not most, of the symptoms women reported are cognitively linked to childbirth in some way. This may be an important reason why women so often mentioned work movements, load-carrying, and temperature changes in connection with agricultural tasks, faena work, weaving, and cooking, as sources of symptoms. The links between reproduction and work symptoms undoubtedly are so taken-for-granted and ordinary that women did not think to mention childbirth to me as the ultimate cause of their work symptoms. However, these connections have become increasingly clear as my analysis has proceeded.

Women's health is also worsened by the lack of availability and knowledge of birth control methods in Cuyo Cuyo. Cuyo Cuyo women must undergo the risks of pregnancy and childbirth, whether or not a child is wanted. Years of childbearing, under conditions of marginal nutrition and hard work, deplete their health. Although Cuyo Cuyeños may to a degree be controlling family size and composition through active or passive infanticide, this method of family planning -- in contrast to family planning methods that operate at the point of conception -- is costly to women's health.

The Social Body

Andean culture and society in the past placed a high value on females and fertility, values which are evident to a limited degree in present-day Cuyo Cuyo. Powerful symbolic links between women's two most vital roles in Cuyo Cuyo society -- producing crops and producing children -- suggest that Cuyo Cuyo women still obtain power from their reproductive capabilities. The causes women gave for reproductive illnesses reflect these links: Reproductive illnesses are blamed both on reproductive physiology and events, and on women's work in agriculture and in the home. Through reproductive illnesses, women express the physical toll their combined reproductive and productive work takes on their health.

Gender roles and relations are played out on the terrain of women's bodies and reproductive illnesses in Cuyo Cuyo. Women's heavy workloads and the emotional and physical stresses of juggling their many responsibilities in childrearing, domestic, and subsistence work are represented in reproductive illness symptoms, such as lower back pains, and those caused by negative emotions. Subordination to husbands, as represented

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by the prevalence of domestic violence, is another factor. These problems may be worsening with Cuyo Cuyo's present social and economic transformation.

The burden of women's responsibility for child-bearing and -rearing extends to numbers of children produced. A woman who bears too many children is criticized by being called chancha (Sp., pig), in reference to her "litter" of babies; men stated that one way to avoid large families was to marry older women. These examples represent Cuyo Cuyeños' worries about the economic liability of large families. Yet, if a woman bears too few children, another set of problems arises. Couples with few children not only have difficulty carrying out subsistence and household tasks, they have less access to the compadrazgo ties essential to the economic and social fabric of Cuyo Cuyo. Women who are unable to bear children are stigmatized and miss out on community life in very real ways. The case of D2, who was unable to bear children, emphasizes the importance of children to Cuyo Cuyeños. She and her husband had adopted the illegitimate son of a relative, but D2 sorely missed having a daughter, both for her labor contribution and for companionship. During the 1987-88 mining season, D2 attempted to solve this problem by adopting the daughter of a widower who had migrated. As I was leaving the field, she was worried that the miner would return to reclaim his daughter.

Within the household, fear of chronic reproductive illness and loss of a woman's labor contribution are major incentives to take good care of a woman after childbirth. The postpartum period -- when husbands and family members take over women's work responsibilities and feed women nutritious diets -- was the only time I observed women being pampered and taken care of in Cuyo Cuyo. All of these behaviors are intended to protect a woman's health.

However, everyone acknowledges that no matter how well a woman is taken care of, she can still get sobreparto or another reproductive illness at any point in her life. Improper care after childbirth becomes a convenient explanation for many symptoms and health problems women experience, whether emotional or physical. Following the concept of the sick role (Parsons 1951: 436ff), women may claim reproductive illnesses when their personal stress becomes overwhelming, in order to achieve respite from their heavy workloads and to enlist the support of husbands and other family members.

The behavior surrounding reproductive illnesses reflects social relations outside of the household as well. Fellow comuneros assign partial blame to husbands for wives' chronic illnesses. A proper husband assists his wife after childbirth, avoids beating her to excess, makes sure she is properly nourished and dressed, and that she does not have to work too hard. Societal pressures to conform to these norms, by marriage godparents and other comuneros, become an added incentive for husbands to treat their wives well.

Finally, in extreme cases, chronic reproductive illness is blamed on social discord among comuneros. S2, for example, attributed a particularly bad case of chronic madre to sorcery committed by a family with whom she and her husband were having a legal dispute.

The Body Politic

A final dimension of reproductive illness relates to the body politic and control of women's bodies in Cuyo Cuyo. Foucault (1978, 1979, 1980), Martin (1987), and feminist biologists such as Birke (1986), Bleier (1984), and Hubbard (1990) have discussed the

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control of bodies, especially women's bodies, in Western culture, science, and biomedicine. But little material exists about this process in non-industrial societies.

Cultural concepts, such as women's debilidad and the devaluation of women's labor, suggest that power relations are an especially important dimension of reproductive illnesses in Cuyo Cuyo. Debilidad explains married women's ill health, and also becomes the rationale for limiting women's social and economic roles. In addition, it is used as a rationale for assigning lighter tasks to women in agriculture, herding, and wasi ruwana. Finally, debilidad and women's roles in childbearing and child care were used by both women and men to explain why women travel less to cities, and especially to the lowlands. The most extreme example of this is the exaggerated fear about what will happen to women's bodies and health if they migrate to Madre de Dios.

Ideas about the vulnerability of women's bodies are further represented by fears for the safety of unmarried daughters. Girls are taught to be vigilant of their bodies, lest they be raped or bear children out of wedlock. Girls' physical vulnerability constrains their activities and the locations in which they are carried out. In contrast, boys are at liberty to travel and contribute cash to the family economy. Families value their sons' potential economic contributions and invest in their educations and migrations, rather than their daughters'. These ideas are reinforced in Peruvian society-at-large. Acquiescence to this social and economic reality is evident in Cuyo Cuyeños' decisions to allocate scarce resources to male children, and in women's acceptance of their subordinate roles to men in present-day Cuyo Cuyo. Thus, the concepts of debilidad and female physical vulnerability effectively limit women's participation in the cash economy and urban culture of Peru, both of which are increasingly important aspects of life in Cuyo Cuyo.

Another aspect of control over women's bodies relates to evaluations of work. In Cuyo Cuyo, subsistence work is largely evaluated according to its "sweat value." Llank'ay, the heavy work of agriculture and mining that is primarily performed by men, is the most highly valued form of work. Women's lighter work in agriculture (placing the seed in the ground, nurturing the plants), and in ruway (women's work in the home and in herding), is less valued. In the present economy, the "cash value" of mining work, combined with its "sweat value," means that gold mining is more highly valued than agricultural work, now the domain of women. Whether in Andean or Western terms, women's work is valued less than men's.

Andean beliefs about women's bodies and the effects of childbearing thus play into and reinforce women's subordinate position in present-day Cuyo Cuyo. These beliefs become a rationale to constrain women's roles, reinforcing inequalities between men and women. This is ironic, considering that, as time allocation data show, women perform long hours of physically strenuous and tedious work, in addition to childbearing, during their most economically productive years. All of this they do in spite of their "debilidad."

Reproducing Illness or Reproductive Illness?

Cuyo Cuyo women show considerable strength and endurance as they manage the physical and emotional stresses of their multiple roles, the cultural devaluation of their work, their subordination to men, and their lack of control over fertility, all of which are amplified with Cuyo Cuyo's social and economic transformation. Cuyo Cuyo women also live longer than their male counterparts, despite these many stresses on their health and well-being.

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If Cuyo Cuyo women are as physically and emotionally strong as the above suggests, then why do they place such an emphasis on childbearing as a source of their symptoms? The answer lies not solely in the physical effects of childbearing itself, but in the broader sociocultural and political issues surrounding women's bodies and health. Women's reactions to their overburdening roles, and the cultural constraints placed on them because of their reproductive physiology and roles, play an essential part in reproductive illnesses.

The present political economic situation adversely affects the health and well-being of all Cuyo Cuyeños. But the situation is worse for women. Women have fewer work and social roles open to them than men, both inside and outside of Cuyo Cuyo. In the present, Cuyo Cuyo women over-produce babies and under-produce crops. Cash and mestizo identities, now important for Cuyo Cuyo's survival, are not readily available to women. With the incorporation of Western values that denigrate the economic and social contributions of women, women's work in agriculture, and in cultural and biological reproduction, is valued less than the work and contributions of men. Women bear and care for children in addition to their other heavy workloads, and they lack knowledge of, and access to, family planning methods that might ease this burden.

Married women have fewer outlets for their distress than married men. Generally they cannot escape marital strife by moving to migration sites, or by becoming violent with their spouse, as do men. They must avoid sexual liaisons with other men for fear of pregnancy and retribution from husbands. Most importantly, perhaps, negative emotions are proscribed for both health and social reasons in Cuyo Cuyo.

How do women cope with their distress, given the many constraints on their behaviors in Cuyo Cuyo? First, women acknowledge and express their distress and suffering through comments such as Maria's in Chapter 1: "We don't want/love girls as much because they are only born to suffer..." In statements such as these, women complain about their situation, passing on this knowledge and acceptance of their lot in life to their daughters.

Another means of coping is through emotion-based illnesses. Symptomatology data show that, despite -- or perhaps because of -- the cultural proscription of negative emotions, Cuyo Cuyeños somatize negative emotions through the illnesses of hap'iqasqa, colerina, and mal de corazón (fright sickness, anger sickness, and heart sickness). Women, more often than men, suffer these illnesses, all of which provide outlets for their distress.

But women's main response to their suffering, I argue, is reproductive illness. Women, who are relatively powerless in present-day Cuyo Cuyo, and who have few allowable means of protest, resist their suffering and subordination through the principal source of power they possess, their reproductive capabilities. While cultural conceptions of women's bodies are generally employed to women's disadvantage in Cuyo Cuyo, in this case, women turn their bodies into weapons of resistance. Men and other family members take women's complaints about madre, sobreparto, and sopla seriously. Reproductive illness is one of women's few acceptable arenas of protest, and one of the few places they can play out their power struggles with men.

Women's reproductive power is no longer formally acknowledged as it was in pre-conquest fertility cults. However, the strong links between women and agriculture, and between women and the reproduction of the household, society, and culture -- links that are supported and promoted by men and women alike -- remain. This suggests that women's reproductive power is still considered to be important to the survival of Cuyo

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Cuyo society. Childbearing is thus something uniquely feminine and empowering. The madre, which only women possess, is an especially effective locus of women's complaints.

Marriage, childbearing, adult female work roles, and reproductive illnesses coincide in Cuyo Cuyo women's lives. This is evident in the ethnographic data on women's lives and health presented in this study. It is also expressed by Cuyo Cuyo women themselves, as they explain the causes of their reproductive illnesses, causes which intertwine women's experiences in economic activities and social roles, and in childbearing. Reproductive illnesses are, therefore, a metaphor for the overall conditions of Cuyo Cuyo women's lives. They embody, literally and symbolically, and give voice and meaning to the suffering of women in Cuyo Cuyo, who bear physical, emotional, social, and economic costs of childbearing, in addition to their multiple work and social roles.

In conclusion, it is appropriate to ask: Are madre, sobreparto, and sopla reproductive illnesses? Or are they evidence that Cuyo Cuyo society and culture are reproducing illness?

It is clear that reproductive illness is a multi-dimensional phenomenon, partly biological, but also created or "reproduced" by Cuyo Cuyo society and culture. Reproductive illnesses have biological, individual, cultural, social, historical, and political dimensions that are interrelated in a complex manner. Only by understanding their many dimensions can we unravel the question of why reproductive illness is so common, and why reproduction has become the potent symbol it is in present-day Cuyo Cuyo.