The social construction/invention of child mortality as a significant social medical issue of "fairly recent vintage"
In Western societies nowadays, it is commonly believed that “babies didn’t die, or if they did it was a great human tragedy for all concerned” (Scheper-Hughes, 2014: 271). But in reality, believing in infant mortality in the West is fairly new.
Indeed, according to Scheper-Hughes (2014), until the early and mid-twentieth century, child mortality was often treated by medical professionals and public officials as normal and routine, and part of the “natural order of things” (Scheper-Hughes, 2014: 274). Deaths were considered to be caused by “diseases of growth, nutrition and decay” (Scheper-Hughes, 2014: 274), alongside with “wasting” and “prematurity” (Ibid, 274). Until the mid-twentieth century, a high infant mortality was hence not “regarded as intolerable or unacceptable but rather a fairly predictable and expected occurrence” (Scheper-Hughes, 2014: 275), especially because this mortality was exceptionally high in poorer rural areas, and thus of little concern to those who had the economic power to intervene. However, and to put it into Armstrong’s (1986 cited in Scheper-Hughes, 2014: 275) words, this social invention of child mortality came about with the apparition of urban industrialisation and the increase in demand of labour power, which was essentially constituted of the poorer population.
With such a high child mortality rate, and the increase of the demand for cheap labour power, the state became interested in regulating the fertility and the control of the population, especially concerned with the child mortality and children’s survival which has now become one of the West’s main concern and problem in developing countries. Thus, the normality of infant mortality was gradually questioned and to recapitulate in Wright’s words: “an infant was no longer regarded as one of the death’s natural habitats, but rather a terrain in which death was an obscene intrusion” (1988:306 cited in Scheper-Hughes, 2014:275). In this sense, in contrast with the general belief that in the West “babies didn’t die, or if they did it was a great human tragedy for all concerned” (Scheper-Hughes, 2014: 271), this social construction and invention of child mortality in the West is only a few decades old.
The effect of high rates of infant mortality on individuals' attitudes to child death
Scheper-Hughes (2014), in the context of a very high rate of infant mortality, has witnessed a process of routinization of the child’s death in “the creation of an average expectable environment of child death” (Scheper-Hughes, 2014: 272), in other words, a set of conditions that put the life of the infant in great danger of sickness and death, “accompanied with the normalization of this state of affairs in both public and private life” (Scheper-Hughes, 2014: 272).
In this sense in Third World countries, that follow a rudimentary form of dependent capitalism and are known to have very high infant mortality rates, parents often understand their infant’s life as being undependable and provisional. Much in opposition with the mainstream Western belief of child mortality as a tragedy, in these countries an infant’s death is considered a relatively minor misfortune, easily accepted by the parents and individuals concerned, and “it is one to be accepted with equanimity and resignation as an unalterable fact of human existence” (Scheper-Hughes, 2014: 275). In this sense, parents already expect a high chance for their infant to die, and the way they care for the infant thus change. The parents then start to consider it normal to see their infant as interchangeable and easily replaceable with another child. Thus, if the child is or seems to be weak and sick, they will consider the survival of the rest of the already existing family as well as the wellbeing of older siblings and not bother trying to save it and will just focus on having another hopefully stronger infants. As Scheper-Hughes puts it:
“Reckonings of the social, moral and economic value of the individual child may be measured against those of older children, adults, or the family unit as a whole” (Scheper-Hughes, 2014:276).
Such decisions are not only influenced by the idea that the infant is replaceable in the parents’ mindset, but these moral evaluations are also heavily influenced by other external powers. Indeed, they seem to also be influenced by population pressures, the household composition, survival strategies, cultural beliefs in regard to the nature of infancy and childhood and the formation of a human being and when one is considered to become one, as well as religious beliefs regarding the infant’s soul and concepts such as immortality. Such indifference in the infants’ deaths is also a reflection of the general official bureaucratic indifference of “local agents of church” (Scheper-Hughes, 2014: 276). Infant mortality thus is normative and to be expected and this leads to sets of conditions putting infants in jeopardy as if the child is considered weak, he may be considered a burden to the family and just left to die in the wait for a stronger infant to be born.
The copping mechanisms used by mothers to cope with the high infant mortality rates
Throughout the chapter, Alto women seem to refer to their dead infants as angels or little angels. More than once, it has been said that the infant was recalled by its saint in heaven. In this sense, these “little angels” seem to return to a place that was always known to be a better place for them, in comparison with the poverty and struggle of their families. Although Alto women seem to recognise that malnourishment is the first cause of infant mortality, when asked about their own dead infants, they deny the possibility of malnourishment and often argue that “the dead infant was judged as lacking a vital life force, his or her own will to live” (Scheper-Hughes, 2014: 314). With such arguments, the women are thus cleansed from any responsibility towards the death of their infant, as the child was simply lacking a will to live and he would be better off going back to heaven with his/her saint. Furthermore, in a society where an infant is considered interchangeable and easily replaceable, the death of an infant seems to be rather normal and not something to be worried or bothered about. In general, infants seen as born weak or not strong enough thus seem to be seen as better in heaven.
Breastfeeding in Bom Jesus
Although it is known that bottle-fed babies have a higher death rate as then very often suffer of malnutrition and are exposed to bacteria present in contaminated water etc…, “each generation of mothers in the Third World is less likely than the previous one to breast-feed offspring” (Scheper-Hughes, 2014: 317). This phenomenon seems to especially be true with rural migrants who come to cities, where wage labour and the work available, as well as the numbers of hours worked are simply not compatible with breastfeeding. Often, Alto mothers use breast-feeding as an initial, however very dependable, supplement to the normal food given to infants; called mingau. Nevertheless, “maternal colostrum is rejected as a dirty substance” (Scheper-Hughes, 2014: 317) and is often extracted by the mother manually and thrown away. Thus, although used in small quantities, the maternal milk is only a supplement with mingau, which is always given to the baby first, to quiet it down. Mingau, is very thick in consistence and the infant very quickly becomes uninterested in the mother’s breast. After a couple days, the maternal milk consequently fails: because the infant is not put to the breast enough, to suck the maternal milk out, and build the mother’s milk supply. After a few days, there is therefore barely any milk in the mother’s breast. Some women, like Black Irene in Scheper-Hughes’ narration, were actively trying and breast-feeding their children for a couple months, but in Black Irene’s case, just like in most women’s case, she was forced to stop when she returned to work. Indeed, if some mothers were willing to breast-feed, their patroas would not allow lactating mothers to work in their homes:
“Dá nojo [it’s disgusting], […], one could not run the risk of suddenly having a wet blouse, in the middle of serving a family a meal: it would make everyone lose their appetites” (Scheper-Hughes, 2014:323).
Breast-feeding moreover seems to become a social stigma in a society in which men are seen to be the ones providing for an offspring. One that breastfeeds is a mother who was abandoned by her husband, whose husband does not provide for her and her infant, or whose husband is no longer sexually desirous of the mother’s body, letting her “breasts be ruined by a sucking infant” (Scheper-Hughes, 2014: 325).
All these obstacles to breast-feeding are further supported by the women’s mistrust in their own bodies and abilities to nourish the infant, creating a form of “social production of scarcity” (Scheper-Hughes, 2014: 325). Indeed, because mothers are concerned about the survival of their infants, they often hasten to provide the weak offspring with heavy and thick foods, that will “stick to their ribs” (Scheper-Hughes, 2014: 325), rather than their own “blue, thin and watery” (Ibid :325) maternal milk from which the woman’s weakness would thus be transmitted to the infant. The local beliefs go even further to say that not only her weakness and sickness could be transmitted to the child but also her original filthy and polluting sin could be transmitted through the milk. A child that was kept away from the mother’s polluted milk and was unbaptised was thus believed to directly go to heaven, free of the mother’s original sin.
Alto women, hence do not get the choice or preference, if they want to make enough money to feed and allow the survival of the rest of the family and not be socially stigmatised; bottle-feeding becomes the only choice for infants. The mother’s body also seems to become a medium and vessel for different social symbols and meanings.
How natural is breastfeeding then?
According to Scheper-Hughes (2014), the culture of breast-feeding has completely been lost in the Alto do Cruzeiro through the whole commercialization of infant feeding. Hence, the whole supposedly intuitive, or “natural” knowledge involving breast-feeding, what maternal milk should look like and how a mother knows when her infant is full or not have all been forgotten and lost.
Scheper-Hughes (2014) argues that just like cooking, breast-feeding is no more natural nor less cultural. Body-feeding would thus be a body practice that needs to be learned and taught, just like one will learn how to swim, dance or make love. It requires teaching to learn “how to do it comfortably” (Scheper-Hughes, 2014: 326) and furthermore, can be lost (with cultural variations as we have seen above).
Reference:
Scheper-Hughes, N. (2014). Death without weeping. Berkeley: University of California Press, pp.268-339.
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