Knowledge and Power: Focusing on Reproductive Rights
Gender dynamics within families have been investigated at length in the previous section, but what about gender dynamics outside of the family, in the realm of medicine and the state? How do the relationships between male and female doctors with their female patients endorse or devalue each side's power? And how has public policy on reproductive rights in Peru's past influenced the direction of female autonomy? These are some of the questions I hope to answer in this section.
Political History of Reproductive Health Policy
Before the 1980s, policies dictating social and health rights in many Latin American countries did not consider women a priority, as far as inclusion in the body politic is concerned (Rousseau 2007:96). After the 1994 International Conference of Population and Development (ICPD), however, large international development agencies placed women’s reproductive rights at the forefront of pressing issues going forth into the next millennium. Since then, the Peruvian government has played a much larger role in family planning and maternal care, but with a distinctly gendered tone in policymaking. The main theme running through health sector reform was focused on poverty reduction, which was introduced by the World Bank again in the 1980s, as a general method of decreasing rates of maternal and infant mortality. Currently, reproductive health issues in policymaking emphasize gender relations and personal autonomy, as well as access to healthcare services, all of which contribute to maternal mortality rates when absent or unequal (Rousseau 2007:97).
Reform was doubly difficult to affect during the last two decades of the 20th century, when the governmental structure of Peru was shifting and in turmoil. During that era, the government, led by President Alberto Fujimori, enacted the previously mentioned health sector reforms that sought a rapid reduction in poverty rates through the control of female reproductive health and family planning, mainly through limiting fertility with contraceptive choices (Rousseau 2007:105). Considered objectively, this method would appear to reduce the rate of maternal death, especially among the high-risk sector of the population, including the urban and indigenous poor, since advocating contraceptive usage decreases the number of pregnancies that occur. However, limiting fertility restrains individual autonomy, bringing to light a primary issue of gender inequality (Rousseau 2007:106). Thus, issues with clarifying the government’s position on women’s reproductive health and the structure of the healthcare system created the first barrier to reducing poverty and the maternal mortality rate in Peru.
Political History of Reproductive Health Policy
Before the 1980s, policies dictating social and health rights in many Latin American countries did not consider women a priority, as far as inclusion in the body politic is concerned (Rousseau 2007:96). After the 1994 International Conference of Population and Development (ICPD), however, large international development agencies placed women’s reproductive rights at the forefront of pressing issues going forth into the next millennium. Since then, the Peruvian government has played a much larger role in family planning and maternal care, but with a distinctly gendered tone in policymaking. The main theme running through health sector reform was focused on poverty reduction, which was introduced by the World Bank again in the 1980s, as a general method of decreasing rates of maternal and infant mortality. Currently, reproductive health issues in policymaking emphasize gender relations and personal autonomy, as well as access to healthcare services, all of which contribute to maternal mortality rates when absent or unequal (Rousseau 2007:97).
Reform was doubly difficult to affect during the last two decades of the 20th century, when the governmental structure of Peru was shifting and in turmoil. During that era, the government, led by President Alberto Fujimori, enacted the previously mentioned health sector reforms that sought a rapid reduction in poverty rates through the control of female reproductive health and family planning, mainly through limiting fertility with contraceptive choices (Rousseau 2007:105). Considered objectively, this method would appear to reduce the rate of maternal death, especially among the high-risk sector of the population, including the urban and indigenous poor, since advocating contraceptive usage decreases the number of pregnancies that occur. However, limiting fertility restrains individual autonomy, bringing to light a primary issue of gender inequality (Rousseau 2007:106). Thus, issues with clarifying the government’s position on women’s reproductive health and the structure of the healthcare system created the first barrier to reducing poverty and the maternal mortality rate in Peru.
Addressing political inclusion is one of the methods that can be used to improve women’s status in Peru overall. Since the political movements of the 1980s, there has been a surge in interest on the part of NGOs to advocate for women’s rights in Peru, and Peruvian women themselves have gained more voice in advocating for their own rights in grassroots organizations and political positions (Rousseau 2007:111). Gaining political voice will prove to be important in the future, as it means women or advocates of women’s rights will be able to aid in forming policy concerning women’s reproductive rights and will be able to promote the increasing access to reproductive health services.
Authoritative Knowledge: Physician v. Patient
The doctor-patient relationship is a theme that is currently explored in medical anthropology in general, not solely in developing nations. My experiences with a wide variety of doctors and obstetricians gave me a comprehensive glimpse at how the relationship functioned in rural Peru. Authoritative knowledge plays a major role in determining the power relationship between a doctor and his or her patients; usually, the doctor has the upper hand. The authoritative knowledge physicians hold is constantly reinforced by discourse by the state, as well as the social and cultural status physicians have (Smith-Oka 2012:111). Any traditional methods of healing are often discredited once a person sets foot inside of a hospital or clinic, despite the fact that such cultural knowledge is held by most people who live in rural geographic settings.
The discrimination women faced with their male relatives was mirrored in some interactions they had with doctors. While some doctors took time to explain a procedure or how a particular medicine worked, others didn't think twice about spending less than ten minutes with a patient, in order to get through a "patient quota" for the rotation. However, these behaviors varied on an individual basis, and from my experiences there is no way to draw a general consensus on the definitive attitudes of doctors in rural and/or impoverished areas to their patients. Nevertheless, the issue of authoritative knowledge in terms of hybridizing a medicine based on traditional and biomedical knowledge, paralleling the relationship between the patient and the doctor, and will hopefully continue to be an area of research in the future.