Documenting Death: Maternal Mortality and the Ethics of Care in Tanzania

271 Pages·2020·14.505 MB·English

by  Adrienne E. Strong

ANTHROPOLOGY S
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Documenting Death is a gripping ethnographic account of the deaths of preg- G
nant women in a hospital in a low-resource setting in Tanzania. Through an
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exploration of everyday ethics and care practices on a local maternity ward,
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anthropologist Adrienne E. Strong untangles the reasons Tanzania has
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achieved so little sustainable success in reducing maternal mortality rates, U
despite global development support. Growing administrative pressures to M
document good care serve to preclude good care in practice while placing E
frontline healthcare workers in moral and ethical peril. Maternal health emer- N
gencies expose the precarity of hospital social relations and accountability T
systems, which, together, continue to lead to the deaths of pregnant women. I
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“This powerful and compelling analysis of maternal mortality in rural Tanzania

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is a groundbreaking addition to scholarship on Africa and its public health
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challenges. Adrienne E. Strong presents a rich ethnography of hospital func-
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tion and dysfunction, to which the voices of patients and staff add poignant T
detail. The ways in which state and global health policy shape maternal health H
and well-being frame individual narratives in a memorable testimony.”
Carolyn Sargent, Professor of Anthropology, Washington University in St. Louis M
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“Documenting Death is an arresting tale of life and death on a busy maternity rn
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ward in rural Tanzania. Drawing on a remarkable period of ethnographic field- l

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work, Strong evocatively details the predicament of nurse midwives caught in
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the ‘biobureaucracy’ of global health projects and their audit trails. A significant rt
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contribution to medical anthropology and critical global health scholarship.” li
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Margaret MacDonald, Associate Professor of Anthropology, York University a
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Adrienne E. Strong is Assistant Professor of Anthropology at the University of h
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Florida. s

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UNIVERSITY OF CALIFORNIA PRESS za
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WWW.UCPRESS.EDU i
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A free ebook version of this title is available through Luminos,
University of California Press’s Open Access publishing pro- ISBN: 978-0-520-31070-4
gram for monographs. Visit www.luminosoa.org to learn more.
Cover illustration: Kanga fabric showing the phrase Dunia si
dunia bila mama (The world is not the world without mothers).
9 780520 310704
Photo by the author.
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from UC Press. Luminos provides a framework for preserving and
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Documenting Death

Documenting Death
Maternal Mortality and the Ethics of Care in Tanzania
Adrienne E. Strong
UNIVERSITY OF CALIFORNIA PRESS
University of California Press
Oakland, California
© 2020 by Adrienne E. Strong
This work is licensed under a Creative Commons CC BY-NC-ND license.
To view a copy of the license, visit http://creativecommons.org/licenses.
Suggested citation: Strong, A. E. Documenting death: Maternal Mortality
and the Ethics of Care in Tanzania. Oakland: University of California Press,
2020. DOI: https://doi.org/10.1525/luminos.93
Names: Strong, Adrienne E., 1988– author.
Title: Documenting death : maternal mortality and the ethics of care in
Tanzania / Adrienne E. Strong
Description: Oakland, California : University of California Press, [2020] |
Identifiers: LCCN 2020014517 (print) | LCCN 2020014518 (ebook) |
ISBN 9780520310704 (paperback) | ISBN 9780520973916 (epub)
Subjects: LCSH: Mawingu Regional Hospital (Rukwa Region, Tanzania) |
Mothers—Mortality—Moral and ethical aspects—Tanzania
Classification: LCC RG966.T34 S77 2020 (print) | LCC RG966.T34 (ebook) |
DDC 362.1982009678—dc23
LC record available at https://lccn.loc.gov/2020014517
LC ebook record available at https://lccn.loc.gov/2020014518 Strong_CIP
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To all the health care workers of the world in this, 2020,
the first Year of the Nurse and Midwife

Contents
List of Illustrations ix
Acknowledgments xi
List of Abbreviations xv
Prologue xvii
Introduction 1
1. The Mawingu Regional Hospital Maternity Ward 22
2. Working in Scarcity 45
3. Protocols and Deviations: Good Enough Care 67
4. “Bad Luck,” Lost Babies, and the Structuring of Realities 91
5. Landscapes of Accountability in Care 110
6. The Stories We Tell about the Deaths We See 126
7. Already Dead 147
8. “Pregnancy Is Poison”: The Road to Maternal Death 165
9. The Meanings of Maternal Death 188
Epilogue 204
Appendix: Deaths Occurring during the Field Period 207
Glossary of Medical Terms 211
vii