Table Of ContentRural Women’s Sexuality,
Reproductive Health, and Illiteracy
Rural Women’s Sexuality,
Reproductive Health, and Illiteracy
A Critical Perspective on Development
Gisele Maynard-Tucker
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Maynard-Tucker,Gisele.
Ruralwomen'ssexuality,reproductivehealth,andilliteracy:acriticalperspectiveondevelopment/
GiseleMaynard-Tucker.
pagescm
Includesbibliographicalreferencesandindex.
ISBN978-0-7391-9232-0(cloth:alk.paper)--ISBN978-0-7391-9233-7(electronic)
1.Ruralhealthservices--Developingcountries.2.Women'shealthservices--Developingcountries.3.
Ruralwomen--Sexualbehavior--Developingcountries.4.Reproductivehealth--Developingcoun-
tries.5.Literacy--Developingcountries.6.Ruralwomen--Servicesfor--Developingcountries.7.
Economicdevelopmentprojects--Developingcountries.I.Title.
RA771.7.D44M392014
362.1'04257091724--dc23
2014036919
TMThepaperusedinthispublicationmeetstheminimumrequirementsofAmerican
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Contents
Preface vii
Acknowledgments xi
ListofAbbreviations xiii
Introduction:MyJourneyacrossCountries xv
1 InternationalDevelopmentandRuralHealth 1
2 Peru:FirstExperienceintheField 11
3 Haiti:TheChallenge 31
4 Africa:Women’sConditions 49
5 IndonesiaandMorocco:BirthingHutsandSelf-Medication 61
6 Madagascar,Senegal,andIndia:SexWork 73
7 NepalandMadagascar:BroadeningtheReachofHealth 91
Conclusion:LessonsLearned? 105
References 113
Index 125
AbouttheAuthor 127
v
Preface
I started being interested in anthropology while I studied for my bachelor’s
degree at the University of California, Los Angeles (UCLA). I was an adult
woman, marriedwith ayoungson, whenI decidedto gobackto schooland
earnanacademicdegree.AftergraduatingwithaPh.D.inanthropologyfrom
UCLA, I worked for many years as a freelance international consultant in
various developing countries, Africa, Latin America, the Caribbean, Asia,
andIndia.Mybackgroundinanthropologyhelpedmeunderstandthevarious
cultures, and I was able to immerse myself in ethnic beliefs, customs, and
practices.Italsohelpedmetonavigatebetweenthepoliciesoftheministries
of health, the administrating agencies, and nongovernmental organizations
(NGOs). I acquired expertise in my field evaluating various programs,
amongthemfamilyplanning,reproductivehealth,maternalandchildhealth,
and HIV/AIDS prevention. The reason I decided to write this book is to
illustrate the years spent in the field dealing with various health topics in-
volvingruralwomen.
I alsowantto sharemy experiences with students andthoseinterestedin
development work. In order to do so, I describe the challenges of being an
anthropologist living in foreign countries and dealing with ethnic customs,
genderinequality,andtheneedforadaptiontoimprobablesituations.Iillus-
trate the problems working for international and national organizations that
werenotalwaysinharmonywiththeirbureaucracy,policies,andsustainabil-
ityprocedures.
Whileevaluatingtheprograms in thehealthfacilities of theministries of
health in various countries, I always had to visit the rural communities that
were the most challenging for the delivery of the programs. I became inter-
ested in rural communities, and my interest in rural women came from the
time I spent living with the Quechua Indian women in Peru. I realized that
vii
viii Preface
illiteracy was a major handicap for them, along with their lack of power to
decide about their reproductive outcomes. In the book, I want to bring to
light the numerous challenges rural women face when dealing with health,
illiteracy, gender inequality, and cultural beliefs, and I describe their ap-
proach to modern medicine and their enduring use of traditional medicine
andhealers.
The book illustrates rural women living in different ethnic societies and
provides insights into health-care delivery in rural parts of the world. It
reveals the intimate life of the women who are subject to gender inequality,
subserviencetotheirpartners,andtheirneedtoconformtoculturalcustoms.
In many cultures girls are not the valued gender and are dependent on their
malepartners or ontheirkin foreconomicsurvival unless theyare educated
or have mastered a skill. I write about their approaches to modern medicine
andtheirpragmatic solutionsto resolvetheirhealthproblems based ontheir
financialmeansandculturalbeliefs.Traditionalmedicineisverymuchalive
in rural communities because of traditional beliefs and the lack of health
facilities, transportation, and cash. Healers and traditional midwives are the
health-carealternativestophysiciansandtrainedmidwives.Thehighmater-
nal mortality in most developing countries attests to this problem, which is
known by international donors, ministries of health, and local NGOs but
remainsunsolved.
I also discuss my findings about women involved in sex work in Mada-
gascar,Senegal,andIndiainordertoshowthatwomenwhoareilliterateand
havenoskillshavenoalternative but to selltheirbodiesin orderto survive.
Clandestine sex work isawayforpoor womento makefastmoneyin order
totakecareoftheirchildrenandtobeindependentfromapartner.However,
it is risky because of the HIV epidemic and also because of violence from
clients.
Women’sstatusandconditionsarerelatedtotheireducation.InMorocco,
there are educated modern women who are ministers in the government’s
offices, and there are women who live in the countryside and are veiled,
wearing the burqa, and follow the cultural customs of subservience to their
husbands. The latter are illiterate and have no skills. Women’s status will
remain unchangeduntil girls are educatedandlearn aprofessionalskill,and
until themothers will changethegirls’ enculturationprocess; that is, raising
girls not as theirimagebut very muchlike theyraiseboys, independentand
assured.Girlsshouldbeliberatedfromculturaloppressionthroughthesame
enculturationastheirmalecounterparts.
The book gives an inside look at the health systems in the rural areas of
Peru, Africa, the Caribbean, and Asia. Everywhere, ministries of health de-
pend on international funding to improve their national programs, but be-
cause of corruption and the constant migration of the trained medical staff,
theoutputsoftheministriesareverylimited.Ontheotherhand,international
Preface ix
organizations do not supervise or monitor the improvement of their projects
through surveys of beneficiaries’ opinions of the quality of care of the ser-
vices. There is a big gap between programmatic improvement that is the
focusoftheorganizationsandthesatisfactionofthebeneficiaries.
Finally,Ihopethatthebookwillenlightenthereadersaboutthereachof
globalization in traditional societies, and the ways of life of rural women in
various cultures, their plight for survival, and their strategies when dealing
with their sexuality and health problems. I try to show that illiteracy affects
women’s health behavior, and their comprehension of modern drugs and
medical explanations. It is a barrier to modern medicine and health-care
deliveryinthecontextofinternationaldevelopment.
For me, this work is a testimony of my involvement in years of research
andevaluations.Iwrotethebookforstudentsinterestedinanthropologyand
other humanity sciences, and I also hope to reach policy makers and the
broader international community who are supporting women’s progress in
developing countries. The book suggests a change of perspective within the
developmentcommunityfromasinglefocusonwomen’shealthtoabroader
perspectiveencompassinglinkagestoliteracy,microcredit,andcommunica-
tion.
