‘“A midwife should be welcoming”: personality, midwives, and shifting perceptions of healthcare in Uganda, 1918-1979’
The sixth HSMT seminar of Michaelmas Term will take place at 16.00 on Monday 14th November (Week 6) in the Lecture Theatre of the History Faculty on George Street, and will be delivered by Kathleen Vongsathorn.
Vongsathorn’s research project focuses on the role of gender in the perception, spread, and adaptation of biomedicine and biomedical knowledge in twentieth-century Uganda. While women rarely appear in formal medical reports generated within Uganda, biomedically trained women outnumbered men in mission medical institutions. Much of the provision of and teaching about biomedicine in Uganda was in the hands of women missionaries, or in the hands of the Ugandan women that they trained. The first formalised biomedical training programmes for women in Uganda were midwifery schools, and these midwives staffed a network of maternity and child welfare centres that stretched across the country. The main goal of these centres was to reduce maternal and infant mortality, but while infant mortality has been drastically reduced over the course of the twentieth and twenty-first centuries, maternal mortality rates in Uganda are still very high, in large part because even today, only 57 percent of women in Uganda have ‘skilled’ assistance in their deliveries. There are a variety of reasons that so many women give birth without a biomedical professional attendance, but significant among them is many women’s – or their relatives’ – reluctance to deliver in health centres.
Drawing on interviews with midwives, traditional birth attendants, and community members in Uganda, and on hospital, mission, and government records, the seminar will discuss the reasons why women have chosen to engage with biomedical services while pregnant and delivering babies, why they have chosen not to, how those choices have changed (or not) over time, and why. Specifically, it will focus on the role of the midwife’s ‘character’, or behaviour, in encouraging and discouraging women from coming to biomedical health centres for antenatal care and for deliveries. For many Ugandans, especially in rural areas, midwives were the first point of contact with biomedicine, and this paper explores changing ideas about health and health seeking behaviour through these women and their social presence in communities.
Vongsathorn is a former doctoral student of the Wellcome Unit, and as such we hold a copy of her D.Phil. thesis in the library, shelved under her surname on the theses shelf in Library Room 1. The work is titled, ‘Things that matter’: missionaries, government, and patients in the shaping of Uganda’s leprosy settlements, 1927-1951, and the abstract can be read here in the Oxford Research Archive.
The Unit Library also holds several monographs specifically concerning the subject of healthcare in Uganda. We have a copy of a survey prepared for the Medicine and Public Health in Africa section of the Oxford Development Records project, entitled The medical services of Uganda in 1954-1955 (RA552.U33 BUL 1984) and written by Mary Bull, and this has a small section on nurses and midwives (p.42-43). The report provides a factual snapshot of the state of medical services during one particular year. A more general account on a period of difficulty in Ugandan health services can be found in Crisis in Uganda : the breakdown of health services (RA552.U4 CRI 1985), edited by Cole P. Dodge and Paul D. Wiebe. The work examines how Uganda went from having one of the most highly-developed health services delivery systems in Africa at its independence in 1962 and into the early 1970s, to being one of the world’s least developed nations following a period of troubles.
Our header image for this week’s post comes from Uganda memories, 1897-1940 (R722.32.C66 A38 COO 1945), which is a memoir by Albert R. Cook, a British-born medical missionary in Uganda who established a maternity training school in the country. The image depicts maternity students in 1921. Chapter 27 of the book, ‘Mortality and Infant Welfare’, is of particular interest, discussing midwifery and infant mortality. The Lady Coryndon Maternity Training School is pictured below.
The professionalisation of African medicine (GN645 PRO 1986), edited by Murray Last and G. L. Chavunduka widens the study of the changes and developments in African biomedicine to a continental level. The work is a collection of articles exploring the relationship between African governments and traditional healers, never previously organised, and the associated problems of African medicine. Chapter 6 is pertinent for the themes of this week’s seminar: ‘Prospects for the Professionalisation of Indigenous Midwifery in Benin’.
For other titles specifically concerning midwifery, shelfmarks in the range RG940-991 cover the subject of maternal care and prenatal care services. One such title is Midwives, society, and childbirth : debates and controversies in the modern period (RG950 MID 1997 and online via SOLO), edited by Hilary Marland and Anne Marie Rafferty. The articles contained in the volume examine midwives’ lives and work in the nineteenth and twentieth centuries. For the study of biomedical care in another developing country – that of rural India – and of women’s experiences of birth and infant death there, Where there is no midwife : birth and loss in rural India (RG965.I4 PIN 2008) by Sarah Pinto is an interesting read. It touches upon themes of caste, emotion, domestic spaces, illicit and extra-institutional biomedicine, and household and neighbourly relations.
Please come and ask library staff if you would like any help with locating resources, or conducting further research. We also welcome further suggestions for reading not included in this post!