Belaboured Lives: An Ethnography of Muslim Women's Pregnancy and Childbirth Practices in Pakistan's Northern Areas

My doctoral thesis, “Belaboured Lives,” examines the relationship between Sunni Muslim women’s reproductive and maternal health practices, Islamic conservatism, federal and non-governmental health programming, intense Shia-Sunni conflict, interpersonal enmity and ‘occult’ forces in Gilgit Town, economic and administrative capital of Pakistan’s semi-autonomous, federally neglected and multi-sectarian Northern Areas. Over 14 months between 2004 and 2005, my doctoral ethnographic fieldwork involved research interviews and participant-observation among Sunni women and Gilgit Town’s biomedical, traditional and Islamic therapeutic service providers, as well as in household, community, mosque and clinical-settings. With Gilgit District’s maternal morbidity and mortality rate (MMR) being among the highest in Pakistan, my thesis argues that Gilgiti Sunni women’s reproductive and maternal health outcomes were the product of restrictive, inter-linked or mutually interacting structural and ideological forces, which were socio-economic, political, familial and religious in nature. By providing an ethnography not only of women’s home-centered health practices but also their in-clinic experiences, I address the wide array of physical, symbolic and cosmological threats women perceived as being interwoven with their fertility, pregnancy and childbirth-related health. To different degrees and in different ways, women, their families and health providers described how the socio-spatial constraints associated with Islamic pardah (veiling, gender seclusion) and izzat (honour) paradigms, conflict-related service exclusions, iatrogenic risk and hospital funding insufficiencies, ‘black magic’ and spirit ‘attacks’ were contributory factors to women’s poor health outcomes. But my participants’ reproductive health was not only the arena for wellness-seeking and crisis resolution, but also for the enactment and expression of cultural values and sectarian identity; the tension between doctrinal Islam and local interpretations, modern/traditional divides; Sunni militarism, symbolic and structural violence. Moreover, Gilgiti Sunni women’s reproductive and maternal health narratives demonstrated subjectivity, inter-subjectivity and reflexivity, resistance and negotiation, and gendered and reproductive agency. Within this context, any one pregnancy could evidence and communicate multiple domains of experience, as well as patient-provider interaction, access to care, its quality and relation to socio-economic factors, ideological stance or community-bound interpersonal relations. Ultimately, by using pregnancy and childbirth as a central point of inquiry, my thesis examines different aspects of Gilgiti Sunni women’s health experiences: biomedical and traditional; urban and rural childbirth and post-partum practices; Family Planning, fertility and infertility, unwanted pregnancies and abortions; conflict-related constraints, medical malpractice and cosmological harm.

Keywords: Islam
women
reproductive health
pregnancy
childbirth
health practices
medical pluralism
biomedicine
Islamic medicine
sectarian conflict
non-governmental organization
federal health services
maternal morbidity and mortality (MMR)
son preference
abortion
Family Planning
unwanted pregnancy
ultrasound
religious conservatism
Shia Islam
Sunni Islam
Ismaili Islam
ethnography
violence
occult forces
'black magic'
infertility
polygyny
medical anthropology
qualitative
risk
Advisor: Lambek, Dr Michael J.