Thursday, November 5, 2009

About pregnancy

Last Friday, Moroccan blogger calabamuse posted an article about the following magazine cover:

This is the November issue of Femmes du Maroc, and the cover prefaces a multi-page feature on pregnancy. Beside the article discussing this particular television personality’s impending accouchement (labor, childbirth), the magazine includes an exposé on the deplorable state of OB-GYN facilities at public hospitals and clinics, advice about how to deal with post-partum depression, a description of a cesarean section, and even a special on fashionable maternity clothes.

I picked up this issue myself last Thursday while shopping at Marjane, and was completely intrigued by the provocativeness of the cover. And indeed, this is the main theme of Calabamuse’s thought-provoking post. The writer suggests that pregnancy, like many other issues relating to sex or the reproductive system, is a phenomenon that makes Moroccan society highly uncomfortable:

The exclusionary and sometimes castigating treatment pregnant women are subjected to is a leading cause of abortion in Morocco where the number of out of wedlock pregnancies have dramatically risen. The pool of medical doctors performing abortions today has grown exponentially. They charge 3000 Dirhams ($391.00). Additionally, an increased number of women, especially in rural areas where medical oversight is minimal and sometimes non-existent, die from standard pregnancy complications.
The message of the magazine’s cover is a loud and clear confirmation of the self: I am pregnant; I am beautiful, and I exist. I agree. In our society, pregnant women need to feel less excluded and be viewed in a more gratifying fashion. For a country like Morocco, where television channels are flipped at the mere sight of a man an a woman kissing, where, in neighborhood foodstuff stores, menstrual pads are stuffed in a black plastic bag to conceal them from the embarassed looks of customers, the idea is outrageous.

Intrigued by this apparently ambiguous regard for pregnancy, I decided to ask around. I used a word that Calabamuse didn’t, and ultimately proved to be too strong a connotation: was pregnancy hshouma, shameful?

Yes, Farid told me, he did think that pregnancy is shrouded in a kind of hshouma, but I needed to be aware that there are two ways to translate this culturally powerful term. Pregnancy is not so much a source of shame, he explained, as it is a source of embarrassment. There are certain topics you simply don’t discuss with certain people, like your parents or your boss, and pregnancy is one of them. It’s a matter of respect, Farid added. As he said this, I suddenly remembered how reluctant Karima, the NIMAR’s housekeeper, had been to discuss her pregnancy in the presence of our director or any other male associate.* Exactly, Farid said. This reluctance wasn’t shame so much as it was just the maintenance of a certain kind of propriety.

A new part-time co-worker at the NIMAR, Aicha, likewise didn’t think pregnancy was seen as shameful. She did, however, remember being told to cover up her pregnant belly in looser clothing when going outside, and she recalled how surprised her parents had been to find out that she had been open about the development of her second pregnancy toward her young son. There did seem to be a kind of discomfort about open manifestations of pregnancy, she concluded. Her environment tended to explain this as a way of avoiding the evil eye.**

These stories do betray a clear sense of ambiguity with regard to the phenomenon of pregnancy. It doesn’t seem to be a source of outright, negative shame, but it certainly makes people uncomfortable. It’s the clear connection to sexual intercourse, Farid explained with slight embarrassment. Pregnancy may be the source of new life, but it is also an unconcealable confirmation of a woman’s nature as a sexual being.

And that, I think, is true for every civilization on earth. I think that pregnancy may harbor that double meaning for almost all of us, because it lies at the heart of the very conflicted way in which nearly every culture deals with human sexuality. Sex is powerful: not only because it is one of our most primal and strongest instinctual drives, but also because it is fundamental to the propagation of our species and civilization. It signifies the glory of future development, but in its sheer primal power can also lead to utter chaos and the destruction of any kind of social order. This is why nearly every civilization has sought to exercise control over its society through the strict regulation of sex.

And let’s not forget the Madonna/Whore complex that torments so many of us. We want to see women as mothers, as the innocent and morally upright nurturers who teach our future generations about right and wrong – but we also want to see women as sexual objects, as the embodiment of sexual desire. Perhaps because we are conscious of the potentially destructive power of sex, we see these two identities as polar opposites that cannot be reconciled with one another – yet they are merged, in the phenomenon of pregnancy.

And so, as curious as I think the abovementioned attitudes toward pregnancy are, I don’t think the ambiguity of it is typically Moroccan, per sé. The way in which it is expressed may be culturally specific, but I’m inclined to believe that this particular stance is one we all have in common as humans who are overwhelmed by the power of their own sexuality. I agree with Calabamuse that pregnancy must be celebrated as something beautiful – but I think a larger problem highlighted by this month’s Femmes Du Maroc is the deplorable state of OB-GYN facilities in the country’s public hospitals and clinics.*** These places suffer from a desperate lack of resources, which results in understaffing, a lack of necessary equipment, and thus a lack of adequate care. Patients are obligated to purchase and bring all necessary materials by themselves: from towels to sedatives to suturing thread, it is the patient’s responsibility to make sure these items are present, because the hospital simply does not provide. Femmes Du Maroc also describes widespread corruption: nurses and other staff provide their services only in exchange for ‘bonuses’ of a few hundred Dirhams. Public healthcare services are officially offered free of charge, but adequate care is thus ultimately received only if one has a considerable sum of Dirhams to spend.

Add to these issues the fact that in rural areas, even such public clinics are few and far between. Obstetric facilities have this in common with nearly every other kind of medical service – including that of psychiatry. Reforming the healthcare system is an important part of Morocco’s development goals, and this month’s Femmes Du Maroc also features an interview with Morocco’s minister of health, Yasmina Baddou, who speaks of everything that’s already been done and who is optimistic about further improvement. I’m hopeful, and curious to see what reforms and improvements will be implemented in Morocco’s healthcare system over the next few years.

* Two months ago, Karima gave birth to a baby boy. When I and a few other female NIMAR co-workers went to visit her and her family, she never talked about how the actual labor and birth had been. We didn’t ask, but amongst ourselves did speculate about how it had been. I remember finding this surprising. This is the kind of thing Dutch women talk about readily, but clearly not something Karima wanted to discuss.
** According to the literature, individuals in transitional phases are particularly susceptible to the gaze of the evil eye. Newborn babies, newlyweds, and pregnant women are often cited as examples. The evil eye can be seen as a kind of curse that can lead to all kinds of malaise. If caught, it can be fought off in a variety of ways, including herbal concoctions or counter-spells. A shouafa, or medium, can often help.
*** At the time of writing, Femmes Du Maroc’s website did not yet publish the article. But here is their website.


A.T.B. said...

I enjoyed reading your post. Good angle.
Corruption and lack of resources in the medical field in Morocco are not restricted to obstetrics and gynecology. They affect anybody seeking medical treatment from Oncology to pediatrics, and let's not talk about emergency patients.
The "hshouma" concept, however, is more specific. There are certain things women in Morocco (and in any conservative society) are taught not to talk about with their husbands, brothers, parents, and strangers. It's hshouma to talk about menstruation (cycle abnormalities), for instance. Let alone talking about vaginal discharges and such. In Morocco (and Moslem societies in general), a husband would not touch his wife if she is menstruating because she is considered impure (najasa).
The idea of the "evil eye" is absolutely correct. In Europe and the U.S., it is normal for complete strangers (women) to complement a pregnant woman they met while shopping and ask her specifics about her pregnancy - When are you due? Who's your doctor? Is it a boy or a girl? Are you getting contractions? Not in Morocco.

Anonymous said...

I am curious how much attitudes towards pregnancy differ between uneducated women from the countryside, and educated women from more urban areas? I have noticed in time spent with women in the countryside that certain "female" topics are somewhat open, even around men. I have observed breastfeeding occur around anyone, men included. I have heard (translated) somewhat sexual jokes from women (e.g. about a wedding night, about getting pregnant, etc), in male company (the males were relatives, not strangers). And similarly, these women have talked about topics related to sexuality (e.g. pregnancy) in front of their children. I wonder if over time, more well-educated, urban women have developed a sense of "embarrassment" or propriety around these topics, where perhaps before it did not exist quite so strongly? And if so, where did this sense of embarrassment come from?

Jillian said...

I'd be happy to email you the article if you'd like!

Charlotte said...

ATB - thanks for your comment - and for letting me use your post as inspiration ;-). You make a good point - the issues faced by OB-GYN wards are faced by all medical facilities. I definitely notice the complete lack of resources in my research on psychiatric care in Morocco.

Krista - that is a really good & very intriguing question! I've noticed some of the same things you've observed, and I'd be really curious to figure out if there's some kind of rhyme and reason as to who discusses what in front of whom, and how this varies across the country...

daniel said...

I was wondering if you have heard of any independant midwives in the Rabat area,
We are relocating there and I am expecting a baby, we have had our other last three children at home with midwives in the USA.
thanks so much.