Indigenous and biomedical practices in the sexual health of indigenous women of the Amazon
Brenda Castillo Rivera
Summary: This essay seeks to deepen the disagreements between indigenous practices on childbirth, sexual health and medicines for women in Amazonian cultures and biomedical practices in health centers found in this region. A systematization of information on ethnographic cases and scientific research will be developed, which will be contrasted with developments on the notion of the body, health and knowledge of healing and care. Through an analysis of experiences, perceptions and conflicts about the establishment of intercultural sexual health and the introduction of indigenous practices in biomedical care. This exercise will help us understand that the problem surpasses the argument about an intercultural dialogue about knowledge and practical systems, but is carried out in the perception of women in both worlds, leading to a gender problem. Thus we can see that the social and cultural changes of health accentuates the vulnerability situation of the indigenous woman of the Amazon. For this reason, as a reflection it is necessary to evaluate the agents of medical centers and indigenous actions on women’s health.
Introduction
The problematic situation of intercultural health is currently persists, despite public policy designs and implementations, interventions and other actions, causing the needs of indigenous peoples not to be supplied by the State and that their still ancestral practices evenThey do not have real recognition.
Even more if we expand those areas that include intercultural health, we will see that different social subgroups of populations are vulnerable by adequate service. Among them we are the health status of indigenous women, especially in what corresponds to births and sexual health.
This essay seeks to deepen the disagreements between indigenous practices on childbirth and sexual health of women in Amazonian cultures and biomedical practices in health centers that are in this region. These disagreements are detected by different social actors, causing themselves to ask why they are not developing properly and is not positively impacting on the health situation of indigenous women, such as high birth rates, continuous pregnancies, gynecological problems, risksin births and the lack of use of contraceptive methods.
A systematization of information on ethnographic cases and socio-medical investigations will be developed, which will be contrasted with developments on the notion of the body, health and knowledge of healing and care. Through an analysis of experiences, perceptions and conflicts about the establishment of intercultural sexual health and the introduction of indigenous practices in biomedical care.
This exercise will help us understand that the problem surpasses the argument about an intercultural dialogue about knowledge and practical systems, but is carried out in the perception of women in both worlds, leading to a gender problem.
Thus we can see that the social and cultural changes of health accentuates the vulnerability situation of the indigenous woman of the Amazon. For this reason, as a reflection it is necessary to evaluate the agents of medical centers and indigenous actions on women’s health.
The limits of intercultural health and its impact on women’s sexual health
The presence of hospitals, medical centers and pharmaceutical medicines in the Amazon had a strong impulse for the religious missions in which it was thought that it was necessary to change the reality of indigenous peoples through a civilization of their behavior (Lobo, 1999). Then, the Peruvian State, in its policy of assimilating the Amazon area with economic purposes, installed health centers for urban population care of the main cities, which were interacting and relating to indigenous populations.
Then, problems about high fertility rates, maternal mortality, population growth, morbidity, caused more attention to these populations, in which cultural gaps accentuated marginalization towards the indigenous people. Here we will emphasize those problems that fell on the health of women, such as fertility, childbirth and sexual health.
However, Warren Heer (1999a; 19994b; 1999c) indicates, with the Shipibo case in Yarinacocha, that the presence of hospitals has not meant an improvement in the birth rate, fertility and population growth, being a failed company of theModernity, but rather exacerbated the social changes that this population of Paococha was experiencing due to the presence of missionaries (evangelicals) and the entrance to the market economy
Warren’s results were that this population had grown at a different rate in the period from 1964 to 1969, caused by the initiation of women as mothers from the age of approximately 15 years and that there is a continuity of having children in short times (1999a);Although there is a knowledge and consumption of medicinal herbs as traditional contraceptives in women, which was accompanied by prolonged sexual abstinence (1999b). The conclusion based on this ethnographic case, is that previously existed polyginia, which was as a way of acting as a fertility control per woman, which was a cultural pattern that was banished by the religious.
Thus, social practices and sexuality were changed by external factors, accentuated by the treatment of health agents and the invisibility of traditional healing practices, led to a state of vulnerability to the indigenous people.
Despite this information, medical practices in Amazonian indigenous populations continued their work marginalizing them, believing that they are carefree for hygiene, care and health. Given this fact, indigenous peoples proposed a demand for adequate and culturally contextualized attention, which their own traditional medicines and healing practices are valued.
Based on cultural justice, the proposal of intercultural health fell as a solution to these demands, generating a cultural dialogue about medical knowledge or but due to dialogue conditions.
In the case of Garzó and others (2019) in Colombia, within a case with ticuna populations in the Colombian Amazon, attention problems were detected in pregnancies, lighting, postnatal and contraceptive care,. The shortcomings are in asymmetric relationships between health centers and peoples, doctors and patients, the absence of traditional knowledge and practices in body care and the devaluation of the vision of the health of the population.
The role of the traditional medical system would provide an important social actor that would be a link between these divergences that are detected. Thus, the conceptions of body health in the indigenous Amazon correspond to a physical and moral dimension, related to the natural and social environment where they are found.
The care includes both first care, as well as actions corresponding to childbirth, fertility, medicine or traditional drugs. Everything is divided according to phases or stages of life. In each of these stages, social, cultural and ideological problems were found within the populations that hindered the correct attention or the optimal involvement of women in these intercultural health spaces
However, although intercultural health policies are still in their early stages, it is necessary to detect that it is not having much impact on the populations carried out. For this reason, the needs to create health promoters, community intercultural health nurses, among other proposals, seek effectively to respond to the need for real intercultural health of the indigenous populations of the Amazon.
Thus, it is necessary to know what are the limits of intercultural health in which the shortcomings of its application are detected, despite the various actions that are carried out for its best function state. In the case of the Bolivian Amazon, Aizemberg (2011) exposes us that the problematic situation of intercultural health in the department of Beni, Bolivia, exposing that health promoters are not working, persisting the risk of sexual health of the sexual health ofindigenous women. This is because the intentions of intercultural health hide discriminatory logic, marginalizing, segregationists based on the application of the theory of poverty culture.
The shortcomings of community health agents do not respond to a clash of traditions and customs, but to a gender obstacle. The application of these measures has not previously deepened the situation and position of women in the social contexts that are found, but has ignored the limits of women’s participation in spaces beyond the scope of the home and the power of decisionsAbout your body and sexual health.
In addition, it presents us that there is an informal support system, or socially recognized, among women with respect to sexual health, care and physical state. This being not recognized by state health agents, so not exploited for a real intercultural health application. So the situation of women, both salub and socially, is at a disadvantage, staying in an atomized or isolated position.
The body, health and care in the indigenous woman of the Amazon.
The considerations of both Western and intercultural medicine still have a unidirectional and asymmetric logic towards the knowledge and practices of indigenous women about their own state of health. So it is important to search and know which are the traditional form of acting at times and occasions to care.
For Rojas (2017), within the Matsigenka case of bass Urubamba, the value of the body in women is important, because it is in the long training process, from its birth to its first menstruation. At this time, care about food taboos such as the adoption of norms of conduct will model their presence as a future mother and wife.
During the pregnancy process and next time of childbirth, it is necessary to return to an adaptation of the body so that another, the baby, in a healthy way. So the use of myths, such as Oseroani, allows women to know that it is not good to consume tapir.
At the time of childbirth, Rojas exposes us that support networks are important, but they also function as a catalyst of emotions, because for the matsigenkas it is not good to demonstrate pain, which means emotional and social weakness, but mustcontrol your emotions. The presence of the midwife is not an indispensable requirement in the childbirth of a woman, it can even arrive after the birth, so any woman can cut the umbilical cord as the first bath of the baby.
In Belaunde’s text, he invites us to reflect on the need to study births as sociocultural phenomena related to kinship, body and rituality in the life of women. Within the Yine case in a community of Madre de Dios, the parturient woman has an agency about her own childbirth, which consists of the elaboration of knowledge about treating the body, emotions and their kinship networks.
The possibility of studying deliveries makes us bring that the vision of the need for a traditional midwife within the community is not true;While there can be cases of women who act as connoisseurs of births, the women themselves have power and agency about the event, reaching the point of having their own self-sufficiency on the body, through decisions about their sexuality, curative practices, care, rites, food taboos and worldviews.
The impact of institutional health, through hospitals, doctors and obstetricians, towards the women of the indigenous Amazon, Belaunde mentions us, includes a situation of uncertainty, extended and helpless pain. The Autonomous Force of women is annulled, because medical practices have control of the "body production" and emotions. Thus, childbirth is no longer typical of the parturient, but of the medical agent who attends.
From here it is necessary to deepen envelope. In other words, there is a horizontal dialogue between health agents with local giving, especially for this issue with women mothers.
Conclusions
The application of an intercultural approach to health services is demonstrating an inefficiency due to the problems of linking with populations. While Western medical practices means questioning and highlighting traditional practices, the logic of this contribution is still supported by asymmetric and unidirectional behavior.
As seen, the woman is stripped of her autonomy about body and health care, this being treated by someone external who takes reins of healing, experiencing a subordination. Moreover, losing that power that confers on decisions about its fertility, childbirth and sexual health cures.
Also in the practice of intercultural health, which does not first evaluate the state of subordination of women in the private sphere, being a problem for it in the access of medical care, which is in a public sphere.
Therefore, it is necessary to adapt the intercultural health application instruments in Amazonian populations to the realities of the woman’s state, thus surpassing gender barriers that still persist and value traditional practices and networks on the healing of the body of the body. This would ensure that social and cultural changes towards women are reversed to a state of full exercise of their health, even in cultural spaces that machismo is difficult to overcome.
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