Alexandra Minna Stern
Eugenics emerged in Latin America in the early 20th century on the intellectual foundations of 19th-century social Darwinism and positivism, and expanded in contexts influenced by Catholicism, nationalism, and transnational scientific exchange. Although the extent and objectives of eugenic policies, practices, and organizations varied across the region, Latin American eugenicists tended to subscribe to neo-Lamarckian principles of environmental modification, foreground puericulture or infant and maternal care, and support new techniques of human measurement associated with biotypology. Overall, eugenics in Latin America was less extreme than in Anglo and Nordic countries, rarely resulting in sanctioned policies of compulsory sterilization or euthanasia. It was an integral component of programs designed to combat infectious ailments, especially sexually transmitted diseases, and to ameliorate national health indicators. This overlap meant that eugenics sometimes was less visible as a stand-alone movement, and that its tenets were absorbed with little friction into public health and social welfare infrastructures and campaigns. At the same time, eugenic racism was expressed in calls for immigration restriction that reverberated across Latin America, most notably in the 1910s and 1920s. In retrospect, eugenics in Latin America contributed both to exclusionary policies that stigmatized certain social groups and to overarching campaigns for health and wellness that were backed by a diverse political spectrum that could include feminists, Socialists, and military leaders.
At the beginning of the 19th century, Colombian physicians thought of food as an essential factor in shaping human character and corporeality. Framed in a neo-Hippocratic system, health and racial differences were related not only to climate but also to the connection between food qualities and humoral fluids. For example, it was believed that the tendency to eat cold and moist food, as well as greasy substances, was one of the reasons why people in warm regions of Colombia were choleric, phlegmatic, and indolent. By midcentury, it was further argued that each regional type—a local racialized categorization based on geographic determinism—had certain diet habits and physiological characteristics that explained its character (sober, obedient, lazy, industrious, etc.), and that made this type “naturally” suitable for different kinds of work. During this period, the working population’s diet was not perceived to be a social problem requiring regulation, at least not by the government. In the midst of liberal reforms, the political elites were more focused on the economic and genetic integration (“whitening”) of highland Indians, and to a lesser extent blacks, than on producing a supposed “better race” through nourishment.
But by the late 19th and the early 20th centuries, however, a new cultural framework that crossed the boundaries of thermodynamics, political economy, experimental physiology, and eugenics had begun to emerge in Colombia, converging in the social problem of nutrition. Centered on the analogy of the human body as a heat engine that transforms energy, local scientists began to conduct surveys of the eating habits of the “working classes,” analyses of the chemical and caloric composition of their foods, and studies on the metabolic characteristics of different regional populations. The results of these investigations were used to push the government to “restore the energies” of an impoverished population that was consistently thought to be weak and racially inferior, but capable of physiological and hereditable improvement. The cry of conservative elites for political and moral “regeneration” at the turn of the century also had a biological component—the optimization of the human motor. In the 1920s and 1930s, several campaigns and institutions were created for this social engineering, aimed at producing a modern, healthy, and industrious citizen. These campaigns gained special political force after the Liberal Party returned to power in 1930.
Today, the death of women during pregnancy, childbirth or postpartum is considered simultaneously a public health, social inequality, and gender discrimination problem. In Mexico, approximately one thousand women die each year during pregnancy, childbirth, postpartum or from an unsafe abortion, experiencing a premature and sudden death in the midst of their most productive years, often with lasting consequences for their families and surviving children. As elsewhere, the great majority of these deaths would not have occurred if women had had prompt and unlimited access to quality emergency obstetric care, as well as easy access to contraceptives to prevent unwanted pregnancies. Most deaths are related to the substandard quality of available maternal healthcare services; services that are provided for free to most Mexican women in an overly saturated and underfunded public health system that also tends to overmedicalize and pathologize normal births. Their prematurity and abruptness, their occurrence in the process of giving life, the fact that these deaths exclusively affect women, and their avoidable nature make maternal mortality unacceptable in today’s social, political, and ethical arenas.
From an historical perspective, deaths in childbirth were much more common in past centuries than today; these deaths were considered inevitable and were accepted as natural occurrences until the late 19th century. However, surrounding rituals, the meaning attached to these deaths, related notions of womanhood and motherhood, and practices to prevent or avoid them, underwent changes according to broader sociocultural, political and religious transformations from Pre-Hispanic times to the 20th century.
As elsewhere, in Mexico maternal deaths declined considerably in the 1930s–1950s with the discovery of penicillin and the concomitant decline of puerperal fever; they reached a plateau in the 1960s and 1970s and began to slowly decline again in the 1980s–1990s with an even steeper decrease after the signature of the United Nations (UN) Millennium Development Goals in the year 2000; time when the reduction of maternal mortality became one of eight high-priority global public policy objectives, closely monitored by UN bodies.
Maternal deaths are a reflection of ingrained multiple social inequalities that characterize Mexican society at large; poor, rural, marginalized and Indigenous pregnant women face a 2–10 times higher risk of dying than the rest of Mexican women, because their access to contraception and to prompt and high quality obstetric emergency care is more limited. Today, research in the field of maternal mortality etiology, measurement and reduction includes the call for women-centered respectful maternal care, the elimination of discrimination in the provision of obstetric services and the application of a human rights perspective to health policies, programs, and care.
Nicole L. Pacino
During the pre-Columbian and colonial periods, Andean cosmological understandings shaped indigenous approaches to maternal health. Women typically gave birth at home with the assistance of a midwife (also called a partera or comadrona in Spanish). Birthing and post-partum care relied on local herbal remedies and followed specific social rituals. Women drank teas derived from anise or coca during the labor process, gave birth in a squatting position (toward Mother Earth, or Pachamama), and drank sheep soup after labor to replenish strength and warm the body. Rooms were kept dark because the common perception was that bright light injured newborn babies’ eyes. After labor, families buried or otherwise disposed of the placenta to keep the baby and mother healthy and facilitate lactation, as per Andean tradition.
Changes in maternal health rituals began in the 18th century, as colonial rule became more consolidated. The rise of a distinct medical profession and government interest in population growth gradually shifted responsibility for maternal health from the Catholic Church and charitable organizations to the state. Throughout the 19th and 20th centuries, the growing power and authority of the state and the medical profession led doctors and urban-based reformers to attempt to change long-standing Andean birthing practices, which they considered archaic and unsanitary. These reforms emerged from a desire to reduce infant mortality rates and to replace traditional healers with medical professionals who were trained, licensed, and regulated by the state. As reformers looked to replace Andean maternal health and healing practices with new scientific understandings of the female body and birthing process, they also worked to discredit and displace midwives’ knowledge and practices. In particular, they encouraged women to give birth in newly constructed hospitals and to seek the guidance of medical professionals, like obstetricians. However, these reforms met with limited success. In the Andes today, midwives still attend to roughly 50 percent of all births, and in some remote areas, the figure is as high as 90 percent. It is also more common today to see the merging of biomedical and ritual practices to increase women’s access to and acceptance of health services and to reduce overall mortality rates.
The prevention of communicable diseases, the containment of epidemic disorders, and the design of programs and the implementation of public health policies went through important transformations in Mexico, as in other Latin American nations, between the final decades of the 19th century and first half of the 20th century. During that period not only did the advances in medical science make possible the identification and containment of numerous contagious diseases; it was also a time when the consolidation of formal medical institutions and their interaction with both national and international actors contributed to shape the definitions and solutions of public health problems. Disease prevention strategies were influenced by medical, scientific, and technical innovations and by the political values and commitments of the period, and Mexico experienced profound and far-reaching political, economic, and social transformations: the apogee, crisis, and downfall of the long Porfirio Díaz regime (1876–1910), the armed phase of the Mexican Revolution (1910–1920), and the period of national reconstruction (1920–1940). Thus, during the period under consideration, and alongside the consolidation of an official medical apparatus as an integral part of public power, the promotion of public health became a crucial element to reinforce the political unification and the social and economic strength of the country.