Delivering Health: In Search of an Appropriate Model for Institutionalized Midwifery in Mexico

This dissertation examines the creation of a new model of Mexican midwifery education as a response to national concerns about maternal mortality. Amid these concerns, debates have emerged between midwives and the state about the best way to standardize midwifery education. In this dissertation, based on 17 months of ethnographic research with midwives, students, doctors and politicians, I describe the historical roles that midwives have played in Mexico, situate Mexican midwifery within broader trends in development and the expansion of Western biomedicine, and trace the lived experiences of Mexican midwives and their students to see how such trends impact their daily practices, experiences, and goals. My findings about midwives and their shifting fields of practice illustrate the stakes, challenges, and productive possibilities of large-scale attempts to standardize new models of medical training and care. They also refresh our understandings of what midwives do and know, and reveal how medical innovations from the margins may arise unexpectedly. By engaging critically with actors at all levels of Mexican midwifery, I reveal how claims to truth, such as in debates over best practices in women’s health care, cannot be separated from the broader socio-political contexts from which they emerge. Specifically, I argue that we must critically examine how medical practices and training develop, especially outside of the global North. My work further engages with discussions about processes of development in Latin America, arguing that we must broaden our conception of what might count as “modern,” while not forgetting the historical legacies tied to notions of modernity. Mexico’s current investment in midwifery destabilizes assumptions about the roles of indigenous, traditional and biomedical knowledge within the development paradigm. I show how both expertise and marginalized knowledge are strategically levied in light of international standards, national projects of development, and local conceptions of appropriate knowledge forms. Finally, my work contributes to debates around reproductive politics by interrogating the relationship between women’s health and national development concerns; international pressures to reduce maternal mortality in Mexico have allowed midwives, who had long been categorized as unsafe, to regain authority in the field of reproduction