Childbirth and Nutrition in Rural Malaysia: A Book Review

Introduction to Carol Laderman and Medical Anthropology

Anthropology, according to the Merriam-Webster dictionary, is "the science of human beings" — in particular, "the study of human beings in relation to distribution, origin, classification, and relationship of races, physical character, environmental and social relations, and culture."

In reading and analyzing Wives and Midwives: Childbirth and Nutrition in Rural Malaysia by Carol Laderman, it is important to recognize that she is far more than simply an author or journalist writing about interesting cultural subjects. She is the former chair of an Anthropology Department and co-director of an M.A. Program in Applied and Urban Anthropology; she has served as a professor at Yale and Fordham Universities; she has received fellowships from the Guggenheim and Rockefeller foundations; and she has lectured on her specialties — medical anthropology, nutrition, reproduction, and the sex roles of indigenous cultures in Asia — in India, Japan, England, Canada, Australia, Norway, and Finland.

Summary of Wives and Midwives

Medical anthropology, which combines the disciplines of physical anthropology, ethnography, linguistics, and archaeology, presents a "picture of the human condition in the round," Laderman writes in her Introduction. Medical anthropology can also be employed to try to understand "the workings of a culture." Indeed, the way a culture functions in one part of the world sheds light on how cultures work in all corners of the world — which is the principal reason for anthropological study.

As for the purpose behind her research and her book, Laderman writes (p. 7) that she intended to focus on the diet and nutrition of women following childbirth, but needed to know whether "the diet during pregnancy varied from the non-pregnant diet" in order to understand the changes that take place "during the puerperium" — the period between when a woman gives birth and when her uterus returns to its normal size.

Among the important anthropological issues Laderman addresses in this book are: (1) cultural adaptation — how cultural traits and the "successful interaction" between a people and their environment provide information for anthropologists; (2) the "relationship between belief and behavior" in the culture being studied — that is, how people's standards and "ideologies" are "manipulated" to achieve "valued ends"; and (3) how humans are affected in their reproductive and daily living dynamics by their environment.

The author describes the environment of the Merchang community of Malaysia (Muslim in faith) in the state of Trengganu (p. 10): a tropical climate with temperatures averaging around 85 degrees on most days; abundant water resources (seashore, river, and swamp offering plentiful fishing); "both sandy and rich soil"; primary and secondary forest; and houses built on stilts two to seven feet from the ground. These elevated structures prevent flooding during the monsoon season, permit the circulation of air during hot weather, give children a place to play, and allow chickens to scurry about beneath.

Laderman takes great pains to fully describe the kinds of fish, vegetables, and other foods eaten by the Merchang people, as well as the "important rites of passage — circumcision and childbirth — that involve both ritual and food avoidances" (p. 66). Throughout the book, she traces the connection between what the Merchang eat and avoid, and how their beliefs — sometimes supernatural and magic-based — guide their daily living patterns.

Pregnancy is a time when Merchang women act on some of their cultural beliefs. For example, some women throw away the vitamins given to them by the Malaysian government's midwife clinic; "their bitter taste may be an indication of their 'heat' (not literal heat, but that it affects the body with a bitter taste) and their potency may cause the baby to grow so large that he tears the birth canal" during delivery (p. 90).

Another subject Laderman explores in considerable depth is midwifery — the training of midwives and their importance to the community. She also devotes substantial attention to the period leading up to childbirth, the birth itself, the role of the shaman (known as the bomoh), and the postpartum period.

Women's Roles, Marriage, and Childbirth in Merchang Culture

A central concern of Laderman's book is the role of women in Merchang society, which is pivotal to understanding the childbirth and nutrition issues she documents. Beyond bearing and nursing children, Malay women in Merchang carry an enormous burden of manual labor (p. 11). They tend wood-burning stoves, scrub dishes with sand and cold water, draw and boil well water for storage, scrub floors, burn garbage, cook meals, and "fuss over" their husbands when they return home from daily migratory labor.

In addition, women spend part of each day cultivating fields and tapping rubber. As in many societies, they earn less than men — a typical day's pay for men is M$5.00, while a woman receives M$3.50 for the same work. Women are so central to keeping the family functioning that "many girls are kept at home after finishing six years of elementary school rather than being allowed to join their brothers in junior high."

"Three-fourths" of girls in this culture are married by age 16, and "pregnancy soon follows." Regarding sexual values, "even the appearance of illicit sex is a criminal offence" (p. 15). When an unmarried Muslim couple is found in a "secluded place" — the offence known as khalwat, or "close proximity" — they are fined severely, serve jail sentences, and their names are published in the newspaper. At the same time, men are permitted to take two or more wives (p. 19). One bomoh told Laderman that he "never committed the serious sin of sleeping with women to whom he was not married." If a man desired another woman, "he married" her rather than violate the social rules against illicit sex.

It is notable that if a woman in labor has broken community rules about her role during pregnancy — or has disobeyed her husband or "attempted to dominate" him — "she may find it hard to deliver her baby" (p. 151). Even having thought about being unfaithful could complicate her delivery. To restore order in such cases, the midwife may instruct the husband "to step over his wife's supine body three times." This act, Laderman observes, "graphically illustrates which sex must be on top and which must be in danger of being trodden underfoot" — a symbolic gesture intended to ensure a successful birth.

Furthermore, if the woman is believed to have had carnal thoughts about a man other than her husband during pregnancy, she might be required to drink water from a cup into which her husband has "dipped his penis." This ritual is meant to "reestablish" the husband's "dominance" and may be thought to ease delivery. Laderman notes, with some irony, that how anyone other than the pregnant woman herself would know whether she had entertained such thoughts is not explained.