When and for whom are they appropriate?
Mark
and Mimi Nichter
Anthropology and International Health, Asian Case
studies
General overview
In this chapter Nichter and Nichter discuss the rhetoric about the
non-adoption of modern contraceptive methods in Sri Lanka and also the
popular interpretations of how they work and for whom they are appropriate.
In Sri Lanka the use of modern family planning methods is relatively low,
in spite of the fact that a majority of women express interest in
controlling their family size and are highly educated. Even aggressive
family planning campaigns did not improve the use of these methods. Women
opt for traditional birth control practices. Even temporary modern methods
have not been more widely adopted.
The main reason for the non-adoption of modern contraceptives are the rumors
about side effects which are circulating in society. And one should take into consideration that these
rumors appeal to the public because they resonate with some already
existing tacit knowledge about the body - knowledge embedded in and
reproduced through popular health practices and discourse about health.This popular health knowledge runs counter to the knowledge propagated by biomedicine and health
authorities, giving rumors the connotation of resistance and resistance
undermines program success.
When using the term side effects there is a need to differentiate between 'negative primary effect' and 'unintended
side effects'. Sinhalese informants interpret side effects in terms of
inherent toxicity and heatiness of medical fixes, the effects of which are
undesirable and emergent over time. Traditinal herbal medicine is on the
other hand perceived as rendering control and balance.
A pervasive notion among informants was that the pill works because of its heating
effect in the body. This heat caused dillution of dhatu, so that it was no
longer strong enough to create a fetus.It also caused long-term dryness which leads to decaying and
deterioration of the womb. Even from temporary methods, promoted by health educators, many Sinhalese
believe they caused permanent damage to the body (drying of the womb), and
are in effect, a permanent method. Nichter and Nichter recommend that when
looking at the symptoms of pill use, one should consider the deep seated
cultural meanings evoked by body signs and symptoms which marshall emotive
response as well as call attention to the status of social relationships
and moral idendity. There also needs to be a consideration of what the
afflicted might be trying to accomplish by communicating to others
feelings of weakness and vulnerability: the symptoms can become empowering
, being a means to articulate problems and negotiate sexual relations in relation to health concerns. Oral
contraceptives are also believed to be possibly harmfull to lactating
children, because they heat the breastmilk, diminishing the amount and
transmitting the harmfull heatiness to the child. Oral contracepts are also seen as self-control measures for
abortion.
Sterilization and IUDs are believed to be unreliable. Sterilization of females is the most
popular method. There were several ideas as to how this female
sterilization works, and there were perceptions about not tight enough
stitches, slipping of the stitches and spontaneous untying after seven
years. Male sterilization was not only seen as affecting a man's semen but
also as weaking his vigor, vitality, and his life energy.IUDs were unreliable because not only were they thought to be
circulating in the body with the risk of perforating vital organs, but
also were they thought to fall out, if the womb was wide. The main health
concerns with IUDs were the bloodloss and it causing cancer.
Condoms are
associated with illicit sex and because of this the secrecy aspect was
very important to the use of this method. The side effects are linked to
friction and again heatiness of the rubber, causing interference with the
natural flow and exchange of dhatu between man and woman. Both sexes are
believed to loose dhatu during sex, and the dhatu economic notions are
very important reasons for non-use of these condoms.
Different bodies
are believed to respond differently to modern methods, and therefore
certain methods that are appropriate for some are inappropriate for others.
Important was that the user should have the capacity and possibility to
counterbalance the side effects of the methods, and to consume cooling and
strengthening foods. Decisions whether or not to adopt various family
planning methods/practices entailed consideration of social and economic
constraints as well as perceptions of health risk and contraception is
associated with increased vulnerability to ill health.
Rumors are very important concepts in this society with a Buddhist ideology which prescribes moderation as an ideal. Anything in excess is
believed to lead to unhappiness and ultimately to suffering. Controle of
one's sexulatiy is a source of respect and social status: hence the
secrecy about method use.
They conclude
that KAP surveys are not the most accurate research methods. Research need
to shift attention from dispelling rumors about contraception to
communication about the conceptual systems of the informants. There needs
to be a shift in thinking about contraception from the need to fit people
to technology to the need to fit technology to people.
Points for discussion
There needs to be a shift in thinking about contraception from the need to fit
people to technology to the need to fit technology to people. Shouldn't
there be a need to inform people properly first?
From:
Furhter readings:
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