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Reflections on “Cr ossing Bor der s in Bir thing Pr actices”: Hmong in Nor ther n Thailand and Saint Paul, Minnesota
By
Kathleen A. Culhane-Per a, MD MA
Hmong Studies Jour nal, 15(2): 1-8.
Abstr act
As a family physician and medical anthr opologist, I have int er acted w ith pr egnant w omen and their families in Minnesota since 1983 and in one Hmong village in Nor ther n Thailand since 1988. In the pr evious ar ticle I descr ibe our r ecent r esear ch about Hmong families’ pr egnancy and bir th pr actices in Thailand. In this ar ticle, I r eflect upon the differ ences in Minnesota and Thailand, consider w hat socio-cultur al factor s may be influencing people’s exper iences, and speculate that Minnesota Hmong exper iences could be helpful to Thai Hmong.
Keywor ds: Hmong Cultur e and Childbir th, Hmong in Thailand
Reflection
Hmong in Nor ther n Thailand have “cr ossed bor der s” about bir th pr actices slow ly. Dur ing the last sever al decades, the bor der s w er e br ought to them, as West er n obstetr ical pr actices ar r ived in the countr y. Over time, Hmong families have faced the differ ences betw een tr aditional Hmong bir thing pr actices and Thai biomedical obstetr ical syst ems, have made car e choices for each pr egnancy, and have been caught in the contest for supr emacy of author itative know ledge. (See study in one Hmong village by Culhane-Per a et al 2014, this volume.) In contr ast, Hmong in the diaspor a cr ossed bor der s quickly w hen they lived in r efugee camps, and w er e r e-settled into Wester n countr ies such as the United States (US) and Austr alia, immediately facing a hegemony of biomedical bir th pr actices. Thr ough these immer sions, Hmong families abr uptly exper ienced the differ ences betw een their cultur al pr actices of pr egnancy and bir th (Cha 2003; Symonds 2005) and the
biomedical concepts and pr actices of antenatal car e, hospital bir ths, and postpar tum car e, w ith the attendant hier ar chical system of contr ol based on biomedical
know ledge, technology, and sur gical pr actices (Bengiamin et al 2011; Br uce and Xiong 2003; Er w in 2005; Faller 1987; Halvor sen 2012; Jambunathan and Stew ar t 1995; Mor r ow 1986; Nibbs 2010; Potter and Whir en. 1982; Rice 1997, 1999, 2000a, 2000b; Spr ing et al 1995).
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lithotomy positions dur ing bir th, post-deliver y uter ine massage, and C-sections), w hile holding onto tr aditional bir thing pr actices (i.e., exter nal cephalic ver sion by Hmong elder s, squatting position, and post-par tum pr ohibitions) (Br uce and Xiong 2003; Er w in 2005; Halvor sen 2012; Jambunathan and Stew ar t 1995; Mor r ow 1986; Rice 1997, 1999, 2000a, 2000b; Potter and Whir en 1982; Spr ing et al 1995). The ensuing conflicts w er e based on differ ences in author itative know ledge, and w er e contests betw een tr aditional social, cultur al, physical, and spir itual aspect s of bir th and the biomedical focus on physical aspects of bir th. Families’ exper iences in the r efugee camps and their concur r ent exper iences w ith the medical system about disease management that included conflicts and disagr eements w ith biomedical per sonnel (Cha 2003; Culhane-Per a et al 2003; Kir ton 1985) w er e also based on similar differ ences in author itative know ledge that ar e gr ounded in lar ger social systems of pow er and contr ol.
Over the past four decades in Minnesota, both the medical system and the Hmong have under gone changes that have lessened these conflicts. The Amer ican medical system has r esponded to movements that advocate for empow er ing w omen dur ing bir th (MacDonald 2011; Matthew s and Zadak 1991; Gaskin 1997 and 2003),
r especting cultur al differ ences (USDHHS 2001 and 2012), focusing on patients’ pr efer ences (Epst ein and Str eet 2011; Stew ar t et al 2013), and pr oviding w omen-center ed car e (Culhane-Per a and Rothenber g 2010; Shields and Candib 2010). These changes have meant that doctor s, nur ses, and medical institutions have become mor e w illing to adjust pr ocesses and pr ocedur es to w omen and families’ desir es. (Nonetheless, w omen and w omen’s advocates w ant to see additional changes—see ACNM 2013 and Hadjigeor giou et al 2012).
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Both Hmong in Minnesota and Hmong in Nor ther n Thailand have exper ienced similar pr essur es and conflicts that have influenced their affor ding author itative know ledge to biomedicine r ather than tr aditional bir thing. Thr ough societal systems of education, gover nance, politics, r eligion, as w ell as medicine, both ar e being socialized into citizens of their r espective societies. Both ar e being instr ucted to defer to major ity societal w ays about biomedical know ledge for all health issues, and r elinquish their connections w ith tr aditional healing knowledge and skills. Both ar e being pr essur ed specifically about pr egnancy and bir th, to confer aut hor itative know ledge on biomedical systems and tur n aw ay fr om Hmong tr aditional bir th know ledge.
Differ ences in societal contexts betw een Minnesota and Thailand could be contr ibuting to differ ent Hmong exper iences (and each of these gener alizations about major societal differ ences is not absolute). Cer tainly, the tr ansition for Hmong in Minnesota star ted ear lier , w as quicker , and w as mor e compr ehensive,
encompassed all aspect s of life, and now the major ity of the r epr oductive gener ation w as bor n and r aised in the US and have had no or limited per sonal exposur es to tr aditional home bir ths. The natur e of the education systems is differ ent, w ith the Thai system emphasizing memor ization and r espect for teacher s and the Amer ican system encour aging pr oblem solving and questioning author ity. The natur e of social class is differ ent. Thailand has a mor e for mal social class str uctur e, w ith highland ethnic gr oups gener ally at the bottom of the hier ar chical class str uctur e. The
Amer ican social system has a mor e flexible soci al hier ar chy classes, such that people may feel less vulner able than they do in Thailand, although Hmong in St. Paul still expr ess their exper iences of discr imination. The emphasis on r eligious author ity is differ ent, w ith Thailand teaching r espect for Buddhist monks in schools, and the US having a histor y of toler ating r eligious differ ences. While both biomedical systems ar e hier ar chical and Hmong ar e minor ities in both societies, this confluence of societal factor s may r ender Hmong in Thailand to be less pow er ful in the healthcar e ar ena than Hmong in Minnesota.
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8 About the Author :
Dr . Kathie Culhane-Per a is a family physician w ith a master ’s degr ee in
anthr opology. She has w or ked w ith the Hmong community inter mittently in Chiang Mai Thailand since 1988 and in Saint Paul Minnesota since 1983, cur r ently at West Side Community Health Ser vices.
Cor r esponding author : Kathleen A. Culhane-Per a
