Those Who Bathe Within the Anthropocene
by Maria Paula Prates
The Anthropocene is a cosmopolitical question.1 It manifests in the form of microplastics and toxicities in the flesh of people and the Earth. It is found in streams, rivers and oceans, and in the diseases caused by predatory relations with forests, such as malaria. It is more than human footprints left on the planet’s crust and in its geo-thermodynamics; it is a concern integral to different modes of existing and relating to vitalities, both human and other-than-human. It is also a question of reproductive justice.
In this piece, I present ethnographic data showing how the restricted access to Indigenous territories and their devastation are intrinsically related to the medicalization of Indigenous women’s reproductive and sexual health. “The territory is our life, our body, our spirit”: this and similar statements are found in the outcome document of the first Indigenous Women’s March2 held in Brazil, in August 2019, and assertively expresses the conception of life for these collectives.
The relationship between the body of the world and the Indigenous body-person can be described as alive. A relationship of, with, and in a lived world not separated between humanity and animals, animated and unanimated beings, but composed by a multitude of desires to allow others to live and die well. In Indigenous socialities of the South American lowlands, bodies are made with and through the vitalities of other-than-humans. Substances classified in western taxonomy as agents of animal and plant origin, along with prayers and song-dances, are active components necessary for the Indigenous person to maintain their alterity vis-à-vis so many other agencies. From the anthropologist Eduardo Viveiros de Castro (1996) we learn that humankind is a perspective rather than a species, while Anne Christine Taylor (1996) and Aparecida Vilaça (2005) teach us about unstable bodies affected by others. Each of them, in turn, has learnt from their Indigenous friends and interlocutors that one cannot be an (in)dividual in a lived world. Indigenous Mbyá collectives, inhabitants of the Pampa and Atlantic Forest biomes of Brazil’s far South, do not possess territories in the sense of ownership, but are part of them and compose with them, co-existing on a plane now in the process of being named by geology, the Anthropocene.
Among Mbyá-Guarani Indigenous women, the impossibility of accessing ancestral territories, due to their devastation, has contributed heavily to the fact that their children are ever more likely to be born in hospital contexts. Elderly women skilled in the art of providing care during childbirth, the ambojau va’e (‘those who bathe’)3, are increasingly rare. They are central persons in caring for the well-being of relatives and in passing on their knowledge. They are trained by and in embodied practice. They learn to care for other women because they learned how to do so from their mothers and grandmothers, and also when they gave birth to their own children, very often alone. They are generally people close to the expectant women. Kin relations shape care practices: the ‘midwife’ is not an institutionalized figure but a relative (Prates, 2021). These Mbyá practices are engendered in the making of bodies that differentiate genders in contraception, in the termination of unwanted pregnancies, and in the management of pain experienced during menstrual periods and childbirth. Generally speaking, the practices involved form part of a deep knowledge of other-than-human substances and vitalities. ‘The women who bathe’, ambojau va’e, are people trained over the course of their lives and recognised through the efficacy of their care, measured by the well-being of the women requiring their assistance. ‘The woman who bathes’ is above all someone who advises, a bearer of words who, on the one hand, guides and encourages the living, and on the other hand, sing-dances while she smokes the petyngua (a clay container filled with tobacco) to better receive the protection of divinities and ward off the dangers of undesired agencies.
In three research projects coordinated over the last eight years,4 I came across a high number of non-consensual episiotomies performed on the bodies of Mbyá-Guarani women that birthed in hospitals. The ‘cut,’ as the Mbyá call it, weakens them for the rest of their lives. There are many accounts from women who say they felt unable to work in the swidden after they gave birth to their children in these institutions. There are ever fewer ambojau va’e and an increasing need to seek support within the biomedical system. Once in hospital, the chance of getting ‘cut’ is high.
Episiotomies are indelible marks on the vaginas and spirits of Mbyá women, in most cases performed without their consent and without any biomedical justification, merely to ease the phase of expelling the baby. It is a difficult procedure to transform into statistical data since it is frequently absent from the medical records and, when registered, there is no way of identifying whether the woman ‘cut’ was Indigenous or, if she was, which collective she belonged to. The only means of accessing such information and turning episiotomies into numerical figures is by carrying out qualitative studies.
Through lengthy conversations based on relations of mutual trust, the ‘cuts’ have been transformed into numbers in the studies I have coordinated. This manual work aims to provide a statistical overview of what happens when Indigenous women give birth in hospitals. Over the last few years, with the help of Yva and Yva Mirim, two long-term Mbyá friends, I have participated in ‘embarrassed’ and reticent conversations, in both the Guarani-Mbyá language and Portuguese, during which I heard interlocutors let slip that they had indeed been ‘cut.’ As well as the frequent performance of episiotomies, another problem faced by Mbyá women in hospital is the impossibility of practicing the food restrictions and prescriptions needed during the period of childbirth.5 There is a virtual consensus that giving birth in the village keeps people strong and healthy. Women only give birth in hospital when there is no network of care in the village. A network of care is understood as a constant investment in bodies capable of giving birth from well before the postpartum period, not just something circumstantial and focused on the physiological process of labour.
A number of variables undoubtedly contribute to determining whether a birth occurs in hospital or in the village. In the case of the villages that I know and have worked in, the biomedical teams of the Special Secretariat for Indigenous Health (SESAI), who provide care locally, are very enthusiastic about births taking place among kin (when a woman births in the village, she is surrounded by relatives.). They provide prenatal care and guide the pregnant women, recognising their own understandings of health, but do not attempt to influence where the childbirth takes place so long as there is no medical recommendation for a hospital birth. This does not necessarily happen among other indigenous collectives and regions of Brazil.
As well as the hospital births caused by limited possibilities for Mbyá care in the villages, a large number of girls and young women are being medicated with hormonal contraceptives. In most cases they receive them through injections, available at the health posts. As the Mbyá women say, their bodies have become ‘swollen’. Some are still advised and cared for by elder women when they want to avoid becoming pregnant, which involves consuming specific teas and taking the recommended precautions. However, most women turn to hormonal contraceptives for closely connected reasons: in many circumstances they have no access to the knowledge of elder women in their kinship networks and if they do, the access to plant vitalities that once worked as contraceptives in Mbyá understanding is now limited or non-existent.
What really seems to be contributing to the use of hormonal contraceptives and the increasing tendency to give birth in hospital, according to the Guarani-Mbyá, is the ‘weakness’ (py’a kangue)6 of their territories and consequently of their bodies and spirits. “If the swiddens (kokué) are weak, then our bodies are too,” Yva told me the last time I visited her in May 2023, when she also explained to me why she was happy in Pará Roké teko’a. As well as possessing water and swiddens, six children were born in the village over the last seven years. This contrasts with Nhuundy teko’a where Yva lived previously. There, the spaces for existence are miniscule and most children are born in hospital, while girls and young adult women make frequent use of injectable contraceptives.
Being unable to grow maize, sweet potato, and manioc because of the soil conditions, for instance, is a sign of a weakening of not only the earth’s flesh, but also the flesh of the body, and the relationship between Mbyá humans and divinities. It is a lived world that needs to be strong and vibrant in order for the bodies of women to be cared for and for births to be performed among kin. By contrasting different Guarani-Mbyá territorial spaces, such as the teko’a of Pará Roké and Nhuundy, paying attention to the possibilities of habitability and the composition of vital relations, we can observe that small and devastated territories result in a higher level of body medicalization and more hospital births, which in turn leads to a greater possibility of interventions considered violent by the Mbyá.
Without strong ambojau va’e, in a biological and spiritual sense, the possibilities of giving birth in the village are also declining while the use of hormonal contraceptives is increasing. Those who bathe need to be strengthened by a kind of poã (‘forest medicines’), animal fats, song-prayers in the opy (ceremonial house), yerba mate, and tobacco. Generations are necessary to ensure the existence and strengthening of those who bathe. It is not biomedical training that makes them skilled and recognised for caring for others but a lived world, a relational apparatus combining territories, bodies, and other-than-humans. The coloniality of the Anthropocene has been embodied in the flesh of the Mbyá world.
Ana Betran, Jiangfeng Ye, Ann-Beth Moller, João Paulo Souza, Jun Zhang, “Trends and projections of caesarean section rates: global and regional estimates,” BMJ Global Health (2021): 6, e005671.
Isabelle Stengers, Cosmopolitics I. (Minneapolis: University of Minnesota Press, 2011)
MARIA PAULA PRATES is a Brazilian-Uruguayan medical anthropologist who grew up in the Pampa biome in South America and has experience in conducting ethnographic fieldwork among Indigenous peoples in the South American lowlands, mainly among the Guarani- Mbyá women of the Brazilian far South. Her current research interests are reproductive and sexual health as well as infectious diseases within the Anthropocene. She is a Research Fellow in Medical Anthropology of the Anthropocene at the UCL Department of Anthropology.
Proofreading by Rasa Kamarauskaite