The Politics of Sobreparto: Beyond the Medical Dimensions of a Postpartum Condition

Karolina Kuberska

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Migrant indigenous Andean women living in the lowland Bolivian city of Santa Cruz de la Sierra often mention sobreparto (“following birth”) among the dangerous consequences of pregnancy. This condition occurs after delivery and manifests with cold chills, fever, and general weakness. If it’s left untreated, it can even lead to death. Some of the most frequently mentioned causes are everyday domestic activities such as sweeping the floor or taking a cold shower. Another family member, friend, or neighbor usually diagnoses the condition, and the treatment includes drinking rosemary infusions and massaging the body with animal fat.

Another feature that many people I spoke to during my ethnographic fieldwork in Santa Cruz agree on is that biomedical doctors do not know how to cure sobreparto. What is this curious condition and what can it tell us about those who suffer from it?

Bolivia and the Politics of its Medical Traditions

First, let’s take a step back and look at the history of the medical traditions landscape of the South American region that now encompasses the Plurinational State of Bolivia. At the time of Spanish colonization in the early sixteenth century, it was home to over thirty indigenous groups with their own medical traditions, including the Incan empire with its practice of advanced surgical techniques.¹ While Spanish colonizers brought Western medical knowledge, it never overtook local insight into health and illness.

Of course, western medicine was not very effective to begin with; treatments such as bloodletting produced rather limited results. Western medicine also was based on often fundamentally different understandings of how the body works. As we know, Western medical knowledge grew into today’s scientific biomedical tradition, whose efficacy in handling certain medical issues has undeniably altered all of our lives. While its prevalence and accessibility in Bolivia has increased in recent years, local medical traditions have nonetheless maintained their place in the Bolivian medical landscape, offering treatments for a variety of conditions, including those, like sobreparto, that biomedical categories fail to understand.

This historical tradition of medical pluralism is written into current law. The 2009 Bolivian constitution officially states that “[t]he health system is unitary and includes traditional medicine of the nations and the rural native indigenous peoples,” recognizing traditional medicine as equal to biomedicine. The state thus regulates and monitors the traditional medicine “health system.”

In practice, the state’s strategy of including traditional medicine within mainstream health services causes a variety of problems. For instance, various local medical systems have been subsumed under a rather simplified — if not reductive — label of “traditional medicine.” At the same time, this official recognition of non-biomedical healing traditions means that there is available funding for certain traditional medical practices, most notably the practice of traditional midwifery in highland rural areas.²

But Bolivia is not just highlands, even though approximately 70% of the population live in mountainous areas.³ The heart of eastern, lowland Bolivia beats in Santa Cruz de la Sierra, a city that aspires to be modern and cosmopolitan. The city’s population grew thirty-fold in less than 70 years, from about 50,000 in 1960 to over 1.5 million now.⁴ Indigenous Andean migrants (including second and third generation migrants) comprise a large portion of that population — most estimates place their number between 30 to 50%.⁵

Despite being a sizeable minority, these migrants’ reputations are ambivalent at best; local Santa Cruz inhabitants often describe them as hard working but dirty, money-savvy but unable to enjoy life, keeping to themselves but seen everywhere. In short, unlike the locals, Andean migrants who live in the lowland city of Santa Cruz brought with them not just their ways of living, but also their ways of thinking and healing. Half of them are women; women who get pregnant, give birth, and sometimes suffer the consequences. Almost all of these women give birth in Santa Cruz’s biomedical hospitals.

Sobreparto, a Strange and Dangerous Postpartum Condition

When asked about possible dangers of pregnancy and childbirth, indigenous Andean migrant women in Santa Cruz de la Sierra often point to sobreparto. It occurs after giving birth, sometimes almost immediately and sometimes after weeks or even months. Cold sweat and chills, fever, general weakness, terrible headaches — these symptoms are enough to render a woman virtually unable to care for her newborn baby.⁶ People say that a woman can fall ill with sobreparto as a result of sweeping, taking a cold shower, doing laundry by hand, cooking, and sitting outside — in other words, causes that involve exposing the postpartum body to excessive cold, heat, or wind.

Sobreparto has to do with indigenous Andean conceptions that view the body as a balance between symbolic notions of hot and cold as well as dry and wet. What keeps the body in balance is not only appropriate diet and body care by wearing appropriate clothing but also maintaining good relationships with other people in the community as well as with the land where one lives.⁷

Almost every story of sobreparto I heard started in the same way: I was alone, I was on my own, there was no one to help me. Then, inevitably, the woman would do something she knew she was not supposed to do — she washed the clothes, or cooked, or cleaned — and then she would become unwell. Someone, a friend, a neighbor, a relative, would come by, diagnose the condition as sobreparto and arrange the remedy: massaging the body with fat and preparing hot infusions, usually with rosemary, for the woman to drink. But these persons did more than that — they also kept the woman company, helped out with the baby, and made sure that the woman knew she was not completely alone.

While I heard stories of sobreparto that ended with the death of the woman, what people mentioned much more often was that doctors in hospitals do not know how to cure it. Biomedical doctors I interviewed suggested that sobreparto might be diagnosed as postpartum infection although none of them were able to explain why it could be cured with fat massages and rosemary infusions rather than antibiotics.

There are many fascinating aspects of sobreparto, but let me focus on a particular one here: only indigenous Andean migrant women (including second and third generation migrants) fall ill with sobreparto. In the modern city of Santa Cruz, this makes them stand out as outsiders who still embrace traditional ways of thinking instead of adopting the modern biomedical model.

But from the point of view of the Bolivian constitution, which recognizes “traditional medicine” as a part of the health system and which enshrines the rights of “indigenous rural people” (a category to which Andean migrants would belong) on innumerable occasions, women who seek traditional remedies for traditional conditions are, in fact, embodying Bolivian citizenship. That is to say, what makes indigenous Andean migrant women stand out as “different” in the more Hispanicized and Western city of Santa Cruz, their traditional illnesses and healing methods, is what actually makes them Bolivian par excellence.

Contemporary Bolivian citizenship embraces indigeneity not just as a part of the country’s history, but also as an important part of its cultural diversity, and women who suffer from sobreparto enact this idea in their bodies. While it is impossible to argue that becoming ill with sobreparto is a political statement, in the Bolivian context there is a political dimension to this postpartum condition.

Notes

1. Marcos Cueto and Steven Palmer, Medicine and Public Health in Latin America (New York: Cambridge University Press, 2015). Return to text.
2. Paola Flores, “Bolivia suma a parteras a lucha contra mortalidad maternal,” Associated Press, August 3, 2017. Return to text.
3. INE 2012, “Población por Sexo y Grupo de Edad,” accessed January 21, 2018. Return to text.
4. Mauricio Manzoni, “Santa Cruz de la Sierra, una ciudad que busca su espacio,” Ciudades 9(2005): 135-60; INE, “1,7 millones de habitantes existirán en Santa Cruz de la Sierra en 2020,” accessed January 21, 2018. Return to text.
5. Manzoni, “Santa Cruz de la Sierra.” Return to text.
6. See Carmen Beatríz Loza and Wálter Álvarez, Sobreparto de la mujer indígena, saberes y prácticas para reducir la muerte materna (La Paz, Bolivia: INBOMETRAKA, 2011). Return to text.
7. See Ann Miles and Thomas Leatherman, “Perspectives on Medical Anthropology in the Andes,” in Joan D. Koss-Chioino, Thomas Leatherman and Christine Greenway, eds., Medical Pluralism in the Andes (New York: Routledge, 2003), 3-15. Return to text.

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Featured image caption: Awayu. (Courtesy Shawn Harquail/Flickr)