Birth In A Pacific Island Society

European principles of giving birth were first introduced into the Pacific by missionaries in the early nineteenth century as part of their belief in civilising the local population. Formal medical practices were not introduced until some forty years later; then they were based only in the urban centres, almost unreachable for many Fijian women from their villages. So birth and reproduction have continued to be handled by local mid-wives in the community. The current calls for greater development of Primary Health Care are based largely on the need to bring modern birthing services to the women, rather than expecting the women to travel vast distances over land and water.

Those missionary wives attempted to introduce new principles of hygiene, aseptic conditions for birthing, and general hygienic household practices. But as Thomas, a missionary husband, remarked, the Fijian women were more successful at raising their children than many of the missionary families. Fijian women commented to him in sorrow that so many European babies were lost, and their mothers suffered, with a number such as Mrs. Cargill, dying in child-birth. The Fijian women could not understand this. If their medicine and their God was so good, how was it that these white women lost so many of the children they bore. David Cargill was left with four of the seven children his wife bore, after his wife died during labour giving birth to the seventh. Fijian women were more successful in their own child birth practices, though they too lost some babies and mothers.

Some of the current proclaimants of the need to limit family sizes in developing countries might argue they were too successful. UNFPA and other organizations are now trying to teach family planning, birth control, or child spacing (depending on the approved jargon) to reduce the population growth rate from 4.8% average across Pacific countries, and to reduce the total fertility rate from 5.6 to 3.3. But as several recent papers have shown, the rates of usage of contraceptive practices are low ranging between 7% and 46% of each island population. The question is do we fully understand this paradox of successful 'primitive' birthing procedures?

I offer you a glimpse of birth on a remote atoll in the Marshall Islands in the mid Pacific, based on my own observations in l968, and another in l993. The official total population of the Marshall Islands in l994 was 54,700, compared to l8,925 in l969. The annual population growth over the last two census periods l980-88-94 remains at 4.2 per cent. Namu, the atoll discussed here, has a population today of around 1100 (very mobile) compared to a census count of 567 in l969. Sixty per cent of the total population of the Marshalls lives in the District Centres of Majuro and Ebeye.

The mother, a classificatory sister, put on a lot of weight during the pregnancy, her seventh. She weighed approximately 300 pounds (but see my arguments re large body size in The Social Aspects of Obesity). When her waters broke all the women of the village gathered in and around a thatch hut that had been specially built for the event. The men gathered on the veranda of a wooden house some 500 yards away, drinking coffee, talking and laughing. The health aide, male, sat with those men, though he did place some surgical scissors in the thatch wall early in the labour. We women sat with Jera in the hut, urging her to kate yuk, press hard, push, and later each holding an arm and her thighs as the baby began to descend. Three local mid-wives had been massaging her stomach from time to time and encouraging her that the baby was coming.

This woman was lying on three pandanus mats on the floor; there was no other 'furniture' in this hut. At some stage during the labour her husband, Lepton, came in and broke a raw egg into her open mouth, after she had cried out. Marshallese don't eat eggs, so this was explained to me as a more symbolic gesture, to ease the baby's head through the passage. Marshallese are also not expected to cry out in pain. We discussed the issue of pain later, and I was assured her cries were just part of her efforts to bring the baby into the world. He, for it was a male baby, came into the world crying lustily, a beautiful boy weighing some l0 pounds, I would guess (there were no scales to weigh him). After the mid-wife cut the cord, he was placed in my arms, wrapped in a couple of clean old dresses, while the mother lay to be soothed and congratulated by the other women.

The baby was not allowed to suckle for several hours until the colostrum had been expressed. Marshallese (and other Pacific island people) believe it is harmful to the child. The mother was removed next day to another small hut specially built where she stayed for a month. There she expressed the after-birth, again with the help of the local mid-wives, and had to squat over fires twice a day to 'dry up the blood'. Her sisters attended her there, feeding her, washing her and taking the baby in and out to be fed whenever he asked. She had copious milk supply. He grew rapidly and was weaned, partially at about l0 months along with three other babies of the same age in that household (it consisted of some 72 members).

Weaning consisted of keeping the babies in the birthing house away from their mothers, but in the care of an older aunt. During the day they were fed rice mixed with sweetened tea, but also suckled, as much for the mother's comfort as also for the comfort of the child. Some women still continue to allow a child to suckle at four or more years of age, and have copious supplies of milk in spite of the poor diet of their mothers. By the time I left in l969 Leki was up and toddling around, a very strong child. Today he has five children of his own.

Each newborn child is welcomed and loved by the household members, her or his extended family, but it is not given a name nor does it become formally part of the community until a special party, kemeem, has been held one year after the birth. Then the child is the centrepiece and gifts of mats and food are exchanged between various sectors of the extended family and the community. Then the child becomes a member of the society, not before. This can be seen as a social procedure recognizing that the newcomer has survived the difficulties of the first year, and is likely to be a full-fledged member of that society

These same procedures are in practice today in that same community. In l993 I arrived back on the atoll to learn of a new baby born two weeks previously. That child was born to a mother who was under l4 years of age, and her partner was about l5. The mother had had only one menstruation before she became pregnant, and had no breasts, or breastmilk with which to feed the baby. She was living in the birthing hut, visited frequently by the father of the child who was holding it when I first met them. The child might have weighed five pounds, but was wizzen and wrinkled, a far cry from the big healthy boy I had held some 20 years earlier. This newborn died at five weeks, mainly of starvation. The mother and the father grieved a little, but the rest of the family buried it, but were not grieving. As I was told, "She is young, she will have plenty more".

The questions that these birthing practices raise are conundrums if seen from a medical point of view. The women are bearing numerous children under conditions that would be clinically described as less than desirable. Yet these women have born, and continue to bear children under such conditions, and both survive. There is little intervention by western medical practices because this community is too far away for western practices to reach them.

Should proper birthing facilities be made available on every atoll, with a properly qualified attendant to tend the mother and child? Where will the money come from to provide such facilities? Are they that necessary if women are successfully carrying their babies to term and raising them past the crucial first birthday? Will medical intervention, possibly through provision of Primary Health Care, increase the size of this already large population by enabling more babies and mothers to survive? Do we fully consider non-western birth practices when discussing health practices generally? What does the medicalization of health contribute to birth procedures outside western society?