I absolutely cannot believe it has been a year since I was interning with the Central Himalayan Rural Action Group in Uttarakhand, India as part of my CASI experience. And a year later, instead of being in the beautiful, peaceful foothills of the Himalayas, I am now living in the bustling, cosmopolitan city of Shanghai, China. In lieu of daal and chapatis, I am feasting on xiaolongbao (Shanghai dumplings), zongzi (sticky rice and filling, usually pork or red bean, wrapped with reed leaves – eaten in time for the Dragon Boat Festival which is June 20th) and other Chinese food that I have grown up with. Rather than hopelessly trying to figure out what people are saying in Hindi or Kumaoni, I can actually communicate with locals in Mandarin (yay!). Instead of living with other interns at the NGO and hiking up mountain paths, I am living alone and dodging unforgiving cars and motor-scooters when I walk to Jiading Central Hospital, where I am conducting my thesis research.

Xiao long bao, shao mai, and pumpkin cakes…because food pictures are always a must.

While it’s a completely different, yet exciting, experience, I am doing the same exact thing I did last year in a far different context: interviewing pregnant women, as well as mothers, family members and doctors. However, instead of asking about neonatal care practices to rural women who often lack access to prenatal check-ups and well-resourced hospitals, I am asking about how urban women give birth in a place where 100% of women deliver in hospitals. In particular, my thesis research is looking at the sociocultural reasons behind cesarean sections on maternal request, in a country where cesarean rates are hitting 50%, and even higher in urban areas like Shanghai. Through ethnographic research: observing the hospital environment and interviewing various actors in the hospital, I have tried to integrate myself into the Chinese context and understand this phenomenon: why are cesarean rates so high in China, and what is even more fascinating to me: why are mothers requesting surgery without medical indication?

Jiading, Shanghai

The “answer” to this, well, could be written into a 60-70 page thesis that clearly would not fit onto this blog. However, there’s a number of reasons: women fear pain and childbirth (and it does not help that the usage of epidurals, or anesthesia for childbirth, is uncommon, nor that women labor without family members in an open ward with other laboring women); doctors are often overworked and underpaid, and perhaps see cesareans as a faster (and more profitable) way to achieving the same outcome; and China’s One Child Policy, which meant that the risk of a cesarean stopped at one birth (although now this is changing as the policy has been relaxed and parents can now have two children). The reasons are numerous and meld together into this environment ripe for cesareans. All of this, however, has been changing in recent years as there has been pressure on the Chinese government from the international community to reduce cesarean births –after 2011, the government began implementing new financial incentives in regards to how the hospital is paid for birth as well as how it is rewarded (i.e. if it’s cesarean section rate is below a certain number), which has so far seemed to have reduced the cesarean rate. I could go on and on, but this would, again, extend into a thesis-long post.

What I have learned from both my experience in India and China, as a Health and Societies major and Anthropology minor, is that while childbirth is the same across all cultures, the childbirth experience is one that differs by country, by region, by class. It depends on the structural environment, financial incentives, and lifestyles. And I feel incredibly lucky to have investigated the experiences of both sides of the childbirth spectrum: from a place where perhaps medical intervention was not enough, risking the life of the baby and mother, to a place where medical intervention has become the norm, which has its own maternal-child health consequences…

The CASI experience definitely helped grow my interest in maternal-child health and global health, and I feel grateful to be able to continue this type of research for my thesis. Not only that, I also feel bolder about traveling about and wanderlusting (India is definitely a harder country to travel in than China is…perhaps because of my language and cultural upbringing?).

Anyway, here’s to happy mothers and babies, and the spirit of wanderlust and intellectual inquiry!