Abortion traditions in rural Jamaica

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Soc. Sci. Med. Vol. 42, No. 4, pp. 495--508, 1996

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A B O R T I O N TRADITIONS IN R U R A L J A M A I C A E. J. SOBO Department of Anthropology, University of Durham, 43 Old Elvet, Durham DH1 3HN, England

Abstract--Abortion is not condoned in Jamaica. Its meaning is linked to the meanings of kinship and parenthood, which are expressed through procreation and involve altruism and the assumption of responsibility for the well-being of others. Abortion subverts these ideals but indigenous methods for it are known and are secretly used. The inconsistencies between abortion talk and abortion practice are examined, and the structural functions of abortion (and of its culturally constructed, ideological meaning) are discussed. The distinction--and the overlap--between abortion as such and menstrual regulation is explored. The use of the culturally constructed 'witchcraft baby' syndrome to justify abortion is also investigated. Traditional abortion techniques follow from (and can illuminate) general health practices, which locus on inducing the ejection of 'blockages' and toxins, and from ethnophysiological beliefs about procreation and reproductive health, which easily allow for menstrual delays not caused by conception. The latter understanding and the similarity between abortifacients, emmenagogues and general purgatives allows women flexibility in interpreting the meanings of their missed periods and the physical effects of the remedy. Key words--abortion, ethnomedicine, Caribbean, gender, procreation, menstruation, parenting

INTRODUCTION: ANTHROPOLOGY AND ABORTION

The anthropological treatment of abortion has, until recently, been limited mostly to brief ethnographic mentions or furtive suggestions concerning 'women's matters'. The first recognized attempt to bring the topic into the anthropological arena was made by Devereux in 1955, with A Study o f Abortion in Primitive Society [1]. But the study was not widely read until its second release in 1976, just after the U.S. Supreme Court decision Roe v. Wade. Devereux notes that he chose the topic of abortion "'more or less accidentally" in his effort to demonstrate the universal validity of psychoanalytic theory [1] (p. viii). In more recent works by others, abortion's salience stems directly from a research problem. For example, Newman [2] has discussed traditional methods of abortion as they relate to international health concerns about family planning. Abortion has also been examined as it informs specific areas and dimensions of culture, as in Morgan's exploration of the concept of personhood [3]. Petchesky's analysis links abortion beliefs to ideas about female sexuality (while demonstrating how patriarchal institutions constrain and condition the abortion-related choices women make) [4]. Ginsburg's recent work [5], which builds indirectly on Luker's sociological inquiry [6], explores the links between ideas about abortion and cultural constructions of gender, motherhood and social responsibility. This article also explores abortion's articulation with larger cultural meaning systems and construc-

tions. I begin by describing the traditional abortion techniques of Jamaica, exploring their connection to both reproductive and general health practices and demonstrating how the meaning of abortion is linked to the meanings of kinship and parenthood. Then, having discussed the ideological context in which abortions are or are not procured, I investigate the real and apparent inconsistencies between abortion talk and abortion practice. I also explore the distinct i o n - a n d the overlap~between abortion as such. efforts at menstrual regulation and the expurgation of 'witchcraft' or monster babies; the methodological and theoretical implications of categorization are discussed and the ramifications that cultural understandings about procreation have on people's interpretations of symptoms and their reactions to them are examined. Finally, I discuss the structural functions of abortion (and of its culturally constructed ideological meaning). This article, which focuses on beliefs and meanings as contexts for bodily experience and behavior, contributes to the general anthropological discussion of abortion practice and the cultural construction of abortion. It adds to our knowledge about ethnomedical categorization and expands our understanding of the ways in which abortion-related beliefs and practices reinforce and reproduce existing constructions of gender [4-6]. This article also contributes to the literature on African-Caribbean gender relations [7-11] and health practices [12-14]. In particular, it builds on Brody's discussion of abortion in Jamaica [15] and augments earlier explorations of Jamaican contraceptive beliefs and behaviors [16-19] by

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examining women's own experience of pregnancy and abortion (or menstrual regulation) and by investigating their active use of ethnomedical and other cultural beliefs. OVERVIEW OF RESEARCH M E T H O D S AND SETTING

Data concerning the views and experiences of rural Jamaican women were mainly gathered in a coastal village just east of Port Antonio, where I lived for a year in 1988 and 1989. A portion of the data was collected in a mountain village near Mandeville, where fieldwork has been conducted previously [14, 20]. My exploratory research in urban areas as well as correspondences between portions of my data and data from other studies [16-18] indicate that my findings may apply also to impoverished urban Jamaicans, many of whom were born in rural areas. As Brody points out, urban residence "does not necessarily mean a modern world view" and many city dwellers continue to perceive themselves as rurally rooted [16] (p. 69). The data discussed in this article was collected for a larger study of traditional health beliefs and practices [21, 22]. Participants in the larger study were of all ages and both sexes; however, with the exception of data concerning Jamaican culture-in-general and gender relations, most of the interview material cited here comes from female participants. I talked with schoolgirls, young women (some pregnant) and older mothers as well as with traditional midwives, the village abortionist and other women known for their knowledge of female matters. I met with participants individually and in groups. Interviews were both formally structured and informal. They took place in community settings (by the river where women did wash, for example, or by the shop) and private yards. I also spoke with pharmacists, Jamaican Family Planning Association clinicians and administrators, and parish doctors and nurses (most medical workers in Jamaica are women). Creating explanations for an anthropologist (no matter how trusted and well-liked) is distinct from 'real life' practice, so special attention was given to actions taken in regard to the body and to the abortion and kinship-related discourse that emerged in the context of key informants' and other participants' day-to-day dealings and in reproductionrelated crisis situations. Participants' drawings of the body's inner workings were also analyzed. This technique of eliciting women's health understandings was used previously in regard to family planning in Mexico by Shedlin [23] and then in Jamaica by MacCormack and Draper [18]. I use the term 'Jamaicans' throughout this article to refer to impoverished rural villagers. Like almost all of the research participants, the majority of Jamaicans are poor and mainly of West African descent. While a small elite class does exist, nearly all

Jamaicans (85%) are very poor [24]. The houses they live in generally lack plumbing and electricity and are made of wood planks and zinc sheeting. In 1987, Jamaica's per capita income was barely $1000 (U.S.) and island-wide unemployment rates were more than twice as high for women (29.5%) as for men (13.6%); they also were higher for people under 35 [25] (pp. 126, 64). Young women have the hardest time finding jobs [1] (p. 125) and women who do find work are compensated with lower wages than men.

One-third of the villagers where I lived could find no work. Unemployment was especially high among women below the age of 34 [26], most of whom are single parents who receive little help from the fathers of their children. As is typical in the island, many villagers engaged in small-scale agricultural pursuits. Yet few could 'manage' through this alone. To supplement these earnings, men hired themselves out for small construction jobs when such work was available, served as seasonal laborers on a nearby banana plantation, or did a little fishing; women took in washing or engaged in petty trade within the village, as by selling oranges. A few women worked full-time as middle merchants, or 'higglers'. Profits from higglering are generally small: charging much more than cost for an item is seen by customers as exploitative and 'mean' (selfish), contradicting the ethos of caring and commitment to others. Ideally, there is reciprocity among kin. Although factors such as migration to cities and overseas have weakened many family ties, almost all villagers belonged to extended kin networks. So in addition to working at multiple pursuits, people relied on relatives for resources. Marriage occurs late if at all; accordingly, women of childbearing age often looked beyond kin circles for help surviving. Women often sought to establish heterosexual relations with certain men and even to bear children 'for' them because by doing so kinship-like obligations for resource-sharing are, ideally, engendered. Many have observed that Jamaican gender relations are adversarial [e.g. 7, 8, 10, 11]. R. T. Smith [27] explains that instead of emphasizing a unity of opposites in heterosexual coupling, Jamaicans highlight the attributes that, for them, differentiate and are expected of each gender. Because these attributes dominate the cultural construction of gender, says Smith, "men and women are to each other only necessary objects for the achievement of their respective ends" [27] (p. 137). Love does exist and feelings of unity can infuse relationships; still, Smith's observation echoes commonly expressed Jamaican sentiments. The sayings "No finance, no romance" and "No money, no love" reflect this. Men without money (and most men are poor) experience lowered self-esteem and resentment toward women who strategically seek (but rarely find) rich husbands; this exacerbates gender tensions.

Abortion traditions in rural Jamaica A typical rural Jamaican village consists of household groups linked to one another by ancestry, or by proximity to a shop or postal agency. In some cases, a village is organized around an estate or factory where villagers sell their labor. Historically, many villages sprung up around the plantations that slaves were freed from in 1834, as ex-slaves often continued to work on the plantations for wages. Although a number of churches founded 'free villages' by buying up ruined estates and selling small parcels to church-going ex-slaves after abolition [28], only about half of all rural Jamaicans now own the land they live on [29] (p. 11). PROCREATION, SOCIAL REPRODUCTION AND SOCIAL ADULTHOOD

The economic, social and historical conditions just described form a background against which to view Jamaican kinship beliefs and the requirements for social adulthood, which deeply affect ideas about abortion. Traditionally, Jamaican kinship is modeled on the interdependence and obligation that Jamaicans believe ensues from sharing bodily substance [30], Blood ties or shared heredity are an important index of kinship. Participants told me that blood comes in different colors: red and white. Male and female sexual fluids are parallel types of 'white' blood. Properly mingled blood leads to conception. Incorporated into its body, shared substance physically compels a child to behave altruistically in relation to its parents, with whom the child shares what Jamaicans refer to as 'one blood'. Jamaicans frequently assert that people of 'one blood' share 'one love' and are of 'one mind', 'one heart' and 'one accord' [22]. The emphasis on shared blood as a symbol of corporate unity is partly rooted in the experience of slavery. As MacCormack and Draper explain, the enslaved were thought of as chattel and so were treated as "abject individuals, detached from the political power of kin" [18] (p. 162); kin were frequently separated and people denied the sense of social continuity that kin-group membership provides. Jamaican customs surrounding the 'navel string' or umbilical cord, which is buried in a special place and ties each generation to the next, reflect a longing for the sense of linkage that slavery threatened and often destroyed [18]. Jamaicans have deep feelings of gratitude and feel obligated to parents for having given them life and kept them alive; this is typical also in West Africa, from which most Jamaican slaves were taken [31]. Fecundity represents reciprocal repayment for parental investments: blood for blood. The practical and immediate nature of such reciprocity is seen when an older relative asks a younger one to lend her one of her children. My neighbor Miss Deborah asked her daughter, Peaches, to send her own daughter, Kayla, to live with her:

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Miss Deborah needed Kayla's help with the household chores. Ideally, a big family provides a large network of unselfconscious, altruistic support that people are physically compelled to lend, simply because they originate from or share 'one blood'. And kin, ideally, find helping each other fulfilling in and of itself. They take care of each other not for monetary rewards but for moral satisfaction. Also, people involved in kin networks gain the security of knowing that when they need help it will be forthcoming. Those who are caretakers now need not fear becoming dependents later as their familial roles or situational conditions (such as employment status) shift. One woman speaking with me called her children her 'pension'. Participants commonly responded to questions about not contracepting or aborting by asking who would care for them in their old age if they had no children. Consubstantial kin circles are strengthened and recreated with the addition of children. With no procreation, society would cease; similarly, without reciprocity, networks would crumble. People who abort do not add to their family circles. Instead, they 'throw away' or 'dash away pickney'. To "dash away' a thing means to spill it or spoil it--to render it useless. Children ('pickney') who spill milk or drop food are often scolded as they 'dash away' valued, life-supporting things. People who have not met in a long time often accost each other, asking "Why you throw me away?" or, "So, you dash me away?" To "dash away' a person means to ignore a relationship and its ensuing obligations. To really do so could be foolish: survival depends upon maintaining network links. Talk of children as material resources, pensions, or old-age caretakers is typical among poor women and women in developing nations. Handwerker [31], who focuses on socio-demographic factors, also argues that childbearing is an investment activity: when children can provide women with desired access to resources, women deem it wise to have them. Handwerker describes birth as a political act through which women can gain power. But children are loved and cherished also for expressive and moral reasons. Children "keep company' with their caretakers and they "lively up the place'; children symbolize, embody and engender social connectedness and an ethos of caring for others. 'Civilized' people take care of one another instead of destroying their kinship networks as through abortion. The heavy loading of the word 'civilized' reveals islanders' insecurity about the perception of Jamaica held by members of modern 'civilized' nations (this insecurity has much to do with the experience of colonization, racism and tourism). Rural Jamaicans disparage their own as 'uncivilized' or 'backward' when social and moral order, which involves altruistic caring, is not upheld. Abortion subverts this order and is therefore a 'backward' practice.

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Abortion is also 'uncivilized' because it is 'sinful' according to the Christian church, a symbol of 'civilization' which has greatly influenced West Indian standards for respectability [32]. American Pentecostal sects have grown increasingly popular [33]. Church rhetoric, in which abortion is labeled as murder, is now used by many to support antiabortion arguments that are based in pre-existing kinship ideology. This increases the strength of the taboo (and may be forcing abortion further underground, interfering with the transmission of knowledge between old and young women and contributing to an increase in abortion-related complications [34]). Social commitment is expressed through procreation, which itself forms the basis for social adulthood. Without having children--and without caring for them responsibly--self-esteem and the respect of others cannot be attained. Infertile women are disparagingly called 'mules': they are compared to nonhuman, non-reproducing animals that are responsible only for themselves. A good career can help lift the status of a childless woman. It affords her an opportunity to serve society and to demonstrate her ability to take responsibility for others. It allows her to care for kin by sharing her earnings. But opportunities are few and positions that can enrich self-esteem and provide a decent salary are mostly closed to the impoverished majority [9-11]. Having children is the simplest way to increase self-esteem and establish adulthood [16, 35]. The instrumental and expressive values of children are important but this must not keep ethnographers from attending to the social value o f - - a n d the "symbolic capital" [36] accrued through--responsible parenting. Theories that focus on the value of children without attending to the value of parenting cannot fully explain reproductive practices such as abortion, at least as they are carried out in rural Jamaica, where full social adulthood is confirmed through the assumption of responsibility for others. Having a child does not in itself bring womanhood, as the Jamaican Family Planning Association slogan "Before you are a mother, be a woman" indicates, but womanhood requires children because children require care: full adulthood involves taking responsibility for the well-being of dependent others. This applies to men too but, in addition to the lack of jobs, cultural factors (more of which later) deter many men from supporting their children. Women, like men, sometimes fail to act responsibly toward their children. Economic hardship can cause women to pass children on to relatives for keeping. Hardship can also lead them to abandon their offspring. Abandonment, first systematically explored by Brodber [37], need not represent willful irresponsibility. As Sargent and Harris [38] show, some mothers abandon their children in strategic places, hoping that financially solvent and loving parents will find them. But there are mothers who leave their children in dangerous environments with-

out concern for their well-being. As Sargent and Harris explain, such mothers are thought morally deficient; they have no sense of responsibility and fail to care for others. They receive no respect as they lack the characteristics women must have to be thought of as 'big'. The following incident illustrates the social importance of parenthood. When two women on a bus began to quarrel over an accidental shove, the fact that one had not borne children was used against her. "You front never burn [hurt] you; you never have no pickney", shouted the aggrieved woman. "You is no woman--you a man!" Like the stereotypical man, a childless women is cast as irresponsible and so as childlike because she is not held accountable for the well-being of any children ('pickney') and has never physically 'hot' (hurt; suffered the pain of childbirth) for them. To quarrel with this 'man' would be a waste of time, because as opponents the two were no match. To argue with the 'man' would be, in this context, like arguing with a child. THE ETHNOPHYSIOLOGY OF REPRODUCTION

Despite the pro-natalist ideology and the ethos of caring for others that stem from beliefs about kinship and social adulthood, abortion is practiced. The techniques used are related to cultural beliefs concerning reproduction and general health maintenance. The following detailed description augments a basic outline offered in MacCormack and Draper [18]. A baby is 'started' when male semen meets a 'ripe' female egg or the female equivalent of semen--female 'discharge'--inside the female body. Participants also said that a baby can be 'started' when a 'duppy' or ancestral ghost 'interferes with', "troubles', or rapes a living woman. Then, the so-called fetus usually consists only of lumps of phlegm and bad, often hot, air. Normally, however, male and female blood come together in a clot or lump when a baby 'starts'. Things begin in the 'tube(s)' and then migrate further into the 'belly' where the lump of blood comes to rest in a 'baby bag'. Their discourse, direct descriptions and body drawings demonstrate that Jamaicans visualize the inner body as a collection of loosely assembled bags and tubes. The most important 'bag' is the 'belly', a cavity extending from just below the breast to the pelvis, with tubes leading out at its bottom. The 'belly' is full of smaller bags and tubes, including the 'baby bag' and 'urine tube'. A main conduit leads from the top of the body through the 'belly' to the bottom (but not from bottom to top), with tributary bags and tubes along its length. Sometimes, tube and bag connections are not tightly coupled. When a substance is not properly propelled it can meander off course and slide into an unsuitable tube or bag, lodge as a 'blockage', and cause problems. 'Blockage' can also happen when 'hard food' or non-nutritive matter like coffee

Abortion traditions in rural Jamaica dregs plug the rectum at 'belly bottom', causing constipation. Stuck inside the body, accruing waste and toxins fester and decompose. This rot can bring dire sickness and physical distress as well as odor. The generic term 'bad belly' is often applied to the sorts of 'belly' trouble 'blockage' brings. 'Washout', the Jamaican cure-all, fixes 'bad belly' by clearing the inner tubing through purgative action. Similar beliefs and practices are found among other people of the African Diaspora [13, 39]; they were probably encouraged in Jamaica by the health culture of the English colonizers [40,41]. Taylor [42,43] argues that an emphasis on maintaining a continuous, unimpeded flow through the body is common among those who value reciprocity and emphasize the obligation kin have to share with each other. Sickness occurs when flow is blocked or otherwise "anomic" [43]; individual pathologies are homologous with social pathologies, caused by disturbances in the reciprocal flow of mutual aid through the social network. Rural Jamaican ethnophysiology dictates that unless food flows through the body in a timely fashion, sickness ensues. Blood must flow freely within the body so that inner areas are kept clear and cleansed. It must also flow between bodies to create kin ties. Kin ties, in turn, involve resource and labor sharing and any blockage of goods or services leads to or indicates social discord, just as 'blockage' in the body can indicate or bring on problems, whether strictly individual and physical or involving social pathologies and spiritual aspects. In the first trimester, it is easy for Jamaicans to mistake pregnancy for 'blockage' as the lump of blood that may become a baby takes up 'belly' space and can cause 'bad belly'-like symptoms: irritable bowels or constipation, nausea and gas. Gastrointestinal distress is not uncommon in Jamaica, and amenorrhea does occur: only those familiar with the signs of pregnancy (or those who definitely want a baby) feel pregnant from the start. Pregnancy tests are not readily available and usually it is not until the fetus begins to move that a woman becomes convinced that she is pregnant. A pregnant woman endures nine months of being 'unclean' [30]. She retains a not-yet-human fetus and its waste stays within her. The toxins carried by would-be menses and in blood that flows to 'feed' the 'baby' collect behind or above the fetus in a clump or 'nest'. Part of this becomes the afterbirth. Some blood is channeled into the fetus, building it; sperm, which reaches it after every act of intercourse, is also incorporated. At first, the growing fetus looks nothing like a child. When it begins to 'form up', it takes on a toad or frog-like shape. It can now begin to eat food, which reaches it through a tube that leads down to the 'baby bag' from the higher regions of its mother's 'belly'. People liken the 'baby', in its 'bag', to a ripening fruit. If it stays inside ('on the tree') too long, the

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'headwater' grows 'overripe' and 'thick with corruption'. The similarity between rotting fruit, past-due babies and festering waste like that swelling behind a 'blockage' is obvious to a rural Jamaican. Birth is, like defecation and menstruation, a cleansing process [30]. Women who are mothers can insult those who have not yet given birth as being 'unclean'. Thyme (Thymus vulgaris) tea and castor oil were regularly used to speed delivery after the onset of labor when home birth was the norm. After birth as after a miscarriage, mild purgatives like broom weed (Corchorus siliquosus) tea can be drunk to induce the quick delivery of the placenta and waste matter left behind by the baby. Ideas about easing it out, as in delivery and for a bowel blockage, follow the purgative model (itself patterned gynocentrically after the menstrual cycle). 'Washout' concoctions traverse and cleanse the 'belly' and inner sacs and tubes, sweeping the placenta and other pregnancyrelated leftovers out through the vagina below. Squatting over a pot of hot water ensures the ejection of all waste. The steam enters the body and 'melts' all recalcitrant matter which then slides out. Purgative drinks like those made from tobacco (Pluchea odorata), rice bitters (Andrographis paniculata), sinkle bible (Aloe vera) or epsom salts can also be used. Washing out is especially important after a miscarriage--or abortion--or when a pregnancy is false and the 'baby' is made up of objects or matter such as phlegm lumps, 'bad' air or mucus. Women's bodies must be thoroughly purged of disagreeable matter. THE GENERAL STATUS OF ABORTION

IN JAMAICA Abortion techniques, which follow from the health and reproduction models just discussed, must be practiced covertly. Abortion is, with few exceptions, illegal, although the law against it is "rarely if ever enforced" [44] (p. 242). Moreover, measured against the general cultural ideology of altruism and kinship described previously, abortion is not an acceptable option: it represents opposition to the social and moral order. Most rural Jamaicans abhor abortionin-general and so to let one's first-hand knowledge of abortion become openly known means forfeiting status and labeling oneself as 'uncivilized' or selfcentered and unconcerned about community and kin. Like abortion, contraception is frowned upon as anti-social and so unplanned pregnancies are frequent. Sex can be for fun, but actively contracepting denies the social exchanges kinship would involve by blocking would-be gifts of male bodily substance. Contraceptives are thought to work by either keeping sperm from penetrating too deeply or washing it (or a conceptus) out of the female body. Such disruption creates "anomic flow" (Taylor's term [43]), which leads to illness. Most people point to the health risks involved in explaining why they do not practice 'the

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planning' (contraceptives are readily available). People also report that it is unreliable (this is partly because, when not properly instructed, people misuse contraceptives). Men are contraception's most vocal opponents. They associate 'the planning' with female promiscuity and they often talk of birth control as genocidal [45]. Despite the importance of motherhood, three out of four pregnant women surveyed in 1989 by government agents reported their pregnancies to be mistimed (55%) or actually unwanted (20%) [46]. Many villagers, clinicians and folk-practitioners claim that the majority of women have had or will have abortions. One person, for example, estimated eight out of ten, another guessed three of four and one other said 95% had done so. The large size of these estimates might be explained by the widelyreported Jamaican tendency to suspect others of carrying out self-centered, evil deeds [47, 48]. E. L. Husting [44] (p. 251) calculated in 1972 that 15,000 to 25,000 abortions are performed in Jamaica each year. Writing in 1981, Brody refers to but does not specify the source(s) of "estimates of illegally performed procedures" that "range up to 25,000 yearly" [16] (p. 51). As there were about 60,000 live births each year between 1972 and 1981 [49] (p. 4), it can be speculated, using the above estimates, that between 20 and 30% of all pregnancies--or about one out of four--are aborted. Bearing in mind these estimates, the large number of septic abortions seen by clinicians [17] (p. 281) and the finding that nurses and midwives feel that miscarriage is less common than illegal abortion, it is not surprising that medical professionals feel that liberalizing abortion laws would lead to such an increased demand for abortion that the health services would have to undergo a change to accommodate it [44] (pp. 250, 252). THE REASONS FOR ABORTION: PARTICULAR CONTEXTS

The act of abortion involves a dramatic departure from kinship and parenting ideals. Yet it occurs 'all the while'. The available data suggest that many women terminate pregnancies illegally and many more long to do so but do not act. Despite its general cultural meaning, certain circumstances make abortion a desirable option. Schlegel [50] shows how inconsistencies that seem at first like contradictions actually make sense when the context in which meanings are assigned is considered. Following her model, the context of general abortion ideology is the total ideology of the culture. According to the general ideology participants held, abortion comes about precisely because people do not retain a sense of moral commitment to each other. Anti-abortion discourse denigrates modern individualism and idealizes kinship and responsible, 'conscious' parenting. But a specific abortion's meaning is arrived at within a specific context: what

Schlegel describes as "a particular location in the social structure or within a particular field of action" [50] (p. 24). Economic reality and the problems that gender segregation involve often dictate that having fewer rather than more kin makes it easier to fulfill (and to enjoy fulfilling) kin obligations. People use this knowledge to privately justify particular abortions, pointing to the greater good they bring. Participants reported many justifications for abortion. Many begin by denouncing 'babyfathers' that do not offer support. While often men do want to 'help' their 'babymothers', the lack of economic opportunity and certain cultural traditions make this hard. Men have multiple demands on their money. Among Jamaicans, as among impoverished urban Blacks in the U.S.A. [51], female kin networks actively try to keep grown sons and brothers (and their resources) from leaving the network. Women who hold onto these men benefit as the women who have children by them suffer. In turn, these suffering 'babymothers' will call on their own male consanguines for help, reproducing the pattern of delinquent support from boyfriends and 'babyfathers' that set them back to begin with. Childrearing practices support this situation. Mothers treat sons in ways that promote dependence and devotion. Moreover, as Clarke shows, neither parent trains sons to be responsible, 'conscious' fathers [52]. Indeed, men are brought up by women who expect them to be--and so treat them a s - irresponsible. As a result, 'babyfathers' frequently abandon their 'babymothers', leaving these women very burdened. Partly in self defense, women relate to men as adversaries. The previously noted practice of highlighting disparate gender-linked attributes rather than gender complementarity in heterosexual relations contributes further to intergender tension [27]. Moreover, men and women hold different opinions about the values of their respective attributes, which increases the tension more. As Wedenoja notes, women often criticize the same male attributes that men see as positive and sources of pride [38] (p. 535, n. 3). Men, particularly impoverished ones, build reputations by expressing attributes that bring harm to women, as promiscuity and irresponsibility do [32]. Women often respond to male irresponsibility by sharing abortion and other information with each other. Women create and reproduce their own informal networks of support through the act of information-sharing, which perpetuates network cohesion. But, like childrearing practices and the pressure that mothers and sisters put on brothers and sons for material aid, the solidarity promoted as secretsharing women seek help from each other supports sex segregation and so exacerbates the intergender tensions that (along with other forces) disadvantage women to begin with. As Bott [53] explains, extramarital kin network density and conjugal segregation

Abortion traditions in rural Jamaica enjoy a positive relationship. Gluckman [54] hypothesizes that close-knit kin networks also are linked to mono-sex groups and Gregor [55] and Sanday [56] show that sex segregation is positively associated with poor gender relations. The benefits of female support networks notwithstanding, Jamaican women's survival networks perpetuate the gender system that (along with national economic factors and traditional health beliefs) generates their abortion needs to begin with. The gender tensions, adversarial gender relations, and related economic pressures that accompany sex segregation in Jamaica figure prominently in the justifications that participants reported for abortion. While some men simply abandon their 'babymothers', those who pay for intercourse directly have no obligation to support the offspring in the first place. Also, some men poke holes in condoms 'for joke'; this can leave a woman pregnant with no male 'owner' for the baby. With no financial help, a woman might try abortion. She might also try it if she has been raped or beaten by the 'babyfather', or if he simply changes for the worse. In such situations, a woman may not want to ally with a man through a child. A woman who is employed may try to get an abortion so that she can keep her job. Jobs enable women to care for those children that they already have. Another child can increase a woman's load of responsibility to the point where she cannot bear or fulfill it. Participants' views supported Brody's suggestion that women's use of abortion increases with successive pregnancies [16] (p. 51). Often, a mother-to-be is herself a child: 16 is the median age for first pregnancies [16] (p. 153). May was the first of the participants to get pregnant; this happened about two weeks into my fieldwork ~ u s t after we celebrated her sixteenth birthday. One-fourth of all live births are to girls like May who are 19 or younger [49] (p. 48). Of all girls in this age group, 39% admit to having been "ever pregnant" [57]. While girls receive the first child with "unequivocal pleasure" nearly three-quarters of the time [16] (p. 172), 92 out of 100 pregnant girls under 19 years of age said that they had not wanted to conceive when surveyed by government agents in Victoria Jubilee Hospital (Kingston) in [58, 59]. Like them, May was not pleased upon discovering the cause for her 'belly's' condition. Even though pressure to prove one's fertility is great, many girls would rather stay in school than have a baby (school rules bar pregnant girls from classes). They believe that education will improve their future ability to mother well. Many know that their own caretakers cannot help them to shoulder the burdens of motherhood. May, for example, lived with her grandmother, who suffered from high blood pressure and already had three other young charges. May's Aunt Ti, who also lived in the two room house, declared to May that a 'washout' was in order.

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Even though people dislike abortion, girls and women often have cause to think of a fetus as a kind of 'blockage' to be rid of. With abortion, undesirable matter is cleansed from the 'belly' of a woman 'sick' with child. Potentially draining obligations to a baby that would impede rather than enable the flow of resources between kin are removed. The vaginally inserted 'blood tie' which would have bound 'babymother' and 'babyfather' is undone and so she is not further burdened by kinship obligations that she cannot fulfill and which might endanger reciprocity networks that are already under strain. In this immediate sense, abortion actually supports cohesion, preserving the solidarity of existing circles of kin. BRINGING BACK THE MENSES

When pro-social ends justify the means, pregnancies can be quietly terminated. They must first, however, be recognized. Pregnancy has many symptoms, but women know from experience that missed menstruation is not always one of them. A number of events can lead to a delayed flow and early signs of gestation altered appetite, nausea, swelling--are no different from the symptoms of a blocked rectum. Badly clogged bowels can keep the menses from passing out the 'belly bottom' and through the vagina. So can 'cold' or mucus. 'Cold' is produced in the 'belly' regularly, but if too much gets made 'blockages' can occur as bits of the excess settle into spaces they should not occupy. A missed period can indicate that 'cold' has blocked the vagina as easily as it can signal the presence of a fetus. A woman can 'take washout' to clear "cold' or whatever might be blocking the menstrual path. Medicines said to 'bring back' or "bring down the menses' are common cross-culturally [60-62]. Because such a description does not indicate the cause of menstrual delay, it can be used euphemistically to refer to abortion. How frequently women talk of medicines that 'bring down the menses' in conscious attempts to maintain decorum remains unclear. But an ethnographer's or reader's suspicion of people's dishonesty regarding the effects of such medicines and the goals of the women who take them is often based in unexamined assumptions about fertility and about the status of a newly conceived fetus. When people do not recognize a conceptus as a baby and a late period as a pregnancy, their labeling of medicines as menstruation restorers rather than abortifacients cannot represent attempts at manipulative misinformation or misrepresentation of self. Fertility is never certain in Jamaica, which supports participants' arguments that menstrual 'washouts' are indeed menstrual 'washouts' and not intended as abortions. Cultural assumptions about fertility's sureness affect what Csordas [63] calls "somatic modes of attention", or interpretations of somatic

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states. Well-fed middle and upper-class North Americans generally feel sure of their fertility; they express shock at the smallest trouble in conceiving and assume that delayed menses indicate pregnancy when frequently they do not. Their cultural assumptions about fertility and menstrual cycling make North Americans quick to see others' claims of menstrual restoration as deceptive. But in Jamaica (as in many other societies where malnutrition, disease and very hard physical labor increase women's chances of infertility, subfertility, amenorrhea and miscarriage), fertility must be proved through the production of children; it is not taken for granted or assumed. A missing period does not necessarily signify impregnation. Privileging the experienced ambiguity of first trimester symptoms allows the circumstances surrounding them--including women's previous experiences and their desires--to affect the meanings attributed to them. The idea that human life begins at conception is a recent one in Western history. Early Christians did not view pregnancy terminations as the taking of human life unless they occurred after the quickening, when 'ensoulment' occurred. Until 1869, even R o m a n Catholicism held that there was a difference between a 'formed' and an 'unformed' fetus [64]. The criminalization of pregnancy termination and the elimination of the importance of the quickening in determining the status of the fetus is linked to the professionalization and masculinization of healthcare. Partly out of their desire for prestige and power, (male) obstetricians appropriated midwifery, decreed self-care a backward practice and promoted biomedicine [5] (pp. 23-27). For rural Jamaicans, a blood-clot conceptus is different from a baby. While pregnancy is a yes-or-no condition from the modern Western point of view, many Jamaicans recognize it as the end result of a lengthy process. The same is true in many cultures, as Newman found in her cross-cultural study of indigenous fertility regulation. "Conception involves a continuum of events" which include germ-cell fusion, cell division, embryo formation and implantation, notes Newman, adding, "That recognition is an assertion of a reality on the part of a woman, derived from her own experience" [2] (pp. 15, 16). A n d that recognition provides a woman with flexibility in interpreting her state and in deciding on and justifying a course of action. The fact that matter washed out during the early and ambiguous stages of pregnancy resembles menses--not babies--often gets used to prove that abortion has not taken place. So does the notion that if a fetus has caused the menses to cease, God will not let it wash out. Still, all women know that since 'washout' concoctions work by passing through the tubes and bags of the ~belly', the contents of the reproductive tract--whatever they are--will get swept out in the purge. So do pharmaceutical companies: they have for a long time printed warn-

ings on boxes of cathartic pills, such as "Not to be taken by married [pregnant] women". The existence of menstrual regulation presents a problem to researchers who would quantify the occurrence of abortion. What gets called an abortion by the researcher may not be viewed as an abortion by the subject; the opposite may also be true, as when women seeking biomedical help after failed abortion attempts explain their conditions as stemming from miscarriages or other involuntary causes. The problem of identification is not easily resolved. However, researchers should make explicit their assumptions about what constitutes and is classified as an abortion. If possible, indigenous methods of classification should be followed. To test the validity of a particular classification of or interpretation about a woman's actions, or if women's perceptions of their actions are not known or are dubious, treatment methods, the timing of the actions and the kinds of contact had with others concerning the conditions to be alleviated should be explored. These angles of investigation are useful for clarifying whether menstrual regulation or abortion has taken place when researchers are dealing with cultures in which techniques for menstrual regulation and abortion differ, the timing of the treatment is important for determining how to classify it and different specialists are consulted regarding each process. But even if such formal distinctions exist, class or other considerations may lead to different rates of consultation and divergent interpretations of similar actions. So care must be taken in drawing conclusions regarding the subject's view of what has actually transpired, as the following case shows. One day, as I picked my way up a path to visit with Aunt Gret while she roasted peanuts to sell, I happened to pass a young woman, Patsy, vomiting behind her small house. She looked up and 1 inquired about her health. She had been feeling sick, she said, so had taken a very strong 'washout', one that causes vomiting in addition to easing the bowels. She knew this would make her feel 'strong' later. But Patsy was ill for a week. Soon afterward, it became quite obvious to her fellow villagers that 'she a breed'. People began to gossip about Patsy's pregnancy. The man for whom they thought she 'carry pumpkin' had a wife. They found out that he had stopped giving Patsy money, food, clothing, or any other kind of help. They also knew that Patsy and the village abortionist were friends. "Look how she shabby", they said of Patsy with glee, using knowledge of her relationships and of her new poverty and lack of male-provided capital to support their hindsighted contention that the bout of sickness Patsy had experienced earlier bespoke a failed abortion attempt. Lucky that her baby came out fine (a 'washout' that does not bring abortion can still cause damage to the fetus; disabled babies often get used as proof of their mothers' subversive tendencies), Patsy contended that she had no clue to her pregnancy when she took her purge. True or not, the villagers saw her sickness as evidence of an abortion and thus of her bad character. Patsy was known as a 'rebel' before, and those bothered by this felt good to 'pull her name down'. Perhaps Patsy had no awareness of her state when she took her big 'washout', but it is just as likely that

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the active properties of West Indian herbs is found in Asprey and Thornton [65]; several descriptions of Jamaican 'bush' medicines exist [15, 66-69]. As commercial goods have become more readily available, the range of non-'natural' substances augmenting WOMEN'S MEDICINE: EMMENAGOGUES herbal treatments has grown larger. AND A B O R T I F A C I E N T S Theoretically, anything that induces a physical Emmenagogues restore the menses while, as one catharsis (whether a laxative, diuretic, bloodwoman explained, abortifacients "make baby turn cleanser, gas-easer, sweat-inducer or any other type into blood and wash out". Abortifacients are similar of purgative) can spur the body to ~dash away baby' to medicines intended to 'bring down' the menses, if taken in quantity. For abortion, people recommend but they are often stronger and their acknowledged teas brewed from the corkscrew plant (Helicteres end differs. Still, although people readily explain that jamaicensis), its name indicative of its nature, or from certain purgatives have certain effects, there is no senna (Cassia occidentalis and Cassia obot:ata), a Jamaican English or Patois word to denote aborti- powerful herbal laxative for men and horses that is facients or emmenagogues in particular; all purgatives not to be taken by pregnant women (the previously mentioned midwife's female cure-all contains this are classified generically as 'washout'. One 'first-time' or old-time midwife, 102 years old, ingredient). A dangerously strong 'tube'-clearing used to make a cure-all that she said could "bring abortifacient can be made by roasting an immature down the menses", "clear the tube", ease out after- paki or calabash (Crescentia cujete), scraping off its birth, enhance fertility and speed delivery. She told blackened outer layer and squeezing the remains for me quietly that the concoction works for abortion juice which is boiled, cooled, strained, doctored with but she also claimed to "hate that thing": "Me no honey and castor oil and drunk. Abortifacient recipes can include the popular business with that wicked something". The brew consists of one long sinkle bible (Aloe vera), a handful blood-cleansing herb cerrasee (Momordica charantia), of senna and one half of a lime cut from a tree (the or the herbs John Charles (Cordia globos) which other half must remain attached), all boiled until loosens ~cold' (mucus) and cures gout, and vervain "well red" (like blood), cooled, bottled and taken in (Stachytarpheta jamaicansis), which washes out worms and 'cold'. Some concoctions call for wild small glasses before and after sleep for three days and nights. Blood, often dark, clotted and stringy, washes basley or basil (Ocimum micrantham), nutmeg and out of the patient in three days. "She happy--she well guava buds. Any cathartic agent that stimulates want fe see it! When the blood come down 'pon him excretion should help. What gets mixed for a case depends on what that woman's body can 'take'. [the woman], you fe charge nuf, nuf money!" In any case, people recommend drinking plenty of A recipe's all-purpose flexibility stems from traditional ethnophysiological beliefs and the pri- water. Jamaicans know many pharmaceutical agents that mary role that 'washout' plays in Jamaican ethnomedicine. Polysemy and multiple-use medicines are bring on cathartic and abortive expurgations. Some especially helpful when individuals desire privacy of these are available at family planning clinics. regarding their intentions or when they have not Women go in for 'injection' (Depo Provera) pretendpreviously established mutually trusting relationships ing to need contraception when they actually seek the with those they seek help from and so wish to hide abortions qnjection' can induce. They eat whole these intentions. Yet ambiguity can be turned packets of birth control pills at once, thinking they against people: it lets observers draw conclusions and work (as ethnomedical logic would have it) by purgmanipulate them in a socially damaging fashion, ing the fetus instead of by preventing conception--an whether through insinuations made during gossip assumption that also leads many to take their pills sessions or by overt accusations concerning abortion. only after intercourse [45]. Hormonal overdoses do Because 'washout' is so important for general induce hemorrhaging, but more important here is an understanding of the ethnophysiological and related health in Jamaica, many abortifacient and emmenagogue ingredients are part of "everyday cultural bases of such practices. Villagers who have lived in the city and those who knowledge" (Brody's term [15]). While many women use what they know of 'washout' ingredients to have had experience ~giving' (or giving advice on) concoct emmenagogues, for abortifacient recipe abortions tell of douches made from carbolic 'soapsuggestions they generally consult with close female water' mixed with laundry bluing or Quinine pills (the relatives. Sometimes, the advice of specialists is pills taken alone, orally, should also work). One sought (more of which later). Help-seeking indi- woman douched with the mix during her fourth or cates--but does not confirm--that a woman seeks an fifth month (her guess) and the fetus came out "right in the bag". Anything which 'operates' (i.e. removes abortion and not a menstrual restoration. In the early colonial years, women relied mostly on or 'cuts' offensive matter, as in surgery) or 'runs ~natural' herbs or 'bush' for preparing abortifacients [things from the] belly' can be used. People mention and other kinds of 'washouts'. An extensive review of Indian Root purgative pills and also the 'Cathartic'

she tried to hide her intention by claiming that the treatment was intended to clear her of perceived sickness and not of a child.

SSM 4 2 4 ~

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or 'black pill', sales of which were discontinued in the early eighties. During the course of my fieldwork Prevcon, a non-prescription post-coital contraceptive containing the hormone Levonorgestrel, was introduced. Importantly, Prevcon was not referred to as an abortifacient, reflecting the understandings that conception is a process and that fetuses are not abortable babies until they 'form up'. Although Prevcon had been available by prescription since 1987 as Postinor (which pharmacists would continue to carry), the "flood" of requests for Prevcon in Kingston alerted officials to the likelihood that women would "abuse" the drug, causing themselves "serious damage". The ad campaign for the pill was halted by the Ministry of Health less than a week after it started [70, 71]. Prevcon's quick popularity, which contrasts with the poor reputation of other available modern contraceptives [16, 45], reflects the eagerness of Jamaicans to take 'washout' to cleanse 'blockage'--blood-clot fetuses included. It shows that women's interest in procuring abortions--as these are biomedically defined--is actually quite high. While post-coital contraceptives can be hard to get hold of, the ingredients for commonly known abortifacients such as Dragon-brand stout boiled down with 'cobweb' (the black soot that gathers on kitchen ceilings) or 'salt physic' (epsom salts) mixed with cream soda are easily procured. Dragon stout may have replaced dragon plant (perhaps Zebrina pendula) in a recipe for a tea to cure bleeding disorders. Menstrual-brown in color, stout often forms the liquid base for brewing abortifacients. Castor oil, which is also often called for, can be bought most anywhere, or it can be made from the seeds of oil nut trees (Rincinus communis). The use of modern materials according to traditional models demonstrates the creativity that culture change can involve. Non-incorporation of modern materials or foreign treatment techniques is equally important as it reflects an item or idea's incompatibility with currently held ethnophysiological models. Because of how they understand the workings of their bodies, rural women never try extraction with knitting needles or wire hangars inserted through the vagina. It makes no sense to pull out what can be washed through and the latter process is much less likely to cause death from a uterine or vaginal perforation. Rural Jamaican women's (claimed) distaste for touching their genitals notwithstanding, there is fear that one might poke the wrong bag or go up the wrong tube, or that the invasive tool might get stuck or get lost inside. Purging makes more ethnomedical sense. While women do not try to extract what can be purged, sometimes they try to break loose a tiny fetus by taxing their bodies with hard work or heavy 'romping', freeing it for expulsion. 'Washout' is taken after the fetus is excreted in order to make sure that the womb gets emptied cleanly. One girl I knew

dislodged a pregnancy by carrying heavy cement blocks; another, by diving off of a high rock into the sea. If miscarrying this way causes problems that force a woman to seek medical assistance, she can claim she had no knowledge of what her 'belly' did contain. Sometimes, this is true. If she did know and cannot cope with the dissonance between this and the general ideology of abortion, she can convince herself of her ignorance. Participants mentioned purging much more frequently than they mentioned taxing or 'hackling' the body, as above. The later the purge is taken in relation to the missed menses, the more likely it is that the purge is considered as abortion rather than menstrual restoration. Like its gestational timing, a treatment's strength indicates--but does not confirm--that it is intended to induce abortion. Abortion identified as such usually occurs later in the first trimester than those purges intended to restore the menses; sometimes it occurs in the second trimester. When the fetus is older and firmer, stronger 'washout' concoctions are needed and abortion causes more physical trauma. There are side effects, such as a softening of the body through the loss of body-plumping fluids. Although softening accompanies maturity, women with breasts which no longer 'stand up' and fat which is 'soft' and no longer firm can get accused of inducing abortions. People 'can tell you about it' by observing a woman's 'shape'. They point to accused women's physical qualities to show that allegations are true. When big or tough enough, a 'belly'-clogging offender is broken down or tenderized (like tough meat) so that it can get flushed through. But some matter cannot pass: for each fetus aborted, especially when late, a 'headskull' can remain. The skull might embed itself in the next conception or cause sickness in the 'belly' or wherever it may lodge. Many women avoid abortion (or at least late abortion) until they have produced at least one child because they fear such problems, which might leave them childless. For particularly late abortions, people make a purgative tea by boiling rusty nails with marigold plants (Bidens reptans or Wedelia trilobata), themselves good for purifying blood. Rusty nails are made of iron, a tenderizer. People often stick rusty nails in gristly meat to make it tender. When stepped on, rusty nails rot the flesh, as with gangrene, which helps explain their use for abortion. The meaning of rust shifts when used in another construction: to 'cut rust'. 'Cutting rust' involves softening and loosening hardened substances. Having sex after abstinence is 'cutting rust'; so is easing arthritic stiffness. Both involve warming and freeing substances that have grown too firm. Old iron and so old blood, like the blood clot from which the baby forms, rusts. Pepsi Cola dissolves certain metals and so must 'cut rust' in the body, too. A Pepsi and two Phensic-brand pain tablets turn a fetus back into liquid blood that can be expunged. One Phensic tab

Abortion traditions in rural Jamaica contains 380 mg of aspirin and 50 mg of caffeine. A maternity nurse confirmed that such pills can induce abortion. But a woman in her thirties who often talked with me as she sold oranges in front of her cousin's little kiosk confided that the Pepsi and Phensic combination may not work. She tried it when 16 and still had to carry that pregnancy to term. ABORTION SPECIALISTS

Women often prepare emmenagogues or abortifacients themselves, sometimes seeking help from trusted female relations. As Brody [15] explains, sharing knowledge necessitates and supports female exchange networks. It promotes reciprocity and solidarity between women, upholding and recreating the kin network system that women rely on to alleviate some of the daily survival problems that poverty and adversarial gender relations bring. Also, sharing family planning and abortion knowledge in particular provides women with a way of dealing with the male threat to their autonomy and promotes a "shared sense of independence from male dominance" [15] (p. 176), raising self-esteem. (Further discussion of psychological concerns is beyond the scope of this article; see Sobo [22, 30]). But fear of gossip and even future blackmail leads some women to argue that it is best to go to a sympathetic biomedical doctor for an abortion; certain private physicians will perform the procedure. Doctors do not talk about their patients' private matters, as folk-healers are said to often do. But everyone knows which doctors do abortions and people often make assumptions about women entering their offices or waiting to be seen by them. Still, their waiting rooms offer more privacy than home yards, where kitchens and toilets are often out of doors and people passing by on errands may see if a woman 'boil bun pan' (brews an abortifacient) or if her 'belly working [to push matter out]'. In addition to the desire for privacy, many women attributed what they saw as a growing preference for clinical procedures to women's desire for surer, safer therapies. They also pointed to the low status of folk-healing as an explanation for the shift: people overtly frown upon what they disparage as the 'bongo" and ~tribal' ways of the ~old heads'. Because rich, developed nations and the elite favor biomedicine, it 'looks better'--more modern, more 'civilized'--and so it feels better to be seen by a biomedical specialist. Status and therapeutic efficacy concerns notwithstanding, younger women and girls have little understanding of how to prepare an effective 'washout' to begin with; knowledge of this is disappearing with each senior woman's death. Privately procured biomedical abortions cost about U.S. $100--one-tenth of the average yearly income in Jamaica. Very few can afford this fee. In lieu of private treatment, a woman willing to compromise the need for secrecy regarding her con-

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dition can seek a government abortion. But unless she agrees to a tubal ligation, got pregnant while enrolled in a family planning program, or is in dire mental or physical danger, the government can do nothing to help. Inopportunely pregnant women must trust each other for assistance. They can ask close relatives or dear friends for technical advice and recipe suggestions. They can also turn to individuals known to be experts in the field of folk or 'bush' medicine. Scattered among the villages live people secretly famous for their expert ethnomedical knowledge. Their numbers are shrinking as new generations reject anything linked to what they call 'first-time fool-fool business' or 'superstition'. Yet some 'bush doctors' do remain to carry on. In public places, they are treated with a mixture of respect and disdain, the balance of which depends on how covertly they ply their trade and how well they get along with neighbors. 'Bush doctors' do not solicit but are sought out by those who need help. Still, patients are wary about letting others see them traveling to and from a 'bush doctor' because of the connotations. Even those who cover their tracks most carefully show health-related changes both in body and behavior, from which others draw conclusions. Patients often speak poorly of their healers in efforts to lessen the suspicions others may have that they consult them. Folk-healers commonly complain of patients who act like children, forget to pay, or are otherwise 'ungrateful'. One local 'bush doctor' expressed a wish to give her practice up but every so often someone comes for help and she provides it. She no longer actually performs abortions, as she fears legal trouble and social problems, but she advises her visitors as to the methods for washing clean and getting free from pregnancy and the constraints it represents. Sometimes people do not correctly understand her instructions and complications arise. One 'young miss' brewed her 'washout' mix too strongly and, after she 'dropped' the fetus in its 'bag', she began to pass 'tripe' (probably placental matter). Panicking, she cut it off, "damaged herself", and had to be hospitalized. The 'bush doctor' complained that "the girl lack sense" as she did not send for her help when trouble struck. Such incidents make this 'bush doctor' want to withdraw from practice even more completely. Some villages have no 'bush doctors' willing to help women with abortions. But many do have spiritual healers whose treatment practices traditionally involve expurgation. While 'bush doctors' heal 'temporal' or 'natural' sicknesses (albeit with 'old fashioned' methods), spiritual healers deal with 'spiritual' or 'supernatural' ills. Unlike the 'bush doctors', they treat problems which are out of biomedicine's ken. An unhappily pregnant woman can seek a spiritual healer's help by claiming to carry a 'witchcraft baby'. A woman doing so makes strategic use of a culturally constructed syndrome in which 'unnatural babies' are

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magically 'set upon' women by jealous or 'grudgeful' neighbors or by those whom they have offended. This syndrome is also used to make sense of the symptoms generated by tumors and other disease states or to explain unusual births [72]. Treatment can involve grand sums of money, ugly public confessions or accusations and lengthy spiritual cleansing in addition to physical expurgations. Almost all of the participants had tales of full-term 'witchcraft babies', which take the shapes of lizards, cow heads and other disgusting things. But many 'witchcraft babies' end up as 'unnatural' miscarriages in which they are revealed as frogs or toad-like creatures. Similarly, real or 'natural" babies are known to resemble frogs before they 'form up'. So, finding herself pregnant, a woman desiring an abortion can decide that a frog and not a fetus occupies her 'belly'. This way, she can seek help from a specialist and her purge will be socially sanctioned and deemed ethnomedically necessary. The following case illustrates how 'witchcraft baby' works. Mrs Brown was about 50 years old, very poor and already the mother of seven dependent children when she found herself pregnant again. Thinking that her 'belly' held a frog, Mrs Brown sought help from a local healer. Her husband put her on their last donkey (the rest had died of overwork and lack of food, as the couple had come upon hard times) and 'carried' her over the hill to the healer, who prescribed what another healer told me was a purgative. The second healer, Mother Elnie, knew this because Mrs Brown's daughter paid her a visit, seeking help for her mother's predicament. She advised the daughter to fetch Mrs Brown before she took that medicine. After listening to Mrs Brown's story and 'sounding' her body by groping it, Mother Elnie declared talk of frogs 'pure foolishness'. According to Mother, Mrs Brown did not think her 'belly' held a frog until after having a discussion with a 'bad minded' neighbor who convinced her this was possible. But her 'belly' actually held a 'natural' baby; to take 'washout' would be to "dash away pickney'. To Mother, this would have been an evil deed. Mother promised to help the family through their hard times and to pray for them. Mrs Brown decided to have her baby after all. In her attempt to justify 'washing out' a conceptus that she would have had no means to support, Mrs Brown made strategic use of a cultural tradition in which women are impregnated with frogs by the action of witchcraft. She may have done so unconsciously; she may have honestly mistaken her condition, perhaps by connecting it with a past wrongdoing or through suspicion over someone's grudgeful intention to harm her. But chances are that Mrs Brown knew full well what she sought to do and also knew that without a cover a healer might not have given her advice. Mother Elnie lived closer to Mrs Brown than the first healer did but it was known in the village that Mother would never have colluded in an abortion----even when disguised. (Had the abortive 'washout' been taken, proof that Mrs Brown had indeed carried a frog would have been found in the aborted matter.) The lack of explicit references to abortion by many women seeking or giving them does not always mean

that the intention is not there or that everyone remains unaware of it. Jamaican conversational style and rules of conduct in regard to others' business demand that speakers leave much to listeners' imaginations. Culturally provided discourses which justify and actually call for cleansing the 'belly' of unwanted matter get used strategically and diminish the need for direct talk of abortion. Not directly signaling their intents allows people to act in collusion and hide what is ideologically unpalatable a b o r t i o n - - w h e n by doing so they can profit. CONCLUSIONS

Abortion cannot be made sense of unless the influence of traditional health and kinship beliefs on women's reproductive behavior and experience is examined. Importantly, the Jamaican data demonstrates that biomedical understandings of abortion, which collapse the distinction between pregnancy termination and menstrual regulation, are inadequate for cross-cultural abortion-related research. Linking abortion rates (however arrived at) to the cultural value of children while ignoring ideas about parenthood is, similarly, too simplistic. In addition to demonstrating the relationship between abortion practice, the ethnophysiology of procreation and general health traditions, the data show that ethnophysiological understandings and ethnomedical practices are linked to the broader sociocultural context in which they are put to use. Methods for physical cure and health maintenance suggest techniques for restoring the health of one's social circle, too: in Jamaica, both physical and social health depend on unimpeded flow. A woman who misses her period is allowed a variety of ways to interpret her predicament. Her reproductive tract may be blocked (with 'cold' or other matter) or she may be pregnant. As conception is seen as a process, she may carry a blood clot or a fetus, depending on how far along she is. She may even carry a 'witchcraft baby', although this does not happen often. Importantly, pregnancy is not the default interpretation. Often its symptoms are interpreted as a 'bad belly' or a reproductive blockage and it is treated accordingly, with a generic 'washout' or with an emmenagogue. When in doubt about their reproductive status, women can use ambiguous traditions concerning the curative, preventative and even fertility-enhancing qualities of 'washout' to their benefit. Women restore missed periods without recourse to abortion and so without having to act anti-socially--and without having to acknowledge that the dual cultural goals of having children and of being able to care for them well are often incompatible (economic pressures and the adversarial nature of gender relations make them so). When abortions must be had, people justify them as exceptions, calling attention to their valuable conservative effect on social networks that would

Abortion traditions in rural Jamaica otherwise be weakened by the additional demands brought by new, dependent members. Abortion affords individual women one way to control their lives, helping them resist total subjugation to biology and to men who 'spin you around' with false promises. It gives women a chance to achieve more for themselves and so for their children than would be possible with large numbers of offspring. In specific circumstances, abortion becomes the pro-social choice for rural Jamaican women. Ironically, it serves as an idiom of resistance to modern liberal individualism by strengthening group cohesion, even as it expresses individuals' intergender and economic problems. But unless women voice their personal protests in public view, the ideology surrounding abortion-in-general will obscure this. Until its altruistic dimension is acknowledged and it is accepted as a useful, pro-social practice abortion will remain stigmatized and, even though its practical effects will still be felt, its potential to subvert prevailing systems of gender and economic oppression will be muted. Acknowledgements--The larger study of Jamaican health traditions and their uses from which this essay draws was carried out with the guidance of Frederick G. Bailey, to whom I owe great thanks. I am also indebted to Thomas Csordas and to Patricia Antoniello, Barbara Rylko-Bauer, Harvey Smallman and Lynn Morgan for commenting on earlier versions of this article and to Mark Nichter, Alice Schlegel and William Wedenoja for their support.

REFERENCES

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