Review of No Alternative: Childbirth, Citizenship, and Indigenous Culture in Mexico. Rosalynn A. Vega, Austin, TX: University of Texas Press, 2018, 238 pp.

Reviewed Book

No Alternative: Childbirth, Citizenship, and Indigenous Culture in Mexico. Rosalynn A. Vega, Austin, TX: University of Texas Press, 2018, 238 pp.

Rosalynn A. Vega’s No Alternative: Childbirth, Citizenship, and Indigenous Culture in Mexico is a deeply theoretical and richly ethnographic critique of the relationship between traditional midwifery and the humanized birth movement in Mexico. It is important to note that my own research overlaps geographically and temporally with Vega’s, although our specific interests and conclusions diverged in significant ways.

A central strength of Vega’s work is the breadth of her data and the range of her field sites and informants. Her commitment to multi-sited ethnography is evident throughout each of her chapters, as she weaves together cases from across Mexico and from varying kinds of practitioners and advocates. She spent 28 months in the field, during which time she clearly formed deep connections with many of her key informants. She also followed leads to track down practitioners and attend events across Mexico and beyond. She describes visiting an upscale obstetrician in Monterrey who is frequented by helicopter-chauffeured clients, but she also describes the lives of rural traditional practitioners. Rather than feeling disjointed, Vega’s ability to tack back and forth between her diverse field sites reveals the concerns shared across geographic space, as well as the trends that themselves define or restrict spaces. Such revelation ties in well to Vega’s assertions about the importance of place in the differential access to resources in Mexico.

Vega’s central concern is with how “traditional Mexican midwifery is transformed into a series of commodified practices that are then marketed in other countries, and how humanized-birth techniques originating in the Global North are combined with ‘traditional’ methods through a New Age logic that confounds Euro-American notions of chronology and progress” (p. 152). From medicinal plants associated with traditional midwifery to objects and techniques (such as the use of the rebozo shawl during labor)Vega traces how select symbols of Mexican-ness have become commodities that travel beyond their geographic origins and whose applications may extend beyond their original intentions. Vega’s concern is that, as such commodification occurs, the realities of life for traditional midwives are obscured; that is, the more that “traditionalities” (as she calls them) are disrupted from their places of origin and put into global circulation at a price, the less those who rely on them can lay claim to full authority over them.

Throughout her book, Vega reminds us that the process of commodification is unequal in its effects. To understand her analysis of this inequality, it is important to clarify her distinction between humanized birth proponents and traditional midwives, a distinction that she paints as clear cut and vital to a reading of the directionality that knowledge flows and the hierarchies within which power is distributed (although in my own research, such distinctions were not always as clear). For Vega, humanized birth proponents appear generally as educated and urban, often originating outside of Mexico, and charging more for their services. Traditional midwives are categorized as largely indigenous, practicing in rural regions, lacking institutionalized education, and not making much money from their work. These distinctions, she argues, create the conditions within which unequal commodification occurs.

While Vega describes numerous commodities born of the humanized birth movement (which she locates as originating in the cosmopolitan, Global North) that have made their way into alternative Mexican birthing practices, it is the commodification of Mexican-origin traditions that she finds damaging. In particular, she is concerned with the ways that the humanized birth movement embraces traditional Mexican practices, employs them in conjunction with other kinds of methods, and potentially exploits them. She argues that the “[h]umanized birth movement inadvertently commodifies indigenous culture in symbolically cannibalistic ways” (p. 24). Race, class, and gender are the key lenses through which Vega examines this process, and she seeks out opportunities throughout the book to uncover the role privilege plays in determining who gets credit, who maintains power, and who can make a living as a midwife in Mexico. When describing this cannibalism, however, I would have liked to see Vega discuss the uptake of biomedical birth techniques among traditional midwives, to balance her analysis about the flows of knowledge in health care.

Commodification depends on a market, however, and Vega asserts that certain kinds of educated, breastfeeding, organic food-buying, yoga-practicing parents are in part driving this market. Vega calls such parents “aspirationals” and claims that “these parents view themselves as actively resisting materialism,” but notes that “their very refusal of the corruption they diagnose in consumerism, nationalism, and late capitalism leads to the commodification of culture, heightened moralization and gradation of motherhood, reinscription of racial hierarchies, and (false) appropriation of indigenous notions of spirituality” (p. 96). While I find Vega’s analysis of the drivers of commodification compelling, her conclusions about what drives parents to seek out more humane birthing conditions could have been strengthened with more data from diverse parents about their experiences and desires. Might some parents who would not be classified as aspirationals also want more humane treatment in birth, given the ways many women are treated in Mexican public hospitals?

Vega is concerned throughout her book with practicing “hyper self-reflexivity” as part of her broader critique of power and privilege. She describes her own privilege and illustrates the ways she tried to shed it and how that process in turn impacted her research, relationships, and her health. This kind of detailed, personal reflection contributes to broader disciplinary conversations about positionality. However, in some cases her approach raises questions about how much anthropologists can truly experience the kinds of discrimination faced by their informants. For example, in one case, Vega describes how she and a midwifery student attempt to use a Starbucks bathroom to see if they will be barred because of how they look (and are turned away because they have no receipt), while in another, Vega sits, writing in a book at a library café, wearing clothes and a hairstyle that a local woman might wear, to test whether the waiter will ask her to leave if she does not order anything (which he does, though he notably does not ask the same of a nearby white woman) (pp. 110–13). While such cases highlight the kinds of systemic inequalities found in Mexico and are important to Vega’s analysis, their manufactured setups meant that they were not as powerful as those described by her informants alone.

Because of its thoughtful engagement with theory, No Alternative would be well suited to graduate courses interested in long-term, multi-sited ethnography, and to a critical examination of reflexivity in anthropology, although undergraduates would also benefit from its rich descriptions and core arguments. Vega adds important provocations and depth to scholarly and activist conversations about power in health care in general, and about the intersecting forces that direct flows of knowledge and authority in the field of childbirth in particular. Further, her work adds to scholarship on indigeneity in Mexico by providing clear examples of the ways in which indigenous populations’ access to and experiences of reproductive healthcare are curtailed. She brings to light concerns that speak beyond Mexico and the world of midwifery about how health care interventions are designed and who they ultimately benefit.