In Childbirth, Maternity, and Medical Pluralism in French Colonial Vietnam, 1880–1945, Thuy Linh Nguyen, professor of history at Mount Saint Mary College in Newburgh, New York, examines the pluralist system that emerged out of French colonial administrators’ attempts to Westernize childbirth practices in Vietnam and the eventual compromise and integration of traditional childbirth practices. Relying primarily on French archives and Vietnamese printed materials, Nguyen illustrates the colonial administration's initial strategy to medicalize reproduction and institutionalize childcare. She examines the two-way exchange between French medicine and Vietnamese society, and the struggles that existed in governing maternal health and infant care between colonial administrators and the Vietnamese. Aside from humanitarianism, the state's objective was to improve the overall health of future laborers and create a society of robust citizens.
Chapter 1 illustrates the French reconstruction of Vietnamese culture and the relocation of Vietnamese childbirth into a clinical setting. French medical administrators employed scientific measures to justify colonial state objectives with bio-anthropological research, including a racial categorization of indigenous ethnicities. Furthermore, administrators conducted surveys to compile a demographic profile of Indochina (p. 25). The surveys were complicated by discrepancies in death and birth registrations, and low population numbers that were inconsistent with medical studies indicating high fertility among Vietnamese women. These findings prompted colonial administrators to assess cultural birthing methods and traditional midwives, bà mụ (old style); they found that infant umbilical tetanus was the primary cause of infant mortality. Describing traditional methods as backwards, the administration linked decreasing birthrates to the “primitive” practices, further justifying a medical intervention and medicalization.
The second chapter discusses the establishment of maternity hospitals. The first maternity wards were add-ons to the main hospital in Chợ Lớn. Maternity hospitals were also a source of racial and class tensions, separating European women (regardless of class) from Vietnamese and indigenous women.
Chapters 3 and 4 discuss école des sage-femmes (midwifery school) and integration of the bà mụ. Nguyen asserts that the conception of maternal policy in Indochina was not without failures and addresses the social struggles across race, class, and gender that resulted from the clash between Vietnamese and European societies. Upon certification completion, colonial midwives were assigned to rural areas for extended periods of time. As a result, the administration faced issues retaining colonial midwives. Many requested transfers or leaves of absence, or abandoned their post altogether. Administrators failed to recognize the cultural and societal roles of Vietnamese women, which resulted in a high turnover rate and lackadaisical birthing practices. Childbirth pluralism emerged as a result, and administrators slackened midwife school admission requirements. Lack of the French language had prevented the bà mụ from entry into the program, but without the requirement, they could complete the certificate and practice in their villages, where bà mụ were more trusted than colonial midwives. However, the French continued to underestimate the bà mụ and neglected to offer a stable salary, even as colonial midwives were granted such benefits. They relied entirely on service charges and gifts from clients. Nguyen discusses how, despite these challenges, the colonial administration conceded to a health system that correlated with the demands of the local traditions and placed more emphasis on women's professions in Vietnamese society.
Chapters 5 and 6 discuss the science of motherhood and childcare during the Depression Era. Here Nguyen examines the administration's focus on infant survival and goals to decrease the infant mortality rate. Nurseries were implemented to promote Western-style childrearing education, hygiene, and feeding schedule programs. Catholic churches played a role in managing crèches (day nurseries) and orphanages to cope with abandoned children due to economic hardships and illnesses, such as gastrointestinal diseases, that plagued children. The global food corporation Nestlé promoted infant care under the banner of science (p. 146) and provided orphanages and crèches with nutritional supplies. With the intention of assisting working mothers, the daycares benefited a certain class of families, thus the administration's failure to acknowledge Vietnamese family traditions. Nguyen credits the administration for improving infant survival and health by implementing motherhood counseling programs and introducing puericulture (p. 145).
Throughout the book, Nguyen emphasizes medicine as a tool of health improvement and posits that, through local resistance, Vietnamese women helped create a pluralistic system. Despite her reiteration of the key issues between colonial administrators and Vietnamese birthing practices, the book is strengthened by Nguyen's use of French archives and comparative literature. Through the use of physician and midwife reports, and a memoir, the book offers insights into the clinicians’ and student-midwives’ experiences. In addition to colonial Vietnamese literature, she also draws from sources with perspectives on reproductive health history across cultures, including American, European, and African. Moreover, Childbirth, Maternity, and Medical Pluralism in French Colonial Vietnam provides a provocative obstetrical history that is valuable in understanding contemporary issues regarding women's bodies and reproductive health governance.
