Reproductive Labors: Women’s Expertise and Biomedical Authority in Mali, 1935-1999

Over the 20^th century, Malians relied on local reproductive specialists: excisers (who oversaw initiation and circumcision ceremonies), nuptial counselors (who provided sexual education at marriage), and midwives. These older women’s work remained vital to social conceptions of proper reproduction, even as the biomedical maternal health system expanded, and Malians adjusted to new forms of religiosity and new ideas of status. Reproductive Labors: Women’s Expertise and Biomedical Authority in Mali 1935-1999 traces how, as biomedical care expanded over the 20th century, women and their families, feminist activists, medical professionals, and non-profit workers began to debate the importance of local reproductive practices.

Part 1 explores the role of specialist labor in socializing sexuality and gender norms. In Chapter 1, I argue that following the end of slavery in the early 20^th century, Malian families used nuptial counseling to instill concepts of honorable sexuality and demonstrate status at marriage (1935-1958). After independence, public outcry over unwed mothers revealed different visions of extra/marital sexuality and adolescence for nuptial counselors and state-affiliated women activists (1959-1986). In Part 2, I turn to reproductive health interventions. Chapter 3 reveals how the colonial maternal health system relied on external actors, from benevolent associations to Malian midwives, all of whom defined women’s bodies as childbearing bodies (1935-1958). Successive post-colonial governments sought to develop policies to ensure rural health access, toggling between training medical professionals to work in rural places and training local specialists, such as midwives, in biomedical techniques (1957-1976). The integration of midwives into biomedical clinics created substantial overlap between various therapeutic interventions, as I show in Chapter 5. Finally, Chapter 6 demonstrates how Malian participation in anti-excision activism owed as much to previous debates over marriage, unwed mothers, and rural maternity care as to transnational feminist movements and developmentalist interventions (1984-1999).

Reproductive Labors is based on interdisciplinary research in Mali, Senegal, France and the US, including archival research, oral histories, and ethnographic work. In addition to working in national archives, the project engages with the floatsam of project reports now safe-guarded in people’s homes, bureaucratic documents from institutional archives like Mali’s National Health Directorate, and student theses. However, women’s specialist labor is less visible in archival material. In response to this elision of gendered knowledge, the project integrates ethnographic observation and French and Bamanakan oral history interviews with women specialists, as well as medical personnel and gender-rights activists.

Reproductive Labors demonstrates how Malians were socialized into heterosexuality not simply through family or media, but through specific specialist interventions which linked heterosexuality to biological reproduction and gendered identities, deepening key themes in gender and sexuality studies. Reproductive specialists’ expertise was defined by their gender, skill, age, and social status, as most were older women of endogamous social group descent. Conversely, the activists who campaigned against them were usually highly-educated young women with close ties to international feminist institutions, although these linkages were structured by the colonial afterlives of educational and financial networks. Over the 20th century, questions about which group should have authority over young women’s reproductive experiences led to numerous debates for women and their families. Secondly, this project demonstrates that the continued value of local specialists for Malians, alongside the medical system’s reliance on external actors and instability in rural areas, created a specific form of Malian biomedicine driven as much by local therapeutic practices and social hierarchies as by international norms, enriching recent scholarship on the local specificities of biomedicine. Finally, this dissertation deepens scholarship on state-making in Africa. It demonstrates that reproductive health was not simply a subfield of the post-colonial Malian health system but that it became a key site for innovation in governance. As the first academic history of reproductive health in Mali, which has one of the world’s highest rates of maternal and child mortality, this dissertation seeks to understand the history of reproductive practices as a step towards reproductive justice.