Pluralism and pragmatism: Knowledge and practice of birth in Morocco

This article examines knowledge and practice surrounding birth in Morocco; using women's narratives of their recent birth experiences, observations of medical encounters, and statements about prescribed behaviors during pregn ancy and birth, as well as the vocabulary used to refer to physiological pr ocesses, disease conditions, and social relationships. The analysis shows t hat the three major themes that define the traditional Moroccan ethnophysio logy of birth-conceptions of hot and cold, the symbolism of blood, and the metaphors of openness and obstruction-are not inconsistent with the precept s of biomedicine and public health and do not in themselves constitute obst acles either to safe home births or the use of formal health services. Wome n integrate biomedical and local knowledge and practices and simultaneously seek care from "traditional" and "modern" practitioners, creatively combin ing elements in accordance with their situations and the means at their dis posal. Birth narratives show the eclecticism and flexibility that character ize women's attitudes and behaviors regarding pregnancy and birth. Women's decisions are shaped by two overriding considerations: incertitude about wh at can happen during the last phase of a pregnancy and ambivalence toward t he available alternatives for care, both of which reflect a realistic asses sment of their situations. By showing how women make decisions in response to these considerations, this article seeks to clarify some of the links be tween beliefs and practices and to contribute to ongoing discussions regard ing the relevance of local knowledge for patterns of health care.