"A Rich, Multivocal Collective Text": An In-depth Review of NCNV
The review below was originally published in the March 2001 issue of Sojourner: The Women's Forum, and is posted here with the permission of the author and Sojourner.
Este articulo en Español.
Nuestros Cuerpos, Nuestras Vidas: La Guía Definitiva Para la Salud de la Mujer Latina
Por La Colectiva del Libro de Salud de las Mujeres de Boston
Siete Cuentos Editorial, 2000, $24
Reviewed by Ana Ortiz
(Notice to English language readers: Learn Spanish right now!)
In 1992, The Noyes Foundation provided funds for what seemed a "simple" translation project: take the premier women's self-help health encyclopedia, Our Bodies, Ourselves, and produce a Spanish-language edition.
Instead of approaching the task as one of literal translation, however, the Boston Women's Health Book Collective sought to create a resource that would take into account the local histories and contexts of the potential Spanish-language users, thus avoiding the kind of conceptual imperialism that characterize endeavors of this type. The collective sought out and recruited an impressive network of collaborators from the Caribbean, Mexico, Central America, and the Southern Cone nations, in addition to expanding the role of Latina organizations that had worked on Our Bodies, Ourselves, such as Amigas Latinas en Accion Pro Salud.
The paradox is that in creating an 'adaptation' of this classic self-help manual for a specialized population (i.e. women in Latin America and Spanish-speakers in the United States), the resulting product is actually of greater value and utility to the hypothetical "general population" that forms the original volume's readership than is the English-language edition. The impressive work carried out by the contributors and editors of Nuestros Cuerpos, Nuestras Vidas has created a powerful testimony to the social justice principle that affirms that it is in attending to the needs of those at the perceived margins and greatest socioeconomic disadvantage that the needs of many, and of those "at the center," are best served. The Spanish-language text assumes an environment of aggressive neo-liberal policies -- including a retreat from state provision of basic human needs and the increasing commodification of healthcare -- that applies equally to many women in the United States. The collapse of healthcare infrastructures is a reality all too familiar to women living in rural and inner-city areas of the United States. The cultural resources that women bring to bear on these challenges -- represented in the text by well-selected poems and testimonies, and histories of organizations and health-centered political movements in Latin America -- are tools that need to be integrated into the organizing and self-help practices of so-called "mainstream" readers.
'To Know is to be Able'
The book opens with a section titled "Saber es Poder," which loosely translates as "Knowledge is Power," even though the Spanish phrase conveys the overarching theme of activism much better, since it has a secondary meaning of "to know is to be able." This section is required reading for anybody who can use a concise, well-organized discussion of how overseas development affects women's well-being at home and abroad, and lucidly explains who profits from ill health. In response to this scenario of global networks of oppression, the Grupo de Mujeres de San Cristobal of Chiapas (as primary authors) provide a chapter on how to organize for change, which complements detailed descriptions of organizing strategies drawn from Latin American and Caribbean examples. Particularly inspiring is a section on how women's organizations have achieved the formation of massive coalitions and alliances to force government response on issues ranging from providing healthcare to women of African descent (Uruguay) to reducing maternal mortality (Nicaragua).
The second section of Nuestros Cuerpos, "How to Care for Our Health," does a fine job of presenting a biopsychosocial approach. The chapters on exercise (primarily adapted by Venezuelan health activists), and on environmental and occupational health stand out as remarkable achievements. While the chapter on nutrition acknowledges structural constraints on women's food choices, it does an inadequate job of presenting women with guidelines on how to make "good enough" choices in very difficult circumstances (such as incarceration); however, I was pleased to see attention to dental health and micronutrient deficiencies included in the text.
The chapter on "Women in Movement," by contrast, discusses options ranging from the resource-intensive (such as swimming in pools) to yoga and meditation, which can be carried out by individuals with limited space and equipment. Like the chapters in the first section, the chapter on environmental and occupational health makes excellent linkages between the international and U.S. contexts. This chapter is useful for both understanding the futility of exclusively pursuing legislative solutions to workplace safety (the laws are just as detailed and just as ignored in Argentina as in the United States) and for helping women workers see their precarious situations as generalized and intentional within the processes of global profit-making. Women working in the U.S. prison-industrial complex will no doubt identify with many of the constraints on reform and organizing faced by women in free trade zones overseas.
The problems with this section of the book are worth noting because they are amplified in the last two sections of the book, which focus on maternity and reproductive health. Even though psychosocial processes are well-integrated into all the chapters in this and subsequent sections, the chapter on mental health is unforgivably short and skirts the Issues of power and agency that are so visible in the rest of the text. Perhaps because of the stigma still accruing to those conditions loosely clumped under the term "mental illnesses," there are no testimonies or examples of women organizing here. There should be, especially given the many vibrant self-help entities available for inclusion as examples, such as the "clubhouse" movement, which provides social support and affirmation for persons coming out of psychiatric hospitals. The section on reproductive health provides detailed information on the benefits and risks of a variety of contraceptive methods, including pharmaceutical ones. Surely comparable information could have been included on psychotropic medications, for which women constitute the primary market.
'Maturing' into Modern Diseases
As "developing" countries see their populations "maturing" into the diseases of modernity, understanding certain problems as psychiatric in nature is an expanding global trend, even though a commitment to appropriate and meaningful mental health services has practically disappeared in the United States. Impaired mental health -- whether in the form of serious illness or the stigma of a politically charged label -- is an added burden many women face as they negotiate the healthcare system and try to maintain their overall well-being. It needs to be treated as part of the expected context within which women are claiming their health. By the same token, there is only the briefest of mention of infectious diseases that are not sexually transmitted, even though tuberculosis is a major problem in poor communities and in prisons in the United States.
There are many other conditions or ways of being that are treated in the text as parenthetical, or as "special cases" that are exceptions to the rule. These include disabilities and chronic conditions such as diabetes and hypertension. For the target population of this text, however, these are not "unusual" conditions. In the section on pregnancy and contraception, for example, diabetic women are set aside as high-risk cases who cannot have happy, healthy pregnancies, or for whom the pill is contra-indicated. This sends a very dour message indeed, and one, which runs counter to the program of empowerment that Nuestros Cuerpos is committed to. In fact, hypertensive women, diabetic women, and women with different disabilities can have happy, healthy pregnancies and can successfully use the pill, and they need to read about it in Nuestros Cuerpos.
This problem of losing sight of how heterogeneous the readership is, and of how common it is to fall outside biomedical definitions of "nor- mal," is absent in the third, well-written section of the book, which is on relationships and sexuality. There is a fascinating history of lesbians organizing in Mexico here, as well as more familiar materials on sexual empowerment that recognize many different kinds of women as sexual beings. Both the possibilities of pleasure and experiences of abuse are presented as common to large numbers of women, and thus the text serves to counter isolation and misinformation. For those readers who must deal with censorship, the relatively sparse and tame photos do not reflect the detailed, user-friendly descriptions on how to pleasure one's self and others.
Ringing with Passion
I will be rather brief in reviewing the last two sections of the book, because with the exception of the chapter on abortion, these parts of the text most closely follow the English-language version. These sections ring with the passion of the original Boston Women's Health Book Collective, and they continue to provide the most comprehensive manual for women to monitor their health status in these areas. Readers of Nuestros Cuerpos will certainly know more than the average physician providing care in correctional facilities: physicians practicing in these settings are more likely to be "impaired" physicians (physicians whose practice histories have led local medical associations to require increased monitoring as a condition for keeping their licenses). The most commonly used textbook in prison medicine, Michael Puisis' Clinical Practice in Correctional Medicine has a total of 25 pages of text on "women's health" and reproductive health, versus Nuestros Cuerpos' hefty 605.
Beyond its use in personal health maintenance and healthcare organizing, readers should consider using Nuestros Cuerpos for a variety of other purposes. Because of its breadth it is appropriate as a text for Spanish language classes, and for women's studies courses on activism, women in Latin America, and health. Women in need of hope and motivation can draw from the inspiring case studies, as well as from the creative spirit of Julia de Burgos, Claribel Alegría, and Marjorie Agosín (among others), whose works are included in the text. BWHBC is to be applauded for having evolved a process to produce this rich, multivocal collective text.
Ana Ortiz is an assistant professor of medical anthropology at the University of Arizona.
© Sojourner, 2001.
Spanish version of this article