Jada Senior

Department of Women and Gender Studies/Anthropology 388

ANTH 388: Cultures, Pregnancy, and Birth

Dr. Kathryn Luchok

4-26-2023
 2

The Conception of Pregnancy and Cultures in South Korea and Brazil

Bernadette Boussada, a Brazilian OBGYN, learned from traditional midwives in rural

birthing that “the two most important things the traditional midwives taught her were (1) respect

for the woman, and (2) respect for the physiology of birth.” (Davis-Floyd, 2017, p. 148)

Respecting the physiology of birth and the overall female body is essential. Universally

pregnancy and birth is associated with “women's business” and often birth is standardized to be

handled as a pathological emergency which requires surgical and advanced technological

interventions. The fear based mindset created around birth and pregnancy is to create a belief that

the female body is being attacked and putting itself in harm's way. In terms of health equity and

access, Brazil and South Korea are two unique countries facing maternal and child health battles.

Brazil is a large culturally diverse nation with issues of violent technocratic births. South Korea

is known to be a business oriented society with a fertility crisis. The cultural context and

traditions of both nations is important to further examine the evolution of childbirth and

pregnancy, quality of care, and to understand the women’s self perception as a potential mother

in their cultures.

Brazil, like the United States, is always referred to as a "melting pot" of many cultures

and ethnicities. This paradise consists of Black, biracial, and Indigenous women being unjustly

represented in maternal and health. Economically “The average monthly income of Black and

Brown people (pretos and pardos) in the city is nearly three times lower than that of Whites

(brancos) (IBGE) (Davis-Floyd & Cheyney, 2019, p. 92). Socially and systematically

comprehending how being a preta is a huge sociodemographic factor in maternal health and

overall acceptability is a motivation to want better for the future. Primarily affecting pretas it is
 3

more common to have underlying conditions such as chronic hypertension, sickle cell, and

HIV/AIDS. In a research study trying to find a correlation between skin color and the birth

outcomes it's conclusions and results were drawn from over 80,000 live births which showed that

"White women with SMO had a higher prevalence of other relevant conditions: low weight,

neurologic disease, cancer, and drug "addiction" (J. G. Cecatti et al., 2019). On the other hand,

black mothers are suffering from worse conditions of delivery and perinatal outcomes were

consistent in being more severe. Increased risk of preterm deliveries, bleeding, infections, low

birth, stillbirth, and NICU admissions was heavily associated with Black births. The largest

population of African descent outside of Africa is Brazil as little over 50% of Brazilians identify

as Black. According to Times (2020), they only hold weight in ““18% of congress, 4.7% of

executives in Brazil’s 500 largest companies, 75% of murder victims and 75% of those killed by

police.” Brazil has never experienced a limiting systematic discrimination in laws such as

Apartheid or Jim Crow laws but white supremacy and privilege still reigns the nation. In the

1930s an attempt to increase Portuguese and European immigrants and labor, the government

and media promoted the beauty of Brazil. Mischievously the government and scientific goals of

this movement was to promote the natives “to marry and have children with the descendants of

white colonizers, as well as an influx of European immigrants, in order to produce increasingly

lighter-skinned generations and “whiten” the country” (Nuggent and Regina 2020). This

erotization of Black and native women combined with fetishization of biracial children as a

product of interracial marriage. Everyday language has controversial terms such as mulata which

was once degrading names for mixed race slaves and is now used as a common term for biracial

Brazillians. Though The Root does mention how 70% of Brazillians marry within their race in

the past few decades. The reality is socioeconomic and income is a huge determinant of marriage
 4

and dating in Brazil. The Root references a study done where “high-level black Brazilian

businessmen in 2011 found that out of the 50 interviewed, 49 were married to white women '' as

an example of the practicality in family planning and racial relations pretas. This sense of

pushing away from their identity can be a subconscious mechanism of survival for both the men

and women in Brazil. As once the economic and career barriers are crossed, in order to seem

reputable in higher societies a white spouse serves as emphasis and explanation on how you got

so far by dissociating from quilombo or black people from favelas. Women’s work and education

achievements are a reflection of their dating life. Bolina (2020) recalls experiences as preta in

Brazil and how amongst all siblings it was found they “have different levels of education where

darker siblings are more likely to drop out of school at earlier ages than their white brothers or

sisters. In that study, all factors besides discriminatory treatment on the basis of race (by

teachers, parents, etc.) are strictly taken into account.” Access to education and work is defined

by color in Brazil. In a home with multiple color siblings we see similar macros levels of

influence but the micro level of skin complexion is essential for professional opportunities and

desirability to fill positions.

South Korea birth outcomes issues are unique as they have reported the world's lowest

fertility rate frequently in the past decade. Many women are calling off their childhood dreams in

exchange for more realistic goals to their current circumstances. Rising cost of living and

housing, oversaturated and competitive job market, and alarmingly failing marriage rates are

causing disinterest in pregnancy. In the last decade, marriage rates in North Korea have dropped

by more than 35%, statistically supporting the trend of Koreans pursuing to break the nuclear

family tradition. For those who would consider having a child later once they are financially

stable, freezing their eggs early can serve as an effective method of having a safe pregnancy
 5

when they are older. The reality is the process isn't quick and easy financially or physically.

Increase in the maternal age as the new normal defying the concept of the biological clock as a

limit. The historic norm was for young adults to get married and have children as soon as

possible in their 20s, for chances of parenthood. Alternatively, some people may view older

parents as a threat because caring for a child can be difficult with energy levels. The nature

perspective oppositions will mention the chances of biological effects and congenital disabilities

are higher. These are essential factors to be considered for health and increase in potential

underlying conditions in older mothers. According to Ahn (2023) South Korea isn't alone as

China recorded its first population decline in decades and “In 2020, the United States saw 43

states register their lowest fertility rates in at least three decades” The U.S. Census projects

concern that 65 and older people will outnumber all minors by 2034. An aggressive approach is

necessary as when you have the elderly population outnumbering the younger people, there

won't be enough younger people to work for the economy and provide care to the older

population. The article also mentions the government's failed attempt at pouring more than $200

billion into programs to incentivize and encourage women to give birth in the past 16 years. In

response the fertility rate dropped more than 25%. This method is only covering the root of the

issue; aside from the high cost of living and economic issues, many countries that have a high

importance on work life have a lower fertility rate. Especially in Korea where sexism in the

workforce is still making it very rare for women to hold high executive and manager positions.

These minority of women in power work tirelessly to maintain their seat at the table so taking

maternity leave to the corporation may decrease their productivity levels and many fear that they

will be terminated or disqualified from the competitive culture. Perhaps this wave of feminism

and resistance will help dismantle the patriarchy in Korea that is holding women back from
 6

having an equal chance in the race. But considering the sexism and pay gap, the necessary years

of catching up to get financially and personally prepared for motherhood, the reproductive years

may be over. Although if this plan does work in society, the Korean males, government, and

medical providers will realize the worth of women’s choice in reproduction and keeping the

population going. Firstly stopping the unfair work culture by allowing women equal chances to

job stability and proper maternity leave.

Medical aesthetics and cosmetic surgeries are the intersection of health and beauty. Korea

and Brazil are leading markets internationally in both arenas. The Brazilian butt lifts, Korean

skin whitening products, face surgeries, and Brazilian waxes are examples of invasive and

noninvasive maintenance routines expected of these women. Acknowledging this market of

medicine and lifestyle is significant as it impacts women's self esteem and goals. In an interview

amongst young Koreans and their perception of aesthetic surgery, many associated attractiveness

as a pivotal factor for employment success. “Interestingly, participants indicated this is more

helpful for potential female job applicants than males.” (Park,Myers, Langstein, et al. 2019) The

concept of "lookism" or "외모지상주의" is a term defined by the National Institute of Korean

Language as "prejudice or discrimination based on physical appearance." To their Brazilian peers

there isn’t a specific name to this but the public perception around cosmetic surgery is

supportive. As many citizens place “ high value assigned to the corporeal self by Brazilians and

also identified the body itself as a status symbol, and that recognizes physical appearance as an

essential element in the construction of a national, Brazilian identity [21].” (Denadai et al.,

2016) Therefore the financial upkeep of cosmetics procedures prior to and after a child is a

burden for women to consider as it's imperative in their careers and or community which they

take huge pride in.

 7

It is essential to recognize and respect all cultural practices of birth and medicine,

especially as providers and citizens who experience cross cultural interactions with patients

daily. In the comparison of birthing and labor experiences in South Korea and Brazil, the focus in

this paper will remain on midwives practices and outcomes as both countries are aiming to adopt

the Midwifery model due to negative statistics and mother’s experiences. A summary on birth

outcomes in hospitals in these countries is that the universal birth today in both nations is

adopted by the technocratic model of birth that has overridden traditional medicine and home

births. Davis-Floyd & Cheyney, (2019) explained in Brazil “Particularly since the latter half of

the 20th century, the vast majority of women give birth in hospitals and, increasingly, by

cesarean section (CS).” (p. 90). During 2019, the rate of CS was 55% and public health experts

are concerned about the excess of medical interventions and the premature rates due to early

forced surgical removal. Commonly when a mother rejects this routine procedure of “universal

birth”, a lithotomy position and OBGYN, the responses aren't favorable. They will include a mix

of cultural insensitivity, accusations of malpractice, and overall take as a violation to modern

medicine and science. Brazil has high obstetric violence rates and is continuously in the need and

progress to humanize the birth experience. The few holistic based healthcare workers in birth

were limited in numbers and communication during the 1980s and 1990s. Therefore many were

self teachers of the ethical, professional, and medical training not offered at Brazilian

institutions. Many of their influence and credited sources come from the honorable Robbie

Davis-Floyd, and two French birth reformers; Michel Odent and Fredrick Leboyer. With help of

Aprenda a Nascer e a Viver com os Indios (Learn How to Give Birth with the Indians) and Birth

in the Squatting Position, a birth refromer physician and professor, Pacirnil and Hugo Sabtino

sparked the conversation of on squatting and alternative birthing methods for citizens. In Brazil
 8

the role of obsteriz were trained by direct-entry professional midwives prior to the trend of

homebirth to hospitals was halted by villainizing nontraditional medical models and practitioners

which replaced obsteriz with nurse-midwifery programs attached to Universities. The new age

direct-entry programs has its affiliation at the University of São Paulo. “Yet nurse-midwives

have made few inroads into Brazilian birthing culture to date—they still attend only 9% of

Brazilian births” (Davis-Floyd 2017). Replacing obsteriz has disregarded traditional and

Amerindian indigenous women years of work and knowledge. Simultaneously, it can deny or

delay humanistic midwives to practice if barriers to transportation, income, or acceptance rates to

nurse-midwife programs overruled. Presently the gap of birth inequity was filled by indigenous

and Afro-descendant midwives facilitating in rural and Amazon areas. At the end of a study

interviewing multiple Brazilian humanistic healthcare providers (OBGYN, CNM, OGYN

nurse,etc.) all supported and respected traditional and professional midwives dedication and

contribution to medicine. With the overall belief and confidence that globally “midwives are or

should be the experts in normal physiological birth” (Davis-Floyd, 2017, p. 149). In January of

2003 Debra Pascali-Bonaro increased an influx of doulas in Brazil. While developing doula

programs at the only hospital that allows laboring women to have visitors, the hospital was

experiencing better outcomes with increased requests for doula services. As physicians and

nurses were hesitant and not as welcoming at first, soon they realized the doulas ability to be

emotional and companion support to soothe mothers during high anxious times making birth

easier. From an holistic OBGYNs’ perspective, Ricardo Jones was attempting to lower his

cesarean rates to or below WHO recommendation and stumbled on doula methods of embracing

women but knew the controversial feeling of hugging a woman who isn’t his wife in a vulnerable

state. He ironically ran across a doula named Chrisitina who explained that was her very job and
 9

it clicked. His wife became a midwife later and they practiced this utopian model and team of

birth workers. With proper allocation of tasks and roles for each mother’s circumstances, great

success and satisfaction was made amongst the new team and model. In his attempt to preserve

the integrity of the “psycho-sphere” of birth by keeping interventions and stressors at a

minimum, by retirement, “over half of their births were home births, and Jones’ cesarean rate

had long stood at the 15% that had always been his goal.“ (Davis-Floyd et al., 2019)

“In Korea, where 99.5% of newborns are born in hospitals, midwives are also facing a

crisis due to the deteriorating circumstances in the field of obstetrics and gynecology resulting

from the ultra-low birth rate.“ (Kim 2021) A sanpa were Koreans first lay midwives now

referred to as josansa who today are required to pass a national exam post Midwifery

curriculums with a nursing license. Korean midwives' flexibility in multiple roles in healthcare

began In the 1950s they were responsible for managing infectious diseases, basic health, and

population death or birth rates updates during the Korean war. The Medical Service Act of Korea

has made guidelines for on-site midwives that state: “midwives perform 56 tasks in 7 areas:

pregnancy management, childbirth management, postpartum management, newborn care,

primary health care, law/ethics, and general management [8]. ”(Kim 2021) With the recent trend

of wanting more natural births, keeping up with changing roles along with higher demand, the

midwives are underprepared. Once the push to standardize hospital births, many

dmiwiveshaven;t been able to compete financially with hospitals which results in career changes

or centers closing. The Korean midwifery model in a combination of Korean medicine based

postpartum can provide better outcomes. “Sanhupung” is the cultural disease correlated to

postpartum for which consist of pain related, systematic, and psychological stress related

symptoms. Interventions for Sanhupung are ancient and traditional Asian practices such as
 10

acupuncture, electroacupuncture, herbal medicine, cupping, and moxibustion. In a satisfaction

survey post treatment,“ 85.24% of women reported greater satisfaction with postpartum care that

included KM treatment than with other types of postpartum care that they received following

previous pregnancies.”(Lee et al., 2022) Koreans have a firm belief in building a supportive

community during postpartum care as it is impossible to do so alone with the automatic

assumption that the body is under physical and psychological discomfort and changes. Physically

is a transformative occurrence to that body that exhausts vital substances such as energy (Qi) and

blood (Xue) due to bleeding and loss of fluids. From South Korea, we can see the importance of

self-care for a new mother for the baby to be viable and healthy during the postpartum year.

In conclusion, looking at Brazil and South Korea compares and contrasts societal

expectations, personal goals, and inequalities in maternity healthcare which affects women’s

perception of birth. South Korea is in crisis with the fertility rate which is alarming for

population growth and economic concerns. The governments’ enticing stipend cannot solve the

culture of misogyny and patriarchy in daily life. In comparing the countries, an attempt to return

to indigenous and traditional birth rituals is difficult in today's technocratic medicine. The

collaborative Midwifery model is being pushed in both nations by birth activists and humanistic

providers to expand roles in hopes of reducing health disparities. Everybody must be global

citizens and birth advocates in order to eliminate obstetric violence, continue population growth

and create collaboration between healthcare providers, patients, and policy makers. Constantly

modernizing and advancing birth cultures with interventions is controversial and ethically wrong

of advertisers and health professionals. They are tricking women into believing this is the easy

way to a mess and pain free birth while denying them of the informed consent and the choice.
 11

References

Ahn, A. (2023, March 19). South Korea has the world's lowest fertility rate, a struggle with lessons

for us all. NPR. Retrieved April 20, 2023, from

https://www.npr.org/2023/03/19/1163341684/south-korea-fertility-rate#:~:text=South%20Korea

%20has%20had%20the,woman%20in%20her%20reproductive%20years.&text=The%20drop%2

0in%20fertility%20rates,aging%20populations%20and%20shrinking%20workforces.

Davis-Floyd, R. (2017). Ways of Knowing about Birth: Mothers, Midwives, Medicine and Birth

Activism. Waveland Press inc.

Davis-Floyd, R., Cheyney, M., Dixon, L. Z., Smith-Oka, V., Kotni, E. M., Cogburn, M., Strong,

A. E., Wood, S., Williamson, K. E., Matsuoka, E., Georges, E., Daellenbach, R., Goodarzi, B.,

Wiegers, T. A., & Vedam, S. (2019). Birth in eight cultures: Brazil, Greece, Japan, Mexico, the

Netherlands, New Zealand, Tanzania, United States. Waveland Press, Inc.

Denadai, R., Araujo, K. M., Samartine, H., Denadai, R., & Raposo-Amaral, C. E. (2016,

December). Public perceptions of plastic surgery practice in Brazil. The Indian journal of

surgery. Retrieved April 23, 2023, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218927/

Fernandes, K. G., Costa, M. L., Haddad, S. M., Parpinelli, M. A., Sousa, M. H., Cecatti, J. G., &

The Brazilian Network For Surveillance Of Severe Maternal Morbidity Study Group (2019).

Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for
 12

Surveillance of Severe Maternal Morbidity. BioMed research international, 2019, 2594343.

https://doi.org/10.1155/2019/2594343

Freelon, K. (2016, March 3). Why successful black men in Brazil won't marry Black Women.

The Root. Retrieved April 25, 2023, from

https://www.theroot.com/why-successful-black-men-in-brazil-won-t-marry-black-wo-179085448

Kim K. W. (2021). Expanding the role of midwives in Korea. Korean journal of women health

nursing, 27(3), 167–170. https://doi.org/10.4069/kjwhn.2021.09.09.1

Lee, D.-E., Suh, H.-W., Park, H.-S., Youn, I., Park, M., & Seo, J. (2022, April 27).

Mothers' experiences of childbirth and perspectives on Korean medicine-based postpartum care

in Korea: A qualitative study. International journal of environmental research and public health.

Retrieved May 26, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9105879/

Nugent, C., & Regina, T. (2020, December 16). How Black Brazilians are fighting racial

injustice today. Time. Retrieved April 20, 2023, from

https://time.com/5915902/brazil-racism-quilombos/

Park, R. H., Myers, P. L., & Langstein, H. N. (2019). Beliefs and trends of aesthetic surgery in

South Korean young adults. Archives of plastic surgery, 46(6), 612–616. Advance online

publication.
 13

https://doi.org/10.5999/aps.2018.01172

Rodrigues Bolina, S. (2020). The Lived Experience of a Black Brazilian Woman. The Lived

Experience of a Black Brazilian Woman | Forbes and Fifth | University of Pittsburgh. Retrieved

April 23, 2023, from

https://www.forbes5.pitt.edu/article/lived-experience-black-brazilian-woman

Telles, E. (n.d.). Racial discrimination and miscegenation: The experience in Brazil. United

Nations. Retrieved April 23, 2023, from

https://www.un.org/en/chronicle/article/racial-discrimination-and-miscegenation-experience-braz

il