Territory of the Moon Not the State
Partería and the fight for control over life & death in El Salvador
Noemí Delgado
Ixchel by an unknown Maya artist, PD-US
My abuela says that, because she was born during a tropical rainstorm, the partera told her mother, “esta niña va a ser muy llorona.” The partera was right. Despite her tough persona, my abuela cries when she reads poems, watches telenovelas, prays, and even when she laughs. Unlike her mother, who gave birth to all of her children in the countryside of El Salvador, my abuela had four institutionalized births in San Salvador.
My abuela got pregnant shortly after moving to the city as a teenager looking for work. She tells this story that’s both funny and tragic, about how she very confidently went to the hospital to give birth at 19. She walked to the bus stop with my abuelo. He got on one bus to go to work while she got on another to go have her baby, as if she were just running a quick errand. When she stepped into the room where everyone was in labor—lying next to each other like a Fordist production line—she thought, que mujeres más dramáticas, because they were all yelling in pain. She always laughs at her own naiveté when she gets to that part of the story. After giving birth for the first time in that crowded hospital room, she took her baby home on the bus by herself with a new understanding of how painful bringing life into the world is.
Noemí’s abuela with two of her children in the late 60s
Instead of birthing and grieving in her community with the companionship of a partera, like the generations before her, my abuela learned to experience life and loss in secret. Her relationship with death—the portal that all life enters/exits this dimension through—became property of the state. With less humor, she tells me about going to the hospital after the miscarriage that ended her second pregnancy. She talks about doctors and nurses accusing her of killing her baby, while violently sticking their fingers and apparatuses into her. Since my abuela’s miscarriage experience in the early 1960s, obstetric emergencies have been increasingly criminalized in El Salvador. A total abortion ban was passed in 1998, and in 1999 an amendment declaring that life begins at conception was added to the constitution. Today, a poor young woman who shows up to the hospital alone after a miscarriage—a woman like my abuela—would likely be charged with homicide. According to Amnesty International, at least 19 women are currently in prison or being charged with sentences of up to 40 years for abortion accusations by the Salvadoran government.
My abuela learned to experience life and loss in secret. Her relationship with the portal that all life enters/exits this dimension through became property of the state.
My abuela’s experiences giving birth and miscarrying in an unloving hospital environment marked a generational change in my family’s movement through the portal of life/death. Migrating to the city cut my abuela off from the possibility of a community birth, a practice that survived for longer in the countryside likely because of the state’s general disinterest in the health of campesinxs. In 2011, though, the Ministry of Health passed a policy requiring all births be hospitalized, essentially suspending partería as part of their “National Strategic Plan for the Reduction of Maternal, Perinatal, and Neonatal Mortality.” Wrapped up in the state’s attack on the poor, these threats of imprisonment against birthing people and parteras are weaponized as tools of control.
I spent the past nine months with the Asociación de Parteras Rosa Andrade, a group of thirty parteras in Suchitoto—a municipality in central El Salvador with a strong presence of former-guerrilla fighters. Formed at the end of the Civil War, its members played a crucial role during and after the 12 years of armed conflict, when there was virtually no access to public health services in much of the country. While collecting oral histories and working with some of the people the association cares for, it became obvious that parteras continue to be essential to the health of their communities, despite government efforts to eradicate their work. Laws that criminalize abortions on paper and miscarriages in practice paired with public health policy that mandates ALL births be institutionalized are mechanisms of state surveillance.
Farabundo Martí National Liberation Front guerrilla fighters, courtesy of Spain831 / CC BY-SA 4.0
Like my abuela, my cousin has a story too—and hers is about how anti-abortion laws help criminalize home births. Last year, my cousin had a traumatic miscarriage while already at the hospital. Unlike my abuela, though, she could be considered “lucky.” Since the medical staff witnessed her miscarriage, she could not be accused of abortion. This cousin, who is pregnant for a second time, told me that she wishes she could give birth at home, in a tub of water like she’s seen some white ladies doing on YouTube. Despite her fantasy of a water birth, she says she won’t stay home when she goes into labor. If something were to go wrong again, she knows she could go to prison—and so could the partera attending her birth.
Home birth being understood as just a fantasy, or something of the past, is a result of the Salvadoran government’s response to the United Nations Millennium Development Goals (MDGs). Created in 2000, the MDGs target eight different human rights issues, with all 191 UN member states having agreed to achieve the goals by 2015. Since 2006, El Salvador has received hundreds of millions of dollars in so-called “aid” in a compact from the Millennium Challenge Corporation, a US agency created under the George W. Bush administration which works to meet the MDGs as part of an effort “to reduce poverty and stimulate economic growth in the poorest countries of the world.” (In 2011, El Salvador was deemed eligible for a second compact.) This money is explicitly aimed at helping the state meet the MDGs, one of which is to “improve maternal health.” In practice, though, this aid became a mechanism of dependency. To ensure funding would keep rolling in, El Salvador needed to ensure low maternal mortality rates. And, instead of providing resources to support parteras, the Salvadoran government scapegoated birth workers for the country’s high maternal mortality rate—demonizing them and suppressing ancestral practices. When imperialist powers both define and fund “development” for countries in the Global South, colonial violence seeps into cracks where Indigenous roots are being kept alive.
Emblematic of the continuing colonial project of social and physical domination is the cultural repression of parteras, who use Indigenous practices and worldviews to support pregnant, birthing, and postpartum people. Plants remind us that all life fractilizes from the same divine source—they have a vital role in birth both physiologically and spiritually. Parteras in El Salvador use many different native plants to make teas that help people in labor: raíz de limón, pie de venado, cáscara de morro, orégano, semilla de aguacate, siempreviva. They also use the leaves of lemon and mango trees to bathe people during and after the birthing process. The parteras I work with explain that the moon has a strong influence on birth, such that when it is closer to being full the person giving birth has more force. The older parteras, who are in their late 70s and 80s, explain how, when they were young, people followed the moon’s schedule; couples knew when to conceive so that their child would be born around the full moon. These technologies have been categorized as outdated and in opposition to scientific progress by the post-colonial state. One partera named Cecilia said to me with deep concern, “it’s like people don’t know what the moon is anymore.”
National Conference of Salvadoran Midwives: “Cuido Colectivo de la Siembra”
The parteras tell me that the persecution started around 2011, at the same time as the second MDG pact. They say that doctors and nurses began telling pregnant people not to go see the partera, in some cases attempting to degrade the parteras by referring to them as parcheras: a term that means something like a witch who works with plant medicine. One partera recounted that a doctor told one of her patients that only perras birth at home. Others said that government “health promoters”—public officials who go out into the rural communities on behalf of the Ministry of Health to bring basic services like vaccines—started threatening parteras in their own homes, telling them that they are not authorized to attend births and that they could go to prison if they continue. Still others tell me that the government has blackmailed people who give birth outside of a hospital by withholding birth certificates. Two different parteras told me that they have seen the police go into communities to look for pregnant people who refuse to go to a hospital. A few of the parteras I interviewed have the outstanding bravery to continue attending births, but most no longer do so because they fear persecution.
The criminalization of parteras has not only stripped communities of their ancestral birthing rituals but has also forced birthing people into situations of obstetric violence. Birthing people in El Salvador are regularly subjected to non-consensual episiotomies, verbal abuse, neglect, and unnecessary cesarean sections. One young woman who I’m friends with explains that her doctor did an episiotomy after she gave birth. When she asked the doctor why, he told her, “so that you don’t come back here within a year with another belly,” implying that she would have to abstain from sex because of the painful wound. My friend told me that, seven years later, the scar still hurts her when the moon is small and when she has sex.
In the hospitals, birthing people are forced to lay down during labor, which contradicts gravity—a natural force traditionally used to ease birth through various positions and exercises. People who give birth in public hospitals are not allowed to bring anyone into the labor and delivery room, creating a lonely and defenseless environment. Some women told me stories of forced sterilizations after a birth. Others told me about being sexually assaulted during prenatal check-ups. But, of course, the patriarchal biomedical establishment that reflects the values of the US is more “developed” than the inherited art of partería—oh, and not coincidentally, it allows the state to surveil and control the arrival of all newly incarnated ~*human life*~.
El Zonte, La Libertad
Birth and Death are the most important energetic transformations we experience in this dimension. In these moments, we should be accompanied by those who hold us up, by our community. During the conflict between the people’s guerrilla movement and the military dictatorship in the 1980s, the US-funded and trained military was the largest force accompanying Death, killing entire villages in incomprehensibly cruel ways. At the same time, parteras were there accompanying Birth as they always had—and perhaps even more than before, as hospitals were totally inaccessible amidst the violence.
The parteras I work with practiced, and in many cases began practicing, during the civil war. They tell stories of attending births in tatus (holes that the guerrillas dug for protection from bombs), in the middle of crossfire, in the dark, under mango trees, while escaping massacres. They think “back” on the first births they attended and describe them with a mixture of pride and sadness: cutting umbilical cords between two rocks, putting a baby to the mother’s chest and immediately having to flee—giving her no time to rest. With an unspoken understanding of the non-linear nature of time, many of the parteras repeat over and over again, “lo hacemos con amor.” In the middle of the violence, they guided life into this realm with love. They cared and continue to care for birthing people with a tenderness that jumps timelines and a wisdom generated by ancestors.
In the middle of the violence, they guided life into this realm with love.
Today, 28 years after the war’s official end, the state has a vested interest in birth: reporting low maternal mortality statistics qualifies El Salvador for “aid” and monitoring pregnant people makes it easier to criminalize abortions. Suppressing partería is the government’s way of commanding birthing bodies under the guise of protecting them. The state has always monopolized the portal into/out of this realm. The government stopped directly killing people on such a large scale when the war ended, but now they rule travel through the same portal they dominated during the war. They control life, and death, through births. When the portal is in our hands, we get to bury our loved ones and our placentas in a return to the earth. During the war, the government threw our family members’ bodies off of cliffs into the ocean and now they throw our placentas into the trash. The fight for partería in El Salvador (and beyond) is a fight for the sovereignty of our physical bodies and the right to harmonize with our natural world. Parteras fight for Birth and Death to be territory of the moon, not the state.
Liked this piece? Venmo @cuidandoalas to support the Asociación de Parteras Rosa Andrade directly. Cuidando A Las Que Nos Cuidan is a collective generating ongoing support for Indigenous language keepers and midwives in El Salvador.