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The revitalization of medical history as a branch of academic history (rather than of medicine) has been underway for decades, illuminating themes such as the nature of embodiment, the history of patient-practitioner relationships, the centrality of anatomy in shaping early modern understandings of body and society, and, of course, the importance of medical science and women’s reproductive bodies to the biopolitical aims and practices of the modern state. In brief, the history of medicine has changed fundamentally, from a triumphalist narrative whose primary focus was on the development of medicine itself to today’s medical history, which is as likely to focus on blind alleys as on “firsts,” and whose narratives tend to trouble notions of progress whilst enshrining medical conceptions and advances at the heart of social and cultural history.

This transformation of medical history has borne fruit in many European and some colonial contexts, and is increasingly influencing a global narrative of medicine and health in which Latin America figures prominently.[1] The “new” cultural history of medicine has made smaller inroads in Latin American colonial and national histories, though a burgeoning crop of dissertations in the area promises much for the future. In addition, the Latin American historiography contains several significant works which are relevant here for the connections they make among medicine, conceptions of the body, and the development of the state. Susan Caulfield’s In Defense of Honor (2000) examined how medicalized notions of female sexual purity were linked to nationalism in late nineteenth-century and early twentieth-century Brazil; more recently, Rebecca Earle’s Body of the Conquistador (2012) illuminated the importance of Galenic humoural theory to the patterns and processes of Spanish colonization. Martha Few’s For All of Humanity (2015) demonstrated how late-colonial Guatemalan humanitarian responses to epidemic diseases also extended the state’s power over the bodies of its colonial subjects.

Both complementing these works and extending their concerns into a new domain and previously unexamined evidence, Nora Jaffary’s Reproduction and Its Discontents is a powerful achievement. What makes Professor Jaffary’s book doubly significant is not just that she places medical understandings at the heart of Mexican history, but that she does it so well. The first book on a Latin American topic to receive the Ferguson Prize in over twenty years, Reproduction and Its Discontents rests on a broad and deep base of primary evidence drawn from late-colonial and nineteenth-century Mexican criminal, religious, medical, and governmental records. In addition to being exceedingly well researched, the book is theoretically canny, well written, and profoundly significant in its feminist exegesis of the often-coercive relationship between the modern state and women’s bodies.

Almost encyclopedic in scope, Reproduction and Its Discontents surveys a lengthy and transformative period between 1750 and 1905. The book proceeds through a systematic reconstruction of the varied topics that reproduction comprises: perceptions of virginity; pregnancy, conception, and birth attendance; contraception and abortion; infanticide; monstrous births; and finally, the emergence of obstetrics and gynecology. In each case, Jaffary summarizes the theme’s colonial past before tracing its evolution after 1750. And without exception, Jaffary judges that after relative stability in the earlier colony, each element of reproduction underwent significant and in some cases monumental change during the period she studies, and particularly after 1850. Jaffary shows, for example, how virginity was always significant to colonial Mexicans, but nonetheless changed dramatically through the processes of modernization; it was transformed from a religio-moral category into a medical one with its own typologies and biological markers, identified by often macabre anatomical experiments. In uncanny resemblance to events in contemporary Brazil, medical “hymenolatry” led to the naturalization of virginity as a biological state with putative population variations, as in the case of the “horseshoe” hymen identified as unique to Mexican women. By the late nineteenth century, Porfirian medical science was thus linked not only to modernization’s international ambitions, but to its often-anxious parsing of Mexican distinctiveness (construed, often, as racial inferiority).

To a great extent, as has been documented for other contexts, advancing obstetrical knowledge and the incursions of male practitioners catalyzed the growth of both a new attitude toward women’s bodies and knowledge, and the professionalization of both male and female practitioners. In Mexico, however, as Jaffary and Luz Hernández Sáenz both argue, the process of professionalizing obstetrics moved slowly. Pregnancy, conception, and birth attendance were perhaps more resistant to “medicalization” in Mexico than in some European countries, in part because of a chronic shortage of trained medical men in both the colony and the republic, and in part because midwives had been deregulated in the sixteenth century and were only reregulated in 1750. There was thus no crowded field of ambitious young man-midwives seeking employment, as has been documented for England by Ornella Moscucci and Adrian Wilson; nor was there anything resembling a corporate body of midwives that might be professionalized and medicalized.

Still, Jaffary argues, a new attitude and its accompanying practices could be seen, for example in the nineteenth-century introduction of internal examinations to determine pregnancy and its stage of development. While traditional knowledge and practitioners persisted, bodies of practice became identified with gendered and racial markers. The medical man was identified with European science, the midwife with femininity and Indigenous medical traditions; Jaffary thus illuminates a particularly Mexican form of medicalization in which both gender and colonialism played major roles. The transformation of birth was less actual than rhetorical. Indeed, the most significant marker of medicalization may not have been a change in birth attendance, but rather the deterioration of the once respected position of midwives even as they continued to attend most Mexican women well into the twentieth century. To the familiar if often complicated story of medicalization and the “decline of midwives,” Jaffary adds a particularly useful case study. Many studies of medicalization have focused on the European metropolis, but Jaffary is able to examine how women’s health was navigated in a context where Indigenous medical traditions remained strong and learned European medicine was beyond the reach of all but a few because of both its scarcity and its cost.

Medicalization still altered beliefs and practices around women’s bodies and birth attendance; but the process was even more haphazard, uneven, and protracted than its European counterparts. This “long game” of reproductive change can also been seen in the case of contraception and abortion. Jaffary details how, from the very dawn of colonialism in the sixteenth century, Mexicans of every ethnicity were aware of the effective emmenagogues/abortifacients derived from the American materia medica and documented within the Central Mexican Indigenous medical tradition. Nonetheless, she argues, there was little concern about these substances, or about abortion and contraception in general, until the nineteenth century. Striking to the modern reader is the revelation that colonial religious authorities seldom commented on these matters, while the medical men of the nineteenth century found Mexican women’s “habit” of destroying their fetuses a matter of grave and public interest. Jurists were no less concerned. Legal changes in the second half of the nineteenth century enshrined not only the prohibition of abortion, but the differential treatment of what might be called the “decent aborters,” women of generally good habits who concealed their pregnancies and sought abortion to protect their honour, versus the more shameful women who flaunted pregnancies and had no honour to speak of.

A similar trajectory was followed by infanticide. One of the strongest and most fascinating parts of Jaffary’s analysis, her chapter on infanticide presents evidence that denunciations and prosecutions of mothers increased significantly after 1800, following a long colonial period in which such prosecutions were virtually non-existent. Jaffary links this not only to changes in the law, but to new attitudes among a public that had once, she argues, viewed infanticide without much concern. Now, animated by belief in female and maternal honour, members of the public scrutinized and denounced pregnant and newly delivered women whose babies died mysteriously. Judges, however, were reluctant to convict. Operating in these denunciations were not only a new and urgent concern about female honour, but a discourse of naturalized, essential motherly love that in turn produced repugnance for the “unnatural” act of infanticide. Jaffary thus effectively limns the contours of the Mexican version of a pattern found elsewhere: the nineteenth-century naturalization of motherhood as women’s destiny and duty to the state.

Jaffary’s chapter on monstrous births provides a similarly rich and fascinating discussion of the relationship between reproduction and the nation. Examining reports of such births from the Gaceta de México and other periodicals from the late eighteenth and nineteenth centuries, Jaffary finds a transition from a focus on the marvelous powers of nature to a new emphasis on hereditability and the fetal environment — that is, a more scientific approach to teratology. This transition produced a change in the emotional register with regard to monstrosity. In the late colony, Jaffary argues, monsters were feats of nature, marvels that elicited admiration, publicity, and even regional and viceregal pride. By the end of the nineteenth century, they were deplorable objects of horror clearly resultant from natural defects.

Any one of these themes might have been topic enough for a monograph; Jaffary deftly synthesizes them in a manner that allows her to advance a clear and compelling argument: that in Mexico, scrutiny, surveillance, and control of women’s reproductive bodies increased apace with scientific modernity; and that modernity was marked by a conflation of reproduction with national identity and destiny. The book’s final chapter provides a crowning summation of this argument in its discussion of routine birth. While most women were still giving birth with midwives in the late nineteenth century, the Porfirian medical and legal establishments were united in denigration of the Indigenous practices that formed the backbone of “traditional” midwifery in Mexico; in celebration of interventionist birth, even given evidence of appallingly poor outcomes; and in description of Mexican women as ill-suited for birth and fundamentally flawed. These beliefs formed the foundation for Mexican national childbirth practices, with effects that endure to the present. However, as Jaffary documents throughout the book, this model of national birth became hegemonic only slowly and incompletely. All of the shifts in medical theory and practice detailed by Jaffary were significant, but she shows that to some degree, the new hegemon always remained coexistent with variant and hybrid practices and beliefs. Jaffary’s analysis, then, while conveying a clear and powerful argument, never totalizes.

Throughout the book, Jaffary’s handling of evidence is masterful and nuanced. In documenting the increase of surveillance and control over women’s bodies, Jaffary marshals compelling and meticulously analyzed evidence of increasing legislative and community scrutiny of women’s pregnancies. However, much of her argument about the period before 1750 rests not on interpreting evidence, but on interpreting the absence of colonial documentation evincing concern over abortion, contraception, and infanticide — and indeed, the absence of documentation relating to birth itself. My own perspective as a scholar of the early colonial period calls me to reflect upon this absence of documentation: an issue whose implications I must often ponder, given the highly fragmentary nature of sources for much of the colonial period. The colonial archives are riddled with silences — both complete silences, or what I would call absence (the lack of representation of marginalized lives, voices, and perspectives) and silencing, the bare representation of such voices and perspectives but without authority or licence truly to speak.[2] This raises a question that has always bedeviled the history of women: What do archival silences and absences mean?

Jaffary systematically lays out the ways in which she interprets documentary silence, which makes this work both an exemplum of intellectual honesty and a virtual clinic for students beginning to engage seriously with primary sources. Her transparency in interpretation permits the reader an interlocutory role, which I found myself adopting. For example, with regard to the quotidian experience of birth, Jaffary summarizes both the absence of evidence and the silences even in documents that mention birth as producing an “overwhelming impression … that mothers and other community members viewed the act of giving birth as a pedestrian event” (p. 175). Here, absence and silence are interpreted as meaning that birth was unremarkable. But unremarkable to whom? Perhaps to male authorities, who were in any case excluded by customary notions of women’s modesty and privacy. But this silence — as well as the fragmentary early colonial evidence I work with — raises the persistent question of what childbirth meant to women and how we can ever know.

Other absences and silences abound in the colonial record, of course. As William Taylor noted in his classic Drinking, Homicide, and Rebellion almost forty years ago, the criminal records of colonial Mexico are not a reliable indicator of actual crime, and they almost certainly underrepresent crimes considered less serious by the state and by communities themselves. Homicide documentation is thus much more likely to be complete than documentation for virtually any other crime. Infanticide, as Jaffary shows, was in contrast to homicide a crime about which both legal codes and judges could be extremely ambivalent. On one hand, the crime as codified called for extreme punishments; on the other, such punishments were in practice rarely invoked even when prosecution occurred. Infanticide was considered a capital crime by the Siete Partidas, but the code treated killing a child during its first three days of life more leniently.

Such legal ambiguities signal that the archives are likely to be far from complete, and our conclusions correspondingly less watertight. Maddeningly, perhaps, I wonder whether it may simply be impossible to determine the prevalence of infanticide and abortion in Mexico during the colonial period (as indeed is the case for much of European history). Given the extremely feeble evidence for the colonial period, can we suggest that members of colonial society “looked the other way” or considered newborn plebeian children of little value, in contrast to the nineteenth-century view of children as “valued beings”? Certainly, the “remarkable degree of leniency” (p. 92) with which colonial officials treated women accused of infanticide or abortion is a striking phenomenon; but it may have owed more to protective colonial conceptions of women’s weakness than to dismissive attitudes toward children or a lack of concern about the sinfulness of such practices.

Powerfully suggestive to this colonial historian is the absence of sinfulness as a category by which Jaffary’s subjects measured women’s reproductive failings. Jaffary’s evidence suggests a major change during the period she studies: as she documents in the case of virginity, primarily religious discourses about women and their nature were ceding place to more clearly secular and medical ones. One hesitates to ask for more from a book that already covers so much so well, but I found myself wishing that Jaffary — with her fine grounding in colonial religious realities — had delved further into the role of the nineteenth-century church and its apparent withdrawal from public debate on matters of reproduction. While I am reluctant to speak of secularization given its contested nature in Mexico and my lack of expertise in the period, it is difficult to avoid the conclusion that changes to the status of the institutional church and to the culture of popular Catholicism may have had a corresponding impact on some of the matters that Jaffary addresses. To take just one example, might the declining status of Catholicism have affected overall attitudes toward women, slightly shifting the discursive register from women-as-weak-sinners to women-as-sly-creatures and thus increasing the willingness of Mexican plebeians to denounce and condemn women for apparent abortion and infanticide? Might religious changes, among other cultural changes, have also fostered the decline of the notion of “women’s secrets” that shielded women from scrutiny and kept men from inquiring into their affairs? How much did religious change foster the changing attitude toward monsters that Jaffary describes so convincingly? And might changes in religiosity, along with the social changes that Jaffary documents, have fostered an actual increase in infanticide rather than simply an increase in its denunciation? All of these questions depend on arguments about silences and what they mean; that this book should suggest so many further questions, and so many avenues for fruitful close study, is a testament to its significance.

The importance of silence and absence in this work highlights one final important contribution. Jaffary’s comment that only royal births were considered noteworthy in the colonial period demonstrates with utter clarity how much of this story concerns publicity and the growth of public discourses around events once considered private and secret. If modern Mexican statesmen and physicians were in large part the drivers of this change, Jaffary makes clear, most notably in the case of infanticide and abortion, that nineteenth-century plebeian Mexicans were also agents in the transformation of “women’s secrets” into “public business.” Mexicans avidly condemned women for alleged abortion or infanticide, only to see them treated leniently by the state that seemed to be encouraging scrutiny and control over women’s bodies. The agency of the public, then, is as much a part of this work as the efforts of medical men and lawmakers. Jaffary’s book thus makes significant contributions to the growing literature on gender, the public sphere, and the state in nineteenth-century Latin America.

Jaffary begins and ends Reproduction and Its Discontents with powerful pleas for the relevance and importance of women’s reproductive history — to academic history, to our understanding of the state, and to women generally. In my view, any reader of Jaffary’s fine book will be more than convinced of the significance and import of reproduction not merely for colonial women, nor just for their husbands and families, but for the Mexican state and nineteenth-century society in general.

A Ferguson-Prize-winning book is by definition outstanding — a work that not only represents the best combination of historical questions, sources, and methods, but that changes the field. Reproduction and Its Discontents is such a book. It immeasurably enhances our understanding of modernizing Mexico, contributes to our knowledge of the particularly Latin American tropes of modernity, and will catalyze future scholarship in the many realms that the book so beautifully embraces.