Who benefits from hospital birth? Perceptions of medicalised pregnancy and childbirth among Andean migrants in Santa Cruz de la Sierra, Bolivia

This paper uses ethnographic data on reproductive experiences of Andean migrant women to the lowland eastern Bolivian city of Santa Cruz de la Sierra as a starting point for discussion of different perspectives on the efforts of the Bolivian state to biomedicalise the processes of pregnancy and childbirth. Pregnant women and babies up to six months of age are covered by the state-funded Universal Mother-Infant Insurance (SUMI) that favours the use of biomedical facilities over the services of traditional midwives that are not covered by the insurance. Unlike in the western Andean highlands of Bolivia, most women in Santa Cruz give birth in hospitals while actively negotiating their options. They are not motivated by strictly medical factors as social or economic circumstances also come into play. Simultaneously, the increased levels of hospital deliveries in Bolivia translate into decreased levels of maternal and perinatal mortality, which in turn helps Bolivian statistics to fare better from the point of view of the government and international bodies, such as the WHO. However, the restrictions on qualifying for SUMI are such that women in Santa Cruz are often forced to meet the costs of medical services themselves. I argue that the initial socio-biomedical intention of SUMI has become obscured by its political impact.