Developing an Indigenous Modernity: Changing Birth Practices in Bali Lyn Parker (The University of Western Australia) Abstract Wacana akademis internasional tentang modernitas seringkali mengasumsikan modernitas bersifat universal dan homogen. Tulisan ini membantah asumsi tersebut melalui penelitian tentang medikalisasi kelahiran di Bali. Tiga tempat utama untuk melahirkan—rumah keluarga laki-laki, klinik lokal, dan rumah sakit umum daerah—memperlihatkan peningkatan derajat‘modern’, namun banyak staf medis masih mengakomodasi praktik-praktik kelahiran tradisional. Sebagai contoh, keyakinan tentang kemampuan Kanda Mpat—empat spirit pelindung setiap bayi—diakomodasi, bahkan di rumah sakit sekalipun. Perawatan secara ritual terhadap Kanda Mpat berlanjut; dan pengetahuan tentang Kanda Mpat secara umum meningkat. Tulisan ini menjelaskan bahwa keberlanjutan dan penyesuaian praktik-praktik kelahiran terhadap lingkungan baru memperlihatkan tidak adanya suatu pertentangan antara tradisi asli dan modernitas global. Wanita-wanita Bali menciptakan versi mereka sendiri tentang modernitas pada saat kelahiran. Introduction roots and history, of families and communities— The ‘moderen’ and a splitting of new from old, of younger from older.1 The international academic discourse of ‘the The harnessing of ‘tradition’ in service of modern’ often assumes modernity to be univer- ‘modernity’, for instance in nationalism’s ‘in- sal. This irresistible modernity is associated with vented traditions’ (Hobsbawm and Ranger the hunger of advanced capitalism, the cultural hegemony of the West, and ways of knowing that are traceable to the European Enlightenment. 1 Berman’s All That is Solid Melts into Air gets at this With such a view, it is hard to see how modernity aspect of the modern: ‘Modern environments and ex- periences cut across all boundaries of geography and in postcolonial countries can be other than the ethnicity, of class and nationality, of religion and ide- mimesis of a Western model. By definition mo- ology: in this sense, modernity can be said to unite all dernity implies the seductiveness of the new, of mankind. But it is a paradoxical unity, a unity of dis- unity: it pours us into a maelstrom of perpetual disin- fashion, change and excitement. However, it also tegration and renewal, of struggle and contradiction, involves loss—of place and environment, of of ambiguity and anguish’ (Berman 1982:5). 20 ANTROPOLOGI INDONESIA 70, 2003 1983), shows the instability and malleability of and increased mobility, literacy and urbaniza- tion (Gaonkar 1999:2). both concepts. Ironically, modernity has also thrown up some reactions—localization, reli- In New Order Indonesia, modernization— gious fundamentalism, ethnicization, fervent usually called ‘development’ (pembangun- nationalism, terrorism—which effectively work an)— held sway as the state unifying discourse against the expansionist and homogenizing ten- for thirty years of imposed social order, steady dencies of modernity. For these reasons many improvement in living standards, rapid deple- now see, especially in postcolonial countries, tion of natural resources and suppression of the possibility of alternative modernities.2 civil liberties and political expression. The In- Modernity is both a condition and an aspi- donesian version of the modern, ‘moderen’, ration. The tension between these two is cap- was and still is always positively valued. De- tured in that classic 1960s term, ‘moderniza- velopment ‘successes’ legitimized a large range tion’. Modernization theory assumed that some of state interventions at all levels of society, nations of the world had already reached this neutralized and enabled rampant corruption desirable condition and others could only work and disarmed critics of the regime. towards it. Thus, while the whole process of Within Bali, the moderen is a hot issue and becoming modern assumed a linear progres- much discussed. What is at issue is not the de- sion—progress—towards an already-attained sirability of being moderen—that is assumed Western model, the very setting of this goal throughout all levels and groups within Bali— defined a set of hopeful, needy, and, therefore, but the particular form that being moderen in inadequate, nations which had to undergo ‘a Bali should take. Debates revolve around ques- set of cognitive and social transformations’ tions of Indonesian hegemony, Balinese iden- (Gaonkar 1999:2, following Bell 1976): tity, the authenticity of Balinese culture and the threats of globalization (e.g. Picard 1990, 1996 ...the growth of scientific consciousness, the de- velopment of a secular outlook, the doctrine of and 1999; Putra and Vickers 2000; Rubinstein and progress, the primacy of instrumental rational- Connor 1999; Vickers 1996:1–36). In the late 1950s ity, the fact-value split, individualistic under- the Hindu Balinese feared Islamic domination and standings of the self, contractualist understand- ings of society, and so on; the social transforma- learned to present a rationalized version of their tions refer to the emergence and institutional- religious practice that was acceptable to the De- ization of market-driven industrial economies, partment of Religion (Forge 1980; Geertz 1973). bureaucratically administered states, modes of In the early 1960s, the rapid growth of the Indo- popular government, rule of law, mass-media, nesian Communist Party (Partai Komunis Indo- nesia, PKI) collided with the interests of the armed 2 The journal Public Culture recently ran a four-issue mini-series on alternative modernities, globalization, forces, extremist Moslems and ultra-nationalists, millenial capitalism and cosmopolitanism. Although producing a crescendo of identity politics that the latter three topics would seem to suggest the uni- was to climax in Bali with the murder of perhaps versalizing tendencies of modernity, the series was designed to interrogate these ‘as defining sites for one hundred thousand ordinary Balinese. The imagining newness in the world, for marking critically New Order period in Bali was characterized by and historically transformative projects, and for the [a] political stability, centralized authoritarianism localization of global formations’ (Breckenridge 1999:ix). A recent collection of work on Bali is en- and social order, with the dominant narrative one titled Staying Local in the Global Village: Bali in the of development and modernization. Since 1998, Twentieth Century (Rubinstein and Connor 1999) and the possibility for greater local autonomy vis-à- in my reading shows the tendency of ‘the local’ to have expropriated ‘the global’ in many ways. vis the central government has been seen as a ANTROPOLOGI INDONESIA 70, 2003 21 great opportunity by the Balinese. For the time and are in the same bracket as those of India being at least, the Jakarta government is weaker and Bangladesh rather than those of its South- and more democratic, open to negotiation and east Asian neighbours.4 The official rate for mindful of Bali’s tourist industry, which it sees Bali is above the Indonesian average.5 as a milch cow. It remains to be seen to what In Indonesia, the emphasis has been on the extent and in which ways Balinese relations with top-down provision of adequate biomedical the dominant and largely Islamic nation-state, care and on the expansion of biomedical net- will be significantly altered. The central problem works to handle obstetric emergencies effi- is how to develop, to be healthy, educated and ciently (Hull 1990). The state provided a two- prosperous but still be Balinese. tier system of obstetric care in village clinics and town hospitals. As part of its umbrella pri- mary health care policy, the government claimed The development of primary health care that it attempted to integrate traditional birth After the WHO conference at Alma Ata in attendants into the modern health care system 1978, Indonesia, like many developing coun- (Ministry of Health 1990:6). The Ministry of tries, adopted the primary health care (PHC) Health boasted that: principle as the basis of its health development programme.3 As part of this, Indonesia claimed to incorporate traditional birth attendants 4 A figure of 450 deaths per 100,000 live births seems (TBAs) into its primary health care programmes to be commonly accepted. For example, Smyth and embarked upon crash training courses for (1996:132) accepts 450 maternal deaths per 100,000 traditional midwives, as well as a host of other live births and USAID (1998) quotes this figure. How- ever, WHO/UNICEF (1990) reports maternal mor- measures designed to introduce simple, pre- tality rates of 650/100,000 live births for Indonesia ventative health care into villages. Then in 1988 in 1990. The average for Asia is 420, for Singapore Indonesia joined the international ‘Safe Moth- 45, Malaysia 69, Thailand 100 and the Philippines 162 (various sources quoted in Smyth 1996:132). erhood’ campaign, making the commitment to reduce maternal mortality by 50% by the year 5 The figure for Bali is 780, and shows a marked in- creased recently, but this is probably too high. Wirawan 2000 through the National Initiative for Mater- and Linnan (1994:307) report that the increase is nal Welfare (Smyth 1996:133). Indonesia’s ma- partly accounted for by high under-reporting in 1991, ternal mortality figures are unacceptably high, and may be due to the mathematical model used to calculate these rates. They suggest that the fixed math- ematical relationship between the Total Fertility Rate and the Maternal Mortality Ratio lies at the heart of 3 However, Hull’s work on health care during the colo- the apparent increase in the MMR. Using this model, nial period shows that the principles of primary health as the TFR falls the MMR rises: as the number of care were already being implemented in the nineteenth births falls, the obstetric risk per birth will increase century, albeit on a small scale, and that the first ef- unless the risk of death is decreased at a rate commen- forts to train TBAs date from 1807 (Hull 1989; Hull surate with the birth rate. Thus, they suggest, the ap- 1990:5). WHO defined primary health care as that parent increase in the MMR in Bali is a statistical health care considered to be essential care based on artifact due to the great success of family planning in practical, scientifically sound and socially acceptable bringing down the TFR. They tested another model methods and technology made universally accessible for measurement, the indirect sisterhood method: sur- to individuals and families in the community through viving sisters were asked if they had had any female their full participation and at a cost that the commu- siblings who died. This study and the experience of nity and country can afford to maintain at every stage other experts suggest that the figure of 718 deaths per of their development in the spirit of self-reliance and 100,000 live births is too high, and that a figure in the self-determination (WHO 1978 quoted in Saunders region of 331 and 359 deaths may be more accurate 1989:6–7). (Wirawan and Linnan 1994:308). 22 ANTROPOLOGI INDONESIA 70, 2003 Indonesia is one of the first countries to inte- In this context, ‘traditional’ means ‘non- grate traditional birth attendants into the mod- government’ is synonymous with ‘dangerous’ ern health care system and to train them as fam- ily planning motivators. and is acceptable only as an interim measure (Achmad 1999:128; Hull 1990:5–6). Although At present there are about 97,362 TBAs in this the government includes TBAs in the rhetoric country who attend 80–90 percent of all births… They not only deliver babies but also assist of its health programmes, it is on their biomedi- women during prenatal periods, give advice on cal terms. It is seen as a stop-gap measure that child care, infertility and play important ritual will not be necessary once sufficient qualified and religious role[s] (Ministry of Health 1990:6). biomedical personnel are available. In fact, this It is an integration which has not been with- view of trained doekens (TBAs)—‘to help the out its problems (Grace 1992; Sciortino 1996; people temporarily’—is exactly the strategy Slamet-Velsink 1996). Indeed some have ques- taken in a 1937 report: the use of doekens ‘To tioned if there has been any integration help the people temporarily’ (Hydrick 1942 (Sciortino 1995:233; Hull 1990:6). Despite the [1937]:53 quoted in Niehof 1992:168). TBAs are rhetoric of primary health care and the integra- a ‘necessary evil’: tion of traditional birth attendants (dukun bayi), Due to their ignorance about the physiology in practice the biomedical model is the only and anatomy of the human body, and also not accepted paradigm (Sciortino 1995:232ff). ‘In- being aware of the state of health of the moth- tegration’ is a misnomer: for instance, govern- ers, mortality is high both for the mothers and the babies. The Ministry of Health would like ment survey statistics on personnel attending to end this malpractice. However for the time births carefully distinguish TBAs from doctors, being it is not possible to prevent them from midwives and other medical practitioners. As attending births. Lack of qualified midwives to Sciortino notes, ‘The integration of dukun bayi replace them is one reason why the government cannot yet take steps to lessen the hazards implies their retraining according to biomedi- (Subagio 1974, quoted in Sciortino 1995:233). cal notions of hygiene and health’ (Sciortino 1995:233). Hull writes, ‘Following such train- Tradition versus modernity in health care? ing, traditional attendants are not integrated into the health care system as acknowledged A recent spate of books and papers on birth, members of the health service team, nor are maternity, nursing and health care in Southeast their ceremonial practices and beliefs accepted Asia, including Indonesia, indicates both a new as valid elements of maternity care procedures interest in the topic and the rapidity and extent in the local setting’ (1990:6). In fact the use of of the ‘medicalization’ of birth and of health de- TBAs has continued but is unmeasurable. Be- velopment in the area (e.g. Boomgaard et al. 1996, cause TBAs generally do not keep written Hay 1999, Hunter 1994 and 2000, Ram and Jolly records, the statistics on patronage of TBAs, as well as on infant and maternal mortality as- reporting of TBA-attended births is common. Data sociated with their utilization, are unknown.6 from ethnographic and lower-level surveys throw doubt on these high figures. Cameron, for instance, notes that the 100 Villages Survey shows almost a reversal of these percentages, with TBAs attending the major- 6 In direct contradiction with the above quote, the ity of births. She reports ‘no systematic change over Ministry of Health 1999 reports that the national the period’ [1997–1999], though the table indicates coverage of deliveries by health professionals (i.e. not that TBAs attended 65.5% of births in 1997 and this TBAs, trained or untrained), was 62.3% in 1998; the declined to 60.5% in 1999, while professional mid- percentage in Bali was the highest of all provinces, at wives attended 24% of births in 1997 and this rose to 92.7%. The national figures seem very high, as under- 29.6% in 1999 (2001:57 and Table A1, 64). ANTROPOLOGI INDONESIA 70, 2003 23 1998, Rice and Manderson 1996, Sciortino 1995, However, it must be noted that in Indone- Whittaker 1999 and 2000). The theme of opposi- sia in the field of health, the negotiation of tion between tradition and modernity is salient tradisi and the moderen in Bali and Indonesia in most of these studies. This theme is indicated is not perceived by local people as a conflict by titles such as ‘Tradisi and Moderen, Village (Sciortino 1995:236ff). ‘Traditional’ medicine in and State: Emergent Tensions in a Sasak Health Indonesia is usually regarded by anthropolo- Quest’ (Hunter 2000) and ‘Birth and the Post- gists as a much more holistic and integrated partum in Northeast Thailand: Contesting Mo- system of belief and action than Western bio- dernity and Tradition’ (Whittaker 1999). The stud- medicine. The biomedical model is based on ies have highlighted areas of misfit or incompat- ‘the premise that every disease has a specific ibility of Western biomedicine with traditional pathogenic cause, treatment of which can be healing (Sarwono in Boomgaard et al. 1996, best accomplished by removing or controlling Slamet-Velsink in Boomgaard et al. 1996), the ex- that cause’ (Lockerman 1984:360 in Sciortino istence of parallel discourses of curing and car- 1995:231). The body is regarded as a machine, ing (Sciortino 1995 and 1996), contradictions and it is the perfect functioning of its parts between theory and practice (Kollmann and van which indicates a state of health (Sciortino Veggel in Boomgaard et al. 1996, Sciortino 1995), 1995:231). In indigenous Indonesian medicine, and tensions between outsiders and insiders the human body is thought to be a microcosm (Hay 1999). of the social, natural and supernatural macro- Whittaker, like other writers, reported that cosm, subject to but also able to influence the village women were not averse to using clinics social world, the forces of nature and sources and hospitals and had rapidly adopted a hos- of life and energy (Slamet-Velsink 1996:70). ‘Tra- pital birthing norm. However, she went on to ditional health care’ assumes that disease is describe how, in north-east Thailand, once out caused by an imbalance or disturbances, ei- of hospital, new mothers went home and re- ther within the human body or in the equilib- sumed traditional post-partum practices such rium which is believed to exist normally in the as ‘roasting’ and resting by a constantly burn- micro-macrocosmic relationship between hu- ing fire for a period of from five to eleven days. man beings and the social and super/natural This was done in order to redress the ‘cold’ environments. The human body is thought to condition caused by childbirth, to dry out and be permeable, the individual self partible and cleanse the womb, to benefit from a range of to exist in some sort of continuum with other practices such as massage and herbal tonics, supernatural beings.7 to rest from household and work duties, and to Observers of the interface between the mark and perfect the change in social status as practice of traditional and modern medicine in a mother (Whittaker 1999:229–235). She sug- Indonesia frequently comment upon the open- gested that in north-east Thailand, ness of Indonesians in seeking different types of cures, their willingness to consult a wide In birthing and the postpartum period, women move between the spatially separated domains of the hospital and the home and in doing so move between discursive frameworks: the first, 7 References on traditional medicine in Bali and Indo- where discourses of biomedicine and state de- nesia include Connor (1983); Connor et al. (1996); velopment prevail and the second where com- Lovric (1986, 1987); McCauley (1984); Mitchell munity discourses and meanings prevail (1982); Rienks and Iskander (1988); Ruddick (1980); Sarwono (1996); and Slamet-Velsink (1996). (Whittaker 1999:216). 24 ANTROPOLOGI INDONESIA 70, 2003 range of practitioners and the catholic nature (bidan) in village clinics, a benign community of their medical belief (Hunter 2000; Hay 1999; model of birthing that tolerates important tra- Sciortino 1995). Medical doctors and nurses ditional ritual elements. are often sought early in the process of diag- My paper supports one of the key conclu- nosing a problem, especially as Western-style sions of Marshall Sahlins in his recent assess- medicine is seen as quick-acting, simple and ment of the contributions of ‘anthropological technological compared with indigenous medi- enlightenment’ in the twentieth century. He cine. In this sense, biomedical treatment of dis- argued that anthropology has revealed an im- ease or ill-health is not seen as competing portant complement of the ‘new global against traditional medicine but rather as just ecumene’: the development of ‘a self-con- one in a range of possibilities. The apparent sciousness of …culture, as a value to be lived discursive conflict between ‘scientific con- and defended, that has broken out all around sciousness, …a secular outlook, …instrumen- the Third and Fourth Worlds’ (Sahlins 1999:10). tal rationality, …[and] individualistic under- This new culturalism is not a naïve attempt to standings of the self’ (Gaonkar 1999:2) and a turn back the clock, to recover a world without more holistic, religious and personalistic medi- technology and ‘stay traditional’. Rather it is cal theory is not evident in the Indonesian re- an active project of the ‘indigeniza-tion of mo- sort to whatever works best. dernity’ (Sahlins 1999:10) which has surprised In this paper I will argue that in Bali there many development planners. They have found has not been a switch from discourses of tradi- that developing countries have not become tion to discourses of modernity in birthing prac- clones of the West. They have also discov- tice, despite the ‘medicalization’ of birth ap- ered that ‘traditional’ cultures are not inevita- parent in the shift from home birthing in the bly vulnerable to development nor are they in- village to delivery in village clinics and hospi- evitably incompatible with it (Sahlins 1999:17). tals. I use my own field notes of births in a ‘The struggle of non-Western peoples to cre- village clinic and district hospital in east Bali ate their own cultural versions of modernity between 1980 and 1994 and intermittently refer undoes the received Western opposition of tra- to other anthropological sources. Although dition vs. change, custom vs. rationality—and there are many aspects of birthing practices most notably, its twentieth century version of that could be examined, here I restrict myself to tradition vs. development’ (Sahlins 1999:11). a consideration of the ritual practices of birth, sites of birth and birth attendants. I argue that Village clinic births—an indigenous in the Balinese case, there has not been a rup- modernity ture between tradition and modernity, and that In 1980, I began doctoral fieldwork in a vil- to represent the medicalization of birth in this lage, ‘Brassika’, in east Bali.8 I boarded in the manner would be to present a false split. How- Puri, the house of the village head and satria ever, the new practice of childbirth in Bali is not that indicated in government rhetoric about the integration of traditional birth attendants. 8 ‘Brassika’ is a pseudonym chosen by the village That is, traditional balian manak have not been head. Fieldwork has been supported by various univer- sities and research funding bodies—The Australian incorporated into modern birthing practice in National University and The University of Western Bali. Rather, Balinese village women are now Australia, the Australia Research Council and the Spen- patronising biomedically trained midwives cer Foundation, Chicago. Fieldwork was sponsored by ANTROPOLOGI INDONESIA 70, 2003 25 (high-caste, royal) traditional ruler, Cokorda During labour, the woman typically sat on and his satria wife ’Gung Biyang. She was a a low stool or mat and was physically supported fully trained nurse and midwife (bidan), and by her husband or other attendants such as a became a permanent civil servant and the head female neighbour, children or female affines. of the village sub-clinic (Puskesmas Pembantu). Balinese traditional midwives were unusual in She also ran her own thriving clinic and mid- their gender: many were male, perhaps because wifery practice. Her clinic is now housed in a men dominate the healing profession (as three-room extension of the Puri, one in a line of balian) and midwifery was seen as one among shop booths on the main bitumen road, across many duties. By all accounts, these men usu- the road from the government sub-clinic. This is ally adopted a ‘hands off’ approach, often re- her profession and the source of livelihood for maining outside the building, perhaps bring- herself and her household. ing herbal or bark drinks (loloh), or oil to make In 1980, most births were home births. A the passage more slippery and hasten birth. In typical birth took place in the couple’s marital Margaret Mead’s field notes of births in Bayung quarters in the husband’s natal house-com- Gde in the mountains of Bali in the late 1930s, pound. Some labouring women were unat- there were experienced women present at all tended by traditional village midwives (balian the births but the midwife, Nang Karma, a man, manak), by choice or circumstance; others was never actively involved in the delivery.9 made some effort to be attended by these tra- He was often present, in a token sort of way— ditional specialists; a few were starting to ask standing outside the house ‘on duty’ and spo- for ’Gung Biyang to attend them, though she radically calling in to check on progress or to had no accommodation at this time. Three reg- send in supplies—but he never delivered ba- istered traditional village midwives had just bies. He seems to have enjoyed some status as attended a short training course in the use of a source of knowledge and experience. The clean instruments and hands for the delivery husband or father of the baby was usually of babies. One of them, I Nyoman, was a balian present and centrally important and useful. He (healer) or tukang urut (masseur); his practice was mainly active in holding and supporting consisted of bone-setting, massage, midwifery his wife from behind in her seated position with and a variety of other interventions including raised knees and splayed legs. Husbands fre- the manipulation of a foetus to turn it head- quently tended to their wives’ attire, especially down. Other traditional village midwives that I headcloths, and found food, water, rope, cloth came upon in Brassika included two lower and other implements, and ran messages. Sev- satria-caste women, both of whom underwent eral women told me that traditional male mid- a short course at the Puskesmas or subdistrict wives and husbands were ‘takut’ or afraid. clinic, and three low-caste men, who were un- registered and completely untrained in biomedi- 9 Mead’s field notes of birth are treated more exten- cal midwifery. sively in a forthcoming book (Parker forthcoming). I would like to express my thanks to Mary Wolfskill at the Library of Congress in Washington, for her assis- the Lembaga Ilmu Pengetahuan Indonesia (LIPI) and tance in accessing Margaret Mead’s field notes (Mead Universitas Udayana. Doctoral fieldwork was con- 1936–1938). Danandjaja who worked in the moun- ducted in 1980–1981 and for another month in 1989. tain village of Trunyan, not far from Bayung Gde Subsequent fieldwork has been intermittent but included states that ‘In Trunyan and Bali in general, the birth seven months in 1992, which was when most of the of a child is a matter for men’ (Danandjaja 1980:467, clinic and hospital observations were made. my translation). 26 ANTROPOLOGI INDONESIA 70, 2003 Some women reported that they felt uncom- the treatment of the Kanda Mpat, or Four Sib- fortable being physically exposed to view in lings, which are held to accompany the new their in-laws’ compound. Some, especially those baby. The blood of birth, the amniotic waters, who were reporting first births as young newly- the umbilical cord, and the placenta embody weds, felt isolated and helpless among their the Four Siblings.12 After birth the Kanda Mpat affines. They were dependent upon their in- are normally buried in the houseyard near the laws’ goodwill and generosity in seeking help entrance to the new parents’ meten (sleeping if problems arose. One woman felt totally alone quarters): they are placed in a hollowed-out (sendirian). She had married into her husband’s coconut shell wrapped in white cloth along with Brassika family from north Bali and was quite various symbolic foods and spices and maybe unsupported by family or close friends.10 some magical letters written upon a scrap of Mead’s field notes are valuable sources of white cloth or a piece of palm-leaf (pipil). This information about birth in the 1930s. What per- is a small, private ritual usually conducted by vades her dramatic notes is the pain, danger the new father and perhaps attended by only and uncertainty of birth as it was experienced one or two other family members. A cutting of by the villagers in the mountains of Bali in the pandan (pandanus) or large pebble marks the late 1930s. The concern of those attending the burial spot. At the time of burial the subtle as- birth was with the management of the labour— pects of the Kanda Mpat return to the four that the parturient woman’s pain was allevi- points of the compass, where they may be iden- ated and shortened by correct seating posi- tified with the Panca Maha Bhuta (Five Great tion, massage, drinks, poultices, and the use of Elementals: pretiwi (earth, human flesh, skin accessories such as rope; that experienced and and bones), apah (water, blood and bodily flu- appropriate people were there to support the ids), teja (fire, metabolic heat), bayu (wind, mother; and that a new human being was safely breath) and akasa (ether, soul)). added to the family and community. When the baby is 105 days old, the princi- The rituals surrounding the birth of a child pal ceremony attached to birth is held: the centred on the post-partum period11 and on nelubulanin, or three-month ceremony.13 This 10 There was a strong feeling by women that they 12 A continuing puzzle for myself, and one also noted should not return to their natal home to give birth. I by Hooykaas (1974:8n), is the fact that some sources, heard of one lower-satria woman titled Desak who such as Mershon (1971) and Weck (1973 [1937]), married a Cokorda., i.e. she married up the hierarchy state that the umbilical cord is one of the Kanda Mpat; to the highest title for satria people. The couple ar- my informants say that the vernix caseosa is intended. gued prior to the birth of their first child, so she went 13 In fact this is not the next ritual. First comes the home to give birth. Her new son was ‘thrown away’ by kepus pungsed, when the umbilical stub falls off, then her husband’s family and demoted by being given the ngelepas aon, 12 days after birth. The umbilical stub title of Dewa, the male equivalent of Desak, rather is wrapped in white cloth and stored with a ketipat than the Cokorda or Anak Agung to which he would kukur offering over the baby’s bed. The tutug normally be entitled. He is now a middle aged man, kambuhan, at 42 days, marks the end of the seclusion still titled Dewa, but at a recent family death cer- or sebel period when the mother and baby are ritually emony he was allowed to pray to the ancestors of his impure (sometimes translated as polluted, dirty or dan- father. This birth occurred, I was told, when people gerous). The father is sebel until the umbilical stub were more fanatical about caste, in fanatical times drops off. After the three-month ceremony, rituals (zaman fanatik). continue at designated times, such as at the first oton, 11 The 6- or 7-month ritual (pegedong-gedongan) the baby’s first ‘birthday’ (210 days after birth) and practised elsewhere in Bali is not and probably was not subsequent oton, when the child’s milk teeth fall out, practised in Brassika. and so on. ANTROPOLOGI INDONESIA 70, 2003 27 is a large social celebration of a successful birth its forebears. In the transformation of the and contrasts with the actual birth, which is Kanda Mpat in the period between birth and barely ritualized. Neighbours, friends and fam- three months (105 days), they are considered ily are all invited. After this, the Kanda Mpat wild, chaotic and uncontrollable, inhuman. In return to the baby, and from then they nor- this period, a baby is considered not yet hu- mally live in the vital organs of the body until man; it is entirely dependent upon its mother; death. The Balinese have considerable feelings and if it dies it is buried with much grief but of affection for their elder sibling guardians and without ceremony because it is thought that routinely make offerings to them at life-cycle the reincarnating ancestor has changed its mind ceremonies.14 and the baby still occupies the realm of the The anthropological literature emphasizes ancestors (Filloux 1991:276). The relative im- the co-association of the directions, colours, portance of the three-month ceremony—a large elements, animals, gods and the waste prod- social occasion—contrasts strongly with the ucts of birth, the Kanda Mpat. For instance, small, private birth ceremony. It marks the end the most powerful of the Guardian Spirits or of the baby’s transition to the realm of human ‘Brothers’ is the placenta. It is associated with beings and the return of the Kanda Mpat to the northerly direction, with water, with the god the body of the baby wherein they should re- Wisnu (lord of water), and with the water buf- main until death. It is important to understand falo, and bears the name Banaspati Raja. How- that these two rituals are conducted as part of ever, it is important to stress the central agency a series of life-cycle rituals, the manusa- of the Kanda Mpat in the life of the individual. yadnya, which culminate in the elaborate death The ability of the Kanda Mpat to mutate is a rituals. These ceremonies mark ‘the passage double-edged sword—if assiduously pandered from the innocent and inherently godlike child to they make fine protectors, but if neglected to the duty-bound and vulnerable adult’ they can be malevolent and violent.15 Tending (Eiseman 1990:84). the Kanda Mpat means ensuring future well- By 1992, the year of my next long stint of being—hence the seemingly endless offerings, fieldwork, childbirth practices had changed post-partum rituals and apparently infinite dramatically. Nevertheless, birth remained a multiplication of co-associations. magically charged event that was managed and The elements of the afterbirth literally and interpreted in culturally distinct ways. cosmologically link a child, via its mother, with By 1992, most births in Brassika occurred in the private clinic owned and run by ’Gung 14 Before eating, many people put aside a small por- Biyang. It was possible for her to accept tion of rice for their siblings; before she begins breast- labouring women at the government sub-clinic feeding, a new mother expresses a few drops of breast across the road from her private clinic and the milk onto the ground to feed the new baby’s Kanda Mpat; before embarking upon a difficult feat, or even Puri. The government sub-clinic was equipped before jumping into a river to bathe, children may with a high delivery bed, complete with stir- address their elder siblings, sometimes just attending rups, in a separate obstetrics room. As far as I to them and sometimes asking for help or protection. know, this delivery room has never been used. 15 There is a corpus of work on the Kanda Mpat. See Hooykaas (1974) for a narrative compilation and As with her normal nursing practice, villagers various lists of these co-associations gleaned from lo- preferred to see her in her non-official capacity cal manuscripts, priestly litanies and the findings of and in a more home-like setting, and it was Weck, the Chief Medical Officer in Bali in the 1930s. Eiseman (1990) is a more accessible source. easier for her to receive and nurse patients 28 ANTROPOLOGI INDONESIA 70, 2003 twenty-four hours a day at her home-based Women in labour arrived at ’Gung Biyang’s clinic. The women I asked about their choice of private clinic at any time of night or day. One site and care during childbirth considered that room was a waiting room, another the dispen- it was more moderen dan bersih (modern and sary and the third room was the delivery room, clean), patut (appropriate) and maju (progres- through which there was access to a tap and sive) to have their babies delivered in the clinic cistern. Village women gave birth on a simple, than at home. Although to me the clinic was metal-framed bed in this dark and rather dank neither clean, light nor cheery, they preferred it delivery room. Commonly a new mother stayed to home—they said they could rest and be well here for one night after the birth. For this ac- looked after, it was private and clean, and they commodation and the delivery ’Gung Biyang felt that ’Gung Biyang was more knowledge- usually charged Rp15,000 (at that time, able and expert than the balian manak. A AUD$10.00). For the actual delivery, the couple of women whom I asked about ’Gung birthing woman, her husband and ’Gung Biyang Biyang’s reputation for sorcery fended off the herself were the only people that ’Gung Biyang insinuation by saying that she would not dare allowed to be present—usually only the two to practise black magic in a proper modern prac- women were there. It was often said, by ’Gung tice—it would be very obvious in the clinic Biyang, traditional midwives and mothers alike, documentation if all the patients died! As for that husbands did not dare (sing bani, tidak why ’Gung Biyang’s private practice attracted berani) to attend. many times more patients than the official gov- ’Gung Biyang’s routine preparation con- ernment practice, the usual response was that sisted of fetching a couple of buckets of water, her private clinic was open at times when the pocketing a tube for sucking out the baby’s patients could come (i.e. particularly in the af- airways, placing a stainless steel basin under ternoons and evenings); it was more informal the bed (for the afterbirth), setting out a towel, and less ‘official’ (dinas) than the clinic; al- blanket, long gauze bandage with strings at though not cheaper, it was not expensive and the corners (for tying around the baby’s waist), payment was flexible; and she had a greater a swab of gauze on the bottle of Betadine (an- range of medicines than the government tiseptic), clamps, a bottle of oil, scissors, clinic.16 foetoscope, baby bath and rubber gloves. Usually the woman laboured and delivered 16 Sciortino (1995:199–225) discusses the contrast be- the baby lying on her back, wearing a bra and tween private and public practice by doctors, nurses with her kain (skirt cloth) lying loosely around and midwives in Java. Almost all public employees are also engaged in private practice, and, as in Brassika, her. The loosening of clothing was always a private practices are usually much better patronised precursor to the birth, both in hospitals and in than government health clinics. Many of the points the village clinic. This practice probably de- she makes in explaining the relative popularity of nurses’ and midwives’ private practices are relevant rived from a Balinese medical theory of the for Brassika. She makes the point that curative pri- body which aimed to facilitate the flow of vital vate practice is illegal for nurses, though not for mid- life forces and fluids through the channels of wives; as a result, she says that in private practice nurses are more careful in their diagnoses, take longer the body—hence the importance of massage to examine and interrogate patients, more solicitous and the concern with orifices. and ‘friendly’, more cautious in their administration An interesting example of the operation of of antibiotics, etc. than when practising in public clin- ics. Unfortunately, she does not consider cases where this theory was the alleviation of an obstructed the nurse is also the midwife, as in Brassika. or prolonged labour. The pregnant woman lay ANTROPOLOGI INDONESIA 70, 2003 29