Pascale Hancart Petitet

Résumés des communications scientifiques

2004 – fev 2009

2009

Hancart Petitet Pascale., “They only have to use condoms!” Social aspects of
contraceptives use amongst ARV users in Cambodia. Research perspectives.
International workshop on The Impact of HIV/AIDS and its Treatment in Asia Chiang
Mai, Thailand, 19-21 February 2009

Aim: According to WHO's Medical Eligibility Criteria for Contraceptive Use, most of
contraceptive methods are considered to be safe and effective for HIV positive
women. However, in Cambodia, we found that it is generally assumed by caregivers
and PLWA representatives that people leaving with HIV/Aids only have to use
condoms. The aim of this paper is to describe firstly, caregivers and PLHWA’s reason
for not considering other contraceptive options for people on ART. Secondly, we will
investigate various social factors that lead people under ART to use other birth
spacing methods like contraceptives pills, Depo-Provera injection, contraceptive and
abortive “Chinese pills” as well as abortion.

Methods: The study is based on an ongoing ethnographical research conducted with

the project “HIV, HVB, HVC Transmission and Reproductive Health Care in Cambodia,
An anthropological approach” (ANRS 12102). Observation and interviews have been
conducted in urban areas with 20 women living with HIV, 5 PLWHA representatives
and 5 caregivers. Broader interviews related to contraceptives uses have also been
conducted with 130 people (mainly women and 25 caregivers).

Results: The analysis shows various factors that lead caregivers and representatives
of PLHWA not to consider methods different from condom for birth spacing practices
amongst people under ART. Those factors are related to the consensus about the
need of dual protection for people living with HIV, to medical assumptions that are
not validated anymore in the scientific community (drugs interaction leading to
decrease efficacy of ARV treatment) and to social categorizations of patients
(condoms user described as the good ART patient, reproductive health care refusal
for PLHWA). Our data suggest also that many other factors lead people under ART
not to use condom. Those factors are related to the discomfort with male condoms
expressed by people and to women difficulties to negotiate safer sex. Various
common social representations on contraceptives secondary effects or lack of
knowledge on contraceptives drugs lead also some women to go for abortion. Finally,
the fear to talk about such subject with caregivers appears also to be an important

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 1

point to consider as it leads ART patients to hide their contraceptive practices to
caregivers.

Discussion: From a theoretical point of view, this study suggests relevant hypotheses
for the anthropology of reproductive health. For example, we may consider why, how
and to which extend social norms in the field of reproduction are build and
interpreted in the Cambodian context of AIDS. From the perspective of applied
research, those findings demonstrate the necessity to consider seriously the need of
contraception for people undertaking ART. This issue raises a problem for public
health, as many women go for unsafe abortions or other treatments like
contraceptive and abortive “Chinese pills” (whose effects on ARV treatment have not
yet been documented). From an ethical point of view, there is a need for people
under ART, as for everybody, to receive accurate information on contraceptive
methods and to get benefit from counseling sessions that will help them choosing
the best adapted one.

2007

Hancart Petitet P, Samuel NM, Desclaux A, Pragathi « Missed opportunities for HIV
PMTCT: A case study in South India . Abstract n°61 International Conference Aids
Impact Marseille 1-4th July.

Aim: In India, PMTCT programs are available at tertiary hospital level and numerous
women, particularly, when living in remote areas do not have access to those
services. Others, living in cities are not receiving the correct information about
PMTCT, or are not able to follow the entire protocol required by caregivers. For
various reasons some women are lost of for follow up. The aim of this paper is to
describe the various social factors that do contribute to missed opportunities for
PMTCT.

Methods: The study is based on an ethnographical research conducted in rural areas

with women and in a public hospital where PMTCT and HAART programs have been
set up. In- depth interviews have been conducted with women attending antenatal
care, involved in PMTCT activities, or receiving HAART treatment. Interviews were
also held with healthcare providers.

Results: The analysis of factors for transmission shows the intricacy of various social
factors that limit women’s access to PMTCT. For example: social categorization of
patients done by health care givers when deciding whom to test or not; economical
factors that limit the possibility of women to follow the rules required by protocols;
social factors that shape discrimination and stigma of HIV infected people;
inadequacy of ethical norms edited by international health institutions that are
sometimes difficult to implement in some contexts. Some factors are related to the
poor living conditions of women in rural areas, others are related to relationships
between pregnant women and the health system, mainly through their interactions
with health workers.

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 2

Discussion: These data are relevant to identify the missed opportunities for PMTCT
regarding the integration of a continuum of surveillance and control of PMTCT. The
presentation will describe and analyze factors that enhance the continuum of care
regarding PMTCT and identify factors that facilitate and hinder efforts to prevent and
treat HIV-related diseases in mothers and children in India.

Hancart Petitet P, Samuel NM, Desclaux A, Pragathi « Sociocultural factors of hiv

transmission during delivery in India. » Abstract n°60 International Conference Aids
Impact. Marseille. 1-4th July.

Aim: In India, programmes for Prevention of HIV Mother-to-Child Transmission

(PMTCT) have been implemented in some public health structures since 2001.
However, the majority of women do not access these programs since many deliveries
occur at home, with the help of Traditional Birth Attendants, or in Maternity wards
that do not develop MTC prevention. This is important not only for infants but also
for women’s health, since the context of pregnancy and delivery is the main
opportunity in India for women’s information on HIV and testing. The aim of this
paper is to describe factors that favour or hinder mother-to-child transmission and
iatrogenic transmission at field level and according to delivery settings.

Methods: The study is based on an ethnographical research conducted in four birth

settings: at home with a Traditional Birth Attendant, in a district clinic without PMTCT
program, in a public hospital with a PMTCT program, in a highly specialised HIV
centre. In depth interviews have been conducted with women, healthcare providers
and Traditional Birth Attendants.

Results: The analysis of factors for transmission shows the intricacy between
biological and social factors, such as the length of labour due to poor management of
delivery in some health services for women from low social status. In each setting,
some factors are specially related to HIV (such as women’s low level of knowledge
about AIDS or unavaibility of HIV testing), when others are not (such as high
frequency of C-sections in hospitals and private clinics). Most factors are related to
relationships between pregnant women and the health system, mainly through their
interactions with health workers.

Discussion: These data are relevant for the on-going debate about the involvement
of Traditional Birth Attendants in decentralization of PMTCT, which meets the issue of
changes in women’s roles in the time of AIDS. They are also relevant when
considering the consequences of delivery for women’s health, including iatrogenic
transmission and opportunities for HIV care, a topic that has often been neglected.

Socio cultural epidemiology of HIV/ AIDS. A case study in India. International

Seminar. Medical Anthropology as a tool for Public Health. University Heidelberg. 9-
11 May.

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 3

In Southern India, HIV MTCT programs have been started in some governmental
hospitals and by some NGOs but it exist neither in private clinics nor in rural areas
where deliveries are conducted at home by the so called “Traditional Birth
Attendants”. In such context, the distance that separates HIV MTCT
recommendations of International Health Organizations from the actual delivery
practices at home may be viewed as an extremely fertile field of study of the diverse
social factors which condition the actual implementation of the envisaged safeguards.
The notion of MTCT has two specificities. First, the transmitter defines this mode of
transmission: the mother. Other modes of HIV transmission are defined by sexual
behaviour, blood transfusion or drugs injection. The MTCT define also three modes
of transmission, the pregnancy, the delivery and the breastfeeding. Thus seems to
show the responsibility given to the mother related to the HIV transmission to her
baby. The MTCT concept seems to give to the mother a major role as a source of
transmission. However, the HIV MTCT rate are also due to various individual,
collective, institutional and contextual factors around the pregnancy and delivery that
I propose to describe in using the conceptual tools proposed by the socio cultural
epidemiology.

« Naissance et VIH en Inde du Sud : conflits, questions d’éthique et méthodologie ».

10èmes Ateliers Jeunes Chercheurs en Sciences Sociales Pondichéry, 27 février - 2
mars 2007. Conflit, négociation, coopération. Enjeux et méthodes pour aborder les
rapports sociaux en Asie du Sud.

Aujourd’hui en Inde, pour de nombreuses femmes des zones rurales le sida reste
une maladie peu connue. La plupart ont entendu parler de cette maladie. Cependant
peu connaissent les modes de transmission du VIH et les moyens de s’en protéger.
Par ailleurs, les personnes infectées par le VIH sont souvent victimes de
stigmatisation et d’actes de discrimination. La faible réponse initiale du
gouvernement face à l’épidémie, sa résistance face aux mises en garde des
institutions internationales quant à la diffusion d’une épidémie indienne à VIH et le
maintien de son discours moralisateur et conservateur sur l’épidémie auraient retardé
la mise place des actions nécessaires. La position gouvernementale est peu claire.
L’étendue de l’épidémie ne fait pas non plus consensus. Je propose de rendre
compte de certains aspects conflictuels autour de la lutte contre le sida en Inde du
Sud ; d’abord selon du point de vues des femmes d’un village des environs de
Pondichéry, puis selon une perspective plus large, à l’échelle nationale. Enfin nous
verrons comment l’accès à un programme de réduction de la transmission mère-
enfant du VIH est aussi une source de conflits divers pour les patients et pour les
soignants chargés de sa mise en œuvre. Cette ethnographie des conflits propose
donc une lecture des normes, des valeurs, des règles éthiques et des intérêts divers
que l’épidémie de sida, « réformateur social », vient révéler.

2006

« Rencontre des savoirs autour de la naissance, les cas des matrones au Tamil
Nadu ». séminaire organisé par l’Association des Jeunes Etudes Indiennes, Savoirs et

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 4

savoir-faire dans le sous-continent indien accès, transmission et enjeux. 16
novembre, EHESS, Toulouse.

Dans les pays du Sud, les matrones sont la cible de programmes de développement
variés et l’objet de nombreuses recherches dans le domaine des sciences sociales.
L’Inde ne fait pas exception comme en témoigne l’abondante littérature scientifique
et/ou militante à leur sujet. Les matrones sont l’objet de discours opposés et
contradictoires. Ces derniers conduisent grossièrement à distinguer les « pro-
matrones », persuadés de la nécessité de ces praticiennes dans le champ de la santé
de la reproduction, et les « anti-matrones » convaincus de la nuisance de leurs
pratiques. En adoptant un point de vue émique, je propose de montrer l’impact de
ces formations, ou de leur absence, sur les pratiques des matrones en Inde du Sud.
En effet, face aux pressions exercées par les représentants locaux du système
biomédical et afin de répondre à la demande des patientes pour des soins
« modernes » de l’accouchement, les pratiques des matrones sont transformées. Ce
sont des pratiques variées et syncrétiques agencées pour tenter de satisfaire les
exigences des nouveaux contextes. Certaines matrones, revendiquent la spécificité
de leurs pratiques comme une variation et une recomposition de celles
recommandées et pratiquées en milieu biomédical. D’autres matrones, voient leur
statut de praticienne et leurs soins dévalorisés. Entravées dans leurs activités
d’accoucheuses, le manque de pouvoir social et d'opportunité de ces dernières
paralysent la réadaptation de leurs pratiques aux nouvelles demandes de soin. Ainsi,
cette communication vise à décrire les causes, la mise en œuvre et les effets des
transformations contemporaines des savoirs et des pratiques des matrones dans le
contexte de la bio médicalisation de l’accouchement.

« State of the Art: PMTCT and Counselling », Second Annual IS-Academy Expert
Meeting on HIV/AIDS, Rethinking HIV/AIDS Preventive Counselling.13-14 November.
ASSR, Amsterdam.

As health care practices, counselling is a social practice. Thus, researches on

counselling practices are relevant to describe how those practices take place in social
order. Various aspects of social order may be described. For instance how
counselling session design, implementation, and effects are shaped by gender issues
(ASSR 2006) or how the meaning of counselling is an object of disjunction between
programme providers and patients (Obermeyer 2005). The objective here is to
consider counselling in PMTCT from a broader perspective. I will present five topics:
1. Local interpretation of the international guidelines on PMTCT counselling
2. Care givers and PMTCT counselling: Who should be counselled?
3. Counselling & Feeding practices: The concept of « choice »
4. Counselling on procreation for HIV+ women. Medical discourses on vertical risk
of transmission
5. Residual risk of transmission of HIV: A “blind stain”
Conclusion: Counselling practices analysis in various cultures and contexts show that
further research are needed in considering counselling as a « social fact » and as a
« cultural interpretation » Until now, researches focussed on counselling session and

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 5

on patient care/givers interaction quality and efficacy. The researches I presented
today show that following aspects must be investigated: Various women
interpretation of the medical information on risk and prevention - Women personal
experience of PMTCT (with hindsight distance) - Mediator role given to women by
health system in order to involve their partner in PMTCT- Women discourses and
personal experiences on PMTCT limits and failures - Care givers social
categorisations: Application of various norms depending on economical or social …
background of patients. All those aspects are not only interesting for social sciences
researchers. Their consequences are obvious for practices adjustment to women
needs. In those fields, conditions in North and South are not so different and a
comparative approach might be very useful.

« Programme de prévention de la transmission mère-enfant du VIH en Inde du

Sud :Dilemmes du chercheur et questions d’ethique autour des pratiques de conseil.
Séminaire du CRECSS. L’éthique en anthropologie de la santé : valeur heuristique,
conflits, pratiques. Le 18 Octobre 2006. MMSH. Aix en Provence

En Inde du Sud les programmes de prévention de la transmission verticale du VIH

sont principalement mis en œuvre par le gouvernement dans des maternités
hospitalières. Certains sont menés par des ONGs. L’observation du déroulement de
ces activités dépend de l’obtention préalable d’autorisations de recherche par des
comités divers au niveau fédéral et local ainsi que de procédures administratives de
longue durée. Pourtant, certaines circonstances ont permis de contourner ces étapes
et de rendre possible une ethnographie d’un programme de PTME dans un hôpital de
district. Une fois sur place, la confrontation aux contraintes du terrain ont confirmé
les dilemmes éthiques envisagés lors la construction de l’objet d’étude. Comment
documenter l’expérience de la séropositivité d’une femme enceinte lorsqu’un
entretien n’est a priori possible que durant le temps immédiat qui suit la révélation
du test VIH, ou au moment de l’accouchement ? De plus, les modalités
d’organisation du conseil par l’équipe de programme invitent à discuter des
agencements possibles, ou non, entre les principes de l’éthique tels que définis par
l’éthique de la recherche et ces principes tels qu’ils sont interprétés par les personnes
supposées les appliquer. Enfin, les publications et les communications scientifiques
produites ultérieurement à partir de ce recueil de données ne sont pas non plus sans
soulever de nombreuses interrogations. L’objectif de la communication est donc de
rendre compte des questions d’éthique rencontrées par le chercheur (lors de
l’initialisation du projet de recherche, lors de la confrontation des objectifs de l’étude
aux réalités du terrain et lors de la restitution des résultats), et par les responsables
de programme lors de la mise en œuvre des activités de prévention de la
transmission verticale du VIH.

.“HAART as An Opportunity to Improve HIV PMTCT ? An Indian Case Study” Abstract

N°TUPE0824, Poster Exhibition. XVI International AIDS Conference. Toronto. 13-18
August, 2006.

Background: International public health organizations stand in favour of using HIV

Prevention of Mother To Child Transmission (PMTCT) as an entry point to Highly

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 6

Active Antiretroviral Therapy (HAART). The impact of PMTCT activities on HAART
access is currently investigated. In India, few HIV infected pregnant women know
that they are infected by HIV and few have access to free PMTCT. Recently, public
hospitals have started activities to provide free access to HAART. In such context it
appears relevant to explore if HAART could be an opportunity to improve PMTCT.
Method: The study is based on an ethnographical research conducted in a public
hospital in South India. In depth interviews have been conducted with healthcare
providers as well as with female patients involved in PMTCT and HAART
programmes. Results: Until recently, PMTCT programme faced various difficulties,
which resulted in high rates of lost patients. Because of fear of stigma and
discrimination or due to social and economical constraints some women were not
able to follow the rules required by PMTCT protocol. Some of them escaped from the
protocol and delivered in maternity wards where no PMTCT programmes were taking
place. On another side, HAART patients had a good observance. Interviews pointed
out the positive impact of HAART on the patients’ physical and psychological welfare
as well on their social integration. Since the implementation of HAART activities in
the hospital, including Information Education Communication activities on availability
of AIDS treatment in the area, PMTCT activities have improved. Women are more
willing to receive counselling, to be tested and to be involved in PMTCT protocol.
Conclusions: The availability of HAART programme improves the implementation of
PMTCT activities in our research area in India. Our presentation will show more
precisely the social and psychological impact of HAART provision for women engaged
in PMTCT

Poster. HIV PMTCT In Home Delivery Care In South India: An Anthropological

approach. HIV Congress 2006. 10-12 March. Mumbay. India

Objective: Today, there is a common assessment that broadly 15% of HIV infected
pregnant women involved in HIV Prevention of Mother to Child Transmission
(PMTCT) protocol escape at the time of delivery. They give birth at home with
Traditional Birth Attendants (TBAs). In some part of India, women of remote rural
areas also deliver at home with TBAs, without any PMTCT care, as such programs
are only available in few health care services. In such context it is highly relevant to
explore the possibility to provide HIV PMTCT care during home delivery. Methods:
This paper presents results of a research Project « HIV Transmission amongst
birthing practices in Southern India, anthropological approach » which aim was to
study delivery practices in various system of birth (from biomedical to traditional
setting) in the context of HIV/Aids. Results: The study of birthing practices in rural
areas points out the lack of awareness of TBAs as well as rural women on HIV/AIDS.
It also shows TBAs practices that may increase (such as late cut of the cord) or
decrease (such as the absence of artificial rupture of membrane) the HIV MTCT.
Conclusions: Women delivering at home should also benefit of HIV PMTCT.
Prevention should then be adapted to local contexts and cultures to reach as many
women as possible. Relevant activities can be done in order to provide HIV PMTCT in
home delivery care.

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 7

 2005

Demedicalization of HIV PMTCT in South India:The opportunity of theTransfert of

knowledge to Traditional Birth Attendants. 5th International AIDS INDIA Conference-
OCTOBER 20-23rd, 2005. Chennai, India

In Southern India, programs of Prevention of Mother to Child Transmission of HIV (

HIV MTCT) have been started in some governmental hospitals and by some NGOs
but it exist neither in private clinics nor in rural areas where deliveries are conducted
at home by the so called “Traditional Birth Attendants” (TBAs). In PMTCT programs
itself, there is a high loss of follow up of patients who got tested and were attended
antenatal consultations but who don't coming back to deliver at the hospital. In such
context, the distance that separates HIV MTCT recommendations of International
Health Organizations from the actual delivery practices at home may be viewed as an
extremely fertile field of study of the diverse social factors which condition the actual
implementation of the envisaged safeguards. The question to train the TBAs, first to
reduce the maternal mortality, then to play an active role in the prevention of HIV
transmission is one of the debates in the international Health Organizations. In one
side, the « for TBAs » are fully convinced on the benefit to train them. In an other
side, the « against TBAs » wish to fight for the complete disappearance of their
practices. In this framework, we can explore the social role and position of TBAs as
well as the determining factors of their abilities, knowledge and social capacities to
apply preventive measures during delivery. The objective of the paper is to describe
the complexity of the question to know if the TBAs have to be or not to be involved
in the implementation of HIV PMTCT programs in South India.

Birth Practices Today. The Popular Representation of the Rise of Caesarean Section
In India Healing Today Soundings in the contemporary fashions of Indian medicines
International Seminar. 28.10.2005. French Institute Pondicherry.

In India, Sushruta considered in Ayurveda history as the father of surgery already

performed Caesarean section in IV century. Since the end of XX century, C. Section
was mainly a surgical procedure implemented to insure the security of woman and
child. Today, in India as in many countries, Caesarean has also become very popular
and is sometimes done without medical needs. Determinants of change in obstetrical
practices with favour to C. Section are concerned with various logics coming from
medical side as well as from patient side. I will focus on the latest and explore how
the logic of the star and logic of the body drive people to the demand of C. Section.
In opposition to this, social constraints (mostly) shape also resistance to C. Section
practice. Finally popular representation of the rise of C. Section will be described in
the whole context of social change in India shaped by what Reynolds called, the
“technocratic imperative”.

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 8

 2004

Enjeux des formations des matrones en Inde. Aspects sanitaires, sociaux et

politiques et portrait ethnographique. Séminaire Histoire, anthropologie,
démographie de la petite enfance EHESS Paris le 19 novembre 2004

Les données présentées ont été recueillies dans le cadre du projet de recherche
« Transmission du VIH et pratiques d’accouchement en Inde du sud, approche
anthropologique » initié par Centre de Recherche Cultures, Santé, L’objectif général
de ce projet est d’éclairer la façon dont les facteurs sociaux et culturels relatifs à la
conception, la grossesse et l’accouchement, au sein d’un contexte donné, accroissent
ou non la vulnérabilité de l’enfant à naître à l’infection par le VIH. J'ai choisi de vous
parler des matrones parce qu'en tant qu'institution sociale elles représentent un
prisme à l'étude des représentations et pratiques autour de la naissance. Dans un
premier temps de cet exposé, je présenterai les enjeux des formations des matrones
en Inde. Dans un deuxième temps nous nous intéresserons au cas particulier de
Satchadie une matrone de Pondichéry et aux transformations contemporaines de ses
savoirs et pratiques. L'objectif de cette présentation est de montrer comment des
approches théoriques diverses de l'anthropologie de la reproduction permettent de
mettre en évidence certaines logiques culturelles, sociales et politiques, individuelles
et collectives, en œuvre lors de l'événement de la naissance.

HIV Transmission and Delivery Care in South India: Theoretical approach and
practical issues. SSR-WISER seminar Risks and realities of HIV-AIDS in everyday
lives: Ethnographic insights and implications for Policy. October 6th & 7th 2004,
Amsterdam

In Southern India, HIV MTCT programs have been started in some governmental
hospitals and by some NGOs but it exist neither in private clinics nor in rural areas
where deliveries are conducted at home by the so called “Traditional birth
Attendants”. In such context, the distance that separates HIV MTCT
recommendations of International Health Organizations from the actual delivery
practices at home may be viewed as an extremely fertile field of study of the diverse
social factors which condition the actual implementation of the envisaged safeguards.
This paper presents the main preliminary results of a research Project “HIV
Transmission amongst birthing practices in Southern India, anthropological
approach”. The specific objectives are to: 1) set up an ethnography of child-birth
practices for studying the underlying causes of HIV MTCT 2) analyze the variations
in the practices in various systems of birth (traditional, semi traditional and
biomedical) 3) evaluate the applicability of the preventive measures recommended to
health care providers as well as to TBAs. I will consider the question of MTCT from
the point of view of public health and then suggest research perspectives in four fold
approach of anthropology of reproduction presented by the problematic of MTCT and
HIV: “socio-cultural”, “medical”, “social change” and “political” approach. In using
the frame given by the four fold approach, I will present the problematic of HIV
PMTCT from the perspective of the Home Delivery Practices of TBAs.

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 9

The “cultural approach” will focus on the representations, role and limitation of
training of TBAs, the “medical approach” will be illustrated by two examples of birth
practices of TBAs, the “social change” approach will show how the concept of
authoritative knowledge in obstetric is relevant to study the discourse and practices
around TBAs. Then, the “political approach” will point out how HIV PMTCT ARVs
procedures can be seen as an example of social categorisation of patients.
Meanwhile I will describe the constraints of women and TBAs to deal with ARVs at
home. Finally we hope to show how the four fold approach of anthropology of
reproduction is relevant to study HIV MTCT and home delivery care in South India.
At the end, some recommendations will be given on the training of TBAs and their
eventual role in HIV PMTCT in communities.

Notes on the sanitary, social and political stakes of Traditional Birth Attendant’s
training in India International Workshop Mirrored Views on Healing Systems in
India : Merging Policies, Politics and Practices, 19th and 20th of April 2004, French
Institute of Pondicherry. India.

My current research is principally related to study of reproduction in Tamil Nadu One

of the objective is to understand the role of different health practitioners in
traditional, semi-traditional and ‘contemporary/western’ medical settings. In that
context, and particularly in rural areas it is highly relevant to study holy sphere in
witch the practices of the traditional birth attendant are taking place. The objective
of this presentation is to describe and analyse how the TBAs are in the middle of
political stake’s debates on representations on modernity and tradition. The recording
of the various social movements around TBAs training demonstrate how those
relations are built with and by the distribution of power. It shows how the
authoritative knowledge is produced, distributed and fight in the sanitary, social, and
politic interactions.

Naître dans une communauté d’Intouchables en Inde du Sud. Cycle de conférences.

Exposition « Naissances, objets, rituels ». Musée de l’Homme. Paris. 4 Février 2004

Aujourd'hui en Inde, malgré le développement d'infrastructures sanitaires, une

majorité de femmes accouchent toujours à domicile, en particulier en zones rurales.
C’est le cas de Karik, un village du Tamil Nadu, en Inde du Sud, abritant une
communauté d’intouchables, où les femmes ont recours aux matrones pour les soins
de l’accouchement. Dans un premier temps, j’aborderais le contexte de la
procréation d’un enfant en Inde. Ensuite je présenterais différents aspects des
pratiques d’une matrone lors de l’accouchement : le déroulement du travail
d’accouchement, la gestion de l’accouchement compliqué et les variations de
pratiques autour du cordon. L’objectif de cette présentation est de décrire le sens
donné à l’événement de la naissance en milieu dit « traditionnel » et les contextes
sociaux, économiques et politiques dans lequel il s’inscrit.

Pascale Hancart Petitet. Communications scientifiques 2004 – février 2009 10