Canada history research paper 2000
Balance and biomedicine: how Chinese Canadian women negotiate
pregnancy-related ‘risk ’and lifestyle directives
Shannon Jette a*, Patricia Vertinsky band Cara Ng c
aDepartment of Kinesiology, School of Public Health, University of Maryland, College Park,MD, USA; bSchool of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada; cSchool of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
(Received 4 January 2014; accepted 2 July 2014 )
In this article, we contribute to a growing body of literature that explores how risk discourse functions in the (globalised) neoliberal era of ‘intensive mothering ’.A comparison of traditional Chinese medicine and Western biomedicine indicates that in these two approaches to medicine, pregnancy-related risks are derived from different sources and seen in different ways. In this article, we examine how women with aChinese background living in North America negotiate these differences. More speci-fically, we use data from a qualitative research study to examine how 15 pregnant Chinese Canadian women living in Vancouver, British Columbia, understand and experience pregnancy-related risk and lifestyle directives. Examining data from aFoucauldian perspective that views ‘risk ’as a biopolitical technique of governance, we show that the ways in which the majority of the participants use traditional Chinesemedicine and Western biomedicine –and identify risk –change as they move through the stages of pregnancy. While many of them integrated aspects of both traditionalChinese medicine and Western medicine prior to pregnancy (using Western medicine for acute issues and traditional Chinese medicine to restore bodily balance and strength), once pregnant the majority of the women in the study used biomedical‘proof ’to guide them through a healthy pregnancy. They tended to avoid traditional Chinese remedies due to the ‘risk ’of teratogenic effects, and also avoided family advice intended to ensure bodily balance. Once the child was born, the participantsviewed the (maternal) body in a different way: as a body out of balance in the yin-yangsense –and in need of traditionally ordained practices (typically called ‘doing the month ’).
Keywords: globalisation; risk; risk perception; maternal health; traditional Chinese medicine; ‘doing the month ’
Introduction
In this article, we aim to contribute to the understanding of the relationship between
health, risk and society by examining how risk discourse functions in the (globalised)
neoliberal era of ‘intensive mothering ’.1In traditional Chinese medicine and Western
biomedicine, pregnancy-related risks are derived from different sources and seen in
different ways. In this article we examine how women who are on the interface of the
two systems, that is pregnant women from a Chinese background living in North America,
negotiate these differences. We are concerned with what happens when these complex and
shifting ideas about health, the body and appropriate lifestyle practices in North America
collide with other ways of thinking, such as those rooted in traditional Chinese medicine
*Corresponding author. Email: [email protected]
Health, Risk & Society , 2014
Vol. 16, No. 6, 494 –511, http://dx.doi.org/10.1080/13698575.2014.942603
© 2014 Taylor & Francis where the opposing forces of yin-yang have to be balanced and a different set of
pregnancy proscriptions are made explicit (Lau, 2012 ; Martin, 2001 ). In a globalising
world of rapid knowledge dissemination, it is important to examine how traditional
notions of health, risk and pregnancy impact and converge with Western biomedical
views on the subject. We begin with an overview of the historical relations between
Eastern and Western understandings of the (gendered) body, and then move to a discus-
sion of the theoretical work around the body, risk and society as well as substantive
research on the topic that has guided our analysis. We articulate our research questions
and provide an overview of the methods used to address them before sharing our findings,
discussion and conclusions.
Risk, pregnancy and medical practices
Geographies of the body: Eastern and Western understandings
In his historical analysis of European and Chinese medical traditions, Kuriyama ( 1999 )
notes how accounts of the body in the two systems of thought can appear to describe
mutually alien worlds even though there are many similarities. Comparing ancient
anatomical charts of Chinese and Western bodies, he shows how muscularity was
historically a peculiarly Western phenomenon while the tracts and points of acupuncture
in the Chinese body seemed to have escaped the West ’s anatomical vision of reality.
Similarly, Scheid ( 2002 ) notes that while the body in Western medicine is viewed as an
aggregate of discrete morphological substances ‘linked to each other anatomically by
means of mechanical structures and physiologically by way of interactive functional
systems ’(p. 28), the body in Chinese medicine is a complex unit of functions and a
site of regular transformations. A fixation on establishing the ‘ruling ’principle or con-
troller of the body in the West led to a specific focus on the heart and brain while the
Chinese body was viewed more as a dynamic system in which no one organ dominated
(Alberti, 2010 ).
Historically, the body in both traditions has been understood in terms of vital energy
and depletion with disease stemming from an imbalance in vital forces (although these
ideas remain central to Chinese medicine while only an indirect influence remains in
Western biomedicine). Hippocratic medicine took up a concern with the need to balance
the humours (blood, phlegm, black bile and yellow bile), elements (earth, air, fire and
water) and qualities (hot, cold, wet and dry) with the seasons in order to maintain a
healthy constitution. In this way the human body (and health) was part of and subject to
impersonal cosmic forces at the same time that personal behaviours (proper diet, comport-
ment, exercise, sleep) were seen to assist in the project of health (and care of the self)
(Krieger, 2011 ; Lupton, 1995 ). Lupton ( 1995 ) notes that remnants of this focus on bodily
balance and constitution remained well into the age of Enlightenment and its new ways of
understanding and seeing the body.
While the ancient Greek approach equated health with an ability to balance the
humours and disease, the Chinese approach, itself a fusion of differing belief systems
forged over the course of several millennia (Krieger, 2011 ), linked bodily health with the
preservation of social hierarchies and saw disease as arising from a disturbance in ordered
relationships. It was based on a correlative relationship between cosmos and the micro-
cosm of the body (Furth, 1999 ). As Guo ( 2000 ) describes it, Chinese medicine was slowly
systematised into the two philosophical doctrines about health and disease that came to
reflect the Chinese view of the world: the Doctrine of Two Principles –yin-yang –and the
Health, Risk & Society 495 Doctrine of the Five Elements. Yin-yang theory epitomised a dualistic line of association
where natural events were explained by a model of the ceaseless rise and fall of opposite
yet complementary forces. Yin was initially seen as the shady side of a hill –related to
cold, rain, femaleness, inside and darkness; yang denoted the sunny side –associated with
sunshine, heat, summer and masculinity. The continuing desire for order and balance by
reconciling opposing views and building bridges underpins this view of the body. The
central symbols of the Doctrine of the Five Elements were natural phenomena: metal,
wood, water, fire and soil that constituted a foundation for the five lines of correspon-
dence. Simply put, together the two doctrines sought to explain the laws of motion and
change in the natural world and the desirability of seeking a harmonious balance of health
through proper diet, correct personal behaviour, emotional balance and exercise. The
development and rise to prominence of Confucianism integrated these ideas into a more
concrete hierarchical (patriarchal) system that strictly defined social roles in society and
linked health of the individual and society to the respect of the system.
In her analysis of gender in China ’s medical history, Furth ( 1999 ) shows how in
classical Chinese medicine, men and women were described as having androgynous
bodies and similar physiologies related more to yin-yang cosmological concepts than
their physical makeup. 2Blood was thought to have an overwhelming presence and
influence in women ’s physiology and signal a key difference from the male body; it
was the energetic base for women, becoming transformed into breast milk and the foetus
but also a source of illness stemming from a blockage in flow (related to women ’s
inherent depletion and coldness) (Valussi, 2008 ). Furth ( 1999 ) notes that this heuristic
has been deconstructed and reconfigured as successive generations of healers considered
the clinical problems of their female clients, starting with the development of Fuke
(gynecology) in the Song dynasty (960 –1279 CE) and beyond. Indeed, the rationale for
pregnancy and post-pregnancy health rituals now viewed as ‘traditional ’(as opposed to
their biomedical counterparts) is rooted in theories of the somatic balance of yin-yang or
hot and cold (Tung, 2010 ). Regulation of yin-yang can be achieved by controlling diet,
daily activities and emotional states, resulting in a number of rules and restrictions during
pregnancy. These include avoiding foods such as watermelon, pears, lettuce, celery and
savoy cabbage, turnip, green beans, millet (cold foods thought to slow down circulation
and affect absorption of nutrients by the foetus), ice cream and bananas (cold foods
believed to cause miscarriage if eaten in early pregnancy) and dark foods (which might
result in a dark rather than light complexioned baby), as well as delicacies such as snake
(thought to give the baby eczema) and lamb (thought to cause epilepsy in the baby) (Lau,
2012 ; Lee et al., 2009 ; Yates, 2006 ). A number of physical activities were also considered
dangerous such as moving house, home renovations and/or moving heavy objects
(thought to destabilise vital energy or qi of the foetus and cause spontaneous miscarriage
and/or foetal malformation) as well as raising one ’s hands above the shoulders, walking
too fast/too often, squatting, jumping, climbing up and down (thought to cause a sponta-
neous miscarriage). There are also a range of post-pregnancy proscriptions, a time thought
to be crucial for restoring the yin-yang imbalance caused by the event of childbirth in
which blood (considered a ‘hot ’element) is lost, leaving women in a cold state. Regaining
hot/cold balance is the primary aim of the practice of ‘doing the month ’(zuo yue zi )in
which the new mother is warned not to go out into the sunshine, walk, read, cry, bathe,
wash her hair, touch cold water, or be exposed to wind or breezes (from outdoors or air
conditioning) lest cold enter her joints or slow the shrinking of the uterus (Kim-Godwin,
2003 ). Post-natal women are encouraged to consume ‘hot ’foods (such as soups with
ginger) and rest in order to regain balance.
496 S. Jette et al. Many of these directives stand in contrast to current Western biomedical advice
concerning appropriate fluids (for example cold water is considered the ‘fluid ’of choice),
food choices and physical activity levels during and after pregnancy. Western science, of
course, has its own history of explanations for foetal defects/malformation (Kukla, 2005 )
as well as weak, sickly babies or miscarriage (Vertinsky, 1994 ) that are based on theories
that functioned to regulate women ’s bodies and gender roles. Many of these ideas are now
dismissed as superstition or pseudoscience (although strands still remain), and biomedical
advice concerning prenatal diet and physical activity, while certainly not free of social and
political influence (see Armstrong, 2003 ; Jette, 2011 ; Jette & Rail, 2013 ), tends to be
based upon epidemiological studies that seek an association between exposure to a risk
factor (for example, eating a food that contains a chemical/toxin) and a negative health
outcome (birth defect or miscarriage) (Weir, 2006 ). The finding of an association does not
equate to causation, although anxiety about the reproductive body means that women are
pressed to manage potential risks even in the face of uncertainty about causation (Lupton,
1999 ; Ruhl, 1999 ). In this manner, then, societal beliefs concerning pregnancy risk as
defined by traditional Chinese medicine and biomedicine are not that dissimilar –despite
the fact that the physiological elements creating the ‘risk ’are imagined differently. ‘Risk ’
represents the potential of an outcome; it is not a guarantee of that outcome, leaving it
(and how the risk should be managed) open to interpretation.
Theoretical framework: risk as a biopolitical technology
In this article, we draw heavily on Foucault ’s( 2003 ) analysis of knowledge, power and
governance (further developed by Rose, Rabinow, O ’Malley and others), and these
provide insight into issues of globalisation and population control in China
(Greenhalgh, 2005 ) and the West (Weir, 2006 ).
From a Foucauldian perspective, knowledge circulated and accepted as ‘truth ’in
society becomes a ‘dominant discourse ’with the power to shape the ways individuals
make sense of and act in the world. His genealogy of power over life in the eighteenth and
nineteenth centuries led him to the concept of biopower that consisted of two poles. One
pole is centred on the individual body, to be disciplined and integrated into systems of
efficient control through continuous observation while the other pole centres on the
population, intervening at the level of ‘vital ’indices such as the birth rate and life
expectancy (Foucault, 1990 ). Supervision of the individual body and population (or
species body) was effected ‘through an entire series of interventions and regulatory
controls: a biopolitics of the population ’(Foucault, 1990 , p. 139), including the creation
of ‘norms ’(often based on ‘truths ’put forth by medical experts) to which individuals are
exhorted to compare themselves, engage in practices of self-care (including exercise/diet)
and ultimately regulate the population (for example controlling weight gain) (Foucault,
2003 ). The pregnant body is an ideal site for the administration of biopower as the
disciplining of the individual pregnant body results in the simultaneous regulation or
management of the social body.
Biopower is part of a larger complex of power relations that Foucault later termed
‘governmentality ’, which he defines as ‘an ensemble formed by institutions, procedures,
analys es, and reflections, the calculations and tactics ’(2003 , p. 244) that regulates the
population not through coercive power but by providing guidance on how individuals
should conduct themselves. He, therefore, used the concept of governmentality to help
explicate the close link between power relations and the process by which individuals are
made into subjects (subjectification) (Lemke, 2001 ). With his writings on
Health, Risk & Society 497 governmentality, Foucault ( 2003 ) extended his discussion about the influence of the State
on populations to focus more on the links between micro- and macro-workings of power.
Viewed through a Foucauldian lens, ‘risk ’is one of the:
heterogeneous governmental strategies of … power by which populations and individuals are monitored and managed so as to best meet the goals of democratic humanism. (Lupton, 1999 , p. 4)
The proliferation of biomedical ‘risk ’(and risk categories) that has come to define
pregnancy in Western society (Lupton, 1999 ; Ruhl, 1999 ; Weir, 2006 ) can be seen as a
biopolitical technology of governance, a bringing together of population level data to
create norms (that is, epidemiological risk) that are mobilised at the individual level in
clinical practice as clinical risk.
In North America, biopower is put into effect through clinical guidelines and/or
prenatal advice that is not ‘mandatory ’but rather recommended and as such serve as
‘modes of subjectification ’whereby women are encouraged to:
work on themselves, under certain forms of authority, in relation to truth discourses, by means of practices of the self, in the name of their own life or health, that of their family [unborn child] or some other collectivity. (Rabinow & Rose, 2006 , p. 197)
This is not to say that legal power is never used in the reproductive context in North
America (women have been jailed for foetal abuse in the form of drug use or had their
children taken away (Stengel, 2014 ), for instance) but such cases are the exception to the
rule (Rabinow & Rose, 2006 ; Weir, 2006 ). Rather, in the current neoliberal moment, and
through the mobilisation of the discourse of intensive motherhood, women are made
aware of the multitude of risks to their (unborn) child, and pressed to control for them in
order to be a ‘good ’mother and citizen (Kukla, 2010 ; Lupton, 1999 ; Ruhl, 1999 ; Weir,
2006 ).
While ‘power over life ’has historically played out in a more coercive manner in
China, as evidenced by the One Child Policy that aimed to curb excessive population
growth and aid China ’s modernisation project (with sterilisation as the technical centre-
piece) (Greenhalgh, 2005 ), biopolitical techniques put into place to ensure population
control (which incidentally have ‘lightened ’over the past decade) have had the effect that
‘permission ’to have one child has instead become an obligation to have a mentally and
physically superior single child. When combined with longstanding cultural imperatives
to reproduce (especially a son), the onus of responsibility falls on women to have a ‘high
quality ’birth, a goal aided by a combination of new reproductive technologies and
diligent prenatal care (Handwerker, 1995 ; Zhu, 2008 ). Thus, in the post-Mao era, one
sees a very ‘modern ’environment with regard to health (and childbirth). And yet,
traditional Chinese ideas about balance and the nature of the body remain strong and
appear to inform ideas around appropriate pregnancy health practices (Harvey & Buckley,
2009 ; Martin, 2001 ; Wan-Yim, 2009 ; Zhu, 2008 ) that are at odds with biomedical
prescriptions concerning pregnancy risk.
Our intention in this article, therefore, is to build on an appreciation of notions of
governance, biopower and care of the self to explore how pregnant Chinese Canadian
women have brought their perceptions of reproduction and body culture, along with
appropriate ways to respond to health concerns (and risk) into their personal lives. In
doing so, we contribute to a growing body of literature that draws upon social theory to
498 S. Jette et al. explore pregnancy ‘risk ’and understand why pregnant women and their unborn children
are ‘such potent focal points for regulation, monitoring and control ’(Lupton, 2012 ,p.
330) in contemporary Western societies. Feminist scholars (Lupton, 1999 ; Mitchell &
McClean, 2014 ; Ruhl, 1999 ) have drawn on Beck ’s( 1992 ) notion of ‘risk society ’to
make the point that in contemporary society, risk is central to pregnancy –it is ubiquitous
and pervasive. 3Noting that medical professionals have added ‘growing risk ’to the
existing categories of ‘high risk ’and ‘low risk ’, Ruhl points out that ‘there is no “no
risk ”category. Threat is everywhere ’(1999 , p. 101). Others have shown how technolo-
gical advances in foetal imaging and assessment have allowed the foetus to be seen,
monitored and tested, establishing the foetus as a patient in its own right, with needs
separate from (and often placed above) those of the mother (Weir, 1996 ). Wetterberg
(2004 ) argues that these social and techno-medical changes from the 1970s onwards have
resulted in the pregnant woman being constructed as predominantly responsible for, and
the main risk factor in, foetal outcomes.
Particularly relevant to our analysis is Mitchell and McClean ’s( 2014 ) exploration of
how (mostly white) British women used complementary and alternative medicine as a
resource to manage the uncertainty of childbirth and avoid manufactured (medicalised) risk
while at the same time selectively using expert medical knowledge. We build on their
analysis by exploring how pregnant Chinese women residing in North America negotiate
competing ontological and epistemological systems of thought concerning maternal care,
and the extent to which alternative medicine (in the form of traditional Chinese medicine)
informs their pregnancy experience and practices. While researchers have examined preg-
nancy-related practices of Chinese-origin women in modern China (Harvey & Buckley,
2009 ; Zhu, 2008 ), Hong Kong (Lee et al., 2009 ; Wan-Yim, 2009 ), Scotland (Cheung,
2002a ,2002b ), Australia (Hoang, Le, & Kilpatrick, 2009 ) and Pakistan (Mumtaz & Salway,
2007 ), examinations of the Canadian context that we could find are limited to one study
(Brathwaite & Williams, 2004 ) of the childbirth experiences of six professional Chinese
Canadian women living in Toronto. Brathwaite and Williams ( 2004 ) found that the women
adhered to many traditional values, beliefs and practices throughout their pregnancy and
childbirth experience, modifying others to fit their new cultural contexts. They also found
that recent immigration to Canada was associated with less adherence to traditional Chinese
rituals and beliefs. While providing helpful insights, a more up-to-date examination in the
context of Western Canada, with a combination of first and second generation Chinese
Canadian women, will contribute to this existing literature, as will a study that explores how
‘risk ’(and competing risk discourse) functions as a technique of governance.
In this article, we were therefore particularly interested in: exploring from which
authorities or modalities of transmission pregnant women of Chinese origin (both first
and second generation) 4tend to access their understandings of bodily function and preg-
nancy-related risk, as well as information about appropriate bodily practices/behaviours
during and immediately after pregnancy; and how, if at all, traditional Chinese medical
views and/or Western biomedical narratives are integrated into their daily lifestyles.
Methodology
Overall approach
In this article, we draw on data collected through in-depth semi-structured interviews
conducted with Chinese Canadian pregnant women residing in Greater Vancouver, a
richly multicultural community in which people of Chinese descent are the largest visible
Health, Risk & Society 499 minority group, comprising 18.2% of the population generally and substantially higher
(almost 50%) in certain municipalities (NHS, 2011 ). The use of in-depth interview
methodology enabled us to explore participant ’s understandings of pregnancy-related
health, body and lifestyle practices while at the same time providing space for participants
to frame and structure their own responses and introduce new ideas/topics (Rossman &
Rallis, 2012 ). Through our investigation, we were not concerned with identifying which
system of thought (traditional Chinese medical or biomedicine) more accurately identifies
risks that are ‘real ’. Rather than viewing risk as an objective phenomenon that can be
measured through quantitative risk assessment techniques, we were interested in the
broader social, historical and cultural contexts in which ‘risk ’as a concept derived its
meaning and resonance (Lupton, 1999 ).
Sampling and the sample
We decided to include women in the project who were:
● Chinese-origin women (either first or second generation) residing in the Greater
Vancouver area;
● aged 19 –40;
● at least 4 months pregnant or have given birth in the past year.
We selected these criteria so that we would speak with women who had been exposed to
both traditional Chinese medicine and Western medicine throughout their lives and who,
based upon age, were not in the ‘high risk ’category of 40 years of age or over (or
conversely, a ‘teen pregnancy ’). We preferred a gestational age of at least 4 months given
the popular practice of delaying announcement of pregnancy until the 2nd trimester, and
we allowed for inclusion up to a year post-natal as we felt that these women would be
well-positioned to reflect on their overall pregnancy experience.
Upon receiving approval from the University of British Columbia ’s Behavioural
Research Ethics Board in April 2012 (reference H08-1573), we started recruiting partici-
pants through several methods: leafleting at baby fairs, advertising the study through
social media (such as Facebook) and posting study information in physicians ’offices and
midwifery clinics. We recruited 15 women (see Table 1 for participant demographics).
The participants we interviewed were between the ages of 28 and 40; 5 were born in
Canada but with one or both parents born in Asia (these participants were second
generation Canadian), and 10 were first generation Canadian, listing Mainland China
(5 participants), Taiwan (3), Hong Kong (1) and Vietnam (1) as their place of origin. 5Of
the 15 participants, 12 indicated a household income of above $75,000 while 2 claimed an
income of $35,000 –45,000 and 1 an income of $15,000 –25,000. One participant had a
high school education and the remainder held university degrees. Overall, the sample can
be classified as well educated and middle class.
Interviews
We interviewed the participants between April and November 2011 and Cara Ng (third
author, research assistant and Cantonese-speaking) conducted the interviews in partici-
pants ’preferred location (including at the participants ’homes and in coffee shops). Before
the interviews were conducted, the purpose of the project was explained; it was made
clear that participation was voluntary and written informed consent was obtained. Cara Ng
500 S. Jette et al. Table 1. Participant demographics.Year of birth/Place of birth Age moved to Canada
and year Pregnancy status at time
of interview and parity EducationIncome
1 Stacey 1971/Canada N/APost-natal w/1st High School 45,000–55,000
2 Lucy 1974/ Hong Kong Age 8 (1982)Post-natal w/1st College/University Above 75,000
3 Eileen 1979/China *moved to Fiji in 1985 (age
6) before moving to Canada in 2001 Age 22 (2001)
Pregnant w/2nd College/University Above 75,000
4 Shirley 1975/Cambodia (Vietnam for time) Age 5 (1980) Post-natal w/1st College/UniversityAbove 75,000
5 Vanessa 1977/China Age 4 (1981)Pregnant w/1st College/University Above 75,000
6 Laura 1979/Canada N/APregnant w/1st University (Medical degree) Above 75,000
7 Miranda 1986/Taiwan Age 11 (1997)Pregnant w/1st University (Medical degree) Above 75,000
8 Rosanna 1974/Canada N/APost-natal w/2nd Graduate School Above 75,000
9 Edith 1974/Canada N/APost-natal w/1st College/University Above 75,000
10 Jennifer 1979/Taiwan Age 14 (1993)Post-natal w/1st College/University Above 75,000
11 Patsy 1980/Taiwan Age 11 (1991)Post-natal w/1st College/University 35,000–45,000
12 Patty 1980/Canada N/APregnant w/1st College/University Above 75,000
13 Virginia 1970/China Age 30 (2000)Post-natal w/3rd College/University Above 75,000
14 Gladys 1976/China Age 22 (1998)Post-natal w/1st College/University 35,000–45,000
15 Vivian 1983/China N/A (recently)Post-natal w/1st Graduate School 15,000–25,000
Health, Risk & Society 501 conducted the interviews in English though some Cantonese words or expressions were
used when participants found it difficult to say what they wanted in English.
The interviews were loosely structured and Cara Ng flexibly used a schedule of open-
ended questions to foster conversation about the origins of our participants ’understand-
ings of ‘health ’(in general) and what constitutes a ‘healthy pregnancy ’, with a particular
focus on their own health behaviours pre-pregnancy, during pregnancy and/or post-
pregnancy and how these did or did not change. We asked the participants about
information sources regarding health (including family members so as to examine the
intergenerational transfer of ideas/knowledge), as well as the influence of both traditional
Chinese medicine and Western medicine on their health-related practices.
Analysis
We digitally recorded the interviews which lasted between 45 and 90 minutes (two of the
interviews exceeded this time lasting from 2 to 3 hours). Cara Ng transcribed all the
audio-files. We conducted a thematic analysis of the transcribed texts seeking to identify
how the participants understood the (pregnant) body and lifestyle practices especially as
these are related to pregnancy-related health risks.
Shannon Jette (first author) and Cara Ng reviewed the interview transcripts and
together created a codebook based on the content and meaning that was explicit in the
data (largely a reflection of the topics explored through the interview guide) (Saldana,
2009 ). They then coded the same five interviews and discussed/clarified code definitions.
Cara Ng then coded the transcripts using NVivo 10 software (QSR International Pty Ltd.,
Doncaster, VIC, Australia). The coded text fragments were then reviewed repeatedly and
overarching themes that captured more subtle and tacit processes were identified (Rubin
& Rubin, 1995 ).
Findings
While we entered the interviews with an interest in the uses and understandings of
medicine throughout the pregnancy experience (that is, a deductive category), the issue
of balance (inductively) emerged through our analysis. We were struck by the shift
through the varying stages of pregnancy (from pre- to post-pregnancy) regarding appro-
priate practices/activities and how they relate to notions of balance that were in turn
informed by differing ontological views of the body. We have organised our findings into
two main themes: during pregnancy, biomedicine over ‘balance ’; and ‘doing the month ’–
regaining balance. All names are pseudonyms.
During pregnancy, biomedicine over ‘balance ’
While it is common in this era of intensive motherhood for women to make lifestyle
changes once pregnant, many of our participants also changed their utilisation patterns of
biomedicine and traditional Chinese medicine during pregnancy, seeking biomedical
‘proof ’to guide them through a healthy pregnancy, with most avoiding traditional
Chinese remedies. This contrasts with their pre-pregnancy behaviour since the majority
of the participants (12 out of 15) indicated that they incorporated both Western biomedical
and Chinese medicine directives in their lives. For instance, Miranda recalls that tradi-
tional medical remedies were a part of her life as a child, especially those related to food.
She explained:
502 S. Jette et al. if you were sick for a long time and then afterwards you need to get better, like you’re done
being sick …but you ’re still kind of like weaker, and then [mom] would buy these Chinese
medicine, and she ’d cook it with chicken or something, to make this big pot of Chinese
medicine …bring your energy back I guess.
In her family, Western medicine and traditional Chinese medicine were harmonised to
assist with recovery: when symptoms first appeared, the advice of Western medical
authorities was sought. Once symptoms subsided, the family turned to traditional medi-
cine in order to restore the body to its original strength. Eileen ’s experience was similar:
My dad was into those Chinese concoction soups… so we’d go there [the market] and buy the
ingredients, and then boil the soups… we were brought up, when you take Western medica-
tion there’ s always a side effect to certain things …with the Chinese medication …it has
maybe a lot less, or minimal side effects, they tend to treat the cause of whatever sickness that
you have versus the symptoms in the Western medicine.
Miranda and Eileen ’s recollections were representative of the narratives of many of the
participants who described integrating Chinese medicine and Western medicine while
growing up, although integration of biomedicine with Chinese medicine appeared to be
slightly more prevalent amongst the first-generation Canadian women as opposed to the
second generation. Nine of our ten Asia-born participants (as opposed to three of the five
second generation) combined traditional Chinese medicine and Western medicine while
growing up (under the guidance of their parents), although a few admitted that their use of
traditional medicine tapered off in adulthood and was only used to appease their parents. Once our participants became pregnant, however, they leaned increasingly toward
Western medical and/or midwifery expertise. Laura explained that when she was looking
for advice she accessed Western medical sources including:
up-to-date medical professionals or health care, not necessarily medical but your midwife …
someone who ’s actually up-to-date with, you know, current practices, current evidence.
Because I think our parents, our relatives have lots to say but a lot of it is passed down,
and a lot of it doesn ’t have any backing.
She distinguished expertise supported by ‘evidence ’from the advice of family members,
which she saw as lacking empirical proof or backing; she categorised the knowledge
‘ passed down ’generationally as potentially unreliable or unusable. Once pregnant, there-
fore, the women felt a greater need for scientific evidence; the epistemological standard –
what counted as evidence –changed and biomedical knowledge gained the most trust. For
instance, Vanessa was accustomed to drinking Chinese soups to please her mother, but
stopped during pregnancy for fear of their impact on the foetus. Edith tried some herbal
soups at the start of her pregnancy, but ceased taking them after an Internet search cast
doubt on their efficacy and safety. Concern over the possible teratogenic effects of
Chinese herbs/medicine as perceived through the calculus of biomedical ‘risk ’thus out-
weighed the perceived risk of not taking the tea during pregnancy (in order to balance yin-
yang). While Chinese remedies were dismissed as potentially dangerous, most participants
made a point of taking prenatal vitamins and supplements endorsed by the Western
medical system. As Miranda told us:
Cos, you know, you worry that, what if I missed a day of vitamins, if my baby ’s gonna have a
neurologic defect or something?
Health, Risk & Society 503 Thus, while traditional herbal remedies were perceived as potentially risky to the foetus,
vitamins and supplements approved by Western science were viewed as tools to mitigate
the various risks associated with pregnancy and help to ensure a favourable birth
outcome.Some participants were quite outspoken about their preference for medical advice
from a physician rather than an older family member who drew on Chinese traditions.
Shirley felt that her mother ’s views on pregnancy-related health were deeply informed by
Chinese culture and she expressed scepticism:
Cos [because] only the Chinese say stuff like that, ‘don’t eat so much of this ’or, ‘cos then
your baby ’s gonna come out this way ’.I’m just like ‘seriously?’[laughs]
Shirley wanted biomedical evidence supporting any food restrictions, and she (like many
of the other participants) looked to her doctor for this information. She went on to explain
that her mother warned her not to eat watermelon during pregnancy, as it would cause her
to experience yeet hay[hot air] which is bad for the baby. Shirley described her response
to her mother ’s advice in the following way:
Everything has to do with energies in your body because I think that ’s what the Chinese
medicine stems from, it ’s about balance of energies and whatnot, in your body I guess, so
whatever you put into it, causes a disruption …and the Chinese stuff it ’s like ah it ’s a little bit
to the extreme sometimes, ‘it’s a little bit farfetched, mom. ’
Vanessa also expressed scepticism about traditional ways of approaching pregnancy risk:
After I got pregnant…not so much my parents but other aunties and uncles would try to give
me advice to don ’t drink ice water, that ’s what I get a lot of, and I don ’t understand why …
and they’re just like ‘it’s too cold for the foetus ’or ‘it’s not good for your body ’um but I
haven ’t been listening [chuckles slightly] well cos …my doctor said it ’s fine, there ’s nothing
wrong with that. So um, I think I tend to follow more Western recommendations for health.
Cos I need the proof.
While the participants were, in general, vigilant about avoiding exposure to things that
had the potential to harm their foetus, what constituted a risk for them was informed by a
Western body ontology, giving them the confidence to dismiss (and even laugh about)
traditional Chinese medical directives concerning the danger of bodily imbalance.
Significantly, all of the participants exercised during pregnancy, some directly resist-
ing advice of parents and Chinese ideas about the need to rest. Miranda, for instance,
disagreed with her mother ’s advice:
She tell me …‘you don ’t have to exercise ’, that sort of thing. And I don ’t really listen to her.
I just kind of, you know, I nod and I say okay but I don ’t really agree with her.
Jennifer ’s parents also advised her against engaging in physical activity:
My parents don ’t want me to do any exercise because …they think …the water might not be
good for the baby …and they probably think that the yoga involves too much movement for a
pregnant lady to do. I don ’t know, maybe in Asia or in Taiwan, you ’re not supposed to do any
exercises at all, you ’re supposed to kind of sit steady, walk slower, don ’t do anything, to
make sure that you ’re safe…but I think movement is actually good.
504S. Jetteet al. When we asked Jennifer if she took notice of their concerns, she recognised that there are
different cultural perspectives on pregnancy and exercise but said she trusted the views
espoused in the West regarding exercise practices suitable for pregnancy, and listened to
her doctor.This is not to say that the participants wanted a medicalised pregnancy. Approximately
a third sought care from midwives rather than physicians in order to have a more ‘natural ’
birth experience and to receive the more personalised care offered by midwives. However,
while they might look to midwives in order to have a less medicalised experience and
more control over their birthing options, they still viewed midwives as medical experts
who draw upon Western evidence-based knowledge.
While biomedical ‘proof ’was the knowledge privileged by many of our participants,
this was not the case for all as four participants indicated that they avoided certain foods
and drink as per traditional Chinese medical directives. Stacey, who rejected traditional
Chinese medicine pre-pregnancy, followed her mother ’s advice not to eat lamb even
though she thought it was ‘superstitious ’behaviour. Nevertheless she avoided it ‘just to
be on the safe side ’. The other three women showed more concern over the potential
influence of hot and cold foods on the health of the baby and balance was an important
consideration, especially as it related to a potential miscarriage. For these women, Chinese
views of health, the body and pregnancy risk appeared to be more prominent than for the
other participants. As Jennifer explained:
A lot of foods in Chinese medicine are categorised as hot and warm foods or cold foods, so I
wouldn't eat a lot of food or foods that are considered cold …I still eat bananas during
pregnancy, but somebody told me that …some of the colder foods will actually have an
effect on the pregnancy and cause miscarriage or something.
Patsy agreed about the danger of foods that might bring out the cold and cause mis-
carriage and took her mother ’s advice so as not to risk the life of her unborn child.
Similarly, Gladys talked at length about needing to balance hot and cold since ‘if you eat
cold foods it will cause you the baby …liúch ăn [miscarriage] ’. It seemed that these
participants continued to respect Chinese understandings of the body (at the same time
that they adhered to Western directives) and avoided cold foods in order to minimise
pregnancy risks –especially miscarriage. Aside from these few exceptions, the majority of
the participants tended to favour biomedical knowledge and rejected concern over main-
taining bodily balance.
‘ Doing the month’– regaining balance
In contrast to their views about pregnancy, many participants more readily accommodated
traditional Chinese ideas following the birth. Some spoke about ‘doing the month ’,
illustrating how they reintegrated traditional medicine into their lives at this time (or
planned to). Referring to her mother ’s views on this practice, Shirley said:
My mom just thinks you need to stay in confinement for at least a month. Not really go out
and, stay in and have lots of soup and ginger, yeah, just really give yourself time to recover.
She felt that this practice of staying at home during the first month after giving birth was a
valid one, but only to a degree: Health, Risk & Society
505 There might be some merit, you do need time to recover, um, but it’s also …healthy to kind
of get out once in a while and …yeah, just using common sense.
Patsy discussed how she navigated the myriad requirements associated with ‘doing the
month ’:
My mom was really big on it, but I couldn ’t bear not washing, not taking a shower, not
washing my hair, …for the first couple days, I used towels, I didn’ t actually jump into the
shower, I used a wet towel to wipe my body up and downward …I listened to my mom for
the first two weeks and [then] I just let it go [chuckles]. But I stuck to the meals because my
mom has a friend who knows how to cook the Chinese, like, traditional meals, and she
cooked the meals for me, for a month so that ’s all I ate… like I didn’t drink any cold water.
Thus Patsy had modified traditional aspects of ‘doing the month ’to suit her personal
preferences and lifestyle. From her perspective, not showering for an entire month was
more of a problem than adhering to the Chinese diet, just as remaining in bed for a month
seemed much less feasible than avoiding cold water.
Virginia, on the other hand, adhered to directives to stay at home for the entire month,
and was also careful to avoid cold:
You do not use cold water. You do not put hand into fridge, grab stuff, especially you do not
put hand into freezer, because the temperature there is so low. You don ’t do those stuff. And
… you do not do things to, you know, make yourself feel really tired …you try your best to
be relaxed at home, even though sometimes you do need to take care of your baby. You ’re
tired, but you try not to do other stuff to make yourself more tired, because it might hurt you.
However, there were some restrictions such as not showering that Virginia could not
accept: ‘[My friend] didn ’t want me to take a shower. I said “no I feel gross if I don ’t take
shower ”’. Virginia received the go-ahead from her doctor that it was, indeed, safe to
shower and therefore decided to ignore her friend ’s advice.
Vivian also discussed complying with certain ‘doing the month ’practices while
ignoring others. Since her parents were not in town after she gave birth, Vivian decided:
‘ I can do whatever I want. I just wash hair, brush teeth ’, suggesting that for some of the
women, certain ‘doing the month ’practices were perhaps observed more out of familial
respect than belief in their efficacy. She ate raw fruits, which went against ‘doing the
month ’guidelines, but she did avoid drinking ‘cold water ’and eating ‘cold meals ’. She
also avoided touching cold water in order to avoid the ‘cold ’seeping ‘inside [her] joints ’.
When her mother suggested she rest in bed and not do anything for the full month, she
refused, saying, ‘It’ s very hard. It ’s very boring! ’Like Virginia, she decided to take a
shower but she also chose to only wash her hands with warm water since this cultural
requirement was ‘easy to follow’ and convenient. Gladys, on the other hand, explained
that she did not go outdoors for the entire month, except to visit the doctor. When asked
why it was thought to be dangerous to go outside she explained ‘the wind will get into
you, …there ’s the coldness out there so you stay home away from it ’.
Thus, for almost three-quarters of our participants (11 of 15), Chinese traditions –
especially avoidance of cold –took on a fresh relevance during the month after birth, at
times overruling biomedical advice, with many of the women negotiating the directives
and pressures from mothers and family members, in contrast to the time during pregnancy
when they were mostly dismissed. 506 S. Jetteet al. Discussion
Before pregnancy – and in particular while growing up – many of the participants
indicated that they utilised Western medicine for ‘big ’or acute/traumatic problems,
while keeping Chinese medicine and herbal remedies for ‘small ’problems such as the
common cold, and to help restore bodily balance (yin-yang). This elasticity in appropriat-
ing a variety of health and body practices has been identified elsewhere (Guo, 2000 ; Jette
& Vertinsky, 2011 ; Lai & Surood, 2009 ); it is what Guo ( 2000 ) found in his ethnographic
study of Chinese American immigrants ’health seeking behaviour in which he provides a
detailed picture of how immigrants modified their cultural habits pragmatically over time
to adapt to new cultural and social environments. During pregnancy, however, the women
were less comfortable with this model of ‘efficacy in practice ’(Allchin, 1996 ) whereby
one comfortably maintains a dual approach to health beliefs (Western and Eastern) while
fully embracing their incommensurability and pragmatically pursuing both Western and
Chinese styles of treatments simultaneously. Instead, our participants appeared to be well-
versed in the biomedical risks of various lifestyle practices during pregnancy, especially
where foodstuff and chemicals (what Beck ( 1992 ) would call ‘manufactured risks ’) were
concerned, and regulated their behaviours accordingly in order to have a healthy child. In
particular, they tended to avoid traditional Chinese medical soups/remedies that they
might otherwise use when not pregnant given that these are not sanctioned by the
biomedical establishment, and all engaged in moderate exercise which is endorsed by
Western medical institutions. The notion that certain foods would cause temperature
imbalance was mostly dismissed as lacking scientific proof, although a few continued
to heed such directives for fear that consumption might indeed induce miscarriage.
Our participants were therefore very much influenced by the discourse of intensive
motherhood, and drew upon the system(s) of knowledge that they believed would best
allow them to optimise their future child ’s health. In this way, their behaviour is in line
with that of other middle class educated women who, in the present neoliberal moment,
constitute themselves as ‘good ’mothers by doing all they can to ensure the health and
safety of their unborn child (see Lupton, 2012 ). The majority of the participants opted to
negotiate the uncertainties of pregnancy by looking to biomedical knowledge, indicating a
high level of trust in this knowledge that did not extend to traditional proscriptions
provided by family members. This discrepancy in trust appears to be underpinned, in
large part, by the participants ’ontological beliefs about the pregnant body and its
susceptibilities (that is, the threat of manufactured risks such as toxins versus the
importance of balancing yin-yang), and the institution of Western ‘evidence-based ’
medicine seemed to provide them with some measure of protection against anxiety. For
the few who also incorporated traditional medical ideas about the need to avoid some food
and drinks in order to maintain bodily balance, knowledge imparted by their mothers
(and/or the view that it is better to be ‘safe than sorry ’) held additional weight.
Regardless of its ontological and epistemological origins, ‘risk ’performed the biopo-
litical function of regulating the women's behaviours in order to ensure the safety of their
unborn child. Biopower was put into effect through pregnancy lifestyle directives that
served as ‘modes of subjectification ’encouraging the women to work on themselves by
means of practices of the self in relation to truth discourses (Rabinow & Rose, 2006 )–
although it was not the only truth discourse in operation. Biomedicine did appear to be
dominant, but traditional medicine was also present for some of the women when
negotiating pregnancy risk. Biopower functions, in large part, through ‘norms ’and the
women more exposed to traditional Chinese ‘norms ’regarding appropriate behaviour
Health, Risk & Society 507 appeared to be the ones more likely to follow both traditional Chinese medicine and
biomedical directives concerning risk. This finding is in line with previous examinations
of health practices during pregnancy in modern China (Harvey & Buckley, 2009 ; Zhu,
2008 ) and Hong Kong (Wan-Yim, 2009 ), in which the authors found a very ‘modern ’
environment with regard to health (and childbirth) at the same time that traditional
Chinese ideas about balance and the nature of the body remained influential.
There seemed to be more room for additional negotiation and experimentation in the
post-pregnancy period when kinship connections –and the need for social support –
seemed to overrule the biomedical paradigm, and the participants bowed more easily to
traditional views on rest and diet and the benefits of familial support. Once the child was
born, the (maternal) body became imagined in a different way –as a body no longer
posing a potential risk to the unborn baby, but rather a body out of balance in the yin-yang
sense –and in need of traditionally ordained practices ( ‘doing the month ’) to restore
balance, including the consumption of Chinese teas and herbs that were avoided during
pregnancy. At the same time, we need to be aware of the possibility that once the child
was born and free of the ‘risk ’of the mother ’s body, participants felt more able to please
their relatives who insisted on ‘doing the month ’practices; thus, it might be that a sense of
obligation to highlight their Chinese identity (rather than a shift in view of body ontology)
underpinned their post-natal practices. These findings illustrate the complexity of the
ways in which women make sense of their pre- and post-natal bodies and medicine, and
the ways in which Chinese medicine became for them a tradition to think with rather than
a system which could be proved right or wrong, beneficial or not. According to Harvey
and Buckley ’s(2009 ) examination of zuo yue zi in China, post-pregnancy can be seen as a
cultural space where the State and kin negotiate control over the mother ’s body. While the
State controls the rituals of biological reproduction, kin groups control the rituals of social
reproduction. The elderly women ’s ability to control this time period is evidence of the
‘persisting strong social authority of the kin system in China, despite disruptions to this
system during the Cultural Revolution ’(Harvey and Buckley ( 2009 , p. 66). Thus, in post-
Mao China, childbirth must be ‘managed and controlled by science rather than tradition
for the progress of the modern Chinese nation ’(Harvey and Buckley ( 2009 , p. 57) while
traditional Chinese knowledge (and the social hierarchies embedded within) continues to
play a role during the post-pregnancy period when mothers are granted authority to care
for their daughters. Based on discussions with some of our Chinese Canadian participants,
it appears that the social authority of the kin system in China migrates across borders
where post-natal health is concerned as the participants incorporated aspects of ‘doing the
month ’into their lives.
Conclusion
In her introduction to a recent special issue of this journal, Katz Rothman ( 2014 ) draws on
her nearly 40 years of research to reflect on the medicalisation of pregnancy and child-
birth. She begins by posing the question of whether, in contemporary Western society, it is
even possible to talk about pregnancy and childbirth in language other than that of risk?
She goes on to argue that in pregnancy and childbirth, it is not just a matter of ‘real risk ’
versus ‘perceived risk ’but rather the ‘intelligent balancing of risks, weighing of risks and
contextualising of risks ’that she and others have found through their research. Through
our own investigation, we have similarly seen how participants constantly balance risk as
they negotiate knowledge systems of both East and West that differently ‘imagine ’(and
mitigate) risk. Strikingly, one similarity amongst all participants was their seeming
508 S. Jette et al. interpellation by the dominant discourse of ‘intensive mothering ’. In this way, they appear
to be ‘produced ’as autonomous subjects who wish to do what is best for their unborn
child and, depending upon which knowledge system they draw upon, the directives that
serve as ‘modes of subjectification ’may shift and change. Although our sample was
limited, it appears that those newer to Canada may have a stronger connection to
‘traditional ’ideas, even if they do not follow these guidelines in their entirety. More
research would therefore be helpful to further understand possible differences within and
between the practices of first and second generation Chinese Canadians.
Notes
1. Feminist scholars argue that in Western societies, we are now living in an era of ‘intensive mothering ’that requires mothers to always put their children ’s needs first (at the expense of their own selfhood), with culture holding out the promise of child-centred mothering as a uniquely rich source of personal fulfilment (Douglas & Michaels, 2004 ; Hayes, 1996 ; Lee, 2008 ). Such ‘intense mothering ’is especially prominent during pregnancy as women are constructed as a potential ‘risk ’to the health of the baby they are carrying, and pressed to make prudent and rational decisions about their own behaviours to mitigate the risk (Lupton,2012 ; Ruhl, 1999 ). 2. Furth describes the way that beginning in the Han dynasty (late third century BCE to the start of the third century CE), the body was conceived in medical discourse as genuinely androgynous.Similarly, Galenic medicine subscribed to the one-sex model where both genders had a penis but men were associated with heat that allowed for expression of the organ while women ’s inherent coldness caused the inversion of the organ inside the body, demonstrating her ‘incomplete ’nature (Laqueur, 1990 ). 3. According to Beck ( 1992 ), the growth of science and technology in late modern societies has led to an increase in manufactured (external) risk –such as pollution, nuclear warfare and chemical residue. In other words, the perceived risks produced under the conditions of latemodernity have increased in magnitude and become globalised and are therefore more difficultthan in past eras to calculate and manage or avoid. As such, we live in a ‘risk society ’. 4. We are using Statistics Canada's definition of first- and second-generation Canadians whereby first generation refers to people born outside of Canada, and second generation includesindividuals who were born in Canada and had at least one parent born outside Canada (NHS, 2011 ). 5. We recognise that Hong Kong and Taiwan differ from mainland China and are aware of the complex political and social issues leading to these divisions (that are beyond the scope of explanation here), but for the sake of this paper we designate all participants as ‘Chinese Canadian ’given the influence of mainland China over both Hong Kong and Taiwan. Moreover, our recruitment adverts specified a desire to speak with ‘pregnant Chinese-origin women ’. The participant originally from Vietnam (Shirley) acknowledged the important role of Chineseculture in her life, largely influenced by her mother.
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