Caring for Sexuality and Reproduction: Experiencing community based care and state-run health care in a Ngöbe indigenous community in Costa Rica

Abstract

The Ngöbe are an indigenous group that resides in the north of Panama and the south Pacific region of Costa Rica. This thesis uses the ethnographic method to examine indigenous Ngöbe women’s practices and experiences of sexual and reproductive health care in a rural community in the southern region of Costa Rica. Indigenous Ngöbe women from El Bajo seek social and medical care practices provided by the community and the state-run health care facility. In their search for well-being, health care seekers consider diverse possibilities within their kin relationships, the community resources, and the state-run health care facility. This thesis also analyses the practices of health care professionals and the subjectivities associated with their work as well as the policies and discourses impacting the state-run sexual and reproductive health care actions, which influences the process of receiving/providing care. This thesis treats care as a practice that is informed by the logics of relationality and individuality. These logics are located in what Bourdieu terms habitus and as such are related to action and not to conscious reasoning. These logics highlight the individual’s relationship to their kin, their community and the environment, as well as the individual’s autonomy in relation to society and nature. These logics inform the practices of both health care professionals and Ngöbe indigenous women and, as a result, the two groups display different combinations of these logics which exist in the form of a spectrum. The actors’ positionalities play a role in shaping the logics within the structure in terms of gender, ethnicity, class, geographic location, and access to biomedical knowledge. Thus, the logics of relationality and individuality are combined in multiple ways; and in the process of exercising their agency people navigate the spectrum according to their possibilities ―social, economic, etc.― based on their positionality within the structure. This thesis follows a comprehensive understanding of women’s exercise of agency through resistance, the inhabiting of norms, and connection and belonging. Consequently, the main focus here is on the Ngöbe women of this community and their experiences and practices of sexual and reproductive health care.