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Complicities and Resistances: Naxi Women’s Embodied Citizenships in Post-Mao China

Paper prepared for the international conference Medical Diversity and Its Spaces, Max Planck Institute

for the Study of Religious and Ethnic Diversity Gottingen, March 28 & 29, 2011

Submitted by Sydney D. White

(Associate Professor, Department of Anthropology, Temple University, sydneyw@temple.edu)

Abstract

From the contemporary ethnographic context of southwest China’s Lijiang basin, this paper

explores both the complicities and the resistances that are reflected in rural Naxi (minority) women’s

engagements with the medical and public health policies and knowledges of the socialist Chinese state

that have targeted their reproductive bodies. Naxi women in particular construct their PRC citizenship in

profoundly embodied ways through their negotiations of normative state and popular culture birth

practices, of state public health discourses on the “five periods” of reproductive “reprieve” (based on

neo-Confucian legacy narratives of women’s reproductive bodies as chronically depleted), and of a

range of practices related to the post-Mao Birth Planning Policy. My paper further addresses the role

that female Naxi midwives and other village health practitioners, as well as female public health and

birth planning officials, play as intermediaries in the negotiation of rural basin Naxi women’s compliance

with state public health and medical policies at the ground level. I conclude by addressing broader basin

Naxi constructions of an embodied gendered ethnicity as reflected in male prestige narratives based on

discourses of “fame” versus female prestige narratives based on discourses of “sacrifice.”

With an eye to the conference’s focus on conceptualizing medical diversity within a spatialized

framework, my paper simultaneously engages two projects. On one level, I address the nation-state

specific and historically layered contingencies of PRC healthcare policies, knowledges, and practices as

powerful icons and manifestations of socialist Chinese narratives of modernity in both the Maoist and

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post-Mao contexts. On another level, I address the implications of these healthcare policies, knowledges,

and practices for rural basin Naxi women vis-à-vis both how the socialist Chinese state has defined their

cultural citizenship in a profoundly embodied way, and how they as a constituency have navigated these

embodied citizenships.

Introduction

What has been distinctive about healthcare in socialist countries is that “science” takes on the

valence of both a religion and a collective morality for the state, essentially putting scientific knowledges

(including medical and public health knowledges) at the center of a socialist narrative of modernity, and

presenting a different discursive arrangement from the more typical dynamic between science on the

one hand and religion and other ideologies on the other in most capitalist nation-state projects. This has

had significant implications for the particular ways in which citizen bodies are gendered in healthcare

knowledges and practices—particularly women’s reproductive bodies, which are so often placed at the

center of the nation-building projects of the modern state. While paternalism has generally been a given

with respect to how the reproductive bodies of female citizens are construed in most nation-state

projects, the role of this paternalism has played out variably in the distinctive narratives of modernity of

different socialist states.

This being said, it is essential to view the biopolitical projects of specific modern nation-states—

whether they define themselves as socialist, postsocialist, or capitalist—as embedded in the ideologies

and apparatuses of previously existing –and also very specific—state “civilizing projects” (1). In other

words, modern state projects of nation-building—in this case with respect to health care and citizen

bodies—need to be seen as having their own ongoing “civilizing projects” that are embedded in the

ideological and bureaucratic legacies of the previous state “civilizing projects” that have shaped them in

a complex historically contingent and layered fashion.

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With particular reference to how this issue bears on the People’s Republic of China (PRC), I will

explore in this article the case of how rural Naxi (minority) women in Yunnan Province’s Lijiang basin

have negotiated the state healthcare policies as well as the medical and public health knowledges that

have targeted their reproductive bodies. On one level, I will be addressing the nation-state specific and

historically layered contingencies of PRC healthcare policies, knowledges, and practices as powerful

icons and manifestations of socialist Chinese narratives of modernity, in both the Maoist and post-Mao

contexts. On another level, I will be addressing the implications of these healthcare policies, knowledges,

and practices for rural basin Naxi women vis-à-vis both how the socialist Chinese state has defined their

cultural citizenship in a profoundly embodied way, and how they as a constituency have navigated these

embodied citizenships.

The Naxi “minority nationality” of southwest China’s Lijiang basin has been particularly

influenced by the legacies of both the imperial era Confucian and the Maoist and post-Mao era socialist

“civilizing projects.” The Lijiang basin was formally incorporated into the Qing imperial system of

“regular government” in 1723. Basin Naxi have thus nominally subscribed to Confucian lineage, family,

gender, and medical norms for quite some time. At the time of Liberation in 1949, an estimated 90% of

basin Naxi lay claim to having been members of the Underground Communist Party, and basin Naxi

represent themselves as “relatively obedient” with respect to their adherence to Communist Party

policies and how they construct their socialist Chinese citizenship. Nonetheless, among basin Naxi,

gender norms of femininity and masculinity have also long been characterized by ideals of “sacrifice”

through the hard physical labor and often entrepreneurial money-managing skills of Naxi women and by

ideals of “fame” through the Confucian scholar/ socialist cadre informed notions of “cultured” and

educated Naxi men. Gender has thus played a critical mitigating role in Naxi negotiations of their

socialist state imposed “minority nationality” status.

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Thus I explore both the complicities and the resistances that are embedded in basin Naxi

gendered negotiations of the ongoing legacies of the respective Confucian and socialist civilizing projects,

and I do this specifically through an examination of rural basin Naxi women’s engagements with the PRC

medical and public health policies and knowledges that have targeted their reproductive bodies. The

official PRC practices of “Chinese medicine” (zhongyi), “Western medicine” (xiyi), and “integrated

Chinese and Western medicine” (zhongxiyi jiehe) all have embedded in them the legacies of the

longstanding “medicine of systematic correspondence” Confucian medical project (i.e., classical Chinese

medicine), which has played an important role in both the Confucian and socialist state civilizing projects.

I address how basin Naxi women in particular construct their PRC citizenship in profoundly embodied

ways through their negotiations of normative state and popular culture birth practices, of state public

health discourses on the “five periods” of reproductive “reprieve” (based on neo-Confucian legacy

narratives of women’s reproductive bodies as chronically depleted), and of a range of practices related

to the post-Mao Birth Planning Policy. I go on to address the role that village female health practitioners

and other public health and medical practitioners play as intermediaries in the negotiation of rural basin

Naxi women’s compliance with state public health and medical policies at the ground level. I conclude

by addressing broader basin Naxi constructions of an embodied gendered ethnicity vis-à-vis the “fame”

and “sacrifice” narratives described earlier, and I conclude by addressing how these discourses both

have and have not been re-packaged by basin Naxi for consumption by the more than six million tourists

annually (most of them Han) who have been visiting the Lijiang area over the past decade.

On the Lijiang Naxi, the Chinese State, and Civilizing Projects

The Naxi are an originally Tibetan (or Qiang) people who migrated to northwest Yunnan (in SW

China) from the Qinghai Plateau more than a millennium ago. They had a kingdom that was always

betwixt and between other more powerful states historically: the Tibetan state to the northwest, the

Nanzhao and then Daliguo states to the south, the Yi peoples to the north, and the Chinese state to the

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northeast—into which the Naxi were incorporated under the tusi system of indirect rule during the Yuan

Dynasty (1271-1368). During the subsequent Ming dynasty (1368-1644), there was significant

inmigration of Han Chinese to Lijiang from the Jiangsu area, many of whom intermarried with Naxi. As

noted earlier, in 1723, under the Qing (1644-1911), Lijiang was incorporated into the Chinese state

under “regular government,” direct rule status. By the late Qing and the Republican (1912-1949) period,

Lijiang basin Naxi were thoroughly incorporated into the Chinese state (as opposed to Naxi of more

remote mountainous areas). Ever mindful of staying on the good side of power-holding constituencies

within the rising PRC state (1949-present), the overwhelming majority of contemporary basin Naxi

jumped on the bandwagon of the Communist Party just prior to the 1949 revolution, and most basin

Naxi have been avid participants in carrying out every political movement that has come along during

the Maoist (1949-1979) and post-Mao (1979-present) periods (2).

The implications of this history is that Naxi cultural citizenship—including its embodied

dimensions— has been very much shaped by first the Confucian “civilizing project” of the imperial

Chinese state, and by the subsequent “civilizing projects” of the Republican and Communist incarnations

of the Chinese state—the latter in both its Maoist and post-Mao iterations. Medical knowledges and

health care systems have been at the center of these civilizing projects, first through the Confucianist

state messages embedded in classical Chinese medicine, and then in the various projects of embodied

citizenship of the modern Republican and then socialist states (3). Because the Nationalists’ New Life

Movement and other health care related initiatives had limited impact in the Lijiang basin or the rest of

China given the general political instability and economic chaos with which the Nationalists contended,

however, my focus is primarily on the public health and medical policies of the socialist Chinese state,

which had as powerful an impact on the Lijiang basin as they did anywhere else in the PRC.

Notwithstanding the legacy of Lijiang basin Naxi incorporation into the Chinese state via the

medical and other apparatuses of various state civilizing projects, however, gender has proven to be a

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persistent faultline of difference in terms of how basin Naxi construct their identity and their citizenship

with respect to the Chinese state, and this is particularly reflected in Naxi women’s responses to

healthcare policies and the medical knowledges that they embody in the post-Mao context of basin

villages. In the next two sections, I will be addressing the two prevailing narratives that are reflected in

gynecologically- (fuke-) related rural public health practices in the basin (4).

Biomedical legacies and socialist Chinese modernity: hygiene, salvation, progress, and the CCP

Health care was one of the critical pieces of what the Chinese Communist Party (CCP) promised its

citizens in the New China, and health care interventions represented “hygiene” and “progress” in a

discourse of “salvation” by the Party. This discourse was an important component of the larger emerging

PRC project of a distinctively Chinese socialist modernity, which encompassed the central tenets of a

science-centered socialist modernity (initially following the Soviet model), unilineal social evolutionist ideas

of history (via Morgan, Engels, and the Soviet Union), and long-standing notions of the Chinese Confucian

civilizing project vis-à-vis the incorporation of non-Han peoples into the Chinese state (White 1993, 1997,

2002). This discourse of hygiene, progress, and salvation reverberated throughout the public health political

movement mobilizations of the masses during the Maoist period in particular, in such forms as sanitation

campaigns, pest control campaigns, and the eradication of infectious diseases through vaccination and

other programs. With respect to women’s health, it played out in the arena of midwifery in particular and

gynecology in general beginning in the Maoist period, and in the birth planning policy in the post-Mao

period.

The "new method of midwifery” was introduced just after the Communist Revolution in the 1950's.

The following excerpt on health care from an official history of Lijiang provides the CCP's representation of

this policy as the key to the Party's salvation of women and children (LJNXZZZXGK 1986:147).

Before Liberation, women's and children's health was completely unprotected. Everywhere the

deaths of new mothers and new babies could be witnessed. Prolapse of the uterus [zigong tuochui],

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severe cystitis [niaolou], and other gynecological disorders [fukebing--literally "women's diseases"]

seriously sabotaged the health of numerous working women. After Liberation, the Party and the

government regarded women's and children's health prevention as extremely important [shifen

zhongshi]; in 1953, the [Lijiang] County Women and Children Health Protection Station [xian fuyou

baojian zhan] was established. The "new method of midwifery” [xinfa jiesheng] was put into

practice for women of every nationality.

During my original fieldwork research in 1989-1990, in interview after interview with county and prefectural

public health bureau officials, the prolapsed uterus and cystitis tropes, along with the introduction of the

"new method" to replace the "old method" of midwifery, were brought up as examples of what the Party

did for women's health and for the reproductive safety of both women and newborn infants. From the

perspective of discursive deconstruction, these policies were clearly metaphors for the Party's salvation of

the very reproduction of the country.

The "new method of midwifery” was of course premised upon germ theory and was characterized

by village midwives as well as other public health officials as “hygenic” (weisheng), "clean"(ganjing),

“scientific” (kexue de), and associated with a "high level of 'culture’ (wenhua)” (i.e., high education levels).

This discourse was juxtaposed against the "old method of midwifery” (jiufa jiesheng) that was characterized

by practitioners as “non-hygenic (bu weisheng)” "dirty (zang)", reflective of “feudal superstition (fengjian

mixin),” “backward (luohou)” and associated with a "low level of 'culture' (di wenhua shuiping—i.e., low

education levels). Epistemologically, this discourse of hygiene, progress, and "culture" is integrally linked to

a socialist Chinese state discourse of scientific modernity (noted in the introduction).

In the contemporary basin, state public health system-designated village midwives and birth

planning representatives are the implementers of these public health policies. Village midwives are

themselves village residents who have generally married in from other villages, are they are in the Janus-

faced position (Potter and Potter 1990) of other types of village cadres, in that they have to answer both to

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the state (i.e., with respect to county and prefectural level cadres) and to their peasant neighbors whom

they serve. So they are designated by the state to mediate Central Government policies, but at the most

grassroots level, where indeed their own bodies are also subject to those policies. The words of a Lijiang

basin village midwife below reflects this gatekeeper positionality:

My role as a midwife is to give advice and tell people not to worry. If someone is not educated (mei

zhishi--literally "has no knowledge"), then they will not listen to what I say. A lot of the time, the

village environment (cunzi limian de huanjing) [for giving birth] is not good. The houses are old (jiu

fangzi), not disinfected (bu xiaodu), and there is bacteria (xingjun) everywhere. During a birth, my

job is to inspect (jiancha) the hygiene conditions (weisheng tiaojian) of the house and wash it clean

(xi ganjing). Just after a birth, I make sure the uterus is in good order. I go to check up on the new

mother three to four days after the birth as well.

In the post-Mao period, hospital births in Dayanzhen—the town that is the county and prefectural

seat of the Lijiang Naxi Nationality’s Autonomous County—have become routinized for those basin Naxi

peasants who can afford it for the birth of their first child, though eighty percent of basin village Naxi

women have their second child at home in the village if their first births are non-problematic.

The Birth Planning Policy (jihua shengyu zhengce), introduced at the beginning of the post-Mao

period, also reflects a discourse of hygiene and scientific advancement, with an emphasis on the “cultured”

(you wenhua de), “educated” (shou jiaoyu de), “modern” (xiandaihua), “advanced” (fazhan), and “scientific”

aspects of having less children, rather than on "hygenic" aspects. Peasants in particular are exhorted to

overcome such “feudal” (fengjian) and “backward” tendencies as believing in "the more sons, the more

happiness” (duo zi duo fu), and "placing more importance on males than on females” (zhong nan qing nu);

through abandoning these beliefs, they can become an “advanced” county in the very serious endeavor of

birth planning (for the country's future). As of course was the case throughout rural China, the Birth

Planning Policy was never a one-child policy, and most basin villages emphasized a two-child and birth

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spacing policy starting in the early 1980’s. As Ann Anagnost (1993) has described for most urban residents

of the PRC, the Birth Planning Policy was regarded by most rural basin residents as a logical and integral part

of the post-Mao socialist Chinese market economic and nation-building agenda which embraced “socialism

with Chinese characteristics” (Zhongguo shehuizhuyi de tese)—in contrast to Mao’s pro-natalist policies

which were held responsible by the post-Mao government and in post-Mao popular culture beliefs for

holding China’s economic development back. I will address the Birth Planning Policy in greater detail below.

Chinese medicine legacies, neo-Confucian citizenship agendas, and Chinese socialist modernity:

depleted female reproductive bodies

The other prevailing discourse that informs PRC public health policies, birth planning policies, and

popular culture practices concerning Naxi women's bodies is a discourse on the intrinsically deficient and

vulnerable nature of women's bodies precisely due to their reproductive functions. This discourse is rooted

in the medicine of systematic correspondence legacy that was reworked in its incorporation into

“Traditional Chinese Medicine” (TCM) as the official PRC practice of Chinese medicine. The view of women's

bodies as normatively weak, out of balance, and depleted developed out of neo-Confucian influences on

Chinese medical thought and is reflected in textbooks which emerged in the Ming and Qing dynasties (Furth

1986, 1987, 1999). Such notions of women's bodies as chronically out of balance parallel similar Victorian

constructions of women's bodies (Ehrenreich and English 2005). Judith Farquhar’s work on the construction

of female infertility in Chinese medicine in the early post-Mao PRC (1991) illustrates the continuity of these

representations of female reproductive bodies as vulnerable and constantly threatened by depletion in

urban Chinese medicine clinics in Guangzhou (1991).

This discourse is reflected in the "five periods of female health protection" public health policy

established by the Women and Children Health Protection Bureau in both urban and rural areas in the late

1950's and early 1960's. While a woman had her period, was pregnant, was soon to give birth, had just

given birth, or was nursing, she was to be assigned lighter work and/or special attention. These policies are

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still officially promoted by the Women and Children Health Protection Bureau today. They are linked to the

deficient female reproductive bodies discourse just outlined.

By the late 1960's and early 1970's, attention was directed to two particularly painful health

problems of women mentioned briefly in the text quoted in the previous section that were purported to be

widespread throughout the PRC: prolapsed uterus and cystitis. These particular problems were attributed

to “working conditions” (laodong tiaojian), “living conditions” (shenghuo tiaojian) and “giving birth to many

children” (sheng xiaohar duo). While these were unquestionably afflictions that merited the attention of the

officials, my research indicated that they were not particularly common afflictions among basin women. I

would suggest that the decision to focus on prolapsed uterus and cystitis as key concerns was connected

more to its discursive and rhetorical usefulness vis-à-vis both the salvation narrative agendas of the Party

and models of female physiological deficiency than to its epidemiological statistical significance.

Additionally, elaborate, month-long postpartum practices in both town and village contexts reflect

this discourse of female vulnerability after birth (referred to as zuo yue)—a practice of longstanding

throughout Chinese societies, and also reflect the humoral logics of bodily balance embedded in Chinese

medicine. These humoral logics of bodily balance—framed in terms of yin/ yang and five-element theory in

Chinese medicine, and restoring the balance of women’s postpartum bodies arguably can be seen as

paralleling the restoration of the reproductive balance of the family and ultimately of the state per the

dictums of Confucian logics. Young mothers get a temporary reprieve, and in a reversal of the social order

their mother-in-laws are responsible for caring for them. A village midwife describes these practices in the

following passage.

Most women like the first month after they have given birth (zuo yue), because they can

eat well (keyi chi de hao). The traditional period of rest for the mother is 100 days; 70-80% rest 50-

60 days. Forty days is the prescribed (guilu) period of time when a new mother is supposed to avoid

cold [drafts] and avoid drinking cold water; families with better economic conditions (jingji tiaojian

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hao) can observe this period--otherwise the mother goes back to work sooner. Most women get up

out of bed after 7-8 days.

There are four (sidun) special combinations of foods, especially for the first 7-8 days. These

include sweet glutinous rice dumplings (nuomi tangyuan), fermented rice (mijiu), eggs, brown sugar

(hong tang), white sugar, yak butter tea (suyou cha), chicken, and pork. These are all rich foods.

Customarily, it is believed that if the new mother eats things like bean curd (dofu) and green

vegetables (qingcai), she will get rheumatoid arthritis (de le fengshibing). Now, according to

scientific thinking (kexue sixiang), this has changed somewhat. If the new mother only eats things

like meat and eggs, she will become constipated. Usually her mother-in-law watches over her quite

strictly (laopo guan de bijiao yan); if her mother-in-law understands knowledge (dong zhishi), she

will give her daughter-in-law more vegetables.

The midwife's description also makes a clear distinction between the new "scientific" version of postpartum

dietary pracitices in contrast to the older, “less knowledgable” dietary practices typically encouraged by

mothers-in-law. All basin women who give birth in Dayanzhen hospitals are expected to observe zuo yue

practices—through prolonged stays in the hospital and/ or once they get home.

Two additional examples of how this discourse of deficiency is reflected in contemporary

reproductive health practices can be seen in Lijiang basin cultural constructions of tubal ligation and of

abortion. Much like the findings of Potter and Potter (1990) in the Canton Delta, neither vasectomies nor

tubal ligations are highly regarded by village men or women (respectively) as birth control strategies. In fact,

in all my research inquiries in the basin, no health practitioner had ever encountered a case of a patient who

had undergone a vasectomy (due to fear of vital depletion of jing and subsequent loss of strength). While

Naxi women did undergo tubal ligations, these were likewise considered to have a seriously depleting effect

on their bodies. This is reflected in the discourse of another basin midwife.

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There are some women who go through surgery (tongguo shoushu) [a common euphamism for

tubal ligation (jiezha)], but not too many. These women get backaches (yaotong), get fat (fa pang),

and can't do any work at home for about one year (jia limian bu neng zuo yi nian). They don't have

much energy (jingsheng bu hao).

These are Chinese medical bodies that are out of balance with flows of “blood (xue)” and “vital essence

(jing).”

Likewise, ideas on the appropriate timing of an abortion from a basin midwife also reflect

conceptualizations from Chinese medicine about how a foetus is constituted of “blood” and “bone:”

If an abortion is necessary, it is best to do it either before the first 40-50 days, or after the first four

months. Before the first 45 days or so, the foetus has no shape: it is not yet meat/ flesh, but rather

is blood (hai bu shi rou, shi xue). After this time, the foetus starts to have a shape and to have bones.

By the fourth month, the baby is already formed. So for the health of the mother, she should not

have an abortion while the foetus is in the process of forming. Otherwise, it is possible that part of

the foetus may be left inside (keyi wanchuan nong liuxia yibufen). This way is responsible and safe

for the mother (dui muqin fuze, anchuan) to have an abortion.

While it is not clear to me how representative of “official” fuke (gynecological) knowledges throughout the

basin this perspective is, it was also presented to me at the County Women and Children Health Protection

Station clinic in Dayanzhen—clearly as a Chinese medical legacy incorporated matter-of-factly into the

scientific logics of socialist (modern) Chinese medical practice.

Health care practitioners, the gendered division of labor, and gendered mediations

What is significant for understanding the practice of midwifery and gynecology in general in the

basin is that there is a clear gendered division of labor in the practice of health care that has unfolded with

the post-1949 establishment of a public health infrastructure. In the town (Dayanzhen) hospitals of the

basin, male doctors predominate in all departments but the obstetrics and gynecology departments. In the

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town-based public health bureaus, an overwhelmingly male staff prevails in the Hygiene and Preventive

Health Stations, but an overwhelmingly female staff prevails in the Women and Children Health Protection

Stations. In the village contexts, male practitioners overwhelmingly serve as “village doctors” and Hygiene

and Prevention Station representatives, while female practitioners overwhelmingly serve as midwives and

Women and Children Health Protection Station as well as Birth Planning Policy representatives.

Female Naxi health practitioner discourses both parallel and diverge from those of male Naxi

health practitioners. With respect to discourses of hygiene, science, progress, culture/ education, and

ultimately of “civilization (wenming)” female practitioner discourses definitely parallel discourses of

male practitioners. This (taken together) “civilizing” discourse takes on a particular significance among

female health practitioners because the primarily female clientele with whom they are dealing in fact

has a much lower average educational level than a male clientele does in the village context. So while

female health practitioners are, like their male colleagues, intermediaries between state policies and

local level practices, there is a greater discrepancy in fit between the epistemologies embodied by the

policies and the epistemologies held by the majority of village women, than with respect epistemologies

held by the majority of village men. Female health practitioners can either take a position of offering

their advice and then letting their female clients either take it or leave it (e.g., with respect to

postpartum or abortion practices), or they can use pressure and persuasion to negotiate compliance

(e.g., the birth planning policy).

The two key discourses that I have argued are reflected in PRC state policies vis-à-vis women’s

reproductive health—i.e., of hygienic and of deficient female bodies, respectively—are reflected in the

discourses of these female health practitioners. Data suggests, however, that these state policies and

discourses are varyingly accommodated, resisted, or appropriated by village women.

Notwithstanding the different constituency that they serve, however, these female practitioners,

like their male colleagues, see themselves as part of a larger national socialist Chinese project in their

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roles as healers and as representatives of the state. In fact, the discourse of service is in some ways even

more accentuated for female practitioners since it is indeed a great sacrifice for these women to take on

a commitment to their health practitioner tasks. Basin village women already have an extremely heavy

work burden with their combined agricultural, animal care, and home responsibilities, while male

practitioners tend to just be full-time practitioners. While there is to some degree a discourse of “fame”

among female health practitioners which parallels that among male health practitioners, there is an

important fundamental difference. While Naxi male health practitioners are negotiating their fame and

prestige in a competition-based discourse, (e.g., vis-à-vis how clever they are for coming up with a

specific treatment), Naxi female health practitioners are emphasizing their helpfulness and self sacrifice

for other women and for the abstract concept of the good of the country.

Basin Naxi female health practitioners play the central role in implementing the Birth Planning

Policy—both in the village and town contexts. As is the case elsewhere in the PRC, this policy is very

much a policy directed primarily towards women and carried out by women. In order for the policy to

have any degree of success, it was necessary for the Party to obtain the cooperation and complicity of

women in general, and a large part of this cooperation was mobilized through the various administrative

levels of the Women and Children Health Protection Stations as well as the female health practitioners

at the local level in both rural and urban contexts. In basin villages, the official Women’s Federation

representative was often placed in charge of implementing and enforcing the Birth Planning Policy, and

this representative would usually work closely with the Women and Children Health Protection Station-

designated village midwife.

While in theory PRC minorities were supposed to be exempted from the Birth Planning Policy,

this did not completely apply to the Naxi. As has been the case with every other central government

policy since 1949, this policy was assiduously carried out and enforced in the basin by both rural and

urban Naxi. As of 1990, village residents of the basin (as with village residents throughout Yunnan) were

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officially permitted to have two children. Throughout basin villages, there was also a requisite three-

year spacing between births. Theoretically, no additional births were allowed, regardless of whether or

not either of the first two children was a son. While most rural basin Naxi unquestionably parallel rural

Han in their desire to have a son—both for “social security” given that daughters marry out, and to

perpetuate the patrilineage, it is generally not a source of great despair among basin Naxi not to have a

son, as basin Naxi daughters are seen as particularly filial as well as hardworking and capable, and the

longstanding rural practice of “marrying in a son-in-law” (referred to as shang men in the basin) when

one does not have a son is well-accepted and not particularly stigmatized in the Lijiang basin.

The degree to which this in essence two-child policy was enforced in villages throughout the

basin varied according to the strictures of the person placed in charge of local enforcement, and the

degree to which the people of an area believed that either a son or more than two children were

important. In the predominately Naxi context of the Lashi basin (adjacent to the Lijiang basin), having

more than two children was not uncommon, although concerned families were expected to pay fines.

The areas of the basin where significant numbers of the Bai minority group lived (most originally from

the Jianquan area) also had a reputation for exceeding the limit in a big way, the Bai being particular

notorious among basin Naxi for their “regarding males as more important than females” attitudes, and

for equating more children with more material gain. Some Han peasants in the basin also disregarded

birth planning policy limits, and had significant fines levied against them. Han men from son-hungry

provinces such as Zhejiang and Jiangsu would also come prospecting for Naxi peasant women as brides,

since as minorities rural Naxi women would be allowed at least two children legally.

In Dayanzhen, Naxi and other minority nationalities were generally also permitted to have two

children, but the timing of both the first and the second child was very much controlled by a person’s

work unit. A number of Dayanzhen Naxi families in fact opted to have only one child. Since virtually all of

them could have two children, and since few of them really want more than that, most basin Naxi

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women are reasonably content with the Birth Planning Policy. Most significantly, for Naxi in both

Dayanzhen and the particular villages of the basin that postion themselves as more “cultured” and

“civilized” (i.e., educated and more economically well-off), as well as more aligned with “progress” and

“modernization” in the form of improving the “quality” (suzhi) of their families and their county and

their country, having two children or less served as an important marker of social status.

The burden of birth control is more of a subject of disgruntlement and most basin women will

readily bemoan the side-effects of practically every method available—IUDs and abortions being the

primary methods in addition to some tubal ligations. Nonetheless, as with everything else in their lives,

it is assumed by basin Naxi women and female health practitioners that women will assume

responsibility for birth control.

The increase in hospital births among basin peasant women whose families can afford it (at least

for their first child) only started in the late 1980’s. While this raises questions about the medicalization

of childbirth in a biomedical genre, I would suggest that with respect to both village and town residents

of the basin, the reproductive discourses from Chinese medicine play a much more potent normativizing

role on Naxi women’s bodies than any biomedical reproductive discourses at this point.

Discourses of “hygiene,” “progress,” and “civilization” (all of which are invoked in birth planning

practices in the post-Mao basin) have particular salience for Naxi given that they are a minority

nationality which positions itself as “relatively advanced” on the social evolutionary scale that still

constitutes one’s stage of “historical development (lishi fazhan)” in the PRC, although this official PRC

narrative of history does not allow Naxi to claim being as at quite an “advanced” stage as the Han.

Likewise, Naxi women are seen in basin discourses as (and in fact for the most part are) less educatied,

so these female health practitioners are negotiating additional discourses of “backwardness” given their

own lesser educational opportunities in the basin historically, and the likely even lower educational

levels of the rural women they serve.

17

Naxi gendered ethnicities: complicities and resistances

In terms of how they are reflected in policies and in everyday practice, the two discursive influences

outlined above—one rooted in biomedical hygiene and Party salvation and socialist progress narratives, and

the other in Chinese medicine narratives vis-à-vis countering the naturalized intrinsically depleted narrative

of female reproductive bodies—are intertwined in the public health policies and practices as well as medical

knowledges of the socialist Chinese state, and this hybridity of medical knowledges is intrinsic to the

socialist Chinese narrative of modernity. In many respects the significance of Chinese medical epistemology

in both clinical and popular contexts of the contemporary Lijiang basin suggests that Chinese medicine

exerted a powerful "civilizing" force on all citizens as a technology of the imperial Chinese state, and that it

continues to serve a similar, equally powerful "civilizing" role on all citizens of the socialist Chinese state,

alongside discourse of hygiene, science, and progress attributed to biomedical approaches.

Nonetheless, it is important to also address how Naxi women—and Naxi men— do not wholly

subscribe to the normative gender practices of the socialist Chinese state with respect to their actual bodily

practices—either in terms of fuke knowledges (i.e., official narratives of PRC gynecology), or with respect to

the gendered division of labor in basin Naxi society. Naxi gendered prestige plays out in a distinctive

pattern in contrast to gendered prestige patterns in Han parts of rural China. There is a discourse of

“fame” associated with a Confucian scholar styled masculinity that prevails among Naxi men, and a

discourse of intrinsically embodied “suffering” and self-sacrifice through constant physical labor that

prevails among Naxi women. Even before the post-Mao feminization of agricultural labor in the PRC

(Bossen 2002), village basin women did most of the field labor, and both village and town basin women

tend to do virtually all of the physical labor for their families. A Naxi woman's prestige is based on her

ability to labor for her household, as well as to save and manage money for the household.

As I have argued previously (1993, 1997), it is this ethos of ceaseless work that points to a major

faultline between normative Naxi constructions of gender and normative Han constructions of gender.

18

Naxi women are demonstrating the depth of their commitment to their families through literally giving

their bodies to them, and this is made evident by their epidemiological health profiles. I have also

argued that Naxi women are associated with production and Naxi men are associated with consumption

(1997). This dynamic is played out epidemiologically with the major chronic afflictions of Naxi women

being those associated with activities of production. Naxi women, both rural and urban, suffer in highly

disproportionate numbers (compared to Naxi men) from arthritis, chronic headaches and other pain,

and a condition that they and local practitioners refer to as shengjing shuairuo (literally “weakened

nerves,” or “nervous system disorder”), which Kleinman (1990) has identified as the Victorian era

malady neurasthenia. The symptoms of neurasthenia include insomnia, exhaustion, headaches, and a

variety of other symptoms. Kleinman has argued very convincingly that “neurasthenia” in the PRC

represents a very inviting diagnosis precisely because it signifies a somatized (as opposed to psychological)

distress. As in the case of anthropological analyses of “nerves,” “susto, “stress,” and “spirit possession,”

such afflictions can represent a medicalized form of resistance that can register protest or at least a

legitimate excuse for a break from one’s everyday routine. With respect to medical practices, Naxi women’s

ethos of ceaseless work and of shouldering the bulk of physical labor (in both village and town contexts of

the Lijiang basin) contests the neo-Confucian medicalized notion of deficient female bodies that has been

perpetuated in post-1949 public health policies.

Naxi men, on the other hand, are plagued by diseases associated with consumption: liver and

gallstone or kidneystone ailments from excessive consumption of grain alcohol, heart disease and

strokes from excessive consumption of pork fat and meat in general (of which men get choice portions),

and lung cancer and chronic bronchitis from excessive smoking. There is also the new form of heart

disease known tongue in cheek locally in the basin as "(government) official heart disease" (guanxing

xinzangbing). This affliction is allegedly due to the consumption of too much rich food and too much

19

grain alcohol among cadres at state sponsored banquets (the overwhelming majority of whom are Naxi

men).

What is significant about the ways in which Naxi women respond to the symptoms of neurasthenia,

headaches, and arthritis, however, is precisely that they do not rest. Indeed, they use the medication

prescribed by practitioners for their work-ethos-related afflictions (a medication that purportedly contains

an opium-based derivative) in order to persist in their demanding everyday work schedules. For basin Naxi

women then, with respect to the gendered construction of basin Naxi identities, the “hidden transcripts”

(Scott 1990) of complaint are not being played out as they would be in Han culture (rural or urban). The

ideal of the constantly working, self-sacrificing Naxi woman is one that most Lijiang basin Naxi (both male

and female) warm up to as a veritable hallmark of Naxi identity. It appears that Naxi historical responses to

the potently gendered codes of neo-Confucianism were themselves informed by indigenous Naxi concepts

of gender. Distinctively Naxi gender ideologies mediate the public health discourses that reproduce neo-

Confucian notions of the deficient female body through the ethos of Naxi women’s ceaseless physical labor.

Basin Naxi are themselves conscious that their gender system is not exactly “official;” they are, however,

quite accomplished at appropriating official discourses to mask the faultlines between the official and the

unofficial.

This particular basin Naxi practice of simultaneously negotiating embodied gendered ethnicity

norms for the Lijiang basin while subscribing to the Chinese medicine informed state normative discourses

of fuke that dictate somewhat different gendered embodiments has become even more complicated over

the past decade, as the Lijiang basin has become a major ethnic tourism (5) destination—primarily for

domestic tourists, to the tune of six million tourists per year (White 2010). Given that Lijiang basin Naxi had

been so Confucianized in many respects vis-à-vis their gender practices, basin Naxi have neither developed

nor cultivated the trope of exotic minority sexual practices as part of their ethnic tourism marketing strategy.

Instead, Lijiang is marketed for its pristine alpine locale, unpolluted air and water, luxury condos, world’s

20

highest golf course, the Qing dynasty carved wooden courtyard houses along charming cobblestone streets

of Dayanzhen and now Shuhe, the clear streams running through Dayanzhen and Shuhe as well, and the (re-

invented) legacy of dongba ritual healers (White 1993, 2010; Chao 1996). Young female Naxi tour guides

have taken to wearing “traditional” outfits that they have borrowed from their “sexier,” “walking marriage

(zouhun)” Mosuo cousins (see Walsh 2001a, 2001b, 2005; Walsh and Swain 2004) rather than the stalwart

(but hardly titillating to tourists) sheepskin capes and repeatedly patched old clothes that Naxi women

(especially older women) would wear to bear testimony for their hard physical labor, careful management

of money, and sacrifice for their families and friends. While the Lijiang basin has apparently had the same

boom in sex work that most other tourist or urban areas of China have experienced, apparently staffed

primarily by immigrant Han from “outside,” what Lijiang has become most famous for (other than for family

vacationers or high level cadres who come to play golf), is as a locale for young, in-search-of-self

cosmopolitan Han Chinese to flock to in order to seek short-term romantic liaisons with other young Han

cosmopolitans.

Conclusions:

I have argued that a Confucian, “medicine of systematic correspondence,” classical Chinese

narrative of medicine has played a significant role in the imperial Chinese “civilizing” project with respect to

medicalizing basin Naxi women’s reproductive bodies. The hybrid reconfiguration of the Chinese and

“Western” medical knowledges and practices brought about by the socialist Chinese state again presented a

sequence of medicalizing discourses and practices to basin Naxi women’s reproductive bodies. But these

potently coded gendered embodiments brought to the Lijiang basin by the Chinese state throughout its

various incarnations also serve to reveal the faultlines of difference with respect to the gendered way in

which Naxi continue to construct their gendered identities, and with respect to the embodied complicities

and resistances vis-à-vis these Chinese norms enacted by basin Naxi women.

21

Acknowledgements: I am indebted to the following organizations for research support: the Committee on

Scholarly Communication with People’s Republic of China (CSCPRC), the Wenner-Gren Foundation for

Anthropological Research, Sigma Xi, and Temple University. Special thanks to the health practitioners

(including midwives), public health representatives, and other citizens of the Lijiang basin—particularly

to the women, without whom this research would have not been possible.

Notes:

(1) See Harrell (1995) on ‘civilizing projects’ in China, which he delineates as the Confucian, Christian

missionary, Republican, and Communist projects, respectively.

(2) For ethnographic scholarship on contemporary Lijiang basin Naxi, see Mueggler (1991), White (1993,

1997, 1998a, 2001b, 2002, 2010), Chao (1995, 1996), Hsu (1998), Hansen (1999), Rees (2000), and

McKhann (2001). For ethnographic research on Naxi of more remote regions of the Lijiang area, see

McKhann (1989, 1992) and Chao (1995). For English language scholarship on Naxi dongba practices, see

Rock (1947), Jackson (1979), Bockman (n.d.), Chao (1990, 1995, 1996), Mueggler (1991), McKhann

(1992), Yang (1998), Mathieu (2003). For an ethnographically rich account of Lijiang during the 1930’s

and 1940’s see Goullart (1955).

(3) Elsewhere I have argued (1993, 1999, 2001) that the clear hegemony of Chinese medical practices

(essentially Confucian medicine) in Lijiang basin popular culture prior to 1949 is indicative—alongside

the hegemony of Confucian kinship, marriage, and ritual practices, and alongside the veneration of a

specifically Confucian narrative of education, literacy in Chinese, and gentleman-scholarly-erudition

among basin Naxi men—of the longstanding impact of what I have termed (following Harrell 1995) the

Confucian civilizing project of the imperial Chinese state. Unschuld (1986) has presented a powerful

analysis of how the “medicine of systematic correspondence” both reflects the organization of the

agrarian Confucian Chinese state at the microcosmic level of the body and came to be the prevailing

official therapeutic practice of the Chinese state. The civilizing projects of the imperial Chinese state that

22

have influenced the Naxi have not always been Confucian—specifically, the early Mu kings of Lijiang

submitted themselves to Mongolian rule during the Yuan dynasty, who indeed utilized a Buddhist

civilizing project in their narrative and governance of the Chinese state. And prior to the Yuan, Naxi were

influenced by the Tibetan Buddhist civilizing project that overlaid Bonpa practices (see Adams)—both of

which they appropriated into Naxi dongba practices. However, the neo-Confucianism of the Ming and

Qing, particularly with the imposition of regular government in Lijiang in 1723, clearly subsequently re-

shaped the civilizing project agenda of the imperial Chinese state in the Lijiang basin.

(4) My periods of fieldwork research in the Lijiang basin encompass the summer of 1987, February

1989-December 1990, and subsequent follow-up research visits in 1994, 2000, 2004, 2005, and 2009.

Data and analysis presented in this article are based on this research unless otherwise noted, and

fieldwork research encompassed interviews with representatives of all twelve county and prefectural

public health bureaus in Lijiang, interviews with eighteen village health practitioners in the rural basin

(including midwives and Birth Planning representatives), ten interviews with town health practitioners,

participant-observation in village and town clinical contexts, in-depth household surveys with 40 village

and 20 town households, and twenty in-depth interviews on health and diet beliefs and practices (see

White 1993).

(5) Anthropologists who have written about the emergence of ethnic tourism and the minority

representations they entail in southwest China include Swain (1990, 2001), Gladney (1994), Schein

(2000), Notar (2006), Walsh (2001, 2005), Walsh and Swain (2004), McKhann (2001), Blum (2002), and

Litzinger (2004).

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