Contradicting Maternity
HIV-positive motherhood in South Africa
Carol Long
Wits University Press
1 Jan Smuts Avenue
Johannesburg
South Africa
Copyright © Carol Long, 2009
First published 2009
The publishers gratefully acknowledge financial support for this publication from the Faculty of the Humanities, University of the Witwatersrand, Johannesburg.
ISBN 978-1-86814-494-5 (Print)
ISBN 978-1-86814-841-7 (Digital)
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the express permission, in writing, of both the copyright holder and the publisher.
Photographs on pages 8, 9, 11, 14-18 copyright © Gideon Mendel and on pages 12 and 13 copyright © James Nachtwey
Cover artwork: Thula Mama by Karen Lilje
Cover design and layout by Hybridesign
Printed and bound by Creda Communications
Contents
Acknowledgements
vi
Preface by Juliet Mitchell
vii
1. Introduction
1
2. Facing the HIV-positive Mother
23
3. The Joys of Motherhood
54
4. Finding the HIV-positive Mother
81
5. Minding Baby’s Body
105
6. Mother’s Mind
127
7. Mother’s Body
145
8. Thula Mama
168
9. Contradicting Maternity
190
Appendix: Interview Content
209
Bibliography
211
Index
229
Acknowledgements
I would like to thank the mothers who generously shared their experiences with me and whose stories are told in this book. Thanks to the hospital for their humane and dedicated service despite the odds. Special thanks to Juliet Mitchell, who took me under her wing and guided me through this project with brilliance and compassion. To my family, particularly my parents Linda and Nigel, and to my dear friends who supported me through this process, I could not have done it without you. And to Michael, of course …
Sincere appreciation to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, for financial support and provision of an intellectual environment. Within the Faculty, the School of Human and Community Development has provided an intellectual home.
I would also like to thank the bodies who funded my PhD, upon which this book is based, including the Ernest Oppenheimer Memorial Trust, the Skye Foundation, the Cambridge Commonwealth Trust and the Smuts Memorial Fund.
Finally, thank you to the staff at Wits University Press, including Melanie Pequeux and Veronica Klipp, for making this book a beautifully presented reality.
Preface
One cold white day in Cambridge, England, Carol Long, an always shivering and very blonde young woman, told me she wanted to research the experience of being simultaneously given a death and life sentence. She proposed to interview women diagnosed pregnant and HIV positive at the very same moment; the test for pregnancy revealing the disease. Instantly my stomach contracted in identification with the unknown mother, but almost immediately, as Carol talked on and I questioned, I realised how very little I understood. My gratitude for the journey Carol took us on will always be immense.
The modest presentation of a central part of this journey here in book form is extremely welcome; the book captures the work’s importance. The importance is, of course, practical – aspects of policy, of psychological and political understanding can be re-thought: for instance, I was struck by the importance of community. The mothers talked to Carol and to each other in their hospital groups and medical check-ups – a stigmatised disease lived in social isolation and the privacy of the home changes somewhat by being shared, its pariah status slightly eroded. But beyond the implications for how to change attitudes and therefore the conditions of both HIV and motherhood, what I want to convey is a larger, more general sense of why this book truly matters.
It matters of course enormously to all the women for whom the mothers of this book speak. We, the readers, are almost certainly not these women; but, for all our sakes, we need to listen. If we do not, our ‘cultural anaesthesia’ will prevail: our knowledge of what Carol Long has heard as she asked and listened to the world’s catastrophes and its people’s trauma, will be without meaning. A meaningless knowledge diminishes us all. Instead of this Contradicting Maternity breaks through this anaesthesia, eroding the binaries of pain and pleasure, fear and joy, even death and life, us and them. It collapses our categories: the objects of research have become the subjects who address us with their big loves and small hates, with their lives and their impending deaths, their children’s heritage.
Professor J C W Mitchell
Cambridge University, UK
1. Introduction
HIV prevalence among South African women attending antenatal clinics is estimated at 30.2 per cent: i.e. nearly one in three pregnant mothers is HIV-positive (Department of Health, 2006). Because this is also the time when women are particularly motivated to test, many discover that they are HIV-positive only when they realise that they are pregnant. Hearing that one is pregnant may produce a variety of emotions and responses. Whether excited or scared or devastated, it is news that changes one’s life. In a context in which motherhood is highly valued, there is always recourse to the expectation that one will be admired by others and will experience joy and fulfilment. Hearing that one is HIV-positive produces very different kinds of emotions and expectations, particularly in an environment that is saturated by misunderstanding and horror at the social category of ‘HIV-positive’. The process of becoming both a mother and HIV-positive begins in the moment when the news is received, but proceeds through a series of confusions, prejudices and adjustments in which the process of becoming exists in an uneasy space between internal reality and external discourses. In this sense, it is transitional and paradoxical, with opportunity for painful splits.
This means that HIV-positive mothers enter into two contradictory identities simultaneously: the denigrated, abject and feared identity of being HIV-positive and the idealised identity of motherhood, with all its associations of purity and goodness. Both identities hold complex and competing personal and social meanings, with motherhood and HIV invoking powerful discursive positions. Both motherhood and HIV are created in a moment of intimate sexual contact, but both exist uneasily