A version of this article appeared in The Berkeley Review in Latin American Studies, Spring 2013.
It was almost fifty years ago that I first walked to the top of the Alto do Cruzeiro (the Hill of the Crucifix) in Timbaúba, a sugar-belt town in the state of Pernambuco, in Northeast Brazil. I was looking for the small mud hut, nestled in a cliff, where I was to live. It was December 1964, nine months after the coup that toppled the left-leaning president, João Goulart. Church bells were ringing, and I asked the woman who was to host me as a Peace Corps volunteer why they seemed to ring at all hours of the day. “Oh, it’s nothing,” she told me. “Just another little angel gone to heaven.”
That day marked the beginning of my life’s work. Since then, I’ve experienced something between an obsession, a trauma, and a romance with the shantytown. Residents of the newly occupied hillside were refugees from the military junta’s violent attacks on the peasant league movement that had tried to enforce existing laws protecting the local sugarcane cutters. The settlers had thrown together huts made of straw, mud, and sticks, or, lacking that, lean-tos made of tin, cardboard, and scrap materials. They had thrown together families in the same makeshift fashion, taking whatever was at hand and making do. In the absence of husbands, weekend play fathers did nicely as long as they brought home the current baby’s powdered milk, if not the bacon. Households were temporary; in such poverty women were the only stable force, and babies and fathers were circulated among them. A man who could not provide support would be banished to take up residence with another, even more desperate woman; excess infants and babies were often rescued by older women, who took them in as informal foster children.
I spent several months making the rounds between the miserable huts on the Alto with a public-health medical kit strapped on my shoulder. Its contents were pathetic: a bar of soap, scissors, antiseptics, aspirin, bandages, a glass syringe, some ampules of vaccine, several needles, and a pumice stone to sharpen the needles, which were used over and over again for immunizations. Children ran away when they saw me coming, and well they might have.
But what haunted me then, in addition to my own incompetence, was something I did not have the skill or maturity to understand: Why didn’t the women of the Alto grieve over the deaths of their babies? I tucked that question away. But as Winnicott, the British child psychoanalyst, liked to say, “Nothing is ever forgotten.”
If mother love is the cultural expression of what many attachment theorists believe to be a bioevolutionary script, what could this script mean to women living in these conditions? In my sample of three generations of mothers in the sugar plantation zone of Pernambuco, the average woman had 9.5 pregnancies, 8 live births, and 3.5 infant deaths. Such high rates of births and deaths are typical of societies that have not undergone what population experts call the demographic transition, associated with economic development, in which first death rates and, later, birth rates drop as parents begin to trust that more of their infants will survive. On the contrary, the high expectation of loss and the normalization of infant death was a powerful conditioner of the degree of maternal attachments. Mothers and infants could also be rivals for scarce resources. Alto mothers renounced breastfeeding as impossible, as sapping far too much strength from their own “wrecked” bodies.
Scarcity made mother love a fragile emotion, postponed until the newborn displayed a will to live—a taste (gusto) and a knack ( jeito) for life. A high expectancy of death prepared mothers to “let go” of and to hasten the death of babies that were failing to thrive, by reducing the already insufficient food, water, and care. The “angel babies” of the Alto were neither of this Earth nor yet fully spirits. In appearance they were ghostlike: pale and wispy-haired; their arms and legs stripped of flesh; their bellies grossly distended; their eyes blank and staring; their faces wizened, a cross between startled primate and wise old sorcerer.
The experience of too much loss, too much death, led to a kind of patient resignation that some clinical psychologists might label “emotional numbing” or the symptoms of a “masked depression.” But the mothers’ resignation was neither pathological nor abnormal. Moreover, it was a moral code. Not only had a continual exposure to trauma obliterated rage and protest, it also minimized attachment so as to diminish sorrow.
Infant death was so commonplace that I recall a birthday party for a four-year-old in which the birthday cake, decorated with candles, was placed on the kitchen table next to the tiny blue cardboard coffin of the child’s nine-month-old sibling, who had died during the night. Next to the coffin a single vigil candle was lit. Despite the tragedy, the child’s mother wanted to go ahead with the party. “Parabéns para você,” we sang, clapping our hands. “Congratulations to you!” the Brazilian birthday song goes. And on the Alto it had special resonance: “Congratulations, you survivor you—you lived to see another year!”
When Alto mothers cried, they cried for themselves, for those left behind to continue the struggle. But they cried the hardest for their children who had almost died, but who surprised everyone by surviving against the odds. Wiping a stray tear from her eye, an Alto mother would speak with deep emotion of the child who, given up for dead, suddenly beat death back, displaying a fierce desire for life. These tough and stubborn children were loved above all others.
Staying alive in the shantytown demanded a kind of egoism that often pits individuals against each other and rewards those who take advantage of those weaker than themselves. People admired toughness and strength; they took pride in babies or adults who were cunning and foxy. The toddler that was wild and fierce was preferred to the quiet and obedient child. Men and women with seductive charm, who could manipulate those around them, were better off than those who were kind. Poverty doesn’t ennoble people, and I came to appreciate what it took to stay alive.
Theirs were moral choices that no person should be forced to make. But the result was that infants were viewed as limitless. There was a kind of magical replaceability about them, similar to what one might find on a battlefield. As one soldier falls, another takes his place. This kind of detached maternal thinking allowed the die-offs of shantytown babies—in some years, as many as 40 percent of all the infants born on the Alto died—to pass without shock or profound grief. A woman who had lost half her babies told me, “Who could bear it, Nancí, if we are mistaken in believing that God takes our infants to save us from pain? If that is not true, then God is a cannibal. And if our little angels are not in heaven flying around the throne of Our Lady, then where are they, and who is to blame for their deaths?”
If mothers allowed themselves to be attached to each newborn, how could they ever live through their babies’ short lives and deaths and still have the stamina to get pregnant and give birth again and again? It wasn’t that Alto mothers did not experience mother love at all. They did, and with great intensity. But mother love emerged as their children developed strength and vitality. The apex of mother love was not the image of Mary and her infant son, but a mature Mary, grieving the death of her young adult son. The Pietà, not the young mother at the crèche, was the symbol of motherhood and mother love on the Alto.
In Death Without Weeping I first told of a clandestine extermination group that had begun to operate in Timbaúba in the 1980s. The rise of these vigilantes seemed paradoxical, insofar as it coincided with the end of the twenty-year military dictatorship. What was the relationship between democracy and death squads? No one knew who was behind the extrajudicial limpeza (“street cleaning,” as their supporters called it) that was targeting “dirty” street children and poor young black men from the shantytowns. But by 2000 the public was well aware of the group and the identity of its leader, Abdoral Gonçalves Queiroz. Known as the “Guardian Angels,” they were responsible for killing more than 100 victims. In 2001 I was invited, along with my husband, to return to Timbaúba to help a newly appointed and tough minded judge and state prosecutor to identify those victims whose relatives had not come forward. In the interim, the death squad group had infiltrated the town council, the mayor’s office, and the justice system. But eleven of them, including their semiliterate gangsterboss, Queiroz, had been arrested and were going on trial.
Excluded and reviled, unemployed black youths and loose street kids of Timbaúba were prime targets of Queiroz and his gang. Depending on one’s social class and politics, the band could be seen as hired serial killers or as justiceiros (outlaw heroes) who were protecting the community. Prominent figures—well-known businessmen and local politicians—applauded the work of the death squad, whom they also called “Police 2,” and some of these leading citizens were active in the extrajudicial “courts” that were deciding who in Timbaúba should be the next to die.
Brazil’s national central statistics bureau, the Instituto Brasileiro de Geografia e Estatística (IBGE), began reporting data for the municipality of Timbaúba in the late 1970s. In 1977, for example, IBGE reported 761 live births in the municipality and 311 deaths of infants (up to one year of age) for that same year, yielding an infant mortality rate of 409 per 1,000. A year later, the IBGE data recorded 896 live births and 320 infant deaths, an infant mortality rate of 357 per 1,000. If reliable, those official data indicated that between 36 and 41 percent of all infants in Timbaúba died in the first twelve months of life.
During the 1980s, when I was doing the research for Death Without Weeping, the then mayor of Timbaúba, the late Jacques Ferreira Lima, disputed those figures. “Impossible!” he fumed “This município is growing, not declining.” He sent me to the local private hospital built by, and named for, his father, João Ferreira Lima, to compare the IBGE statistics with the hospital’s records on births and deaths. There, the head nurse gave me access to her records, but the official death certificates only concerned stillbirths and perinatal deaths. In the end I found that the best source of data was the ledger books of the cartorio civil, where births and infant and child deaths were recorded by hand. Many births were not recorded until after a child had died, in order to register a death and receive a free coffin from the mayor’s office. The statistics were as grim as those of the IBGE.
In 2001, a single afternoon going over infant and toddler death certificates in the same office was enough to document that something radical had since taken place—a revolution in child survival that had begun in the 1990s. The records now showed a completed birth rate of 3.2 children per woman, and a mortality rate of 35 per 1,000 births. Subsequent field trips in 2006 and 2007 showed even further reductions. The 2009 data from the IBGE recorded a rate of 25.2 child deaths per 1,000 births for Timbaúba.
On my latest return, just this June, the reproductive revolution was complete. The little two-room huts jumbled together on the back roads of the Alto were still poor, but as I visited the homes of dozens of Alto residents, sometimes accompanied by a local community health agent, sometimes dropping in for a chat unannounced, or summoned by the adult child of a former key informant of mine, I saw infants and toddlers who were plump and jolly, and mothers who were relaxed and breastfeeding toddlers as old as three years. Their babies assumed a high status in the family hierarchy, as precious little beings whose beauty and health brought honor and substance—as well as subsistence—to the household.
Manufactured cribs with pristine sheets and fluffy blankets, disposal diapers, and plastic rattles were much in evidence. Powdered milk, the number one baby killer in the past, was almost a banned substance. In contrast, no one, literally, breastfed during my early years of research on the Alto. It was breast milk that was banned, banned by the owners of the sugar plantations and by the bourgeois patroas (mistresses of the house) for whom the women of the Alto washed clothes and cleaned and cooked and served meals. Today, those jobs no longer exist. The sugar mills and sugar estates have closed down, and the landowning class has long since moved, leaving behind a population of working-class poor, a thin middle class (with washing machines rather than maids), and a displaced rural labor force that is largely sustained by the largesse of New Deal–style federal assistance.
Four of the thirty women we interviewed had lost an infant, and one had lost a two-year-old who drowned playing with a large basin of water. Those deaths were seen as tragic and painful memories. The mothers did not describe the deaths in a monotone or dismiss them as inevitable or an act of mercy that relieved their suffering. Rather, they recalled with deep sadness the date, the time, and the cause of their babies’ deaths, and remembered them by name, saying that Gloria would be ten today or that Marcos would be eight years old today, had she or he lived.
What has happened in Timbaúba over the past decades is part of a national trend in Brazil. Over the past decade alone, Brazil’s fertility rate has decreased from 2.36 to 1.9 children per family—a number that is below the replacement rate and lower than that of the United States. Unlike in China or India, this reproductive revolution occurred without state coercion. It was a voluntary transition, and a rapid one.
A footnote in Death Without Weeping records the most common requests that people made of me in the 1960s and again in the 1980s: Could I possibly help them obtain false teeth? a pair of eyeglasses? a better antibiotic for a sick older child? But most often I was asked—begged—by women to arrange a clandestine sterilization. In Northeast Brazil, sterilization was always preferable to oral contraceptives, IUDs, and condoms. Reproductive freedom meant having the children you wanted and then “closing down the factory.” “A fábrica é fechada!” a woman would boastfully explain, patting her abdomen. Until recently, this was the privilege of the upper middle classes and the wealthy. Today, tubal ligations are openly discussed and arranged.One woman I interviewed, a devout Catholic, gushed that God was good, so good that he had given her a third son, her treasure trove, and at the same time had allowed her the liberty and freedom of a tubal ligation. “Praise to God!” she said. “Amen,” I said.
In Brazil, the reproductive revolution is linked to democracy and the coming into political power of President Fernando Henrique Cardoso (1995–2002), aided by his formidable wife, the anthropologist and women’s advocate Ruth Cardoso. It was continued by Luiz Inácio Lula da Silva, universally called “Lula,” and, since 2011, by his successor, Dilma Rousseff. President Lula’s Zero Hunger campaign, though much criticized in the popular media as a kind of political publicity stunt, in fact has supplied basic foodstuffs to the most vulnerable households.
Today food is abundant on the Alto. Schoolchildren are fed nutritious lunches, fortified with a protein mixture that is prepared as tasty milk shakes. There are food pantries and state and municipal milk distribution programs that are run by women with an extra room in their home. The monthly stipends to poor and single mothers to reward them for keeping their children in school has turned elementary school pupils into valuable household “workers,” and literacy has increased for both the children and their mothers, who study at home alongside their children.
When I first went the Alto in 1964 as a Peace Corps volunteer, it was in the role of a visitadora, a public-health community worker. The military dictatorship was suspicious of the program, which mixed health education and immunizations with advocating for water, street lights, and pit latrines as universal entitlements—owed even to those who had “occupied public land” (like the people of the Alto, who had been dispossessed by modernizing sugar plantations and mills). The visitadora program, Brazil’s version of Chinese “barefoot doctors,” was targeted by the military government as subversive, and the program ended by 1966 in Pernambuco. Many years later President Cardoso fortified the national health care system with a similar program of local “community health agents,” who live and work in their micro-communities, visiting at-risk households, identifying crises, diagnosing common symptoms, and intervening to rescue vulnerable infants and toddlers from premature death. In Timbaúba, there are some 120 community health agents, male and female, working in poor micro-communities throughout the municipality, including dispersed rural communities. On the Alto do Cruzeiro twelve health agents each live and work in a defined area, each responsible for the health and well-being of some 150 families comprising 500 to 600 individuals. The basic requirement for a health worker is to have completed ensino fundamental, the equivalent of primary and middle school. Then, he or she must prepare for a public concurso, a competition based on a rigorous exam.
The community health agent’s wage is small, a little more than the Brazilian minimum wage, but still less than US $700 a month for a forty-hour work week, most of it on foot up and down the hillside “slum” responding to a plethora of medical needs, from diaper rash to an emergency home birth. The agent records all births, deaths, illnesses, and other health problems in the micro- community; refers the sick to health posts, emergency rooms, and hospitals; monitors pregnancies and the health of newborns, the disabled, and the elderly. He or she identifies and reports communicable diseases and acts as a public-health and environmental educator. The agent participates in public meetings to shape health policies. Above all, the community health agent is the primary intermediary between poor people and the national health care system.
I am convinced that the incredible decline in premature deaths and useless suffering that I witnessed on the Alto is primarily the result of these largely unheralded medical heroes, who rescue mothers and their children in a large town with few doctors and no resident surgeons, pediatricians, and worst of all, obstetricians. A pregnant woman of the Alto suffers today from one of the worst dilemmas and anxieties a person in her condition can face: no certain location to give birth. The only solution at present is to refer women in labor to distant obstetric and maternity wards in public hospitals in Recife, the state capital, a sixty seven-mile drive away. The result can be fatal: at least one woman in the past year was prevented (by holding her legs together) from delivering her baby in an ambulance, and both mother and child died following their arrival at the designated hospital in Recife. For this reason Alto women and their health agents often choose prearranged cesarian sections well in advance of due dates, even though they know that C-sections are generally not in the best interest of mothers or infants.
Then, beyond the human factor, environmental factors figure in the decline in infant mortality in the shantytowns of Timbaúba and other municipalities in Northeast Brazil. The most significant of these is the result of a simple, basic municipal public-health program: the installation of water pipes that today reach nearly all homes with sufficient clean water. It is amazing to observe the transformative potential of material conditions: water = life!
Finally, what about the role of the Catholic Church? The anomaly is that, in a nation where the Catholic Church predominates in the public sphere and abortion is still illegal except in the case of rape or to save a mother’s life, family size has dropped so sharply over the last two decades. What is going on? For one thing, Brazilian Catholics are independent, much like Catholics in the United States, going their own way when it comes to women’s health and reproductive culture. Others have simply left Catholicism and joined evangelical churches, some of which proclaim their openness to the reproductive rights of women and men. Today only 60 percent of Brazilians identify as Roman Catholic. In our small sample of thirty women of the Alto, religion—whether Catholic, Protestant, Spiritist, or Afro-Brazilian—did not figure large in their reproductive lives.
The Brazilian Catholic Church is deeply divided. In 2009, the Archbishop of Recife announced the Vatican’s excommunication of the doctors and family of a nine year-old girl who had had an abortion. She had been raped by her stepfather (thus the abortion was legal), and she was carrying twins—her tiny stature and narrow hips putting her life in jeopardy. After comparing abortion to the Holocaust, Archbishop José Cardoso Sobrinho told the media that the Vatican rejects believers who pick and choose their moral issues. The result was an immediate decline in church attendance throughout the diocese.
While the Brazilian Catholic hierarchy is decidedly conservative, the rural populace, their local clerics, and liberation theologians such as the activist ex-priest Leonardo Boff are open in their interpretations of Catholic spirituality and corporeality. The Jesus that my Catholic friends on the Alto embrace is a sensitive and sentient Son of God, a man of sorrows, to be sure, but also a man of compassion, keenly attuned to simple human needs. The teachings of liberation theology, while condemned by Pope John Paul II, helped to dislodge a baroque folk Catholicism in rural Northeast Brazil that envisioned God and the saints as authorizing and blessing the deaths of angel babies.
Padre Orlando, a young priest when I first met him in 1987, distanced himself from the quaint custom of blessing the bodies of dead infants as they were carried to the municipal graveyard in processions led by children. He also invited me and my Brazilian research assistant to give an orientation on family planning to poor Catholic women in the parish hall. When I asked what form of contraception I could teach, he replied, “I’m a celibate priest, how should I know? Teach it all, everything you know.” When I reminded him that only the very unpredictable rhythm method was approved by the Vatican, he replied, “Just teach it all, everything you know, and then say, but the Pope only approves the not-so-safe rhythm method.”
The people of the Alto do Cruzeiro still face many problems. Drugs, gangs, and death squads have left their ugly mark. Homicides have returned with a vengeance, but they are diffuse and chaotic, the impulsive murders one comes to expect among poor young men—the unemployed, petty thieves, and small-time drug dealers—and between rival gangs. One sees adolescents and young men of the shantytowns, who survived that dangerous first year of life, cut down by bullets and knives at the age of fifteen or seventeen by local gangs, strongmen, bandidos, and local police in almost equal measure. The old diseases also raise their heads from time to time: schistosomiasis, Chagas disease, tuberculosis, and even cholera.
But the bottom line is that women on the Alto today do not lose their infants. Children go to school rather than to the cane fields, and social cooperatives have taken the place of shadow economies. When mothers are sick or pregnant or a child is ill, they can go to the well-appointed health clinic supported by both state and national funds. There is a safety net, and it is wide, deep, and strong.
Just as we were leaving in mid-June, angry, insurgent crowds were forming in Recife, fed up with political corruption, cronyism, and the extravagant public expenditures in preparation for the 2014 World Cup in Brazil—when the need was for public housing and hospitals. Those taking to the streets were mostly young, urban, working-class and new middle-class Brazilians. The rural poor were generally not among them. The people of the Alto do Cruzeiro (and I imagine in many other communities like it) are strong supporters of the government led by the PT (Partido dos Trabalhadores, or Workers’ Party). Under the PT the government has ended hunger in Pernambuco, and has opened family clinics and municipal schools that treat them and their children with respect for the first time in their lives.
The protesters in the streets are among the 40 million Brazilians who were added to the middle class between 2004 and 2010, under the government of President Lula, and whose rising expectations are combustible. When the healthy, literate children of the Alto do Cruzeiro grow up, they may yet join future protests demanding more accountability from their elected officials.