Tsipy Ivry’s book titled, Embodying Culture: Pregnancy in Japan and Israel, is a well-designed double ethnography. Through cultural immersion and the creation of a thick description, Ivry sought out how cultural beliefs weigh into views on prenatal testing and diagnoses in these two non-western, medicalized countries. Ivry performed fieldwork in both Japan and Israel, where she collected her research through four different sources: interviews with ob-gyns, interviews with current and past pregnant women, attending pregnancy classes, and lastly, attending pregnancy events. Ivry learns early on that both pro-natal cultures focus on delivering babies healthily and to full term. Yet, she identifies the different systems and methodologies employed to achieve this shared goal: “Geneticism” versus “Environmentalism.” Ivry claims that while Israeli healthcare systems heavily emphasize genetics through the endorsement of prenatal testing, Japanese healthcare systems rather focus on environmentalism by maintaining perfect maternal environments.
Pre-natal testing is more common in Israel than it is in Japan. One reason for this is explained by the directors of the Program for the Prevention of Inborn Abnormalities that “… in Israel ‘we are simply tailored to deal with our own problems’” (41) to address and eliminate genetic anomalies unique to Jews. The Jewish population appears to be susceptible to specific diseases and, in the hopes of “eliminating genetic ‘Jewish diseases’ in the Israeli population” (44), prenatal testing exists to analyze genetic markers in genomes of pregnant mothers. For example, Tay-Sachs disease is a specific genetic disorder associated with Jewish people, and pre-natal testing can detect this disorder during the pregnancy. Given the prevalence of these genetic concerns, I believe it makes complete sense for Israel to advocate for more prenatal testing than other countries, such as Japan, as a means for combating Jewish-specific diseases. Ivry interviewed doctors such as Dr. Ramon, a well-established Israeli ob-gyn who specializes in obstetrical ultrasound, to explain how important and common it is for Israeli ob-gyns to rely on testing, examinations, and all existing prenatal tests as a source of information and education. Doctors must be completely transparent about these options so that their patients are well-versed to make critical decisions about their pregnancies. I believe this level of commitment and investment in the doctor-patient relationship creates the solid foundation to combat genetic pre-dispositions and pregnancy hurdles. The emphasis on pre-natal testing and education is also critical to managing patients that experience high levels of anxiety or hysteria, as supported by Ivry’s discussions with Dr. Ramon. Dr. Ramon explains that during bouts with hysteria, patients look to their doctors for comfort and assurances that the pregnancy is normal. As these patients utterly trust their doctors, it appears only right that the doctors want to make sure that all the bases are covered and that technology and testing is fully employed to inform the situation. In Israel, doctors strive to assertively recommend and deploy all the genetic tests available and designed to assess fetus anomalies before birth, while also providing the patient comfort, and striving for healthy births.
Ob-gyns in Japan, in contrast to Israel, focus on the environments of childbearing women rather than genetic testing. Ivry explains that pre-natal routines in Japan consist of “measuring the patient’s weight gain, abdominal circumference, and funcal height.” (84) Additionally, Japanese ob-gyns take “taijukanri”, weight supervision, exceptionally strictly. The Mother-Child Health Handbook is a book given to all Japanese pregnant patients at the first pre-natal visit. In this handbook, mothers record their weight, meals, temperature, and many other things that is a departure from how pregnancies are followed and recorded by Israeli doctors. While both Japan and Israel are striving for the same goal, the Japanese approach to pregnancy is largely based on environmental factors and the Japanese healthcare system places significant importance and responsibility on ensuring that these environmental factors are properly measured and observed during the pregnancy. I found this chapter of the book extremely interesting because I was unfamiliar with these principles of Japanese healthcare. The early distribution and depth of the Mother-Child Health Handbook shows how vital the environment is on Japanese pregnancy. By contrast, as Ivry points out that, in Israel, there are no such written disclosures or guidelines during the pregnancy and any sort of disclosures about how to care for the baby are only handed out to patients after a successful birth, never before. Also, Ivry writes that the well-being of Japanese babies is entirely dependent on the environment, “kanya” of their mother. If the environment is not well-kept, or if the fetus is underweight, or overweight, the teachings tell the mother that the baby may not be born healthy or birthed to full term. Genetics do not appear to be a primary concern. You can even see this point through the language used in some of the interviews. A specific interview with Dr. Ootsuma intrigued me. Ootsuma said “Maternity checkups are not free of charge, so from one visit to another the mother should check herself, how much she has gained …” (92) It is evident that mothers play the central role in determining the outcome of their pregnancy, and doctors do not prioritize the discussion of or recommend pre-natal testing with their patients because they believe that keeping the mother in healthy shape is much more valuable and impactful on the fetus.
Ivry noted many other interesting differences between the Israeli and Japanese health systems. One that stood out to me involved the differences between the ob-gyn offices. In Dr. Ramon’s waiting room in Israel, there was a mural that read, “’Aloka (a popular ultrasound technological brand) gives birth to perfection’” (46). This contrasts to the waiting room of Dr. Oikawa in Japan where on his waiting room’s wall there “was a colorful placard of the food pyramid, with a digital scale just below it.” (84). She noted that women would routinely walk into the office and weigh themselves on this scale. These two contrasting environments illustrate the varying frameworks of the healthcare systems’ approach to pregnancy. Just viewing these two waiting rooms, the difference in priorities that each culture places on genetic testing and natural environmental factors is plainly obvious.
The book raises the interesting question of whether either approach is better than the other to ensure a healthy pregnancy. I wonder whether the similarities of the Israeli and Japanese approach are more important that the differences. I question whether cultures that place an emphasis and importance on pre-natal care, whether driven by genetics, environment or simply education, is sufficient to trigger mothers to take pregnancies seriously and to be mindful of their health during the pregnancy. I would be curious to compare whether the percentage of healthy births dramatically differs in both countries and whether either approach is more effective. In her first chapter of the book, called, A Risky Business, Ivry reports on a pregnancy event speech given by Dr. Cohen in Israel in which he readily conceded that ultrasound technology is not perfectly designed to identify every anomaly. In her third chapter, Japanese Prenatal Care, Ivry suggests that “[a] body that can give a good birth is the result of the continuous hard work of “bodybuilding””(92). But, a healthy mother does not guaranty a healthy birth, and I believe that it is the emphasis on healthy pregnancies is the common denominator that motivates both communities to manage their pregnancies with the goal of healthy births.
Questions for Class Discussion:
-How do Japanese and Israeli Americans view pregnancy and new reproductive technologies?
-Do they carry the cultural perspectives that are outlined through this book?
-Do you believe that pre-natal testing mutes diversity of disabled people?