▪ Abstract This review discusses pharmaceuticals as social and cultural phenomena by following their “life cycle” from production, marketing, and prescription to distribution, purchasing, consumption, and finally their efficacy. Each phase has its own particular context, actors, and transactions and is characterized by different sets of values and ideas. The anthropology of pharmaceuticals is relevant to medical anthropology and health policy. It also touches the heart of general anthropology with its long-time interest in the concepts of culture vs nature, symbolization and social transformation, and its more recent concerns with the cultural construction of the body and processes of globalization and localization. The study of transactions and meanings of pharmaceuticals in diverse social settings provides a particularly appropriate empirical base for addressing these new theoretical issues.

THE ANTHROPOLOGY OF PHARMACEUTICALS: A Biographical Approach

Part I. Introduction: 1. An anthropology of materia medica Part II. The Consumers: 2. Mothers and children: the efficacies of drugs 3. Villagers and local remedies: the symbolic nature of medicines 4. Women in distress: medicines for control 5. Sceptical consumers: doubts about medicines Part III. The Providers: 6. Drug vendors and their market: the commodification of health 7. Pharmacists as doctors: bridging the sectors of health care 8. Injectionists: the attraction of technology 9. Prescribing physicians: medicines as communication Part IV. The Strategists: 10. Manufacturers: scientific claims, commercial aims 11. Health planners: making and contesting drug policy Part V. Conclusion: 12. Anthropologists and the sociality of medicines.

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Social Lives of Medicines

A cross-sectional survey was conducted during 1993 in urban and rural areas of Karnataka State, India. The survey included 3595 currently married women aged under 35, who had at least one child under five. Nine out of ten women had at least one antenatal consultation during their most recent fertile pregnancies. Most consultations were with doctors and there was minimal use of the services provided by paramedical staff of the primary health care system. Of all respondents, 38 per cent (57% urban and 29% rural) delivered in a hospital, and a majority of institutional deliveries were in private hospitals. Surgical interventions were made in more than one-third of hospital deliveries. There was a marked imbalance between antenatal and postnatal care as fewer than one-fifth of the mothers had a postnatal checkup. The educational level, economic status and religion of the mother are significant predictors of use of maternal health services. The relationship of problems during pregnancy and delivery with subsequent health-related behaviour is also examined. One of the dominant themes of the International Conference on Population and Development held in Cairo in September 1994 was reproductive health. This has been defined as a state in which People have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and childbirth safely; the outcome of pregnancy is successful in terms of maternal and infant survival and well being; and couples are free to have sexual relations free of the fear of pregnancy and of contracting disease (Fathalla 1988). Maternal health services have a potentially critical role to play in the improvement of reproductive health. There is little doubt that access to skilled assistance and well equipped health institutions during delivery can reduce maternal mortality and morbidity and improve pregnancy outcomes. The effectiveness of routine antenatal and postnatal care is less certain. However, a few hospital based studies (Melrose 1984; Boes 1987a, b) and some community * The Ford Foundation provided financial support for the study, which is gratefully acknowledged. We would also like to record the hard and diligent work of Dr N.S.N. Rao in the organization and supervision of field work and the able assistance provided by Mr N.S. Sanath Kumar and Mr S. Ramaswamy in data processing. The interviewers, who collected data under rigorous field conditions, deserve our appreciation and commendation. Thanks are also due to the Karnataka health and ICDS officials for their full support and co-operation in the conduct of this study.

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Determinants of maternal care in a region of South India

This article presents an analysis of self-reported symptoms of gynecological problems among 3,600 recent mothers in Karnataka State, India. Approximately one-third of all women reported at least one current symptom; the most common were a feeling of weakness and tiredness (suggestive of anemia); menstrual disorders; white or colored vaginal discharge (suggestive of lower reproductive tract infection); and lower abdominal pain and discharge with fever (suggestive of acute pelvic inflammatory disease). Obstetric morbidity, associated with the last live birth, was strongly predictive of current gynecological symptoms. Women who delivered their last child in a private institution were significantly less likely to report symptoms than were those who delivered at home or in a government hospital. Nonusers or users of reversible contraceptive methods were also less likely to report symptoms of morbid conditions than were sterilized women. These associations persisted in analyses controlling for potentially confounding economic and demographic characteristics, and have far-reaching policy implications.

https://www.jstor.org/stable/pdfplus/2137846.pdf

Self-reported symptoms of gynecological morbidity and their treatment in south India.

A total of 421 young married mothers in Karnataka State, India, were followed up at monthly intervals for 1 year. Results are presented on self-reported morbidity, treatment-seeking behaviour and health expenditures. A total of 911 completed illness episodes were reported, of which 58% resulted in consultations with practitioners, mostly working in the private sector. Amongst those who did consult physicians, an average of 1.76 visits was made per episode. The average cost per visit was 46 Rupees and 38 Rupees, for private and public-sector consultations respectively. The overall mean annual expenditure on treatment and associated costs for the entire sample was 172 Rupees, of which 104 Rupees was spent on private-sector treatment. Poorer women reported significantly more days of morbidity than richer women but spent significantly less per 100 days of illness.

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Health-care seeking and expenditure by young Indian mothers in the public and private sectors

Traditional healers and modern medicine.

A survey of indigenous medical practitioners in rural areas of five different states in India.

Factors responsible for under-utilisation of Primary Health Centre-a community survey in three states of India.

A nationwide program requires the active cooperation of all sections of the community. The participation of practioners of the indigenous system of medicine is therefore very essential as they constitute the major source of medical care for the rural people. 93 practitioners were identified and contacted individually through a study carried out in 3 states in India Haryana Madhya Pradesh and Uttar Pradesh. These 93 full-time Indigenous Medicine Practioners (IMPs) were interviewed and 93.5% approved of the concept of a small family. 67.7% expressed their approval of the family planning program but the remaining 32.2% disapproved of the way in which it is being implemented. 80.6% of the IMPS interviewed expressed their willingness to participate in the present family planning program. 81.3% were prepared to render unconditionally their help to the government. Of these 93 IMPs it was found that 18.2% were literate 22.6% studied up to the middle school level 53.8% passed high school and 5.4% were graduates. 54% of IMPs had obtained various diplomas in Indigenous or Homeopathic systems of medicine from institutions not generally recognized by the State Registration Boards and 33.3% did not possess any professional qualifications. A little more than half used mainly modern or allopathic medicines sometimes in combination with indigenous drugs and about 20.4% resorted to indigenous modes of treatment but often in combination with allopathic medicines. About 73.1% of the IMPs interviewed were registered with the State Boards.

Chuttani Cs

Papers

Traditional healers and modern medicine.

A survey of indigenous medical practitioners in rural areas of five different states in India.

Factors responsible for under-utilisation of Primary Health Centre-a community survey in three states of India.

The role of practitioners of indigenous medicines in the family planning programme - a study in three states (India).