My first hypothesis was: Q’eqchi’ traditional medicine has an extensive ethnophar-macopoeia of medicinal plant species used for reproductive health, as well as cul-turally specific ethnomedical practices. I interviewed 6 male traditional healers, 3 female midwives, and 12 female herbalists in the Q’eqchi’ Maya communities of Belize. There are at least 60 species used to treat reproductive health ailments among the Q’eqchi’ Maya in Belize, in 50 genera, and 36 plant families. In this study, 52 species have been identified to species, and 8 to genus. While plants re-ferred to by 41 different common names have not been collected, or identified if they were collected, some of these 41 may be conspecifics to those already col-lected or those referred to by other common names. Piperaceae was the plant family with the most species used in Q’eqchi’ reproductive ethnomedicine, followed by Fabaceae and Malvaceae (Table 5.1).
An interesting pattern emerged, with similarities in species use down gender lines, in Q’eqchi’ medicinal plant knowledge. Table 5.2 shows species used com-monly, here defined by at least 25 % of females (total N = 15) or males (total N = 6).
Note that there are plants of the same genus used commonly by both genders, from the genus Piper, however this is from the plant family Piperaceae, with the highest
114 5 Conclusions
number of species used in Q’eqchi’ reproductive ethnomedicine, and is the only similarity between the two genders’ commonly used plants. It is clear that while Q’eqchi’ reproductive ethnomedical knowledge is the domain of both male and female healers and herbalists, it is highly gendered.
Women and men are using different species to treat reproductive health ailments;
in fact none of the species most commonly used by one gender (used by at least 25 % of the individuals) are commonly used by the other gender. Female midwives and herbalists are primarily utilizing common weedy species like Momordica charan-tia and Neurolaena lobata; culinary spices like Allium sativum, Piper nigrum, Pi-menta dioica, Ocimum campechianum, and Syzygium aromaticum; and food plants like Theobroma cacao, Citrus aurantifolia, and Zea mays. By stark contrast, all the species commonly used by the male healers are found growing in forested areas (Fig. 5.1), with only one species Piper peltatum growing primarily in successional or riparian areas. The species used by the male healers are not weedy, cultivated or eaten as food like the plant species commonly used by women.
Table 5.2 Most common species used by Q’eqchi’ female midwives, herbalists, and male healers Most common species
used by females Number (percent) of
women using species Most common species
used by males Number (percent) of men using species Momordica charantia 8 (53 %) Clidemia crenulata 3 (50 %)
Piper nigrum 8 (53 %) Maranta arundinacea 3 (50 %)
Theobroma cacao 8 (53 %) Piper peltatum 3 (50 %)
Neurolaena lobata 6 (40 %) Piper tuerckheimii 3 (50 %)
Allium sativum 5 (33 %) Desmoncus
orthacanthos 2 (33 %) Pimenta dioica 5 (33 %) Psychotria acuminata 2 (33 %) Citrus aurantifolia 4 (27 %) Tococa guianensis 2 (33 %) Ocimum
campechianum 4 (27 %) Syzygium aromaticum 4 (27 %)
Zea mays 4 (27 %)
Plant family Number of species
Piperaceae 6
Fabaceae 4
Malvaceae 4
Melastomataceae 3
Apiaceae 2
Asteraceae 2
Cucurbitaceae 2
Lamiaceae 2
Lauraceae 2
Myrtaceae 2
Poaceae 2
Table 5.1 Plant families with the most species used in Q’eqchi’ reproductive ethnomedicine
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The most medicinal plant species in Q’eqchi’ reproductive ethnomedicine were used during labor and childbirth (24 species; Table 5.3). This was followed by men-strual pain (22 species), postpartum treatments (21 species), female infertility (15 species), and menopausal symptoms (14 species).
From a biomedical perspective, some traditional Maya medical practices and concepts may be difficult to understand. Interestingly, many of these practices and concepts are found in cultures outside of the Maya world. As the biological assay re-sults have shown, there is great wisdom behind the Maya medicine still practiced in Central America today. Corroborations by cultures on other continents add another level of validity, beyond that inherent in the maintenance of a practice or concept within a single traditional medical system. Consider these examples of culturally specific reproductive health ailments from other cultures. Regarding womb disor-ders, Ward (1977) discusses a disease from the island of Pohnpei, Federated States of Micronesia that is strikingly similar to k’uub’sa’ in Q’eqchi’ ethnomedicine. The Pohnpeian womb disorder is called soumwa en pahsoan or “foundation sickness”
that can be caused similarly if a woman falls, carries heavy loads, or engages in too much strenuous activity. Like k’uub’sa’, foundation sickness can also result in a range of reproductive ailments such as abdominal pain, irregular menstruation, miscarriages, or infertility. He explains that:
If the “foundation” works properly, a woman has regular periods, conceives and bears healthy children, and other internal organs also function smoothly. The trouble with the foundation organ is that it tends to move around inside the body. When a woman falls or performs too much exercise, it can be jarred out of place…A married woman whose foun-dation is out of place is unable to conceive, and the pains initially experienced in the uterine area may spread to other parts of the body (back, legs, joints, and so on).
Commonalities of postpartum precautions across medical systems exist as well.
Women in Asia and in Latin America will each follow a period of physical con-finement after giving birth often in a warmed area, and follow other practices and restrictions in order to protect her at this vulnerable time from the cold and wind, and maintain her humoral balance (Manderson 1981). Variations on these practices have been found among Malay women (Manderson 1981) and rural Korean women (Sich 1981). These periods of confinement help to ensure the new mother rests and avoids contact with carriers of infections (Manderson 1981).
5.1 Q’eqchi’ Reproductive Ethnomedicine Fig. 5.1 Don Francisco
col-lecting medicinal plants in a forested area of Toledo
116 5 Conclusions systems on this topic. Prolapsed uterus may correspond or overlap to some degree with the womb disorders recognized in Q’eqchi’ ethnomedicine. This may be under-diagnosed in biomedical practices or not considered the cause of other conditions like heavy menstruation and infertility, as with Q’eqchi’ womb disorders.
According to the Centers for Disease Control and Prevention (CDC 2013), in the USA, Cesarean sections and hysterectomies are the two most frequently performed major surgical operations for women of reproductive age. Approximately 600,000 hysterectomies are performed in the USA every year. Between the years 2000 and 2004, the three conditions most often associated with hysterectomy were uterine leiomyoma (“fibroid tumors”), endometriosis, and uterine prolapse (Whiteman et al. 2008). Uterine fibroids are noncancerous growths on the uterus that can cause
Condition category Number of species
Labor and cildbirth 24
Menstrual pain 22
Postpartum treatment 21
Female infertility 15
Menopausal symptoms 14
Female contraceptive 12
Miscarriage prevention or treatment 10 Amenorrhea (lack of menstruation) 9 Galactagogue (increases breast milk) 9 Hemorrhage (uterine and postpartum) 9
Uterine fibroids 7
Heavy menstruation 7
Womb disorders ( K’uub’sa’ and “Cold
Inside”) 7
Delayed menstruation 6
Placenta expulsion 6
Abortifacient 5
Pregnancy 5
Body pain from pregnancy and birth 4 Male impotence and infertility 4
Morning sickness 4
Infection (vaginal or uterine) 3
Irregular menstruation 3
Male contraceptive 1
Pregnancy test 1
Swollen testicles from Obeah 1 Table 5.3 Number of species
used for categories of repro-ductive health conditions
117 5.2 Estrogenic Plant Use in Q’eqchi’ Reproductive Ethnomedicine
bleeding, pain, infertility, and pregnancy complications. Uterine fibroid prolifera-tion is estrogen-dependent, and selective estrogen receptor modulators (SERMs) have been shown to inhibit growth in fibroid cells (Fuchs-Young et al. 1996). En-dometriosis is a complex condition characterized by cells from the lining of the uterus (endometrium) growing outside of the uterus, which can lead to pain, bleed-ing, and infertility. Endometriosis is also estrogen-dependent, and current therapies focus on lowering endogenous estrogen levels (Rizner 2009). Uterine prolapse is the falling or sliding of the uterus from its normal position, and has actually been associated with low levels of endogenous estrogen in premenopausal women (Lang et al. 2003).
Q’eqchi’ Maya reproductive ethnomedicine emphasizes womb health, thermal equilibrium, hormonal equilibrium, and healthy fertility regulation. Given the fre- quency of such conditions as endometriosis, uterine fibroids, infertility, and repro-ductive cancers in the world, worthwhile lessons may be gleaned from the Q’eqchi’
ethnomedical conception of maintaining reproductive health. Perhaps uterine mas- sage and estrogenic plant-based medicines can provide an alternative to hysterec-tomy in some cases. The position of wombs is regularly considered in Q’eqchi’
ethnomedical diagnoses related to reproductive health, and care is taken to maintain womb health starting from menarche. If malpositioned wombs and the hormone imbalances are diagnosed and treated early as they are in Q’eqchi’ traditional medi-cine, perhaps hysterectomies and other surgical procedures will not be needed in some of the biomedical cases.