Abstract

This text describes and analyzes the processes of exclusion or secondaryization that exist in local studies of traditional medicine with respect to a whole series of health/disease/care/prevention processes that operate in the life of native peoples, despite the fact that a large part of these processes are included in the uses and customs of these peoples. The main exclusions reviewed refer to epidemiological processes, and especially to maternal mortality, as well as to close violence, childbirth and culturally forced child and youth relationships. It is shown that these studies exclude processes that are part of the native cultures and that generate a partial and distorted vision of their life, which does not allow understanding the current social, cultural and economic rationality of these peoples.

Keywords: biomedicine, exclusions, traditional medicine, methodology, transactions

traditional medicine: where are the lives, suffering, violence, and mortality rates of indigenous peoples?

This article analyzes the exclusion and sidelining evident in local studies on traditional medicine and a whole series of processes related to health, illness, healthcare, and prevention in the lives of Indigenous peoples, many of which are part of their practices and customs. The main forms of exclusion examined herein are related to disease, especially maternal mortality, but also to domestic violence, childbirth, and the forced marriage of children and adolescents. The analysis sheds light on how native cultural processes are excluded from these studies on traditional medicine, creating a biased, distorted vision of the lives of Indigenous peoples today and hindering an understanding of their social, cultural, and economic rationale.

Keywords: traditional medicine, biomedicine, methodology, transactions, exclusions.

We need to assume that if anything characterizes studies on traditional medicine (mt) are the exclusions and secondaryization of aspects that are basic to understanding the processes of health/illness/care/prevention (processes of health care and prevention). seap) that affect the so-called original peoples. Among the main ones are the exclusion of Afro-Mexican knowledge; the scarcity of studies about mt in the non-indigenous population, but also in the indigenous population living in cities; as well as the scarcity of studies on mortality and morbidity.

The exclusion of these and other processes generates a distorted view of the processes of seap that operate in native peoples, given that these are studies in which the mt and not what the indigenous population is doing with their health problems, including the mt. They do not seem to be interested in the relationship of traditional diseases not only with mortality, but also with the suffering due to the death of loved ones; I do not know of studies that analyze the social normalization of death, especially of children within families and communities. Although we do have studies on the wake of the little angel, a ritual that is disappearing largely due to the reduction of infant mortality.

When the study of the mt In the late 1930s, the native peoples, but also a large part of the Mexican population, were being served with mt; a mt The study of the history of the indigenous culture, which developed during the colonial situation and included diverse knowledge that became part of the uses and customs of indigenous and non-indigenous people, is one of the major problems of studies on the history of the indigenous culture. For this reason, I consider that one of the major problems of the studies on the mt is the exclusion of a whole series of processes, despite the fact that they have been part of the life of indigenous peoples for decades and even hundreds of years. This leads to the presentation of a biased picture of indigenous peoples' processes. seap that are part of the life of the native groups.

I will now present and analyze two complementary fields in which I observed exclusions and secondarizations - I am referring to the epidemiological field in general, although focused on violence - and secondly to processes related to pregnancy, maternal mortality and some sexualities.1

Epidemiological exclusions

In principle, we have no studies on the health of indigenous peoples, on what they consider to be health, as well as on the health system they generate and use; we have studies on the worldviews of indigenous peoples, but we do not know what worldviews emerge with respect to the processes of health care. seap in the daily knowledge of the communities. Although the concept of Buen Vivir has been developed in recent decades, it has been used basically in ideological terms without referring to the processes of seap that actually operate in the daily life of families and communities, which appear to be saturated by biomedical knowledge, loss of life and suffering.

There are two complementary aspects that currently characterize Amerindian peoples: I am referring to the notable and constant demographic growth and the extension of life expectancy. These processes did not occur when these peoples were dominated by traditional medicine, but their increase is generated when the forms of care for illnesses were diversified, especially from the 1940s and 1950s onwards and even during neoliberalism. I would like to emphasize that the vast majority of those who study the mt and especially those who speak of Buen Vivir and those who call themselves decolonial and postcolonial do not describe, analyze or explain what has happened for the Mexican indigenous population to grow continuously and to do so when the role of the indigenous population is diminishing. mtDespite the fact that they continue to constitute the most marginalized and exploited sector of the population, they do not propose explanations for why Mexico's native population has almost doubled its life expectancy between 1930 and today. They do not propose explanations to understand why the native population in Mexico has almost doubled its life expectancy between 1930 and the present, nor has it reduced mortality in the different age groups.

Germán Freire concludes that in Latin America and in Venezuela, in particular, the indigenous population is increasing and mortality is decreasing due to several factors, but mainly

[...] due to the expansion - albeit precarious - of biomedicine. A comparison between two segments of the Piaroa population in 1992; one with access and the other without access to the national public health system, showed that the population with access to biomedicine grew 65% faster than the one without [...] The former had a life expectancy of 47 years, and the latter of 34 years [...] Biomedicine is one of the fundamental pillars of the recovery of the indigenous population (Freire, 2007: 14).

A whole series of analysts have strongly questioned biomedicine and pointed out a large part of its limitations and negative consequences, expressly considering or connoting that the mt is better than biomedicine in several aspects. Thus, for example, René Dubos (1975) pointed out that in 1949 studies had shown that the Otomi of the Mezquital Valley (Mexico) had a more adequate diet than that of the population of cities in the U.S.The results of this study show that they did not show signs of malnutrition. With this I conclude that the rupture of this diet generated malnutrition in this group; but what Dubos does not describe or explain is why before the rupture of their diet by acculturation this group had such high mortality rates, which decreased as they became increasingly acculturated.

We need to assume that the uses and customs, including cultural rituals regarding the processes of seap do not prevent high mortality rates, as Victor Turner (1980) points out with respect to African groups, given that

the public health situation of the Ndembu, like that of most Africans, is highly unsatisfactory... The fact that a rich and elaborate system of beliefs and ritual practices provides a set of explanations for illness and death, and gives people a false sense of confidence that they have sufficient means to cope with illness, in no way contributes to raising the level of health or increasing life expectancy. Only better hygiene, a better and more balanced diet, a wider diffusion of preventive medicine and the extension of the possibilities of hospitalization can destroy that "arch-villain" that is disease, and free Africa from its old dominion (Turner, 1980: 397-398).

Epidemiological exclusions referring to mortality, morbidity and hunger in indigenous groups lead to denying or hiding the most serious deficiencies of these groups, given that, according to different analysts and health institutions, indigenous peoples have been characterized in the past and at present for having the highest mortality rates and the lowest life expectancy, as well as for dying largely from "preventable causes". This situation has been repeatedly recognized by the health sector and by specialists (Aguirre Beltrán, 1986; Hernández Bringas, 2007; Page, 2002). In other words, the groups with the worst and most lethal health conditions have almost no studies and/or epidemiological information. These deficiencies refer not only to traditional ailments, but also to allopathic ones, although in recent years - as we shall see below - some groups of anthropologists have been generating important epidemiological information, especially concerning women, especially on maternal mortality, gender-based violence and vih-AIDS.

Research on mt have studied the diseases and, to a much lesser extent, the mortalities recognized by native groups and their healers, excluding until very recently biomedically defined diseases and mortalities, although the main causes of mortality were infectious and contagious diseases, to which chronic degenerative diseases such as diabetes mellitus 2 and cardiovascular diseases have now been added. Although these causes were referred by the native peoples, at least in part, to traditional diseases and processes such as fear, envy or witchcraft, what has not been described or ethnographically analyzed is what was and is the effectiveness of traditional treatments for these ailments to prevent or reduce the high mortality rates. What we have, for example, are studies that demonstrate the healing potential of medicinal plants, but not their use in relation to the dominant mortalities in the native communities.

However, these epidemiological shortcomings are found in all theoretical/ideological trends, which merits some explanation given the strong differences between them. In principle, I believe that these similarities are due to the fact that the different trends omit these data or treat them superficially so as not to contribute to the stigmatization of indigenous peoples. These are the same reasons why they tend to omit the analysis of processes of seap that would contribute to confirm racist stereotypes about the indigenous population, such as cleft lip or other congenital malformations. Nor are infanticides studied, despite the fact that some of them refer to traditional causes, as is the case of infant death by witchcraft (Fábregas and Nuttini, 1993; Peña, 2006).

Some analysts, especially Carlos Zolla (1994a), recognize that several of the traditional diseases are fatal, as well as the main causes of death according to the traditional healers interviewed, among which is malnutrition. Since the beginning of the studies on mt The existence of malnutrition and related diseases in indigenous peoples has been recognized (Aguirre Beltrán, 1986), reaching its most notorious expression in anthropological terms in Guillermo Bonfil's text (1962) on hunger in a Yucatecan community, where the explanatory axes are in the economic/political conditions in which the indigenous people of Yucatán live. Although this situation has continued to the present day in the majority of the original peoples, we have few anthropological studies such as those of Arnaiz or Ysunza, despite the fact that in recent years specific institutions and the media have repeatedly pointed out this situation. Thus, in 2003, Unicef stated that 70% of indigenous children suffer from malnutrition (Román, 2003), while in 2021 the National Council for the Evaluation of Social Development Policy (coneval) recognizes that 30% of indigenous people suffer from hunger. But, in addition, in recent decades, problems such as overweight and obesity have been added to hunger, resulting largely from the consumption of junk food (Enciso, 2018). This issue is hardly studied by social anthropologists, as it is a structural problem of native populations, which evidences the inclusion of negative eating styles generated by acculturation. Likewise, this situation of malnutrition contrasts with the anthropological recognition of the existence of an indigenous diet that would be nutritious and cheap, but that works less and less, and we do not have studies on it. However, it is worth remembering that when the positive traditional diet dominated, the natives had higher mortality rates than today.2

As Marcia Inhorn and Peter Brown (1990) point out, infectious diseases are the most important cause of suffering and death in the traditional societies studied by anthropologists. This is largely due to the fact that native peoples are characterized by poverty or extreme poverty, lack of basic sanitary infrastructure, and social marginalization.

The studies of mt are characterized by the exclusion of a whole series of processes of seapstarting with allopathic ones that, according to our studies, were already recognized at least in Yucatecan communities since the 1920s (Menéndez, 2018). While the core of studies on mt have been the processes of seap as Gracia Imberton concluded, there can be no doubt that

A very marked tendency in anthropological studies on diseases in the indigenous world has been to highlight those aspects considered to be part of the cosmovision, such as the chulel and the Mayan naguals, which have occupied a privileged place in this perspective. The concern for the indigenous "souls", which has been a constant since the arrival of Europeans to the American continent, has oriented the anthropological gaze towards this subject, neglecting others (Imberton, 2002:15).

But not only are certain traditional diseases little or very little studied, but also certain traditional healers, especially bonesetters and snakebathers, despite the fact that they treat frequent problems such as fractures and pain or snakebites and scorpion bites.

A basic aspect for health, scarcely studied, except in Yucatan, has been the hygienic conditions described and analyzed by numerous authors for the peninsula (Steggerda, 1965; Ramirez, 1980), recognizing some health specialists -not anthropologists- that the scarcity of death by typhus in Yucatan, which was one of the most lethal ailments in Mexico, was due to the hygienic conditions of its population.

A third aspect almost totally excluded by anthropologists is the study of illnesses generated by work activities in societies such as the Yucatecan one, where we were able to verify that these are frequent. Disabilities affecting both women and men due to genetic causes or contracted in daily life are not studied either. There are also very few studies on skin bleaching and the application of plastic surgeries to modify indigenous facial features, but this occurs mainly in mestizos.

Another of the main under-studied processes is mental illness, since the dominant attitude is to deny that it exists in indigenous peoples or to acknowledge its presence, but without studying it, maintaining explicitly or tacitly that, if it does exist, it is much less serious and less serious than in developed societies. As Natera, a researcher at the National Institute of Psychiatry, points out, "Although mental health is of vital importance in indigenous populations, it is a problem that is little attended to just like the abuse of alcohol consumption and its consequences" (Personal communication, 2018). In the Dictionary of mtCarlos Zolla (1994b, vol. ii548) considers that madness in native peoples refers to disorders of the mental faculties expressed through strange behaviors that make it impossible for individuals to relate to the subjects of their social group, which are generally attributed to the introduction of supernatural beings into the body or to the effects of witchcraft. This author notes that some peoples (Totonac, Huastec, Jacaltec) recognize forms of madness as an ailment; while Güémez (2019, personal communication) points out that there are no traditional diseases in Yucatán that refer to madness, although there are colloquial Mayan words that refer to the loss of reason.

In recent decades, studies have been generated on "nerves", epilepsy or madness that would have been generated by fright or anger (Castaldo, 2002; Gallardo, 2002). They have also been detected in rural clinics of the Mexican Social Security Institute (imss) depressive and anxiety processes, especially in women. But several of the main specialists such as Barragán, Campos, Güémez or Villaflor (personal communications) recognize that mental illnesses are little or not studied at all in the native peoples. This issue does not ignore that traditional healers, at least in certain communities, are attending people with nervous breakdowns, anxiety, depression, insomnia.

Moreover, although Yucatan has historically had the highest suicide rates in Mexico, documented since at least the end of the 20th century, it has also had the highest suicide rates in the country. xixIn addition to the fact that in 2020 there was a wave of suicides among indigenous adolescents in Chiapas and that there has been a notable increase in suicide in general and especially among young people between 1970 and the present in the country, we do not have studies on suicide in indigenous groups. It is interesting to note that while for South American indigenous peoples we have a compilation of twelve works on suicide (Campo and Aparicio, 2017), for Mexico we have almost no such studies.

Violence as part of the culture

A whole trend has pointed out the role of systematic violence in the generation of mental or emotional illnesses (Farías, 1999; Frías, 2021), and Mexico is a society that at least since the European conquest has been characterized by the dominance of systematic violence at the national level and in the native peoples. The denial of mental illness in oppressed and colonized peoples has to a large extent to do with the evolutionary hypothesis generated in the 20th century (Frías, 2021). xixThis premise was questioned at various times and especially in the 1950s, 1960s and 1970s by studies of the colonial situation, recognizing these diseases as a product, at least partially, of colonial domination and exploitation, as Balandier, Bastide and Fanon have proposed, but which has not been applied among us. Therefore, I consider that this denial and secondaryization have to do to a great extent with the fact that mental illness is thought of as another possible stigmatization against native peoples.

But violence is not only ignored as a cause of mental illness or emotional suffering, but it is not usually studied as violence, despite its notorious existence and possible increases. They are not studied with respect to women, but especially with respect to men, despite the fact that at the national level more than 90% of homicides are committed by men against men and that Mexico has one of the highest homicide rates; let us remember that Latin America is the region with the highest homicide rates in the world. Furthermore, the few studies on masculinity among indigenous people in Mexico, such as that of Martín de la Cruz (2010), do not include the role of violence in male/male and male/female relationships, despite the fact that this is one of the cultural characteristics of a large number of indigenous and, of course, non-indigenous peoples.

The recovery of this problematic has occurred exclusively with respect to women, largely due to the development of feminist perspectives. It has been documented that between 2012 and 2018 the homicides of women speakers of an indigenous language have increased more than 154%, going from 79 to 122; moreover, in 98% of indigenous communities in the states of Mexico, Morelos, Veracruz, San Luis Potosí and Mexico City aggressions against women are on the rise (Xantomila, 2020). In such a way that some studies conclude that "[...] the most severe forms of sexual violence such as rape and attempted rape are more prevalent among women speakers of an indigenous language" (Frías, 2021a: 381; Cacique, 2021).

It has been found that most of this violence is perpetrated by family members, which is documented not only in socio-anthropological research, but also in biographical testimonies, such as the case of the Zapotec indigenous woman Odila Romero, who recounts how she was groped and sexually penetrated by her uncles before the age of eleven (Blackwell, 2009). In communities of different Mexican ethnic groups it has been recorded that violence against women is culturally legitimized, including by the mtFor example, some traditional illnesses such as fright or bile would be generated by this violence and, therefore, healed, but without altering the cultural normality of the violence. These intrafamilial violences occur in communities where male domination is absolute and a great part of these violences are extreme and even lead to the death of the woman. The continuous violence in very different situations would fulfill the symbolic role of showing who has the power not only in gender relations, but also in the community and in the culture.

Despite these acknowledgements, specialists such as Sonia Frías conclude that these forms of violence against women have been scarcely studied, since "they have been made invisible both by a large sector of academia and by different government agencies" (2021: 433), in addition to the fact that "In fact there are few studies that have approached the magnitude of gender violence experienced by indigenous women and girls; and when they have, they have focused on the problem of intimate partner violence" (Frías, 2021a: 18). Berrio, Castro, De Keizer, Gamlin, Minero, Núñez, Ravelo, Sierra and I confirmed this perception through personal communications made in 2021; they also emphasize that the Instituto Nacional Indigenista has not raised this problem during its integrationist stage, but neither during its participatory period (Muñiz and Corona, 1996).

Guillermo Núñez, a leading authority on gender studies, believes that "there is almost nothing written about gender violence in indigenous contexts; he recalls that there are some old theses that present mythologized visions, where everything is beautiful." In her studies on the Yaqui, she documents male hegemony and points out that indigenous intellectuals do not talk about gender inequalities or violence; according to them,

although we understand that it is an important issue, but hey, it is a delicate issue, because if one piece of the Yaqui family structure moves, of the woman and the man... Uuff, there is a risk that everything will fall apart. Indigenous activist intellectuals do not address the issue of gender violence, as they believe that by doing so they contribute even more to the stigmatization of indigenous people (personal communication, 07/29/2021).

In turn, Jennie Gamlin observes that the majority of women wixaritari have experienced and/or continue to experience violent intrafamily relationships:

From the conversations I have had, very extreme violence that can cause death emerges. These women suffer violence from their fathers, mothers, brothers and husbands. I have not written about this topic, because it is very difficult for me to talk openly about domestic violence with the community. However, I do say something in some text (Gamlin, 2020). The literature on the Huichol does not deal with this topic; it has focused on religious and artistic processes. I do not know of a single text on gender violence among the Huicholes (personal communication, 03/03/2021).

Although violence against women and, to a lesser extent, violence against indigenous women, has been insistently denounced in recent decades, we observe that most of these reports are dominated by interpretations that recognize the existence of violence, but at the same time avoid including certain aspects and propose interpretations that exclude them and validate others. According to Muñiz and Corona, violence against women in indigenous contexts is largely covered up "[...] with the discourse of cultural preservation. Thus, any type of physical or mental violence against indigenous women is explained by their ancestral customs and traditions" (1996: 42).

What is clear in the few ethnographies is that gender violence is generated and protected by the culture of the native peoples, because instead of describing and analyzing the violent uses and customs, many of the studies, including some of the feminist ones, refer the explanations to "external" processes. In such a way that violence is referred to the mestizo society, to the colonial situation, to racism, to the exploitation of women by whites, to the anti-female violence of the caciques, to the violence of organized crime and even to military violence, but without specifically describing intra-family violence. And while I do not deny the important role played by the violence listed above, the core of violence against women is intra-family and intra-community violence.

I emphasize that we have very few studies on homicides in general, and the few that exist have been developed by foreign anthropologists. Moreover, it is generally recognized that witchcraft can cause deaths in children and also in adults, but with some exceptions (Peña, 2006) we have no local studies on infanticide, even though it appears as part of the uses and customs. Moreover, at the national level, child homicides have increased in recent years and are committed almost entirely by the victim's relatives (Hernández Bringa, 2007). Therefore, the majority of physical and emotional violence, as well as homicides, occur among family members and close relatives. In other words, the vast majority of violence is not exercised against the subjects and groups that exploit and racialize them, but against members of their community or nearby indigenous communities.

I consider it important to mention that anthropologists do not describe or analyze the corporate deaths expressed above all in blood vengeance, despite the fact that they have been pointed out by foreign authors and recognized, but not studied, by Mexican specialists. Now, as I have pointed out (Menéndez, 2012) explicitly and implicitly, local and Latin American anthropologists, in general, tend to consider that violence and especially homicides are not part of the culture, which is evidenced beyond words in the scarcity of this type of local studies. However, violence and homicides have been recognized and studied in Mexico by foreign anthropologists since at least 1940, when Ruth Bunzell published her text on the Chamulas; this was followed by the texts of Carmen Viqueira and Angel Palerm (1954) on the Totonacas; and in the following decades by Henry Favre (1964), Lola Romanucci-Ross (1973), Veronique Flanet (1977, 1986), James Greenberg (1989), on various groups.

As much as Mexican specialists know about homicidal violence in the communities they investigate, very few study it; Jaime Page, one of the best scholars of the processes of homicide in Mexico. seap (personal communication, 2021), knows of no studies on homicides among indigenous groups in Chiapas and concludes that in some municipalities it is a taboo subject. In turn, De Keizer (personal communication, 2021), one of the greatest specialists in male violence, is unaware of the existence of works on homicides and other violence in ethnic groups; an exception is the work of Zuanilda Mendoza (2013) regarding the Triquis, which is for me the main ethnographic contribution of Mexican anthropology to the description and analysis of violence in an original people in which violence is a structural part of daily life.

Domestic violence, according to Jane Collier (2009), has been structural in ethnic groups, and although there have been changes, such violence continues to exist as a normalized part of gender relations legitimized by the community. It is largely due to this cultural normalization that women and children do not report aggressions, as even some of the women consider it normal to be raped. Moreover, the community authorities support the rapists and second or deny the few demands made by the women. "Among women there is distrust with respect to going to the justice authorities to file a report, because [...] the authorities are masculine and tend to favor their fellow men" (D'Aubeterre, 2003: 54).

Although in Mexican feminist journals there have been references to violence against women in general and with respect to indigenous groups in particular since at least the 1970s, the first systematic works on this violence in Mexican indigenous groups were promoted by Soledad González, although concentrated in Cuetzalan (Puebla) (González, 1998, 2004, 2009; see also Mejía and Mora, 2005). But it was Graciela Freyermuth's thesis that in 2000 developed in ethnographic depth the anti-female violence in an area of Chiapas.

I believe that the concealment of these processes by a large part of anthropological production, rather than covering up the problem, limits or prevents the possibility of reducing and, if possible, eradicating violence. It must be assumed from the outset that this indigenous violence is part of the dominant conditions of violence in Mexico as a society and that it acquires particular characteristics in indigenous peoples. In addition, such violence - at the national and particular level - may be related to processes that may increase it, such as the family planning programs promoted since the 1970s and 1980s, the loss of the social and economic status of the male, given that he is less and less the sole provider of the family group; the inclusion of women in the labor process, the male migratory process that leaves the woman alone for months or years, although controlled by the family group. I believe that these forms of violence must be made evident in all their significance so that we assume them, instead of marginalizing and denying them.

In epidemiological terms, a special situation is the lack of studies on diseases and illnesses that, despite their impact on their lives, are unknown to indigenous peoples, as they are only addressed in a few specific studies. There is Horacia Fajardo's study on the Huicholes, who points out that "patients of different ages with obvious signs of nutritional diseases such as anemia, avitaminosis or extreme weakness due to lack of food, were not classified as sick by 'el costumbre'" (2007: 141; see also Cortés, 2015). Medical and ecological, but also anthropological studies (Pérez Camargo, 2020; Valdez Tah, 2015), have evidenced the lack of knowledge by the population and by traditional healers of Chagas disease in Yucatán. We also have the case of the vih-AIDS which, despite being an important cause of mortality among the indigenous population (Freyermuth, 2017), is scarcely studied. Patricia Ponce concludes that "The profound lack of interest on the part of social scientists to develop research on sexual conceptions, values and practices, gender identities, sex-gender diversity, homophobia, homoeroticism, stigma, discrimination, and vih/(Ponce, 2008: 1; see also Ponce, 2011; Núñez, 2011; Muñoz, 2022, 2023).

Although in recent years research on gender and gender equity processes has been developed, it has been seapHowever, there are practically no studies on the male gender and on gays, lesbians and transgenders in indigenous peoples, with few exceptions. In the case of males this lack is significant because, according to Freyermuth (2017), with data up to 2014, mortality rates of indigenous males double those of females and in municipalities where there are 70% and more of indigenous population, the differences are even greater. We do not have data on which gender gets sick more, although it is noted that women are the ones who seek care more often with mt and with biomedicine, but without a precise ethnographic development. The same occurs with respect to the self-care of ailments at the family level, as it is taken for granted that it is in charge of the woman, but ethnographic work is scarce (Cortez, 2015).

From the epidemiological perspective, it is necessary to recognize that since the research of Berrio, Freyermuth, Muñoz and Sesia, an important stream of epidemiological studies on native peoples of Chiapas, Oaxaca and Guerrero has been developed, which has allowed us to have an increasingly accurate vision of their mortality and morbidity. Ponce has generated this type of studies, but they only refer to the vih-and especially in Veracruz. Most of these studies focus on the allopathic and do not include the traditional as part of the patient's career.

Maternal mortality, childbirth, marriages and sexualities.

There is a whole series of epidemiological processes directly and indirectly related to pregnancy, childbirth and puerperium, which also show exclusions or reduced productions, except in the cases of the groups coordinated by Freyermuth and Paola Sesia in Chiapas and Oaxaca, respectively, which have made known the high rates of maternal mortality in indigenous areas, as well as their gradual decrease, although they maintain notorious differences with the national average. Already in 2001, the Ministry of Health pointed out that indigenous women have a risk of dying three times higher than non-indigenous women from maternity-related causes, which is maintained in 2011 (Freyermuth and Luna, 2014). But, in addition, it is noted that 87% of the women who died in the Chiapas Highlands between 1989 and 1993 had not received medical attention (Freyermuth and Meneses, 2006: 6). Freyermuth and Arguello (2018) show this situation in 1990 and in 2015, as despite a decrease in maternal mortality in Chiapas and in Oaxaca, it is still much higher in indigenous women than in non-indigenous women.

The highest maternal mortality rates have occurred when delivery care was dominated by traditional medicine and can be correlated, at least part of the decline, with an increase in biomedical care, beyond obstetric violence and the fact that such care was questioned by the native population. As evidenced by Sesia and Freyermuth (2017), despite the high maternal mortality rates that occurred between 2004 and 2007 in Oaxaca, we need to assume that these are even higher, given the high level of underreporting that exists in indigenous areas, which the author estimates at between 40% and 50%. She stresses that 75% of deaths in indigenous areas occurred at home; moreover, "44% of women in indigenous municipalities who died from maternal mortality gave birth alone or attended by a family member [...] 33% were attended by empirical midwives, and only 21% had medical care by skilled health personnel" (Sesia and Freyermuth, 2017: 232). But, in addition, 60% of infant mortality in 2013 was in indigenous areas (La Jornada, 20/08/2014). Faced with these figures, the author goes so far as to question in a previous work: "the sometimes romantic image that exists especially in certain anthropological literature regarding the cultural and medical importance of traditional therapists in indigenous communities" (Sesia et al, 2007: 27).

The high maternal/infant mortality in indigenous areas has been periodically documented by the Pan American Health Organization through research on the health of the Americas, but also through anthropological research conducted in several Latin American countries. In the case of Bolivia, not only is maternal mortality high, but "[...] for every woman who dies from causes attributable to pregnancy, childbirth and puerperium, about thirty survive with their sexual and reproductive health severely compromised. Surviving orphans also suffer from health, growth and development problems that have been very well documented in different investigations" (Uriburu, 2006: 173). I clarify that in Mexico we do not have this type of research; nor do we have studies on fetal alcohol syndrome, which in Mexico can be very high given the high alcohol intake in indigenous women, which is partially expressed through their high mortality rates due to liver cirrhosis.

Although empirical midwives are the most studied type of traditional healer in Mexico, most of these studies do not describe or analyze the possible mortality during pregnancy, childbirth and puerperium treated by midwives. Prominent specialists (Berrio, Castro, Freyermuth, Salas, Sesia) are unaware of works on mortality in births performed by midwives (personal communication, 2020/2021); while Jaime Page (personal communication, 2018) notes that midwives and other traditional healers with whom he has spoken maintain that patients never die on them. For Berrio, mother and child mortality in the process of childbirth with midwives is a taboo subject; in my communication with at least four specialists I did not obtain information about mortality in childbirth, despite the fact that they have had direct experiences of death. These experiences refer not only to maternal mortality, but also to neonatal mortality. Obviously, this mortality is not reported, as it can lead to legal situations; but, in addition, such omission occurs due to the dominance of views that try to avoid racist discrimination by mythologizing reality to a great extent.

Maternal mortality and neonatal mortality have been declining for a number of reasons, including the systematic implementation of the family planning program (pf) which has generated a notorious decrease in the number of births and, therefore, in the number of deliveries. Although this program initially operated less in indigenous areas and was rejected by the population and by a large part of the midwives, it gradually took hold and currently excludes midwives from labor. One of the main techniques of pf has been the sterilization of women, which has hardly been studied by Mexican anthropology, including feminist anthropology (Menéndez, 2009).

However, there is very little research on the role and reactions of the male to the application of the pf As we have seen, some violent reactions are reported, but without any ethnographic development to support them. If machismo and the power of men over their wives is as strong as reported, what happened to make them accept the application of contraceptive techniques, even definitive ones, to their wives? It is important to ask ourselves this question, especially because, according to the Mexican proverb, for men: "the woman is always loaded like a rifle, and behind the door". Feminist anthropology in particular has emphasized the strong patriarchal regime dominant in the original peoples, but it does not describe, analyze or explain how, despite this patriarchal regime, the pf, including sterilizations. According to Berrio, Haro, Núñez and Sesia, there are no ethnographic studies on how men reacted to sterilization. pf.

One of the most acute problems operating among indigenous peoples and, of course, not only among them, refers to child marriages as part of their customs and traditions (United Nations/...).cepal 2021). Girls are married between the ages of nine and 14, and in some cases even at a younger age (Juarez, 2016). According to the onuAccording to Unicef, one in five women in Mexico marries as a girl (Juárez, 2016a); according to Unicef, it is in indigenous groups in Latin America where these marriages are more frequent, constituting the only region where child marriage is not decreasing (Poy Solano, 2018). Such marriages are based on uses and customs, that is, they are justified by native cultures, in such a way that women who try to avoid forced marriage are exposed, at least in communities in the state of Guerrero, to being deprived of their freedom by the spouse's family, to having their children taken from them, or even to being imprisoned, as recently asserted by Abel Barrera, a recognized defender of native peoples (Xantomila, 2023). This is the case of a 14-year-old girl who refused to marry another boy, a marriage that had been arranged by her family, who would receive 200,000 Mexican pesos when she was married; but, since this girl refused the marriage, she was imprisoned by the community police (Guerrero, 2021).

These processes occur at least in groups originating in Chiapas, Michoacán, Oaxaca, San Luis Potosí and Veracruz (Bellato and Miranda, 2016; García Gómez, 2017; Camacho, 2017), where in recent years the refusal of girls to marry has been documented journalistically with negative consequences for them. Usages and customs in some contexts can acquire special characteristics, such as the one that occurred with a 16-year-old indigenous girl in a community in Veracruz, where the communal authorities tried to marry her off to the man who raped her (Refoma, 26/12/2019). We need to assume that in these violences operate reciprocity structures that articulate homicides with community needs. According to Mendoza (2013), a Triqui woman informed her that a subject killed her husband and that the communal authorities proposed that the murderer marry her in order to take charge of the family. Or, in other cases, the communal authorities not only do not arrest the rapist, but only impose a fine, as happened in a community in Chiapas (Henríquez, 2003). Moreover, in the Mezquital Valley, two doctors accused of raping a minor only had to pay a fine of 35,000 pesos to the girl's family (Camacho, 2003). To a large extent, due to customs and practices, the un/eclac (2021) estimates that there is a notable underreporting of cases because they are hidden by the community, but also by those who study these facts. The basis of these uses and customs is the sale of the girl to generally adult subjects who pay a dowry, almost always in money nowadays, since, until a few years ago, what was paid corresponded to the drinks and meals involved in the marriage.

As in the other fields of study mentioned above, we do not have ethnographies of these uses and customs, given that although this situation has been raised since the 1980s by feminist-oriented social organizations, anthropological texts are scarce, despite the fact that indigenous activists, such as the lawyer Abel Barrera, denounced and requested government intervention to eliminate marriage sales. However, indigenist visions continue to dominate, omitting or hiding culturally normalized negative uses and customs, in such a way that for men and also for most women violence is part of their cultural normality: "We must fight for indigenism to make conscious the right to question one's own culture and change practices contrary to the human rights of Indian groups, particularly women, especially in relation to domestic violence. It assumes that not everything traditional is good or conceives the ancestral as idyllic and desirable" (Muñiz and Corona, 1996: 58).

I emphasize that these processes do not occur only in the native peoples, but are part of other social sectors, but it is in the indigenous peoples where they are culturally legitimized. Mexico, according to the Organization for Economic Cooperation and Development (ocde), is the country in the world with the highest sexual abuse of children and adolescents (Gómez, 2023); indigenous girls constitute 45% of trafficked minors (Largner, 2018); moreover, sexual abuse by teachers and officials in primary and secondary schools in Querétaro is the main complaint registered by the State Human Rights Commission by the indigenous sector (Chávez, 2004). It is the set of these processes that we need to assume at a national, Latin American and, above all, native community level.

Closely linked to the aforementioned problems is the issue of adolescent pregnancy, which is not only found in indigenous areas, but occurs in them in a higher percentage. A large part of these pregnancies are linked to gender violence; in Mexico, 11,000 girls become pregnant annually as a result of sexual violence committed mainly in the family, according to the director of the National Women's Institute (Martínez, 2019); La Jornada, 2019). In 2015 and 2016, more than 1,000 girls between the ages of ten and 14 who became pregnant were mostly the product of rape and "were forced to continue their pregnancy" (La Jornada, 2017). The head of the National Population Council (Conapo) considered that, during the confinement generated by the pandemic, teenage pregnancies would have increased by 30%. According to Gabriela Rodríguez, 27.5% of the abuses are generated by uncles, 15% by another relative, 13% by someone known, 9.3% by a sibling and 6.6% by the father (Rodríguez, 2021). This process is more frequent in the marginalized areas of Chiapas, Tabasco, Coahuila and Guerrero, especially in areas of indigenous prevalence, being part of the uses and customs (Rodríguez, 2021, 2021a, 2023).

Sexuality is one of the fields most excluded from the study of the humanities and social sciences. mtThe sexuality of women, men and other genders is practically ignored. There are no studies on eroticism, sexual diversity, orgasms, masturbation or erectile dysfunction, despite the fact that, for example, it has been argued that anorgasmia (inability to experience orgasms) affects 40% of urban women and 80% of rural women, which would be a product of female sexual repression (Hernández, 2005).There are also no studies on abortion, although paradoxically we have studies on abortion techniques in Mexican indigenous groups; we also lack studies on infertility and, in particular, on sterility by gender, since the scarce data we have indicate that infertility is attributed communally to women.

There is a process that is important in itself, but which has been enhanced by the expansion of the vih-I refer to the study of sexual diversity and particularly homosexuality, which, according to Guillermo Núñez, little or no work has been done in Mexico and even less in the native peoples (2009: 8). According to Núñez, this absence "derives from the fact that homosexuality or any dissidence among indigenous people does not exist or is not proper to their society, but a decadent expression product of 'outside' influence" (2009: 14). Several analysts, especially Patricia Ponce, state that male bisexuality has as a consequence the transmission of the vih-AIDS by men to their wives.

Now, the set of processes analyzed expresses basic characteristics of the cultures of the native peoples, but above all one: the social, cultural, political and sexual subordination of women not only to men but to their community, to their culture. Although in recent years some women are gaining access to community, state and national political positions, these achievements are still minimal, as communities continue to develop strategies to exclude them from political power. Although women's demands against violence and subordination are growing, at least so far most analysts recognize that women continue to be subordinated to men, to their husband's family, to their community and to their culture. The assembly of San Bartolo Coyotepec (Oaxaca) elected Rutilio Pedro Aguilar as municipal president, who declared women who have demonstrated for the respect of their political electoral rights as persona non grata. It was decided that women cannot be councilwomen or municipal presidents. This decision was made in an assembly attended by 900 people, mostly women; however, the subjugation is such that, when nominated, the women themselves, with heads bowed, asked not to be included, excusing that they could not comply with the registry (Pérez, 2014).

Despite the fact that feminist anthropology has raised several of the processes listed above, there is a tendency in anthropological currents or in political and ideological orientations not to analyze these processes. And it is not only a question of nationalist indigenism, expressed to a large extent by the current government, but also of postcolonial and decolonial currents, as well as sectors of the Zapatista Army of National Liberation (ezln) that place the core of violence against women in Western "macho capitalism", which expresses an ideological mechanicism that has little to do with what happens in reality. There is no doubt that in the different "Western" capitalist countries violence of all kinds is exercised against women, but it is not in these countries where the most frequent, cruel and murderous forms of violence against women occur, but rather in non-Western capitalist countries such as Afghanistan, Iran or Saudi Arabia. It is in these societies where women can be stoned for adultery, where proverbs say that a cow is worth more than a woman, where women cannot dance or sing publicly. So as long as we continue to play ideological games, both to omit/hide the processes listed above and to interpret them in a biased way, not only will we fail to interpret and mobilize reality, but we will continue to contribute to the persistence of such violence, humiliation and suffering.

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— (2023). “Quienes se salen de matrimonios forzados sufren nueva violencia, denuncia el centro Tlachinollan”, La Jornada, https://www.jornada.com.mx/2023/03/06/politica/012n2pol Consultado el 25 de enero de 2024.

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Eduardo L. Menéndez D. in Anthropological Sciences (Universidad de Buenos Aires); Master in Public Health (Escuela Salud Pública de México); PhD in Anthropology (Universidad de Buenos Aires). Doctorates honoris causa by the Universitat Rovira i Virgili; by the Universidad Nacional de Rosario and by the Universidad Nacional de Lanús. Professor/Researcher Emeritus of the ciesas. He has developed numerous researches in the field of medical anthropology that has resulted in the publication of 32 books and notebooks; 119 articles and 108 book chapters. Among his books are the following: The denied part of culture. Relativism, differences and racism (2002); Of subjects, knowledge and structures. Introduction to the relational approach in the study of collective health. (2009); Power, social stratification and disease. Analysis of the social and economic conditions of the disease in Yucatan. (2021); Dying of alcohol. Knowledge and medical hegemony (2020).