MATRILINEAL STRUCTURES AND PATRIARCHAL VALUES: WOMEN’S HEALTH ON LIHIR, PAPUA NEW GUINEA

CHAPTER 12

MATRILINEAL STRUCTURES AND PATRIARCHAL VALUES:

WOMEN’S HEALTH ON LIHIR, PAPUA NEW GUINEA

Martha Macintyre

Improvements in the status and health of women are often

assumed to accompany the economic development process in

Pacific nations. In Papua New Guinea, resource-extraction

industries, especially mining and logging, are the major

ways that people in rural areas are incorporated into the

processes of modernization. For the women of Lihir, in

New Ireland Province (see figure 12.1), where a large

gold mine has been in production since mid-1997, the

changes in their everyday lives have been dramatic and

swift. The benefits and the damaging effects of these

changes on social status and health are in some respects

easily identified. Research over the period from 1994—

before the mine—to 1999 has provided evidence from which

to draw conclusions. A baseline study of the health of

the population (Taufa et al. 1994) and a detailed social

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mapping study (Burton 1995–2001) illuminate issues of

health and demographic change. But the relationships

between the observable changes and the social and

cultural forces that influence and affect them are not

easily identified, as material transformations are

mediated through cultural ideologies and practices.

<Figure 12.1>

Some transformations are novel, introduced by the

mining company and the state. Some are attributable to

cultural globalization and the fact that Lihirians have

suddenly been linked to a wider world—industrially and

through improved transport and communications. Some are

effects of greater wealth as the monetary benefits of

gold production permeate the island community. Women’s

lives are changing and even five years into the mining

project there are discernible improvements in living

standards. As if to demonstrate the accuracy of analyses

that attribute the low rates of education for girls to

the burden of subsistence agriculture on women (Avalos

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1994), enrolments and retention rates of girls at schools

have been rising since 1997. Changes in women’s health

are less evident and while many beneficial changes are

underway, there are also detrimental effects, such as the

increase in domestic violence, which are in many respects

hidden from scrutiny.

ANTHROPOLOGY AND PUBLIC HEALTH: WOMEN’S HEALTH AND

WOMEN’S STATUS

The relationship between anthropology and public health,

as disciplines within the academic domain and as

integrated elements in strategies for improving health in

developing countries, has strengthened during the 1990s.

As political debates about global inequalities and

oppression have incorporated the discourses of culture

and difference, in order to explain disparities and

conflicts, anthropological understandings of culture have

been incorporated into public health debates. The failure

of primary health care initiatives in some communities

and their success in others is conventionally explained

in terms of cultural difference, for instance,

understandings of the cultural construction of sexuality

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in particular groups and communities are integrated into

public health policies on AIDS prevention and family

planning.

Public health analyses deal with populations and

groups, the level of generality paralleling that of

anthropology. Public health studies dealing with cultural

factors often hark back to theories of social and

cultural determinism that underpinned functionalist

theories which informed anthropological studies in the

1960s. While public health and epidemiology have been

criticized from within for their concentration on

“generic methods for the measurement of disease

occurrence” (Farmer et al. 1996, 243) and relative

neglect of social contexts, even when these are

considered, a strange dehumanizing reductionism seems to

creep in, so that being female, or poor or black, become

“risk factors.” The emphasis on statistical demonstration

of causal relationships constrains studies so that

specific factors are identified and analyzed in relation

to each other and to the prevalence, for instance, of

disease, while the reasons for these causal relationships

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or the sociocultural mechanisms at work remain obscure.

As public health inquiry concentrates on the material

effects of sociocultural systems it invokes alternatively

some of the functionalism of British social anthropology

following Malinowski and a cultural determinism

reminiscent of Mead and Benedict. The discovery of

demographic or epidemiological patterns in public health

studies provokes questions about the functions of

particular social arrangements or cultural understandings

that might account for crucial differences between groups

that in many respects are apparently similar. The work of

John and Pat Caldwell in India has consistently

incorporated anthropological analysis to this end, and

their correlation of familial ideologies with the health

status of women from different states in India (Caldwell

and Caldwell 1994, 339–71) provides both the inspiration

and point of departure for this chapter.

Caldwell and Caldwell observe that studies of health

in Third World countries reveal differentials in

mortality that cannot be attributed to either economic

disparities or unequal access to medical services (1994,

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340). The clustering of those countries whose female

mortality rates are relatively high concentrates “along

an east-west axis from the Mediterranean to the Arabian

Sea, precisely the origin of the most rigid patrilineal

and patriarchal society” (340). Their discussion of

regions of excess female mortality and the correlation of

these patterns with particular types of family structure

and gender ideologies demonstrates clear relationships

between patrilineal/patriarchal societies and lower

female health status. They acknowledge that the

mechanisms, which discriminate against females (of all

ages) in such societies, are complex, often covert and

not explicitly directed toward generating female ill

health.

Within anthropology, theoretical concerns with

difference and the poststructuralist criticisms of

materialism and universalist criteria have moved debates

away from comparative studies that have any underlying

principle of relative measurement. But as public health

has become a global concern, the problems are necessarily

posed in terms of universal objectives and ideals of

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improvement that assume fundamental similarities between

populations and cultures. The broad-brush comparative

approach of international public health studies that sets

goals for immunization levels, or sanitation, or

reduction in rates of infant and maternal mortality, has

generic human subjects at its center. In this context the

health of women in one population is legitimately

compared with that of another, and social, economic, or

cultural factors that might determine that difference are

invoked as part of the knowledge necessary to effect

change. Caldwell and Caldwell make comparisons of Third

World mortality rates that clearly demonstrate their

argument about “patriarchy and patriliny” in a broad

sense. But within anthropology the meaning of

“patriarchy” and the complexities of familial systems

associated with various forms of descent reckoning have

been subjected to intense scrutiny. Moreover, ideas about

the “status” or “value” of women have been similarly

destabilized as feminist and postcolonial scholars have

questioned the Eurocentrism of the “values” attached to

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theoretical studies of gender relations in developing

countries (Lepowsky 1993; Lutkehaus 1995; Weiner 1976).

Where once “patriarchy” might have seemed

unproblematic, a term to designate power relations within

social formations (from the family to the State) that

privileged men and their interests over women, feminist

and poststructuralist anthropology has required that

differences and variations be acknowledged.

“Patriarchies” with various forms might exist and be

examined, but the generic term no longer can be applied

uncritically. Caldwell and Caldwell (1994) use the term

in the sense that has been applied to “Eurasian”

societies by Jack Goody (1976) and others—societies based

on agricultural economies with familial hierarchies where

the dominance of an individual older male “is achieved by

having the husband much older than the wife” (Caldwell

and Caldwell 1994, 344). Their argument is supported by

statistical comparisons of adult and child health within

India, which show that variations cannot be explained by

other factors, such as relative poverty.

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Development and health studies of the Pacific region

also assume global categories that facilitate measurement

and comparison between nations and populations. Much of

the development literature on women infers aims that are

uncritically “progressive” and emancipatory: improved

health and education; greater participation in all levels

of government; the removal of discriminatory practices

that impede women’s access to justice; improved economic

status and living standards (Avalos 1994). The research

undertaken to account for gender disadvantage and

disparity assumes the desirability of these aims and

seeks material explanations for differences; cultural

explanations are invoked as “second order” answers to

otherwise inexplicable variation. Concepts such as

“patriarchy” are then reintroduced.

Papua New Guinean health statistics raise questions

that are similar to those of Caldwell about India. When

compared with other Pacific nations, many of which are

less economically developed, the health of women in Papua

New Guinea (PNG) is poor and the rate of infant mortality

extraordinarily high. For example, the neighboring

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Melanesian nation, the Solomon Islands, is poorer, has a

much lower rate of adult literacy (22 percent as opposed

to 52 percent in PNG) and faces similar problems of

transport and communications that limit access to health

services. Yet, people there have a higher life expectancy

at birth (Solomon Is. 62 years, PNG 56 years) and there

is a lower infant mortality rate, with Solomon Islands

estimates currently 44 per 1,000, compared with PNG at 67

per 1,000 in some studies (Brouwer et al. 1998, 29) and

82 per 1,000 in others (National Statistical Office

1991). In PNG women’s life expectancy is 51.4 years,

making it the lowest in the Pacific. Analysis of causes

of death for women between the ages of 15 and 44 years

revealed that 29 percent of deaths were from obstetric

causes (Brouwer et al. 1998, 30). Women’s differential

access to health services and poorer health generally is

also indicated by the otherwise inexplicable masculine

bias in the population. With 111 males for every 100

females (one of the highest differentials in the world)

and no substantial evidence for any systematic female

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infanticide, Papua New Guinea’s women appear to be “at

risk” throughout their lives.

But statistical information for Papua New Guinea is

unreliable. Collection of data presents enormous

logistical problems and the funding cuts to Health,

National Planning, and other government services over the

past decade mean that figures are in many respects

problematic for any analysis. But the disparities on

Lihir are supported by good statistical evidence.

In this context, a re-examination of issues of

women’s relative status and value has new relevance. The

differences between men’s health and women’s health in

Papua New Guinea demand explanation precisely because the

disparities systematically disadvantage women. They are

also expressive of differences in power over the

processes of change occurring in all aspects of life—in

economic development, in government, and in everyday

existence. The societies that Caldwell and Caldwell

(1994, following Goody 1976) identify as patriarchal are

patrilineal, with institutional structures, such as land

ownership, inheritance, and political authority, that

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favor male interests over female. In PNG, communities in

which matrilineal systems of descent, land ownership, and

authority might appear to be more equitable, women are no

healthier (see Lepowsky 1993; Macintyre 1987; Modjeska

1982; Nash 1974). Indeed, the patterns of health and

illness show distinct similarities with the patrilineal,

patriarchal societies described by Caldwell and Caldwell

(1994). Lihir, in New Ireland Province, is one such

place.

MATERNAL AND CHILD HEALTH ON LIHIR

The available information on the health of women on Lihir

suggests that they are in most respects typical of the

rural female population in PNG. Malaria is endemic and

there are several villages where filariasis is common.

These mosquito-borne diseases affect people regardless of

gender, but malaria in women specifically contributes to

the high levels of anemia observed in mothers (Taufa et

al. 1994; Dickson 1994). Both women and men suffer from a

range of respiratory infections and tuberculosis which is

widespread and generally undiagnosed until it is

advanced, when people present at hospitals. In one survey

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conducted in two villages on Lihir in 1995, the medical

team found that 80 percent of people had positive

responses to Mantoux tests. While this is not necessarily

evidence of affliction, the medical superintendent

believed that the rate of infection was extremely high

(M. Golding, pers. comm.).

When confronted by numbers showing that too many

women are anemic, suffering from malaria, or dying in

childbirth, it is easy to see the solutions as either

medical or matters of health education. In observing

women’s lives in villages on Lihir, the problems specific

to women’s health are more complex and not attributable

to either lack of knowledge or absence of services.

Moreover, changes associated with the mining development,

while undoubtedly improving health services and material

standards of living, create new inequalities and have

social effects that reduce women’s health.

Statistical information on birth rates is scant. One

reliable survey of nine villages in 1991 found 38.2 per

1,000 (Dickson 1994) and the current rate is estimated at

34 per 1,000, although this is perhaps too low due to

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underreporting of births outside hospitals and medical

centers. In a small survey in four villages I found that

of 28 births in one year, 8 had occurred in villages and

were therefore unrecorded. The total fertility rate is

estimated at 4.5, comparable with the national rural

figure of 5.00 (Kowal 1999). Certainly, the most casual

observation of households affirms that Lihirian women can

expect to have at least four or five children in their

lives.

WOMEN’S KNOWLEDGE OF HEALTH ISSUES

Since 1995 I have regularly discussed health matters with

Lihirian women and have conducted two formal surveys (in

1995 and 1999) of fifty mothers, in order to gauge health

education needs and awareness of medically identified

health problems of women and children. Three of the

topics regularly investigated are anemia, care of women

during pregnancy and birth, and ideas about being

healthy.

ANEMIA, OR SOT BLUT

The overwhelming majority of women recognize the pidgin

term sot blut, having been told about it by a nurse during

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antenatal care. Their explanations are conceptual and

experiential and two-thirds consistently explained causes

that are based on biomedical information. The most common

understanding of the term sot blut (lit., short blood) is

that the body has insufficient blood—a condition variously

attributed to excessive loss of blood during birth,

depletion of the mother’s blood to the fetus, and falling

pregnant soon after a birth, before the body has time to

“fill up” with blood again. Only a few educated women

described it as a deficiency in the blood, and not many

are aware that malaria can exacerbate or cause anemia.

Half the women described it in terms of their experiences

—the symptoms being extreme lethargy, weakness in the

legs, pallor, and dizziness. Over two-thirds identified

eating greens (kumu) as a way of both treating and

preventing anemia and some mentioned the need for other

iron-rich foods. Adequate rest, bush medicines, and

spacing of pregnancies were also viewed as ways of

avoiding the problem.

While the definitions of anemia do not conform to

biomedical models, Lihirian women display a high level of

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awareness of important causes and treatments. They often

sound as if they were repeating the health messages they

have heard from the clinics. Detailed knowledge of

preventive measures has increased over the past five

years, testifying to the efficacy of the health education

programs conducted under the auspices of the mining

company. Half of the women interviewed (mostly those

between 20 and 30 years) identified medications

obtainable from the hospital and a few knew of treatment

by transfusion. They were able to recognize symptoms in

themselves and others and knew how to respond in ways

that are appropriate. But few women do so.

Given the role of nutrition in improving women’s

health and the fact that the health transition in

developing countries often includes dietary innovations

that have adverse effects on health, such as increased

consumption of saturated fats, sugar, and refined foods,

the gap between understanding and practice is alarming

(cf. Pollock this volume). Customary consumption of

greens is limited mainly because people believe that they

constitute a garnish to starchy staples, so “eating

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greens” may involve quantities as small as one

tablespoon. Eating greens in large quantities is thus

viewed as somewhat eccentric, rather like emptying a

whole bottle of ketchup on one’s meal. At present,

families who purchase food from stores limit themselves

to rice and tinned fish and those who have more money buy

take-away foods that consist mainly of white flour fried

in palm oil or dripping. The supermarket stocks a wide

range of foods to cater for the expatriate families—and

while this is expensive, it is no more so than the

convenience foods. The food of the wealthy Lihirians now

is the food of the poor in industrialized countries—

floury deep-fried convenience food laden with sugar or

salt—that is valued for the feeling of satiation it

brings. Problems such as obesity, diabetes, hypertension,

and cardiovascular diseases are currently the subject of

education campaigns aimed at prevention, but have no

discernible effect on eating habits.

Most women consider store foods unhealthy yet appear

to accept the changes as inevitable. The prestige value

of buying ready-cooked food dominates, in part because

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the idea of modernity or “development” is constructed in

terms of not having to engage in heavy work and being

able to buy, rather than make, food, clothing, and

household items. Thus, the economies of buying the

ingredients for “fast foods” and preparing them at home

are rejected as signs of relative poverty.

PREGNANCY AND BIRTH

The maternal and child health team regularly visits

villages and all women attend for antenatal checks by the

medical staff. All women mention “eating good food” and

“having rest” as crucial to maintaining health during

pregnancy. In 1991 about 50 percent of women gave birth

in the mission hospital. Now almost all women prefer to

give birth in hospital and the majority of women do so.

In the 1995 survey, 29 women had all their children in

hospital, 11 had all in the village, and 10 had

experienced births at both places. In the 1999 survey, 36

had all in hospital, 8 had all in the villages, and 6 in

both sites. In conversations with women of all ages the

ideal birth was represented as taking place in hospital

under medical supervision with analgesia available.

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Questions about length of stay were invariably

interpreted subjectively. Women considered their current

circumstances and so limited their hypothetical stay to

one or two days. When asked how long they would stay if

they knew that their gardens were being cared for and

family being fed each day, the time stretched to five

days. The most common reasons given for choosing to give

birth in hospital were the availability of medical

assistance, access to medication for pain, and fear of

obstetric difficulty. Several women who delivered in the

village mentioned that the labor progressed too quickly

for them to travel. The most common reasons for not going

to hospital were lack of transport and lack of money. The

mission hospital charges 7 kina (US$2) per day and women

can stay as long as they want (usually one week); the

hospital at the mining township charges 21 kina (US$6)

per day. As the weekly income for a person working at the

mine rarely exceeds 200 kina (US$57.50), this represents

a considerable amount of money, even for wage-earning

families. There are additional costs in going to

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hospital, as then women have to buy clothing for the

baby.

The minority of women who preferred to remain in the

village to give birth included some who did not want to

be examined (especially by a man, although there are no

male midwives and the male doctor is called only in

emergencies) or did not like taking medication. Some

women did not like the hospital environment. These

personal preferences did not appear to correlate with any

other defining characteristics, such as age or level of

education. Most women from both groups mentioned the

problems of childcare as a major obstacle and one of the

reasons for not seeking medical attention when

experiencing problems during pregnancy.

RECOGNIZING HEALTH AND ILLNESS

As health status and measurements of health utilized in

public health studies are uncompromisingly biomedical in

their criteria, most awareness campaigns assume the self-

evidence of shared views of health improvements and ideal

health. The failure of some campaigns (notably

nutritional education) in Papua New Guinea inspired

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investigation of local understandings of “being healthy.”

The term helt ‘health’ in Tok Pisin is widely used by

those who have had primary education, but most women use

strongpela ‘strength, health’ when referring to physical

well-being. Women most commonly emphasize high energy

levels and feelings of calmness or happiness and personal

autonomy as the way they feel well.

Inquiries about the time in their lives that they

have felt most healthy revealed the ways that the

experience of motherhood is constituted negatively. By

this, most women were referring to the period when they

were bearing children, breastfeeding, and bringing up

children who were at primary school. Of the fifty mothers

surveyed in 1995, only one nominated her current state as

healthy. In 1999 the result was similar. The vast

majority of women nominated the time that they were young

adults, before their first pregnancy, as the time of

greatest health. The ways in which they explained their

healthy state throw light on the ways that women perceive

the pressures of marriage and maternity as deleterious to

their health:

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Taim mi stap nating, mi no marit yet, mi stap strongpela. Becos mi no gat man mi

ken tingting long givim kaikai, mi kaikai tasol ‘When I was just myself,

unmarried, then I was healthy. Because I didn’t have a husband

to worry about feeding, I just fed myself’.

Mi inap long ple na go raun long poroman na mekim sampela wok olsem laik

bilong mi inap long mekim ‘I could just play and go around with my

friends and work as I pleased’.

One woman who said that she felt healthiest after she

weaned her last child described the change thus:

Mi kaikai bilong mi, mi wokabaut olgeta samting bilong mi yet, mi fil olsem pri. Skin

bilong mi i senis bekos kaikai i halipim bodi bilong mi ‘I ate for myself, I

walked about doing things for myself, I felt free. My skin

changed because the food was sustaining my body’.1

While it is often assumed that motherhood in Papua

New Guinean communities confers status and value, giving

them powers of influence and authority, few women present

this as their own experience. In discussions of the times

of greatest happiness and physical well-being, women of 1Notes

? The Tok Pisin term “skin” usually refers to the body as

well as its surface. The speaker here was differentiating

between skin and body and so used the English word

“body.”

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all ages suggested that motherhood, especially the period

when a woman had small children, was the time that they

felt least well and were most likely to feel unhappy,

linking ideas of health and happiness to freedom and

autonomous action. While a few suggested that they were

happiest and healthiest when they had no

responsibilities, most expressed this in terms of the

freedom to decide, without any coercive pressure, when to

work. Several women described the time before marriage as

one where they could work for long periods without being

exhausted and could grow their own food and give it to

their families, thus pleasing their married sisters and

mothers. Having food to bestow as they pleased gave them

status with other women and, most of all, they felt no

compulsion to do so: “Sapos mi no laik, bai mi no givim kaikai long ol.

Ol ino ken paitim mi ‘If I didn’t feel like it, then I

wouldn’t feed them. Nobody could hit me’.”

Marriage was thus represented as a time when a woman

lost control over her own life. Motherhood is defined as

labor and little attention was given in narratives to

biological processes or birth events. Most particularly,

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a mother’s obligation to feed others meant that she had

no choice about work. This perception of women’s lack of

autonomy over their bodies in marriage was a recurrent

theme, stated quite clearly by one woman who worked at

the mine. She had three children and had never married.

In explaining to me that this was by choice, she said:

Why would I marry? Now I can work for myself, pay my

children’s school fees, give my sisters and mother money. I

don’t have to work hard all day in the garden or get beaten

by a husband who wants his food or wants to sleep with me

when he is drunk. I can go to my garden on my days off, or

help my mother. I am happy like this.

WOMEN’S WORK AS A DEBILITATING FACTOR

Lihirian women, like many other women in rural Papua New

Guinea, produce most of the food consumed by their

families and their pigs. Although some men do work in

gardens, they are in a minority and they draw on the

labor of women to do much of the day-to-day maintenance.

Between 1995 and 1999 I observed the daily routines of

women in two villages. Women between the ages of eighteen

and fifty-five worked extremely long hours each day. In

the months prior to the yam harvest, most women spent

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between four and six hours in their gardens and the

majority went to work in the garden four or five days a

week. Collecting water was a major daily task in both

places. Some women spent up to three hours each day

fetching water in buckets and other receptacles. In the

village where a tank had been installed the time was

reduced by two-thirds. Women walked to streams to wash

dishes and clothes most days. In addition they fetched

firewood, cleaned the hamlet area and their homes, washed

clothes, prepared all meals, and cared for their

children. The two tasks that were shared with men fairly

regularly were the feeding of pigs and childcare. Girls

assisted with all tasks, but especially by fetching water

and caring for young children, often in the company of

their mothers.

The work women do is arduous. They regularly carry

loads comprising more than half their body mass—often for

over an hour at a time. I recall one woman returning to

the village in the evening with a child on her hip, a

basket of tubers hanging down her back from a tump-line

across her head, with two large plastic bottles of water

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in one hand and a pile of wood precariously balanced atop

the basket. Much to her amusement I weighed her burden

piece by piece; the total weight was 25 kilograms.

According to her medical card she weighed 42 kilograms

and she had walked about two kilometers carrying this

load after working all day (see figure 12.2). She was

thirty-six years old and had six children. She also cared

for two children of two sisters who lived in other

villages. She had been diagnosed as severely anemic after

the birth of her last child and had recently had malaria.

<Figure 12.2>

This woman is unusual. She is more highly educated

than most, having completed four years of secondary

schooling. Unlike most women, she has a husband who also

works regularly in their gardens and, as on this

occasion, sometimes helps prepare meals. But in terms of

her daily life, her numerous children, and her health she

is typical. The constraints of her life are shared with

most other village women and she perceives them as things

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over which she can have little control. She has to feed

her family, care for her elderly father, have her

children washed and dressed for school, and has little

time to even think about her own health. Aware of the

strain on her family an absence at the hospital would

mean, she chose to have her last baby in the village and

rested for only two days. Her sisters and husband took

over her normal tasks. She considered herself fortunate

and smiled indulgently at my concern over her pallor,

declining my offer to take her to the hospital. At this

stage of her life her days are dominated by the demands

of bringing up her large family, and even attending

church was sometimes difficult for her.

In both villages the majority of women regularly

participated in church activities, meetings of the

Women’s Fellowship (United Church) or Legion of Mary

(Catholic), cleaning the church and surrounding land, or

engaging in fundraising work. A few older women regularly

decorated the church. Communal work organized by local

government was sporadic and in most instances women

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predominated, although this was attributed to the fact

that many men were working at the mine.

Male labor in food production is concentrated in the

periods for clearing and fencing new gardens. While there

are some coconut plantations on Lihir, these have not

been a source of cash income for many years. Even before

the mining project, transport difficulties and low prices

had provided disincentives and people would only make

copra if they had no other way of raising cash for some

designated purpose, such as school fees.

While all men claim to spend time fishing, this

occurs sporadically and only in the villages that have

adjacent reefs. Boys fish with wire spears and eat their

catch themselves. Fresh fish is consumed rarely and in

small quantities. Similarly, hunting (wild pigs) is

presented as a masculine task, but in five years of

fieldwork I have only once observed one man set out to

hunt with his dogs. Game is a negligible part of the

diet.

In 2001 about five hundred Lihirian men were

employed by the mining company and less than fifty women.

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The company that supplies catering and cleaning services

at the mining camp regularly employs over one hundred

women. The men are of the age group that would in the

past have done most of the heavy work in clearing

gardens. Since the construction phase of the mine women

in most villages claim that they have to work harder in

subsistence activities, even doing tasks, such as mending

fences, that would have been done by men in the past.

They observe that fewer men assist in garden clearing,

resulting in reduced fallow periods, depleted soil

fertility, and lower crop yields. There is a marked

difference between villages in the mine-affected areas

that have received benefits, such as reticulated water

and household tanks, and those (the majority) where the

mining company has no obligation to provide such

amenities. As these tend to be the villages with higher

levels of employment, where people buy rice and tinned

fish to supplement garden food, it is likely that changes

in women’s work will become increasingly obvious. At

present, however, women often perceive the dietary

changes as necessary because of their increased

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obligations to work on communal tasks formerly done by

men and to compensate for the lack of male input into

subsistence production. Nobody interviewed believed that

the mining project had altered work patterns in ways that

had decreased their workloads.

There are a few women—those who have benefited from

large compensation payments for the land leased to the

mining company—who are now much more dependent on bought

food. Husbands rarely give wives control over money, as

most men consider their wages to be personal income. Men

buy food at the supermarket and bring it home, only

giving money for extra purchases at a local trade store

when requested specifically. In the annual surveys on

expenditure, of the 130 men surveyed, only two gave their

wives more than half their earnings. Most men (70

percent) spent over half their wages on beer and gave

more money to fathers and brothers than they did to their

wives. Conversely, women who earned money gave larger

amounts to the church (20 percent of weekly wage), spent

most of it on food and clothing for their families, and

regularly gave small amounts to their mothers and sisters

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(who spent their money similarly). The customary division

of labor and its benefits are thus being maintained in

the distribution of female cash earnings, while the money

earned by men is used in ways that are novel and

contribute comparatively little to the subsistence of the

family. This pattern was most marked in the construction

phase of the mine, when people tended to view wages (and

all money) as a kind of windfall. As the project

progresses and workforce participation stabilizes it is

likely that male employees who do not assist with garden

work will be increasingly forced into the role of

breadwinners. At present, however, the traditional role

of women as breadwinners continues.

Arguments about the benefits of income-generating

development projects for women or female employment

stress that maternal altruism also means improvements in

child health (but see Basu and Basu 1991). On Lihir few

women are able to participate because of the demands of

subsistence work. These demands are real, but they are

reinforced by husbands who are often hostile to any

action that expresses female autonomy. Men are reluctant

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to allow women to work in activities that take them away

from the confines of hamlet and garden, claiming that

they are neglecting their duties and possibly making

assignations with lovers. Similarly, if a woman who is

not obviously very ill attempts to visit the clinic

alone, she is accused of either having other intentions

or of going to get contraception in order to conduct an

illicit love affair. Jealousy or suspicious accusation is

one of the main ways by which men control women’s bodies.

The acceptance of imposed constraints is expressive of

the pervasive view of male sexuality as aggressive and of

sex as the locus of male entitlement. The demands and

restrictions that men impose on wives and the threat of

violence, if these are ignored or defied, are major

factors in limiting women’s choices about work and

health.

VIOLENCE AND WOMEN’S HEALTH

The health impacts of domestic violence worldwide are

well documented (e.g., Astbury 1999), with the two most

common being injury and depression. Women on Lihir rarely

seek treatment for an injury and would usually feel too

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ashamed to explain that it was caused by their husbands

beating them. While they are quite willing to discuss the

problem as pervasive, even implying that they experience

violence personally, the wounds or scars are hidden from

view. In Papua New Guinea there is little data on mental

health generally and psychiatric service provision is

non-existent in most areas. There is almost no

information about the mental health of the female

population (Gillett 1990, 45). Nonetheless, women

themselves observe that many of those whom they consider

mentally ill (there is no specific notion of

“depression”) have been subjected to violence. Three

women whom I know well appear to me to suffer from mental

illness. One was raped as a schoolgirl and the others are

married to men who beat them regularly. The nurses whom I

interviewed suggested that women who left their marital

homes to visit sisters or family in other villages often

did so because they were depressed and unable to cope

with the stress of remaining with a violent husband.

Violence against women certainly has direct impacts on

health, most of which remain undiagnosed, unrecorded and

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untreated on Lihir. The transference of blame to the

wives, their internalization of shame, and the absence of

sanctions against violence in marriage all indicate the

ways that the demeaning use of force by men against women

is symbolic of a hierarchy of relative social value and

status as members of a group. Parents may beat children,

and husbands may beat wives. The resort to violence is

acceptable when it is directed toward an inferior who has

affronted or denied the prerogatives of a superior.

Perhaps more than any other factor, the cultural

acceptance of domestic violence against women is

indicative of the “naturalization” of male dominance over

women. On Lihir both men and women generally accept that

men, as husbands or elders, can legitimately beat women

(see also Dinnen and Ley 2000; Toft 1985). This reveals

the deeply entrenched subordination of women. Interviews

with men reveal a sense of entitlement as regards their

control over women’s work, fertility, and sexuality.

Although some older men regarded the breakdown of

postpartum sexual taboos as reflecting badly on male lack

of restraint, even they were not prepared to uphold the

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right of a wife to refuse her husband’s sexual access. A

very small minority of men regarded it as excessive to

beat a wife who had not prepared his meal at the end of

the day, but over the five years of research I have found

only three men who believe that wife-beating is always

unjustifiable. The vast majority claim that bride-price

confers the right to punish a wife who is not performing her

duties as defined by her husband (see also Mackenzie-Reur

this volume on Vanuatu).

This is in many respects a surprising finding, given

that Lihir is a matrilineal society in which marriage

exchanges are ideally balanced. The ideology of male

dominance resides in the exchange being construed as

between men of each lineage with the “gift” of the

alliance being symbolized in the payment to the groom’s

family and the “purchase” of the woman’s wifely and

maternal capacities in the counterprestation.

RETHINKING PAPUA NEW GUINEAN “PATRIARCHY”—STRUCTURE AND

CULTURE

The health of women on Lihir is compromised by

inequalities comparable to those of the northern Indian

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women Caldwell and Caldwell (1994) perceive as being

deleteriously affected by patriarchal structures. The

structures they stress as crucial are institutional—

systems of identity and descent reckoning, patterns of

property ownership and inheritance. On Lihir, kinship is

structured matrilineally, land and inheritance patterns

are matrilineal, and most married women live in their own

clan villages. These structures do not support a culture

that values women’s bodies or supports their welfare in

ways that mean their health is any better than women

elsewhere in Melanesia. They offer no protection from

violence and no system of customary justice that demands

punishment or compensation for injury.

Culturally, Lihirians seem to share some of the

values surrounding gender attributes that are common in

those Mediterranean societies that Goody (1976)

describes. There is a sentimental idealization of women

as mothers that is mainly expressed rhetorically by adult

sons, often about deceased mothers. The everyday practice

of the Catholic faith on Lihir is predominantly a female

activity with an emphasis on maternal self-sacrifice,

305

long-suffering devotion to familial responsibilities, and

selfless care for others that verges on Mariolatry (see

figure 12.3). In every village, shrines to the Blessed

Virgin are maintained and regularly decorated. Elderly

men and women of all ages worship at these shrines,

offering flowers and daily prayers. Men ostentatiously

participate in feast-days or rituals, such as the

procession of the statue of the Virgin Mary, but these

dramatic public events provide a backdrop for displays of

lineage prestige rather than masculine piety (see figure

12.4).

<Figures 12.3 and 12.4>

In secular activities too, women’s roles are rarely

central. Women’s role in traditional feasts is subsumed

by the men of their households and lineages, as the men’s

house is the focal point for distribution of the foods

that women have produced and prepared. As producers of

food and rearers of pigs they are acknowledged within

their households, but, unlike the men who distribute,

306

their contributions do not confer the prestige and public

status that men accrue through hosting feasts.

In some matrilineal societies the stress on female

transmission of identity does seem to support an

ideological system that values female work, sexuality,

and fecundity as both corporeal and spiritual aspects of

female personhood. On Lihir, women’s labor, sexuality,

and fertility are conceptually abstracted from the person

in a variety of contexts. Women’s fertility and women’s

labor are explicitly acquired in bride-wealth exchanges

and, on the basis of these, men can control them in the

interests of their lineages. The maternal qualities that

are sentimentally valued on Lihir (bearing numerous

children, working hard to feed them, and producing large

quantities of food for feasts) are precisely those that

are acquired by a man’s lineage (see figure 12.5). Women

who perform these tasks “selflessly” are admired and

respected, those who do not are deemed inadequate.

Refusal to conform to male expectations is not regarded

as a form of resistance, but as a failure of capacity.

Thus, women who leave their husbands or have children

307

outside marriage, or do not grow yams for feasts, have

low status within their families. Their “failure to

conform” is viewed as shameful personal inadequacy. Most

unmarried mothers work extremely hard to feed their

children and to make contributions to lineage feasts or

other projects. But lacking a husband as their public

representative, they are often incorporated into lineage

activities as if they were adolescents, “lowly” workers

whose labor is controlled by a father, brother, or

occasionally a mother.

Preliminary investigations suggest that women who

have lower social standing also have poorer health. The

exceptions to this pattern are those few who have taken

jobs that allow them to exercise economic power

autonomously and whose incomes are sufficiently high for

them to be able to rear their children without any male

assistance. They remove themselves from the system in

various ways and then participate on their own terms as

individuals.

<Figure 12.5>

308

CONCLUSION

Anthropological studies of gender relations in Papua New

Guinea have generally stressed the ways that social

distinctions provide the institutional basis for

cooperation and integration in production and

reproduction within a specific community. Ideas such “sex

antagonism”, “status,” “inequalities,” and “patriarchy”

were eschewed as having little analytical utility as they

constituted comparisons that affronted the ideal of

cultural integrity.2 Most of the studies that presented

gender relations as systems of complementarity and

aspects of a benign, self-sustaining sociality are

written from the perspective of a perpetual subsistence-

based economy.

Industrial developments, such as mining projects,

disrupt that apparent complementarity by introducing new

forms of wealth, new ways of achieving status, and

alternative means of gaining political prestige and

power. Men benefit from these changes and women are 2 For example, see the debates around Marilyn Strathern’s

The Gender of the Gift (1988).

309

excluded and disadvantaged. The anthropological studies

that Caldwell and Caldwell (1994) draw on to present

their arguments about structural determinants of women’s

poor health did not examine the cultural ideologies that

devalue women in relation to men, nor did they explore

issues of violence against women. These topics are often

avoided because the implied criticisms are perceived as

ethnocentric. Violence against women occurs in most

societies and responses to it as a social problem demand

that the theoretical dismissal of patriarchy be

reconsidered. Feminist interpretations that assumed an

autonomous subject (arguing that women’s positive

conceptions of themselves and their bodies refuted the

arguments about pervasive patriarchal institutions)

ignored the suffering of women and their inability to

effect change.

Economic development projects and concomitant

government service provision provide the context for

examination of inequalities within and between

communities in terms other than the hermetic analytical

categories that are employed in anthropological studies

310

of single communities. Issues such as gender inequality

attain new salience and significance as simple

investigations of health, education and employment

patterns reveal inequities and disadvantages that

unequivocally reflect a hierarchy of economic and

political advantage based on sex. Women in Papua New

Guinea have poor health because their health is not

valued in itself and because the value of women is lower

than that of men. On Lihir, the health status of women

reflects the complex ways that patriarchal values work

during a period of dramatic social change. The

“traditional” structures of a matrilineally organized

economy—with land, property relations and social identity

conferred through the maternal line—were sustained within

an uncompromising patriarchal praxis that rendered women

subordinate. The patriarchal structures defined by Goody

(1976) and identified by Caldwell and Caldwell (1994) as

determinants in the poor health of women in northern

India might reinforce gender ideologies that place low

value on women. But it is the values rather than the

structures that are invoked to justify continued

311

discrimination during periods of social and economic

change. Patriarchy is remarkably flexible and adaptable;

it appears to be able to thrive in stable and unstable

environments and to sustain the interests of men over

women even when these might appear disadvantageous to the

society as a whole. Patriarchy is hegemonic in Papua New

Guinea and so the recognition of the poor health status

of women by external analysts at present serves to

reinforce ideas about female inferiority, frailty and

marginality rather than to galvanize governments into

remedial actions.

As an integral element in ideologies of

complementarity that exclude women from legal and

political action, patriarchal values can be obscured by

sentimental valuations of femaleness that affirm the

value that women have as producers and reproducers. Their

relatively poor health status can be seen then as

accidental. In the context of industrialization and

economic development, the continued poor health of women

requires explanation and the scrutiny of the issue

exposes the patriarchal foundations of gender

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“complementarity.” The material disadvantages that women

suffer are then revealed as originating in those

traditions that consistently denied women’s interests as

people by privileging the value of men over women,

enshrining these values in those institutions that give

men power over women’s bodies.