Changing Childhoods

About the photograph

The burdens of bus fare, arranging for travel, and the requirements of a full day away from work and subsistence agriculture are significant impediments to accessing health care, illustrating a multi-generational battle with poverty where women and young children are most vulnerable. Without monthly visits from a mobile clinic, many children living in rural Vanuatu would not have regular access to biomedical care. Everywhere, intersections of poverty, health, illness, and medicine require new approaches and culturally diverse solutions, informed by ethnographies of children, to improve health care and so health outcomes for infants and children.

Changing Childhoods

Anthropology has a long history of neglecting children, both ethnographically and theoretically. Only a few anthropologists have made the study of children central to their work, and in general, perhaps unwittingly, we have taken on an understanding-from our own settings and from the people with whom we have worked-of children as not yet 'human,' that is, as not yet enculturated or socialized. Such understandings of what children are, and what they can do, are informed by ideas about age, cognitive development and ideation. Accordingly, children are the subjects of patterns of socialization, formal and informal learning, and ritual occasions that 'make' them human, but they are rarely represented as social actors who might contribute to our knowledge of social processes, structures and institutions or to our imagination of social life. In this chapter, we concentrate on children and adolescents, and their experiences of sickness, discomfort, disability, vulnerability and marginality, so to gain insight into how they experience disease and distress, and how these unfold in different family and cultural contexts. In the case studies, we highlight children's points of view to the extent that we have access to it. Children have their own perspectives on health, disease and agency. Those who work with children argue cogently that adults need to listen to them and grant them power to care for themselves. Children participate in their illnesses, acute, curable, chronic and fatal, with insight and fear, humor and anger, and, ultimately, quite often, with grace.

Anticipating the material we explore here, a number of scholars set the groundwork for contemporary research with young people as key informants. Margaret Mead's monograph Coming of Age in Samoa, based on her doctoral dissertation, was particularly influential. Her descriptions of the relaxed attitudes towards life and the apparent sexual freedom of the young Samoan women with whom she worked was discrepant with American normative behavior at the time of the publication of the book-it was shocking and unsettling to conservative sectors of the public. In many respects, Mead paved the way both for an anthropology of children and an anthropology of sexuality. Much later, both John and Beatrice Whiting and Sandra Burman and Pamela Reynolds carried out comparative fieldwork, highlighting the diverse experiences of childhood in different social systems. As children became a more popular topic of research, ethicists and review boards concomitantly began to question whether and how children might ethically participate in research, how such research might be conducted, what children might reveal, and the obligations and boundaries that need to be honored by researchers. Increasingly, medical and other anthropologists have been asked to reflect on the capacity of children to exercise informed consent, to make their own decisions about participating in research, and thus, to contribute to our understandings of human relationships, social processes and social organization from their points of view. The case studies that we present in this chapter take up this challenge, offering us fresh ways of thinking about children's health and wellbeing, social engagement and resistance.

In Rites of Passage, Arnold Van Gennep drew attention to social elaborations of transitions from birth to puberty and beyond, depending on cultural context and local tradition: hair-cutting, tattooing, naming, circumcision and religious ceremonies have been and continue to be held to link children to particular families and faith, lineage and community. Such practices mark sexual and economic maturation, marriageability and civic responsibility. These ideas are not immutable, however. Family structure and composition have changed substantially everywhere with changes in economic production, monetization, industrialization, and urbanization, influencing what children are and what they able to do. In all of this, children have increasingly been the subject not authors of their lives, that is, their childhood and the activities in which they might be involved are defined for them. Everywhere children's lives are circumscribed and protected through regulations that follow a consensus of adult views and global norms, based on ideas about age-appropriate development goals, activities, age at marriage, the right to education (and its content, often still gender-biased), and the limits to their employment until the age of assumed agency and autonomy. As Allison James and Adrian James note, no-one writes of 'the adult' to refer to all adults, yet 'the child' is routinely the subject of international conventions, national policies, and medical, educational, and other social institutions that directly impact on the health and wellbeing of individual children. Compulsory school attendance and strict controls over work are mandated by international conventions and nation states. Multinational agencies advise and governments determine when children should attend health clinics for monitoring, surveillance, treatment and disease prevention. Yet even so, children work as unpaid family labor in and around the home, and formally or informally as waged labor. And as illustrated in the case studies in this chapter, they manage their own and others' sickness, disease, disability and difference; they provide care both to other younger children and adults; and they question the extent to which others govern their lives.