Birth Politics
Colonial Power, Medical Pluralism & Maternity in Nigeria
By: Ogechukwu Ezekwem Williams
272 pages
Paperback
ISBN-10 : 1421452766
Johns Hopkins University Press
August 19, 2025
Purchase - Publisher $64.95
Reviewed by Tolulope Esther Fadeyi, PhD
Colonial Power, Medical Pluralism & Maternity in Nigeria
By: Ogechukwu Ezekwem Williams
272 pages
Paperback
ISBN-10 : 1421452766
Johns Hopkins University Press
August 19, 2025
Purchase - Publisher $64.95
Reviewed by Tolulope Esther Fadeyi, PhD
The historiography of maternal health in Africa has expanded considerably over the past four decades. Scholars have moved away from linear narratives that cast reproductive healthcare as a simple transition from indigenous practices to biomedical modernity. Instead, they have shown that over time, childbirth has been shaped by the interplay of indigenous care, missionary medicine, colonial public health, religious healing, and international development interventions. Ogechukwu Williams’ Birth Politics contributes to this growing literature by placing childbirth at the centre of Nigeria’s social and political history. Rather than treating reproduction as a purely medical event, Williams reframes childbirth as a contested arena in which various actors sought to influence society, governance, religion, and women’s everyday reproductive experiences.
A major strength of the book lies in its conceptualisation of Nigeria’s “birthscape.” Williams uses this concept to capture the coexistence and interaction among indigenous birth attendants, missionary hospitals, colonial maternal welfare programmes, faith-based healing institutions, government healthcare services, and international development agencies. In doing so, she rejects the familiar dichotomy between indigenous health practices and biomedicine. Maternal healthcare did not evolve by replacing one system with another but instead through continuous negotiation among multiple providers whose authority often overlapped. This perspective enables readers to view maternal healthcare as a dynamic historical process rather than a story of biomedical triumph.
Throughout the book, women emerge not merely as recipients of healthcare but as active participants in shaping reproductive systems. Williams consistently shows that Nigerian women navigated a range of therapeutic options, guided by trust, affordability, spiritual conviction, cultural familiarity, and perceived effectiveness. Medical pluralism, therefore, emerges as a rational strategy in complex healthcare environments. Women consulted traditional birth attendants, mission hospitals, faith healers, and government clinics, revealing the dynamics of reproductive decision-making.
The discussion of indigenous maternal care offers an important corrective to colonial representations of African childbirth. Williams shows that precolonial reproductive systems were highly organised, socially embedded, and supported by extensive networks of family members, traditional birth attendants, and community elders. Fertility held a central place in social and economic life, and childbirth encompassed both physical and spiritual dimensions. Rather than romanticising indigenous medicine, Williams demonstrates that these systems were internally coherent and legitimate. This nuanced treatment moves beyond simplistic binaries of safe and “unsafe” childbirth that have frequently characterised colonial medical discourse.
The book convincingly shows that maternity services were simultaneously humanitarian, evangelical, and civilising enterprises. Mission hospitals and maternity clinics became spaces where biomedical care was closely intertwined with Christian instruction and moral reform. Training African nurses and midwives expanded professional opportunities for women while also extending missionary influence into domestic life. Yet Williams avoids portraying missionary medicine as either wholly oppressive or wholly benevolent. Women's use of multiple medical options highlights the persistence of medical pluralism despite missionary efforts to transform childbirth.
One of the book’s most original contributions is its sustained attention to indigenous Christian healing movements, particularly the Aladura churches and faith homes. These institutions occupy an important middle ground between indigenous healing and biomedical medicine. Williams shows that their popularity rested not only on religious belief but also on their capacity to provide emotional support, culturally meaningful explanations for reproductive difficulties, and holistic approaches to maternal wellbeing. Faith homes emerge as significant healthcare providers whose influence cannot be understood solely through theological analysis.
Williams explores ideas about colonial maternal welfare and international development, broadening the analysis from local responses to state and global interventions. Williams argues persuasively that the professionalisation of midwifery expanded biomedical services while reinforcing state authority over reproduction. Similar dynamics recur in the post-war expansion of international family planning programmes. Organisations promoting fertility reduction often framed reproduction in demographic and developmental terms. By placing colonial governance alongside international development, Williams demonstrates important continuities in colonial efforts to regulate reproduction.
Methodologically, Birth Politics is an important intervention in the history of pregnancy and childbirth. Rather than privileging official medical records or colonial policy documents, Williams foregrounds interactions across multiple healthcare systems and the decisions women made within them. The concept of the birthscape encourages historians to move beyond institutional hospital histories towards more socially embedded histories of healthcare utilisation. Like recent scholarship emphasising therapeutic pluralism across Africa, Williams reminds readers that understanding healthcare requires attention to relationships of trust, community networks, religious beliefs, and local knowledge alongside biomedical expertise.
The book also has significant contemporary relevance. Williams argues that many present-day maternal health challenges cannot be understood without recognising their historical foundations. Persistent reliance on traditional birth attendants and faith-based providers reflects neither ignorance nor resistance to biomedicine, but rather the historical evolution of healthcare systems in which women have long negotiated multiple sources of authority. This insight helps explain why Access alone does not determine healthcare choices; trust, familiarity, affordability, and cultural legitimacy remain equally important.
If there is one area where the book invites further discussion, it concerns mortality statistics, local male agency in midwifery practices, and regional variation within Nigeria. Given the country’s considerable ethnic, religious, and political diversity, readers may wish for a more sustained comparison of how childbirth politics unfolded across regions, beyond the examples emphasised in the study. Similarly, greater engagement with comparative African scholarship might have further situated Nigeria’s reproductive history within wider continental debates.
Ultimately, Birth Politics positions childbirth as a central subject in African political, medical, and social history. Williams demonstrates that reproduction has never been solely a matter of biology but has consistently served as a site where competing visions of authority, religion, medicine, governance, and development converge. By centring women’s agency and medical pluralism, the book offers a compelling account of the historical foundations of contemporary maternal healthcare in Nigeria. It will be of considerable interest to historians of medicine, Africanists, scholars of gender and reproduction, and researchers in global health and policy decision-making.
Tolulope Esther Fadeyi, PhD, is a medical historian at the University of Manchester's Centre for the History of Science, Technology and Medicine.
Date of Review: July 18, 2026
How to cite this review:
Fadeyi, Tolulope Esther. Review of Birth Politics: Colonial Power, Medical Pluralism & Maternity in Nigeria. Ogechukwu Ezekwem Williams. Baltimore, Maryland: Johns Hopkins University Press, 2025. Society for the Study of Pregnancy and Birth Reviews, July 2026. https://www.ssprb.org/book-review-birth-politics.html.
A major strength of the book lies in its conceptualisation of Nigeria’s “birthscape.” Williams uses this concept to capture the coexistence and interaction among indigenous birth attendants, missionary hospitals, colonial maternal welfare programmes, faith-based healing institutions, government healthcare services, and international development agencies. In doing so, she rejects the familiar dichotomy between indigenous health practices and biomedicine. Maternal healthcare did not evolve by replacing one system with another but instead through continuous negotiation among multiple providers whose authority often overlapped. This perspective enables readers to view maternal healthcare as a dynamic historical process rather than a story of biomedical triumph.
Throughout the book, women emerge not merely as recipients of healthcare but as active participants in shaping reproductive systems. Williams consistently shows that Nigerian women navigated a range of therapeutic options, guided by trust, affordability, spiritual conviction, cultural familiarity, and perceived effectiveness. Medical pluralism, therefore, emerges as a rational strategy in complex healthcare environments. Women consulted traditional birth attendants, mission hospitals, faith healers, and government clinics, revealing the dynamics of reproductive decision-making.
The discussion of indigenous maternal care offers an important corrective to colonial representations of African childbirth. Williams shows that precolonial reproductive systems were highly organised, socially embedded, and supported by extensive networks of family members, traditional birth attendants, and community elders. Fertility held a central place in social and economic life, and childbirth encompassed both physical and spiritual dimensions. Rather than romanticising indigenous medicine, Williams demonstrates that these systems were internally coherent and legitimate. This nuanced treatment moves beyond simplistic binaries of safe and “unsafe” childbirth that have frequently characterised colonial medical discourse.
The book convincingly shows that maternity services were simultaneously humanitarian, evangelical, and civilising enterprises. Mission hospitals and maternity clinics became spaces where biomedical care was closely intertwined with Christian instruction and moral reform. Training African nurses and midwives expanded professional opportunities for women while also extending missionary influence into domestic life. Yet Williams avoids portraying missionary medicine as either wholly oppressive or wholly benevolent. Women's use of multiple medical options highlights the persistence of medical pluralism despite missionary efforts to transform childbirth.
One of the book’s most original contributions is its sustained attention to indigenous Christian healing movements, particularly the Aladura churches and faith homes. These institutions occupy an important middle ground between indigenous healing and biomedical medicine. Williams shows that their popularity rested not only on religious belief but also on their capacity to provide emotional support, culturally meaningful explanations for reproductive difficulties, and holistic approaches to maternal wellbeing. Faith homes emerge as significant healthcare providers whose influence cannot be understood solely through theological analysis.
Williams explores ideas about colonial maternal welfare and international development, broadening the analysis from local responses to state and global interventions. Williams argues persuasively that the professionalisation of midwifery expanded biomedical services while reinforcing state authority over reproduction. Similar dynamics recur in the post-war expansion of international family planning programmes. Organisations promoting fertility reduction often framed reproduction in demographic and developmental terms. By placing colonial governance alongside international development, Williams demonstrates important continuities in colonial efforts to regulate reproduction.
Methodologically, Birth Politics is an important intervention in the history of pregnancy and childbirth. Rather than privileging official medical records or colonial policy documents, Williams foregrounds interactions across multiple healthcare systems and the decisions women made within them. The concept of the birthscape encourages historians to move beyond institutional hospital histories towards more socially embedded histories of healthcare utilisation. Like recent scholarship emphasising therapeutic pluralism across Africa, Williams reminds readers that understanding healthcare requires attention to relationships of trust, community networks, religious beliefs, and local knowledge alongside biomedical expertise.
The book also has significant contemporary relevance. Williams argues that many present-day maternal health challenges cannot be understood without recognising their historical foundations. Persistent reliance on traditional birth attendants and faith-based providers reflects neither ignorance nor resistance to biomedicine, but rather the historical evolution of healthcare systems in which women have long negotiated multiple sources of authority. This insight helps explain why Access alone does not determine healthcare choices; trust, familiarity, affordability, and cultural legitimacy remain equally important.
If there is one area where the book invites further discussion, it concerns mortality statistics, local male agency in midwifery practices, and regional variation within Nigeria. Given the country’s considerable ethnic, religious, and political diversity, readers may wish for a more sustained comparison of how childbirth politics unfolded across regions, beyond the examples emphasised in the study. Similarly, greater engagement with comparative African scholarship might have further situated Nigeria’s reproductive history within wider continental debates.
Ultimately, Birth Politics positions childbirth as a central subject in African political, medical, and social history. Williams demonstrates that reproduction has never been solely a matter of biology but has consistently served as a site where competing visions of authority, religion, medicine, governance, and development converge. By centring women’s agency and medical pluralism, the book offers a compelling account of the historical foundations of contemporary maternal healthcare in Nigeria. It will be of considerable interest to historians of medicine, Africanists, scholars of gender and reproduction, and researchers in global health and policy decision-making.
Tolulope Esther Fadeyi, PhD, is a medical historian at the University of Manchester's Centre for the History of Science, Technology and Medicine.
Date of Review: July 18, 2026
How to cite this review:
Fadeyi, Tolulope Esther. Review of Birth Politics: Colonial Power, Medical Pluralism & Maternity in Nigeria. Ogechukwu Ezekwem Williams. Baltimore, Maryland: Johns Hopkins University Press, 2025. Society for the Study of Pregnancy and Birth Reviews, July 2026. https://www.ssprb.org/book-review-birth-politics.html.