Lectures

‘A world that counts’: The rise of infographics in global maternal health campaigns

Infographics have become a ubiquitous feature of the contemporary global health landscape, crowding the presentations and exhibition halls of conferences, the pages of annual reports, and the websites of non-governmental organizations (NGOs). For the anthropologist studying global health policy and practice, they are a powerful sensory and aesthetic element of the ethnographic field.

Infographics are the product of data visualization – the practice of turning raw data into content that can be quickly and easily understood by viewers. Because metrics count in global health,1 infographics count too in the work of practitioners, researchers, and advocates. Yet, infographics do more than make data accessible to viewers; they also do cultural work.

Fig 1: A world that counts.

In this post, I share some preliminary observations from my research on the rise of infographics in global maternal health. My interest in infographics is part of a larger project I call ‘the image world of maternal mortality’ – a notion borrowed from the late Susan Sontag’s work on the aesthetic view of reality that photographs create, one that is distinct from reality but nevertheless informs reality.2 I began the image world project by looking at the still and moving images in the the global campaigns to reduce maternal mortality, arguing in a previous post on Somatosphere and in an essay published in the journal Humanity last year, that the image world of maternal mortality had undergone a distinct shift.3 In particular, I argued that the dominant depiction of maternal mortality as an ongoing catastrophe of suffering and death had been pushed out of the frame and replaced by a new visual narrative of maternal health as an aspirational identity for girls and women in the global south. Underwritten by a neoliberal script, the visual narrative goes like this: if a girl stays in school, delays marriage, uses birth control, delays childbearing, delivers in a health facility with a skilled provider, and has a smaller family, she will not only survive maternity, but live on to enjoy social empowerment and economic prosperity. This shift towards what I call the economization of maternal survival 4 was a deliberate strategy of the global maternal health advocacy community, as they sought to re-pitch maternal mortality as an issue worthy of humanitarian attention, political support, and financial commitments in ways that aligned with what anthropologist Nitsan Chorev called the “neoliberal turn” in global health of the early 2000s.5

Where do infographics come in? While the trend towards the economization of maternal survival was primarily depicted through photographic images, the rise of evidence-based advocacy and datafication found its expression in infographics. As anthropologists have argued, universal, standardised forms of global health data flatten out and clean up the messiness of illness, life, death, and health care in order to render global health problems countable and comparable. Yet as anthropologist Rebecca Howes-Mischel notes, even as humanitarian campaigns increasingly “gain [their] moral and political power through numerical aggregation” they gain their “affective power” through individual stories; in other words, metrics in global health campaigns often employ “an affective tug” alongside the numbers to warm them up and pull the viewer near.6 One way that infographics accomplish this is to use numbers not only to count, but to count down to speculative future data points that affectively condense the aspirations we have for others. With these insights in mind, I offer a quick tour and analysis of the infographics image world in the contemporary maternal health arena.

Fig 2. Progress and Challenges in Maternal Mortality

The above infographic was produced by the International Health Metrics Institute. It’s easy to see the universalizing nature of data here as well as some aggregation and disaggregation in the figures for South Asia and sub-Saharan Africa. But this infographic contains more than putative facts; it also contains a future-oriented narrative in the section on the lower right, “Ways to Improve Maternal Health.” We can also see a human hand at work in the choice to foreground some issues and background others. In this case, the infographic highlights a figure that describes a particular direct cause of maternal death that for decades has been underplayed: “ABORTION COMPLICATIONS = 43% OF ALL MATERNAL DEATHS.” So, this infographic contains the moral power of numbers, future numbers, a politically bold statement and a prescription for a set of actions. But does it contain enough of an affective tug?

Fig. 3:  Marie Stopes International booth at Women Deliver. Photo by M MacDonald  

This series of infographics was displayed at the Marie Stopes International booth at the Women Deliver conference in Vancouver in June 2019 – one of the most influential organisations in the world concerned with the health of women and girls. They present a bare minimum of data: “Almost half of abortions world wide are unsafe”; “Seven million women face complications. 22,800 will die.” And one counts down to a time 5 years hence when the number of abortion related deaths will be zero. So it counts, and it also counts down. It shares these numbers in a way that is beautiful and compelling, as if the women themselves are telling us. There’s an “affective tug.” Though I could certainly find these image online, showing them in ethnographic context reveals how infographics also function as signs in the semiotic sense: the use of infographics by an NGO, foundation, health profession or corporation signals their embrace of the evidence imperative in global health.

This infographic is short on data and long on intangible concepts and unmeasurable goals like “Empower 5 million women by 2020.”  However, it is form, not content, that is paramount here. It’s as if Unilever – the multinational consumer goods company and a major sponsor of the conference – has translated its Corporate Social Responsibility mission rhetoric into an infographic. The end date for the empowerment of women is another clear nod to datafication and infographic conventions in the global health field.

Fig 5. WHO Saving Mothers’ and Children’s lives

The animated infographic above is a particularly powerful genre. It utilizes music and movement as it simultaneously employs the moral power of numbers and the affective power of the individual story, in order to spark empathy and the recognition of a shared humanity. This particular animated infographic is also strongly prescriptive, showing how the arc of a woman’s life cycle could be intervened upon appropriately through techniques of the self and technologies of biomedicine.

Conclusion: Imagin(in)g future facts

This small set of infographics shares a number of persuasive visual tactics. First, as they deploy the moral and political power of numbers, they also tend to harness some form of affective power through color, images, or individuals’ stories. In this way, they attempt to bind the spectator to a distant other in a moment of recognition of the other’s humanity.7 Second, infographics in global health “count” in the cumulative, numerical sense, but they also tend to count down – producing numerical goals that serve as speculative data points, turning the aspirations we have for others into future facts. The rhetoric of ‘scaling up’ and ‘counting down’ that suffuses global health is turned into a metric narrative or data story of hope and achievement. Such narratives are always prescriptive, recommending the uptake of new knowledge, technology, and behaviour for individuals and nations if they are to achieve their goals. And third, one can often see within global health infographics a narrative arc that involves a tension between constraint and liberation – a key characteristic of much popular culture.8

Thus we see that infographics in global health are more than accessible representations of objective data, making tangible the intangible and often opaque world of numbers. As the case of global maternal health infographics reveals, these visualizations are also doing the social and cultural work of constructing the reduction of maternal mortality as a good cause (not a lost cause) and prescribing specific non-neutral courses of action that will lead to speculative facts, future figures, and aspirational end dates. In this way, infographics form part of a global health assemblage with the power to act on material human bodies. 


Margaret MacDonald is Associate Professor and Graduate Program Director in the Department of Anthropology at York University in Toronto, Canada. As a medical anthropologist, her interests lie in how cultures of biomedicine, science, and technology shape ideas, practices, and materialities of gender, health, and the reproductive body. She has conducted ethnographic research within the global maternal health community, health  development NGOs in Senegal, and amongst midwives and their clients in Canada. She is co-editor, along with Lauren Wallace and Katerini Storeng, of the forthcoming volume Anthropologies of Global Maternal and Reproductive Health: From policy spaces to sites of practice (Springer 2021). Twitter: @Reproanth


Notes.

  1. Adams, V. (ed). 2016. Metrics. Durham and London: Duke University Press. See especially Claire Wendland’s chapter in this volume.
  2. Sontag, S. 1973. On Photography. NY: Farrar, Strauss and Giroux.
  3. http://somatosphere.net/2013/the-biopolitics-of-maternal-mortality-anthropological-observations-from-the-women-deliver-conference-in-kuala-lumpur.html/Links. See also MacDonald, M. 2019. “The Image World of Maternal Mortality: Visual economies of hope and aspiration in global campaigns to reduce maternal mortality.” Humanity: A Journal of Human Rights, Humanitarianism, and Development. 10 (2): 263-285.
  4. Here I draw on Michelle Murphy’s concept elaborated in her book, The Economization of Life (Duke University Press, 2017). See also Farzana Shain “The Girl Effect: Exploring Narratives of Gendered Impacts and Opportunities in Neoliberal Development,” Sociological Research Online 18, no. 2 (2013): 9.
  5. Chorev, N. 2013.  “Restructuring neoliberalism at the World Health Organisation.” Review of International Political Economy. 20 (4): 627-666.  See also Behague, D and Storeng, K. 2013. “Pragmatic politics and epistemological diversity: the contested and authoritative uses of historical evidence in the Safe Motherhood Initiative” Evidence and Policy. 9 (1): 65-85 and Storeng K. and D, Behague. 2014. “‘Playing the Numbers Game’ Evidence Based Advocacy and the Technocratic Narrowing of the Safe Motherhood Initiative.” Medical Anthropology Quarterly. 28(2): 260-279.
  6. Howes-Mischel, R. 2017. “Humanizing Big Numbers: Representational Strategies in Institutional films about Global Maternal Mortality.” Visual Anthropology Review. 33(2): 164-176.
  7. Sliwinsky, S. 2011. Human Rights in Camera. Chicago: University of Chicago Press.
  8. Fiske, John. 1989. Understanding Popular Culture. Boston: Unwin and Hyman.

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