Cecilia Van Hollen. Birth on the Threshold: Childbirth and Modernity in South India. University of California Press, 2003. 272 pp. Bracketed by modernization and discourse, this rich ethnography makes a strong contribution to medical anthropology and the cross-cultural literature on birth practices. Using threshold both literally and as a metaphor for changing locations, practices, and meanings of childbirth, Van Hollen introduces us to the world of pregnancy and birth practices of two low-status, poor communities in and adjacent to Chennai (Madras), in the state of Tamil Nadu, South India. This is also a world of women; in fact, men are rarely mentioned in the ethnography. Unlike the West, India is a society where women dominate the profession of obstetricsas doctors, nurses, midwives, and government multipurpose-health-workers; consequently, Van Hollen notes, there is no significant natural, femalecentered homebirth movement. One of the book's contributions is to challenge Western feminist assumptions about male control of women's bodies as pregnancy and childbirth become increasingly biomedicalized. Another contribution is Van Hollen's insistence that, although the global process of biomedicalizing childbirth is occurring in India, it is not hegemonic. Even poor women have choices. Their major concerns, however, are socio-economic ones: What can they afford and how can they avoid being demeaned by mostly higher-status medical practitioners who have been steeped in the values and discourse of development? Drawing upon a year's (1995) intensive fieldwork during which she collected lengthy interviews with some 70 pregnant and postpartum women, as well as with a variety of medical practitioners, Van Hollen draws the reader into the world of these women by interweaving their voices with her narrative and analysis. Chapters 1 and 2 provide a broad historical context for the ethnographic ones by summarizing the professionalization of obstetrics in colonial and post-colonial India. Chapters 3-6 constitute the ethnographic heart of the book, beginning with an excellent discussion of how pregnant women are viewed as auspicious burdens in this part of India. Even among the poor, a pregnant woman should be provided with costly ceremonies to satisfy her cravings, to celebrate her fertility, and to ensure an easy delivery and birth of a healthy baby. Interestingly, the biomedicalization of birth has been accompanied by the intensification of birth-related ceremonies. This chapter also contains a thoughtful discussion of the concept of sakti and reflections upon Wadley and Egnor's important edited volume, The Powers of Tamil Women (1980). Birth on the Threshold interweaves ethnographic accounts of pregnancy, delivery, and the post-partum period with discussions of the effects of modern technologies, changing consumer patterns, and family planning programs. Issues of and modernization are, therefore, always part of the context. For example, Van Hollen discusses Tamil women's preferences for new drugs that accelerate labor pains rather than analgesics to reduce pain. This is related both to indigenous constructions of femininity-with-standing pain is an expression of a woman's power and strength-and to institutional constraints. The over-crowding of large government hospitals in urban centers has encouraged medical practitioners to use drugs to induce labor so as to shorten the birth process, which has, in turn, become an expectation for pregnant women. More troubling, especially for poor women, is Van Hollen's account of the ways that government hospitals and medical practitioners have been imbued with development goals that affect how new mothers and their babies are treated. Examples are the intolerance for mothers' superstitious dietary restrictions; breast-feeding campaigns that involved requiring all mothers in a maternity ward to express milk, which is collected, mixed together, and then given to all babies in the pediatric ward; campaigns to get mothers to change their bathing and feeding practices of infants, which help to promote the use of expensive baby soaps over traditional bath oils and the acquisition of commercial baby foods; and the forced implantation of IUDs after giving birth. …