Special journal issue / Publication collective
TOPÇU S., BROWN, P., LOWY I., COXON K. (eds.), The impact of technology on pregnancy and childbirth : transnational perspectives on risk, Health, Risk & Society, vol. 21, n°3-4, 2019.
Abstract: The growth of medical technology in childbirth is a well established phenomena. During the 20th century, the locus of childbirth, especially in the global North, shifted from women’s own homes to institutional settings managed by professionals. Within these settings technological interventions to manage childbirth have become routinised. In some countries such as Brasil, China, Mexico, Turkey, Italy, C-sections have been normalised as a no-risk and no-pain alternative to ‘natural’ birth ; in others, like France, Québec or United Kingdom, epidural anesthesia is offered to most laboring women. While interventions are justified as being in the interest of mothers and their babies especially mitigating the risk of childbirth, how such risks are perceived varies both over time and between social settings. This special issue examines technology and risk in different socio-economic setting drawing on studies from high income countries in the global North as well as studies from middle and low income countries in the global South. Different approaches (sociological, anthropological or historical) are mobilized so as to examine how technology impacts on the ways in which risk is imagined, talked about, organized and regulated.
- (Editorial) The impact of technology on pregnancy and childbirth: creating and managing obstetrical risk in different cultural and socio-economic contexts
Published online: 23 Aug 2019
Full article: https://www.tandfonline.com/doi/full/10.1080/13698575.2019.1649922
Health regulations and social experiences of ‘high-risk’ pregnancies among young working-class women in Brazil
Author: Alfonsina Faya Robles
Published online: 08 Jul 2019
Abstract: In conjunction with aims to reduce infant and maternal mortality, antenatal care in Brazil is based on risk assessment and monitoring. Exploring the reliance of pregnancy management policies on a distinction between ‘low’ and ‘high-risk’ pregnancies, I conducted two ethnographic studies of pregnant women from a working-class background in Recife and Rio de Janeiro, Brazil. In addition to in-depth interviews with women and professionals, observations were made in public maternity wards and neighbourhood health units. With an approach focused on notions of governance and subjectivity, my data show that risk becomes not only a technique for regulating pregnancies, but also an important dimension of the reproductive experience of women. However, tensions appear between these two dimensions (regulation and experience) of risk. An analysis of my data sheds light on three tensions in particular. Firstly, the notion of risk appears to be a cultural resource for health professionals to transmit norms of parenthood to certain categories of women. Secondly, it allows for distinctions between two registers of care: medicalisation and healthisation. While on one hand the risk approach is aligned with a process of technicisation and pathologisation of pregnancies, it also introduces behavioural and psycho-social perspectives on pregnancy. Thirdly, the risk approach promotes an individualising tendency in the management of pregnancy. Women’s experiences lead them to make pragmatic adjustments to regulations. Women circumvent certain norms and easily articulate the registers of medicalisation and healthisation according to the situation, simultaneously incorporating their experience of risk in a social network of mutual help. This article thus shows that the analysis of pregnancy risk management must take into consideration the difference between expectations regarding the effect of regulations implemented by institutions and the de facto experience of women in a specific socio-cultural context.
Full article : https://www.tandfonline.com/doi/full/10.1080/13698575.2019.1638890
Buying reassurance: uptake of non-invasive prenatal testing among pregnant women of advanced maternal age in China
Author: Jifang Qiu
Published online: 11 Jul 2019
Abstract: Despite much ethical debate concerning non-invasive prenatal testing to abort or to detect genes, research on the experience of those who choose this new technology in China is limited, especially after the introduction of the Two-child Policy. In this article I analyse qualitative data from 25 interviews with pregnant women of advanced maternal age (pregnancy after 35) under the Two-child Policy, conducted in 2014 to 2016, as well as observational data from a 6-month, in-hospital participant observation in 2016. These data were collected with the aim to examine how non-invasive prenatal testing affects pregnant women’s risk perceptions and why this technology is widely accepted by pregnant women of advanced maternal age in China. I conclude that the women in my study accepted their ‘high-risk’ identity within prenatal care, and that non-invasive prenatal testing was integrated in this care. Women’s interactions with genetic counsellors, their husbands and close friends and community doctors produced anxieties, with women feeling responsible for the health of their foetuses. Consequently, the women in my study were willing to ‘buy’ this test for reassurance. The consumption of this new technology by pregnant women after the Two-child Policy lays a foundation for the market development of this technology in urban China.
Full article : https://www.tandfonline.com/doi/full/10.1080/13698575.2019.1639636
Caesarean or vaginarean epidemics ? Techno-birth, risk and obstetric practice in Turkey
Author: Sezin Topçu
Published online: 17 Jul 2019
Abstract: Caesarean sections (C-sections) have become a substitute for vaginal birth in a number of developing and emerging economies. Often in these contexts, the promotion of caesarean delivery as a safe or even zero-risk and zero-pain alternative to vaginal birth continues to serve as a powerful discursive tool in governing childbirth, despite growing international evidence on the iatrogenic effects of C-sections. These caesarean ‘epidemics’ are often explained in terms of obstetricians’ individual preferences for C-sections. Drawing on ethnographic research conducted in one private and one public hospital in western Turkey, I argue that there are a wide range of factors influencing obstetricians’ risk conceptualisations, discourses and practices. I also contend that the medical justifications for C-sections and their public popularity can best be understood by looking at the ways in which both caesarean and vaginal births are organised. In the settings examined, the processes around caesarean and vaginal births were blurred to such an extent that vaginal delivery was, in its technicised and closely monitored nature, transformed into what I propose to call ‘vaginarean’ birth. Recent state regulations in Turkey aiming to prevent ‘caesarean abuse’ had only had limited effects on obstetricians’ practices. The notion of risk continued to operate as a major driving force in that an institutional risk colonisation came to compete with medical framings of risk, while deficiencies in the national obstetric care system were made invisible. I conclude that regulations aimed at eradicating a caesarean epidemic, such as those implemented in Turkey since 2012, are unlikely to be effective unless they also aim to combat the vaginarean epidemic.
Full article: https://www.tandfonline.com/doi/full/10.1080/13698575.2019.1641588
What disasters can reveal about techno-medical birth: Japanese women’s stories of childbirth during the 11 March, 2011 earthquake
Authors: Tsipy Ivry, Rika Takaki-Einy & Jun Murotsuki
Published online: 11 Jul 2019
Abstract: Social researchers of childbirth have argued that techno-medical routines of managing childbirth risk are underpinned by worst case scenarios involving disastrous deliveries, with catastrophic consequences for maternal and neonatal health and life. This article looks into childbirth stories that ended safely amidst serious ruptures in techno-medical surveillance. We draw on the childbirth stories of women who gave birth during the 11 March 2011 disasters recorded by the first author in February 2016 and on an array of childbirth stories published in a journalistic book in 2012. The stories reveal the navigations of women and care providers between two different types of risks: risks associated with birth in the techno-medicalised model of care and risks associated with earthquakes. Underlying the safety management imperatives of each are divergent space and time lines. Significantly, the techno-medical surveillance of risk associated with childbirth proved to be secondary to the earthquake risk. Rather than high technologies, it was low-tech necessities and human care that proved crucial for the management of safe births. Though women interpreted the safe conclusion of their birth as miracle, their stories suggest that childbirth, especially when attended by skilled birth attendants, can take place relatively safely, even in the direst of conditions. Accounts of childbirth in the midst of disasters offer evidence and important insights in developing a critique of technological birth in the social scientific and midwifery literature.
Full article: https://www.tandfonline.com/doi/full/10.1080/13698575.2019.1643827
Conceiving of risk in childbirth: obstetric discourses, medical management and cultural expectations in Switzerland and Jordan
Authors: Irene Maffi &Solène Gouilhers
Published online: 27 May 2019
Abstract: In highly industrialised societies, risk shapes representations and practices surrounding childbirth. However, few studies examine the impact of the transnational diffusion of risk in medium and low income societies, where, despite the adoption of biomedical protocols on an institutional level, women and birth attendants often seem to follow different rationales in their practices. In this article, we are interested in the various components of the notion of risk, which shall be understood and examined in relation to specific socio-economic, political and cultural configurations. Drawing on two ethnographic studies conducted, respectively, in a Swiss university hospital and in three Jordanian government hospitals, we investigate how surveillance and medical interventions are deployed in pregnancy and childbirth in unequally structured health systems and describe negotiations and appropriations surrounding this management. These two contrasting cultural, socio-economic and health ‘system’ contexts reveal important differences in the way birth attendants and women consider the notion of risk in childbirth in that it is seldom present in clinicians’ and women’s discourses and practices in Jordan, whereas it plays a pertinent role in Switzerland. We argue that the heterogeneous configurations of risk mobilised by the participants in these studies reveal that dissimilar histories in terms of medical institutions and health care service provisions, political regimes, economic conditions, and social configurations shape the cultural and techno-medical arrangements of the institutions we studied. Comparing our Jordanian and Swiss ethnographies, we show that the mobilisation of biomedical risk does not happen in a vacuum but rather intertwines with specific social arrangements, eliciting resistance and adaptation that fashion the discourses and behaviours of birth attendants and pregnant women.
Full article: https://www.tandfonline.com/doi/full/10.1080/13698575.2019.162199
Birth models in and between Italy and Senegal: a cross-cultural inquiry on the risks related to childbirth and birth technologies
Author: Chiara Quagliariello
Published online: 11 Jul 2019
Abstract: In Western societies, such as Italy, a positive representation of birth technologies as the main remedy to fight against the uncertainties of physiology and biological risks associated with pregnancy and childbirth has prevailed since the eighteenth century. This process has experienced a strengthening and an acceleration in the last fifty years. Although the (bio)medical discourse has replaced previous representations of childbirth-related risks, other risk categorizations, and search for remedies, have emerged and persist. Relying on the findings of a multi-sited ethnographic work focused on Italy, Senegal and the migratory experience from Senegal to Italy, this article investigates how the representation of childbirth-related risks changes in these three contexts. Working in a risk perception framework, I argue that birth technologies and medical interventions are understood by some groups of Italian women as a risk to be avoided compared to the possibility of experiencing a natural birth. At the same time, through an anthropological perspective, the article investigates how the relatively low level of medicalization in Senegal shapes a discourse on birth based on a very different understanding of health and risk. Unlike the biomedical discourse, childbirth-related risks in Senegal are only partially explained by the physical materiality of the birth process. Finally, stressing the strong interconnection between risk logics and material culture, the article analyses the multiple challenges connected to both the ‘fascination’ for technological births and the transfer of non-biomedical risk models from Senegal to Italy through the migratory process.
Full article: https://www.tandfonline.com/doi/full/10.1080/13698575.2019.1640352
Edited volume / Ouvrage publié
ALKAN H., DAYI A., TOPCU S., YARAR B. (dir.) (sous presse). Politics of the female body in contemporary Turkey. Reproduction, maternity, sexuality, London : Tauris B.
Abstract: Under the leadership of the Justice and Development Party in Turkey came new regulations about reproductive rights, family and gender policies. Women’s central role in reproductive and domestic work was swiftly reaffirmed as a state value and policies surrounding issues such as abortion and IVF were newly debated. Taking Turkey as the case study, this is the first book to examine the various ways in which neoliberal modes of governing women’s bodies come together with conservative and authoritarian measures. The book is divided into three parts – the ‘reproductive’ body, the ‘maternal’ body and the ‘sexualized’ body – to explore the three main governmental representations of, and interventions into, the female body. Topics for discussion include: the increasing control of poor or ethnic minority women’s fertility, the expansion of IVF and egg markets, the commodification of pregnancy and motherhood through surrogacy, and the privatization of gynaecological and obstetrical care. The contributors argue that conservative and authoritarian forms of government lead to a direct assault on women’s bodies, health and sexuality by legitimizing corporeal control, sexual violence and patriarchal conceptions of religious morality. While focusing on the Turkish case, the editors also propose analytical tools for a broader understanding of the recent changes in the politics of the female body in various contexts such as Eastern Europe, Latin America and the United States.
Special journal issue / Publication collective
TOPCU S., MAFFI I. (dir.), Risk, innovation and ignorance production in the field of reproductive biomedicine, numéro spécial pour la revue Reproductive Biomedicine and Society Online
Dossier en cours de publication, parution prévue pour mars 2021
Abstract: Biomedical innovations have radically transformed reproductive processes at every level. Although many of them positively changed the lives of individuals, their risks and side effects were, in cases such as that of pregnancy drugs or contraceptive pills, insufficiently studied, even ignored, until scandals or controversies made them public. Moreover, some innovations, tests and treatments were made routine despite the fact that their efficiency is unproven or unevaluated. Beyond their clinical or practical impacts, innovations within fertility markets, pregnancy surveillance or reproductive care also often have ethical, legal, social, economic and even anthropological implications, which are not always publicly debated. Putting in dialogue reproductive studies and ignorance studies, the aim of this special issue is to analyse the dynamics of ignorance production prior to, during but also after the rapid expansion of reproductive technologies, innovations and products. This special issue brings together original work tackling a wide range of empirical objects that go from new IVF technologies and “fordist” birth technologies to contraceptive pills by passing through medical abortion, pregnancy drugs and endometriosis. The special issue also aims to contribute to an international understanding of the knowledge regimes related to the contemporary management of the reproductive body by drawing on case studies from European (France, Great Britain, Switzerland, Germany), north-American (USA) and north-African (Tunisia) contexts.