Scientific publications of project members (en, fr)

1. S. Topçu, 2021, « Banning Caesarean or ‘Selling’ Choice? The C- section Epidemic and Its Paradoxical Regulation in Turkey in Reproduction, maternity, sexuality. Politics of the female body in contemporary Turkey, London : Tauris B.
(in press)

2. S. Topçu, 2021, “Adopting an ‘unlearner’; technology? Knowledge battles over pharmaceutical birth pain relief in post-1968 France”, Reproductive Biomedicine and Society Online

3. S. Topçu, 2019, « ‘Caesarean’ or ‘Vaginarean’ Epidemics? Techno-birth, risk and obstetrical practice in Turkey », Health, Risk & Society, vol. 21, n°3-4, p. 141-163.

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.

4. C. Quagliariello, 2019, « Birth models in and between Italy and Senegal: a cross-
cultural inquiry on the risks related to childbirth and birth technologies”, Health, Risk
& Society, 21(3-4), 207- 225.

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.

5. Löwy, I. 2018, « The birthing house as a place for birth: contextualizing the Rio de Janeiro birthing house », História, Ciências, Saúde – Manguinhos, Rio de Janeiro, v.25, n.4, p.1161-1169.

Abstract: Within the context of the creation of birthing houses around the world and different models of care for childbirth, the author proposes an analysis that contributes to the discussion about the place for birth, especially in urban Brazil.

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6. M. Arnal, « Les enjeux de l’accouchement médicalisé en France et au Québec », Travail, Genre et Sociétés, 39, 1, 2018.

Introduction: Les réflexions théoriques féministes sur la maternité, tel que le rappelle le récent dossier « Penser les maternités d’un point de vue féministe » publié dans la revue Genre, Sexualité et Société, sont loin d’être convergentes [Cardi et al., 2016]. Sur la question de la médicalisation de l’accouchement, les divergences sont aussi importantes. Dans ces débats où s’opposent les féministes pro ou anti médicalisation de l’accouchement, je propose de montrer, d’une part, qu’il y a une pluralité de controverses et, d’autre part, qu’elles sont liées à des intérêts opposés qui se dissimulent sous les arguments théoriques.

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7. Dayi (avec E. Karakaya), 2018, « Transforming the Gendered Regime Through Reproductive Politics: Neoliberal Health Restructuring, The Debt Economy and Reproductive Rights in Turkey », Les Cahiers du Cedref, 22.

Abstract: The “Health Transformation Program,” started by the AKP (Justice and Development Party) in 2003 in Turkey, is part of the global neoliberal “Health Sector Reforms-HSRs” which have been undertaken since the late 1980s and early 1990s with the support of World Bank advisers and reports, in various ‘developing’ countries such as Brazil, Mexico, South Korea, Taiwan, always with the rationale of a “health crisis” (increasing costs of health care), a need to prevent public corruption and bring “efficiency.” Similar to these other contexts, the Turkish health reform or health restructuring as we call it, comprised changes to finance mechanisms and provision of care and introduced a premium-based compulsory health coverage system. Alongside the neoliberal policies, there has also been a rise in the New Right under the AKP regime, which had at its center anti-women discourses, policies and implementations, including a pronatalist discourse and implementations and statements equating abortion with murder. To contribute to the existing feminist literature that analyzes the intricate links between capitalism, neoliberalism and gender, especially on connecting the latest stage of neoliberalism–the debt economy- to reproductive rights, we designed a multisite feminist research to investigate the effects of neoliberal health-structuring on reproductive rights in Turkey, France and the U.S. Our theoretical groundings are in transnational feminist theory and writings on the state of neoliberalism and the debt economy, especially those of Lazaratto and Berardi. In this paper, we discuss our findings in Turkey, especially the focus-group interviews with healthcare providers working in family health centers, in order to reveal how the gender regime in Turkey is being transformed via reproductive and body politics. Analyzing our existent data on Turkey in light of the writings on the debt economy, we observed the neoliberal mechanisms of the dismantling of the public/privatization and the creation of individual debt and quantification of care (as related to mathematization of life and language). We witnessed how these neoliberal mechanisms interact with the conservative discourse leading to the erosion of women’s rights to access contraceptive and abortion care in Turkey and a transformation of the gender regime through the alteration of its reproductive politics.

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8. C. Quagliariello, « L’accouchement naturel contre l’hôpital moderne ? Une étude de cas en Italie », Anthropologie & Santé, 15, 2017.

Abstract: This article focuses on the so-called « natural childbirth », one of the practices that, since the 1980s, have increasingly constituted a viable alternative to the hyper-medicalization of birth. The analysis of this model of birth will be based on the findings of the ethnographic research carried out in Tuscany, in one of the first maternity services that introduced natural childbirth in Italy. In the first part of the essay, I will explore the connections between the singular history of this maternity ward and the wider movement of criticism towards the increasing medicalization of childbirth. The analysis of natural childbirth will then lead us to investigate the evolutions of this practice over time, paying particular attention to the role played by midwives in this process. Finally, we will reflect on the idea of nature that characterizes this model of birth as well as the choice of women to give birth in a different way, although within a hospital setting.

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9. I. Löwy (avec X.cZeng, L. Zannoni, S. Camporesi), “Localizing NIPT: Practices and meanings of non-invasive prenatal testing in China, Italy, Brazil and the UK,” Ethics Medicine and Public, 2017

Abstract: This paper is the result of a collaborative work between researchers based in UK, Italy, China and Brazil, and aims at providing a comprehensive review of practices and meanings of Non-Invasive Prenatal Testing (NIPT) in these countries, while also highlighting the ethical implications that NIPT poses. In the first part of this paper we describe how the technology is being integrated into the ‘moral economy’ of prenatal testing in the different countries we analysed. In the second section of the paper, we position NIPT within the trajectory of prenatal diagnosis that displays the role of conflicting values and often incommensurable moral economies in the emergence of new technologies, and in their transformation into routine medical procedures. The two ‘often incommensurable moral economies’ are women’s autonomy and individual-centred medicine, as emphasised in gynaecologists and midwives/obstetricians’ public discourse; and considerations about the cost/efficacy of long-term care for people with Down syndrome or other chromosomal-related disabilities as emphasized in public health discourses. We discuss how these two contrasting narratives are also at play in the discourses around NIPT. We then consider some of the ethical issues raised by NIPT, including the argument that NIPT will lead to a harmful bias towards people with Down syndrome and to an increase in termination rates; and the ethical issues raised possible incidental findings resulting from a maternal chromosomal mosaicisms, and other hidden abnormalities in one of the parents, including genetic diseases with late expressions in life. We note how the counselling step following incidental finding will be of the utmost importance and that in many countries, including the ones we analysed, doctors and healthcare professionals are not adequately prepared for it. We conclude that it is important that bioethics scholarship engages proactively with the ethical issues that arise at the nexus of these conflicting values and moral economies, especially as future evolutions of NIPT combined with whole genome sequencing (WGS) will affect women’s reproductive decisions, and shape the scope of their reproductive choices, in a way that will lead to a completely new level of ‘supervision’, ‘management’ and ‘scrutiny’ of human foetuses and pregnant women.

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10. A.R. Nakano (avec C. Bonan et L.A. Teixeira), “O trabalho de parto do obstetra: estilo de pensamento e normalizaçao do ‘parto cesareo’ entre obstetras”, Physis Revista de Saúde Coletiva, 27(3), 2017, p. 415-432.

Abstract: This work analyzes the descriptions of obstetricians from the city of Rio de Janeiro regarding the use of the caesarian section. We aimed to understand the aspects related to the formation of a thinking style that coalesces in the idea of the surgery as a simple and low-risk form of delivery. By using the method of oral narratives, we discuss the construction of an obstetric practice that sees the caesarian section as a suitable option for any kind of labor situation; the association of different values with the caesarian section based on its technical development; and the representations of obstetricians regarding the regulation of their work. We conclude that the normalization of the caesarian section as a form of giving birth is related to the development of a thinking style by the community practice of obstetricians. This community shifts the very concept of the caesarian section from a surgical procedure to a form of regular birth.

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11. Schantz C. et al. (2020), ” ‘A caesarean section is like you’ve never delivered a baby’: A mixed methods study of the experience of childbirth among French women”, Reproductive Biomedecine and Society Online.

Abstract: The experience of childbirth has been technologized worldwide, leading to major social changes. In France, childbirth occurs almost exclusively in hospitals. Few studies have been published on the opinions of French women regarding obstetric technology and, in particular, caesarean section. In 2017–2018, we used a mixed methods approach to determine French women’s preferences regarding the mode of delivery, and captured their experiences and satisfaction in relation to childbirth in two maternity settings. Of 284 pregnant women, 277 (97.5%) expressed a preference for vaginal birth, while seven (2.5%) women expressed a preference for caesarean section. Vaginal birth was also preferred among 26 women who underwent an in-depth interview. Vaginal birth was perceived as more natural, less risky and less painful, and to favour mother–child bonding. This vision was shared by caregivers. The women who expressed a preference for vaginal birth tended to remain sexually active late in their pregnancy, to find sexual intercourse pleasurable, and to believe that vaginal birth would not enlarge their vagina. A large majority (94.5%) of women who gave birth vaginally were satisfied with their childbirth experience, compared with 24.3% of those who underwent caesarean section. The caring attitude of the caregivers contributed to increasing this satisfaction. The notion of women’s ‘empowerment’ emerged spontaneously in women’s discourse in this research: women who gave birth vaginally felt satisfied and empowered. The vision shared by caregivers and women that vaginal birth is a natural process contributes to the stability of caesarean section rates in France

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12. Schantz, C. et al. (2020), “Dépasser la tension éthique de la césarienne sur demande maternelle”, Santé publique, volume 32, N° 5-6.

Abstract : Introduction : Dans un contexte juridique centré sur le droit et l’autonomie de la patiente, certaines femmes souhaitent pouvoir choisir leur mode d’accouchement. Les sages-femmes étant les actrices de premier recours des femmes enceintes avec une grossesse physiologique, nous avons voulu savoir s’il était, pour elles, éthiquement recevable d’accompagner une femme dans sa décision de césarienne.

Méthode : Cette enquête est une étude ancillaire du programme de recherche CESARIA validé par le Comité de Protection des Personnes Sud Méditerranée IV et déclaré au CNIL. Trente-sept entretiens semi-directifs ont été réalisés auprès de sages- femmes et de femmes.

Résultats : La majorité des femmes et des sages-femmes partagent une vision de l’accouchement comme « naturel » et considèrent la demande de césarienne comme relevant de la déviance. Lorsqu’elle est formulée, cette demande place les sages-femmes dans une situation de tension éthique. D’une part, les sages-femmes souhaitent orienter les femmes vers l’accou- chement par voie basse qu’elles considèrent comme étant la norme, et ce choix incarne les principes éthiques de bienfaisance et de non-malfaisance. D’autre part, les sages-femmes expriment vouloir respecter le choix et la liberté des patientes, illustrant le principe éthique de respect de l’autonomie.

Conclusion : L’enjeu éthique de la césarienne sur demande ne se situe pas tant dans la décision d’accepter ou non une césarienne, mais plutôt dans l’écoute de cette demande. Prendre en considé- ration une indication médicale plus largement que la simple indication obstétricale permet d’accompagner de manière éthique ces demandes, dans le respect de l’autonomie de la femme enceinte.

13. Irene Maffi & Solène Gouilhern (2019), « Conceiving of risk in childbirth: obstetric discourses, medical management and cultural expectations in Switzerland and Jordan», Health, Risk & Society, 21, n°3-4, p. 185-206

14. Dayi, A. (2019). « Political Economy and the Limits of Law: Neoliberal Health Restructuring and Rising Conservatism Erode Abortion and Contraceptive Rights in Turkey ». In the Special Issue: Abortion in the Middle East and North Africa (Eds. Irene Maffi Liv Tønnessen) submitted to Health and Human Rights.

15. Quagliariello C., & Ruault L. (2017), « Accoucher de manière ‘alternative’, en France et en Italie. Sur des modalités du travail de mise au monde des enfants et leur portée féministe », Recherches Sociologiques et Anthropologiques, 2, 45-64 

16. El Kotni M., Quagliariello C., « L’injustice obstétricale : une approche intersectionnelle des violences obstétricales », Cahiers de Genre, en cours de publication.