Health regulations and social experiences of ‘high-risk’ pregnancies among young working-class women in Brazil

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 sociocultural context.

Conceiving of risk in childbirth: obstetric discourses, medical management and cultural expectations in Switzerland and Jordan

“…Prior research has argued that this phenomenon must be studied in each context, paying attention to local sociocultural and economic arrangements (Coxon, 2014;Heyman, 2013;Rudrum, 2017). In many low-and middle-income countries, despite the adoption of biomedical risk protocols, women and birth attendants often seem moved by different rationales in their practices (Davis-Floyd, 2001; Faya Robles, 2019;Topçu, 2019). Coxon has also emphasised the lack of studies on women belonging to unprivileged milieus, concluding that 'we are in effect participating in the creation of a classed and ethnocentric social science of risk in pregnancy and birth' (Coxon, 2014, p. 490).…”

The impact of technology on pregnancy and childbirth: creating and managing obstetrical risk in different cultural and socio-economic contexts

“…Following Clarke, Fishman, Fosket, Mamo, and Shim (2000), Faya Robles (2019) tackles healthisation as a way of governing which is less characterised by the preponderance of biomedicine than by the presence of health questions in all levels of daily life, where health has become a value in itself. The self-responsibilisation of individuals, or the conduct of their conducts in the name of risk prevention and mitigation (by opting for healthier diets or lifestyles and by avoiding risky behaviours), appears to be central in this frame.…”

Comprendre le parcours du devenir parent. Regard sur une démarche de recherche collaborative et qualitative à l’international

“…Les études récentes dans ce champ réfèrent à ces deux systèmes de naissance, à leurs interrelations et tensions dans les représentations et les pratiques; elles pointent par ce fait même les enjeux sociaux et politiques de l'encadrement de la naissance aujourd'hui (Lemay,VOLUME 7 • NUMÉRO 1 • Hiver 2020 2017). En effet, des ethnographies récentes (Faya-Robles, 2019;Maffi & Gouilhers, 2019) dans différents pays et contextes font ressortir que les pratiques entourant la naissance sont étroitement liées aux milieux socio-économiques et aux contextes institutionnels. Déjà plusieurs études nord-américaines et françaises (Davis-Floyd, 2001;Quéniart, 1988;Thomas, 2016) rapportaient que les mères, et de plus en plus souvent les couples (Legros-Jacques, 2018), tendent à « bricoler » leurs choix de naissance en prenant ce qui leur convient (en matière de technologie, de lieu et d'accompagnement) pour satisfaire leurs besoins de sécurité, de confort et d'intimité (Champagne, 2017).…”