Obstetric violence, from controversies to interventions: mobilisations, knowledges, and experiences

Our social science research describes and analyzes the controversies concerning "obstetric violence" in French-speaking Switzerland.

A variety of actors have expressed their concern about the issue of obstetric violence (OV). Several reports, e.g. from The World Health Organization, document the existence of abuse during childbirth worldwide. For more than a decade, the mass media, healthcare institutions, feminist and parents' groups, politicians and researchers have debated the situation and have argued about the definition of the problem and about its causes and the means to respond to it.

At the junction of science and technology studies, gender studies and the socio-anthropology of health, this research analyses the perspectives of the different actors involved. It combines complementary methods to account for the knowledges and experiences that are mobilized, produced or ignored in the controversies surrounding "obstetric violence".

Our study is organized in three main work packages which analyse :

1. the public debates concerning OV;
2. the reactions in the healthcare institutions, in particular the development of new forms of care intervention, through an ethnography of maternity wards;
3. associative initiatives and minoritized viewpoints with a focus on the reproductive injustice that concerns immigrant mothers and other minoritized birthing people.

Our research will expand the academic work on medicine and reproductive health, and it will contribute to feminist studies and the comprehension of gender-based violence. Our study also has an applied scope, as it will provide reflexive material for healthcare professionals and institutions and for public action.

Since the 2000s in Latin America, feminist mobilizations concerning mistreatment during the birth process have been structured around the term "obstetric violence" (OV). Activists have specifically striven to establish a legal link between such violence and other forms of gender-based violence. Since then, this mobilization has spread internationally, including to Switzerland. The fight against OV has initiated an essential shift in the history of feminist struggles, which had shown little interest in the experience of motherhood until then. The World Health Organization (2015) has taken part to the debate and published a noteworthy declaration making the prevention and elimination of abuse during birth a public health priority.

While a consensus exists on the existence of a problem and its importance, the definition, causes and responses to obstetric violence are the object of heated controversies. Yet, these controversies have been little explored within the social sciences. There have been only scarce analyses about the legal, medical, scientific and political knowledges which have been mobilized to frame and qualify the issue. Neither have the perspectives of the various actors (professionals/birthing people/institutions) have been substantially examined. Finally, certain contexts – including the situation in high-income countries in general and in Switzerland in particular - or certain points of view - including marginalized women/people’s - have been the object of less attention by social scientists. Thus, "obstetric violence" as a social, scientific and public fact remains to be explored in all its complexity.

Our project hence proposes to fill these gaps by mobilizing an approach at the intersection of the socio-anthropology of health, gender studies and science and technology studies. It aims to map the different kinds of knowledges produced and ignored in this mobilization, in order to contribute to the analysis of social movements on the one hand, and medicine on the other. The investigation is organized around three work packages that deploy complementary methods and perspectives and combine different standpoints. The first consists of a controversy analysis based on documentary research and interviews with experts. It will trace the competing qualifications of obstetrical violence and it will take into account the types of actors and knowledges that are expressed and constituted in this controversy. The second work package is based on an ethnography of the ways in which obstetric violence is dealt with in healthcare settings. It will describe the types of knowledges and interventions on which these institutions rely. It will analyse how these elements contribute to a (re)configuration of the public problem of obstetric violence, including the framing of its causes and of the solution envisioned. The third work package focuses on the experiences and problematizations of birthing people themselves and will focus on standpoints that have been made invisible in the public and scientific debates. By observing discussion groups in associations and interviewing actors with a variety of profiles, we aim to provide an account of the construction of activist and experiential knowledge, but also of the marginalization of certain experiences of maternity and obstetric care.

By analyzing the different kinds of knowledge and experiences mobilized, produced or ignored in the debate around obstetric violence, our research will make an innovative contribution to work on medicine and reproductive health, on the feminist movement, and on the study of gender-based violence. Our findings will have both academic and applied importance, providing fundamental reflexive material for healthcare professionals and public policymakers alike.

• Patricia Perrenoud, co-director (prof, PhD), anthropologist and midwife
• Solène Gouilhers, co-director (PhD), sociologist
• Delphine Gardey, co-applicant (prof, PhD), historian and sociologist
• Clara Blanc, project assistant, PhD student, sociologist