Birth integrity through the lens of medicalization, risk, embodiment, and intersectionality

Abstract

Recent quantitative research in public health indicates that women across the globe report suboptimal treatment during institutional deliveries. The most common approaches used to comprehend this abuse, violence, or mistreatment have not fully achieved a balance between theoretical perspectives and empirical assessment. To contribute to a more accurate account of the cultural driving forces, institutional conditions, direct expressions, and individual perceptions that undermine or preserve what we define as “integrity at birth”, we develop a new theoretical approach and a multi-level model. We ground the terminology for integrity at birth upon theoretical foundations, referring to two theoretical discourses: medicalization and risk theory on the one hand, and embodiment and intersectionality theory on the other. We then contextualize this in a multi-level model in order to operationalize its potential for public health research. The concept and model of “integrity at birth” recognize that women in labor suffer from a number of gender-specific violations, which can be expressed at all levels (macro to micro) as implicit, inherent, normalized and invisible, or explicit, intentional, visible and socially accepted. In distinguishing six separate domains, we propose a theoretical contribution for obstetric care practices. Integrity at birth, as a multi-level and theoretically grounded approach, constitutes an important step towards raising awareness about this issue beyond the dimensions that have been studied to date in quantitative health research. Beyond available evidence of disrespectful and abusive practices constituting violations to integrity at birth, this study takes a step towards understanding gender-based violence and inequalities of health at childbirth.