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

Abstract

Abstract Background Women globally report suboptimal conditions during facility-based childbirth. Most approaches that capture abuse, violence or mistreatment in epidemiology do not reflect a theoretical perspective in their measurement. In order to contribute to a more valid consideration of the cultural drivers, institutional conditions, direct expressions and individual perceptions that violate or preserve what we define as “birth integrity”, we developed a new theory-informed approach and an accompanying multilevel framework. Methods We theoretically substantiated birth integrity, referring to medical anthropology, sociology, social epidemiology and a critical-feminist theory, in particular: risk and medicalization of childbirth, social embodiment and intersectionality. We then contextualized birth integrity within a multilevel framework to operationalize its potential for epidemiological research. Results We present a six-field theoretical framework to operationalise and measure birth integrity violations, from institutional discrimination, to gender norms structuring labour room interactions and restrictions on autonomy. It allows to measure birth integrity violations that women experience at the macro-to-micro level as implicit, invisible and normalized, or explicit, visible and societally accepted. Conclusions Our new multilevel framework, based on a theory-informed construct of birth integrity, allows to measure drivers of health inequality and gender-based violence in more dimensions than so far represented in epidemiological research. Key messages The birth integrity concept integrates theories of medicalization, risk, embodiment and intersectionality into a multilevel framework. Our birth integrity framework is useful in epidemiological approaches to explicitly acknowledge and integrate cultural drivers of gender-based violence and inequalities in maternity care research.