Perinatal and children’s environmental epidemiology: what about birth integrity?

Abstract

BACKGROUND AND AIM Birth integrity and violation of birth integrity are concepts that integrate theories of medicalization, risk, embodiment, and intersectionality into a multilevel framework. Violation of birth integrity is experienced widely across the globe and can coincide with environmental exposures and underly or modify many environmentally associated pregnancy, birth, infant, and children’s health outcomes. Measuring the phenomenon of violation of birth integrity, such as obstetric violence, is critically important for the studies of the exposome, given the focus on comprehensive exposure assessment during sensitive periods. METHODS The aims of this work are to introduce birth integrity into the field of environmental epidemiology, to posit violation of birth integrity as embedded within the broader environmental reproductive justice framework, assess pathways to which violation of birth integrity lead to adverse maternal, infant, and child health, and to put forth research agendas and methodologies to assess and incorporate determinants and measurements of birth integrity into environmental epidemiology. RESULTS Birth integrity is embedded within sociocultural norms, local material structures, physiologies, intersectional and transnational powers, among others. Violation of birth integrity can lead to adverse health through several pathways, including epigenetic remodelling, childbirth trauma, among others, potentially leading to factors such as adverse birth outcomes, barriers to breastfeeding, interruption of bonding and attachment, and other adverse maternal and child health. Birth integrity interacts with other determinants of maternal, infant, child environmentally associated health. CONCLUSIONS Violation of birth integrity must be considered as a maternal health indicator. Neglecting prenatal/antenatal, birth, and postpartum experiences, particularly those surrounding birth integrity and violation of birth integrity is part of a broader epistemological biases in environmental epidemiology. Multilevel interventions are needed to simultaneously address these injustices, particularly in the areas of preconception health, maternal health, infant and child health. KEYWORDS perinatal health, exposome, environmental reproductive justice, birth, children's health