Pregnancy and birth in the global South: a review of critical approaches to sociocultural risk illustrated with fieldwork data from northern Uganda

Abstract

In this article, I examine whether a critical approach to risk is relevant to pregnancy and maternity care in global South settings and I illustrate my review of current literature with examples from fieldwork I conducted in northern Uganda in 2012. Coxon, in a Health, Risk & Society editorial entitled ‘Risk in pregnancy and birth: are we talking to ourselves?’ (2014, Health, Risk & Society, 16(6), 481–493), noted that the analysis of risk in pregnancy has tended to focus on ‘relatively privileged women in high-income countries’ (p. 490), a narrow lens that in her view not only led to an account that was ‘highly partial’ but also contributed to theory in this area being overly focused on individual accounts, rather than structural inequalities. In this article, I draw on my experiences researching and writing about maternity care in Uganda, to consider whether and how a critical approach to sociocultural risk is relevant in low-income global South countries, as well as how a shift in lens to include less privileged women in low-income countries also shifts the theoretical contribution of a critical risk approach. I examine screening and surveillance as well as risk subjectivity, areas central to the discussion of risk and pregnancy, and find that a critical approach to risk offers insight into new forms of control and new discourses of responsibility. At the same time, I note that the social, political and medical contexts shaping both clinical and critical sociocultural approaches to risk have not occurred universally, and the critiques developed by scholars in and of the global North are not directly transferable to global South settings. Overall, I find that a critical approach to risk is indeed relevant and points to specific cases and discourses where such a lens is particularly valuable.