Who decides where women give birth and on what grounds?

22nd September 2015
The traditional medical view of risks associated with giving birth sometimes clashes with what women themselves perceive.

In the Netherlands, some women go against medical advice in choosing high-risk homebirths, because they consider the biomedical model of birth as being risky. They see it as a model in which they have less autonomy and free choice (and in which more intervention during labour is required). In this case, home is seen as a safer haven than the health system. (Study by Lianne Holten from VU University Amsterdam)

While actors in the health system are only required to consider the risks associated with the delivery itself, in Malawi, women are faced with a number of complications to consider and manage when deciding whether to give birth at home or at a hospital (e.g. family responsibilities, distance to facility, etc.). In order to improve safer motherhood messages it is important to understand how the women themselves perceive risk. (Research by Isabelle Uny - Queen Margaret University)

statue of pregnant woman

Photo: Chris Goldberg (CC BY-NC 2.0)

Similarly, women in Rwanda have multiple concepts of risk in pregnancy and use both biomedical and traditional methods to address these risks. Again, the government needs to keep these are considerations in mind. Rwanda may have reduced maternal mortality rates by two thirds in 10 years through strong government policies, but the way in which these have been delivered is sometimes seen as being disempowering and counterproductive. (Research by Frances Haste)

In Manitoba, a remote community in Canada, pregnant women are evacuated to a larger city in order to give birth at 37 weeks. These women and their home environments are constructed as high risk by the government, which can be considered a very technocratic view of birth. The women face a number of non-medical issues during their stay in this town (e.g. isolation, etc.) which also need to be taken into account. (Study by Rachel Olson -The Firelight Group).

These cases show that reproductive health is conceptualised differently in household decision-making and in the health policy discourse. They were presented as part of a panel on ‘Maternal precarity is at the intersection of households and health systems’ at the MAGic2015 conference on ‘Anthropology and Global Health: interrogating theory, policy and practice’ . This conference took place at the University of Sussex from 9-11th September 2015 and aimed to interrogate the paradigms and practice of global health.

A myriad of topics were discussed at the conference. One of the key topics for discussion was the ebola epidemic. The conference started with a plenary session on the topic and included various panels stressing the importance of a community-based and community-led Ebola response. Other topics discussed include: chronicity and urbanisation, health and policy.