Conceiving of risk in childbirth: obstetric discourses, medical management and cultural expectations in Switzerland and Jordan

Abstract

In highly industrialised societies, risk shapes representations and practices surrounding childbirth. However, few studies examine the impact of the transnational diffusion of risk in medium and low income societies, where, despite the adoption of biomedical protocols on an institutional level, women and birth attendants often seem to follow different rationales in their practices. In this article, we are interested in the various components of the notion of risk, which shall be understood and examined in relation to specific socio-economic, political and cultural configurations. Drawing on two ethnographic studies conducted, respectively, in a Swiss university hospital and in three Jordanian government hospitals, we investigate how surveillance and medical interventions are deployed in pregnancy and childbirth in unequally structured health systems and describe negotiations and appropriations surrounding this management. These two contrasting cultural, socio-economic and health ‘system’ contexts reveal important differences in the way birth attendants and women consider the notion of risk in childbirth in that it is seldom present in clinicians’ and women’s discourses and practices in Jordan, whereas it plays a pertinent role in Switzerland. We argue that the heterogeneous configurations of risk mobilised by the participants in these studies reveal that dissimilar histories in terms of medical institutions and health care service provisions, political regimes, economic conditions, and social configurations shape the cultural and techno-medical arrangements of the institutions we studied. Comparing our Jordanian and Swiss ethnographies, we show that the mobilisation of biomedical risk does not happen in a vacuum but rather intertwines with specific social arrangements, eliciting resistance and adaptation that fashion the discourses and behaviours of birth attendants and pregnant women.

Keywords:

• childbirth
• fear
• Jordan
• magic moment
• pain
• risk
• Switzerland

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. World Bank: http://data.worldbank.org/indicator/SH.STA.MMRT. Accessed 16.05.2017.

2. http://databank.worldbank.org/data/download/POP.pdf.

3. OECD Country note 2015 and Annual Statistical Book of the Ministry of Health (2011).

4. On the conception of risk in the global South see Health Risk and Society 2015 vol. 17 issue 3–4.

5. http://www.who.int/gho/countries/jor.pdf?ua=1, accessed 4 June 2017.

6. About 75 per cent of the Jordanian women who married in 2012 were under the age of 25 (UNICEF, 2014).

7. No local literature exists on this topic, and no local actors have ever mentioned an obstetrician’s condemnation.