Risk and intersectional power relations: an exploration of the implications of early COVID-19 pandemic responses for pregnant women

Abstract

The World Health Organization and many national health authorities identifie pregnant women as requiring extra protections during the COVID-19 global pandemic. Nevertheless, many initial responses to the COVID-19 pandemic were implemented in ways that have disrupted the care and support women receive and provide during pregnancy. In this article, I apply an intersectional approach to explore the unintended implications of discourses and practices targeting universal risks of COVID-19 for pregnant women. I discuss three overlapping topics. First, pandemic responses that aimed to negate the universal risk of COVID-19 transmission created obstacles to maternal health care that disproportionately impacted low-income women and regions. For example, rapidly changing public health mandates that were intended to protect the population from the universal threat of COVID-19 have produced unintended results of restricting public transportation, and consequently, access to maternal care. Second, overly precautious healthcare practices aimed at protecting foetuses and new-borns from possible risks can harm women and their new-borns. Recommendations, such as separating women from their new-borns at birth to prevent the spread of COVID-19, are shown to be often entangled with racism and colonialism. Third, in neoliberal contexts, dominant discourses have constructed privileged women as ‘normal’ in a way that responsibilised all women to minimise health risks for their foetuses. Such recommendations ignore inequalities in women’s living conditions and ability to follow public health advice about COVID-19. I argue that responses to COVID-19 were (dis)organised within pre-existing economic, racial, colonial, and patriarchal power relations that disadvantaged some pregnant women more than others.

Keywords:

• pregnancy
• intersectionality
• pandemic responses
• risk
• risk management

Acknowledgements

Thanks are extended to Drs Patrick McLane, Laura Alysworth, and Robin Willey for their thoughtful editorial comments. I am also grateful to Drs Janice Graham, Karina Top, Ipek Eren Vural, and Agnieszak Doll for discussions that contributed to my understanding of topics covered in this manuscript. Thanks also to the Gender and COVID-19 Working Group for sharing their collaboratively updated collection of resources, talks, and virtual meetings (https://www.genderandcovid-19.org/).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Throughout the article, I use gendered terms, such as ‘pregnant women,’ ‘mothers,’ and ‘maternal’ to align with existing scholarship and the identities of most persons who can become pregnant. Gender neutral terms (e.g., pregnant persons) are useful to demonstrate inclusivity, but can falsely align oppressed genders with the majority (e.g., cisgender men). My use of gendered terms is intended to be cognisant that the social location of all persons who can become pregnant is not privileged by patriarchy.

2. In some regions, other practices increased as well, such as the use of medically unnecessary caesarean sections to avoid vertical transmission (Bascaramurty, 2020; Cariboni et al., 2020; Della Gatta et al., 2020) and reports of women electing to terminate pregnancies after being hospitalised for COVID-19 (Qiancheng et al., 2020; Wu et al., 2020). Decisions to terminate pregnancies may be responses to the use of drugs that may be unsafe for the foetus (Wu et al., 2020), and widespread ableist values and affective responses to perceived risks to foetuses (Gentile, 2014; Lupton, 2012). In non-pandemic times, many women undergo prenatal screening and consider abortions based on the diagnosis of foetal abnormalities that could result in disabilities (Qiu, 2019; Rapp, 1999).

Additional information

Funding

At the time of writing, Terra Manca was funded by an IWK Health postdoctoral fellow grant and a Canadian Immunization Research Network grant in Halifax, Canada; IWK Health Centre.