Health regulations and social experiences of ‘high-risk’ pregnancies among young working-class women in Brazil

Abstract

In conjunction with aims to reduce infant and maternal mortality, antenatal care in Brazil is based on risk assessment and monitoring. Exploring the reliance of pregnancy management policies on a distinction between ‘low’ and ‘high-risk’ pregnancies, I conducted two ethnographic studies of pregnant women from a working-class background in Recife and Rio de Janeiro, Brazil. In addition to in-depth interviews with women and professionals, observations were made in public maternity wards and neighbourhood health units. With an approach focused on notions of governance and subjectivity, my data show that risk becomes not only a technique for regulating pregnancies, but also an important dimension of the reproductive experience of women. However, tensions appear between these two dimensions (regulation and experience) of risk. An analysis of my data sheds light on three tensions in particular. Firstly, the notion of risk appears to be a cultural resource for health professionals to transmit norms of parenthood to certain categories of women. Secondly, it allows for distinctions between two registers of care: medicalisation and healthisation. While on one hand the risk approach is aligned with a process of technicisation and pathologisation of pregnancies, it also introduces behavioural and psycho-social perspectives on pregnancy. Thirdly, the risk approach promotes an individualising tendency in the management of pregnancy. Women’s experiences lead them to make pragmatic adjustments to regulations. Women circumvent certain norms and easily articulate the registers of medicalisation and healthisation according to the situation, simultaneously incorporating their experience of risk in a social network of mutual help. This article thus shows that the analysis of pregnancy risk management must take into consideration the difference between expectations regarding the effect of regulations implemented by institutions and the de facto experience of women in a specific socio-cultural context.

Keywords:

• risk management
• pregnancy
• Brazil
• working classes
• regulation
• experiences

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. We use the term ‘high-risk mothers’ because this is how professionals call women whose pregnancy has an increased risk of complications. We keep the ‘native’ term to show the degree to which the woman is defined as a ‘mother’ and how risk is associated with her. Similarly, the term ‘high-risk pregnancy’ is used by professionals indiscriminately in order to designate both the health risks of women and those for the health of the future child.

2. The Brazilian Penal Code stipulates a prison sentence of one to three years for an abortion caused by the woman herself or with her consent (Art.124) and from one to four years for the person who provokes it with the consent of the woman.(Article 126). To this day, abortion is legal only in two situations: when the woman’s life is in danger or when a rape is the cause of pregnancy.

3. The minimum reference age has changed from 19 years old (1998 law) to 17, and then to 15, according to the latest Technical Manual for Prenatal High Risk, published in 2010. Nevertheless, in practice, these changes are not yet observed and ages under 19 are still considered as high risk.

4. My doctoral research project was submitted to an external ethics committee, in one of the public maternity hospitals where I conducted my field research. It was approved on 29/03/2006 by the CEP/CISAM, protocol number: 003/06. Regarding the postdoctoral research project, it was validated by the National Ethics Committee through the ‘Brasil Platform’ (register 20259213.2.0000.5260) by the end of 2013 (under the register 20259213.2.0000.5260), which, since 2012, has functioned as a unified national database of registers of research on human beings.

5. The actions of prophylaxis of the vertical transmission, on behalf of the Brazilian State, resulting in particular from the law 9.313 of 1996 which guarantees the free and universal availability of care, made possible a reduction of the risk of transmission from 30% to less than 1% in 2006.

6. The notion of deviance does not refer here to criminal or illegal acts but is taken in the classic sociological sense of a normative deviation of women’s practices and bodies from the expectations conveyed by professionals.

7. Since 2011, a prenatal program for men has been launched by the Ministry of Health, seeking to integrate men into ‘active fatherhood’ and thus to assess the risks associated with being a parent. However, my research as well as data from other literature concur that men are not present in these services either as patients or as companions.

8. The objects, techniques and devices introduced by these new forms of healthicised regulations, where the importance is given to self-discipline, do not succeed in completely erasing the logic of a disciplinary power and a surveillance exercised from the outside.

9. An affectionate word for ‘mother’ which translates literally to ‘little mother’, i.e. ‘mommy’.

Additional information

Funding

This work was supported by the Ministère de l’Enseignement supérieur et de la Recherche France [doctoral research grant];CNPq (Centro Nacional de Pesquisa) Brazil [151304/2013-0].