The Medicalization of Women’s Bodies: A Study of Changing Practices and Experiences of Childbirth

Introduction:

Since the nineteenth century we see a kind of medicalization of the human body in general and women’s reproductive capacities in particular. This article uses the cultural practices and experiences of birthing to investigate the medicalization of women's bodies. Childbirth has been one of the central concerns of human society. Its experiences and customs, however, change throughout time and space. In view of Ann Oakley's (1976) seminal claim that with the advent of modern medicine, the power which women held over the knowledge and practises of delivery seems to have moved into the hands of medical professionals, this article seeks to investigate childbirth from that perspective. This paper intends to record how women experience this shift and make sense of the changing practices of childbirth. This study examines how motherhood and modernity are experienced, understood, and portrayed via the lens of Cecilia Van Hollen's ethnography "Birth on the Threshold: Childbirth and Modernity in South India" (2003). The three generations of women from an Eastern Uttar Pradesh family now living in Jharkhand serve as a case study for this research. It relies mostly upon in-depth, unstructured interviews with this middle-class family, both in-person and over the phone. The focus of this research is on "real-life" issues such as what sort of maternity care these women should seek. It is an attempt to document the subjective ways in which these women mold such global processes of biomedicalization in local ways, and re-conceptualize and re-organize the world in which they live.

The process of giving birth has always been one of humanity's primary concerns. However, its customs evolve through time, and its experiences differ from one location to the next. This evolution in maternity care methods and perspectives provides an opportunity to consider the medicalization of women's bodies. We can observe this trend beginning in the eighteenth century, when the female reproductive system and the human body as a whole began to be treated more as a medical issue. The birthing process, formerly solely the domain of women, is gradually ceding power to medical experts as modern science advances (Oakley, 1976). There is little question that this change has precipitated a cascade of results for women. Our goal in this research is to collect and analyse data on how women talk about and think about these changes. In this research, we examine how increased medicalization of delivery has influenced the decisions that mothers and their families make. As we try to portray the nuances of this choice, we'll learn about the ways in which women negotiate against the imbalanced power of biomedicine.

Understanding the inner workings of contemporary biomedicine requires paying attention to the "choices" women and their families make on the type of treatment they get during delivery. These decisions are a reflection of how women shape medicalization processes on a global and local scale. Additionally, these "options" might be utilised to inquire into the lived, conceptualised, and represented connections between motherhood and the contemporary era (Hollen 2003). We may learn a great deal about women's efforts to rethink and restructure their worlds from the choices they really make in the midst of actual labour and delivery. The primary purpose of this study is to document the experiences of women on the evolution of maternity care in our societies.

Existing Scholarship

For this paper, we will be referring to some key feminist works on childbirth and modern reproductive techniques. The foremost among them is Ann Oakley’s (1976) “Wisewoman and Medicine Man: Changes in the Management of Childbirth”. Oakley’s fundamental assertion about the transfer of control over reproductive care from women to men forms the baseline of this paper. In addition, the framework provided by Cecilia Van Hollen (2003) in her ethnography- “Birth on the Threshold: Childbirth and Modernity in South India” acts as the constant point of reference. This paper closely follows her analysis of how the modernizing processes which impact childbirth have transformed the cultural constructions and social relations of reproduction in myriad ways. Apart from these sources, this study draws on Tulsi Patel’s (2012) work- “Global Standards in Childbirth Practices”- that investigates the ways in which the birthing body and its healing is understood and dealt with in different cultural contexts and within the same culture across time and social groups to see how different local medical worlds comprehend aspects of reality. Besides, Marcia Inhorn’s (2000) article- “Defining Women’s Health: Lessons from a Dozen Ethnographies”-contributes significantly to our understanding of women’s health concerns. In addition to this, articles like “The Biopolitics of Reproduction: Post-Fordist Biotechnology and Women’s Clinical Labour” (2008) by Catherine Waldby and Melinda Cooper shape our knowledge of modern reproductive technologies. Last but not the least, “Reinventing Reproduction, Re-conceiving Challenges: An Examination of Assisted Reproductive Technologies in India” (2011) is an excellent piece by Vrinda Marwah and Sarojini N. which pushes us to think critically about technological intervention in commonly assumed “natural” biological processes like conception and reproduction.

Changing Practices of Childbirth

There are several layers of complexity in the field of birthing. In the current international system, "modern birth" does not refer to a single entity (Hollen, 2003). However, there has been a recent upsurge in efforts to spread biological knowledge systems. When it comes to making important life choices, more and more people are turning to medical professionals for advice, as Cecilia Van Hollen describes in her work (Hollen, 2003). Thus, the "medicalization of childbirth" is "the process whereby the medical establishment, as an institution with standardised professional guidelines, incorporates birth in the category of disease and requires that a medical professional oversee the birth process and determines treatment," as she puts it (Hollen, 2003). We may examine "how women understand and act upon the changing management of labour in distinctive ways at the microphysical level to develop a particular, or vernacular, shape and experience of modern birth" (Hollen, 2003) by employing her methodology.

The Field Data

The following discussion on childbirth is based on a case study of three successive generations of women belonging to a middle-class family located in Bokaro Steel City, Jharkhand. This family has been residing in Bokaro for the past 48 years and traces its origin to a small village in Eastern Uttar Pradesh. It is an extended family, headed by a patriarch, whose wife Devi is part of the first generation of women (age group: 70s) being interviewed for this paper. Devi has five daughters and two sons; all of them are married and have children. Devi’s daughters and daughters-in-law form the second generation of participants (age group: 30s and 40s). The daughters of this second generation of women form the third-generation participants of this study (age group: 20s). Each generation of women has had distinct encounters with modernity and diverse experiences of maternity. (Note: All the names of individuals in this paper are pseudonyms.)

Generally, childbirth envelops three broad stages: (1) prenatal care; (2) delivery; (3) postnatal care. We will try to structure our study on these three stages and note down the respective experiences of each generation of women. In Cecilia Van Hollen’s words “there seems to be a shift from one institutional site, that is, the family and the midwife to another institutional site, that is, the public hospital as a site of both the state and biomedicine” (Hollen, 2003). According to her, this shift also symbolizes a shift in systems of knowledge about the women’s reproductive bodies (Hollen, 2003). Following this trail, we will record those aspects of change which appear to be of greatest concern to our participants and which exert the greatest impact on their decisions about where to go for prenatal, delivery, and postnatal care (Hollen 2003).

The first, as well as second-generation women, have plenty of tales to tell when it comes to childbirth. They usually converse in their mother tongue, that is, Bhojpuri, especially Devi who cannot speak in Hindi. However, it was not easy to persuade these women to talk about some intimate experiences of their life. In fact, it took a considerable amount of time to have that conversation with Devi. Since, most of these women were raised in their villages which lay on the same belt of Eastern U.P. they have imbibed a similar notion of shame (laaj-sharam).

A heavy baggage of honor (izzat) is attached to the women’s womb, which makes them quite hesitant to talk about its activities. Nevertheless, as soon as our participants got comfortable, the discussions used to stretch on. Keeping such factors in mind, interviews were conducted in an unstructured, face to face mode. They were complemented by telephonic interviews with those women of the family who resided elsewhere. Moreover, this study is still in its elementary stage, and is exploratory in nature. Rather than delving into formidable assertions, its aim is modest. At the very out set it is stated that the objective of this paper is to present the accounts of women, using their own cultural categories and metaphors.

Prenatal Care

Let us now turn towards the first instance where women get a chance to make a choice for themselves. A woman embarks upon a peculiar journey as soon as she acknowledges her conception. The clock of childbirth starts ticking when she misses her period after marriage, says Anjani, Devi’s elder Daughter-in-law. The first thing that comes to a woman’s mind after realizing her pregnancy is who to share the news with. Devi recalls that back in her time women were too shy to share the “good news” (naya samachar) even with other women of their household. Those women came to know of it only when they noticed the baby bump after a few months.

However, Devi’s two daughters-in-law, Anjani and Rekha, recount that Devi was the first one to know about their pregnancies, as she was the one who escorted them to the doctor to get it confirmed. The third-generation women, on the other hand, emphasize sharing the “good news” with their partners first, and only after that with their parents-in-law. Yet it appeared that women of all generations usually prefer to wait till the first trimester before revealing their pregnancy to family and friends. Devi and Anjani call it a general tendency among women to purposefully hide things like pregnancy and childbirth so as to prevent any mishap (nazar lagna), because these are times when women are most vulnerable to the evil eye.

Before moving to the next stage, let us have a look at the grave question of abortion, which comes in front of women at times. Almost everywhere, the patriarchal society in collaboration with religion and law has levied severe restrictions on abortion, so as to maintain their control over women’s reproductive capacities. Devi says that the concept of abortion was rather unknown in her time. She could not recollect any instance of voluntary abortion in her village. Instead, she mentions that miscarriages were more common during those days. The most frequently cited reasons for it included lifting heavy weight articles (bojha) while performing household chores, and sorcery (jaadu-tona).

Devi narrates an incident where she tried to control her reproductive capacity and decided to go for sterilization (nasbandi), after her second son (fifth child) was born. She was almost ready to leave the house with the nurse (memin) who came to fetch her to the block (tehsil) hospital, when the elder women of the house started panicking and informed the men sitting outside. As soon as the men got to know of her step, the male head of the household came to the threshold and shouted at her. He said that “children are a gift of God and one must continue to accept the gift as long as God gives it”. After getting scolded, Devi felt ashamed and dropped her plan.

The advancements in modern medicine have led to relatively more subtle and at the same time more overt mechanisms of controlling female procreative ability. The rising cases of sex selective abortions show us how new technologies, like ultrasound, meant to monitor the progress of the mother-fetus duo are being used to repackage patriarchal control over women’s bodies. Such use and abuse of medical technologies has, in fact, become common and acceptable to some extent in this region, as is evident from the opinions of our participants. The women in this region are doubly burdened with an urge to bear sons at one end and the pressure to regulate the family size at the other. In order to make these ends meet they take recourse to modern medical technologies and tweak them in suitable ways. For instance, it has become a normal, rather expected practice to go for prenatal sex determination if the couple already has a girl child.

Anjani and Rekha remark that even the doctors are aware of the patriarchal mindset of families and concede to the demands of society. Anjani recalls an incident where she had gone with Devi for her last ultrasound before the delivery of her second child. The male doctor was giving details of the baby, when her mother-in-law politely pressed him to spell out the sex of the baby. Devi said- “Doctor (sahib) you are telling us everything except the fact whether it is a boy or a girl”, to which the doctor replied with a sm