Irvine, Lucy Cara; (2021) Citizenship, sisterhood and scientific evidence: Strategies for ‘humanising’ childbirth policy and practice in São Paulo. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

I conducted an ethnography of the humanised birth movement in São Paulo, Brazil between 2015 and 2018. In this thesis I examine the strategies used by the movement to address the two-fold problem in maternal healthcare in Brazil: excessive clinical interventions in childbirth (particularly caesarean sections), and “obstetric violence”: the disrespectful and/or abusive treatment of women during childbirth. Movement activists work towards a shared goal of promoting a woman-centred, normalised model of care through changes to policy and clinical practice. I took an ethnographic approach to “studying through” policies across sites and over time in order to examine how they are formed, implemented and contested. Interviews and focus groups with movement members (including mothers, doulas, midwives, obstetricians, politicians and programme leads), and observations in health facilities, participatory policy spaces, online, and in “everyday” social settings, led me to identify a range of strategies used by the movement to achieve their goals. These include: the strategic use of scientific evidence to support claims about the benefits of humanised birth; driving up demand for private humanised birth services; and the advocacy role of doulas, who “multiply” the movement’s messages. My findings contribute to debates around the medicalisation and humanisation of childbirth, questioning their dichotomisation, and instead provide evidence that what “matters” are women’s perceptions of care. I also found that there is potential in the humanised birth movement as a space for political action and successful health policymaking based around a shared feminine experience of sororidade (sisterhood), which encourages women to work collaboratively in a male-dominated socio-political context. Lessons might be drawn that have wider relevance in settings where policymakers are trying to reduce iatrogenic harm from unnecessary interventions in childbirth, and for supporters of normal birth working to reduce barriers to accessing midwifery-led, woman-centred care.

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