‘Women are supposed to endure that!’ A critical feminist exploration of obstetric violence in women’s and midwives’ birth narratives in India

Abstract

Birth and violence against women are sensitive areas of research surrounded by a thick cultural silence. Women around the world experience different forms of obstetric violence during childbirth in a variety of settings by providers and support workers within health care systems. While there is evidence of obstetric violence as a global issue, more systematic exploration is needed on its causes from the perspectives of women and their carers. Obstetric violence is closely linked with issues of women’s positioning at the intersections of different forms of oppression and their experiences and perceptions of obstetric violence can be influenced by socio-cultural, demographic and economic characteristics, their immediate contexts, their reproductive histories and geographies. In this thesis, I apply a feminist perspective to explore the nature of obstetric violence and the factors that makes women vulnerable during childbirth, considering that women’s and nurse-midwives’ perspectives and experiences. I first conduct a quantitative examination of the determinants of obstetric violence in one of the economically deprived states of Bihar in India, and find women’s experiences of obstetric violence are often plural and multi-layered. Age, parity and education are found statistically significant attributes that increase women’s vulnerability to obstetric violence in Bihar. I follow this with a qualitative exploration through participatory arts-based methods to cut across the power-based and language-based barriers and learn from and present women’s embodied experiences of childbirth and obstetric violence. I used feminist methods such as birth mapping, birthing story, poetic inquiry, feminist-relational discourse analysis and voice-centered relational analysis for data collection, analysis, interpretation and presentation, to bring forth women’s and nurse-midwives’ voices on this sensitive embodied issue. My research indicates that the determinants driving obstetric violence are related to women and their nurse-midwives, at the individual level, in their immediate birthing environment and in the larger social and policy level. Gender, power, culture and structure are the key themes holding the individual and the interactions of the determinants leading to obstetric violence. They need to be addressed at each of these levels through multi-sectoral approaches with women and their midwives as key stakeholders driving the change towards ensuring respectful maternity care.

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ORCID for Zoe Matthews: orcid.org/0000-0003-1533-6618

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