How power relations impact pregnancy and childbirth: Knowledge, Healthcare and Work in France

Abstract

Based on a constructivist approach to human reproduction, this focus analyses the ways childbirth in mainland France is framed by natalist and health policies and by social inequalities. Beyond the tension between naturalness and technicality, birth is subject to a diversity of power relations. We focus here on power dynamics around class, sex and race, which impact the access to and the quality of perinatal care. Drawing on qualitative and quantitative studies, we show that women and couples have unequal access to information during pregnancy, for several reasons. Firstly, the standardised length of antenatal consultations. Secondly, differences in understanding of information that is implicitly adapted to the most educated and affluent social classes. Thirdly, the ambivalence of the information, which oscillates between autonomy and injunction in terms of how the baby should be delivered and fed. Fourthly, pregnant workers have little knowledge of their reproductive rights. We also show that the provision of perinatal care is unequal despite a supposedly universal health insurance system. Racially minoritized women are subject to more complex administrative procedures and to more medical interventions. In addition, health and diet recommendations, and alternative birthing methods, are better suited to the individualistic logic and material conditions of the middle classes than those of the working classes. As far as working conditions are concerned, women in arduous occupations use sick leave as a means of protection, whereas women in less arduous occupations take maternity leave later than the other women. Lastly, men's involvement in domestic tasks during women's pregnancies remains occasional and limited to the physical dimension of those tasks, even more so as the assignment of women to domestic labour is reinforced by healthcare professionals. Finally, we contend that equal care for all pregnant women can only be achieved if the social dimensions of health are fully taken into account.