Some initial thoughts on epistemic arrogance, epistemic humility and obstetric violence

Researching Obstetric Violence: Challenges and Opportunities

During my secondment at INED, I found myself grappling with questions about how knowledge and power dynamics in obstetric care can harm or heal. Motivated by conversations with my colleagues Virginie Rozee and Lucile Faivre at INED, I began to examine what it means to approach obstetric practice with either epistemic arrogance or epistemic humility. In what follows, I discuss how these epistemic attitudes—arrogance and humility—manifest in maternity care and how they might contribute to, or help combat, obstetric violence.

These issues include:

• How to conceptualize obstetric violence
  
• The possible relationships between obstetric violence and maternal morbidity and mortality
  
• The difficulties of producing quantitative data on obstetric violence
  

While these might seem like disparate topics, they are closely interrelated and share common roots.

I would like to highlight that researching a subject as recent and conceptually fluid as obstetric violence is certainly challenging. Its definition is still a work in progress and its boundaries are porous. However, this very situation offers unique opportunities to question ideas, practices, and methods that are deeply embedded in the structure of fields such as the health sciences. Many of these assumptions are so profoundly normalized that they have become almost invisible.

Epistemic Arrogance in Healthcare Research and Practice

In my view, one problematic mindset embedded in healthcare research and practice is epistemic arrogance. This does not mean that healthcare professionals or researchers consciously intend to be arrogant or dismissive of other forms of knowledge; that is rarely the case. Rather, due to complex historical and sociological factors, there exists a widespread hierarchy of knowledge in which knowledge from the “hard sciences” is valued far more highly than knowledge from the social sciences or humanities. Additionally, the health sciences—especially the medical profession—have enjoyed a long-standing social and symbolic privilege. This dates back centuries, even millennia, to times when the power to heal was closely tied to divine authority.

In essence, epistemic arrogance is the belief that one’s own knowledge (or the knowledge one recognizes as valid) is sufficient, and that nothing important can be learned from fields one does not understand or respect. In other words, this mindset not only fails to build bridges across disciplines, but may also destroy any existing bridges.

Consequences of Epistemic Arrogance

The problem with epistemic arrogance is not only that it can lead to epistemic injustice, but that it can also result in flawed scientific reasoning. Life, society, and individuals are all profoundly complex; it is impossible to understand them in depth from any single perspective. We need to connect different pieces of information—often written in very different “languages” (for instance, the language of mathematics versus the language of history)—and that task is far from easy. It is more comfortable to stay within one field. However, solving complex problems requires us to create bridges between disciplines and to support those who serve as links between different worlds of knowledge. This is why, in the twentieth century, interdisciplinary and transdisciplinary research became so important. Indeed, increased cooperation among scientific fields has led to incredible discoveries and technological innovations.

Yet the separation between the life sciences and the social sciences remains problematic. Epistemic arrogance perpetuates the stereotype that qualitative data is less important or relevant than quantitative data, and that only numerical evidence can persuade governments to implement certain public policies. In the context of obstetric violence, this arrogance contributes to a disregard for information obtained from women’s personal narratives about their experiences in healthcare settings during pregnancy, birth, and postpartum.

Obstetric Violence: A Complex Concept with Lasting Impact

Obstetric violence is a complex concept, and work on defining and understanding it is only just beginning. Trying to measure obstetric violence or capture it in a single quantitative indicator is extremely difficult, and even in legal contexts the use of the term is challenging. Nonetheless, these two words—”obstetric violence”—have become an increasingly powerful vehicle for articulating certain experiences that women around the world have endured during pregnancy and childbirth, experiences that often leave long-lasting consequences.

Embracing Epistemic Humility

Overcoming epistemic arrogance and fostering the curiosity needed for scientific inquiry requires adopting the virtue of epistemic humility. This means recognizing that no matter how much a person knows, it is impossible to know everything. More importantly, it means acknowledging that one cannot know what another person has gone through without listening to that person’s account.

Epistemic humility is indispensable for cultivating an open, unbiased attitude toward listening. Such an attitude is urgently needed in healthcare research and practice in order to open up a more horizontal dialogue about the concept of obstetric violence—a concept that is difficult, complex, and still evolving, yet undeniably useful.

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