​The article titled “Group Body Mapping: Exploring Intersectional Aspects of Obstetric Violence Through Embodiment—Experiences of Migrant Women in Situations of Vulnerability” by Serena Brigidi examines the use of group body mapping as a participatory research method to explore the embodied experiences of obstetric violence among migrant women in vulnerable situations. This approach allows participants to visually represent their experiences, facilitating a deeper understanding of the intersectional factors contributing to obstetric violence. The study highlights the importance of addressing these complex factors to improve maternal healthcare for migrant women.

Abstract

This study investigated the use of group body mapping as a methodological tool to explore experiences of obstetric violence among migrant women from Senegal, Morocco, and Pakistan in Catalonia. The research aimed to assess the effectiveness of group body mapping in identifying the barriers these women faced during pregnancy, childbirth, and the postpartum period, while also highlighting the intersectional dimensions of obstetric violence. The study identified seven key codes—Issues/Barriers, Trust, Gender, Body/Embodiment, Significant Relationships, Employment, and Gender-Based Violence—which were analyzed from an intersectional perspective. Group body mapping was presented as an effective strategy to visualize structural and invisible barriers, offering a deeper understanding of the sociocultural dynamics that affected migrant women’s access to and experience of sexual and reproductive health services. This technique complemented traditional research methods by capturing complex narratives and revealing systemic structures tied to social status, gender, religion, language, and age. It empowered women to reclaim agency over their experiences within historically medicalized and colonized healthcare systems. Ultimately, the research highlighted the transformative potential of group body mapping in advancing healthcare equity and promoting culturally and gender-sensitive sexual and reproductive health services for marginalized populations.

Introduction

This article reflects on the use of group body mapping as a methodological tool to investigate obstetric violence (OV) in migrant women in situations of vulnerability. It highlights that vulnerability is not solely due to their migratory status or the maternity process but also to the passive roles imposed on them, limiting their ability to express themselves and participate.

The study underscores the potential of group body mapping to make visible the barriers these women face during pregnancy, childbirth, and the postpartum period. This technique helps overcome obstacles related to time, space, political conditions, and cultural norms, facilitating data collection through visual representations.

The article explores how group body mapping can analyze the intersectional dimensions of OV and complement traditional research methods in sexual and reproductive health. It contextualizes the term OV within European policies, which define it as dehumanizing treatment, abuse, neglect, or non-consensual medical interventions.

The study situates body mapping within an academic trend that employs artistic techniques to represent experiences of illness and maternity. It describes how this tool facilitates non-verbal communication in trauma contexts and allows participants to regain control over their narratives.

In Catalonia, access to sexual and reproductive health services remains challenging for migrant women, despite political advances. Data from the Catalan Institute of Statistics show that foreign women represent a significant proportion of the population and births, highlighting the need for culturally and linguistically adapted healthcare.

Although maternal and child health indicators in Catalonia are generally favorable, qualitative studies raise concerns about excessive medicalization, bodily control, and OV—issues that disproportionately affect migrant women. Additionally, they face greater vulnerability to gender-based violence, discrimination, and racism, which erodes their trust in the healthcare system.

Methodology

Participants

The fieldwork, conducted by the author—a medical anthropologist with extensive experience in qualitative research and participatory methods—in collaboration with cultural mediators and local associations in Catalonia, took place during 2021–2022 in the cities of Badalona, Barcelona, and Lleida (Catalonia, Spain), with focus groups composed of women from Senegal, Morocco, and Pakistan (Table 1).

These nationalities were selected based on data from the Statistical Institute of Catalonia (IDESCAT, 2021), choosing groups with the most significant territorial presence in Catalonia and those about which there was a lack of scientific knowledge in terms of healthcare and social services according to a previously unpublished study conducted with health professionals. Additionally, the significant presence of women of childbearing age among these groups was considered. It is important to clarify that these official data only account for women with administrative stability, not reflecting the entire foreign female population in the territory.

For inclusion in the focus groups and body mappings, the criterion was that participants be mothers who had given birth within the last five years in any hospital of the Catalan public network. To recruit informants, contact was established in Catalan and Spanish with associations in Catalonia that focus on health, migration, and women’s issues. Furthermore, these associations provided the space to conduct the groups and body mappings and store the necessary materials for the mappings. The cultural mediators were women and mothers, well-known to the associations, some having collaborated in previous health studies (Table 1). All had lived in Catalonia for over 20 years, held qualifications as cultural mediators in health, spoke Spanish, and understood Catalan. The cultural mediator played a crucial role in facilitating communication and understanding between researchers and participants.

The COVID-19 pandemic profoundly affected the research methodology and participants’ experiences, requiring adaptations due to health restrictions. It disrupted spatial dynamics, social interactions, and healthcare delivery, particularly in pregnancy, childbirth, and postpartum care. These changes heightened existing socioeconomic disparities and healthcare challenges throughout the project. The women involved in this study have been and continue to be in a position of vulnerability. It is important to emphasize that the groups themselves are not inherently vulnerable but are in a situation of vulnerability due to the process of wealth concentration, economic exploitation, segregation in political participation, and inequality in access to cultural heritage. Migrant women, in particular, face situations of deficiencies and inequalities in multiple aspects, such as social, cultural, economic, and emotional.

On the other hand, although the biomedical system demands profound knowledge about various communities, including their cultural, ethnic, social, economic, and political characteristics, and individual resources, it is crucial to avoid hasty generalizations. Culture, with its diverse traditions and customs, is transmitted through a complex process of socialization that defines the beliefs, values, and customs of those exposed to it, impacting both subjective and collective levels. The field results and records obtained during the research pertain exclusively to the women with whom the body mappings were developed. However, they can offer a valuable perspective and support to healthcare or childbirth personnel, though they should not be understood as a rigid guide of tools applicable indiscriminately to any individual from the mentioned territories.

Multiple forms of violence include physical, economic, psychological, sexual, vicarious, obstetric, and second-order violence as recognized by Catalan law (Law 17/2020). The body mappings have also revealed evidence of these forms of violence.

Procedure

The study involved 13 sessions of body mapping with three groups of 4–5 migrant women, along with a cultural mediator, the principal investigator, and occasionally a research technician. Sessions lasted 3–4 hours and continued until information saturation or participant fatigue. Each group completed 4–5 sessions focused on specific themes: migration, fertility, and body perception; conception and pregnancy; childbirth; and child-rearing practices. The themes, drawn from prior literature, aimed to construct a comprehensive narrative of migration, pregnancy, and maternal care. Instructions were repeated in each session, and participants collectively embodied their experiences on the silhouettes, prioritizing shared experiences over aesthetics.

With participants’ help, I prepared the materials—scissors, colored pencils, pens, glitter, crayons, magazines, and more—ensuring everything was child-friendly. I encouraged participants to bring their own magazines, as Catalan media often lacked diverse body representations, particularly for Black women. Despite these limitations, the women adapted the images and added words or symbols to complete their collages, often involving their children in the process.

Initially, I would remind them to include sexual elements, and then they would draw them, representing their breasts with golden glitter (the maternal milk), bellies and vulvas with stretch marks and scars, cuts (episiotomies), and hands that penetrate them (repeated examinations), knees that press down on them (Kristeller maneuver), or decorating the hands with henna.

The Room and Body Positioning

A critical aspect proved to be the characteristics of the room: it needed to be welcoming, allow movement while fostering elements of circularity, and contain a large piece of paper and all the artistic materials used, without them being too far away. Since there were often children present, the room should not have stairs or furniture with sharp corners.

Each session, after re-explaining the session’s theme and discussing some points that seemed important to address, I asked the group in which position they wanted to draw the woman: sideways, squatting, lying down, etc. This is an important issue and what sets this work apart from other body mapping studies. I never used predefined bodies or models for the research, allowing the choice of position, material, and color used to be collective acts of awareness and themselves material for analysis: why choose this position to represent childbirth? After selecting the position, one of them would lie down on the paper (Images 1 and 2). This was a moment characterized by much hilarity: tracing the body with a pencil, respecting the shapes of traditional clothing, and enhancing the profile by adding biographical and aesthetic elements like curly hair emerging from under a hijab, or nipples, represented moments of unity and sharing.

Findings

The group body mapping analysis identified six key aspects: barriers, trust, gender, body/embodiment, significant relationships, employment, and gender-based violence (Image 4). Trust emerged as a crucial positive element, enabling the creation of a safe space for sharing experiences despite post-pandemic restrictions. This was particularly evident in the final session on childbirth with Senegalese women, where body mapping fostered collective well-being and protection. Additionally, unexpected dimensions such as the pleasure of being together and mutual care surfaced (Image 5).

Gender was a transversal axis in the mappings, allowing women to reflect on femininity and masculinity constructions in both their home and host countries (Image 4). The results highlighted sociocultural expectations that impose subordinate roles, particularly concerning their husbands and families (significant relationships, Image 4), and how these roles relate to sociocultural barriers (issues/barriers, Image 4). Topics like sexuality, desire, and family planning frequently emerged, revealing how family structures and biomedical systems control women’s desires. Body mapping proved effective in capturing the intersectional and structural dimensions of violence while facilitating interactions beyond language barriers (Images 5 and 6).

Gender-based violence (GBV) was a widespread and persistent experience for migrant women, manifesting in various forms—physical, psychological, economic, institutional, and obstetric (Image 6). Many women remained in abusive relationships due to family pressure and fear of losing support. Group mapping provided a space for agency, exposing abusive practices and highlighting the lack of informed consent and cultural mediation in healthcare. The conceptualization of health, disease, prevention, and care (h/d/p/c) reflected systemic failures and underscored the need for transformation within healthcare services (Image 6).

Discussion

The findings reveal the complex, often invisible barriers migrant women face in accessing fundamental rights, which intertwine with obstetric violence (OV) and GBV, perpetuating marginalization. Women’s limited trust in healthcare, compounded by experiences of racism and fear, led them to conceal traditional practices and remain silent (Barata, 2022; Brigidi, 2022). Factors such as ineffective communication, cultural misunderstandings, and religious identity (e.g., wearing the hijab) further intensified these challenges. Additionally, traditional views on motherhood and the body reinforced control structures that negatively affected their sexual and reproductive health (SRH) experiences (Sadler et al., 2020; Schouler-Ocak, 2023).

While body mapping has been recognized as a potentially therapeutic technique (Solomon, 2007), this study focuses on meaning-making and agency rather than pathology or healing (Brigidi, 2021). Trust and group interactions fostered a space of care and co-creation, linking to the concept of pleasure as a bodily and emotional process (Muelas de Ayala, 2023). Similar to DiGiacomo’s (2016) observations on equestrian experiences, the group sessions evoked empathy, laughter, and embodiment, creating an artificial kinship bond (Durkheim, 1993) and fostering commitment to the space, research, and participants.

Conclusion

This study provides significant insights into the multidimensional barriers migrant women face in accessing SRH care, with a particular focus on OV and the experiences of marginalized migrant groups. By employing group body mapping, the research sheds light on the interplay between gender, age, migration status, and sociocultural factors that shape SRH care access and quality.

The findings reveal critical structural deficiencies in the public health and social care system, which often fails to address the specific and diverse needs of migrant women. These deficits manifest through invisible barriers, such as systemic discrimination, culturally insensitive practices, abusive behaviors, and control mechanisms, which compromise both access to and the quality of SRH care. Notably, the study highlights the prevalence of OV, encompassing physical, emotional, and systemic dimensions, as experienced by the participants. These forms of violence include neglect during labor, lack of informed consent, and the imposition of culturally inappropriate practices that deepen feelings of alienation and disempowerment among migrant women.

Through body mapping, the study effectively captured narratives that conventional tools often overlook, providing nuanced accounts of how intersecting vulnerabilities—such as migration status, limited language proficiency, and socioeconomic marginalization—exacerbate inequities in SRH care. For instance, participants reported mistrust in healthcare professionals stemming from discriminatory encounters, as well as intergenerational transmission of fear and disengagement from the healthcare system.

Beyond methodology, this research makes a substantial contribution to the field by offering practical recommendations for developing culturally competent, gender-sensitive policies and practices. It advocates for integrating intersectional approaches in public health strategies, with a focus on addressing structural inequities and fostering inclusive care models. Policymakers and healthcare providers can leverage these findings to design interventions that not only respond to the cultural and social realities of migrant women but also ensure their voices are meaningfully included in shaping healthcare delivery.

However, the study highlights the importance of having highly trained researcher-facilitators, which involves not only implementing body mapping in a careful and context-sensitive manner, avoiding oversimplifications or generalizations, but also creating a safe and supportive environment that encourages participants to openly share their experiences while being able to contain individual emotions and channel them into collective actions.

Future research should explore the broader applicability of body mapping across diverse sociocultural contexts, focusing on its potential to uncover systemic barriers and foster inclusive health interventions. Additionally, further investigation is needed into the social and psychological factors contributing to migrant women’s disengagement from healthcare services, particularly the role of intergenerational and peer narratives of negative experiences.