Obstetric violence, low natality rates, maternal deaths and misogyny

I have been thinking about the ongoing discussion taking place in many different spaces, countries, and institutions about the apparently impending global collapse due to declining birth rates. The alarming tone with which politicians and analysts examine the complex consequences of low birth rates sets an emotional and ideological framework that allows them to easily connect with highly normalised and widespread sexist and misogynistic views that have been gathering momentum over the last few years. According to this oversimplified and baseless narrative, we—women—are the ones to blame. We are failing in our most fundamental duty: reproduction.

Of course, most politicians and analysts do not use those exact words, but many in positions of power do. In any case, that’s the core message, and the manosphere is taking this opportunity to further inflate the misogynistic tropes that dominate public discourse everywhere. Just think about this: why do they (politicians, analysts, influencers, etc.) not talk about the reported 50–60% decline in male fertility among men in North America, Europe, and Australia since 1973? Why is it that, when discussing decreasing birth rates, fingers everywhere point accusatorily toward women’s rights and freedoms? Clearly, the answer is misogyny.

Scholars working on obstetric violence should take both issues—declining birth rates and the rapid social and political reaction rooted in misogynistic prejudices—very seriously, as problems directly related to the structural causes of obstetric violence.

The first step is to understand how a society that is so worried about the falling number of pregnancies is also so indifferent toward obstetric violence, maternal morbidity, and maternal mortality. One of the research questions I have been working on during my secondments in France and England has been to explore the (possible) links between obstetric violence and the social normalisation of maternal deaths and maternal morbidity.

In my view, it is an alarming sign to see how little attention maternal mortality receives in general. The focus is usually on countries where the rate is very high. But in countries where the rate is usually low, the problem seems absent from public discourse—and even from academic research on obstetric violence.

However, as long as maternal mortality is not zero and maternal morbidity is not extremely rare, we have a problem—especially in high- and middle-income countries, where the number of women dying from causes related to pregnancy, childbirth, and the postpartum period should be as close to zero as possible, given standards of care and access to healthcare services. It seems to me that indifference toward maternal mortality, hidden behind the excuse of a low maternal death rate, is a telling sign of the structural factors at the root of obstetric violence.

If there is a general assumption that a low maternal death rate should somehow justify a lack of interest in cases of women dying from causes related to pregnancy, childbirth, and the postpartum period, then why should we assume there is going to be any real interest in the harmful ideas, attitudes, and practices embedded in the cultural and institutional dynamics of healthcare settings providing care for pregnant women?

My argument is that both obstetric violence and normalised tolerance toward maternal deaths share the same primary social and political causes. What lies at the root is one of the oldest prejudices in the history of humankind: misogyny.

As long as we don’t understand more deeply the many ways in which misogyny permeates everyday life—including the social production of science, the organisation of healthcare services, the structures of social communication, and decision-making processes at the highest levels of healthcare management—the possibilities for real change will be extremely limited.

Project IPOV RESPECTFULCARE has received funding from the European Union’s HORIZON-MSCA-2022-Staff Exchange programme. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Research Executive Agency (REA). Neither the European Union nor the granting authority can be held responsible for them.

Disclaimer