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This chapter examines how women deploy gendered motherhood norms to publicly challenge abortion stigma. Drawing on a sample of 41 abortion stories from women living in Tennessee, I find that women evoke notions of intensive, total, and idealized motherhood in order to manage and challenge the stigma of an abortion. A large proportion of these stories were written by married mothers who emphasized their identities as good mothers and wives. A close qualitative analysis of these trends reveals two dominant forms of recasting abortion. First, abortion is framed as an extension of total mothering to spare an unborn baby from risky health conditions. Part of this includes casting abortion as an often-necessary choice in order for a woman to develop into the perfect mother for the benefit of her children – altruistic self-development. Second, abortion is construed as a form of maternal protection of current children to continue intensively mothering them. Both themes speak to women’s strategies for reframing abortion as a health practice to promote the well-being of children. These findings have implications for the study of medical stigma, reproduction, and the impact of gender ideals on women’s health choices.

Unassisted childbirth, also known as “freebirth,” is when a person intentionally gives birth at home with no professional birth attendant. The limited research on unassisted birth in the United States focuses on women’s reasons for making this choice. Studies suggest women are committed to birthing without a professional and that this choice is rooted in religious or natural-family belief systems. These studies do not adequately account for the ways a framework of “choice” obscures the role structural barriers play in decision-making processes. International research on unassisted childbirth finds that it is not always a first choice and may be a last resort for women who have had negative experiences with maternity care. More research on unassisted birth in the United States is needed to better understand if people face similar structural barriers. In this paper I examine how structural limitations of the US healthcare system intersect with values in decision-making processes about childbirth. Drawing on in-depth interviews with nine women who gave birth unassisted in the United States, I examine the women’s shared ideological commitments, negative experiences with health care, and barriers faced seeking care. I discovered that unassisted birth may not be a first, or even positive choice, but rather a compromise informed by ideological commitments and constrained choices. Structural barriers in the US healthcare system prevented women from having a professional birth attendant who they felt was acceptable, available, and accessible. I conclude by discussing the implications of these findings for debates about birth justice and health policy.

Within the field of medical sociology, there is an extensive body of literature on notable family transitions and stages in the reproductive cycle, such as getting married or becoming a parent, as they relate to mental health and well-being. However, the transition to becoming a completed family, that is, the process of determining or recognizing that one’s family is complete, is notably absent. In response to this empirical gap, this chapter presents findings from 114 semi-structured interviews with participants who reported having at least one child and who considered their family to be complete. First, the concept of “family completion” is introduced and conceptualized based on the qualitative considerations of participants and the contextual medical sociology literature. Then, thematic considerations around the process of family completion, related emotional preparations, and factors associated with mental health and well-being are explored. Findings suggest that family completion can be an important transitional period for parents and can be associated with emotional hardship for some individuals. Participants described experiencing conflict with their partner if they disagreed on the completion decision, frustration and sadness related to infertility, and/or feelings of loss or depression when completion was regarded as the end of a personal or familial life phase. This chapter concludes that creating a cultural context in which family completion is a recognized family transition period may spur intentional consideration among parents and promote the design of intervention services for parents experiencing changes in mental health or well-being.

To explore the politics of gender, health, medicine, and citizenship in high-income countries, medical sociologists have focused primarily on the practice of legal abortion. In middle- and low-income countries with restrictive abortion laws, however, medical sociologists must examine what happens when women have already experienced spontaneous or induced abortion. Post-abortion care (PAC), a global reproductive health intervention that treats complications of abortion and has been implemented in nearly 50 countries worldwide, offers important theoretical insights into transnational politics of abortion and reproduction in countries with restrictive abortion laws. In this chapter, I draw on my ethnography of Senegal’s PAC program to examine the professional, clinical, and technological politics and practices of obstetric care for abortions that have already occurred. I use the sociological concepts of professional boundary work and boundary objects to demonstrate how Senegalese health professionals have established the political and clinical legitimacy of PAC. I demonstrate the professional precariousness of practicing PAC for physicians, midwives, and nurses. I show how the dual capacity of PAC technologies to terminate pregnancy and treat abortion complications has limited their circulation within the health system, thereby reducing quality of care. Given the contradictory and complex global landscape of twenty-first-century abortion governance, in which pharmaceutical forms of abortion such as Misoprostol are increasingly available in developing countries, and as abortion restrictions are increasingly enforced across the developed world, PAC offers important theoretical opportunities to advance medical sociology research on abortion politics and practices in the global North and South.

As maternal mortality increases in the United States, birth providers and policymakers are seeking new solutions to address what scholars have called the “C-section epidemic.” Hospital cesarean rates vary tremendously, from 7 to 70 percent of all births. Based on in-depth, semi-structured interviews with 47 obstetricians and family physicians in the United States, I explore one reason for this variation: differences in how physicians perceive and manage risk in American obstetrics. While the dominant model of risk management encourages high levels of intervention and monitoring, I argue that a significant portion of physicians are concerned about high intervention rates in childbirth and are working to reduce cesarean rates and/or the use of monitoring technologies like continuous fetal heart rate monitors. Unlike prior theories of biomedicalization, which suggest that health risks are managed through increased monitoring and intervention, I find that many physicians are resisting this model of risk management by ordering fewer interventions and collecting less information about their patients. These providers acknowledge that interventions designed to mitigate risks may only provide an illusion of control, rather than an actual mastery of risks. By limiting interventions, providers may lose this illusion of control but also mitigate the iatrogenic effects of intervention and continuous monitoring. This alternative approach to risk management is growing in many medical fields and deserves more attention from medical sociologists.

We are in the midst of a broad societal change in which women’s sexual problems are becoming increasingly medicalized, characterized as treatable medical conditions and defined and understood as a largely physiologically based disease, called “female sexual dysfunction” (FSD). When a condition is medicalized, a medical framework is used to understand it, and medical interventions are used to treat it. As part of this process, then, over the last several years, researchers and pharmaceutical companies have turned attention to developing medical treatments for FSD. As this medicalization continues to unfold with potentially important impacts, it is crucial that we understand the forces working to shape it.