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Beyond the Simple Economics of Cesarean Section Birthing: Women's Resistance to Social Inequality

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Abstract

This research explored the reasonsfor women's preferences for cesarean sectionbirths in Pelotas, Brazil. It is argued thatwomen strategize and appropriate both medicalknowledge and the technology of cesareansections as a creative form of responding tolarger public debates (and the practices thatproduced them) on the need for and causes of(de)medicalization. Questioning the reasons whysome women engage more actively in this processthan others elucidates the ways local forms ofpower engage gender, economic and medicalideologies. The current debate on why somewomen prefer c-section deliveries, or indeed ifthey really do at all, has diverted attentionfrom the utility of the technology itself. Thispaper argues that for some women, the effort tomedicalize the birth process represents apractical solution to problems found within themedical system itself. I end by exploring thesocio-biological conditions that have produceda need for the technology.

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REFERENCES

  • Anon, A. 1997 What is the Right Number of Caesarean Sections? The Lancet 349: 815.

    Google Scholar 

  • Appadurai, A. 1996 Modernity at Large: Cultural Dimensions of Globalization. Minneapolis: University of Minnesota Press.

    Google Scholar 

  • Augé, M. 1995 Non-Places: Introduction to an Anthropology of Supermodernity, J. Howe, transl. London: Verso.

    Google Scholar 

  • Banerjee, A., E. Williams, H. Wee, S. Quek, S. Kinsella, D. Lucas, S. Yentis, A. Holdcroft, A. May, M. Wee, P. Robinson, M. Griffiths, B. Sharma, A. Aguillera, P. Barlow, S. Rozenberg, and V. Ric 2001 Letters to the Editor: Delivery by Cesarean Section. British Medical Journal 323: 930.

    Google Scholar 

  • Barros, F., J. Vaughan, C. Victora, and S. Huttly 1991 Epidemic of Cesarean Sections in Brazil. Lancet 338: 167–169.

    Google Scholar 

  • Barros, F., C. Victora, and S.S. Morris 1996 Caeseran Sections in Brazil. The Lancet 347: 839.

    Google Scholar 

  • Bastian, H. 1999 Commentary: Health has Become Secondary to a Sexually Attractive Body. British Medical Journal 319: 1402.

    Google Scholar 

  • Béhague, D.P., C.G. Victora, and F.C. Barros 2002 Consumer Demand for Caesarean Section Deliveries in Brazil: Informed Decision-Making, Patient Choice or Social Inequality? A Population-Based Birth Cohort Study Linking Ethnographic and Epidemiological Methods. British Medical Journal. In press.

  • Berkowitz, G., G. Fiarman, M. Mojica, J. Bauman, and R. de Regt 1989 Effect of Physician Characteristics on the Cesarean Birth Rates. American Journal of Obstetrics and Gynecology 161: 146–149.

    Google Scholar 

  • Berquo, E.S. 1999 Contraception and Cesareans in Brazil: An Example of Bad Reproductive Health Practice in Need of Exemplary Action. Estudos Feministas 7(special issue): 26–37.

    Google Scholar 

  • Bewley, S. 1996 Obstetricians’ Views on Caesarean Section versus Vaginal Birth. The Lancet 347: 1189.

    Google Scholar 

  • Boddy, J. 1998 Remembering Amal: On Birth and the British in Northern Sudan. In Pragmatic Women and Body Politics. M. Lock and P. Kaufert, eds., pp. 28–57. Cambridge: Cambridge University Press.

    Google Scholar 

  • Browner, C.H. and N. Press 1997 The Production of Authoritative Knowledge in American Prenatal Care. Medical Anthropology Quarterly 10(2): 141–156.

    Google Scholar 

  • Burns, L.R., S. Geller, and D. Wholey 1995 The Effect of Physician Factors on the Cesarean Section Decision. Medical Care 33(4): 365–382.

    Google Scholar 

  • Chacham, A. and I. Perpetuo 1998 The Incidence of Cesarean Deliveries in Belo Horizonte, Brazil: Social and Economic Determinants. Reproductive Health Matters 6(11): 115–121.

    Google Scholar 

  • Chalmers, I., M. Enkin, and M.J.N.C. Keirse 1989 Effective Care in Pregnancy and Childbirth, Volume 2. Oxford: Oxford University Press.

    Google Scholar 

  • Comaroff, Jean and John Comaroff 1991 Of Revelation and Revolution: Christianity, Colonialism and Consciousness in South Africa. Chicago: University of Chicago Press.

    Google Scholar 

  • Crouch, M. and L. Manderson 1993 Parturition as Social Metaphor. Australian and New Zealand Journal of Sociology 29: 2972.

    Google Scholar 

  • da Costa, C. 1998 A Sort of Progress. The Lancet 351: 1202–1203.

    Google Scholar 

  • DaMatta, R. 1978 Carnavais, Malandros e Herois: Para uma Sociologia do Dilema Brasileiro. Rio de Janeiro: Zahar Editores.

    Google Scholar 

  • Davis-Floyd, R. 1990 The Role of Obstetrical Rituals in the Resolution of Cultural Anomaly. Social Science and Medicine 31: 157–189.

    Google Scholar 

  • 1993 The Technocratic Body: American Childbirth as Cultural Expression. Social Science and Medicine 38: 1125–1140.

    Google Scholar 

  • de Barbosa, L.N. 1995 The Brazilian Jeitinho. In The Brazilian Puzzle: Culture on the Borderlands of the Western World. D.J. Hess and R. DaMatta, eds. New York: Columbia University Press.

    Google Scholar 

  • de Lima, R.K. 1995 Bureaucratic Rationality in Brazil and in the United States: Criminal Justice Systems in Comparative Perspective. In The Brazilian Puzzle: Culture on the Borderlands of the Western World. D.J. Hess and R. DaMatta, eds. New York: Columbia University Press.

    Google Scholar 

  • DeMott, R.K. and H.F. Sandmire 1990 The Green Bay Cesarean Section Study I: The Physician Factor as a Determinant of Cesarean Birth Rates. American Journal of Obstetrics and Gynecology 162(6): 1599–1602.

    Google Scholar 

  • De Regt, R.H., H. Minkoff, J. Feldman, and R. Schwarz 1986 Relation of Private or Clinic Care to the Cesarean Rate. New England Journal of Medicine 315: 619–624.

    Google Scholar 

  • Dias da Costa, J. 1996 Assistencia medica materno-infantil em duas coortes de base populacional no Sul do Brasil: tendencias e diferenciais. Cad Saude Publica 12(Suplementar 1): 59–66.

    Google Scholar 

  • Duarte, L.F. 1986 Da vida nervosa nas classes trabalhadoras urbanas. Rio de Janeiro: Jorge Zahar Editor.

    Google Scholar 

  • Dumont, A., L. Berni, M. Bouvier-Colle, and G. Bréart 2001 Caesarean Section Rate of Maternal Indication in Sub-Saharan Africa: A systematic Review. The Lancet 358: 1328–1334.

    Google Scholar 

  • Eakin, M.C. 1997 Brazil: The Once and Future Country. New York: St. Martin's Press.

    Google Scholar 

  • Faundes, A. and J.G. Cecatti 1991 A Operacao Cesarea no Brasil. Incidencia, Tendencias, Causas, Consequencias e Propostas de Acao. Cadernos de Saude Publica 7(2): 150–173.

    Google Scholar 

  • 1993 Which Policy for Caesarean Sections in Brazil: An Analysis of Trends and Consequences. Health Policy and Planning 8: 33–42.

    Google Scholar 

  • Foucault, M. 1980 Power/Knowledge. New York: Pantheon Books.

    Google Scholar 

  • Freyre, G. 1986 The Mansions and the Shanties: The Making of Modern Brazil. Berkeley: University of California Press.

    Google Scholar 

  • Giffin, K. 1994 Women's Health and the Privatization of Fertility Control in Brazil. Social Science and Medicine 39(3): 355–360.

    Google Scholar 

  • Gould, J.B., B. Davey, and R.S. Stafford 1989 Socio-Economic Differences in Rates of Cesarean Section. New England Journal of Medicine 321: 233–239.

    Google Scholar 

  • Goyert, G., S. Bottom, M. Treadwell, and P. Nehra 1989 The Physician Factor in Cesarean Birth Rates. New England Journal of Medicine 320(11): 706–709.

    Google Scholar 

  • Gramsci, A. 1971 Selections from Prison Notebooks. London: Lawrence and Wishart.

    Google Scholar 

  • Groom, K., L. Quadros, K. Eftekhar, P. Steer, M. Pai, N. Sabrine, M. O'Connell, W. Lindow, J. Belizán, F. Althabe, F. Barros, S. Alexander, and C. Nuttall 2001 Letters to the Editor: Cesarean Section Controversy. British Medical Journal 320: 1072.

    Google Scholar 

  • Gupta, A. and J. Ferguson 1997 Culture, Power, Place: Ethnography at the End of an Era. In Culture, Power, Place: Explorations in Critical Anthropology. A. Gupta and J. Ferguson, eds. Durham: Duke University Press.

    Google Scholar 

  • Hacking, I. 1990 The Taming of Chance. Cambridge: Cambridge University Press.

    Google Scholar 

  • Haines, A. 1993 Health Care in Brazil. British Medical Journal 306: 503–506.

    Google Scholar 

  • Hess, David J. 1995 Introduction. In The Brazilian Puzzle: Culture on the Borderlands of the Western World. D.J. Hess and R. DaMatta, eds. New York: Columbia University Press.

    Google Scholar 

  • Hodnett, E. 2002 Caregiver Support for Women During Childhood (Systematic Review). Cochrane Database of Systematic Review. Cochrane Childbirth and Prenancy Group.

  • Hopkins, K. 2000 Are Brazilian Women Really Choosing to Deliver by Cesarean? Social Science and Medicine 51: 725–740.

    Google Scholar 

  • Janowitz, B., M. Nakamura, F. Lins, M. Brown, and D. Clopton 1982 Cesarean Section in Brazil. Social Science and Medicine 16: 19–25.

    Google Scholar 

  • Johanson, R. and M. Newburn 2001 Promoting Normality in Childbirth. British Medical Journal 323: 1142–1143.

    Google Scholar 

  • Jordan, B. 1978 Birth in Four Cultures: A Cross-Cultural Investigation of Childhood in Yucatan, Holland, Sweden, and the United States. Prospect Heights, IL: Waveland Press.

    Google Scholar 

  • Klaus, M., J. Kennell, S. Robertson, and R. Rosa 1986 Effects of Social Support During Parturition on Maternal and Infant Morbidity. British Medical Journal 293: 585–587.

    Google Scholar 

  • Lazarus, E.S. 1994 What Do Women Want? Issues of Choice, Control, and Class in Pregnancy and Childbirth. Medical Anthropology Quarterly 8(1): 25–46.

    Google Scholar 

  • Levine, R. 1999 How BrazilWorks. In The Brazil Reader: History, Culture, Politics. R. Levine and J. Cricuttu, eds., pp. 403–407. Durham: Duke University Press.

    Google Scholar 

  • LoCicero, A. 1993 Explaining Excessive Rates of Cesareans and other Childbirth Interventions: Contributions from Contemporary Theories of Gender and Psychosocial Development. Social Science and Medicine 37: 1261–1269.

    Google Scholar 

  • Lock, M. 1993 Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press.

    Google Scholar 

  • MacKinzie, I.Z. and I. Cooke 2001 Prospective 12-Month Study of 30 Minute Decision to Delivery Intervals for “Emergency” Cesarean Section. Observational Case Series. British Medical Journal 322: 1334–1335.

    Google Scholar 

  • McClain, C.S. 1987 Patient Decision Making: The Case of DeliveryMethod After a Previous Cesarean Section. Culture, Medicine and Psychiatry 11(4): 495–508.

    Google Scholar 

  • Melloe Souza, C. 1994 C-Sections as Ideal Births: The Cultural Construction of Beneficence and Patients’ Rights in Brazil. Cambridge Quarterly of Healthcare Ethics 3: 358–366.

    Google Scholar 

  • Morsy, S.A. 1995 Deadly Reproduction among Egyptian Women: Maternal Mortality and the Medicalization of Population Control. In Conceiving the New World Order. F. Ginsburg and R. Rapp, eds., pp. 162–176. Berkeley: University of California Press.

    Google Scholar 

  • Pereira, C. 1996 Public Policy as a Pandora's Box: Interest Organization, the Decision-Making Process, and the Ill Effects of Brazilian Health Reform: 1985-1989. Dados Revista de Ciencias Sociais 39(3): 423–477.

    Google Scholar 

  • Petchesky, R.P. 1987 Foetal Images: The Power of Visual Culture in the Politics of Reproduction. In Reproductive Technologies: Gender, Motherhood and Medicine. M. Stanworth, ed., pp. 57–80. Minneapolis: University of Minnesota Press.

    Google Scholar 

  • Peterson-Brown, S. 1998 Should Doctors Perform an Elective Caesarean Section on Request? British Medical Journal 317: 462–463.

    Google Scholar 

  • Pittrof, R. and V. Filippi 2001 What Obstetricians Don't Do: Responses to Petter et al. Rapid Responses. British Medical Journal 22. <bmj.com/cgi/eletters/323/7322/1155#17677>.

  • Porto, S.M. 1990 Financing of Local Health Systems. Boletin de la Oficina Sanitaria Panamericana 109(5-6): 502–511.

    Google Scholar 

  • Potter, J., E. Berquó, O. Perpétuo, O. Leal, K. Hopkins, M. Souza, and M. Formiga 2001 Unwanted Caesarean Sections among Public and Private Patients in Brazil: Prospective Study. British Medical Journal 323: 1151–1158.

    Google Scholar 

  • Quadros, L.G. 2000 Caesarean Section Controversy. Brazilian Obstetricians are Pressured to Perform Caesarean Sections. British Medical Journal 320: 1072.

    Google Scholar 

  • Rapp, R. 1990 Constructing Amniocentesis: Maternal and Medical Discourses. In Uncertain Terms: Negotiating gender in America. F. Ginsburg and A. Tsing, eds. Boston: Beacon Press.

    Google Scholar 

  • Remez, L. 1997 More than Half of All Brazilian Contraception Users Rely on Sterilization. International Family Planning Perspectives 23(4): 184–186.

    Google Scholar 

  • Ribeiro, D. 1975 Los Brasilenos: Teoria del Brasil. Mexico: Siglo Veintiuno Editores.

    Google Scholar 

  • Roemer, M.I. 1993 National Health Systems of the World, Volume 2. Oxford: Oxford University Press.

    Google Scholar 

  • Sakala, C. 1993 Medically Unnecessary Cesarean Section Births: Introduction to a Symposium. Social Science and Medicine 37(10): 1177–1198.

    Google Scholar 

  • Sargent, C.F. and G. Bascope 1997 Ways of Knowing about Birth in Three Cultures. In Childbirth and Authoritative Knowledge. R. Davis-Floyd and C. Sargent, eds. Berkeley: University of California Press.

    Google Scholar 

  • Sargent, C. and N. Stark 1987 Surgical Birth: Interpretations of Cesarean Delivery among Private Hospital Patients and Nursing Staff. Social Science and Medicine 25(12): 1269–1276.

    Google Scholar 

  • Savage, W. 1992 The Rise in Cesarean Section: Anxiety or Science? In Obstetrics in the 1990s: Current Controversies. T. Chard and M. Richards, eds. London: McKeith Press.

    Google Scholar 

  • Sawicki, J. 1991 Disciplining Foucault: Feminism, Power and The Body. London: Routledge.

    Google Scholar 

  • Scott, James C. 1990 Domination and the Arts of Resistance: Hidden transcripts. New Haven: Yale University Press.

    Google Scholar 

  • Shearer, E.L. 1993 Cesarean Section: Medical Benefits and Costs. Social Science and Medicine 37(10): 1223–1231.

    Google Scholar 

  • Tuffnell, D.J., K. Wilkinson, and N. Beresford 2001 Authors’ Reply to Letters: Delivery by caesarean section. British Medical Journal 323: 930.

    Google Scholar 

  • United Nations Population Fund (UNFPA) 1992 Programme Review and Strategy Development Report: Brazil. New York: United Nations Population Fund.

    Google Scholar 

  • vanRoosmalen, J. 1999 Unnecessary Caesarean Sections Should be Avoided. BritishMedical Journal 318: 121.

    Google Scholar 

  • Velho, G., ed. 1980 O Desafio da Cidade: Novas Perspectivas da Antropologia Brasileira. Rio de Janeiro: Editora Campus Ltda.

  • Victora, C., F. Barros, R. Halpern, A. Menezes, B. Horta, E. Tomasi, E. Weiderpass, J. Cesar, M. Olinto, P. Guimaraes, M. Garcia, and J. Vaughan 1996 Longitudinal Study of the Mother and Child Population in an Urban Region of Southern Brazil, 1993: Methodological Aspects and Preliminary Results. Revista de Saude Publica 30: 34–45.

    Google Scholar 

  • Victora, C.G., F.C. Barros, and J.P. Vaughan 1992 Epidemiologia de la Desigualdad [Epidemiology of Inequality]. Washington, D.C.: Pan-American Health Organization.

    Google Scholar 

  • Vieira, E.M. and N.J. Ford 1996 The Provision of Female Sterilization in Sao Paulo, Brazil: A Study among Low-Income Women. Social Science and Medicine 42(10): 1427–1432.

    Google Scholar 

  • Weil, O. and H. Fernandez 1999 Is Safe Motherhood an Orphan Initiative? The Lancet 354: 940–943.

    Google Scholar 

  • World Health Organization 1985 Appropriate Technology for Birth. Lancet 2: 436–437.

    Google Scholar 

  • Young, A. 1995 The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton: Princeton University Press.

    Google Scholar 

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Béhague, D.P. Beyond the Simple Economics of Cesarean Section Birthing: Women's Resistance to Social Inequality. Cult Med Psychiatry 26, 473–507 (2002). https://doi.org/10.1023/A:1021730318217

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