A second online collection curated by Emma Varley and Adrienne E. Strong
The novel coronavirus is profoundly impacting population health and welfare across the globe, forcing patients, medical providers, and healthcare systems to find ways to rapidly adjust to COVID-19’s complex risks and constraints. The crisis has led to especially severe effects and outcomes for vulnerable persons and healthcare systems.
Women’s sexual and reproductive (SRH) and maternal and newborn (MNH) health, already badly impacted by inattention and disinvestment in many parts of the world, are now even more dangerously deprioritzed and neglected due to the effects of social distancing, lockdowns, and overloaded health systems. Equally worrying is the growing evidence that women in better-resourced settings such as the United States are now also facing similar gaps in care, and are more likely to experience the pandemic-linked health hazards and harms that result.
With many of COVID-19’s short and long-term effects for SRH/MNH still poorly understood, medical anthropologists are uniquely positioned to help fill in the gaps and answer emerging questions about the pandemic’s impacts on women’s health and healthcare services and systems. Not least, our work holds the power to raise necessary attention concerning social, political, and organizational efforts to protect women and newborns from the worst of the pandemic, especially those made most vulnerable by the crisis.
In this spirit, the first round of our online special collection gathered together the work of medical anthropologists whose research, advocacy and activism concern COVID-19’s impacts on SRH/MNH.
By adopting critical and action-oriented approaches, the contributors provide compelling insights into the contextual forces and dynamics at stake in health system and community-level responses to the pandemic as they draw women and their newborns closer to care, further estrange them from the services they need (see Garcia et al, Grotti and Quagliariello; Upton), or, under the pretext of protocol adherence and risk-reduction, separate babies from their mothers (see Bastian and Sanchez). More than this, they show how the pandemic’s challenges are variably experienced, with different cultural, political and geographic sites giving rise to unique forms of need and vulnerability. We see that women of color, those with lower socioeconomic status, and those in under-resourced settings face some of the most challenging circumstances every day, but especially in these times. Their already reduced access to healthcare services is amplified and reinforced by limited access to privilege that would allow them to access alternative care or forms of support.
In assessing health system and policy-level efforts to prevent the adverse outcomes that can follow from, for instance, inaccessible or overwhelmed healthcare services (see Yuill, McCourt and Rocca-Ihenacho), the displacement of women and their key supports from clinical settings (see Castañeda and Searcy), or reductions in the number and types of medical services and treatments (see Mishtal et al), our contributors reveal the limits of large-scale interventions and policies, and they confirm the need for context-responsive solutions to the challenges posed by COVID-19 for SRH/MNH, efforts for which medical anthropology is especially well-suited.
In the collection’s second round, the contributors explore how the pandemic’s containment measures not only continue to pose challenges to women’s ability to access prenatal and postnatal care, but also deny them the chance to deliver with a birth companion, whether their partners or a doula (see Rivera). Rather than develop strategies capable of counteracting the increasingly dehumanizing quality of medical services, with women alienated from family and friends during labour and even their newborns after birth (see Barata, Neves, and Santos), health systems worldwide are instead leaning even more heavily into the obstetric model of care, which prioritizes clinical protocols and regulations ahead of women’s autonomy and decision-making authority, and sense of comfort, well-being, and health. Such service delivery models are all too frequently experienced by women and their advocates as disrespectful and abusive, and by healthcare providers as wholly contradictory to best practices. Many such measures take place in institutions and care relationships fraught by structural violence and racism, and haunted by the violence and genocide made possible by medicine itself (see Downe).
In other instances, pandemic restrictions are harnessed as a pretext to deny care to women from minority or stigmatized communities, practices which result in increasing rates of unmet need, obstetric complications, and death (see Saha). Or, international travel restrictions interrupt reproductive trajectories, such as they include intended parents’ access to assisted reproductive technologies (ART), and their ability to be united with the children born of gestational surrogates in other countries (see König, Jacobson, and Majumdar).
The contributors also pinpoint the ways that pandemic-era constraints serve to re-concentrate medical specialists’ power over the birth process, especially in the Global North. Such shifts reduce nurse-midwives, midwives, and doulas’ decision-making authority, impinge on the otherwise-close relationships they form with women across the continuum of obstetric care, and reify and give new life to the gender asymmetry and professional inequality which have historically marked the relationship between male and female-dominated cadres of caregivers. Social and legal challenges are being mounted by childbirth activists, women’s and midwifery advocacy groups, who contend that pandemic-era restrictions signify additional breaches in women’s human rights (see Drandić and van Leeuwen). Their efforts have yielded a number of important and no doubt lasting gains, including the enhanced integration of midwives to state maternity services (see Murphy-Lawless, Webster, Hughes and Devane).
In less-resourced settings, state efforts to reduce the burden placed on hospital services include downshifting responsibility for obstetric services to midwives, with the expectation that antenatal care and births will take place at the community level, where necessary resources and referral support are scarce (see Williams and Speich). No matter the scale of the crisis forced on them, biomedical and indigenous midwives have proven themselves medically as well as politically capable of meeting the challenge, such as by organizing into collectives to better cover gaps in state healthcare services, and identify and support the most vulnerable of women in their midst.
Overall, the contributors illuminate how the pandemic yields stress fractures and reveals pre-existing fault lines not only in healthcare systems but also in society more generally. More hopefully, they confirm the multiple ways that the pandemic gives rise to opportunity, ingenuity, and activism. By clarifying the ‘lessons learned’ by health systems and medical providers, and SRH/MNH advocates and stakeholders during the pandemic, the contributors pinpoint the specific kinds of policy- and programme-relevant evidence, skills, and strategies needed to successfully navigate the difficult weeks and months to come. In so doing, their work permits information sharing and awareness raising while cultivating the grounds for global action.
Special Collection Essays:
COVID-19: a watershed moment for women’s rights in childbirth | Daniela Drandić and Fleur van Leeuwen
COVID-19 Containment Measures, Perinatal Experiences, and the Fight for Childbirth Rights in Portugal | Catarina Barata, Dulce Morgado Neves and Mário JDS Santos
“The Hospital is Haunted”: Maternal Health, Pandemics, and Collective Care among Indigenous Women affected by HIV | Pamela J. Downe
“Pandemic Disruptions” in Surrogacy Arrangements in Germany, U.S.A., and India during COVID-19 | Anika König, Heather Jacobson, and Anindita Majumdar
COVID-19: challenging Ireland to move from Mastership to Midwifeship | Jo Murphy-Lawless, Jeannine Webster, Patricia Hughes and Declan Devane
New York’s Virtual Black Birth Workers: A Birth Justice Response to COVID-19 | Mariel Rivera
Women struggle to access safe maternal care in the world’s harshest lockdown | Devanik Saha
Home versus the hospital: Negotiating birth location risk and midwifery’s value in Mexico | Sarah A. Williams and Sabrina Speich
Special Collection Organizers:
Emma Varley, Ph.D. is Associate Professor of Anthropology at Brandon University, Canada, and an Adjunct of the Department of Archaeology and Anthropology at the University of Saskatchewan, and Adjunct and Senior Advisor for Qualitative Research on Maternal and Newborn Health at the University of Manitoba’s Centre for Global Public Health. Recent publications explore the contributions of health system mismanagement and medical malpractice to maternal injury and death, the impacts of sectarian violence, natural disaster, and acute forms of social exclusion on obstetric services, and the use of medicine as a tactic of war. Email: varleye@brandonu.ca; emma.varley2012@gmail.com
Adrienne E. Strong, Ph.D. is Assistant Professor of Anthropology at the University of Florida, USA and an affiliate faculty member of the Center for African Studies and the Center for Gender, Sexualities, and Women’s Studies Research. Dr. Strong is the author of the 2020 open access book Documenting Death: Maternal Mortality and the Ethics of Care in Tanzania from University of California Press. Email: adrienne.strong@ufl.edu