Introduction
Modern societies have developed into ones dominated by intertwined systems of social control in the form of state, church, and medicine. The overall tendency toward controlling and preventing multiple phenomena of human life grows and implies dehumanization of some pivotal aspects of existence. Medicalisation, as one of the growing concerns in social sciences, is generally defined as “the processes by which social phenomena come to be perceived and treated as illnesses” (1, p. 229). For example, such moral and social issues as drug addiction, alcohol dependence, deviant behavior, menopause, pregnancy, and other merely natural processes have been subject to medicalization. In particular, the concept of the medicalization of obstetric care is related to the increased involvement of the health care system in the aspects of pregnancy, childbirth, and the postpartum period.
The medicalization and over-provision of obstetric care occurred due to historical and scientific reasons. Indeed, on the verge of the 19th and 20th centuries, the industrial revolution and the overall development in science led to the increasing importance of obstetrics as a medical sphere (9). Like any other health-related issue, pregnancy and childbirth were tackled from the perspectives of the biomedical model, according to which any disease or condition might be defined by medical means. Moreover, the high rate of mortality among newborn children and mothers intensified the process of medicalization by approaching pregnancy-related issues from the perspective of their high risk and pathology, which is why natural processes needed scientific medical intrusion and control (9). In such a manner, specifically designed facilities dominate in the provision of control for health impairments in maternity, which implies the authority and abundant presence of the medicine in the lives of mothers, newborns, and new families.
There is an ambivalent meaning behind this concept since the medicalization of childbirth and obstetric care overall provides both positive and negative outcomes. On the one hand, the extensive medicalization and overprovision of care for pregnant women dehumanize the natural processes and women’s independence in making health- and childbirth-related decisions (9). On the other hand, the medicalization of obstetrics allows for identifying and timely eliminating health problems or complications related to pregnancy, thus saving the lives of mothers and newborns (2). However, recent trends in sociology demonstrate a shift toward demedicalisation. Indeed, as claimed by Ballard and Elston (1), medical dominance tends to decline, and the “idea that medicalization is an inevitable or irreversible process, has become less plausible” (p. 229). Therefore, the over-provision of obstetric care and the overall medical dominance in the sphere of maternity provoke multiple cultural, social, and health-related problems, which need to be tackled on the organizational and public levels to raise awareness.
Current Maternal Health Data and Trends
Medical interventions provided in obstetrics are disproportionately distributed across different countries, depending on socio-economic development and culture. As found by Graham (4), fertility rates, as well as maternal mortality and morbidity rates, differ between developing and developed countries. Maternal mortality in developed countries and regions constitutes 12 cases per 100 000 live births, while the mortality rates in developing countries are 46 times higher and constitute approximately 546 cases per 100 000 deliveries (Graham). The overall increase in the medicalization of obstetric care implies extensive intrusion of health care providers into pregnancy and birth that impedes patient safety. For example, in Brazil, a high rate of cesarean section at more than 36 percent and more than 80% (in some facilities) is observed (8). Thus, there exists a significant gap in obstetric health care provision between economically advantaged and disadvantaged obstetric patients, which produces inequality and the violation of human rights. Importantly, medical invasion in pregnancy and birth leads to complications and often increased mortality. According to Graham et al. (4), such conditions as embolism, complications of anesthesia, complications of abortion, and other problems were the dominating causes of maternal mortality.
The current state of maternal health worldwide indicates that the attitudes toward birth medicalization differ depending on the culture. For example, Christiaens et al.’s (3) findings demonstrate that the rate of hospital births grows intensively and home non-institutional births decrease in number. Similarly, there is a difference in the administration of epidural analgesia and episiotomies to women in labor. The data collected and synthesized by Christiaens et al. (3) shows that in Flanders, 71.5 percent of all primiparous women and 52.6 percent of multiparous women received epidural analgesia in 2008. In comparison, only 16 percent of primiparous women and 5 percent of multiparous women were subject to this intervention in the Netherlands the same year. The indicators are significantly lower for the Netherlands regarding episiotomies, where the total percentage of women receiving this procedure was estimated at 29.2 percent, while the same year’s indicators for Flanders were 57 percent on average (3). Thus, women are disproportionately exposed to obstetric care provision.
Problems Associated with Medicalisation and the Importance of Finding a Solution
The excessive medical intrusion places the health, well-being, and life safety of both mothers and newborn children at risk. Surgical assistance of birth, administering of medication, and other interventions are of particular concern since, when implemented incompetently, lead to complications, morbidity, and mortality. In academic literature, the evidence on the state and trends of maternity health and its relation to medicalization indicates the prevalence of several significant problems. The ones that are identified worldwide, include so-called too little, too late (TLTL) and too much, too soon (TMTS). The lack of timely access to obstetric care and the poor quality of such care in vulnerable regions due to insufficient resources, inadequate policies, and distribution of services constitute the TLTL problem (7). On the other hand, the TMTS problem entails the over-provision of obstetric care throughout all stages of birth-giving.
The abundant medicalization of childbirth provokes the prevalence of harmful interventions. They are predominantly observed in the private sector medicine that functions as a business and is insufficiently compliant with evidence-based practices (7). The lack of scientific evidence leads to another problem, which is disrespect and abuse in low- and middle-income regions, where the lack of protocols and validated tools leads to unprofessional conduct (10). Consequently, the problem of inequality and the violation of human rights arises because vulnerable populations of women suffer from poor maternal health, which is complicated by the absence of accessible care and qualified services (4). Finally, diminished access to care is another significant problem that occurs due to the shift of obstetric care “from the physiologic field of midwife-led care at home to the technical area of medicine led by obstetricians and neonatologists in hospitals” which provoke the application of market and economic indicators to maternal care (5, p. 697). These problems are essential to be tackled due to their significant impact on the health of newborns, who are the future generations.
Objectives to Reduce the Over-Provision and Medicalisation of Obstetric Care
Given the presented data, trends, and emerging problems in the field of maternal health due to the increasing medicalization and over-provision of obstetric care, the following objectives are stated:
- Ensure equality in access to obstetric care and timely qualitative services for vulnerable populations of women;
- Eliminate unnecessary procedures and interventions (7);
- Increase the prevalence of natural births in comparison to medically assisted ones (3);
- Improve the provision of human rights, respect, and safety prioritization in women subject to care;
- Develop evidence-based guidelines for measurement and implementation of medical services to groups of patients in particular need.
Strategies for Achieving the Objectives
The stated objectives of the proposed policy go in line with your organization’s objectives, which, among others, include “the promotion of equality for the public benefit by providing information, advocacy and support services in particular about the entitlements of pregnant women and new parents” (6, p. 2). Since the trends in medicalization depend on state-generated policies and culture, it is necessary to raise awareness about the problematic outcomes of the over-provision of obstetric care (3). It will allow for shifting the agenda of health care policy and making necessary changes to eliminate unnecessary procedures, increase natural births, and ensure the provision of human rights to vulnerable women. The elimination of access to care inequality and socio-economic disparities in obstetric care technological advancement might be applied as the means of reducing medicalization. The advancement of technological non-invasive practices might increase the accessibility and reliability of care (5). To avoid TLTL and TMTS evidence-based guidelines could help healthcare providers, which is why the strategic improvement of academic research in the field of medicalization is encouraged (7). Finally, enhancing advocacy practices for a marginalized vulnerable population of women will help involve more stakeholders.
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