Health regulations and social experiences of ‘high-risk’ pregnancies among young working-class women in Brazil

Abstract

In conjunction with aims to reduce infant and maternal mortality, antenatal care in Brazil is based on risk assessment and monitoring. Exploring the reliance of pregnancy management policies on a distinction between ‘low’ and ‘high-risk’ pregnancies, I conducted two ethnographic studies of pregnant women from a working-class background in Recife and Rio de Janeiro, Brazil. In addition to in-depth interviews with women and professionals, observations were made in public maternity wards and neighbourhood health units. With an approach focused on notions of governance and subjectivity, my data show that risk becomes not only a technique for regulating pregnancies, but also an important dimension of the reproductive experience of women. However, tensions appear between these two dimensions (regulation and experience) of risk. An analysis of my data sheds light on three tensions in particular. Firstly, the notion of risk appears to be a cultural resource for health professionals to transmit norms of parenthood to certain categories of women. Secondly, it allows for distinctions between two registers of care: medicalisation and healthisation. While on one hand the risk approach is aligned with a process of technicisation and pathologisation of pregnancies, it also introduces behavioural and psycho-social perspectives on pregnancy. Thirdly, the risk approach promotes an individualising tendency in the management of pregnancy. Women’s experiences lead them to make pragmatic adjustments to regulations. Women circumvent certain norms and easily articulate the registers of medicalisation and healthisation according to the situation, simultaneously incorporating their experience of risk in a social network of mutual help. This article thus shows that the analysis of pregnancy risk management must take into consideration the difference between expectations regarding the effect of regulations implemented by institutions and the de facto experience of women in a specific socio-cultural context.