Reflecting on the Medical Habitus and Obstetric Violence

In this post, we reflect on Roberto Castro’s compelling article, “Obstetric Violence and Authoritarian Medical Habitus in Mexico” (2021) 2 Cahiers du Genre 25 (English translation). We explore Castro’s incisive sociological analysis of how authoritarian norms and punitive hierarchies are embedded in medical education and practice. Through rich empirical research and theoretical insight, the article challenges resource-based explanations of obstetric violence. Instead, it reveals obstetric violence is perpetuated by deeply entrenched cultural and institutional dynamics.

Reflection 1: Foucault and Medical “Fact”

The first reflection that we discussed was specifically to do with the medical habitus. Castro discusses the idea that there is something inherent in medical education which leads healthcare professionals to consider themselves authoritative and justified in their control over birthing women. His reflections echo Michel Foucault’s critique of medicine, which he described as a system of power that influences social relations and individual autonomy. Foucault, in his discussions of the clinical gaze and biopower, explains how the practice of medicine objectifies patients and privileges medical authority. Moreover, because of the medicalisation of childbirth, biopower has now gained hegemony, and structured childbirth as a site of governance rather than personal autonomy.

An interesting theme across this paper is the position of the medical professional as someone who is factual, detached and objective, whereas the mother is positioned as someone with “emotions”, a lack of rationality and thus easy to ignore or control without guilt.

Reflection 2: Beyond Resources

A second reflection on Castro’s article relates to its implications for arguments that obstetric violence is framed as a “quality of care” issue, which can be resolved with increased resources. It is undeniable that a lack of resources (including insufficient staff) in labour wards plays an important role in facilitating obstetric violence. Indeed, as D’Gregorio notes in relation to the Venezuelan context, optimal treatment of women is “difficult to achieve in overcrowded public hospitals that have a high population of patients to attend, a deficient number of health personnel, scant supplies, as well as an inappropriate infrastructure”. Nonetheless, as Castro’s article highlights, obstetric violence is more than a symptom of inadequate resources. Crucially, it is a manifestation of the medical culture in which healthcare professionals are trained and socialised: a punitive, disciplinarian, and hierarchical culture, in which those professionals learn to assert their own relative knowledge-power over women and birthing people. Castro’s team’s observations of labour wards in Mexico align with observations of labour wards in South Africa, where nurses and midwives justify routine abuse as a tool to demand compliance, control, status, and respect. Attempts to assert power and enforce hierarchy are the antithesis of care, and the former (which manifests as obstetric violence in the context of childbirth) thus cannot be addressed without tackling existing medical culture.

Understanding obstetric violence as a cultural (and not merely economic) problem is further supported by evidence that certain groups are more susceptible to obstetric violence. For example, teenagers in many parts of the world are more likely to experience abuse during childbirth than older women. In South Africa, that abuse often includes public admonishment and scolding for “deviant” behaviour: likely a further manifestation of the disciplinarian, punitive medical culture in which healthcare professionals are trained and socialised.

Reflection 3: Development of the Medical Habitus

As our final reflection, we note that Castro also highlights the lack of broader social and cultural perspectives in analysing women’s reproductive rights violations during childbirth and considers its implications for the Mexican health system. The study draws on two main methods: direct observation of birth room interactions in public hospitals and 14 focus groups with doctors reflecting on their medical training. Both strategies allowed researchers to identify key factors shaping the development of the medical habitus at different stages of a doctor's career.

One of the key factors shaping medical habitus is identified as the role of punishment as a teaching tool. Along with the rigid hierarchies, gender discipline also plays a crucial role in shaping the culture of the medical profession. Women report instances of harassment and exclusion from certain medical specialties during their training. They also describe experiencing demeaning treatment, which often continues into their professional practice.

Castro then examines how this medical habitus manifests in the care provided to labouring women. The study shows that interactions among healthcare providers, as well as between providers and patients, are shaped by deeply internalised, authoritarian norms. The systemic power relations entrenched in the medical field lead to disrespectful behaviours and widespread disengagement from women’s needs during labour. Women are treated as peripheral “outsiders” to the birthing process. This is framed by healthcare providers as a strictly medical one under their exclusive control.

Conclusion

This article provides useful insight into the practices and interactions that occur in institutional childbirth, showing that obstetric violence is not a problem of “quality of care” or limited resources, but one which stems from deeply rooted authoritarian norms within the medical system. Using the concept of medical habitus, Castro shows how hierarchical structures and gender discrimination are taught as a norm of practice during medical training and then practiced by doctors throughout their careers. What is required is a cultural shift within the medical profession, positioning women at the centre of their own birthing experiences and ensuring respectful obstetric care. Whilst further research and discussion may be necessary to determine how such a cultural shift may be achieved, recognising obstetric violence as a structural rather than merely interpersonal form of violence, is an important first step.

Simone Gray, Lecturer and PhD candidate at the School of Law, University of KwaZulu-Natal.

Frances Hand, DPhil in Law candidate at St Edmund Hall College, University of Oxford.

Patricia San Juan, PhD student at Andalusian Interuniversity Institute of Criminology (Malaga Section), University of Malaga.

Kerigo Odada, Reproductive justice advocate and PhD researcher, University of Pretoria.

Camilla Pickles, Associate Professor of Biolaw, Durham University.

Georgia Speechly, DPhil in Law candidate at Exeter College, University of Oxford.