Birth in Crisis: Public Policy and the Humanization of Childbirth in Brazil
Williamson, Kathryn Eliza
Doctor of Philosophy
This dissertation is about shifting paradigms of care in childbirth. Based on over eight years of experience with Brazil and 24 months of ethnographic research for this project, I track the implementation of Rede Cegonha (Stork Network), a federal government program to improve public maternal and infant health care, during a period of crisis in contemporary Brazil. Drawing on multi-sited fieldwork that followed Rede Cegonha from the halls of the Ministry of Health to local government offices, clinics, and communities in Salvador, I examine the program from the perspectives of federal policymakers, local and state government agents, health care professionals, activists, and women and their family members. I draw on their experiences with Rede Cegonha in order to interrogate the program’s central goal of “humanizing” childbirth. Aiming to lower the rate of cesarean section deliveries, combat obstetric violence, and reduce maternal and infant mortality, I contend that Rede Cegonha is a key part of a broader effort to shift the ethics and politics of care in childbirth. The various social actors involved in the program are incited to think and feel differently about care in birth, cultivating ethical subjectivities aligned with the aims of humanization. I show, furthermore, that the strategies Rede Cegonha draws upon are intimately linked to a broader project of instituting and maintaining universal health care in post-authoritarian Brazil. However, the frictions that emerge in Rede Cegonha’s implementation call into question the program’s ability to effectively address the structural conditions that impact maternal and infant health. Health care workers struggle with imperatives to provide care in ways they feel are incompatible with their training and working conditions, and practices officially defined as “humanized” are often interpreted by women and their families as poor care. These tensions in turn reveal the systemic, racialized social inequality that undergirds the very problems Rede Cegonha seeks to remedy. Despite its pitfalls, however, Rede Cegonha produces ethical reflections on the nature of good care and how best to get it and give it in a context of ongoing crisis and persistent social inequality.