Sociology of Motherhood

Davide De Sanctis, Sara Fariello, Irene Strazzeri, Sociology of Motherhood (Mimesis, 2020)

Davide De Sanctis, Sara Fariello, and Irene Strazzeri address the issue of obstetric violence. Through a reflection independent of both an essentialist vision of motherhood and an exclusively medical-scientific interpretation, they denounce widespread conditions of regression in women’s rights.

Review by Claudia Mazzilli

In Sociology of Motherhood (Mimesis, 2020), Irene Strazzeri and Sara Fariello (with the contribution of Davide De Sanctis, author of the appendix) address the issue of obstetric violence through a reflection independent of both an essentialist vision of motherhood and an exclusively medical-scientific interpretation. They demonstrate that it is now inappropriate to talk about a Gender Gap; rather, we should speak of a “backlash”, that is, an actual regression of women’s rights, which have been fragmented and compressed. The core of this investigation focuses on the exasperated medicalization of pregnancy, postpartum depression, and the difficulties of balancing life and work.

Neoliberal medicine, oriented toward profit rather than the protection of citizens’ rights, has taken charge not only of the sick individual but also of the healthy one, aiming to conquer new market segments. While the medieval hospital was a place of care and charity for the sick, the poor, and the marginalized, where suffering was listened too, today’s hospital is a factory-hospital, a department store of medical services where the patient’s voice is silenced as much as possible. For instance, cultural campaigns for early diagnosis (which generate profit for every service provided) have weakened or replaced environmental protection policies. This has exacerbated the individual’s sole responsibility for preserving their own health, regardless of an environmental context that does not guarantee a healthy lifestyle. Consequently, pharmaceutical companies invest more in marketing than in scientific research. Following the same logic, individual organs of the body are separated from the whole, leading to an abuse of superfluous surgical interventions performed to increase the facility’s productivity. All of this also conditions pregnancy: an excess of ultrasounds, an average of 190 different medical tests, diets, pre-birth exercises, and routine cesarean sections (almost as if the scars of a C-section mark a woman’s rite of passage into adulthood…) have turned childbirth from a natural event into an illness managed through rigid and overly standardized protocols.

Conversely, we learn from the medical literature of past centuries that until the 19th century, women did not “have” a baby, but “expected” one: the simple disappearance of menstruation was a necessary but insufficient condition for a woman to be considered pregnant. Women usually realized they were pregnant much later, through a fetal movement or a recognizable symptom (highly prolific women realized they were pregnant because, for instance, their sweating changed, or they recognized bodily changes identical to previous pregnancies). The doctor’s task was to listen: Hippocrates himself insisted on the decisive importance of consulting women, because only they could know what was going to happen. For us, however, obsessed as we are with diagnostic control over the future, it is difficult to grasp the meaning of this waiting. Women’s knowledge has been overshadowed, a knowledge certainly not infallible, but by no means worthless, considering that the American midwife Martha Ballard, in the State of Maine, did not lose a single one of her 814 assisted laboring women between 1785 and 1812!

Thus, there was a shift from the experience of the midwife (who was first and foremost a trusted woman, a comare, in the sense of a co-mother) to the intervention of the barber-surgeon, equipped with the tools of the trade, and then to the male gynecologist, especially after the invention of the forceps by Peter Chamberlen. This resulted in the transformation of childbirth into a surgical procedure starting from the 17th century: women were forced into a supine position to give birth, rather than the position each laboring woman considered most suitable (not surprisingly, bas-reliefs and sculptures from ancient civilizations depict women giving birth standing up, squatting, or sitting, never supine). The Cartesian model, based on the mind-body split, reinforces the view of the body as an object and of the woman’s body as a mere container for the unborn child. This conception, already present in the classical world starting with Aeschylus’s Eumenides, crystallized in Aristotle, and subsequently reinforced by technologies that allow the embryo to be viewed from its earliest stages as if it were autonomous and independent of the mother’s body and well-being, finds new and problematic outcomes in surrogacy (Gestational Surrogacy, GPA). In this practice, the body and its organs are degraded to asset goods and commodities of exchange in the neo-capitalist market. The book dedicates an accurate reflection to this theme as well, bridging Medicine, Sociology, and Law, and convincingly concluding that a distinction cannot be made between altruistic and commercial surrogacy. This is not only due to the opacity of the contracts signed between the surrogate mother, intentional parents, and clinics, but also because “there is no right to a gift.” Furthermore, in any culture, a gift serves to strengthen the relational bond between the recipient and the giver. Who would donate something (a child) at the risk of their health and life, offering such a gift to people living thousands of miles away with whom they do not, and will not, have any relationship?

The authors clarify that this research does not intend to delegitimize diagnostic and surgical technologies, nor to demonize the progress of Science or return tout court to the past. Rather, they intend to establish a dialogue between Medicine and Sociology, Psychology, and Gender Studies, in favor of an interdisciplinary and globally humanistic vision of health and childbirth. Indeed, the experience of pregnancy and childbirth can involve instances where indifference, loneliness, a lack of listening, and subtle, mostly invisible forms of violence are perceived (invisible because they are internalized and thus accepted as “normal”). This ranges to the most blatant manifestations of violence and discrimination, which feminists began to denounce in the 1970s, when the philosophy of sexual difference pushed women toward reclaiming the experience of childbirth and the knowledge connected to the body, to be lived in a freer, more conscious, and self-determined manner.

In Italy, in 1972 in Ferrara, several feminist collectives launched the “Basta tacere” (Break the Silence) campaign to share testimonies of abuse and mistreatment during pregnancy and childbirth. In 2016, this campaign led to the creation of the Obstetric Violence Observatory, a multidisciplinary entity run by mothers. The first guidelines from the World Health Organization (WHO) aimed at eliminating forms of violence against pregnant women date back to 2014. These forms of violence intensify when women belong to an ethnic minority or experience other conditions of economic vulnerability or social marginalization (women without a partner, incarcerated women, women living with HIV, minors, etc.). The first networks for the humanization of childbirth emerged (in Brazil in 1993, in Argentina in 2004, in Puerto Rico in 2006, and in Venezuela in 2007), alongside the first protocols on informed consent and privacy (the duty not to share information about the patient’s health with third parties, including the spouse, parents, or other family members) and other campaigns aiming to improve not only medical services but also the culture of human rights within public education and health promotion, including through connections between health services and legal aid services.

Today we know that very many (too many!) women have perceived abuse or mistreatment during pregnancy and childbirth, with numbers and statistics varying across different countries worldwide. This explains postpartum depression, which cannot be traced back to a purely hormonal or psychiatric etiology but must be understood within a framework composed of multiple variables. Empirical data and scientific literature on the subject show that three types of postpartum conditions exist: baby blues (a transient sadness that affects 50% of new mothers in the first week, mostly without lasting effects, but which must nevertheless be recognized to prevent it from becoming chronic and worsening); PPD (a depressive pathology that is still understudied, characterized by a loss of interest in daily activities, fatigue, self-deprecation, and guilt, affecting between 5% and 40% of women); and puerperal psychosis. Indeed, the first six months of a child’s life are the most critical, with “motherhood work” involving not only practical caregiving commitments but also psychological and relational tasks that can entail confusion and anxiety. Much depends on the support network surrounding the woman: relatives, friends, and professional facilitator figures, which are not always provided by the public health service.

Anthropologists, for their part, highlight that in pre-industrialized societies, no phenomenon comparable to postpartum depression exists, because within the non-nuclear family, other “rearing figures” are present besides the mother, or because prolonged rituals of care and nurturing accompany the woman’s social transition to the role of mother. Could it be that today, a mother is simply asked too much? Indeed, within the nuclear family, too many domestic obligations immediately fall upon the woman (taking care of the home, the husband, and potentially other children) alongside the burden represented by the newborn, with the psychological and practical tasks inherent to this “motherhood work.” Many women complain about being discharged too early from the hospital after giving birth (also due to the dismantling of the welfare state), while they are still suffering from the stitches caused by an episiotomy or a C-section, or from hemorrhoids and urinary incontinence caused by the strain of labor, or from mastitis or cracked nipples that make breastfeeding difficult to manage—vastly different from the images of fulfillment and happy communion between mother and child that we see in glossy magazines and have unfortunately internalized. The mystique of an innate maternal instinct leads to the consequence that a mother finds it difficult to communicate her distress because she fears being judged: she is supposed to be the happiest person in the world, with a newborn in her arms; if she is not, she is deemed crazy or sick. The gap between lived motherhood and dreamed motherhood is an ordinary experience, even when it does not lead to extreme outcomes such as filicide.

The reluctance to analyze the social causes of PPD only began to be overcome in the 1980s, with the model developed by sociologists G.W. Brown and T. Harris. They identified four vulnerability factors: being motherless since childhood, lacking a good relationship with the partner, being a mother of three or more children, and a highly topical issue: being a full-time housewife, which turns the woman into an inmate with no opportunity to “disconnect” from her motherhood by relativizing it and socializing it outside the domestic environment, in relational contexts from which compensatory gratification can be obtained. All of these stressors are non-exceptional and highly widespread circumstances.

Nor should the condition of the multitasking mother be idealized—a tightrope walker heroically attempting to balance work and motherhood, particularly in Italy. While some countries (such as Sweden) have implemented de-familialization policies (long leaves for fathers as well; childcare services) and others (for example, France) promote social policies of supported familialism (leaves and services in favor of mothers), the model in Italy is that of familialism by default. In this model, the state is almost completely absent, and care services fall entirely upon mothers or the kinship network (grandparents). And of course, mothers are always guilty: guilty of being “selfish” if they do not tend to their children to do something else, guilty of “mammismo” (smothering motherhood) if they sacrifice themselves to the care of the family and children! Yet, without women’s domestic labor (free and invisible), any Western economy would collapse within a matter of days.

Regarding employment/employability in Italy, numerous studies now highlight the difficulties women face in becoming employable again after the birth of a child. It should come as no surprise that the plague of dimissioni in bianco (blank resignation letters signed in advance) at the time of pregnancy has not yet been eradicated: Law 188/2007, supported by Labor Minister Cesare Damiano specifically to combat blank resignations, was later repealed by Minister Sacconi under the subsequent Berlusconi government. The fluctuating trend of our local laws speaks for itself, if one recalls that the celibacy clause for female workers was abolished as early as the pre-fascist era, but was then declared lawful again by the Council of State in 1952, until Law No. 7/1963 introduced the ban on dismissal due to marriage or pregnancy. Let us not forget, moreover, that Article 37 of the Italian Constitution establishes formal and substantive equality between female and male workers, but reiterates the “essential function” of the woman within the family, reinforcing the sexual division of labor.

According to the Global Gender Gap Report (an annual report that calculates gender disparities globally based on four parameters: health, education, labor market participation, and political representation), Italy slipped from 50th to 82nd place between 2006 and 2016, precisely due to data on female employment (if we then also analyze health conditions, we plummet to 123rd place…). Women do not work, or work very little, if they have children, and they work progressively less in relation to the number of children they have; men, on the other hand, benefiting from the space left open by their female colleagues, have greater career opportunities when they become fathers, due to the sexual division of labor that deeply structures our societies, in which attempts to support responsible fatherhood with leaves and other incentives often prove ineffective, not only because of the limitations of legislative mechanisms but due to the cultural resistance to imagining a father acting as a “mommy” (mammo).

Backlash, therefore, not Gender Gap: because male dominance, but also the submission of women, are the result of symbolic violence. This violence is exercised in an invisible and repetitive manner, not always in the blatant form of physical violence, through methods of communicating knowledge and reinforcing stereotypes that prevent people from seeing power relations and changing them.

For further reading:

https://www.lunadigas.com/riflessioni/litalia-per-diventare-un-paese-per-madri-deve-uccidere-il-mito-della-maternita/lunadigas.com