The Moralities of medicine and birth care in the Czech Republic

Czech Sociological Review, 2014

This article aims to show how eight women, most of them with higher education, experienced, perceived, and understood birth care in the context of the post-socialist transformation in the Czech Republic. It is based on narrative interviews and a thematic analysis of them. From a description of women's birth-care experiences the author fi nds that women are most critical of the behaviour of health-care workers and the lack of communication provided by the system. Discussing the narrators' birth-care requirements she notes the strategies women use to attain the form of care they wished. Finally, the author observes that the women she interviewed exhibit diverse understandings of birth care, on which basis the author identifi es fi ve distinct notions of birth care that differ in three key aspects: (1) women's attitudes to medical interventions; (2) their awareness of birth care; (3) their subjectivity and position in relation to birth-care providers. These ranged from complete acceptance of the way in which birth care is provided, to notions that are critical but accepting of medicalised care, to a rejection of the medical model of birth care and the assumption of 'a responsible consumer' subjectivity. The article in particular looks at women's disillusionment with birth care and interprets it in relation to clashing ideas about the relationship between birthcare provider and user associated on one hand with the socialist past and on the other with neo-liberal discourses on health.

Czech Sociological Review, 2014

This article aims to show how eight women, most of them with higher education, experienced, perceived, and understood birth care in the context of the post-socialist transformation in the Czech Republic. It is based on narrative interviews and a thematic analysis of them. From a description of women’s birth-care experiences the author finds that women are most critical of the behaviour of health-care workers and the lack of communication provided by the system. Discussing the narrators’ birth-care requirements she notes the strategies women use to attain the form of care they wished. Finally, the author observes that the women she interviewed exhibit diverse understandings of birth care, on which basis the author identifies five distinct notions of birth care that differ in three key aspects: (1) women’s attitudes to medical interventions; (2) their awareness of birth care; (3) their subjectivity and position in relation to birth-care providers. These ranged from complete acceptance of the way in which birth care is provided, to notions that are critical but accepting of medicalised care, to a rejection of the medical model of birth care and the assumption of ‘a responsible consumer’ subjectivity. The article in particular looks at women’s disillusionment with birth care and interprets it in relation to clashing ideas about the relationship between birthcare provider and user associated on one hand with the socialist past and on the other with neo-liberal discourses on health.

Rebellious Parents: Parental Movements in Central-Eastern Europe and Russia. , 2017

This chapter discusses parental collective efforts to challenge existing medical and state authorities in the Czech Republic and to change the current birth care system for the better. In the Czech Republic the issue of ‘natural childbirth’ has recently become a headline, covering newspaper pages almost every other day. In this paper I map the trajectory of the natural childbirth movement to examine forces that have shaped a particular course of this social movement. I employ the theory of health related social movements and new social movements to explore birth activists’ strategies and understand their perspective in depth. To meet these aims, I have been conducting a long-term ethnography of the movement since spring 2011. I particularly build on participant observations of key public events, five in-depth interviews with birth activists and 19 narrative interviews with women who gave birth naturally; qualitative media analysis of 77 media contributions, and the “netnography” (computer mediated ethnography) of Czech childbirth activism. In my analysis I draw a particular attention to the role of science and medicine in the Czech society, and power dynamics between medical and state authorities, and the birth activists. I argue that in the Czech cultural context a traditionally powerful position of doctors and medicine and the related general scientization of the society are biggest obstacles to the movement’ s success, as these prevent midwives and women-birth care users from becoming equal partners in negotiations with medical and state authorities.

The History of the Family, 2020

The paper discusses how selective pronatalism has been incorporated into childcare and reproductive health policies in the socialist state of Czechoslovakia (1948-1989). It answers the question of how pronatalist framing has been used to categorise 'others', whose procreation has been deemed undesirable. It pays attention to the ways limitations on women's bodily and social citizenship were used as a tool of selective pronatalism, as well as how the pronatalist framing was linked to the framing of women´s interests, to determine whether and how women´s interests were present in the debates on reproduction and childcare. It considers both childcare and reproductive health policies to show how a healthy and able population was to be secured in the socialist state of Czechoslovakia. Based on the framing analysis applied to major policy texts and political discussions preceding legislative changes, the paper analyses the development of abortion policies, policies regulating the use of assisted reproduction technologies, prenatal screening, policies of childcare and family support, and the framings that contributed to their development. By linking the analysis of debates on childcare and reproductive health policies, we argue that although pronatalist framing has been used several times in support of women´s interests, it has always been patriarchal and exclusionary.

Czech Sociological Review, 2010

Abortion was fi rst legalised in Czechoslovakia at a relatively early date-in 1957. However, unlike in Western Europe, this did not occur as a result of pressure from civil society and the feminist movement. While attempting to explain the continuity and change of abortion institutions in the former Czechoslovakia /Czech Republic, the article focuses on the framing of the debates that preceded the changes in abortion legislation in the Czech Republic since the 1950s. Discourse analysis of media and expert articles, parliamentary debates, and other documents shows that abortion in the Czech Republic was framed as a medical issue since the 1950s, not an issue of women's rights or bodily citizenship. Gynaecologists were the most important actors in the abortion debates. The effect of this medicalised discourse of abortion was the construction of a specifi c knowledge on abortion. In spite of existing alternative discourses, this original discourse now hinders the possibility of reframing abortion in terms of women's reproductive rights and this is refl ected in the status quo of the abortion legislation. The continuity of dominant discourse therefore refl ects and reinforces the path-dependency of the institutions.

Canadian Slavonic Papers, 2019

The author analyzes the political and medical discourses surrounding the legalization of abortion in Czechoslovakia in the 1950s and the establishment of the institution of abortion commissions to approve women's demands. Through a genealogical intersectional lens, she explores the continuity of this rationality, which started to fear the degeneration of the collective more than its depopulation. As the Cold War commenced, for the first time in history Czechoslovak women obtained reproductive rights, particularly when a pregnancy was recognized as a threat to women's and children's health. Drawing on biopolitical theories and other critical feminist scholarship that have problematized the liberal underpinnings of choice and autonomy, the author demonstrates how eugenics trespassed from expert circles into politics, and, with the help of planned parenthood, recreated a complex system of socio-biological classes, determining who should reproduce and whose life was worth living, and worth protecting. The text defies the classic totalitarian thesis that divides peoples and society into two types, the totalitarian subject and its liberal counterpart. The author argues that, regardless of the political system, abortion rights operate as a regulatory strategy of power aimed at maintaining a certain population optimum by redefining women's responsibilities to deliver a healthy child into a healthy environment.

European Journal of Mental Health, 2018

Background: Informed consent plays an important role in clinical decision making. It is a basis of self determination in health care. In ideal situations health care professionals inform their patients about all relevant aspects of care and alternative care options, map the value system of the patients, and adjust the information process accordingly. Objectives: Our objective was to see the frequency of selected interventions (birth induction, caesarean section, episiotomy, forced supinal position during birth, and the consent process associated to these interventions. Methods: 1,257 women (with childbearing capacity) between the age of 18 and 45 with children under the age of 5 were surveyed online. Results: Caesarian section was done without permission in 10.2% of women. Labour was inducted in 22.2% of all deliveries and it was done without permission in 25.4%. Episiotomy was done in 39.9% of women having vaginal delivery in the Sample 2 group and in 72.2% of women having vaginal delivery in the Sample 1 (representative) group. Women undergoing episiotomy were not asked for consent in 62.0% in the Sample 1 group and in 57.1% in the Sample 2 group. Freedom to choose labour position for women having vaginal birth was restricted in 65.7% in the Sample 1 group and in 46% in the Sample 2 group. Discussion and Conclusions: We have found that the right of women to informed consent and best available treatment is frequently and seriously violated in obstetric practice in Hungary in the given period. These findings should serve as an important basis for improving the quality of maternity care.

The Games of Life analyses current reproductive medicine in the Czech Republic. It targets biomedicine, as a concrete manifestation of modern society’s normalization of the Western approach to human health and illness by focusing on three specific fields: childbirth, assisted reproduction, and embryo manipulation. All three themes are approached with the concept of biopower as a form of governance and administration of modern populations (Foucault 1999). The objective of the book is to provide a critical sociological analysis of reproductive medicine, as one of the key poles in the current form of biopower (Rabinow, Rose 2003, 2006). The reason for our focus on this area is the relationship between reproductive medicine in the Czech Republic and technology, the commodification of health and illness, and the normative character of reproductive medicine with its consequences in the broader social context. The authors start by filling the gap in critical reflection and thelack of debate of these issues in the Czech professional context, and by understanding the mechanisms reproducing the hegemony of a biomedical approach to human reproduction beyond national borders. They do so in the Games of Life by providing specific fieldwork data from the Czech context. They focus their empirical analysis on the issues of everyday practice in reproductive medicine, such as establishing trust in the process, or on topics channelling and polarizing both professional and public discussions on transforming the practices of Czech hospital birth, or the debate on the status of the embryo as a bio-object. These particular issues have been studied to answer the research questions: How are the borders between normality/legitimacy in the definitions of health and illness negotiated within three specialized fields of reproductive medicine? In what way is trust established within the system of modern reproductive medicine? How are the categories of status, gender, and ethnicity introduced into this process? The book analytically situates Czech reproductive biomedicine within a broader critical approach to biosociality manifested in profound changes in contemporary societies.

Review for "Anthropology Now" Findings Collective