On Care, Birth and Racialized Stratification: Review of Jennifer Rogerson’s Privileges of Birth

Caroline Mathilde Toft, Anne Rathcke Simonsen, Maja Hyldgaard Kristiansen, Alma Fonsesca Fjeldsted og Amalie Birch.

Antropologi BA, 3. Semester, Aarhus Universitet, 01/12/2020.

Jennifer J.M. Rogerson’s Privileges of Birth is an ethnographic account with vivid descriptions of every-day life encounters in birth consultations and birth experiences in midwife-client relationships. The book explores the different factors that allow white middle class women to make choices surrounding care and birth within South Africa’s racialised history. Through a focus on elite women’s pregnancies, she uncovers birthing privileges otherwise masked as rights; her understanding and conceptualization of these privileges of birth furthermore reveals how reproductive work turns into a project of self-making. It is the project of becoming a mother through specific, ‘natural’ birthing practices and with this, expectations of certain forms of care and attention are created.

Rogerson thus shows how care is pursued as a commodity even if hidden behind the illusions of and expectations for personal, relational midwifery care and ideas on ‘natural’ birthing.

Rogerson lived in a middle-class suburb of the, if no longer segregated, then heavily racialised South African capital. While her nearby residence made her an insider to the socioeconomic experiences of the women she interviewed, never having given birth herself required her to ask questions as an outsider to the birth experience. This self-reflexivity is key to the book and further directs a larger question towards the discipline of anthropology itself: How native can the native anthropologist become? And is the outsider-status not a necessary prerequisite for anthropological inquiry? This continuous stepping back is a means to establish credibility through reflexivity, which Rogerson does brilliantly. The empirical narratives presented throughout her ethnography is analysed in depth with analytical focus such as the ability to choose, myths and self-making as techniques of crafting the self, aligned to notions of womanhood. Through these in-depth narrative analyses, Rogerson exposes broader structural and historical issues concerning how race and class is distributed materially in the South African health care system.

Through an empirical focus on the privileged elite in Cape Town, Rogerson unveils the logics of conceptualizing birth as choice-based, and she shows how conceptions of ‘the good birth’ and ‘the good mother’ is tied to understandings of the universal feminine and the natural birth as the only right birthing practice. White middle-class women purchase the midwifery package as a commodity; an option available to the few. It becomes clear how these women express their desires of birth in consumerist framings such as choice, service and right. This framing of birth within a discourse of choice reconfigures birth and birthing as a project. Implied in the concept of project is failure and success. The women’s comprehension of these possible outcomes is intrinsically connected to the myths of natural birth (birthing without medicalized involvement) and the discourses on the universal feminine (reproductive work as women’s work). This surrounds birth practices with certain expectations and standards of a good birth. These standards are not reflected in the public health system of South Africa. Therefore, being heard and acknowledged is a service that can only be expected through purchasing it as a commodity. In this, the women are able to follow their identity-project; being able to perform a natural birth in accordance with the universal feminine is linked to becoming a good mother. Performing a natural birth is to choose facing every facet of the natural pain that comes with labour. Rogerson, therefore, argues for the moral dimensions of pain and the facing of pain as ethical techniques of the self, the good mother. Through this, Rogerson’s book enters a broader anthropological literary world on the social dimensions of pain and how pain is imbued with meaning (Throop 2010, Good et al. 1994). Rogerson argues that by going through pain, women are understood to gain social capital as women, and birth can therefore be understood as a rites de passage into becoming a good mother.

Rogerson’s thorough writing style establishes reliability, but sometimes hinders a coherent, flowing reading process; she repeatedly diverts from the actual ethnographic stories of her participants to elaborate on points that she covered earlier. However, overall Privileges of Birth is a worthy contribution to the anthropological debate on the importance of privileges – like the privilege of choice in creating the desired project of birthing. Tied to these privileges are specific practices concerning care, and thus she establishes her ethnography of a care world. Thereby, care becomes a prism through which the aforementioned privileges can be studied. Rogerson explicitly enters a conversation with existing anthropological birthing literature which, according to Rogerson, roughly represents two models of bodies; the natural and the biomedical. Through her empirical data, she seeks to bridge the divide between the natural birthing body and the medicalized, thus critically deconstructing the nature-culture divide in questions of birth. We would argue that this insight is the fundamental contribution to anthropological literature on care, birth and racialized stratification in South African health care systems, and abroad. Privileges of Birth is an insightful and in-depth contribution to the growing literature on race- power- care in the anthropological discipline and feminist scholarships

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