Finding a 'safe' place on the risk continuum: a case study of pregnancy and birthing in Lao PDR.(Lao People's Democratic Republic)

ABSTRACT

This paper addresses two questions. Firstly: are the risk regimes faced, and perceived, by pregnant women in rural Lao PDR substantially different from those experienced by pregnant women in western societies? Secondly, if the Lao experiences and perceptions are different, can improvements in maternal health in Lao PDR be achieved without Laotians inheriting the risk regimes of late modernity experienced by many women in western societies? Secondary analysis is undertaken of data collected in 2005 for the evaluation of a pilot maternity waiting home in Bolikhan, Lao PDR. The results suggest significantly different risk perceptions and experiences between Lao and western communities, based on contrasting views of embodiment, identity construction and cosmologies. In the Lao rural communities studied, there is little evidence yet of 'risk society' despite the introduction of western technologies and practices to improve maternal mortality and morbidity. It is argued that 'risk society' can be avoided.

KEY WORDS

Sociology, risk, birthing, maternal mortality, Lao PDR, development

Paradoxes of risk society

Beck's (1992) concept of risk society provides an explanatory framework to elucidate some of the contradictory imperatives which contribute to identity construction and embodiment experiences for many pregnant women in late modern mainstream western societies (Lupton 1999, Lane 1995, Zadoroznyj 2001). Lifestyle risk discourses impact on pregnancy practices. Medical risk discourses influence both pregnancy and childbirth experiences. Many women in late modern western societies are still subject to the normalizing gaze (Foucault 1991) of medicalized births (Martin 1987) and heavily regulated pregnancies (Lupton 1999) at the micro level. They are also faced with the macro deregulation of a 'profusion of possibilities' and choices of providers and settings for birthing (Zadoroznyj 1999: 268), deregulated and uncertain insurance arrangements, and privatization of services, all of which involve inherent risk contingencies and undermine their subjective wellbeing (Pesavento, Marconncini & Drago 2005). How these conflicting risk imperatives of chaos and order (Turner 1997) are interpreted, and acted upon by pregnant and birthing women, are tempered by dimensions of difference such as ethnicity (Hsee & Weber 1999), age (Reichman and Pagnini 1997), geographical location, in particular rural living (Maternity Coalition 2005a, 2005b, Health West 2000) and social class, especially for the first birth (Zadoroznyj 1999).

Thus the extent to which women feel they have power and control over their pregnancy and birthing embodiment, and develop a confident capacity to negotiate the restrictive imperatives of surveillance of their bodies during pregnancy, as well as the multitude of birthing options, economic imperatives and insurance arrangements, varies with social, economic and demographic positioning. However, for mainstream western women, from all walks of life, pregnancy and birth remain domains of risk and disquiet despite relatively low mortality and morbidity ratios in the twenty first century (Lupton 1999, 2003b). The palpable risks of death, sickness and disability associated with pregnancy and childbirth have been largely replaced with the unintended 'risks' of both governmentality and unbridled choice which form part of a risk management cosmology. The 'risk meanings and strategies' which individuals reflexively develop 'are attempts to tame uncertainty, but often have the paradoxical effect of increasing anxiety about risk through the intensity of their focus and concerns' (Lupton 2003b:13). These paradoxical effects include emotional alienation, obsessive concerns with avoiding risk, feelings of failure and inadequacy at not having the 'perfect' pregnancy or birth, the stress of too much choice, negotiating the vagaries of economic rationalism in service resourcing, over-medicalization and disempowerment (Lupton 1999).