Researchers’ perspectives of self-agency within a context of violence and harm in maternity care

Abstract

Problem: There is an increasing awareness of the prevalence of obstetric violence within maternity care and that some women and birthing people are at greater risk of experiencing harm.

Background: Supporting self-agency for women and birthing people in maternity care may be a way of addressing the disparities in vulnerability to violence and harm.

Aim: To explore researchers’ perspectives of self-agency for women from different backgrounds, what inhibits and prevents self-agency, and how self-agency can be enabled.

Methods: A qualitative research design was undertaken underpinned by a reproductive justice framework. Group interviews were held with researchers working with perinatal women/birthing people with histories and experiences of violence and abuse. Reflexive thematic analysis using Bronfenbrenner’s ecological systems theory was undertaken.

Findings: 12 participants took part in two group interviews. Two themes were developed: ‘defining self-agency’ and ‘ecological influences on self-agency’.

Discussion: The findings identify how self-agency should not be perceived as an intrinsic attribute, but rather is underpinned by exogenous and endogenous influences. Whether and how self-agency is enacted is determined by interacting factors that operate on a micro, meso and macro level perspective. Self-agency is undermined by factors including immigration policies and sociocultural perspectives that can lead to under-resourced and judgemental care, other intersectional factors can also lead to some individuals being more vulnerable to violence and harm.

Conclusion: Implications from this work include strategies that emphasise woman-centred care, staff training and meaningful organisational change to optimise positive health and wellbeing.