La mobilité : sésame d’un accouchement sur mesure pour les élites économiques ? - EHESP - École des hautes études en santé publique Access content directly
Journal Articles Revue francophone sur la santé et les territoires Year : 2023

In search of the ideal maternity: Mobility, key to childbirth dreamed of by economic elites?

La mobilité : sésame d’un accouchement sur mesure pour les élites économiques ?

Abstract

This article focuses on the relationship to childbirth of women from the internationally mobile elites and giving birth in a private maternity hospital (Gelly &al., 2021). Recent work on the social differentiation of perinatal care (Sauvegrain et al., 2022) often explores the question of social relations of domination, from the perspective of racialization. Few studies have addressed this issue by exploring the relationship of health professionals to the upper classes. We have recently treated this question from a sociological point of view (Cristofalo & al., 2019; Gelly &al., 2021). Here we wish to approach this theme from the point of view of critical social geography. The analysis conducted and developed here is part of a research project on trajectories and social relations in perinatality (TRASOPER project) and opens up reflections on mobility, circulation and migration in the field of health. While we usually worked with people "migrating" for economic reasons (looking for work or better living conditions) and/or political reasons (persecution, violence), this survey confronted us with women from international elites, rather "mobile" than "migrant". These women had a specific mobility profile, insofar as their mobility is not the result of economic or political constraints, but of professional or residential choices (Wagner, 2005). We propose a discussion on the one hand on the registers of mobility, movement, and migration of these women, and on the other hand on the social relations that structure the relations between these women and health professionals in the context of pregnancy. Mobility appears here as a means of accessing places, maternity wards, where they can access services “sur mesure” (i.e. adepted to elite families way of life and to social expectations). Thus, we seek to show how pregnancy and childbirth, for these women and the professionals they meet, reconfigure specific spatial and temporal arrangements. In this article, we will analyse only one of the fields (the "pioneering" terrain) of the TRASOPER programme, which, for the project's researchers, proves to be the most original. This allows us to renew our theoretical and epistemological questions. The survey took place in a private non-profit maternity hospital, carrying out about 750 deliveries per year. It is a maternity hospital that takes care of physiological, non-pathological pregnancies, located in wealthy neighbourhood in western Paris. This maternity hospital welcomes an audience of women from elites classes, well endowed with economic and cultural capital. Between June 2018 and May 2019, we conducted 36 semi-directive interviews with women during hospitalization in the maternity ward that follows or precedes their delivery, 12 interviews with obstetricians, midwives, nurses, psychologists and secretaries, the observation of 60 medical consultations, 5 staff and service meetings. The interviews were transcribed and anonymized. We are interested in the social relationships that structure the relationships between patients and health professionals, and will show that body assignments of gender and class contribute to differentiating medical practices in places of care. In addition, our survey in structures dedicated to perinatality leads us to look at the mobilities of women from transnational elites (and their relatives) as well as the practices of health professionals who will take care of them. Also, at the crossroads between transnational circulations (of individuals, practices and knowledge) and migratory trajectories of women and their families, this article proposes a discussion on the terms and concepts to be mobilized to qualify and understand the mobilities of these women and inscribes the analysis of the circulations of elites in those of the development of "sanitary capitalism" (Batifoulier, 2015). Finally, we observe that class and gender relations structure mobility practices in relation to perinatality. The specific medical offer intended for international elites has characteristics of sanitary capitalism: privatization of the offer, diversion of doctors from the public to the private sector, consumption of care and technicality at all costs, individual negotiation of care reducing the risks associated with certain care). The desire to satisfy the wealthiest contributes to a differentiated medicalization of childbirth. Therefore, the possible circulations, for these women, puts health as an element "almost common" among others at the heart of mobility practices standardized internationally. In this, these practices differ from the notion of medical tourism, since these logics of consumerist choices are, through class practices, anchored in a possible and very easily accessible transnational space and refers to pratices of lifestyle mobilities and therapeutic mobilities.
Cet article porte sur les rapports à l’accouchement au sein d’une maternité privée recevant des patientes françaises et étrangères issues de classes sociales économiquement privilégiées, enquêtées dans le cadre du projet TRASOPER. Nous proposons une discussion portant d’une part sur les registres de mobilité, de circulation et de migration de ces femmes, et d’autre part sur les logiques animant les rapports sociaux entre femmes et personnels soignants autour de la grossesse. Nous montrons comment la grossesse et l’accouchement, pour ces femmes et les personnes qui les prennent en soin, reposent sur des agencements spatiaux et temporels qui produisent des pratiques de santé spécifiques chez les élites, aussi bien à l’échelle de leurs espaces de circulation transnationale, qu’au sein de l’établissement qu’elles ont sélectionné pour accoucher, et qu’à l’échelle de leur corps.
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halshs-04380222 , version 1 (10-01-2024)

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Anne-Cécile Hoyez, Clelia Gasquet, Paula Cristofalo, Maud Gelly. La mobilité : sésame d’un accouchement sur mesure pour les élites économiques ?. Revue francophone sur la santé et les territoires, 2023, ⟨10.4000/rfst.1818⟩. ⟨halshs-04380222⟩
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