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 violence and 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.