Bridging Feminist Scholarship and Epidemiology: Concept, Framework, and Research on Birth Integrity

### Executive Summary The primary objective of this PhD project was to examine how birth experiences, including obstetric violence, shape maternal perceptions of childbirth (PUB-A to E). To achieve this, I developed the concept of Birth Integrity (PUB-A), embedding it within an empirically grounded multidimensional framework (PUB-B) and investigating it across three studies (PUB-C, PUB-D, PUB-E). My dissertation explores the intersection of feminist and sociological perspectives on childbirth while incorporating an epidemiological viewpoint. Recognizing the limited application of feminist analysis in quantitative health research, this synopsis aims to explore how feminist principles can be adapted into epidemiologic work and demonstrate their implementation within the Birth Integrity project.<br /><br /> Epidemiological and feminist epistemologies differ fundamentally; while epidemiology operates within a positivist paradigm advocating for objectivity and value neutrality through rigorous methods, feminist researchers argue that scientific inquiry often reflects the values and ideologies of dominant social groups, including those of the researchers themselves. Feminist critiques challenge the over-reliance on quantitative methods and expose underlying biomedical and misogynistic biases in health knowledge production, emphasizing the need to amplify the voices of historically marginalized groups and prioritize their experiential knowledge.<br /><br /> By recognizing obstetric violence as an under-researched phenomenon in high-resource healthcare settings, my research aligns with core feminist principles, acknowledging the lived, often traumatic experiences of individuals during childbirth as a form of gender-based violence. The concept of Birth Integrity focuses on the subjective perceptions of birth and advocates a holistic, intersectional, and embodied understanding that transcends a mechanistic approach to birthing. This focus on lived experiences underscores the necessity of safeguarding women’s mental and emotional well-being during childbirth.<br /><br /> Birth Integrity has been conceptualized theoretically (PUB-A) and methodologically (PUB- B). From a theoretical perspective, birth integrity is situated within gendered discourses on medicalization, risk, intersectionality, and social embodiment theories (PUB-A). The literature review (PUB-B) revealed a critical gap between theoretical discourse and empirical evidence, particularly in integrating theories with epidemiological studies, risking oversimplification of the complex factors in childbirth experiences. The Birth Integrity framework allows for more precise distinctions among macro, meso, and micro-level factors influencing childbirth. The concept of Birth Integrity and its multilevel factors were applied to three datasets (PUB-C, PUB-D, PUB-E), utilizing mixed methods triangulation for conceptual validation – an approach aligned with feminist principles. PUB-C, derived from a multicountry study during the COVID-19 pandemic, identified key variables associated with Birth Integrity, indicating that women lacking attention or facing abuse felt significantly less dignified. In PUB-D, social media comments revealed experiences of isolation, verbal abuse, and non-consensual examinations. PUB-E evaluated determinants of Birth Integrity within German standard perinatal datasets.<br /><br /> In conclusion, this synopsis advocates for a paradigm shift in health research methodologies by integrating feminist principles into epidemiological studies, fostering inclusive and reflective research. By engaging marginalized populations and employing mixed methods, this approach enhances research validity and empowers individuals to reclaim their narratives, ultimately addressing the historical neglect of women’s and marginalized health issues while promoting health equity.

Level thesis:degree_level

thesis.doctoral

Grantor dc:publisher

Universität Bielefeld

Year

2025

Author dc:creator

• Batram-Zantvoort, Stephanie

Repository record source_url

https://pub.uni-bielefeld.de/record/3006474

OAI identifier oai:identifier

oai:pub.uni-bielefeld.de:3006474