Governing pregnancy in the Global South: the case of post-apartheid South Africa

Abstract

Critical feminist research on risk, pregnancy, and birth, mostly conducted in the Global North, has generally focussed on how risk responsibilises pregnant women. In this article, we provide a critical history of the development of maternal healthcare policy and practices in democratic South Africa as an illustration of the government of pregnancy in a Global South context. Using Michel Foucault’s governmentality framework, we show that the risk techniques deployed in the South African maternity clinic primarily aim to govern the conduct of healthcare workers rather than that of pregnant women. This includes a shift from traditional clinical judgement towards clinical risk management, working within a referral system and simplifying diagnostics through risk assessment. Adopting development as a rationality of government was a condition of possibility for this shift, resulting not in responsibilisation but rather the management of risk on behalf of the pregnant subject.

Keywords:

• governmentality
• risk
• pregnancy
• maternal health policy
• maternal mortality
• South Africa

Acknowledgments

We want to acknowledge the Atlantic Philanthropies and Andrew W Mellon Foundation for funding the first author through a PhD scholarship on which research this article is based.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13698575.2023.2249943

Notes

1. In this paper we consider critical research to be research that employs critical methodologies that problematise knowledge and knowledge creation. Feminist research falls within the domain, although it should be noted that not all research on pregnancy healthcare mentioned here draws on feminist theory and that we referred to this research as critical feminist in order to avoid confusion among those who employ different definitions of ‘critical research’.

2. Bantustans, or homelands, were areas set aside by the apartheid regime for black people; they were supposedly ‘independent’ or ‘self-governing’, but in reality, operated as labour reserves for white capitalism in South Africa, with little real autonomy.

3. See for instance Zanotti’s (2005) genealogy of the UN notion of ‘good governance’ which reorganises local government practices, rendering them governable as liberal democracies and Manokha’s (2009) analysis of ‘human rights’ in which they argue that it produces the conditions of possibility of certain forms of interventions. Sharma (2006) interrogates a popular and widespread NGO concept, that of ‘empowerment’ that is argued to produce acutely modern subjects who are governed at a distance.

4. In this paper we describe the process through which pregnancy is (meant to be) brought into relations of power in post-apartheid South Africa, at least as represented in official policy and procedure documents, reports, guidelines, handbooks, and protocols. By ‘meant to be brought’ we are referring to a specific character of the analysis as well as a limitation: we did not do interviews or study the clinic setting in person. Whether the proposed practices and guidelines are properly implemented, whether they are resisted or whether they succeed or fail in their intentions were not the focus of this research. This project is thus a study of the government of pregnancy in the South African public health setting in terms of the ‘intended consequences of action’ rather than the ‘unintended consequences of action’ (Osborne, 1997, p. 176).

Additional information

Funding

This research was funded by the Atlantic Philanthropies and Andrew W Mellon Foundation for PhD scholarship as well as the South African Research Chairs initiative of the Department of Science and Technology and the National Research Foundation of South Africa (grant number 87582)