Letter to the Editor
The symbolic framework of obstetric violence
El entramado simbólico de la violencia obstétrica
a Centro de Salud Fontiñas, Servicio Gallego de Salud (SERGAS), Santiago de Compostela, Spain
b Hospital Provincial de Conxo, Servicio de Psiquiatría, Servicio Gallego de Salud (SERGAS), Santiago de Compostela, Spain
c Servicios de urología, Hospital Clínico Universitario de Santiago, Servicio Gallego de Salud (SERGAS), Santiago de Compostela, Spain
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Based on this approach, we propose studying obstetric violence based on the imaginary social constructs of Castoriadis<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and the symbolic violence of Bourdieu.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Castoriadis believed that imaginary social constructs are socio-historical structures that individual create by accepting a series of norms, symbols, signs and institutions which they belong to and identify with.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The imaginary social constructs of obstetric violence are the results of a system of social frameworks that determine medical roles and practices associated with sexist viewpoints based on a power dynamic, and which in turn underlines inequalities that lead to physically and psychologically aggressive behaviours against women. These forms of behaviour reproduce a model of power-based relationships that are governed by individual imaginary constructs grounded on domination by medical professionals.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Together with the input from Castoriadis, the thoughts of Bourdieu<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> on symbolic violence help us to understand the mechanisms which underlie and legitimise it. Bourdieu believes that this symbolic violence is expressed in the power that is achieved by imposing certain meanings as the correct ones, masking power-based relationships, that is, those which intrinsically symbolize the said power-based relationships.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> One of the fundamental characteristics of symbolic obstetric violence is the asymmetrical relationship, where the “dominator” and medical professionals use indirect violence against the “dominated”, women, which is justified and warranted by the clinical protocols of the medical system that legitimize and encourage this relationship. According to Bourdieu,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> this symbolic violence works as a social control mechanism which, through the customary means and practices of obstetric examination, reproduces sexual inequalities. On the other hand, in connection with the causes that make obstetric violence possible, Castro,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> aligned with Bourdieu’s thought, states that it is the hegemonic habitus which enables the reproduction of symbolic violence, functioning as the axis where obstetric practice is organized. The training received by medical professionals and the students of health sciences therefore acts as a drive belt that brings about the creation of a professional habitus that, together with the official curriculum, develops another parallel curriculum based on the acceptance of asymmetrical power relationships that becomes visible in medical practice.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Lastly, we agree with the authors’ conclusions about the need to create spaces for ethical education, making it possible to thoughtfully consider the implications of obstetric practice in women who receive sexual and reproductive care. Furthermore, in this pre-graduate education and continuous training it will be necessary to reflect on and become aware of the dominant role symbolic violence in the relationship between healthcare professionals and women, to eradicate obstetric practices which have become accepted in the treatment of women’s bodies; in this way, professional ethics will be promoted that respect women’s rights and encourage the creation of protocols which are not invasive, painful or hazardous, within the context of humanized and respectful treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percepción de estudiantes de ciencias de la salud sobre la violencia obstétrica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Biurrun-Garrido" 1 => "S. Brigidi" 2 => "D. Mena-Tudela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.enfcle.2023.02.007" "Revista" => array:5 [ "tituloSerie" => "Enferm Clin" "fecha" => "2023" "volumen" => "33" "paginaInicial" => "234" "paginaFinal" => "243" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hacia una indagación de la vertiente subjetiva de los imaginarios sociales: aportes desde la obra de Cornelius Castoriadis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. 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