妇女健康运动与分娩的去医学化

Women's health movement and the de-medicalization of childbirth

"医学化论题"(medicalization thesis)自20世纪60年代提出以来,已成为西方医学文化批判理论中最为重要的思想资源之一。伴随着70年代妇女健康运动的兴起,女性的生命周期如怀孕、分娩、月经、更年期等成为医学化研究的新焦点。本文梳理了20世纪40年代到90年代美国先后爆发的自然分娩运动、家庭分娩运动和替代分娩运动,作为分娩医学化的逆过程——去医学化的尝试,在考察这些运动的发生源起、基本主张和社会响应的基础上,比较它们之间的联系和冲突,认为分娩的去医学化努力最终未能实现的原因在于:概念层面上,将分娩重新定义为一个正常的生理过程,无法与主流医学界将分娩定义为疾病相抗衡;建制层面上,没有或仅有极小的建制化贡献,无法摆脱对医疗系统的依赖;医患互动层面上,只有少数中产阶级女性接受了分娩的新定义并付诸实践,大部分女性依然希望在分娩的医学化中获得福利。

＂ The medicalization thesis＂ has become one of the most influential theories for studies of western medicine since 1960 s.With the rise of Women’s Health Movement in the 1970 s,women’s life cycle,including pregnancy,childbirth,menstruation,and menopause,has attracted the attention of medicalization related research.This paper summarizes the three movements devoted to de-medicalization of childbirth,including the Natural Childbirth Movement,Home Birth Movement,and Alternative Childbirth Movement,which emerged in the United States in the mid and late 20 thcentury.Through tracing their origins,basic claims and social responses,and analyzing their relevance and conflicts,it is concluded that their efforts of de-medicalization failed in three aspects.Conceptually,existing pathological definition of childbirth still overwhelms the attempt to redefine childbirth as a natural physiological process.Institutionally,none of them has been institutionalized or get rid of its dependency on medical institutions.In terms of interaction,most women still expect to gain benefits from the medicalization of childbirth,with only few middle-class women accept and adhere to the new definition of childbirth.