Authoritative knowledge: collaboration and consensus?

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The similarities and differences in meanings and practices that exist in

relation to the management and experience of childbearing emphasise the

complexities inherent in drawing distinctions between different forms of

authoritative knowledge. Over time, ways of knowing and what counts as

authoritative knowledge shift. Similarly, boundaries around and between

cultural scripts cannot be rigidly defined and should not be tightly drawn.

But clearly some key differences are discernible and these do help to

shape the forms of authoritative knowledge and associated practices

that dominate in different cultural contexts. For example, using their

work in Jamaica, Sargent and Bascope (1997) have shown that highly

developed technology need not be a prerequisite for the possession of

authoritative knowledge, or for perceptions of who holds authoritative

knowledge. In contrast, however, technology has become an important

feature of authoritative knowledge in the USA and UK. In these countries

technology increasingly plays a part in constructions of ‘expert’ and

perceptions of ‘expertise’ in relation to pregnancy and childbirth and

associated normative practices. Professional expertise is premised on

hierarchies of knowledge developed through often lengthy training,

which in turn is related to positions of power. The development and use

of technological interventions in reproduction and childbirth also has a

gendered history. It is interesting to note that men first became involved

in assisting at births when forceps were introduced (Tew, 1990). Of

course, modern technologies can be both liberating and oppressive. But

as tools which require expert management, they can be seen to further

contribute to hierarchical forms of authoritative knowledge, distancing

women further from knowing their own bodies (see chapter 3). Yet, as

earlier noted, because of the processes by which practices and knowledges

become normalised and accepted over time, many women actively collaborate

with those they regard as experts. In the West these are the health

and medical professionals (Davis-Floyd, 1992; Fox and Worts, 1999).

This may be especially pronounced in those who are becoming mothers

for the first time when particular ‘expert’ ways of knowing are prioritised

and regular interaction with professionals sought (see chapter 4). But as

journeys into motherhood unfold, or as subsequent births are experienced,

perceptions of who is the expert, what constitutes authoritative

knowledge and the ways in which cultural scripts shape narrations,

may shift.

As we have seen in this chapter, in some contexts authoritative knowledge

is consensual and shared. In others, one kind of knowledge is

regarded as most authoritative and more powerful, reflecting pre-exisiting

power structures. The important point is that ‘the power of authoritative

knowle dge is not that it is correct but that it counts’ ( Jordan, 1997 :58).

A shared characteristic of cultural scripts that shape reproduction and

childbearing in the UK and USA is that any knowledge a woman may

have about her own body is regarded as less accurate or relevant when

placed alongside biomedical ways of knowing (Graham and Oakley,

1986; Davis-Floyd, 1992). As childbirth becomes increasingly medicalised

there is a pressing need to take account of lay knowledge, which is

not ‘simply diluted versions of medical knowledge’, but rather ways of

knowing grounded in subjective, embodied experiences (Nettleton,

1995:37). In turn, biomedical knowledge resides within professional

groups who occupy positions of power and in the West this hierarchy

shapes ‘the way interactions take place’, although historically this has not

always been the case (Sargent and Bascope, 1997:192). One aspect of this

changing context is ‘the current revolution in reproductive technologies’

which has led to new ways of thinking about ‘social definitions of motherhood

and fatherhood’ (Scheper-Hughes and Sargent, 1998:16). Contexts,

meanings and associated practices, then, shift over time. So, how can we

move towards a more collaborative, consensual model of authoritative

knowledge in which different types of knowledge can be accommodated

and shared? A model that does not reinforce pre-existing forms of

gendered authority and power? It is this quest which Jordan regards as

being ‘the challenge for the future of childbirth in the technologized

western world, as well as in the developing countries of the third world’

(1997:73).

Yet the complexities and challenges in moving to more consensual,

collaborative constructions of authoritative knowledge, not just in those

contexts currently characterised by high-tech, are considerable. This is

because of the complex interplay between technology, development,

perceptions of progress and different ways of knowing: all of which are

set within an increasingly globalised world. As Scheper-Hughes and

Sargent have pointed out, ‘local societies and cultures are as much

influenced today by what goes on outside their borders as within them’

(1998 :10). However, these chang es an d transfor mations continue to be

differentially experienced, intersected as they are by class or caste position,

gender and other structural inequalities. As we have seen, whilst

technology is not a necessary prerequisite for constructions of authoritative

knowledge, and there are very real dangers in confusing development

with technology, nonetheless many developing countries aspire to patterns

of development seen in the West. For example, the increase from

2 per cent to 5 per cent of women in Bangladesh giving birth in hospitals

will be widely welcomed as progress. And if perinatal and maternal

mortality rates fall as a result, it is a form of progress. Is there greater

opportunity now, as a result of increased global communication, for

convergence between different ways of knowing, and is this desirable?

Certainly, in those societies characterised by more horizontal forms of

authoritative knowledge andwhere technology has not largely replaced more

embodied, experiential ways of knowing, there remains the opportunity to

build more collaborative and inclusive models of authoritative knowledge.

However, in the USA and UK, transformations and changes in

how we live mean that individuals continue to look to experts for guidance,

even though some theorists claim trust in expert bodies of knowledge is

increasingly regarded as less relevant (Beck, 1992). In the case of childbearing,

many women prioritise information from professionals. They

seek out and value particular ‘expert’ forms of authoritative knowledge,

which they have come to accept as the natural and normal way to prepare

for motherhood. Moving to a more consensual and collaborative construction

of authoritative knowledge in this context will be much harder

to achieve, so accepted and normalised are current practices. The themes

raised here: perceptions of development, technology and ways of knowing

in the context of differentially experienced transformations, bring together

important questions, which will be revisited in chapter 7.

The path to achieving more consensual, collaborative models of

authoritative knowledge is a difficult one to negotiate. The challenge is

how to retain the best practices of the collaborative models that currently

exist in different cultures, at the same time, making available to all women

the means by which pregnancy and childbearing can be made safer and

ultimately more personally fulfilling. This raises questions about the

relevance of cultural scripts in an increasingly globalised world, where

cultural boundaries are becoming less distinct. A more individualised

focus is called for by Willard, who argues that it is ‘necessary to turn

our focus away from those cultural scripts that are increasingly unconnected

to the realities of women’s lives and turn towards the experience of

women themselves as they make decisions about their lives in relation to

cultural expectations and realities’ (Willard, 1988:231). Yet there

remains much to be learned from observing and exploring the different

(and similar) cultural practices that exist around childbearing. They help

to remind us of the shifts that have occurred in how we think and practice

reproduction and childbearing. They enable us to question and challenge

taken for granted practices such as the liberating and oppressive dimensions

of development. But most crucially, they remain important because

individual lives are lived out in particular cultural contexts. In all

societies, then, transition to first-time motherhood involves women in

journeys that are both culturally scripted and personally uncertain.