Q&A with Elizabeth O’Brien

Your research agenda focuses on history of medicine, specifically in Latin America. What drove you to explore these issues and how they relate to gender and race?

What a great question. When I was a kid my mom was very interested in midwifery. She even did the training to become a midwife, but the irregular hours were very difficult for her because she had three small children. By the time I was around 10 she started working as a nurse. I always loved to read, so whenever I was bored at home I would read her nursing textbooks as well as the homebirth literature she had (classics like “Brought to Bed” by Judith Leavitt and “Immaculate Deception” by Suzanne Arms). As an undergraduate I was involved in student activism and focused a lot on Latin American History and Chicano/Latino Studies. When I began to read books on women’s activist movements in Latin American history, I knew I could combine my two interests by researching reproduction in Mexico. I initially began with an interest in the history of midwifery, but I realized that this topic had already been explored to a greater degree than the history of medical injustice. From there I just followed my sources. 

What are your current research interests?

I’m currently working on a couple of projects. Over the last several years I’ve been working with a group to produce the first translation of a very important 1745 text, which was written by an inquisitor in Sicily. It’s called “Sacred Embryology,” and is a key eighteenth century text on the idea of fetal personhood. I’m also extremely excited to be working on a graphic novel version of my book, with the support of two student artists and my colleague, Lan Li, who is also a historian of medicine. 

What do you hope to achieve through your work?

That is such an excellent question. I hope that greater awareness of past injustices will help address maternal, infant, and family health problems today. I hope that as our society continues to change and evolve, we implement greater protections for vulnerable groups and that we prioritize the well being of everyone instead of the profit of a few. I hope that medicine and public health serve people instead of profit. In this country, this means that everyone should have access to high quality healthcare, regardless of their employment or citizenship status. And I hope that the medical system begins to take better care of its health workers, giving them more time to rest and lower caseloads so that they can spend more time with each patient. Finally, I hope that people in the United States realize that people in Latin American countries have been advocating for these kinds of reforms for a long time. The movement called social medicine essentially seeks to put medicine in the service of social justice. Latin American progressives were at the forefront of these movements from the 1920s to the present, and many Latin American countries today provide free access to healthcare—not just for their citizens, but for anyone in the country. None of these things will happen as a result of my work, but it’s an honor to be part of the conversation and to be able to share classroom space with future healthcare providers and other inspiring youth who will tackle these problems in the future. 

One of your more recent publications in The Lancet examines the connection between obstetric violence and social inequities. Can you discuss your main findings? Are there any policy implications you can derive from that paper?

Thanks for asking about this! One exciting thing we wanted to emphasize was that Latin American feminist first started using the term obstetric violence in the 1990s, and that they—along with African American Reproductive Justice activists—have given us a new language with which to discuss maternal and infant health. In that publication we wanted to emphasize exactly what you said: that obstetric violence is not just an act of violence by an individual healthcare practitioner towards an individual woman (although this sometimes happens and it is, of course, regrettable and should not be tolerated). But there’s another, larger kind of injustice: entire groups of women or childbearing people can be subjected to systemic kinds of violence by state or institutional policies that harm or vulnerabilize them. These vulnerabilities can come from their gender, pregnancy status, age, race, class, disability, or any combination of these factors. So for example, Latin American feminists insist that to deny women access to abortion is to force them to bear children, or “forced childbearing.” This is especially the case because many women (especially if they are young, Indigenous, Black, or impoverished) lack access to contraceptives. Sadly, many also experience sexual assault or coercion at some point in their lives. Therefore to deny women access to safe abortion is to force them to bear children—which can sometimes be dangerous, especially if one is in need of pregnancy termination in case of risk to their health. Activists insist that if the state does not provide access to safe and dignified abortion, the state is committing an act of violence against women as a whole. Therefore they see abortion access not just as a right, but as a matter of maintaining health. Without it (and other healthcare services), women suffer state-sponsored violence.  

Can you share a little about what you plan to talk about at the upcoming event on November 8?

Sure thing! Efforts to restrict abortion often fixate on slippery questions about when life begins and what constitutes fetal personhood. Catholic authorities arguably led the charge from the mid-18th century to the present, as a long line of popes and their subordinates made the protection of unborn life a cornerstone of the church’s philosophy. But this was not always the case. In fact, the Catholic Church’s positions on fetal life have changed throughout history. It was actually not until 1869 that Pope Pius IX (1792-1878) removed the long-held distinction between “animated” and “unanimated” fetuses and then declared that abortion merited excommunication. Previously, influential thinkers had accepted the long-standing Aristotelian idea that the unborn first had a plantlike soul, then, by mid-pregnancy, a sentient soul and only after birth did they have a rational human soul. This talk will focus on how the caesarean operation played a role in shaping Catholic claims about unborn life. During the 18^th century, under orders by the Spanish Empire, priests became surgeons in order to perform Caesarean surgeries. Their goal was to advance the religious notion that the unborn were ensouled early in pregnancy. King Charles IV wrote in 1804 that he considered all unborn products of conception to be ensouled, even if they were “as small as one grain of barley.” His mandate meant priests performed surgery to extract unborn products of any size, no matter how small. That same year, Charles IV also said priests must not allow the burial of any woman in their parishes unless they first ascertained whether she was pregnant — even if the pregnancy was in its very early stages. If a priest had already buried a woman and then he heard that she had been pregnant, the priest was obligated to dig up her body and cut open her womb. In short, women’s dead bodies became objects of theological scrutiny, and the discovery of a conception outside of marriage could bring shame onto their families even after her death. Pre-modern surgery, colonial violence and theological mandates, therefore, are all at the heart of the fetal personhood debate.