Power and Patients : An ethnological study of access to maternity care in rural Sweden

Abstract: In february 2017 the maternity ward in Sollefteå was shut down. The citizens of the surrounding area, Ådalen, thus have more than two hours - with private transportation on narrow roads without phone connection - to the nearest maternity ward. The shutdown is a result of various developments in society, connected to larger structures of power that present these changes as natural and inevitable. This qualitative study explores the relationship between individual and structure by examining the area of Ådalen and its inhabitants’ access to maternity care. The emphasis lay on power dynamics within - and between - different structures and how these come to influence people’s everyday life. With ethnographic material collected through in depth-interviews and observations, the impact of these power structures are exemplified and discussed from the perspectives of a few individuals. The relevant structures are examined through three norms; a male norm, a neoliberal norm and an urban norm. The analysis problematize how the norms, through the conceptions of women, rurality and human values they reproduce, influence access to maternity care and limit the agency of the study’s participants. The analysis is based on power theories of both Foucault and Bourdieu. Foucault’s theories of subject and resistance are used to examine structural exercise of power and the informants’ collective actions and experiences. While Bourdieu’s theories of habitus, capital and field are used to analyze the informants’ individual perceptions of power. The power structures discussed are tied together by an intersectional framework, which enables a broader analysis of how these structures cooperate and strengthen each other. The study shows the complexity of power where the local movements challenge prevailing structures through mobilization and resistance.