It is well established, sociologically, that attitudes, expectations and access to healthcare differ according to the individuals’ social structures. Blaxter (1990), for example, points out in her analysis on ‘fatalism/activism’ in health behaviours that these concepts are socially structured along class lines. Middle class individuals tend to be more activist in their orientations and practice and, hence, have more sense of control than working class individuals, who tend to be much more fatalistic. Blair (1993: 40–1) too, demonstrates differing personal control of distress and illness along class lines. Working class participants ‘gave less value to personal control’. They tended to say that recovery from illness such as cancer was a matter of ‘luck’ more than their own role. Middle class participants, however, showed a stronger sense of their personal involvement in determining their fate. They talked more about fighting the illness they had.
Issues of childbirth and social class have received less attention. A few social scientists (e.g.Nelson 1983, Hurst and Summey 1984, Martin 1992, Davis-Floyd 1992, 1994, Lazarus 1994, Zadoroznyj 1999, Kabakian-Khasholian et al. 2000), however, have shown that social class plays a significant role in how women perceive childbearing and the extent to which they wish to have control over their pregnancies and births. Martin's work (1990, 1992) is situated well within the analyses of Blaxter (1990) and Blair (1993). Martin (1990, 1992) has shown that social class impinges on women's perceptions and expectations of their births and bodies. The issue of control was the most salient for middle class women. These women sought control of themselves as they laboured and gave birth and resisted medical control. Working class women, however, rejected the idea of self-control but focused more on their lived experience of childbirth such as the intensity or length of labour pain.
The work of Lazarus (1994) contains a similar suggestion. She showed that lay middle class women were concerned with making choices that would allow them to have some control over their pregnancies and childbirth. To ensure this control, the women chose their own doctors to act as their advocates within the healthcare system. Middle-class health professionals were also concerned with issue of control, but their knowledge of the system was exercised as a way of maintaining that control. Poor women, however, ‘neither expected nor desired control but were more concerned with continuity of care’ (1994: 25). Lazarus admits that ‘choice and control are more limited for poor women, who are overwhelmed with social and economic problems’ (1994: 26).
Zadoroznyj's recent work (1999) explores the issues of power, identity and control in childbirth among working and middle class Australian women. Her research suggests that women's attempts at control over the management of their first births are markedly influenced by their social class. Middle class women were able to exercise choice and control more than the working class women and this, Zadoroznyj argues, is because the middle class women's material resources ‘enable choice’ (1999: 284). To begin with, in their birthing career, middle class women were more ‘active seekers’ and working class women tended to be more ‘fatalistic’. For both groups of women, a number of changes took place in attitudes and sense of self following the experience of first birth. But for the working class women, cultural resistance became much more evident than for the middle class women. Clearly then, Zadoroznyj's research shows that cultural resources such as education, social milieu and material resources play major roles in shaping the characteristics of obstetric encounters.
Kabakian-Khasholian et al. (2000) suggest that similar class distinctions also characterise women in non-Western societies. Their work highlights issues of self-control among women in Lebanon. Perceptions of the obstetric care received by Lebanese women were generally characterised by the feeling of passivity. But the extent of their passivity and the desired level of personal control over the process of childbirth differed according to the women's social class. For middle class women in Beirut, the feeling of subordination to the medical professions is less apparent than that of women from the other areas. Women in remote rural areas are less demanding despite the accessibility of prenatal care. This may be because of their low social class and low educational levels as compared with women from Beirut. As Lazarus (1994) suggests, the middle class women in this study are more likely to demand personal choice and reduced professional dominance over their childbirth process (Kabakian-Khasholian et al. 2000: 111).
What makes the middle class women behave so differently from their working class counterparts? Following Bourdieu's (1977) theoretical framework of ‘habitus’, I argue that individuals’ choices and sense of control are determined by their social positions. Habitus, according to Bourdieu (1977: 95) is ‘an acquired system of generative schemes objectively adjusted to the particular conditions in which it is constituted, the habitus engenders all the thoughts, all the perceptions, and all the actions consistent with those conditions, and no others’. To Bourdieu (1984) the habitus is embodied in the context of social positions of people. This indoctrinates people into a life style that is based upon their position. And hence it serves to reproduce people's existing social structure. Williams (1995: 599) argues that, ‘it is in the relationship between habitus and capital, located within the context of the different social fields of society (i.e. the relationship between position and disposition) and the struggle for social distinction, that lifestyles are constructed’. Individuals from different social classes may then have their own ‘logics of practice’ (Bourdieu 1990) and ‘tastes’ (Bourdieu 1984), by which I mean ‘choices’, that fit their social positions. For some, their lifestyle choices, or ‘choice of necessary’ (Bourdieu 1984), may be limited, or even made impossible, by their economic and social constraints. Even if people have a similar goal to achieve, such as giving birth, their actual experiences and their levels of control are likely to be very different according to their social class memberships (Williams 1995: 597). As Bourdieu (1984: 172) contends, ‘life-styles are thus the systematic products of habitus, which . . . become sign systems that are socially qualified (as distinguished, vulgar . . . )’. To put it simply, to Bourdieu, as Williams (1995: 597–8) suggests, ‘it is the (class-related) habitus which, through taste and the bodily dispositions it engenders within particular social fields, together with the volume and composition of capital, determine not only lifestyles and the chances of success in the symbolic struggles for social distinction, but also class-related inequalities in health and illness’. Adding to Bourdieu and Williams’ argument, I contend that as a result of inequalities in access to and choices of healthcare, we witness an unequal struggle in empowerment and control between individuals (and here I mean the women from different social class backgrounds) in the society