Colonizing safety: Creating risk through the enforcement of biomedical constructions of safety

Abstract

In the normative health care discourse, safety is represented as a concept that is at once universal, irrefutable, and inherently beneficent. Yet, research at local levels in the Philippines challenges these assumptions embedded in the biomedical construction of safety. This article examines how the imposition of a biomedical construction of safety onto a given local group, which does not share this construction of safety, can affect the local group. Specifically, this article examines the application of the biomedical construction of safety to the regulation and control of local nonbiomedical practices and practitioners in the rural Philippines. This twenty-two-month field research was carried out through interviews, focus groups, and participant observation within communities of four rural municipalities in the Philippines and with stakeholders at state and multilateral levels. The case study of the implementation of safe delivery through the insistence on in-facility birthing with “skilled birth attendants” and the cessation of training for traditional birth attendants provides an illustrative example of the need for more nuanced and complex understandings of safety and risk within any given context. This research identifies that the enforcement of an etic conception of safety onto any given group can, ultimately, compromise the safety of that group.