Paper short abstract:

Through twenty-two months of field and archival research this paper examines how rituals of safety are mechanisms by which dominant social orders are protected and identifies how the enforcement of an etic system of safety onto any given group may, ultimately, compromise the safety of that group.

Paper long abstract:

In the normative global health discourse, safety is represented as a concept that is universal, inherently beneficent and ultimately irrefutable. Yet, research at local levels in the Philippines problematises these assumptions embedded in the biomedical construction of safety. This paper examines how the imposition of an etic construction of safety onto a group can affect the group's health and well-being. Twenty-two months of field research were 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. Archival research and participant experience at the World Health Organization were employed to contextualise the global discourse of safety that, at least in part, can be traced back to the construction of biomedical expertise via the work of the Rockefeller Foundation in internationally establishing the hegemony of biomedicine in the early 20th century. The case study of the implementation of safe delivery in the rural Philippines through state 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 within any given health context and problematises the assumptions of local universality embedded in the global health discourse. This research examines how rituals of safety are mechanisms by which dominant social orders are protected and identifies how the enforcement of an etic system of safety onto any given group may, ultimately, compromise the safety of that group.