The persistence of the hegemonic and patriarchal healthcare model during women-centered reforms of Costa Rica's public health system

Abstract

This study examines how hegemonic medical models and patriarchal structures persist within healthcare reforms ostensibly designed to promote women-centered maternity care. Following obstetric violence complaints in Costa Rican public hospitals in 2015, health authorities developed a comprehensive maternity care model based on nine principles, including human rights, gender focus, and person-centered care. We analyze the tensions between reform intentions and implementation realities through in-depth interviews with ten participants representing three stakeholder groups: policymakers who formulated the model (n = 3), clinicians who implemented it (n = 4), and feminist advocates (n = 3). Data collection occurred during 2020–2022 at the implementation site of the Puntarenas Hospital in Costa Rica. Through triangulation of perspectives, we demonstrate how the authoritarian medical habitus persists despite explicit reform efforts, with women continuing to be perceived as objects rather than rightsholders. Our findings contribute to social science theory by illustrating how biomedical hegemony absorbs progressive reforms while maintaining fundamental power relations, confirming Menéndez's theories on medical hegemony and bringing Bourdieu's practice theory into healthcare institutions. We argue that transforming maternity care requires addressing both individual practices and the structural conditions that normalize obstetric violence, advancing theoretical understandings of institutional change in gender-based healthcare contexts.