Understanding Positionality and Reflexivity in Scholarly Writing

Midwifery, and by extension, midwifery research, exists within a complex social and political context. The ideation, construction, conduct, and presentation of midwifery scholarship are embedded in these structures, as well as the researchers and research participants who contribute, in varying ways, to the construction of the work. Positionality is understanding one's social identities and how these identities influence our interactions with others. Reflexivity can include examination of one's assumptions, biases, and blind spots.¹ Seeing things from multiple perspectives expands knowledge beyond the researcher's lived experience. Positionality and reflexivity are important in both qualitative and quantitative research.

Midwifery is built on the foundation of having the knowledge to address issues such as social determinants of health, racism, and other sources of inequity. Health care practitioners are increasingly aware of the societal structures that exist in our health care system and that influence health outcomes. Similarly, researchers need to be aware of the structures that exist within the research context to address health equity.

Our experiences shape who we are. Messages received since childhood shape our perception and understanding of the world. When generating knowledge to inform midwifery practice and education, it is important that we stay true to the realities of those we care for. The research findings should reflect their perceptions to inform how we understand the challenges and circumstances, and not be limited by our own perspectives.

Systems of power and oppression are built into the systems within which research is conducted. Underlying assumptions about value and importance that determine what is being studied (ie, what health conditions), who is being studied (what populations), and how it is studied (what methods) are determined by those who hold the most power (researchers, funders, authors, journals, and editors). These systems can be challenged only if we are aware and acknowledge that they exist. These include not just racism, but sexism, classism, and other forms of marginalization that can intersect within individuals. These oppressive structures are embedded so deep in our society that, as researchers, we may unknowingly become a part of these systemic issues and cause unintentional harm throughout the research process.

Qualitative research often involves direct contact between researchers and participants in dynamic data collection in the form of interviews. The researcher is the instrument of data collection when there is an interview. Similarly, the researcher is intricately part of the analysis and interpretation of findings. Interviews can be impacted by the lenses that interviewers and participants bring to the interaction from their social identities, past experiences with the topic of interest, and level of trust that the participant has in the researcher. The researcher needs to be aware of their positionality to prevent unconscious bias throughout the research process.

Sources of bias are unavoidable, even when researchers and participants share identities. For example, participants may leave some assumptions unspoken, assuming that the researcher has a shared experience, thereby minimizing the diversity of experience within communities. On the other side, researchers who are outsiders may miss nuances and subtleties that are lost to the researcher who lacks the context of understanding.³ Thus, the positionality statement will be incomplete if it merely states the social identities of the researchers without elaborating on how the research team investigated, questioned, and addressed the power dynamics and sources of bias that can influence the collection, analysis, and interpretation of data.

Positionality and reflexivity statements have been incorporated into guidelines for reporting qualitative research and are therefore expected in these types of research. This expectation is codified in the Consolidated Criteria for Reporting Qualitative Research⁴ and the Standards for Reporting Qualitative research.⁵ All forms of scholarship, including quantitative studies and reviews, benefit from increased transparency. Although these statements are expected and codified in qualitative reporting guidelines, they are encouraged in all research processes.

The assumption that quantitative research is purely objective and disconnected from the researchers is pervasive.⁶ The same opportunities for bias exist, including the choice of research questions and topics, use of research instruments, and what sources of data are available. The composition of the research team may influence the approach to understanding phenomena by focusing on individuals at risk or societal structures, who is included and excluded from data sets, and interpretation of findings. The problems of the ownership of data and control of dissemination have been highlighted in areas of genetic research and Indigenous studies.⁷ As editors of the JMWH, we recognize our own positionalities in our work as midwifery researchers.

LC identifies as a Black woman; descendent of enslaved Africans; nurse-midwife; scholar, educator, historian, artist, and poet; and mother of a 14-year-old Black male. I recognize the privileges I have and acknowledge the structural barriers that I will face.

IKG identifies as Jewish American of Ashkenazi descent and White; male; nurse and nurse-midwife; husband, father, and grandfather; and as an educator and life-long learner. My understanding of the world is influenced by all of these positions, and I strive to balance them with centering the experiences and perspectives of patients, research participants, students, and colleagues.

Examining our positionality helps us to identify and understand how our privileges influence how we are perceived by society. We often do not have control over these perceptions, but our awareness helps us see how our scholarship could be influenced. It is not about forcing people to share identities that they feel uncomfortable with sharing as we continue to learn about ourselves on a daily basis. To alleviate concerns about introducing bias in the review process, authors may mask their positionality and reflexivity statements in part or in full. At JMWH, we expect that the inclusion of this content will increase awareness of the contexts in which all forms of scholarly work are created and enhance the quality of published articles. We anticipate that this expectation of positionality and reflexivity will be the norm in midwifery scholarship.