Sarah Kaddoura is a Palestinian feminist researcher, activist, content creator, and organizer. Based in Madrid, she is currently working towards a PhD focused on the Arab manosphere, and facilitates political education teach-ins with South Feminist Futures. She also analyses social movements and contemporary debates through the lens of feminist theory on her YouTube channel, Haki Nasawi.

In this interview for The Fifth Wave Institute, we spoke about the roots of her feminism, starting in Lebanon where the exploitation of domestic workers is a key issue for activism. We spoke about funding streams, how they boost masculinist groups and build structural barriers to feminist organising; about the violence faced by women in Gaza, and the risks of romanticising their pain.

Sarah’s words open paths of reflection into how a feminism rooted in care, community, interdependence and collective liberation offers an opportunity to go beyond the often narrow confines of Western liberal structures, and build new bridges towards each other.

What was your introduction to feminism?

I grew up in southern Lebanon, in the fairly conservative town of Saida. Before even knowing what feminism was, I always felt a strong sense of injustice. My father passed away when I was eight, so I was raised by my mum in a society that puts a lot of pressure on women and mothers, particularly widows. I was raised differently to my brothers – I didn’t have theory to back it up, but I could tell from daily interactions that there was a double standard. I became curious about what life could potentially be without the control of certain powers and norms.

My first proper interaction with feminist ideas was online. At the time, in the early 2010s, Tumblr brimmed with people sharing their experiences, their understanding of gender, women’s rights, sexuality. Many of those discussions challenged my ingrained principles.

Then, in 2013, I moved out to go to university and started to read feminist literature through the library there. I also had an incredible philosophy professor who made us read classic feminist texts. There were gradual levels of learning and finding my space within the movement.

Eventually, two of my friends and I co-founded an intersectional feminist club. We hosted readings, conferences, panels on feminist resistance and liberation. We were the first on campus to really broach the status of the LGBTQ+ community, the promises and limits of what could be achieved through legal change. Those were some of the harder conversations, as there was a lot of policing of how openly we could discuss these issues.

Through the club, we connected with other groups working in Lebanon. Anti-racist organisations came to speak to us about decolonial frameworks, especially with respect to Palestine; and migrant domestic workers’ (MDW) groups gave us lectures on global chains of care and the sponsorship system.

The sponsorship or ‘kafala’ system, which is directly rooted in the misogynistic devaluation of care work, is a key issue for feminist organising in Lebanon and other countries across the region. Could you explain how it works?

The kafala system refers to the employment structure of migrant workers in countries like Lebanon, Jordan, the UAE, Oman, and Kuwait.1 It involves binding the rights of a foreign worker to their employer, granting the individual ‘sponsor’ full decision-making power over their wage, their work hours, their ability to change jobs, travel, and access healthcare. As you can imagine, such a steep power imbalance is ripe for abuse and exploitation.

The system explicitly differentiates between the labour of domestic workers and that of ‘regular’ migrant labourers, with the former – overwhelmingly women – having even less protections, if not none at all. Say a wealthy Lebanese family wants to hire a cleaner: they will go to a recruitment agency, ‘pick out’ a woman, then be handed her passport, visa, and often also confiscate her phone to prevent her from communicating outside the home. It’s essentially a form of modern slavery.

Racial hierarchies play a role: female domestic workers in Lebanon mainly come from countries like Ethiopia, Sri Lanka, and the Philippines – but anti-Black racism means it’s more expensive to hire a woman from the Philippines than from Ethiopia. These countries’ embassies also participate in the dehumanisation and exploitation of their people: some lobby for the protection of their citizens, but most ignore their pleas.

Given the particular exploitation of women that the kafala system enables, dismantling it has been a central priority of Lebanese feminists. One emblematic group is the Anti-Racism Movement (ARM), a collective of feminists organising around migrants for “social, economic and gender justice”. They opened a migrant community center for MDWs to meet, socialise, learn new skills and advocate for their rights.

Another prominent organisation is Egna Legna Besidet (which roughly means ‘from us migrants to ourselves’ in Amharic), which is run by Ethiopian domestic workers and helps other MDWs access judicial support, workshops, and runaway assistance in Lebanon, as well as vocational training in Ethiopia for those who return. They were instrumental in distributing aid to MDWs during the financial crisis in Lebanon.

Despite these efforts, the situation hasn’t structurally improved. There was an attempt to put together a migrant domestic workers’ union back in 2015 – but the government detained and deported most of the people involved. And in any case, the wider conjecture is unfavourable to all organising: the banking crisis, the global funding drop, and the war with Israel have all led to the dismantling of militant spaces and the expulsion of many activists. Many MDWs themselves left when the crisis hit.

You’ve written about how some Arab feminist movements are increasingly adopting discourses that repackage conservative positions. Why is that?

It’s the result of a parallel process: the amplification of digital feminism on the one hand, and the disappearance of grassroots activism on the other.

In Saudi Arabia, for example, for many years there was a strong cyber feminist movement fighting for the right to drive and against the guardianship system – which treats women as legal children under the authority of their male relatives. Because the country is an authoritarian monarchy, the movement was mostly confined online, yet they managed to remain meaningful.

Then, in the last few years, the relative opening of Gulf countries came with some legal changes to the status of women, including the right to drive and lowered mobility restrictions. Yet at the same time, feminists who had pushed for this change and had already been organising on the ground were arrested or deported. Tens of feminist activists and human rights defenders, many of whom are still in prison today, paid the price for the liberalisation that MBS now takes credit for.

This led to the emergence of a new kind of ‘state feminism’ that supports women’s rights to a certain extent, and only insofar as they align with a patriotic, anti-migrant, classist discourse. A feminism without class-based analysis can never build solidarity around issues of care, like domestic work – which as we’ve seen mainly concerns the exploitation of poorer women. And indeed, you don’t see the struggle of MDWs appear nearly as much in the Gulf as it does in Lebanon.

Moreover, on top of being instrumentalised by the state, exclusively digital feminism ends up so detached from its local reality that it simply regurgitates Western discourses trending online. It’s not just the case for the manosphere, it’s the case for feminists. Its only exposure ends up being to notions like the ‘divine feminine’, ‘natural submission’, feminine and masculine ‘energies’, or movements like trans-exclusionary feminism. In other words, the lack of grassroots third spaces and democratic organising yields a feminism that often repackages patriarchy.

An example of this is sex work: when you’re never exposed to people’s lived realities because your involvement happens mostly online, you don’t have the full picture. I completely understand where abolitionist positions come from – but when feminists don’t physically meet or speak to sex workers, don’t witness their efforts to unionise, they can end up being outright dehumanising and humiliating to them. They might pin the responsibility of the industry on the women involved in it, or exclusively point to solutions like the Nordic model without considering how violently it impacts certain categories of women.

If you don’t organise alongside people, if you are never made to feel uncomfortable in-person and have to work through those conflicting feelings, you can end up taking a less challenging position that appeals to a sort of abstract morality.

You’ve spoken about how the genocide in Gaza, and the networks of solidarity that developed both within Palestine and outside it, are reshaping feminist discourse in the Arab world. In a video for Oxfam, you warn of the risk of excessively romanticising the “resilience” of women in conflict situations. Could you elaborate on that?

In communities with a high death toll, who face immense violence, who are under occupation, and where the loss of children – young or old – is a very common thing, people often turn to women for hope.

Similarly, we on the outside have this image of women as resilient through loss, who keep bringing children to life despite the horror. It’s often an understandable coping mechanism, but it’s a dangerous trope to be stuck in. It’s easier for us to take a backseat, look at these people’s suffering and think, ‘wow, they’re so powerful, courageous, resilient’. It alleviates some of the guilt of not being able to put an end to the violence.

Along with the loss of their loved ones, we mustn’t forget that these women are still exposed to the daily encounters of patriarchy. Sexual harassment and violence are made much worse in moments of precarity, during moves for shelter, in encounters with Israeli soldiers at checkpoints.2 Each family in Gaza had to move over ten times during those first two years, living in tents and makeshift camps.

Moreover, if a woman has lost her husband and older sons, she has to put herself out there to find shelter and food, things that men typically would be expected to do. That puts her at further risk of exploitation.

On top of all that, you have to navigate the demands of reproductive and sexual health: pregnancy, abortion, miscarriage, period pain, all without available medication or anesthesia. I was moderating a session with a couple of women journalists from Gaza recently, and they spoke of how things we usually take for granted suddenly feel hugely dehumanising: not having a space to change away from prying eyes, sharing bathrooms, the lack of basic hygiene, the lost privilege of having a shower. Small, intimate details of daily life that get lost in the big picture.

So the ‘resilience’ trope often ends up painting a one-dimensional image of what it’s like to be a woman living through war and genocide. These women’s lived reality goes far beyond the responsibility to keep everything and everyone together. That isn’t to say this war is any easier on men – but there are different layers to the experience.

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Your PhD research focuses on the Arab manosphere.3 Do you have any initiatives in mind across the region that successfully engage young men in the fight for equality?

In Lebanon at least, we have a long history of such initiatives. There is an organisation called ABAAD, which specifically works on including men in its campaigning, and offers workshops that help build non-violent forms of masculinity. Their ‘Men Centre’ also has a hotline specifically for men to receive support.

But I think that work will always be lacking – not in the sense that it’s not important, but that it should be happening on a much wider level than what can be achieved through NGOs and workshops. It should be an integral part of our curriculums, in schools, at university; in all of the media we consume. We can and do create alternatives, but it’s still limited; we’re still exposed to endless cultural productions that reproduce misogyny and rape culture.

There’s also only so much discourse can do: it’s really hard to reach young men when their distress is rooted in material conditions, in unemployment and precarity, and when endless amounts of funds are spent pushing the opposite attitudes at them. In Lebanon for example, there is a Christian fundamentalist group called Jnoud al-Rab (Soldiers of God), funded by a banker whose banking group was partly responsible for the financial crisis. They’re these macho men with big crosses, roaming the streets and producing social media content warning of moral degeneracy, anti-Christian values, LGBTQ conspiracies and low-value women.

It’s important to remember that these manifestations of violence, whether digital or IRL, are not as organic as they’d like to seem. They play on the fears, the anger, the disappointment of young men while being directly funded by the people causing these feelings. The banker I mentioned has strong connections to the US far-right; it’s an interlinked global network of funding. Ironically, they don’t struggle at all to organise across North and South! It’s primordial to turn our eyes there, and not just at the outcomes expressed by individual men.

Individual men, however, do have a responsibility to be actively engaging boys and other men in their communities. The same way that we, as women, often share experiences with each other, discuss feminism in subtle ways from quite a young age, challenge each other’s thought patterns as we grow up. Men should be doing that work with their nephews, their sons, their colleagues. It will have a much more lasting resonance than an anti-sexist workshop ever could.

Can feminist solidarity with and across the Global South help us build a feminism that is more about the collective and interdependence?

Historically, feminist movements across the Global South have been very intersectional, drawing on decolonial struggles, working towards collective liberation and being critical of liberal feminism’s focus on individual success and personal choices.

However, they also have to operate in a context marked by the heavy presence of NGOs. Take Lebanon: for such a small country, we have thousands of human rights and feminist NGOs. It’s not surprising, since these thrive in environments where social safety nets are lacking. There’s a gap to fill.

But the problem is that it can cause organising to fragment. Instead of having collective logics for radical action, it risks segmenting each struggle into neat boxes, with each organisation competing for funding by putting forward their niche.

Funding is of course also an issue. These NGOs are both local and international, but the money is mostly Western. It’s a new form of imperialism, where populations in the Global South are dependent on fluctuations in Western political trends and funding cycles to have their needs met. USAID was obviously a massive source of cash, and thousands of people have now been left on the street or without support since it’s been cut.

German funding, for example, typically comes with a lot of policing around politics, especially with respect to Palestine and occupation. In the last few years, we saw many German-funded organisations suddenly fire people, cut resources, or change their policy about what can be spoken about and who beneficiaries can be.

Not only does this model impact what kind of organising can take place, it also puts feminists in very awkward positions. Say an organisation you’ve contributed writing to or has supported one of your community programs posts a really dehumanising statement about Palestinians. You start being seen as an outsider. You can lose the trust of your community, something conservatives want to see happen.

This isn’t just German funding – it can be US funding or other European countries. It happened in Iraq, in Afghanistan, on other feminist issues like LGBTQ+ rights or abortion (with the Global Gag Rule).4 It serves to drive a divide between feminists and the communities they come from.

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I’m currently working with an organisation called South Feminist Futures (SFF), in their political education program. It’s been a wonderfully formative experience. It’s the first time I’ve been truly engaging with the work of feminists from all over the Global South, mobilising along with them. I’m in touch with many people from Latin America, Africa, Asia, whose work you might miss if you don’t actively look for it. Because the models they propose are not the mainstream.

There are people in Brazilian favelas planting these huge community urban gardens, where women and gender-nonconforming people in particular can cultivate, protect each other, and organise against incarceration. There are women-led solar cooperatives and startup incubators emerging across the African continent, for whom it’s a deeply feminist issue to challenge IMF standards that present as “gender-sensitive” and liberatory but barely take the reality of care work into account.

I’m exposed to a world of feminist organising that does not compromise on its ethics, that takes place outside of the structures we tend to get stuck in, yet also works to push those structures to evolve. There is much to be learned from it.

The last two years, as sad and terrifying as they have been, have also opened a space for many people to rethink their methods of action, meeting across the Global South and with organisers from the Global North. We have an opportunity to connect more meaningfully than we ever have.

In this vein, who are some international feminist thinkers you find inspiring?

I like the work of Verónica Gago, who is based in Argentina. She was very active in the social movements sparked by the 2001 debt crisis, and is one of the leaders today in the country’s #NiUnaMenos (Not One Less) movement against femicide.

Selected text: Feminist International: How to Change Everything. Verso Books, 2020.

There is Sylvia Tamale, who I got to work with through SFF. She’s a Ugandan lawyer, sociologist and activist, and the first-ever woman to be Dean of Law at Makerere University.

Selected text: ‘African feminism: How should we change?’ Development, 2006.

There’s the essential work of Nada Elia, a Palestinian feminist writer and theorist who writes on internationalism and solidarity.

Selected text: Greater than the Sum of Our Parts: Feminism, Inter/Nationalism, and Palestine. Pluto Press, 2023.

And finally, I can’t miss an opportunity to give my friend Islam al Khatib a shout-out. She works on surveillance technology and the tech industry in the region from a feminist and decolonial perspective.

To wrap up, the question I always ask: Who do you care for, and who cares for you?

I care for my partner and he cares for me. In our world right now, at this stage of our lives as recent immigrants, we mostly have each other. We put all the care we have into each other (and into our gorgeous orange cat).

We are also nourished and sustained by the years of care we both received and poured within our families, within our friendships. In the context of war and financial crisis, the last few years have been full of a profound care I don’t think I would have survived without.

Further resources:

• Know your African Feminists by the African Feminist Forum (AFF), a great resource to explore five decades of feminist activism across Africa.

• South Feminist Futures’ knowledge hub.

• Resources from the Palestinian Feminist Collective.

Claire Favre is a clinical psychologist in the Varennes-le-Grand Penitentiary Centre in Burgundy, France, and an associate researcher of the Psy-DREPI lab at Bourgogne Europe University. She also trains professionals in addressing domestic violence for Solidarité Femmes 21, a victim support charity.

In a recent paper, she examines the growing intrusion of the carceral system into therapeutic relationships within prisons, and its ethical implications for her practice.

This interview for The Fifth Wave explores a central question, whose relevance goes far beyond the penal context: what does it mean to care in an environment defined by its violence?

Interview conducted, written and translated from French by Mélina Magdelénat.

What led you to become a prison psychologist?

A class on totalitarianism in middle school. Specifically, we read Death Is My Trade by Robert Merle. The novel tells the story of a Nazi officer tasked with finding the most efficient way to exterminate Jewish people — the ‘final solution’. He sees himself as trapped by an impossible choice, a classic illustration of Milgram’s obedience to authority experiment.

I discovered that people could commit atrocities without being inherently monstrous. Later, I explored this further through Eichmann’s trial and Hannah Arendt’s work on the banality of evil. I wanted to understand why people do atrocious things; prison felt like a natural extension of that inquiry.

Early in my psychology studies, I got involved with the Génépi [the National Student Group for Prison Education, dissolved in 2021], a student association that provided classes in prisons, which Robert Badinter1 helped set up. Its name comes from a plant that grows where no one else goes.

Its central mission was to give detainees access to education – it’s worth pointing out that the average educational level in prison is equivalent to primary school. I taught French and Spanish there. But it also allowed detainees to discover that young people could voluntarily want to spend time with them, want to engage. Prison is a strange space; if we don’t talk about it, it doesn’t exist. People don’t necessarily think about what happens behind those walls.

The organisation’s secondary mission was to raise public awareness of prison conditions – that was the more ‘activist’ side. Through the Génépi, I visited several types of prisons and later did internships in a remand centre (for pre-trial detainees and short sentences) and a penitentiary centre (which includes a remand centre and a detention centre for longer sentences and convicted individuals).

Did the reality of prison match your expectations?

We were repeatedly warned about security: in the Génépi, we were regularly told to be very careful with detainees, that it would be dangerous, especially as young students. There was a lot of pressure on how we should interact with them.

But in my experience, the environment is so secure — in consultation rooms, there’s an emergency pedal on the floor or a panic button, guards patrol behind glass doors — that we’re actually freed from the responsibility of securing ourselves. We can truly be available for the person.

I’ve actually felt much less unsafe working in prison than, for example, in a community mental health centre on a Friday evening, more or less alone in the building, attending to someone who’s drunk or difficult. Similarly, some colleagues who work in the ER are a lot more at risk than in prison.

You later moved into research alongside your clinical work. Why?

As a young graduate, I struggled to find meaning in certain violent acts. The literature explains that there isn’t one type of violent act, but many — but I needed to push the reflection further, to understand, by turning to research.

During my studies, I read the book on violent acts by Claude Balier, one of the first psychoanalysts to introduce psychological care, including psychoanalytic approaches, into prisons in the 1980s.

I contacted him because I wanted him to supervise me. He was retired, but we formed a bond, and he became my informal supervisor for a long time. He encouraged me to do my thesis on emotions and violent behaviour. It was a very meaningful encounter.

I then started teaching alongside my clinical practice, so I wear both hats. It’s good to step out of the prison environment from time to time.

In your article Psychological care in prison: the importance of ethical reflection, you examine a certain “infiltration” of the judicial institution into the process of care2.

You cite an interview with Michel Foucault and Pierre Werner, where Foucault discusses the central role of medical practice in mechanisms of social repression: “As if punishing a crime no longer made much sense, we assimilate the criminal to a patient, and the sentence claims to be a therapeutic prescription.”3

How does this infiltration alter the encounter between caregiver and patient, which is essential to a true care relationship?

To take a recent example, a man told me at the beginning of a session, “The judge said I won’t go to trial until I’ve put meaning to my actions.” So he doesn’t come to the consultation to deeply understand the causes of his distress or his actions. He comes with an order, to tick a box.

Detainees struggle to imagine that our sessions could be solely for them, to relieve their suffering, rather than another instrument of the prison institution. It’s very difficult as a care professional to break free from this once the mechanism is set in motion. But on the other hand, we can understand that he wants his trial to take place, that he wants to move forward in his incarceration.

Many patients also ask us if we will write a report for the judge, because they think it might benefit them. But it can just as easily harm them. There’s confusion between care and expertise: we’re perpetually forced to reset the framework.

We regularly clarify in interviews that we have nothing to do with forensic psychiatrists, that we don’t write reports, that we don’t transmit information, that professional secrecy is preserved. We remind them that here, we are under the responsibility of the Ministry of Health, not the Ministry of Justice, which is the case for the rest of the facilities.

And a few months later, we have to clarify it again, because in the meantime, people receive conflicting instructions. Other intervenors tell them, “I’ll talk to your psychologist,” or ask them to work on a specific topic, rather than letting them come to me autonomously.

My mission is a public health mission, aimed at relieving suffering. The person works on what they want to work on. Often it’s around the violent act, but it can also be about relational and family issues outside, or about incarceration itself — living in nine square metres with a cellmate you didn’t choose to live with, yes, that can make you want to go mad.

We try to access the authentic in the encounter with detainees. And that’s very difficult when the person acts based on an external, institutional injunction. It’s only possible after we’ve explained to them at length that what they say will not leave our exchange.

It should also be noted that infiltration can go both ways: we, in the care world, can also, out of convenience, infiltrate the judicial. We can start wanting to know a lot of things about a patient, to have access to information that isn’t intended for us. Maintaining our stance requires real ethical rigour.

What risks do you see in approaching care in prison settings by categorising people based on what they did?

Categorisation traps people. Before even meeting someone, we’ve already formed a simplified idea of who they are.

Of course, it’s human nature. We need to categorise to understand, to reassure ourselves. But the risk lies in confusing penal and psychiatric categories — when within the “sexual offender” category, for example, there are many different psychological mechanisms. The same goes for domestic violence offenders or drug users.

The same act can reveal a very different cognitive structure: for one person, a reactivation of trauma; for another, psychopathy. It’s not the same approach to care.

Similarly, as the psychoanalyst Christophe Dejours shows, there are sexual crimes that are more about violence than sexuality, and violent crimes that are highly eroticised. That’s something the penal category might miss.

The risk, then, is having a “tell me what you did, and I’ll tell you who you are” approach. One day, I had an older man come in; and with the extension of the statute of limitations for sexual violence, we had many older men arriving in prison with convictions of that type. I admit that in my head, I thought he was definitely a sex offender.

And turns out, not at all, he had dealt drugs, even though he was over 80. I wasn’t the only one, by the way — everyone else also thought he was a sex offender. And that’s not well seen at all in prison: other detainees call them “pointeurs,” don’t tolerate them, mistreat them. The man had to ask prison staff to be allowed to carry his criminal record on him, to get others to stop bothering him and see him as the ‘grandaddy dealer’ instead.

To avoid these pitfalls, with my colleagues, we propose therapeutic groups that consider psychological symptoms rather than penal categories — for example, alexithymia, the inability to express one’s emotions.

It’s interesting to see how these categories not only trap people but also permeate social relations within the prison itself.

Yes, there’s a whole hierarchy. To caricature, at the top are robbers without blood on their hands, then dealers who don’t use drugs themselves, then traveler people, and so on. In some prisons, they almost have entire floors based on these categories; others are specifically designated for sex offenders.

So detainees don’t meet a person, they meet an act. That’s why I rarely ask my patients what they’ve done. Sometimes, it comes up after two or three interviews if the person wants to talk about it; but it’s not my mission. Many announce it immediately, very easily, because they’re used to being asked; in those cases, I often say, “We’ll talk about that later, I’d first like to know who you are.”

In prison, there are so few boundaries, the intimate systematically becomes extimate. My role is to help people put boundaries back in place. To make them understand that we can meet without necessarily being determined by the penal context.

This “forced extimacy” ties in to the notion you address in the article of a prison system that “traps patients in heteronomy4, not giving them the possibility to access physical and psychological autonomy.”

The fact that you help these people “put boundaries back in place” may seem counterintuitive to some — it requires us to question our ingrained punitive reflex that would deny a detainee any right to claim autonomy, especially a sexual offender who themselves took away another’s autonomy. But it’s essential if we want to build a society no longer enslaved to violence.

What strategies do you implement with your patients to allow them to maintain a semblance of autonomy and intimacy in the prison space?

To me, that’s partly what therapy is meant for. When patients have gone through a trial, they’ve been “narrated” by everyone else: their family, witnesses, sometimes even their kindergarten teacher came to talk about who they are. Therapy sessions are one of the rare places where they can “subjectify” themselves, tell their own story, make their own narrative without it being used for any purpose.

It is therefore vital to offer a secure framework. That’s why I reiterate the dimension of professional secrecy so much — something I wouldn’t necessarily do in other structures or workplaces. Autonomy is partly built through it.

The notion of “good care” as that which allows a person to regain autonomy is central to the construction of better care systems.

As philosopher Christine Leroy explains in her interview with the Fifth Wave Institute:

“Those who educate or provide care are often dominant when they should be supportive. (...) This dilemma lies at the heart of the difficulty of caregiving: does helping someone mean doing things for them, or enabling them to do things themselves? (...)

It’s not that the person isn’t autonomous; it’s that we deprive them of their desire for autonomy. Letting them try would require time and resources that are cruelly lacking. In this context, care – or what remains of it after hyper-rationalised costs and work schedules – often contributes more to the loss of autonomy than to its preservation.”

For a concrete example of a system that contributes to such ‘reablement’, see this Danish study on home care reforms5.

Autonomy also comes from breaking free from external injunctions coming from the judicial system or the family. On the contrary, we ask detainees: “What about you? What are your anxieties, your desires?” Without positioning ourselves as experts, without telling them we know what’s good for them. They have resources, we help them find them. Discovering a capacity to reflect on themselves will also help them when they’re back outside.

In the context of sexual violence in particular, it is often said that psychiatry is too mobilised in the judicial process, to the detriment of other explanatory frameworks for violent acts, like sociology. Do you agree?

There is definitely a difficulty in considering the patriarchal context beyond the individual context. Judge Édouard Durand said about incest, “We have freed speech, but we haven’t yet freed listening.” It’s true for all of society, whether it be about incest or rape or domestic abuse: people are not yet ready to hear that violence is systemic. There’s still a lot of work to be done.

I’m currently training in systemic therapy — a discipline that takes into account the environment, the competence of families, the competence of individuals, and how to activate them, to achieve more comprehensive care.

Systemic theory speaks of equifinality: there can be multiple causes for the same result. This aligns with Edgar Morin’s complex thought theory, which invites us to resist the tendency to simplify, to categorise. Having a field of practice shouldn’t blind us or confine us to a very linear understanding.

And at the same time, we always start from the principle that people are responsible for their actions. Reflecting on the reasons why a person acted violently never aims to excuse the violence.

You host workshops for Solidarité Femmes 21, a charity that supports victims of domestic violence. What’s the goal of these workshops?

We mainly train VIF (intrafamilial violence) networks in Saône-et-Loire and Côte-d’Or. The goal is that on the same territory, a set of professionals — caregivers, social workers, lawyers, police officers — can meet, exchange, reflect together, and coordinate care provision.

The workshops must imperatively be multi-institutional and multi-professional. Meeting each other allows for a better understanding of the limits of each other’s missions: in case of failed care, it helps avoid the pattern of always blaming others for not doing their job properly.

My colleague, who works with victims, and I with perpetrators, bring an important base of theoretical knowledge. This allows us to go beyond a very Manichaean conception of “good victims, mean perpetrators” as well as to constitute a common language within the network on one territory: what are we talking about when we talk about domestic violence? What are the different types, the different mechanisms?

Finally, understanding allows us to move from reaction to intervention. Domestic violence produces a high level of reactivity: we want the violence to stop as quickly as possible, partly because we ourselves, as professionals, can’t take it anymore.

For example, when some women return to their violent homes, care providers can get frustrated, because they don’t understand why. So in our sessions, we explain to them that these are not pointless back-and-forths that reset everything to zero but that at each stage, a little power has been gained, something has evolved, we can work on it.

Understanding allows us to work with, rather than against, the unique temporality of each person. Rushing them risks aggravating the situation. The workshops allow us to put the person back at the center, to make them the master of their life, and not to replay the violence they have experienced by ordering them what to do.

Do the workshops also include femicide prevention?

Yes, we work on assessing levels of danger. Beyond observed physical violence, coercive control and the context of separation are major risk factors. And one can be very controlling without being physically violent.

We also work on anticipating intervention: how to react if tomorrow, within my institution, I am confronted with a risk of femicide? For example, if I’m attached to the hospital, the lifting of professional secrecy is subject to rigid procedures, whereas other institutions approach it differently.

To explain a detainee’s journey, we often point to unidentified violence and missed opportunities for psychological or psychiatric care. Is this something you’ve observed?

Yes, our patients often grew up in contexts of violence and neglect. Childhood and its difficulties are very present. It’s often normalised: they say their childhood was “like everyone else’s”, but we quickly realise that wasn’t the case. And often, indeed, they themselves say that they might have turned out better if they had seen a psychologist earlier.

But we also have the wrong filter: we only see those whose paths have led them to prison. If we take domestic violence, for example, 70% of people who grow up in such a context do not reproduce it in adulthood. But I see those who, among the 30%, become perpetrators; and my colleague who works with victims sees those who reproduce the cycle in the other direction.

So we must not forget that beyond those for whom difficulties persist, there are those who are doing well.

Moreover, even if therapy occurs upstream, a certain mindset and living environment are also needed to truly work on oneself. Time must be freed up. Prison is obviously very heavy, but it also has a “parexcitatory” dimension: it isolates one from the external environment. Therapeutic introspection can therefore be made easier.

I work with a few people who’ve been released from prison, and it’s often complicated to maintain constructive exchanges; they are caught in other difficulties. So it’s a shortcut to say that if a person had been taken care of earlier, they wouldn’t have acted out violently — because even if they had benefited from therapy, they might not have been able to do it properly.

Finally, we also cannot place the responsibility for a violent act — or the lack thereof — on psychology alone. A psychiatrist colleague reminded me that some people can do intense work on themselves and reoffend, while others do none, but the sanction of prison will be enough to stop them reoffending. We must not see psychologists as a deus ex machina: when someone’s entire life context is violent, it’s never linear.

Finally, a question I ask all my interviewees: who do you care for, and who cares for you?

I take care of those we forget. Those we don’t see — they may be in the news all the time, but it’s not really them we look at, but rather what they did. Even within prison walls, I am very sensitive to the quiet ones, those we don’t hear. I’ve worked on the silence of emotions a lot, I’m particularly sensitive to it.

On the other hand, my team takes care of me. I couldn’t work without them. We operate in an environment with a lot of destruction, so it’s vital to have pockets of support. Supervision, in particular, plays an important role for me, to be able to put thought back into lived experiences.

Finally, in the context of care, we are very exposed to compassion fatigue and vicarious trauma. We must therefore implement practices that take care of us: reading light things, spending time with family, creating a soothing environment. It’s vital to have the space to do this.

Thank you for reading this interview. If you know care workers, caregivers, policymakers, researchers or other actors invested in the construction of better care systems, don’t hesitate to share our work with them. And if you have suggestions of people you think we should interview, don’t hesitate to let us know :)

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Myriam Chatot is a sociologist working on family, gender, and health, affiliated with the Centre Max Weber in Lyon. Marine Quennehen is a sociologist focusing on family, gender, and prison, based at the Interdisciplinary Research Centre on Families and Sexualities at the Catholic University of Louvain.

Their book, “Being a feminist dad: mission impossible?”1, presents a central observation: there is a disconnect between perceived changes in how involved modern dads are, and a reality that remains deeply unequal.2

That disconnect stems partly from shifting reference points. Men compare themselves to their own fathers, relative to whom they are indeed much more present. But sociologists, feminists, and many women measure fathers’ involvement against that of mothers – who still bear the bulk of family responsibilities.

How can we acknowledge the efforts being made without obscuring the work that remains? Do the mainstream discourses around involved fatherhood strip it of its feminist content? Can institutions help us move beyond an exclusively two-person model of parenting? In this interview for The Fifth Wave, the researchers reflect on the obstacles still standing in the way of true feminist fatherhood.

Despite talk of significant shifts in fatherhood, you note that the time fathers actually spend with their children hasn’t increased all that much. And even when it is more evenly distributed, qualitative studies reveal persistent knowledge gaps within couples – dads can be very present yet shoulder little to none of the mental load.

Should we move the debate away from the notion of ‘involved fatherhood’ toward something more explicit, like ‘competent’ or ‘capable fatherhood’?

Marine Quennehen: The question would quickly become who gets to define what a “capable” or “competent” father is. If men define themselves as such, we’re back to the same problem: they may be more capable than their grandfathers, but they’re not necessarily as capable as their partners.

We’d need to clarify expectations: as sociologist Michèle Ferrand famously showed, being competent isn’t just about giving a bottle, but knowing the right amount of formula, how to wash, sterilise, and put away the bottle. Adding new categories without clear content risks leading to purely cosmetic change.

Myriam Chatot: When I hear “capable father,” I think of autonomy. That’s what emerged from my interviews with fathers on full-time parental leave: being alone with their child forces them into responsibility and self-sufficiency. Each couple can then set its own standards as to what being autonomously capable looks like.

As we argue in the book, the norms of “good parenting” are shaped by institutions and the upper-middle class. The risk with “capable father” is therefore also that it could become another way to stigmatise working-class fathers.

Because if these fathers are deemed “not capable,” it implies they need re-education, that programs must be put in place – when in reality, their limited involvement often stems from lack of time, economic resources, or cultural capital.

Marine Quennehen: The key is that fathers feel able to act, to care for a child without their partner’s oversight. The notion of autonomy helps confronts the reality of a fatherhood that happens mostly alongside the mother, the one really giving the instructions.

The language of education comes up a lot in the book: the “bad student strategy” [i.e., weaponised incompetence], women’s role as “transmitting parental knowledge”. There’s a kind of infantilization of men as attending “the school of parenting”.

Yet these same men routinely highlight their professional competence. They don’t see the contradiction between their infantilization at home and their autonomy at work. It’s a strange dissonance.

M.C.: It’s an inferiority that’s fully compatible with their masculinity because it’s tied to tasks themselves perceived as inferior.

A study from a few years ago on domestic chores in the military showed that these tasks were assigned to the lowest-ranking conscripts, those at the bottom of the hierarchy. When we had mandatory military service, that means we were teaching entire generations of young men that housework is degrading, uninteresting – and that it’s therefore only natural for women and those deemed inferior to be assigned to it.

So they understand there’s no prestige in these tasks. But this perception can also benefit men who do invest heavily in the private sphere: they are praised as heroes for caring about something others consider secondary.

You write that some discourses “capitalise on fatherhood,” making the subject increasingly consensual while erasing its feminist political dimension. But at the same time, isn’t that the inevitable fate of any social movement: as it becomes more mainstream, it gets diluted? Isn’t it still a feminist victory, regardless of whether it’s acknowledged as such?

M.Q.: It’s always positive that fatherhood is gaining importance. But outside certain social circles, I’m pessimistic about how widespread this consensus really is. Looking at the comments under recent articles about our work… There’s still massive resistance. Even when attitudes do shift, men are reluctant to call themselves “feminist fathers” or even feminists. The word is seen as scary.

There are notable individual changes. Some fathers adjust their careers, have real conversations with their partners about equitable parenting. But at the macro level, deep change is much slower.

M.C.: Feminist struggles have secured major victories in this respect, that’s undeniable. It’s now widely accepted that men should be more involved in the home. But what does “more” actually mean? That’s the question our book explores.

It looks like politics also has that kind of ‘flattening’ effect on the fight for equal parenting.

M.C.: Absolutely. One thing we don’t discuss in the book is the 2014 French parental leave reform, which reserved part of the allotted leave for the second parent. It was passed as part of the law on real equality between women and men, and hailed as a revolutionary measure that was going to change everything.

But when you look at parliamentary debates, the arguments revolved mostly around work. Supporters of the reform wanted to encourage women to return to the workforce earlier; opponents wanted to protect businesses and men’s role as breadwinners.

Either way, the well-being of parents and children, and factors that influence it like perinatal mental health, was barely considered. The central assumption was that both parents’ primary commitment should always be work, and that nothing should disrupt the economic status quo.

And by the way, unlike the German reform which led to 20% of fathers taking leave from a prior 3%, the French version had negligible effects.

For more info on this reform, see my analysis of why it failed:

The book notes that the perspectives of children themselves are often overlooked in discussions around parenting choices. You mention the case of a father who explained that his kids asked him to work less on Wednesdays, as he’d been given the option to; he replied that he couldn’t, or else they wouldn’t be able to go skiing or to sailing camp.

But at no point did he ask them whether they’d prefer spending Wednesday afternoons with their dad over an annual ski trip. The way these men articulate it, fatherhood often comes across more as a social role – a checklist of duties and tasks – than as the construction of real relationships with individual children.3

M.Q.: This came up clearly in my research on pilots and flight attendants. For men in these jobs, family is just one variable among many, far from a priority. They often see themselves as model fathers because their irregular schedules mean they’re home when others are working, and because they provide a high standard of living. They don’t realize what their prolonged absences mean for their children, for their marriage.

Female pilots and flight attendants, on the other hand, feel the weight of absence more acutely. They prepare everything ahead of their departure: meals, clothes, childcare, pick-ups and drop-offs; they choose flights around their children and to attend family events. Yet they’re accused of having “Disneyland jobs.” Their children complain that they don’t see them; school staff remark, “You look tired” or “We don’t see you much.”

They embody absence, while the father’s absence goes unquestioned. Their partners sometimes even weaponise the children’s words: “See, they’re sad when you’re not here.” Suddenly, the children’s perspective matters – but only to guilt-trip the mother.

M.C.: There’s no secret: an interpersonal relationship develops with time, listening, attention, availability – care, in short. The more present fathers are – whether by choice or because they were made to by a shift in trajectory – the more they pay attention to their children as individuals.

I had one participant who was overwhelmed by work, on the brink of burnout. His wife threatened to leave him because she was equally exhausted. To reorganise his life and his availability and preserve his marriage, he changed jobs. Thanks to that, his perspective on fatherhood changed, too: he got to know his children better, learned more about their actual personalities. Today, he picks up his eldest from school, they chat, his son jumps in puddles on the way home; it’s an important moment of connection.

This theme of an awakening after a crisis or “shift in trajectory” is a recurring one, both in the book and in cultural narratives. It’s that image of the father who realises – too late, after burnout, a fight, a divorce – that it wasn’t worth it, that he missed out on his children’s childhoods, that he asked too much of his wife.

How can we ensure it doesn’t take a crisis to spark this realisation?

M.C.: Unfortunately, these regrets are often seen as inevitable. I remember a survey a couple years ago that asked fathers of young children, “Do you feel you spend less time with your children than you’d like?” Nearly half said yes.

When asked whether this made them feel dissatisfaction, frustration, or guilt, dissatisfaction was most commonly picked, whereas mothers would be more likely to feel guilt. Many fathers feel trapped by their work arrangement and powerless to change it.

That said, it would help to have more transparent discussions about both the joys of fatherhood and its bitter regrets. In the book, we talk about fathers showing their joy at being dads, showing they’re present; one man told us, ‘Feminism has allowed us to be a truly happy couple’; others told me in interviews that they didn’t expect to love their children this much.

Sharing these stories is essential, and we also need more men to speak openly about what they didn’t do, how they could have done better – especially from older generations, for whom this feeling is widespread, to help younger generations avoid repeating their mistakes.

M.Q.: When we asked men about who were their “go-to” people they could talk to about what it’s like to become a father, few could name any. The advice they got from their male relatives and friends was usually, “Don’t worry, you’ll figure it out as you go, don’t overthink it.” And maybe in a way that’s good advice! But when there’s an asymmetry, it means one person is doing all the worrying and thinking. They socialise each other into a kind of conscious passivity, avoiding real reflection or admitting difficulties.

We need to encourage men to question the deeper dimensions of fatherhood earlier – how it transforms their inner lives and relationships. Women are expected to talk about motherhood; it’s an experience that’s passed down across generations. But you rarely hear a father-in-law sharing his parenting experiences with his son-in-law or giving him advice.

What would a truly transformative parental leave reform look like?

M.C.: Mandatory, well-paid, longer parental leave. A paternity leave aligned with maternity leave for essential co-presence early on, followed by staggered periods that can’t be taken simultaneously. As it stands, maternity leave still contributes to setting early asymmetries into stone.

With respect to work, we need to stop considering that it’s necessarily a person’s primary organisational concern – not everything has to be organised around work, work could also be organised around other areas of life. And we need to stop treating parenthood like a hobby you have to apologize for to your employer.

M.Q.: And beyond the focus on the parental couple, there’s a huge urban planning challenge to rethink our modes of living and inch towards more collective spaces.

Our current spaces aren’t designed for children to move around independently, to be autonomous; commute times can be long, communities are spread out. Relying on other parents or family is harder when people live far apart, but it can lighten the load and give children a network of support and role models. We need to move away from the idea that child-rearing rests solely on two people.

The risk is that even the work of maintaining community-based models tends to fall to women. Some people advocate for introducing “grandmother leave,” for example, without realizing that they’re still assigning all care work to women, just of a different generation.

M.Q.: Exactly. We have to ask: who sustains the village? And we need to adapt institutions to this new paradigm. I’ve heard from fathers who had to insist and argue with daycares to be listed as equal contacts on their children’s files. Some couples create shared email addresses, because we’re not used to sending child-related information to two people. But we have to ensure the shared address doesn’t by default become the mother’s.

M.C.: Systematically informing fathers could also help working-class men who can’t be at school pickup. If they had access to information, they might feel more involved, ask questions, and strengthen their bond with their children. This would expand the notion of “presence” without reinforcing unequal norms.

Finally, who do you care for, and who cares for you?

M.C.: I care for my parents, not in a daily way because they live autonomously, but psychologically. I try to help them articulate things, open up about unspoken feelings, especially my father. It’s a generation that doesn’t talk, so there’s a kind of reverse socialisation involved in getting him to express himself. And as for me, my friends and partners take care of me.

M.Q.: I care for my partner, my roommate, and my rabbit. They’re my daily companions. To care for me, I can count on my friends, who are very feminist and deeply care about care; and I can count on my partner, too.

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Christine Leroy is an associate professor of philosophy at the École des Arts de la Sorbonne (Paris I University) and the University of Lille (STL lab). Her book Kinaesthetic Empathy, Ethics and Care: A Phenomenology of Dance1 offers a reflection on the embodied roots of our concern for others: without the body, there is no care.

From palliative care and disability rights to the place of motherhood in feminism, Christine’s interview with The Fifth Wave Institute examines how an ethic of care can enrich our collective ability to carve out space for alterity.

Pour lire cet entretien en français:

Your master’s thesis focused on the history of euthanasia and its moral stakes for today’s societies. What does an ethic of care bring to the discussion?

It points to a troubling gap: that between the state’s investment in the right to die and its disinvestment from care that helps people live better. It considers three perspectives in particular: that of disabled people, that of care professionals, and that of the individuals themselves facing the end of their lives.

Drawing on arguments laid out by disability rights activists, sociologist Patricia Paperman – a key figure in the dissemination of care ethics in France – points out that disabled individuals are regularly encouraged to consider suicide, through back-handed remarks like “you’re so brave; I couldn’t live like you”.

It does indeed take immense courage for disabled people to assert their right to exist and the value of lives that defy conventional norms. Lives with disabilities are costly for society; the state’s withdrawal of support discourages access to medical assistance, subtly pushing people to prefer death to a life lived in undignified conditions.

The choice of assisted suicide, then, is not always free, despite what theory might suggest: ultraliberalism devalues disabled human life, placing extreme pressure on those deemed ‘unnecessarily burdensome.’

Far from this being a traditionalist or reactionary position, many radical-left activists like No Anger, a queer, anarchist, and disabled artist, or Elisa Rojas, a poly-disabled lawyer and activist, have been sounding the alarm.

Deeply invested in fighting for the recognition of the right to vulnerability, Rojas sees France’s proposed euthanasia bill as a betrayal by the left of disabled and marginalised people. To her, the legalisation of euthanasia would mean the surrender of humanist values to the pressures of economic liberalism.

As for care professionals, though few would openly admit to it, many know they have sometimes wished to forever silence those difficult and sometimes unfriendly bodies – if only in a fleeting, quickly suppressed thought. This is especially true given the exhausting working conditions in hospitals. And unlike procedures like abortion, which is only legally allowed under highly regulated conditions, current euthanasia legislation authorises without truly prohibiting.

It is therefore extremely anxiety-inducing to place this burden of life or death on caregivers – who already often face precarity themselves – while simultaneously keeping palliative care underfunded2. We cannot emphasise an ethic of care without acknowledging the suffering that legislative decisions can inflict on those who provide care.

Finally, from the perspective of those nearing the end of their life, practice once again clashes with theory. My grandmother is in a nursing home. Every day, she says she wants to die. But when the nurses make a mistake with her medication, she shouts, “They’re trying to kill me!” Does she really want to die? It seems to me she would rather live better. She feels condemned to isolation, lacking any sense that she matters to anyone. She wants social connection, relationships, and life around her.

As a philosopher working on care and someone who espouses left-wing humanism, I see the legalisation of euthanasia in its current form as dangerous. But nothing is either simple or final when it comes to death: I once had a deeply painful experience with a great-aunt who, after a stroke that left her able to move only her left eyelid, tore out her own feeding tube. She took her own life, in a way.

The debates on euthanasia remind us that death is at the heart of our lives, despite neoliberalism’s vast efforts to distract us from that fact. Applied to the end of life, an ethic of care calls for humility rather than certainty, while challenging us to be critical in the way we view solidarity. I do not believe we should force individuals to live, but I do believe we must listen to their pain rather than turning away and telling those who suffer to be forever silent.

Your book ‘Kinaesthetic Empathy, Ethics and Care’ argues for a particular care dynamic in the experience of dance. Where does this idea come from?

My own dance practice was never very caring. Trained in classical ballet, I developed a complex relationship with my body. The body is not something you manipulate like a pen: it sometimes does what it wants, and when the mirror does not reflect what you hope to project, you enter into a conflict with your own body.

And yet, paradoxically, even if you torture yourself to achieve a perfect arch, even if your feet bleed from friction in your pointe shoes, you also take great care of your body to make sure it moves in the desired way.

I had to stop dancing due to repeated fractures—sometimes, the body also breaks—and for a time, I could only watch. I found something in it that went beyond pleasure, a kind of balm for the soul, but I couldn’t pinpoint what.

I was particularly moved by the momentum, the lift, the sensuality of grace… It was neither purely intellectual nor merely aesthetic, but ethical: watching dance was good for me, regardless of the beauty of the choreography. It seemed to me that between what I saw and what I experienced, something akin to care was at play.

In the book, you write: “Ethics consists in restoring to the individual their human dignity; […] such care is a vector of cure in the therapeutic sense, its foundation: there can be no healing without the patient reclaiming their own body; to heal is precisely to move from the state of the patient—etymologically, one who suffers passively—to that of an autonomous agent.”

In contexts like disability, where the notion of autonomy differs from that of an able-bodied person, what does it mean to say that caring is about restoring someone’s autonomy or agency?

I think it is important to caveat that theory does not always hold up well against the harshness of reality. There is often more hope than reality in what I write.

That said, in contexts of reduced autonomy, such as disability or early childhood, we often face a dilemma: should we do things for the other person – which is obviously more efficient with respect to the end result – or should we accept that they are slower, less precise, and help them act?

When developing the concept of “portance” (carrying, support) philosopher Emmanuel de Saint Aubert borrows from theology the idea of an “all-sustaining” rather than “all-powerful” God: omnitenens3 and not omnipotens. Those who educate or provide care are sometimes too dominant when they should be supportive. Saint Aubert draws on osteopathy: when held from below, a baby will lift up their head. If you need someone to rise up, it’s better to support them than to try to pull them up.

This dilemma lies at the heart of the difficulty of caregiving: does helping someone mean doing things for them, or enabling them to do things themselves? It’s the basis of educational methods like Maria Montessori’s: if a child needs help, they’ll ask for it. Only help if asked, and never deprive a child of the desire to try for themselves.

For caregivers, it’s even harder to accept the slowness of a disabled person because everything has to be done quickly. It’s tough to accept the mediocrity of a gesture when you’re the one dealing with the consequences: if the person’s hand is shaking and they risk spilling everything, you’d rather pour the water yourself.

It’s not that the person isn’t autonomous; it’s that we deprive them of their desire for autonomy. Letting them try would require time and resources that are cruelly lacking. In this context, care – or what remains of it after hyper-rationalised costs and work schedules – often contributes more to the loss of autonomy than to its preservation.

Toward the end of the book, you write: “To exist for oneself, to give oneself form, is not to tear oneself radically away from a whole in order to face it, but to participate in it in one’s own way; to contribute ethically to the community is not to melt into it but to take up a unique, irreplaceable place within it.”

This passage echoes the parallel with dancing, where one can be simultaneously part of a whole and detached from it in a singular way. Binary discourses are rife on the tension between individualism and community, so it’s really interesting how this idea reconciles the two: we can be “irreplaceable” within a group, carve out a distinct place for ourselves through our contribution to the collective.

This is the direction my work is taking today. I’m trying to show that the common opposition between individualism and community is often not an opposition at all. It’s really two forms of individualism: a self-sufficient, sterile individualism on the one hand, and a fusionary individualism on the other, where identities and the uniqueness of individuals dissolve into a pathological indistinction. This is not a community but a vague amalgam of individuals.

To move beyond this opposition, I explore the idea that one cannot be unique without others: alterity must support, rather than erase, singularities. As philosopher Edith Stein argued, for empathy (Einfühlung) to exist, for there to be a relationship, there must be an awareness of separation. Without otherness, there can be no relationship. Similarly, for there to be a group, there must be individuals; but without separation between individuals, between self and non-self, there can be no true bond between subjects, and thus no collective.

Many well-meaning contemporary discourses ignore this human need for separation. Social media, which perpetuates the illusion of a loving collective, erases the boundaries between people, intrudes into the private sphere, and blurs the lines of intimacy. This is extremely anxiety-inducing and fuels a desperate need for barriers, for borders, which escalates into xenophobia and paranoia about “intruders” that threaten one’s identity. A lack of healthy otherness leads to dangerous othering.

The only ‘border’ that can remedy this social and nationalist anxiety is separation, distance between individuals, and the reinstatement of space and time for private life. These are essential conditions for creating liberating connections.

This dichotomy seems to reproduce the one between a total lack of concern for the other and a ‘pseudo-care’, a suffocating care, which Maurice Hamington calls ‘bad care’4: “I’m helping you, I help you so much that you no longer exist, only I exist”. There must be a middle ground. An ethic of care isn’t about everyone getting along and being nice: it’s an ethic that emphasises the relationship over theoretical norms about what one should or should not do, about what’s good and what’s evil.

But for there to be such a relationship, there must be distance between two distinct, separate poles. If we do everything for someone else, we’re not respecting this distance: we absorb difference into unity. Without true listening, there is no bond, no care. We must value distance, difference, otherness without othering: it’s a sine qua non of good care, care which respects both the caregiver and the care-receiver and leaves space for an encounter.

In a 2021 article titled “Killing the Mother”, you speak of a “symbolic matricide in the feminist quest.” What do you mean by that?

Feminism is to me first and foremost a struggle against male domination, which imposes itself on women and gender minorities through violence. Since this violence primarily comes from men, feminism understandably harbors a certain mistrust of men, who are more likely to be violent or dominant. And I can only agree – there was a femicide in my family.

But I also sense that within feminism sits another equally complex and difficult-to-articulate struggle between generations of women. For example, after Simone de Beauvoir’s generation fought for women’s rights, the following generation, that of Judith Butler and Monique Wittig, sought to challenge the idea that categories like “woman” and “man” could be so easily defined as mutually exclusive.

The next generation, in turn, revalued non-Western and sometimes essentialist or matriarchal conceptions of what it means to be a woman, as seen in Latin American and some Asian feminisms. Each generation continues to challenge the certainties of the previous one.

If there is a common thread in all feminisms – namely, the fight against male violence – each generation also asserts the right to be a woman differently, to be a woman in place of the other woman, the one we need to distance ourselves from in order to become who we are. And this symbolic woman, who passed on to us the rules of her generation, is often projected onto the figure of the mother. Hence my use of the term “matricide.”

This explains part of some feminists’ rejection of motherhood: it’s a refusal to pass on what was received5. This was especially true in the generation before mine.

There was a time in France when being a mother was seen as anti-feminist, a submission to the injunction of motherhood. The new feminist generation is now much more inclined to talk about motherhood and fight for mothers’ rights – the right to breastfeed in public, the right of single mothers to be supported.

Today, being a mother, with or without a partner, is more widely recognised by feminists as simultaneously beautiful, worthwhile, and difficult. We grant more of its full complexity to the experience, which is as universal as it is unique. But let’s not fool ourselves: there is still much to be done for the recognition of the rights and needs of mothers.

In any case, I’ve benefited first-hand from the lasting impact of feminism. I recently filed a police report against an erotomaniac individual who has been harassing me for thirty years, and for the first time, my complaint was taken very seriously, even with a degree of concern, by the officers. Fifteen years ago in Paris, I had been met with laughter and indifference. This time, I felt support, a form of care from the police. That is no small thing.

And finally, as I always ask: who do you care for, and who cares for you?

I take special care of my relationships with current or former students. They’re a bit like my kids – with added distance, of course, we’re not family; but it’s very precious. And it goes both ways: my former and current teachers care for me. A few weeks ago, my old primary school teacher sent me photos of myself that she’d found. I saw the letter, recognised her handwriting on the envelope, and started crying.

My current dance teacher also continues to help me grow, assert my femininity. She’s an extraordinary woman: I really admire her as a potential horizon for myself. She’s the one who told me recently, “those we care for are always a bit like our children.”

Perhaps that is the care relationship: raising others and being raised ourselves – in the literal sense of elevation, of reaching higher6. It does not always take hold: there can be missteps, followed by efforts to repair; like with our parents, with whom there is less distance with them, more projection, which can make the relationship more difficult. We return to separation: distance lets us build a relationship more thoughtfully, since it isn’t self-evident. And this effort elevates both parties.

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Prof. Dr. Rita Thapa is a renowned Nepalese public health leader, widely recognised as the visionary behind the country’s maternal, child and primary health care framework. A relentless advocate for reproductive rights and women’s empowerment, her programme of female community health volunteers (FCHVs) was and remains the backbone of Nepal’s health system.

Today, as the founder and executive director of the Bhaskar-Tejshree Memorial Foundation, she leads the implementation of interactive educational programmes in schools aimed at preventing high-risk behaviours such as alcohol, tobacco and carcinogenous food consumption, as well as gender-based discrimination and sexual harassment.

In this interview for The Fifth Wave, Dr. Thapa reflects on her six decades of transformative work in maternal, child and community health. We discuss the integration of family planning with maternal and child health, the struggle that led to the legalisation of abortion in 2002, and how one mother’s care inspired the entire FCHV programme – all of which have made Nepal a global model in reducing maternal mortality.

This interview is the third in our inaugural series on perinatal care. You can read the first two here and here.

What led you to work in maternal and child health?

What I saw in Nepal’s first maternity hospital in the 1960s. Women coming in with repeated unwanted pregnancies, suffering complications from dangerously performed clandestine abortions. Women feeling helpless and powerless, unable to make their own reproductive choices.

I had just come out of med school, and I naively asked one woman, ‘Why do you always want to get pregnant?’. She paused, and replied: ‘Doctor, we are not like you. We have to do whatever our husband wants.’ I knew that if those women were given access to even the most minimal family planning services, much pain and many deaths could be prevented.

That’s why in 1964, despite my supervisor’s warning that public health had “neither money nor glamour”, I became the head of Nepal’s first ‘Maternal and Child Health and Family Planning’ programme. It was hard: we had to start from scratch, and very few people involved had any meaningful experience. I had to fight the male representative of a foreign donor agency to carry out my vision of integrating the MCH and FP components into a single department. But I’m tremendously proud of all the change that first programme initiated.

You pioneered the creation of a now-celebrated Female Community Health Volunteers programme. How did you go about it?

Once the MCH-FP department was well-established, which strengthened the evidence base in favour of de-siloing health systems, I went on to lead the national integrated primary health care project. This was a key priority in the Nepalese government’s first long-term health plan (1975-1990), sparked by a worrying resurgence of malaria and other communicable diseases, as well as alarmingly high maternal and child mortality. My mandate was to unify five vertical programs – maternal and child health, smallpox, malaria, TB, and leprosy – under one administrative umbrella, to deliver an integrated package of basic health care.

It felt like another ‘Mission Impossible’. Once again, the heads of all five vertical programs were united in opposing the integrated approach. But I soldiered on, and managed to unify thousands of community-based health workers from the five verticals, allocating one to each village to guarantee comprehensive coverage. However, we soon realised a single ‘village health worker’ could not deliver the full package of basic health services across all priority areas. This signaled an imminent crisis: failure to show results would mean losing the hard-won gains of the entire project.

Then, my mind flashed back to a scene I’d witnessed back in 1968. I was in a village in Ilam establishing a new MCH-FP clinic for the area. A desperate mother came in at midnight with her severely dehydrated, listless baby. I had nothing on hand to help her, the clinic hadn’t been furnished yet. But as a doctor, I had to do something.

Though I had little hope this would work, I hurriedly taught her how to make a homemade oral rehydration solution using boiled water, sugar and salt, and told her to feed it to her baby while intermittently breastfeeding. Importantly, this went against the folk knowledge in the villages that forbade people from giving fluids to children who suffered from diarrhea – the leading cause of death among children in those years. I went to bed with a lingering fear that the little girl wouldn’t make it.

The mother and child stayed in a room next to mine. At around five in the morning, I opened the door… only to see the child happily playing and cooing on her mother’s lap. It felt like a miracle. It was a vivid manifestation of what Professor Carl Taylor had taught me at Johns Hopkins: mothers are frontline caregivers. Not only had that woman been willing to trust me against popular advice, but she’d competently done what it took to save her child with a few kitchen ingredients. And maybe she could be relied on to pass that knowledge to others.

We therefore decided to leverage local married women’s community leadership and caregiving skills by training one “community health leader” (CHL) per village. These women would take on the bulk of health education and preventive work at the community level: delivering contraceptives, setting up immunisation outreach clinics, teaching homemade oral rehydration techniques, and promoting clean birthing practices to avoid infection.

They were also responsible for referring cases of illness to the relevant local integrated health post. That way, medical staff could focus on providing clinical services, while we ensured that our CHLs reached every locale in their perimeter.

The concept was strong, but it had to be backed by solid scientific evidence to survive the political challenges ahead.

In 1978, we piloted a CHL training program. We designed a job description and training manual, using a staggered model of an initial 12-day session followed by one day per month of both additional training and reporting at the local health post over the remainder of the year. The women received compensation for each day’s wage lost – about 50 rupees or $4 at the time.

The evaluation showed significant improvements to service delivery: the CHLs were performing as expected. Encouraged by the positive feedback, I submitted a proposal to the ministry of health, asking for funding to train one CHL per health post in the country. I heard nothing for a month. I approached the health secretary, and he said to me: “I thought you were an intelligent woman, but now you want to place a leader in every village. How many leaders do you need in such a small country, Dr. Thapa, isn’t one enough?”

I understood the political undertones. In my enthusiasm, I’d almost forgotten Nepal was then under an absolute monarchy. Leaders in every village sounded like an uprising in the making. I withdrew my proposal and re-labelled CHLs ‘female community health volunteers’.

I liked the original name, it was a way for us to pay tribute to women’s enduring leadership in their communities. But what’s in a name? A rose is a rose, and that leadership endures, whether recognised by the authorities or not. I returned to the health secretary and got immediate approval.

That’s how the program began, out of necessity, with grit. I never imagined it would grow into 50.000 volunteers, recently recognised as the WHO South-East Asia Public Health Champions. It is profoundly rewarding.

Nepal’s FCHVs each lead a monthly “Mothers’ Group” to share health information and coordinate prevention efforts. What is the history of these groups?

The Mother’s Groups emerged out of centuries of patriarchal oppression in Nepal. They first started as informal village groups, gathering to discuss how to improve local women’s lives by tackling deep-rooted problems, such as men’s alcohol abuse and associated violence. Today, they are well-structured national-level advocacy groups, working on maternal health and domestic abuse but also agriculture, microfinance, and peacebuilding. I remember reaching out to them for support in identifying and recruiting motivated mothers as FCHVs. They are truly vital sites of change in the country. Honestly, they should form a political party.

Nepal legalised abortion in 20021, while neighbouring countries like Sri Lanka, Pakistan or Bhutan still broadly restrict it to life-threatening cases. What explains this outlier status?

Three factors: activism, public health research, and democratisation.

Debates around abortion were already brewing when I first joined the medical field, largely thanks to the work of women’s rights activists. It was a dangerous fight: even before the Panchayat era2, activists were being jailed for campaigning in favour of girls’ schooling, and women were imprisoned with draconian sentences for soliciting abortions – many of whom had gotten pregnant following rape.

Several large-scale studies then made it impossible to ignore the extent of the public health emergency. One showed that as many as 50% of maternal deaths in hospitals were due to abortion-related complications; several others that one-fifth of women in Nepalese prisons had been convicted of performing or receiving abortions.

The end of the Panchayat era further opened the doors to change. Newfound media freedom allowed a variety of television channels and newspapers to spread information about women’s rights and abortion to the public. After much legislative reticence, the government passed the Muluki Ain3 11th Amendment Bill, which enshrined the right to terminate a pregnancy of up to 12 weeks, or 18 weeks in the case of rape or incest.

Thousands of women were released from prison. It was a historic milestone. Together with the broader advances in maternal healthcare, the legalisation of abortion further contributed to the sharp decline in maternal mortality. For reference, there were about 1500 deaths per 100,000 live births during the 70s, and by 2000 that had dropped to less than 500. In 2023, the ratio was down to 142 – a 70% drop in under twenty-five years. It’s still too many, but we’ve come a long way.

You founded the Bhaskar-Tejshree Memorial Foundation, named after your son Bhaskar Thapa, a geological engineer, and your daughter Tejshree Thapa, a renowned human rights advocate who helped establish wartime rape as a crime against humanity. What does it focus on?

The foundation was born out of our unbearable grief. We lost two of our precious children in the prime of their years. Bhaskar was such a thoughtful young man, whom we lost to a heart attack. And Tejshree… She was a different character. She took everybody’s pain as her own pain. We pledged to do our best to protect other families from suffering the loss we did.

As in many other places, heart disease is now the number one cause of death in Nepal, followed by other non-communicable diseases (NCDs) like cancer, kidney failure or diabetes. For a long time, many Global South countries battled tirelessly against communicable diseases like malaria; much of that fight has now shifted to NCDs. We know that about 80% of NCDs are preventable through better lifestyle habits. Things like junk food, sugary drinks, tobacco, alcohol, physical inactivity and stress are huge problems in Nepal that can’t be addressed by building more hospitals. We wanted to focus on prevention.

Over the last decade, we’ve developed and implemented two flagship initiatives for experiential school-based prevention: one focused on heart disease (dedicated to Bhaskar), the other on raising awareness of sexual harassment and gendered discrimination (in memory of Tejshree). Both are designed to help adolescents question the attitudes and consumption patterns that carry the greatest physical and mental health risks, at a period in their lives where they haven’t yet cemented those harmful habits.

Both programmes are now a part of school curricula across all provinces of Nepal. It heartens me to think that even when I’m gone, we’ll have helped some of these young men and women to grow into more conscientious, kind, thoughtful adults.

Any other words of wisdom for public health leaders everywhere?

One, reach every doorstep. Always focus on the most vulnerable, underserved groups of population. They may be in the cities, they may be in the countryside. But try to reach them.

Two, practice what we know works. We have so much proven knowledge by now, we know community-based health works – yet there is a reluctance to empower communities to be better informed and take charge of their own healthcare, even for low-technicity tasks that don’t require extensive training. People have a deep capacity for caregiving when they’re well-supported: we need institutions to understand and mobilise that.

Some of the richest countries in the world are withdrawing funds from rural health, letting small-scale birthing homes close down, and encouraging the further centralisation of care provision. Nepal has far fewer resources, but we’re managing to reach almost everyone by tapping into the energy and creativity of the women in our communities. That takes a particular kind of political will.

And finally, as I always like to ask: Who do you care for, and who cares for you?

I’m blessed to be a part of a deeply caring family, which includes my husband and our remaining daughter. I cherish them every moment. My daughter-in-law and grandchildren also care for me. And in a different way, I always feel invigorated and hopeful when meeting people like you who are taking this work forward!

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Eva-Luna Tholance is a doula, queer feminist activist, and journalist specialised in sexual health and medical violence. She co-edited the collective volume Coming into the World: Autonomy, Dignity, and Struggles for Reproductive Justice, [in French, not yet translated] published in September.

In this interview for The Fifth Wave, she reflects on her journey to becoming a doula, the need to change our perceptions of parenthood, and the transformative power of a philosophy of care rooted in reproductive justice.

This interview is the second in our inaugural series on perinatal care. You can find the first one here.

How did you come to work on reproductive justice?

I started with activism. I was part of a collective focused on menstruation and endometriosis awareness, which gradually expanded its work to sexual and reproductive health. I also wrote about these issues as a journalist.

I first encountered the reproductive justice movement through Amandine Gay, a French Afrofeminist filmmaker and writer, and then Alana Apfel’s Birth Work as Care Work: Stories from Activist Birth Communities. It’s a stunning book that explores the central role of midwives and doulas in shaping an alternative vision of birth.

I had never heard the word “doula” before, nor the concept of reproductive justice. It was a revelation. It perfectly encapsulated the role I wanted to play in my community and in society: providing care, engaging with the medical world yet fighting obstetric violence, humanising patient experiences — all while steeped in the militant and feminist legacy of birth work.

I looked into becoming a doula but hesitated: I felt illegitimate. I was 22, and thought one needed to have had children to support others through perinatal experiences. But that’s not true. A friend preparing for IVF asked me to be her doula, and that pushed me to train. There were very few training programs in France at the time, so I enrolled online with Birthing Advocacy.

It was incredible—a second political awakening. The school was founded by Sabia Wade, a Black queer American activist, so the courses were deeply rooted in reproductive justice, with a queer and decolonial approach to doula work. It’s a political school as much as a practical one: the first lessons cover antiracism and queerness in perinatal care, and obstetric violence. Their philosophy isn’t just to train competent doulas, but “active partners in the movement to transform birth and reproduction.”

I began with postpartum training, then ‘full-spectrum’ training1, supplemented by specialised courses on childbirth preparation, disability, mental health, and abortion. The only one I haven’t yet completed is on supporting people with histories of addiction, which I’m eager to do, especially since it’s a significant issue in the queer community.

Your work focuses particularly on LGBTI individuals, survivors of sexual and domestic violence, and those whose bodies have been “pathologised and harmed by the medical industry.” As a care professional, how do you address their distrust of the medical world?

My support complements, not opposes, the medical system. I’ve attended prenatal appointments and hospital births, including C-sections. I am not against medicalised birth as such; my work is about preventing abuse and violence.

During preparation, we discuss different scenarios and how to respond: What’s a routine intervention? How does a cascade of interventions happen? What constitutes medical violence, and how do you confront it? Often, we dedicate a session to the birth plan, clarifying in advance which interventions are welcome and which are not. I also teach self-defense and co-defense techniques. Ultimately, we focus on how to make a space for oneself in the medical system, how to be heard.

Let’s talk about Coming into the world, which you co-edited with Johanna-Soraya Benamrouche. It’s structured around the three pillars of reproductive justice, as defined by the SisterSong collective in the 1990s:

1. “The right not to have children, through abortion, sterilisation, contraception, or choosing never to have them.

2. The right to have children when and how we want, and to give birth under the conditions we choose.

3. The right to raise children in safe, fulfilling environments, free from violence and environmental harm.”2

How does the concept of reproductive justice expand on the more commonly used ‘reproductive rights’?

It emphasises that rights alone aren’t enough. It adds an intersectional lens—antiracist, decolonial, queer. SisterSong’s core insight was that a right taken for granted by middle-class white women doesn’t necessarily mean justice for others. While women in mainland France fought for abortion rights, for example, many women in La Réunion were still subjected to forced sterilisation and coerced abortions.

Structural obstacles, systemic discrimination, and material barriers often prevent people from fully exercising their rights. French patients’ rights law, for example, guarantees informed consent, interpretation services, and the right to have a support person present at all times—but these are unevenly applied.

And finally, rights can always be revoked, as we’re seeing unfold in the United States.

In the intro to the book, you cite activist and poet Malkia Cyril:

“Right-wing movements have invested in culture wars, often led by women portrayed in the media as spokespeople for conservative visions of family, work, and the economy—vehement opponents of migrant rights and restorative justice. Conservative organisations have cultivated a generation of anti-feminist female leaders who continue to redefine feminism and motherhood in their most destructive, hierarchical forms. By underestimating their impact and failing to invest in cultural and communication strategies that center the voices of marginalised mothers, progressive movements have weakened themselves.”

This resonates with a central thesis behind the creation of The Fifth Wave Institute: that faced with the co-optation of natality, parenthood, and family, it is vital to shed greater light on feminist and research-based perspectives on those issues.

One such perspective highlighted in the book comes from the founders of La Bulle, a collective which sets up child-friendly spaces at activist events so parents can participate. They critique the portrayal of parenthood as “dull, exhausting, and boring,” in contrast to the “cool” freedom of non-parenthood — a binary, dogmatic narrative that often goes unchallenged even in supposedly subversive circles. It refuses to acknowledge parenthood as a rich, intellectually and emotionally profound experience, often out of a legitimate fear of reinforcing the injunction leveraged at women to become mothers.

This narrative also erases the historical role of parents, especially mothers, in revolts and uprisings — and their ongoing activism. In France, for example, ethnic minority mothers have been at the forefront of denouncing violence and discrimination against their children, as have many parents fighting against child abuse.

How do we change this reductive perception of parenthood?

Precisely through initiatives like La Bulle: by creating truly intergenerational spaces, by including children and parents in our movements and our thinking. By considering parenting as deserving of as much nuanced and complex attention as other experiences.

We do it by showing that children’s rights are radical struggles, that the fight against childism3 is fundamental to building a society that stops crushing the most vulnerable. We also need to reject the idea that the only voices advocating for children are those opposing comprehensive sex education or trans children’s rights.

Reproductive justice also helps to reclaim parenthood by confronting the ways the concept of family has been frozen in whiteness and heteronormativity. This means addressing uncomfortable truths: the reproductive barriers placed on people of colour, the criminalisation of their families, the historical exclusion of queer people from family-making. It’s about showing that family can mean a thousand things.

You offer specialised support for people undergoing abortions. In the book, you write that “of all perinatal experiences, abortion is the most solitary.” Why?

The discourse around abortion is just as binary as that around parenthood, leaving little room for nuance. On one side, it’s framed as liberating and feminist—asking for help is seen as admitting failure. On the other, it’s assumed to be inherently traumatic, shameful, and taboo. In reality, it’s usually somewhere in between. People are often relieved because they didn’t want or weren’t capable of welcoming a child, but also sad if they had envisioned themselves as parents. And no one is safe from feeling shame and guilt.

This is experienced in isolation, especially among young people: few ask friends to support them during a medical abortion. It happens in private, unlike surgical terminations where a midwife or healthcare provider can be present. With medical abortion, you’re alone in your living room, unprepared for the physical symptoms, the bleeding, the pain—with only a prescription for paracetamol. I’ve heard many stories of people thinking they were dying because they hadn’t been warned of what to expect.

The book mentions that doulas in France are monitored by Miviludes, the government agency combating sectarian tendencies. Is this rooted in genuine concern or resistance to the autonomisation of birth?

Both.

The skepticism isn’t baseless: in 2008, Françoise Souverville, a Franco-American who worked as a midwife in the U.S., moved to France. Her degree wasn’t valid here, so she became a doula and attended unassisted births4. A baby died during one of these home births. She was sentenced to 18 months in prison for illegal practice of medicine and involuntary manslaughter.

After that, doulas were especially scrutinised, catapulted into the public eye as women who deliver babies in the woods, a bit witchy, shamanistic. And there is definitely some truth to that: some incorporate the whole “divine feminine” thing into their practice, some sell overpriced energy healing products and supplements. All the new age elements you find online can seep into the profession.

But most doulas do rigorous, ethical work. And that work doesn’t always sit well with the medical establishment: we’re present in delivery rooms, we know patients’ rights, we encourage questions. Not to slow things down pointlessly, but to ensure birth plans and informed consent are respected—rights guaranteed by law. In a system that prioritises speed, this is disruptive.

I’ve learned to defuse potential tensions. When I intervene, I always address my clients: “Do you understand everything? How are you feeling? Do you want to take five minutes?” I’m not the center; I won’t create conflict where there isn’t any.

The book stresses the importance of comparing maternity ward practices when planning for birth, as levels of medicalisation and respect for autonomy vary. How can we improve national frameworks for more humane perinatal care and greater reproductive justice, regardless of where someone gives birth?

Laws have limited reach. They can’t, and shouldn’t, dictate every aspect of private life or professional practice. But there’s much to be done regarding the training healthcare providers receive. For example, normalising the use and respect of birth plans as serious documents — they aren’t a Christmas wishlist.

The shift can’t be exclusively top-down; our entire philosophy of care must evolve. We need a more human, person-centered, inclusive approach and a broader definition of a ‘good birth’. Does ‘it went well’ just mean ‘mum and baby are alive and healthy’, or does it account for the fact that both feel emotionally secure, and aren’t traumatised?

Today, care is performance-driven. Many providers are paid per procedure and thus push certain interventions, like epidurals, even when unnecessary. Some anesthesiologists resort to threats during prenatal visits: “If you don’t take the epidural when offered, I won’t come back when you need me.”

It’s a system that exhausts both providers and patients—but the latter still bear the brunt of medical violence.

The book includes an ecofeminist angle, with an article by the Vietnam-Dioxin Collective on the impact of Agent Orange on pregnancies and fertility. You also discuss your investigation into the link between tear gas, reproductive disorders, and miscarriages. How did you conduct it?

During France’s 2021 protests against a controversial security bill, my partner always had painful periods afterward. She came across a post by Gina Martinez, founder of the Colorado Doula Project, who had researched the issue. I realised there was extensive global documentation, especially from Black Lives Matter, but little in France. I put out a call for testimonies on Instagram and interviewed Martinez and Rohini Haar, a member of Physicians for Human Rights and co-author of a report on tear gas use in Bahrain. That became my first article.

After each Saturday protest, I repeated the call. I gathered about a hundred testimonies from people with a variety of backgrounds. Many reported the same symptoms at the same point in their cycles, even while on testosterone, birth control, or in perimenopause. It’s self-reported, but it’s the most ethical scientific method available—you can’t expose pregnant women to tear gas for a study. This approach was later used in a U.S. epidemiological study on the same topic.

Despite this data, building a legal case would be difficult. The miscarriage stories shared with me weren’t medically documented—only one participant who miscarried following a protest saw a gynecologist, but she hadn’t yet made the connection with tear gas. Gathering sufficient evidence would require many people to have the information, energy, and willpower to get blood tests immediately after a miscarriage.

One of The Fifth Wave Institute’s missions is to highlight initiatives shaping the futures of care. Do you have one in mind that advances reproductive justice?

The Observatoire féministe des violences médicales (Feminist Medical Violence Observatory). It was founded in 2024 by Johanna-Soraya Benhamrouche and Tsippora Sidibé after the death of Aïcha, a 13-year-old Black girl who died after being accused of faking her symptoms by emergency responders. I sit on their advisory board.

It’s a fantastic organisation working to change minds and practices through advocacy, victim support, and training for providers and patients in respectful care. They just launched a campaign to display patients’ rights in waiting rooms, with downloadable posters in multiple languages.

Initiatives like this give me hope for the future of reproductive justice. I trust the people doing this crucial work and my doula colleagues who offer beautiful support.

Finally: Who do you care for, and who cares for you?

I care for my clients, my friends (I hope), and my partner. And he cares for me.

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Rubi Rodriguez Nieto is a Mexican-born anthropologist, doula, and community organiser. She also manages the volunteer team at Birth Companions, a London-based charity that supports disadvantaged pregnant women, mothers and babies. She recently started RedMAMI: The Latin American Migrant Maternities Network to tackle systemic inequality in maternity care in her community.

In our conversation for The Fifth Wave, she reflects on her family heritage of traditional healing practices, her intellectual debt to Indigenous autonomous organisations, and outlines concrete pathways to providing migrant women with culturally aware and empowering maternity care.

What inspires your work in maternity care?

I grew up in a small town called Ciudad Valles, in Mexico. It’s a really culturally rich region with a strong presence of Indigenous communities. Even though I didn’t grow up learning an Indigenous language, our traditions are intertwined with their cultural practices.

I also grew up in a family of healers, with practices unconventional to Western medicine. I am marked by the way my grandma used to heal us with touch, with food, with songs, when we’d get ‘susto’ (startled), said to harm your spirit and make you vulnerable to illness. These beliefs are part of what it means to be a Mestiza woman1.

I then left my town to study anthropology at university, where I started thinking more deeply about my background and the complexities of cultural identity. Passionate about social justice, I got involved in environmental activism – which, in Latin America, tends to be about opposing mega infrastructure projects and supporting Indigenous communities’ right to self-determination.

One of those communities I’ve always admired are the Zapatistas. They are an autonomous group led by Indigenous people in Mexico’s southern Chiapas state, where they’ve now recovered a substantial amount of territory. They started out as the ‘Zapatista National Liberation Army’ with the explicit goal of freeing themselves from 500 years of colonial and capitalist oppression – a process they call ‘The Long Night’. They organised clandestinely, and in the 90s became an armed movement and started recovering their ancestral territories.

The movement is now over 30 years old. They function in mirror resistance to the intentional erasure, starving, discrimination and exclusion from political life of Indigenous people: so they have their own governance, currency, food, health and education systems. More recently, they’ve been raising funds to open surgery centres, because the children who were born in Zapatismo are now studying and preparing to take on more specialised roles in their communities.

I’ve visited and learned from those communities several times, and I always carry their teachings with me. One thing the Zapatistas say is “another world is possible”. We are made to believe that the current capitalist system is the only way. But after 30 years, they are still standing, proving it is possible through regaining power and organising. It’s a great message of hope.

Their political ideology inspired many of the principles of collective organisation and self-determination which infuse my work with mothers today. That’s the intellectual terrain I come from.

You ended up leaving Mexico. Why?

At university, my research focused on how Indigenous agriculture adapts to competition from bigger players. I started working in a community-managed forest, where locals used reforestation and other techniques to preserve their environment, as well as protesting the construction of a highway through their lands. We organised visits with schools and organisations from the nearby city, so they’d get a sense of the work and resistance involved in keeping their air and water clean. I also got involved in national political activism.

That was twelve years ago. In those years, it started becoming dangerous for anyone to be politically outspoken, particularly for journalists and women, and especially in Veracruz where I lived. My family received threats to my safety, my compañeros de lucha (fellow activists) were intimidated with physical violence. So I made the difficult decision to leave. It wasn’t paranoia – barely a year after I left, two known critics of Veracruz governor Javier Duarte were murdered in an atrocious massacre.

Has the situation gotten better with the new president, Claudia Sheinbaum?

It’s definitely not as bad. The historical vectors of instability haven’t changed much: we’re close to the US and their oversupply of guns, we have a perpetual debt to the World Bank. But Duarte is now in prison for corruption, so there was some level of accountability.

Greater transparency also has its downsides: Sheinbaum has a lot more eyes on her, and developing a country always implies trade-offs. For example, the Mayan Train project is quite controversial, because it brings dynamism and infrastructure to the long-forgotten South, but also raises serious environmental and safety concerns.

Your son was born in the UK. What was your experience with pregnancy and perinatal care?

At some point in life comes the ‘baby wave’. There’s something about sharing in that experience and not wanting to do it alone. As I left Mexico, most people my age I knew were having babies. I was in a very serious relationship, so it felt like the right time.

Another big drive behind my desire to become a mother was the Zapatistas. Their thinking is, the people who’d rather we didn’t exist are reproducing, so why wouldn’t we? If we want to stay alive, if we want to build the future we believe in, we need more Zapatistas. We need to grow as a community. This is an especially strong sentiment in Indigenous communities, just like in other groups that have survived attempts at forced sterilisation and eradication: we will not be erased.

I was seeing some people around me have children, and I thought, ‘I don’t necessarily want to live in a world where their kids are in charge of the country’. We want the children of the people that surround us to take part in building the future.

I had my son just over a year after I moved to the UK. It was hard, it was isolating, it was very lonely. Coming from Latin America, our culture of obstetrics is cut through with deep misogyny and violence, which makes the bar extremely low for the quality of care we feel we deserve. In Mexico, you are made to feel like you know nothing – the doctor knows. The way you eat is wrong, your weight is wrong, your exercise is wrong. Everything about you is wrong, and little by little, you get stripped of any power you had to advocate for yourself. Some women recall being treated ‘peor que una chancla’ – worse than a slipper.

Coming from that context, I was very grateful for my care in the NHS. I didn’t have to pay, I could be seen by a midwife, and she actually listened during our appointments. She made me feel safe and confident. However, when I gave birth, it was a different story. I wasn’t informed or supported enough, my history and background weren’t taken into consideration. Even though I spoke English, when someone gives you technical information very quickly in the middle of labour, it’s hard to feel like you truly know what’s going on. And I know now there were resources they could’ve shared, organisations they could’ve told me about to help me feel less alone.

It took me many years to finally acknowledge that my needs hadn’t been met. I always sort of said, ‘Yeah, I felt like a train ran over me, but it doesn’t matter, I have my baby!’

My highest point at the time was when I attended a breastfeeding group. I was about to have mastitis, and ended up cancelling my GP appointment. Theirs was all the help I needed. I showed up, interacted with a few people, got some advice, and everything was suddenly more positive. The mere fact of someone acknowledging that what I was going through was rough, that they were there – it changed a lot for me.

Later on, after I came out of the fog that is caring for a tiny baby, I needed to decide what to do with my life. Being a migrant and being a mother is similar in that way: as a migrant, you often have to rebuild a career from zero in a new context, and as a mother, your brain and body takes some time to guide you to who you are as a new person, with a child that fully depends on you. I looked into becoming a lactation consultant, but it required many years of training. I decided to become a doula.

I did two different trainings. The first one felt disconnected from my values: the trainers were renowned, the clients wealthy, and the whole thing made having a doula feel like a luxury item. The second one was amazing. The woman I trained with founded Doulas without Borders, so we had many shared concerns – coming from abroad, how do we empower someone to advocate for herself? If she’s never been given the opportunity to be the leading agent in her own medical care, how do we change that?

As a doula, you provide ‘culturally competent’ perinatal care to women in your community. What does that look like, in practice?

I’d pinpoint two layers of cultural awareness. One, as I mentioned, is awareness of the medical culture we carry in our luggage. Knowing that Latin America has some of the highest rates of C-section and obstetric violence, and understanding how that affects the way we relate to doctors, to medical environments.

The second is a decolonial awareness that for us, ‘health’ goes beyond Western perceptions. The hospital is an authority, in the same category as the state or the law. But then we go home, and our grandmothers, our mothers, our aunties see it differently. For example, the Indigenous understanding of health where I’m from is based on a balance between hot and cold. Any imbalance leads to illness.

So if you went outside without a coat, or early at dawn, your body was thrown off-balance. To heal, you need something hot, like nurturing food, to restore the balance. Warmth can also come from the act itself of someone caring for you, or through a ‘rubbing’ – we have a lot of touch-based healing. I once explained to a psychologist the way my grandma would press on specific spots in order to heal us, and she said, ‘Oh, that’s EFT!’ My grandmother didn’t finish primary school, but she had knowledge that’s since been theorised by Western medicine.

So cultural competency means understanding that we navigate between our traditional, home care, and our less-than-ideal relationship with medical culture. My clients continue to teach me about it every day: I can see them balancing these two paradigms when thinking about their own pregnant body or birth.

Could you describe the practice of the Rebozo ceremony?

In rural Mexico, a woman’s postpartum recovery process typically involves a woman healer, a mother, or an auntie coming to her house and giving her a bath of herbal water. It’s a sacred moment, meant for her to reconnect with her body as well as with higher forces. We don’t even call it a ‘ceremony’, it’s just what is done. I had my own back home when my son was 6 months old, and I wanted to integrate it into my own doula practice. As a Mestiza woman, I feel I have a responsibility to honour these Indigenous traditions that otherwise would be either forgotten or appropriated.

I start with a massage, connecting my energy to the person as a whole as well as my own guides, my abuelas, my ancestors. Then I prepare the bath, adjusting the herbs depending on how she wants to feel coming out of the ceremony. I use locally sourced (European) herbs – there are centuries-old postpartum healing traditions here as well, not just in Mexico!

The bath is a very tender moment – it’s as much for their bodies as their minds. Sometimes they want to chat or confide in me, sometimes they want me to pour water over them, sometimes they just want to sit in silence with the dim lights. One woman told me, ‘No one has even given me a bath since I was a baby, yet I do this for my kids every day.’ It’s a rare moment for them as a caregiver to receive the care they deserve.

You’ve just started RedMAMI, a London-based network of community support and resource sharing for Latin American women and mothers. What sparked its creation?

Discussions with friends about parenting issues specific to us Latin American migrant mothers. For example, one of my friends didn’t feel like people in the UK understood her fears around girls’ safety, rooted in her experience of being a woman in Latin America. We shared stories with each other of being a mother in a foreign country, of feeling different from others at the school collection or nursery.

Culturally, we’re more “huggy” and physically close with our kids: I had a (white British) therapist once tell me I didn’t set enough boundaries with my son because I let him sleep in my bed every once in a while. We’d just moved flats then, he was 8. I thought, ‘I used to sleep in my mum’s bed until much older!’

We realised that there are vital cultural elements to parenting that need to be acknowledged. Our culture of care is different, our culture of mothering. Our fears, too. That’s how the group was formed. We wanted to reduce the isolating feeling of, ‘is this normal? Am I doing this right?’.

Because of our specific relationship to medical culture, we also wanted to help each other exercise having a voice. We see each other in waiting rooms and discussion groups, try to look out for each other, but we don’t always have a space to share our experiences. RedMAMI is that space. It’s there to spread information, support women to be more empowered, in their own voice but also by having advocates in and outside the labour room, so they feel confident to demand better care.

Speaking of advocates in the labour room, a big focus of RedMami’s work is on interpreters. You cite the 2024 perinatal confidential enquiry, which reviewed the care of 24 recent migrant women with language barriers whose babies died. The study showed that while 96% of them needed an interpreter, only 27% used one. What are the main obstacles to accessible communication, and what are the consequences?

The first problem is that most midwives don’t seem to know what the process is to request an interpreter. And when they do, it’s often long and complicated, ill-adapted to the swift decision-making childbirth calls for.

The second is that they have a very limited amount of time to dedicate to each woman – and handling language barriers takes time. You might need to ask the attendant to repeat something two or three times, and by the fourth time, you just give up. Us migrant women, we have our pride, same as anyone else: we don’t want to come across as not understanding anything. So you say, ‘okay’. Your face is not saying ‘okay’. But the midwife doesn’t have time to pick up on your body language, she has three other women to attend to, she’s under-resourced and underpaid.

I’ve seen improvements in the last couple of years: I recently came across a specialist midwife who works exclusively with refugees and asylum-seekers. She works across four hospitals, so she’s obviously stretched, but it’s a start.

In terms of consequences, when you don’t fully understand what someone explains to you, it’s very difficult to know your options, feel confident to question things or ask for clarifications. It affects how you advocate for yourself, accepting procedures and medicalised pathways that you might not otherwise have wanted. If you have prior vulnerabilities in your history and didn’t feel confident enough to disclose them, that can also lead to tragic outcomes.

The other repercussion of women lacking accessible information is that some are going to seek out that information from friends and relatives, where the most traumatic stories tend to get shared the most – and fear does not aid a good birth outcome. Fear inundates your body with adrenaline, inhibiting the production of oxytocin which is essential to birth. What you need in the birthing room is to be fully present, confident, and trusting of the people caring for you.

What does it mean to be a part of RedMAMI?

We have two levels of participation. There are those who simply want to get support, meet other mothers, receive guidance and be better informed. That works through community events and a WhatsApp group. The second level involves organising the network and being part of the decision-making. It’s horizontal, anyone can bring their ideas to the table.

We also want to hold thematic workshops and create charts in Spanish and Portuguese to help walk women through ‘who’s who’ in maternity care. There is a lot of UK-specific terminology, like gas and air or health visiting, that we can help clarify. At this stage, we’re mostly determining what resources are needed: asking people about their needs, where they feel they struggle the most, and how we can help.

In the meantime, we’re holding each other, to feel less alone. We just had the first open meeting, and interestingly, the people who came were more on the giving than the receiving side of care. There was another doula, a lactation consultant, a pediatrician – all wanting to prevent other women from going through negative maternity care experiences. From feeling lost, unheard, unseen.

Thank you for all your insights and wisdom, Rubi. Finally, a question I like to ask all my guests: who do you care for, and who cares for you?

I care for Emilio, my son. He’s ten years old and an amazing little boy. My boyfriend cares for me, cooks for me. And even though most of them aren’t in the UK, the people who mostly hold me emotionally are my friends.