Contenu du sommaire : Santé critique 1

This article revisits three field-studies carried out in hospitals in the United States in the 1960s: that of Glaser & Strauss, Sudnow, and Roth. These studies underline dynamics of differentiation in physicians' practices according to the social profiles of their patients. The methodological tools, empirical findings and heuristic conceptualization deriving from the notion of the “social value” of patients (on the basis of approaches that could, retroactively, nearly be qualified as intersectional), their focus on the social relations at play in these interactions, as much as the convergences and divergences between these sets of studies, prompt us to re-acknowledge the strength of ethnography as an entry-point to trace the social variations of medical practices. This comparative overview is built as an invitation to foster a research agenda on these processes of differentiation in the contemporary period and to further unpack paths until now left largely unexplored, in particular what could be framed as “differentiation dynamics of differentiation”.

The apparently paradoxical situation of a pregnancy led to term in the absence of any childbearing project constitutes a powerful revealer of the conditions for exercising fertility control. This article is based on a qualitative research on neonaticide cases in France (2005-2015): the killing of a newborn baby, following a concealed pregnancy and a secret delivery is the outcome given by some women to a pregnancy experienced as catastrophic. The analysis of their socialisations, family situations and resources allows to identify the obstacles they encountered in order to implementing effective contraception or accessing abortion within the legal timeframe. It also reveals the core role played by social support and conjugal relationships in the implementation of their reproductive choices. Yet the judicial narratives produced in the context of criminal courts, which permeate the public space, perpetuate essentialist assumptions on motherhood and misrecognize the specific challenges faced by women living in precarious situations to manage reproductive risks. Judicial actors share an individualizing interpretation coupled with a familialist moral – itself embedded in a class distance from the accused women – that contributes to invisibilizing social inequalities in health.

When employees fail to have their workrelated injury acknowledged as such by primary sickness insurance funds, they can appeal the decision in court. The judicialization of these work-related injuries provides an entry-point to trace how judges perceive and confront social inequalities in negotiating the boundary between work-related and other injuries. This investigation, carried out in six tribunals, underscores that the social class of the litigants, for the most part from working class backgrounds, positions them as dominated within the judicial process. These individuals tend to frame their injuries based on a pragmatic and lay logic at odds with the judicial and legal framing of these incidnts. Confronted with this unequal relationship – perceived by all judges – some attempt to mitigate their effects on the judicial process. Their pedagogical approaches to the law tend to redress the class inequalities that constrain access to remedies. This mitigation however remains limited and biased in favour of male workers. It thereby contributes to reproducing gender inequalities and to the institutional invisibilization of females' work-related health problems.

Scholarship on social inequalities in health tend to focus on health among the working class, and growingly on the health of migrants in situations of administrative and social insecurity. This however overlooks what the health of the dominant classes reveals about social inequalities. This investigation was carried out in two private maternity clinics in the Paris region, on the basis of interviews and observation. It underscores how ? despite their weak level of medical specialization and technical expertise ? these clinics manage to attract and retain a privileged national and international customer base by revamping an ordinary medical offer into a scarce and distinctive commodity. In the first maternity clinic, catering to women belonging to the economic pole of dominant classes, customer retention is fostered through luxury hotel services as well as the provision of medical examinations and treatments hailed as unavailable in other hospitals – notably in the public sector. In the second maternity clinic, catering to women relatively more endowed in cultural capitals, customer retention is fostered through the promotion of obstetric practices minimizing technical medical gestures. These two maternity cli nics also differ in terms of their relations with international clients. The first clinic seeks to attract international customers through a culturalist approach that legitimizes practices that diverge from medical standards on the basis of a universalizing rhetoric.