From quacks to professionals: the importance of changing social constructions in the policy-making process

The social construction of target populations (SCTP) approach assumes that policies are constructed to benefit (or punish) specific groups of citizens based on their relative power and social construction. This contribution tackles one of the most sustained critiques of the SCTP literature, namely, how a group can alter its social construction and power. Stated differently, how does a group move from being constructed as dependent or deviant to contenders or advantaged? In 1991, the government in Ontario, Canada, proclaimed what is arguably the most progressive midwifery legislation in the world. The Midwifery Act established midwifery as a self-regulating profession, fully integrated into the province's public health insurance system, and enables midwives to catch babies in hospitals, homes and birthing centres. What is striking about the legislation is the contentious debate preceding it, in which midwives were constructed as ‘quacks’, incompetent and unclean, compared to professional physicians. In this paper, we explore the role of commissions of inquiries (COI) in shifting social constructions. Specifically, we argue that COI legitimised the authoritative knowledge of moral entrepreneurs and facilitated the necessary interaction between moral and political entrepreneurs, which in turn reconstructed midwives from ‘quacks’ to experts, and resulted in significant policy change.