Thursday, October 6, 2011

Anthropology of Reproductive Health: Part 2

This is the second part in my sharing of my Anthropology of Reproductive Health graduate course topics and readings.

This semester I am taking a fabulous anthropology course on reproductive health. With topics like state control/social control, pregnancy/prenatal care, childbirth/breastfeeding, abortion, infertility, STI's, and circumcision, what's not to love?

So, I thought I'd list the articles we've been reading so that you can read them, too, if interested. My professor has compiled an excellent reading list, and I hope she doesn't mind that I'm sharing them here. I will do this in parts, so as not to overwhelm anyone interested in seeing the full list, and I am including some notable quotes from some of the articles to give you an idea of what I found most interesting about them.

Our third class was dedicated to the topic of State Control/Social Control, and we touched on the following issues:

Medical Accuracy in Sexuality Education: Ideology and the Scientific Process. Santelli, J. (2008)
"The Waxman Report found that 11 of the 13 curricula [of commonly used abstinence programs] contained false, misleading or distorted information about reproductive health, including inaccurate information about contraceptive effectiveness and the risks of abortion, among others."
"Withholding potentially life-saving information from sexually active adolescents is ethically troubling. The principle of informed consent suggests that persons should be given all the information they need to make informed choices."
Counseling Contraception for Malian Migrants in Paris: Global, State, and Personal Politics Sargent, C. (2005)
"Sub-Saharan Africans had the highest fertility among foreigners living in France in 1999, with an estimated 4.72 children per woman, in contrast to 1.72 children born to mothers with French nationality."
"An implicit hospital policy opposes immigrant births and strongly encourages contraception."
"The prescription for the pill may be added to the stack of prescriptions a woman receives at discharge, without explanation."
"The predominant perspective among our informants was that Islam opposes contraception. In fact, Muslim jurists and theological texts demonstrate ambivalence regarding birth control."
Unintended consequences: Exploring the tensions between development programs and indigenous women in Mexico in the context of reproductive health. Smith-Oka, V. (2009). [I've read this before for another class; it seems to be an important one]

"Reproductive rights are culturally and historically located."
"I use a political economy framework to explore how seemingly innocuous programs, such as cash transfer policies, shape women's reproductive choices... My purpose includes the following: a. to examine women's perceptions of forcible interactions and the medical staff's use of insistence and a joking relationship to implement policies; b. to show how the implementation of development programs often goes awry on the ground; and c. to illustrate the intersections between medicine, economic development, and the state on women's reproductive freedom."
"Their knowledge about health and their bodies carry less weight than the knowledge of the medical personnel. In these contexts their knowledge becomes discredited and devalued in the light of the authoritative knowledge of doctors and nurses."

Sterilized in the name of public health: race, immigration and reproductive control in modern California. Stern, A.  (2005) 
"California defined sterilization not as a punishment but as a prophylactic measure that could simultaneously defend the public health, preserve precious fiscal resources, and mitigate the menace of the 'unfit' and 'feebleminded.'"
"foreign-born were disproportionately affected, constituting 39% of men and 31% of women sterilized."
"African Americans constituted just over 1% of California's population, they accounted for 4% of total sterilizations."
"California's sterilization program was propelled by deep-seated preoccupations about gender norms and female sexuality...the sterilization of women and young girls categorized as immoral, loose, or unfit for motherhood intensified."
"Sterilizations were particularly pushed on women with 2 or more children who underwent cesarean deliveries."
The social life of emergency contraception in the United States: disciplining pharmaceutical use, disciplining sexuality, and constructing zygotic bodies. Wynn, L and J. Trussle. (2006)

This article examines the FDA hearing on the proposal to permit nonprescription access to the Plan B emergency contraceptive pill. The arguments of those who came to testify for or against it are laid out and analyzed. Some of the reasons I highlighted in my text were "doctors would lose key opportunities to talk with their patients about contraception, sexual decision-making, and the risk of sexually transmitted disease" (which I've never had a doctor do, and would require women to pay not only for the pill, but also the doctor's office time, not to mention is an unequal power relationship), portraying Plan B, but not Viagra, as facilitating the sexual exploitation and seduction of women, contestations of zygotic personhood (not fetal personhood, but actually zygotic prior-to-implanation personhood), and more. Great article!
"Political debates over new medical technologies, especially new reproductive technologies, are not so much debates about science and technology as they are centrally concerned with interpreting these technologies within a web of (sub)culturally defined moral valuations and social interpretations."
 "Because the contraceptive effect of breastfeeding may operate by preventing the implantation of the fertilized eff, should the merits of breastfeeding be rethought in the name of human (zygotic) life, or should female sexuality be avoided during lactation? Because half of fertilized eggs never implant, should more respect be given to the menstrual blood of sexually active women that most Americans dispose of unceremoniously in tampons and other sanitary protection products?"

The following fabulous articles consider issues regarding Pregnancy/Prenatal Care:

Ethics: ‘‘Life Before Birth’’ and Moral Complexity in Maternal-Fetal Surgery for Spina Bifida Bliton, M.J. (2003)

The Production of Authoritative Knowledge in American Prenatal Care Browner, C.H. and N. Press (1996)
"Patients are active interpreters of medical information. They pick and choose, using and discarding advice according to internal and external constraints and considerations. In our case of pregnant informants, embodied knowledge and everyday life exigencies proved to be pivotal in their selective designation of certain biomedical knowledge as authoritative."
"Valuing information about prenatal care derived from embodied knowledge over that of biomedical knowledge contrasts with the attitudes and behavior that characterize most American women as they give birth. During labor American women are highly acquiescent to biomedical authority at the expense of embodied knowledge."

God-sent ordeals and their discontents: Ultra-orthodox Jewish women negotiate prenatal testing. Ivry, T., E. Teman, et al. (2011).
"Ethnographies of reproduction teach us that a religion's formal attitude to a certain technology may be notably unrelated to its practical use... being religious does not always mean refusal [of prenatal diagnosis]."
"Carrying and raising an unhealthy child is a task God might assign a woman to test her faith... women in our study constantly prayed not to be she whom God chose for such an ordeal."
"Nearly all the women could recall at least one story of another woman getting rabbinic permission to terminate a pregnancy that was life-threatening or after lethal anomalies were detected."

Interrogating the dynamics between power, knowledge and pregnant bodies in amniocentesis decision making. Markens, S., C. H. Browner, et al. (2010) 
"A common assumption is that women who decline prenatal testing distrust biomedicine and trust embodied/experiential knowledge sources, while women who accept testing trust biomedicine and distrust embodied/experiential sources. Another major assumption about prenatal testing utilization is that women who are open to abortion will undergo prenatal testing while those who are opposed to abortion will decline testing."
"'Should a pregnant woman do everything doctors advise?' 'No, they may be wrong too, you never know.'"
"'What is to guarantee the doctors know? They are human beings, and they make mistakes too... while pregnant you need to get as much advice from them [as possible], but also not to believe in everything.'"
"It is important not to view biomedical and other knowledge sources as inherently in opposition - many women see various source as powerful, valid and useful. In other words, accepting biomedical knowledge implies neither passivity in the face of technology not a necessary distrust of experiential knowledge sources."
"In our study, Mexican-born women were much more likely than the US-born women to both believe that they can 'tell' if the baby is fine and to believe it's important for pregnant women to do everything doctors advise."

Perils to Pregnancies:On social sorrows and strategies surrounding pregnancy loss in Cameroon. Van Der Sijpt, E. and C. Notermans (2010) 
"Pregnant bodies have been predominantly homogenized, politicized, and medicalized."
"Spontaneous losses are often suspected to be provoked; induced abortions are often presented as spontaneous ones."
"Local notions of loss are thus not only more encompassing and diverse than assumed in global debates, but they also require strategic values that cannot be understood if not situated within local atmospheres."

Do these quotations spark any feelings or considerations? Have you read these articles? Please share your thoughts!

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