Procréation médicale et mondialisation. Expériences africaine ed. by Bonnet Doris, Duchesne Véronique (review)

This collective work, edited by two anthropologists at the Paris Population and Development Centre, focuses on sterility and medical treatment of it in a region about which we know little in this connection: sub-Saharan Africa. With the exception of path-breaking studies by Marcia Inhorn on the Middle East and Elizabeth Roberts on the Ecuadorian Andes, social science research on these topics has primarily focused on Europe and North America. This is therefore a key study that provides a great deal of empirical information on sterility, treatments available for it in Africa, treatments used there, and collective and individual strategies for overcoming sterility, including biomedical techniques. Authors from three European countries and three disciplines (anthropology, education, and IT and communication sciences) analyse local ways of appropriating new reproduction techniques. Drawing on field surveys of sterile heterosexual couples and physicians in urban contexts and using communication analysis tools, the book’s fourteen chapters cover nine African countries: South Africa, Burkina Faso, Cameroon, Ivory Coast, Gabon, Ghana, Mozambique, Uganda and Senegal. Each country situation is positioned within the current international context, thereby creating globalized “reproscapes” in which individuals seeking reproduction assistance circulate together with different types of biomedical knowledge. The book concerns a region so diverse and with such particular political, policy, medical and social situations that it is difficult to present them in full here. However, the major features of assisted reproduction in the countries studied can be identified, together with the specificity of the African context.

To begin with, the book shows that sterility in Africa is a combined public health and social problem. It is quite prevalent: 15% to 20% of couples experience problems of sterility in South Africa; 30% in Gabon. The main problems are STI-induced sterility or secondary sterility; that is, conceiving a second time after untreated or poorly treated complications of an earlier pregnancy, abortion, or delivery. However, sterility in the region is never thought of as a public health problem because the main preoccupation there is overpopulation and the problems it creates.

Because the individual in Africa has a personal duty to ensure the perpetuation of the family, sterility there can be a source of stigma and marginalization. As Marie Brochard points out, individuals have “a symbolic debt to their family and lineage” (p. 169). Adoption and fosterage cannot stand in for “biological” procreation when it comes to perpetuating the lineage. The “injunction to engender” (p. 219) applies to both women and men. In becoming a mother, a woman acquires status within the family and community: reproduction is understood as an “empowerment mechanism” (p. 124) for women. Men too undergo social pressure, though of a more intimate and personal kind that concerns their reproductive performances (see chapter by Bonnet); this in turn often leads to denial behaviour around male sterility.

The new reproduction techniques first appeared in sub-Saharan Africa in the 1980s but they have not been practiced much in the region, for a combination of political, economic and cultural reasons. Moreover, as there is very little in the way of public policy in this area the techniques are only available in a limited number of private clinics in large cities, leaving a considerable proportion of sterile couples without access to treatment and creating “stratified reproduction”, as illustrated by Frederic Le Marcis in his chapter on South Africa. The policy vacuum has another effect: physicians are the ones who decide on and manage medical practices and diffusion of information on them. To compensate for their lack of knowledge and practical competence, these same physicians go abroad to train, later adapting what they have learned to the specific context of their country in connection with a set of biomedical, economic and moral concerns and assumptions, the main objectives of which are to keep costs down and improve success rates (see chapter by Hörbst and Gerrits).

Furthermore, biotechnologies are not democratically...