Infertility around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies

1. Introduction. Interpreting Infertility: A View from the Social Sciences

3 ONE Introduction Interpreting Infertility: A View from the Social Sciences Frank van Balen and Marcia C. Inhorn After decades of scholarly neglect, human reproduction, as a biological phenomenon that is socially constituted and culturally variable through space and time, has slowly gained the attention of social scientists from a variety of disciplines. Largely as a result of the feminist movement and the entrance of greater numbers of women into the academy, the past twenty- five years have witnessed a veritable explosion of research on the social construction and cultural elaboration of women’s reproductive experiences (Greenhalgh, 1995a). From menarche to menopause, few aspects of the human reproductive life cycle, particularly as it pertains to women, have been left unexamined by social scientists working in a wide variety of cultural settings. This interest in reproduction is clearly evident in the numerous articles, monographs, and major recent anthologies devoted in part or in toto to subjects of fertility, family planning, childbirth, breastfeeding, menopause, abortion, and the various reproductive technologies, old and new, being applied to facilitate, curtail, or in some way shape human reproductive processes (e.g., Davis-Floyd & Dumit, 1998; Davis-Floyd & Sargent , 1997; Franklin & Ragone, 1998b; Ginsburg & Rapp, 1995a; Greenhalgh , 1995b; Handwerker, 1990; Lock & Kaufert, 1998; Morgan & Michaels, 1999; Stuart-Macadam & Dettwyler, 1995). Rapp and Ginsburg, in “Relocating Reproduction, Generating Culture” (1999), note the diverse and pioneering range of research on reproduction that has been generated during the past decade, typifying it as a “cresting wave” of scholarly and activist interest. In their paper, intended in part as an update of their earlier theoretical reviews of the politics of reproduction (Ginsburg & Rapp, 1991, 1995b), they identify a dozen “recent genealogies” of social science research on reproduction, particularly in the domain of anthropology, their central discipline. Among these genealogies, they highlight work under- 4 DISCOURSES AND DEBATES scoring the dilemmas of “disrupted reproduction” in which the standard linear narrative of conception, birth, and the progress of the next generation is interrupted by pregnancy loss, reproductive pathology, abortion, and childlessness. REPRODUCTIVE DISRUPTION: A SCHOLARLY LACUNA It is to the last domain of disrupted reproduction—infertility leading to involuntary childlessness—that this volume is dedicated. We argue that, despite the inspiring proliferation of recent studies on the relationship of reproduction to culture and politics, certain reproductive topics continue to be overprivileged at the expense of others. In particular, we now know much more about what might best be called normative human reproduction —particularly “high” fertility that is “controlled” through “modern” contraceptive technologies, as well as successful childbirth at the hands of physicians and midwives, resulting in maternal and child well-being—than we do about non-normative reproductive scenarios and experiences. Unfortunately , the taken-for-grantedness of reproduction can never be assumed . Rather, in many cases, reproduction goes badly and sadly awry (Inhorn , 1994a), marring individual lives and even wreaking havoc on entire populations. Moreover, the ways in which reproductive trajectories may be disrupted, generating suffering and even death, are manifold. Such reproductive disruptions include various sexually transmitted diseases (STDs), including AIDS, that negatively affect sexuality, fertility, and maternal and child health and survival; ectopic (tubal) pregnancy that if undiagnosed can lead to maternal death; pregnancy loss through miscarriage and stillbirth ; premature births accompanied by neonatal morbidity and mortality; births of children with congenital health problems and disabilities; lactational difficulties leading to poor neonatal and maternal outcomes; maternal deaths from pre- and postpartum complications; chronic, debilitating complications of childbirth in multiparous (as well as “circumcised”) women; unwanted pregnancies leading to safe and unsafe abortions; lifethreatening reproductive diseases such as cervical and ovarian cancer; endocrinological disorders leading to menstrual problems and premature menopause; and infertility leading to involuntary childlessness. This volume interprets infertility from multiple global sites and disciplinary perspectives. It is the first attempt to bring together the work of social scientists, including anthropologists, sociologists, psychologists, and behavioral health scientists in schools of nursing, medicine, and public health, who have focused their empirical research on infertility and new reproductive technologies (NRTs) over the past two decades. This small group of scholars—and a handful of others who, for various reasons, are not represented here—have been committed to rescuing infertility from the afore- INTERPRETING INFERTILITY 5 mentioned list of neglected reproductive subjects, in part by proving its relationship to some of the most hotly contested political and bioethical (thus morally contentious) issues of our time. These include, but certainly are not limited...