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ChAPTER 10 Imaging Maternal Responsibility Prenatal Diagnosis and Ultrasound among Haitians in South Florida Lauren Fordyce One afternoon toward the end of my ethnographic fieldwork in South Florida, I received a call from the nurse-practitioner at Prenatal Clinic, the public clinic where I was conducting participant-observation. Portia told me that she had given my name and number to a local obstetrician.1 She explained: “Dr. Albert is the perinatologist who runs the ultrasound clinic where I send the patients who don’t have Medicaid. She has some questions and concerns about her Haitian patients, and I told her she should talk to you.” Within a week, I was sitting across from Dr. Albert in her patient waiting room with my digital recorder and a list of questions. Dr. Albert explained that she wanted to speak with me about her frustrations with prenatal counseling among her Haitian patients: They make it very hard to do antenatal diagnoses and counseling. [I will say to them,] “As far as I see this on the ultrasound, I think there’s an increased risk that your baby might have Down syndrome” or [explain] what Down syndrome is. “This is that, and implies this and that, and you know, we want to try and give you the option of knowing before the baby is born, if the baby has this or not?” I do amnios [amniocentesis] here, but they always decline. I’ve never had a Haitian patient consent to an amnio. Dr. Albert’s comments echoed much of what I was finding to be most salient in my research with providers who administer prenatal care to Haitian women—that is, the ways in which narratives of risk and responsibility figure prominently within the biopolitics of contemporary pregnancy care (Fordyce 2009). Underlying the choice to use prenatal diagnosis, such as ultrasound or amniocentesis, is the notion that pregnant women have a responsibility to understand the genetic “risks” to their unborn child, as well as a responsibility to use biomedical technologies to “know” these risks (Browner and Press 1995; Hunt and Voogd 2003; Kenen 1996; Lupton 1999b; Rapp 2000; Weir 2006). Ultrasound examinations, an important component of prenatal diagnosis and a gateway to further diagnostic measures, provide a particularly important site for research into these narratives of risk and responsibility in biomedical prenatal care. 191 While initially used as a diagnostic tool in high-risk pregnancies, ultrasound has become a ubiquitous aspect of prenatal care in the United States, such that it is rare for a woman not to have at least one scan, if not many, during her pregnancy (Georges 2008; Mitchell 2001; Mulcahy 2004; Taylor 2008). For women who have no insurance or Medicaid coverage, ultrasounds done at County Hospital cost US$750, but Dr. Albert, the supervising physician at the private Ultrasound Clinic, worked out an arrangement with Prenatal Clinic by which these patients received an ultrasound for US$175. The majority of the Haitian women I interviewed saw ultrasound as a valuable part of the pregnancy experience and therefore a necessary expense for their families. Questions about their experiences with ultrasound exams solicited a show-and-tell of their fetal photos. Often they would interrupt our conversation to get the images to show me—from their purse or the baby album, in a frame next to their bed, or, in one case, from the glove compartment in the car. Clearly, ultrasound examinations are a highly valued aspect of pregnancy experiences among Haitian immigrant women, yet Dr. Albert’s comments on prenatal diagnosis speak precisely to what makes ultrasound such an interesting case study: the ways in which ultrasound is situated as a both a diagnostic tool and a pleasurable experience. Discourses of risk and responsibility contribute to the creation of particular kinds of subjects: “autonomous, self-regulating moral agents” who voluntarily take up government imperatives and embrace expert advice (Lupton 1999a:105). Yet far from docile bodies, Haitian women are reflexive about the narratives of risk in their everyday lives. And by situating the technologies of prenatal risk within women’s experiences in pregnancy, we can begin to explore the varied and dynamic ways in which Haitian women encounter and respond to these discourses of risk and responsibility. Biopolitics of Being haitian in the United States I imagined that when I moved to South Florida I would find the Haitian community bounded by a shared culture, language, and pride in Haiti’s legacy as the first black republic, yet one also...

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