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171 6 Medicalized Birth and the Construction of Risk India’s rate of cesarean deliveries—15 percent in public hospitals and 28 percent in private ones (IIPS 2007)—reflects the broader increase in surgical deliveries around the world. Cesarean rates rise with socioeconomic status and educational level in India, where many poor women labor outside hospitals. However, India’s flourishing commercial surrogacy industry is bringing the procedure to increasing numbers of poor women who would otherwise have no access to the private, hightech medical care that facilitates their cesarean deliveries. The medical interventions and procedures that attend high-tech medical care expose surrogate mothers to significant physical and psychosocial risks, with cesarean sections chief among the causes. In the previous chapter I demonstrated how transnational surrogacy relies on the work of doctors to organize and facilitate relationships between commissioning clients and Indian surrogates, arguing that doctors racialize the population of surrogates in particular ways in order to justify the lack of contact between clients and surrogates. In this chapter, I extend this analysis to examine how medical discourse and doctors’ views of surrogates influence the kind of medical care they receive. How does biotechnology (and the process of biomedicalization) racialize populations into social groups requiring high-tech medicalized care? I suggest that doctors’ practices produce the bodies of poor surrogate mothers as a racialized social group necessitating social and medical control, thus justifying the excessive medicalization of surrogate women’s bodies. Central to this process of “racialized medicalization” is the construction of surrogates’ bodies as inherently risky. Racializing this population of women helps to situate their bodies as intrinsically dangerous and in need of highly medicalized care. However, while medical discourse can powerfully racialize groups of individuals as naturally perilous, it also naturalizes societal inequalities. 172 | Medicalized Birth and the Construction of Risk Within this context, I examine the medical technologies and treatments that Indian women endure as part of the surrogacy process. Doctors ’ approaches to cesarean section and the ways in which surrogates understand and experience pregnancy and cesarean delivery—perhaps the most medicalized type of birth—reveal the relationship between medicalization and racialization at work in transnational surrogacy. More broadly, I take up the question of how political economies and reproductive bodies shape each other. What influences the medicalized care that surrogates receive? How does surrogacy across geographic scales solidify the global inequalities in which poor bodies labor to reproduce ? In addressing these questions, I elucidate the relationship between bodily labor and commercial value, examining the intersection of bodies, technology, and economy and how medicalized practices naturalize social inequality. This chapter interrogates the intersections of commercial surrogacy and cesarean section in order to demonstrate how surrogate mothers, doctors, and intended parents experience and actively address social inequalities and processes of racialization. My goal is to draw attention to the risks and prevalence of cesarean deliveries among surrogate mothers in India and to contextualize women’s experiences of surrogacy and childbirth in order to show how gestational surrogacy and cesarean delivery are inextricably intertwined. These interrelated processes, I argue, stem from practices that racialize this group of women as inherently risky, which simultaneously erases from view the risks that surrogates themselves must bear. These processes justify the use and medicalization of Indian women’s bodies for the purposes of commercial surrogacy . However, such processes are fragmented and complex, as surrogate mothers too argue that their scars merit access to economic and political rights previously denied. Intersecting Health Risks: Cesarean Sections and Assisted Reproductive Technology In a cesarean section, the surgeon cuts through the skin and fat of the lower abdomen, slices through the tough underlying fascia, and pulls apart the muscles of the abdominal wall. Opening the peritoneum, a thin sac that encases the abdominal and pelvic organs, the surgeon peels the Medicalized Birth and the Construction of Risk | 173 bladder away from the uterus, cuts open the uterus itself, and pulls out the baby and placenta. All of this can usually be done in a minute or two; the remainder of the operation consists of suturing or stapling together the layers previously cut. (Wendland 2007, 219) Obstetrical surgery is now a routine practice, but it was once a procedure performed only when women were near death; few women survived these early operations at the end of the nineteenth century. By the 1930s, however, advances in surgical techniques helped reduce maternal mortality to below 20 percent in the United States, and obstetricians reviewing case reports realized that the timing...


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MARC Record
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