Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization (review)

Khiara Bridges opens Reproducing Race with a telling and disturbing story. Three physician assistants, all with roots in the Caribbean, are chatting in a nurse triage room, complaining about problem patients. “They come in here with their little lousy Medicaid and be the main ones raising up in the hallway,” one opines while another agrees: “They have more money than we do. They have two or three baby daddies that they get child support from. They have Section 8, so they pay $100 in rent. They have food stamps; they have WIC [Women, Infants, and Children Program]...That’s why they have kids. For real” (1–2).

Welcome to Alpha Hospital, New York City’s largest and quite legendary medical center which serves the working poor, the uninsured, immigrants from more countries than you can probably name, and even significant portions of the City’s prison population. Both reviled and revered as the simultaneous site of urban decay and brilliant medical care under fire, Alpha’s welcome signage is printed in 21 languages, its corridors are marked to resemble passageways in the subway system, and its newest wings and facilities are the envy of many richer, private hospitals. No one is ever turned away from medical care in Alpha’s emergency room (most often and stereotypically described as a “war zone”), or from its various services, for which waiting lines and appointment times are hugely encumbered. It was here, at Alpha, that Khiara Bridges chose to study the Ob/Gyn service, whose prenatal clinic is lightly disguised in the book as the Women’s Health Clinic (WHC). There, she investigated how medical management of fertility and reproduction is producing far more than healthy babies: in Bridges’ strong and titular analysis, Alpha is also adept at “Reproducing Race.”

This is an enormously challenging and valuable book; having done my time as a researcher at Alpha, I also found it a difficult book to read. I struggled with both accepting and resisting Bridges’ generalizations, especially those surrounding staff behavior under the daily duress of serving a poor, multi-lingual, sometimes hard-to-reach group of patients. (And due diligence: I am thanked rather too generously in this book). At the same time, Bridges builds a thoughtful and important argument replete with rich ethnographic examples revealing the contradictory nature of highly stratified reproduction in early 21st century America: Alpha’s patient population receives vast amounts of the most expensive and technologically-driven medical service, granting them arguably equal access to the same services richer women and their partners receive during pregnancy. Indeed, it is part of Bridges’ argument that women who rely on state-provided medical payments are frequently over-medicalized in the service of demeaning social control. Nonetheless, this access to both the burdens and benefits of medicalization for uninsured pregnant women is an accomplishment of the tattered and contradictory barely-liberal welfare state whose mission New York City has long championed in the field of public health. At the same time, the women who use Alpha’s WHC are also labeled, held hostage to state surveillance in the classic Foucauldian sense, and too often treated with dismissive contempt. That both statements could be true suggests the complexity of the analysis that Bridges’ hard-earned insights make clear. Welcome again and again to Alpha, which stands at America’s racial/ethnic, class, and nationally heterogeneous cross-roads, engaged in the gendered business of serving pregnant women. Khiara Bridges proves herself to be a very reliable and provocative guide to its labyrinths.

Reproducing Race is divided into two parts containing six chapters and an epilogue. The first part focuses on class and lays out legal entitlements and surveillance, making a clear and level-headed case for what it means to be pregnant and poor or under/un-insured in the contemporary US. There, we see how the pregnant bodies of women whose prenatal care is funded by Medicaid are monitored far more intensively for...