Haunting Images: A Cultural Account of Selective Reproduction in Vietnam by Tine M. Gammeltoft (review)

When Tine Gammeltoft conducted an ethnographic project on intrauterine devices in northern Vietnam during the early 1990s, ultrasound scanning was still reserved for special circumstances. Ten years later, she found that women at the Obstetrics and Gynaecology Hospital in Hanoi had an average of 6.6 ultrasounds during their pregnancies. Sonograms — the digital image created during an ultrasound examination — have become a source of joy and wonder for the people who produce and consume them, even as the possibility that they will detect abnormalities in foetal development elicits dread. Vigilant for signs of trouble, many pregnant women are unsettled by the spectre of malformed foetal bodies submerged beneath the actual images of the normally developing babies that are presented to them.

An ethnographically rich study of selective reproductive technologies that encourage or discourage the births of different types of individuals and the controversies that follow in their wake, Haunting Images focuses on what happens after foetal anomalies are detected. While the widespread availability of new biomedical technologies has clear benefits for reproduction and reproductive health, it also raises difficult questions about how some forms of human life can be made or interpreted to be worth more than others. After reading the book, I can only surmise that the people who vividly populate this study have marshalled answers to these questions that are ambivalent and partial at best.

One of the book’s most important contributions for Southeast Asian studies is a nuanced treatment of the relationship between subjectivity and political economy that avoids the state–citizen binaries characteristic of many studies of Asian neoliberalisms. Indeed, ultrasound as a taken-for-granted component of antenatal care can be traced to neoliberal market reforms and the privatization of the health sector in Vietnam: health care providers supplement their income by providing ultrasounds in private clinics, while some women’s medical decision-making increasingly resembles patterns of self-interested consumerism. However, Gammeltoft frames Vietnam’s cultural politics of abortion not around individual choice but rather around social belonging. Her analysis of self-making projects draws less from Michel Foucault’s writing on governmentality and focuses more on Emmanuel Levinas’s phenomenological position that subjectivity arises in a relationship of responsibility and vulnerability to the other.

Reproductive selection has become a matter of improving Vietnam’s population quality as well as a communal — at the family and national levels — obligation. The self-responsibilization often associated with neoliberalism emerges alongside renewed responsibilities to one’s family. Here, kinship is not set in opposition to the state but is theorized as a reimagined domain belonging to the state.

How family members relate to each other fluctuates significantly during a pregnancy, as they must adapt to an addition to the family and prepare to take on new social roles. Frequent monitoring of foetal development through ultrasound scanning gives pregnant women the hard-won identity of “good mother”, someone who dutifully belongs with her child, her husband and her husband’s patrilineage. Patients and medical staff use 3D scans of the foetus to identify physical similarities to its relatives. Even in utero, personhood and subjectivity are defined in relation to the family. Thus, it should be no surprise that decisions to terminate pregnancies are made collectively in Vietnam: the expecting couple’s elders are called upon to advise what is best not just for the foetus or its parents but also for the extended family. Can people born with severe disabilities have good lives? Can their caregivers cope with the extended responsibilities of care for a child with disabilities? How much might be sacrificed for the child? Such considerations expose the contingencies, vulnerabilities, and obligations of their belonging to one another.

Although a focus on sonography is most directly relevant to medical anthropology, and particularly the anthropologies of reproduction and disability, its timeliness and insights into biopolitics, gender, morality, selfhood and social issues relating to science and technology make Haunting Images...