Plastic Bodies: Sex Hormones and Menstrual Suppression in Brazil by Emilia Sanabria (review)

Grounded in an ethically rigorous ethnographic account of the widespread administration of hormone regimes to manage menstruation and fertility among racially and socioeconomically diverse populations of Brazil’s northeastern Bahia region, Emilia Sanabria’s Plastic Bodies: Sex Hormones and Menstrual Suppression in Brazil promises a uniquely valuable contribution to the concerns that, well beyond the parameters of geography and case specificity, have animated scholars working at the nexus of feminist science studies, trans studies, biopolitical theory, and new materialisms in recent years.

Sanabria’s fieldwork orbits the empire of Dr. Elsimar Coutinho, “a polemical and highly mediatized doctor” who has, with much fanfare, “ ‘declared a war on menstruation’ ” (1). Coutinho, professor of human reproduction at the Federal University of Bahia’s medical school, author of Menstruation: Useless Bleeding, and director of the Centre for Research and Assistance in Human Reproduction (CEPARH), is widely influential in his advocacy for the use of long-acting reversible contraceptives in order to suppress fertility as well as eliminate monthly bleeding, which he and his followers figure as medically unnecessary, bothersome, and unproductive. Situating herself within the framework of feminist science studies and participating in the progressive anthropological tradition of “studying up” (Nader 1972), Sanabria’s project uses a framework of plasticity, drawn from Catherine Malabou, to investigate the ways in which sex hormones “are enrolled to create, mold, or discipline social relations and subjectivities” (5) within the intensely biomedicalized Brazilian context.

Chapter 1, “Managing the Inside, Out: Menstrual Blood and Bodily Dys-Appearance” performs the contextualizing work of investigating the cultural narratives of menstruation in Bahia, drawing on interviews with over sixty women from diverse racial and class backgrounds. Moving past a simple positive/negative binary, Sanabria is most interested in the “ambiguous aspects of menstruation,” which she argues are often perceived as “unsettling a state of normal embodiment” (43, 44). Sanabria differentiates her goals from existing menstruation scholarship in classical anthropology, which is more concerned with the symbolic function of menstruation than it is with phenomenological dimensions, turning instead to the experience of menstruation and its management. Sanabria synthesizes the findings of her interviews through theoretical engagements with Julia Kristeva, Mary Douglas, and Elizabeth Grosz in order to consider the materiality of blood itself, arguing that menstrual excretions “continually re-attest to the porous nature of bodily boundaries,” producing such boundaries while troubling “the very distinction between them” (63). The following chapter, “Is Menstruation Natural? Contemporary Rationales of Menstrual Management,” continues in this vein, following menstrual discourse into the clinic through ethnographies of women who use uninterrupted hormonal contraceptive methods as a means of reducing or removing monthly bleeding from their lives. Sanabria also analyzes the language of clinics, doctors, and pharmaceutical companies who advocate such methods, demonstrating that masculinist biases privileging bodily fixity as the norm mobilize a narrative in which medical interventions are called upon to save women from the unpredictable and unsafe volatility of their otherwise unruly bodies. In this context, pharmaceutically managed female bodies are recast as more natural, while “hormonal intervention is mobilized as a means to mold the body back to a purportedly original state” (102).

The third chapter, “Sexing Hormones,” opens with a brief foray outside the context of menstrual management toward “more marginal hormonal practices” (107) that illustrate the ways in which hormones destabilize ontologies of sex while always already participating in the materialization of sexed bodies. To this end, Sanabria gestures toward two practices: the largely improvised and unregulated¹ use of hormones within Bahia’s travesti and transsexual communities, and the increasingly prevalent phenomenon of prescription testosterone supplementation as a means of for libidinal augmentation for women within an aggressively heteronormative, medically sanctioned paradigm. While a comprehensive account of transsexual and travesti hormone usage in Brazil is understandably beyond the scope of Sanabria’s expertise and present project, her brief engagement would have done well to draw on existing scholarship within transgender studies. Hailey Kaas’s (2016) short essay...