Reproductive Agency, Medicine, and the State (review)

This book in some ways delivers more than it promises. While the various essays address all types of reproductive technologies and processes from fertility and pregnancy to childbirth and postpartum care, many of them derive their data from rural women and therefore show a considerable sensitivity in dealing with in situ perspectives on fertility, conception, and postpartum care. The "double gaze" of the authors makes this a valuable study not only for those engaged in community medicine but also for medical anthropologists. The collection has particular value for Third World countries because many of the studies focus on the correlation between reproductive technologies like IVF on the one hand and state and societal responses to these on the other. Reproductive agencies take on special significance in the context of "developing" economies like those of Pakistan (Alison Shaw), Sri Lanka (Bob Simpson), and India (Maya Unnithan-Kumar). Given the editor's own problematic, the majority of case studies are from India.

Simpson's essay, "Localising a Brave New World," deals with the contrary pulls of population control and state promotion of IVF and surrogate pregnancies. Links between induced fertilization and state-led sterilization— as during the so-called Emergency in India—are explored in Asha George's essay on the contraceptive uses of Quinacrine. In the context of state policy and reproductive technologies, I would wish to draw attention to Mohan Rao's 2004 book, From Population Control to Reproductive Health: Malthusian Arithmetic, which introduces a refreshing perspective to state-led family planning programs under India's Five Year Plans.

Medicalization and the very private emotions, including pain (even shame), which are involved in IVF, are explored by Monica Bonaccorso in the context of Italy, by Henrike Donner for the Calcutta fertility clinics, and in William Stones's theoretical essay "Women, Doctors and Pain," dealing largely with labor pain. Ethical notions regarding the use of reproductive technologies form the substratum of many of these essays. Unnithan-Kumar's "Conception Technologies, Local Healers and Negotiations around Child-bearing in Rajasthan" focuses on that particular Indian state, which has come in for searching moral questions regarding the use of fetal ultrasound scan as sex-determining means. This was often driven by Rajasthani patriarchal pressures rather than by any concern for the well-being of the fetus or the pregnant woman. The female fetus was often aborted.

The Sri Lankan experience analyzed by Simpson once again gets to the moral dimensions of sperm or ovum donation—whether the donor should be anonymous or kin. Saraya Treayne's very interesting intervention in this debate, "And Never the Twain Shall Meet," deals with Iranian initiatives in family planning and reproductive health while keeping in mind the ethical implications of Islamic jurisprudence, Sharia, on which the Islamic republic rests.

Only two of the essays actually engage with indigenous technologies of reproduction, childbirth, and postpartum care: Unnithan-Kumar's on "Local Healers," and the essay titled "She Has a Tender Body," written by a team of Indian researchers, which deals with postpartum care in rural Karnataka, in south India.

I am strongly of the opinion that this collection would have been enriched by a consideration of the indigenous technologies practiced by the "dai" or midwife. The many writings of Janet Chawla and her nongovernmental organization of midwives called Matrika focus on this crucial cultural aspect of childbearing. In fact, the delineation of the role of the traditional midwife who attended to deliveries and postpartum care in many of the traditional societies of South Asia is conspicuous by its absence in an otherwise excellent compilation.

I recommend Reproductive Agency, Medicine, and the State as a valuable addition to the ongoing studies on reproductive health, most of which have tended to focus on women's health in conjunction with population growth and state family-planning programs. These essays look not merely at reproductive health and the right to abort but also focus on the reproductive rights of women. Reproductive technologies are linked biologically...