An ethical response from South Africa informed by vulnerability and justice
Two articles in the Universal Declaration on Bioethics and Human Rights are of particular relevance to the issue of assisted reproductive technology in the global south, and in South Africa especially. Article 8 mentions respect for human vulnerability, while article 10 calls for equality, justice and equity. In this chapter, these two articles will be brought into conversation with the issue of assisted reproductive technologies in the global south, taking the South African context as the point of departure. The articles underscore the necessity for vulnerable groups and individuals to be protected in the application and advancement of scientific knowledge, medical practice and associated technologies, while also emphasising that all human beings should be treated in a just and equitable manner. In the context of South Africa, where the majority of the population are unable to access and afford most forms of assisted reproductive technology, the issues of biopower and misuse of power come particularly to the fore. Especially in forms of biotechnology where donor material is utilised, donors often come from vulnerable groups, while those that benefit are in positions of privilege, where they can both access and afford these treatments. This also raises the issue of intersectionality in the ethical discussion on assisted reproductive technologies in the South African context.
This book analyses the world of selective reproduction – the politics of who gets to legitimately reproduce the future – by a cross-cultural analysis of three modes of ‘controlling’ birth: contraception, reproductive violence, and repro-genetic technologies. The premise is that as fertility rates decline worldwide, the fervour to control fertility, and fertile bodies, does not dissipate; what evolves is the preferred mode of control. Although new technologies, for instance those that assist conception and/or allow genetic selection, may appear to be the antithesis of violent versions of population control, the book demonstrates that both are part of the same continuum. Much as all population control policies target and vilify (Black) women for their over-fertility, and coerce/induce them into subjecting their bodies to state and medical surveillance, assisted reproductive technologies and repro-genetic technologies have a similar and stratified burden of blame and responsibility based on gender, race, class, and caste. The book includes contributions from two postcolonial nations – South Africa and India – where the history of colonialism and the economics of neoliberal markets allow for some parallel moments of selecting who gets to legitimately reproduce the future. The book provides a critical interdisciplinary and cutting-edge dialogue around the interconnected issues that shape reproductive politics in an ostensibly ‘post-population control’ era. The contributions range from gender studies, sociology, medical anthropology, politics, science and technology studies, to theology, public health, epidemiology and women’s health, with the aim of facilitating an interdisciplinary dialogue around the interconnected modes of controlling birth and practices of neo-eugenics.
In his seminal work of 2018, Fatal Misconception, Mathew Connelly surmises that the global campaign for population control is a neo-colonial attempt to control the world. What are these neo-colonial projects that attempt to control the world? What shape do these projects take in an era where population control has become a taboo phrase in policy making? This chapter draws on the concept of birth projects to demonstrate that as fertility rates decline worldwide, the fervour to control birthing bodies, especially of poor and Black women in the global south, does not dissipate. The twentieth-century top-down population control projects, embedded in state propaganda and policies, were easily identifiable because of their starkness and brutality. What we have today are birth projects that are diffuse and couched in the frame of individual choice, which absolve the state of its responsibility. These neo-eugenic birth projects are based on a subtle form of eugenics that depoliticises issues and justifies systemic inequalities by couching them in the frame of choice. The chapter compares the history and presence of population control policies in South Africa and India to two other modes of delimiting the fertility of a certain demography – obstetric violence and repro-genetic technologies – to argue that forced contraceptive, limiting (legal) access to contraceptive, exposing women to violence during pregnancy and birthing, and the inherent stratifications of new repro-genetic technologies, although seemingly contrasting, belong to the same neo-eugenic continuum.
This chapter is based on a unique and new set of data, which explores tensions within Indian feminist discourses on reproductive technologies, rights and justice. It builds on in depth interviews with Dalit feminists on reproductive technologies, in particular, commercial surrogacy and egg donation, to argue that these voices challenge hegemonic discourses of reproductive technologies through an insistence on the wider socio-economic context of women’s lives. Inspired by African American feminists and the Sister Song collective, the chapter conceptualise these conflicting perspectives as reproductive rights versus reproductive justice and points to the complex dynamics between caste, class, patriarchy and neo-liberalism in the contemporary Indian setting.
South Africa is the site of a professionalised market for human oocytes in the context of assisted reproductive technology and, as such, is part of the rapidly growing transnational fertility industry. This chapter explores the biopolitical dimension of the South African market for ‘donor eggs’ by putting it into the larger frame of ‘technologically assisted’, global politics of reproduction. Based on an analysis of a rich corpus of ethnographic data, the chapter argues that Foucauldian biopolitics are reshaped as they operate on different levels within this specific economy of egg donation – linking genetics, biocitizenship, and geopolitics. In doing so, the chapter highlights new forms of eugenics that are emerging in the global business around fertility-related services, eugenics that come in the positive frame of choice. It stresses the importance of paying attention to both continuities and changes regarding eugenics as the reproduction of existing hierarchies – even more so against the background of a postcolonial history of racialised population control and reproductive injustices.
Protecting egg donors’ reproductive labour in Kolkata, India
India is an egg donation ‘hot spot’, which relies on some of the country’s poorest women to source its gametes – yet it remains legally unregulated. Given that egg donors’ experiences rely on the discretion of fertility clinics, it is imperative to analyse the meso-micro interactions between clinic institutions and low-income women. This chapter analyses how commercial egg donation is organised in unregulated fertility markets, such as Kolkata, India, and what the implications are on donors’ wellbeing. Harnessing in-depth interviews and participant observation at a fertility clinic in Kolkata, it unpacks the theoretical potentiality of agency bound by financial desperation, unequal gendered positions, and institutional imposition. In doing so, it illuminates how clinics structure a donor market incentivising low-income women while also strategically distancing themselves from these networks of women. This neglect from the clinic has severe consequences for the wellbeing and safety of donors, which in turn compromises their ownership over their bodily labour. It argues that greater institutional accountability for clinics is fundamental to recentring donors’ agency. Overall, the chapter reinforces a need for contextual specificity to develop meaningful discourses about women’s bodily labour in the global south.
This chapter interrogates the utility of the term obstetric violence in the Indian context using ethnographic insights from research conducted between 2015 and 2019 in two geographically distinct areas of India, as well as the scholarship on obstetric violence, disrespect and abuse and respectful maternity care. It argues that the circumstances under which institutional births became widespread in India, the conditions under which rural Indian women give birth, the excessive focus on individual provider responsibility while ignoring the systemic and normative mechanisms that routinise disrespectful and abusive treatment, and poor health that is an outcome of exclusion due to social identities and remoteness in terms of geography, make it difficult to capture these inequities within the conceptual category of obstetric violence. It problematises the role of transnational and global health initiatives (GHIs) that have reduced maternal health to a set of technological fixes instead of using a framework that privilege the social determinants of health and/or strengthen health systems. These GHIs have not been attentive to the quality of care that women receive unless they have causative impacts on reducing infant and maternal mortality. A case study of Shaheed hospital, a worker’s hospital in Chhattisgarh, central India, is used to demonstrate that alternative institutional possibilities may exist, which keep service users at the centre of care. This analysis reveals that a different vocabulary, taxonomy, and imagination is essential for a safe and dignified childbirth experiences in low- and middle-income countries that are rooted in their contextual realities and constraints, rather than importing blueprints that work in the developed countries of the global north, as is currently the case.
Regulation of populations has been one of the central concerns of nation states since the latter half of the eighteenth century, when disciplinary power over individual bodies shifted to power over populations, in what Foucault termed biopower. Depending on the biopolitical objectives of indiviudal nation states, this resulted in the promotion of pro- and anti-natalist measures as part of a capitalist, racist, and imperialist agenda. Over time, the biopolitical project of eliminating bodies deemed superfluous to the economy moved from ‘making die’ to ‘letting die’. However, this chapter argues that the active promotion of anti-natal technologies, such as long-acting injectable contraceptives, which are inherently hazardous and life-threatening, indicates the reverse, from ‘letting die’ to ‘making die’. Evidence comes from the three-decade long struggle in India against the introduction of injectable contraceptives into its national family planning programme. The chapter analyses the context within which the struggle gained currency and in which it lost out. It examines the truth claims of the medical establishment, the NGO-isation and conflation of diverse ideologies under the rubric of ‘women’s’ groups as strategies deployed to overcome resistance to these technologies of power. In the context of liberal democracy, the removal of certain populations’ rights and their elimination makes the state of exception the new normal. The chapter concludes that, notwithstanding the rhetoric of reproductive choice and women’s empowerment, the discourse demonstrates the class, gender, and caste dimensions (with its underpinning of racism) of the biopolitical intention of ‘making die’, ably aided by transnational capital.
The Introduction provides the main premise that connects the various chapters – that as fertility rates decline worldwide, the fervour to control fertility, and fertile bodies, does not dissipate; what evolves is the preferred mode of control. The preface introduces connections between the debates around eugenics, Malthusianism and selective reproduction. It provides an overview of the book by outlining the various chapter contributions as well as highlighting the interdisciplinarity of the volume. The final section connects these debates to the Covid-19 pandemic and the crisis of reproductive health and justice.