Reproductive Governance, Redux

Defining the Limits of Acceptable Parenthood: Reproductive Governance in Brazil

Drawing on sources relating to the Brazilian scenario - from ethnographic research in lower-income neighorhoods to the analysis of official documents and public debates - we build on cases of forced child removals to explore the intersectional dynamics of class, race, and gender that underlie institutionalized practices of discrimination against poverty-stricken families. After first addressing the influence of recent global trends in child-protection policy, we observe how adoption procedures in Brazil have been increasingly facilitated by the resignification of rights and corresponding changes in the country's legal infrastructures. Next, asking what sort of authoritative knowledge is invoked to define a child's best interests, we reflect on the role played by biomedicine in appraising the limits of acceptable parenthood. Guided by the notion of stratified reproduction, our investigation of these political, scientific, and moral technologies suggests plausible connections between policies that condition the demand for and the supply of adoptable children.

Information flow as reproductive governance. Patient journey analysis of information barriers and facilitators to abortion care in the republic of Ireland

Background

Information flow - information communication and transmission pathways and practices within healthcare systems - impacts patient journeys. Historically, regulating information flow was a key technology of reproductive governance in the Republic of Ireland. Pre-2018, law and the State sustained informational barriers to and through abortion care in Ireland. An expanded abortion service was implemented in January 2019.

Method

Patient Journey Analysis (PJA) interrogates informational facilitators and barriers to/through post-2019 abortion care in Ireland. We focus on information flow at the interfaces between the 'public' sphere and 'point of entry', 'point of entry' and primary care, and primary and secondary care.

Materials

The paper uses data from a mixed-method study. A tool for assessing online abortion service information (ASIAT), desktop research, and qualitative data from 108 in-depth interviews with providers, policy-makers, advocacy groups, and service users informed the analysis.

Results

Abortion patient journeys vary. Information flow issues, e.g. communication of how to access services, referral systems, and information handover, act as barriers and facilitators. Barriers increase where movement from primary to secondary is needed.

Applications

The article identifies good practice in information flow strategy, as well as areas for development. It illustrates the significance of information flow in accomplishing reproductive governance.

"But it's not that they don't love their girls": Gender equality, reproductive rights and sex-selective abortion in Britain

Recent demographic analysis of sex ratios at birth in the UK has signaled the issue of "missing girls" in British Asian minority populations. This paper juxtaposes the processes of reproductive regulation set in motion by this new demographic knowledge of son preference, with lived experiences of gender equality and family-making practices. Ethnographic research conducted with British Pakistani, Indian, and Bangladeshi families reveal diverse mechanisms of family decision-making that add to and nuance the prevailing statistics. We use the lens of "gender equality" and vernacular framings of sex-selective abortion to advance conceptual understandings of son preference as increasingly disconnected from selective reproduction, at the same time as selective reproduction is connected with the governance of ethnic minority identity and reproduction.

What's so troubling about 'voluntary' family planning anyway? A feminist perspective

Voluntary family planning is a key mainstay of demographic work and population policies. The 1994 International Conference on Population and Development (ICPD) signalled a decisive shift away from fertility reduction and target-setting to an emphasis on voluntary family planning as intrinsic to reproductive health and women's empowerment. Yet, criticisms of voluntary family planning programmes persist, interrogating how 'voluntariness' is understood and wielded or questioning the instrumentalization of women's fertilities in the service of economic and developmental goals. In this paper, I reflect on these debates with the aim of troubling the notion of voluntary family planning as an unambiguous good that enables equitable empowerment and development for all. Drawing on literature from cognate disciplines, I highlight how voluntariness is linked to social and structural conditions, and I challenge the instrumentalization of voluntary family planning as a 'common agenda' to solve 'development' problems. Engaging with this work can contribute to key concepts (e.g. 'voluntary') and measurements (e.g. autonomy), strengthening the collective commitment to achieving the ICPD and contributing to reproductive empowerment and autonomy. Through this intervention, I aim to help demographers see why some critics call for a reconsideration of voluntary family planning and encourage a decoupling of interventions from fertility reduction aims, instead centring human rights, autonomy, and reproductive empowerment.

Vidas precárias: tecnologias de governo e modos de gestão da fecundidade de mulheres “vulneráveis”

Resumo Lacunas no planejamento reprodutivo, após 25 anos da Lei de Planejamento Familiar, no Brasil, têm promovido uma ressignificação do controle reprodutivo. As expressivas dificuldades para realização da laqueadura tubária no Sistema Único de Saúde têm permitido o florescimento de estratégias governamentais fomentando acesso estratificado e racializado a métodos contraceptivos reversíveis de longa duração (LARC). A pesquisa etnográfica apoiou-se em fontes documentais sobre iniciativas institucionais para inclusão de LARC no sistema público de saúde, tomando-se o município de São Paulo como caso empírico paradigmático. Envoltas no ideário da cidadania, argumenta-se que tais tecnologias de governo são acionadas na direção contrária à ampliação de direitos sexuais e reprodutivos, para reificar estereótipos sociais que subtraem a autonomia reprodutiva das mulheres. Tomando o conceito de “coerção contraceptiva” como categoria de análise, demonstra-se como tais expedientes ferem o paradigma da justiça reprodutiva no Brasil ao se institucionalizar a exclusão social pelo útero das mulheres “vulneráveis”.

Motherhood in Spain: From the "Baby Boom" to "Structural Infertility"

We analyze the mechanisms of reproductive governance that influence reproduction in Spain through 66 semi-structured interviews with heterosexual parents. We examine reproductive governance through moral regimes surrounding four arenas: the labor market, gender relations at home, institutional feminist discourses, and the narrative of choice. We show that mothers are considered to be socially responsible for children, a fact that is key to understanding how Spain went from a "baby boom" between the 1950 and 1970s to "structural infertility" since the 1990s.

A Stalled Revolution? Misoprostol and the Pharmaceuticalization of Reproductive Health in Francophone Africa

Misoprostol entered the global market under the name Cytotec in the mid-1980s for the treatment of gastric ulcers. Decades of research have since demonstrated the safety and effectiveness of off-label use of misoprostol as a uterotonic in pregnant women to prevent and treat post-partum hemorrhage, treat incomplete abortion, or terminate first-trimester pregnancy. Global health experts emphasize misoprostol's potential to revolutionize access to reproductive health care in developing countries. Misoprostol does not require refrigeration, can be self-administered or with the aid of a non-physician, and is relatively inexpensive. It holds particular promise for improving reproductive health in sub-Saharan Africa, where most global maternal mortality related to post-partum hemorrhage and unsafe abortion occurs. Although misoprostol has been widely recognized as an essential obstetric medication, its application remains highly contested precisely because it disrupts medical and legal authority over pregnancy, delivery, and abortion. I draw on fieldwork in Francophone Africa to explore how global health organizations have negotiated misoprostol's abortifacient qualities in their reproductive health work. I focus on this region not only because it has some of the world's highest rates of maternal mortality, but also fertility, thereby situating misoprostol in a longer history of family planning programs in a region designated as a zone of overpopulation since the 1980s. Findings suggest that stakeholders adopt strategies that directly address safe abortion on the one hand, and integrate misoprostol into existing clinical protocols and pharmaceutical supply systems for legal obstetric indications on the other. Although misoprostol has generated important partnerships among regional stakeholders invested in reducing fertility and maternal mortality, the stigma of abortion stalls its integration into routine obstetric care and availability to the public. I demonstrate the promises and pitfalls of pharmaceuticalizing reproductive health: despite the availability of misoprostol in some health facilities and pharmacies, low-income and rural women continue to lack access not only to the drug, but to quality reproductive health care more generally.

Backlash or Widening the Gap?: Women’s Reproductive Rights in the Twenty-First Century

This article examines legal challenges to women’s reproductive rights in Ireland and the United States, arguing that backlash against reproductive rights is a consequence of the long unsettled position of women’s reproductive freedom in liberal democracies and the catalogue of rights. It examines the legal foundations of reproductive rights and their perceived conflicts with other values, such as religion, and focuses on the current legal challenges to women’s bodily autonomy regarding choice and motherhood. It demonstrates the many contexts in which women have not acquired full reproductive freedom, and explores the nature of the current backlash. It argues that the nature of the backlash is not simply a reclamation of what has been legally guaranteed, but instead a deepening of the preexisting divides within reproductive justice globally.

Arbitrating Abortion: Sex-selection and Care Work among Abortion Providers in England

The UK's on-going sex-selective abortion (SSA) controversy remains a major obstacle to the liberalization of national abortion governance, and is an issue broadly attributed to a "cultural" preference for sons among South Asian women. We conceptualize how healthcare professionals "arbitrate" requests for SSA by exploring the tension between its legal status and how requests are encountered by abortion providers. SSA is framed in this article as a legitimate care service that can support providers to meet the diverse reproductive health needs of women to the full extent of the law.