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Annu. Rev. Anthropol. 1991. 20:3lJ-43 Quick links to online content
Copyright © 1991 by Annual Reviews Inc. All rights reserved
Faye Ginsburg
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Department of Anthropology, New York University, New York, New York 10003
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Rayna Rapp
INTRODUCTION
'The 1 970s proliferation of gender studies provided a matrix from which a revitalized,
feminist scholarship on reproduction emerged. Since the early 1980s, activists and scholars
concerned with sexuality in all its diversity have produced a rich literature, insisting on the
conceptual distinction between sex and reproduction (70, 334, 353a,b). A review of this work is
beyond the scope of this essay.
311
0084-6570/91/10 15-0311 $02. 00
312 GINSBURG & RAPP
Since the 1970s, the analysis of reproduction has been greatly enriched by
the encounter between second-wave feminism and anthropology, in which
women's reproductive experiences were analyzed as sources of power as well
as subordination. The fallout from this encounter was rich and impressive:
Some authors considered whether "women's secrets" might be a power base,
or even a site of resistance (36, 292). Others used data from "women's
medicine" (like herbal birth control, and prolonged nursing as a method of
ovulation suppression) to show the effectiveness in scientific terms of such
alternatives to medicalized systems (30, 31, 217, 252, 256, 283). Western
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CONCEIVING REPRODUCTION
forces within which their lives are embedded. To understand this problem,
anthropologists used methods of both social history and Foucauldian analysis
to explore the dialectic between, on the one hand, discursive strategies of the
state, the market, and international medical institutions, and, on the other,
resistances to them (209, 340, 352). This inter-disciplinary perspective has
shown us how power differences not only repress but also construct identities.
For example, the restrictions placed upon women in many cultures have often
served as a basis on which to stake claims of women' s superior political
morality, using maternalist discourses (163, 210). Claims articulated in the
language of motherhood have been made on the right as well as the left, for
suffragism, and anti-suffragism, in the "march of the pots and pans" against
the Allende regime in Chile, in the antimilitarism of Greenham common, and
by the mothers and grandmothers of Argentina's Plaza de Mayo. Thus the
"politics of reproduction" may open new spaces for the production of politics
(77, 97, 109, 139, 150, 175, 307).
women's behavior during pregnancy, birth, and in the perinatal period (208,
279, 351), and even to exclude them from hazardous work places on the basis
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category requiring both medical care and public health surveillance (65 , 375).
These same sentiments fueled the crusade to criminalize abortion in the
United States (200, 238); ironically,abortion laws were liberalized a century
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214, 311), and sociologists (299) that the provision of Western biomedical
services is a double-edged sword. While the benefits are undeniable, the
spread of medical hegemony, through the introduction of hospital-based birth
technologies, for instance, often displaces or competes with indigenous prac
tices and may disorganize or extinguish local forms of knowledge (158, 267).
(Because this phenomenon has been so widely explored by anthropologists,
we discuss it in detail below, in the section on birth . ) Anthropologists have
studied the micro-politics of reproductive medicine, for example, in doctor
patient interactions (64, 187), and the ways African-American and white
women of different classes describe their embodiment (206). Working from a
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forward a hegemonic and unified rationality for prenatal genetic testing but
muffle the aspirations of women of diverse backgrounds for their pregnancies
and children (286, 287).
Sometimes, the interests of medical and local communities coincide. For a
short period in Louisiana during the 1960s, a birth control movement de
termined to serve poor black women remade alliances among teaching hospit
als and health activists while neutralizing the Catholic church. Unfortunately,
this alliance collapsed as local, national, and international politicians and
agencies exploited its success for their own ends , which often meant a focus
on top-down population control (356). Such studies reveal the power an
anthropological perspective can contribute to understanding the specific sub
jective consequences, local responses, and human costs of hegemonic medi
cal interventions into women's reproduction. They also demonstrate the
particular ways racial, gender, and class categories are imposed upon and
construct social and individual bodies.
These global processes encounter local cultural encodings and practices sur
rounding fertility. Anthropologists have attempted to comprehend these prac
tices in their own terms. For example, symbolic elaborations of menstruation
have long received scholarly attention in anthropology, considered by some to
be a central component in human social organization (15, 83, 240). A critical
appraisal of both early and current work on menstruation (39) points out that
only recently has such research attempted to fully contextualize menstrual
rituals into larger cultural systems. For example, among the Oglala Sioux, the
Beng (Ivory Coast), and Yurok, menstruating women are considered to have
creative spirituality (38, 119 , 281). By contrast, in rural Turkey, where
Muslim tradition dictates the subordination of women to men, menstruation is
POLITICS OF REPRODUCTION 319
corporation into the welfare state (40). Young West African women find
themselves caught in a squeeze play between the high value placed on early
and continuing fertility and pressures to complete secondary education (18).
One explanation for the dearth of such studies may be the preoccupation in
Western industrial societies with categorizing teenage sexuality and preg
nancy as a "social problem" ( 182). Cross-cultural comparison makes clear
that this "problem" is as much a reflection of our own society's marking off
and prolongation of adolescence, reduced value placed on fertility, and lack
of cultural and social supports, all of which are differentially mediated by
considerations of age, class, race , ethnicity, sexual preference, and marital
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RE: BIRTH
treated the cultural aspects of the perinatal environment (224, 258) and others
analyzed the cultural factors in family planning, birth, breast-feeding, and
abortion (252, 253, 282, 283). Some cross-cultural surveys were influenced
by feminism (269) and aspired to popularize anthropological findings con
cerning pregnancy and motherhood in nonmedicalized contexts (168, 252,
296). Newer studies have undertaken comparisons of the explicitly cultural
nature of Western, medicalized births with non-Western, nonmedicalized
birth practices (169, 259, 260). Scholars have noted cross-national variation
among medical practices in Western countries. Strikingly different prefer
ences with respect to labor-related anesthesia, home versus hospital births,
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birthing positions, and use of neonatal intensive care make it clear that
"Western medicine" is not a monolithic category (125, 156, 211, 213, 227).
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For all these reasons, the appearance of Jordan's work presaged a boom in
studies of birth practices cross-culturally, studies that turned their gaze home
ward and became increasingly political over the decade of the 1980s (37, 87,
165, 201, 229, 296, 365).
Critical attention has been paid to birth as a true rite of passage for both
mother and newborn (68, 283, 325), thus placing birth in its life-cycle and
community contexts (41, 120, 264). Even American obstetrical training has
been analyzed as ritual initiation (66). A still broader perspective is provided
by biocultural and physical anthropologists investigating the evolution of
mother-infant bonding: These studies include discussions of whether differ
ences among birth practices have evolutionary significance, including the
presence or absence of birth attendants, frequent nursing and late weaning, or
mUltiple versus single caretakers for newborns (173, 174, 348, 350).
Some studies focus directly on the power of beliefs and practices that
privilege men within the "women's world" of birth: The powerful meanings
men culturally assign to semen, and the assumption that women are responsi
ble for infertility or bad pregnancy outcomes, for example, give absent men a
strong presence in women's discussions and consciousness in Egyptian vil
lages (243). Elders often ascribe infertility and pregnancy loss to disorderly
social relations, for which the women are held responsible (21, 89, 202, 335).
Gisu, Zulu, and Mende birth practices can quickly transform a female
centered experience into a patrilineal interrogation of the laboring woman,
who is in a liminal-indeed, potentially life-threatening-position (41, 202).
In rural northern India, mothers-in-law carefully survey their daughters-in
law's menstrual cycles and pregnancy regimes, exerting strong pronatalist
pressures. On visits to their natal villages, unsupervised by husbands and
in-laws, wives have more room and support to practice menstrual regulation
and early abortion as methods of family planning (152). The limits of male
dominance may also be inscribed in community beliefs and practices. In rural
Haiti, for example, the folk illness of bad blood (move san) and spoiled milk
322 GINSBURG & RAPP
is most likely to afflict pregnant and nursing women who are. suspected
victims of abuse. Once they report or are reported to have move san, com
munity surveillance and intervention occur (96).
Tn their US studies, anthropologists and sociologists often focus on
women's individual aspirations and experiences in giving birth (86, 87, 299,
366). Such a framework closely mirrors the American cultural privileging of
individual choice. More recently, studies have begun to stress that social as
well as individual aspirations and experiences differ. Working-class women
have a tendency to want an "easier" birth, middle-class women want to
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"control" their births, and both may willingly accept medical interventions as
strategies enabling them to fulfill those desires (250). For middle-class
women, medical models closely mirror larger cultural assumptions about how
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BIRTH ATTENDANTS
Social support is crucial not only during childbirth but also during the period
immediately following delivery. As Mead & Newton pointed out long ago,
birth is the beginning of a "transitional period" of infant dependency, which is
324 GINSBURG & RAPP
ing poor birth outcomes,which are generally labeled "social problems" when
they involve the poor, anthropologists have noted powerful socioeconomic
circumstances that cannot be corrected via individual action. Primary in a
complex web of problems is expensive, inadequate,and sometimes patroniz
ing health care that leads to miscommunication,distrust,and irregular use of
pre- and perinatal services (24, 154,187-89, 275,276). Others have probed
the contemporary wisdom of the middle class-embraced by both the medical
establishment and resistant self-help groups such as La Leche League-which
assumes that phenomena such as post-partum depression,successful nursing,
and the transition to "competent motherhood" are mainly shaped by individual
action (227, 242). Creative reframings by anthropologists attempt to de
mystify motherhood, examining it as work, even using models from occupa
tional health and safety literature: Childcare is a 24-hours-a-day hard job,
often with few breaks,lack of social support,and hazardous workplaces (297;
cf 136).
The changing circumstances of mother work may be implicated in the
worldwide decline of breast-feeding, as several studies indicate (127, 153,
282). Some researchers use data from contemporary gatherer-hunters to argue
that our species is "hard wired" for frequent,short bouts of nursing (126, 174,
219),even though this pattern is not easily accommodated to the conditions of
sedentary, urbanized life. In the West, as physicians began in the late
nineteenth century to focus on infant feeding problems, a profitable industry
arose to produce prepared infant foods. During the same period, industrialized
schedules for infant feeding developed. Women accepted the advice of
scientific experts, which often undercut such older practices as feeding-on
demand and wet-nursing (5,230). The pressures of urbanization--especially,
paid employment outside of their homes-have also made nursing on demand
a more difficult task throughout the 20th century (242). Recent social move
ments like the International La Leche League and the women's health move
ment have encouraged breast-feeding, a practice now often backed up by
POLITICS OF REPRODUCTION 325
medical discourse, which has swung back toward a positive evaluation of the
benefits of human breast milk. Contemporary cross-cultural studies suggest
that a similar decline (and partial restoration) of breast-feeding has occurred in
many Third World countries (127). Local cultural discourses play a powerful
role in the mix of breast and bottle. In urban Mali, for example, breast
feeding remains popular not only because government policy supports it, but
also because of indigenous beliefs that a woman who does not nurse is
relinquishing kin ties to her infant (73).
In recent years, interests of First and Third World women have been linked
in global boycotts of Nestles and other corporations that aggressively mar
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use of packaged formulas lethal. A recent study suggests that the controversy
is not simply about the efficacy and costs of breast or bottle; it also concerns
the importance of using a renewable resource such as breast milk in economi
cally vulnerable, developing nations (352).
The advent of new neonatal intensive care unit (NICU) technologies in
industrialized societies has also attracted a spate of studies. Anthropologists
have pointed out that while the technology holds the promise of salvation for
individual high-risk and premature infants, it diverts collective attention and
resources from preventive care for far larger popUlations of at-risk mothers
and children. Studies have analyzed NICUs as cultural environments in which
social relations among physicians, nurses, newborns, and parents are played
out. Such work challenges the abstract, individualist models of medicine and
bioethics, demonstrating that the stressful social situations that bring together
preemies, parents, and professionals, cannot be understood apart from their
multiple social interests and contexts (4, 125, 191, 192, 254, 256a, 257).
Whether or not they focus on high-tech interventions, anthropological
studies of child survival all indicate the impact of social arrangements. For
example, sudden infant death syndrome (SIDS) seems to be rare in cultures
where parents and infants sleep together but is frequent in societies such as the
United States where solitary infant sleeping is valued. Research suggests that
the latter practice is a recent development by evolutionary standards, and is
not necessarily appropriate to the young infant's developing nervous system
(219). But the high rate of SIDS among African-American low-income teen
mothers who do sleep with their babies is a reminder that the health of infants
is also profoundly shaped by socioeconomic and maternal health factors
(198), no matter how the species may be "hard wired."
More dramatic illustrations of the combination of intended and unintended
ways in which cultural practices strongly influence child survival are provided
by a number of recent anthropological studies (318). For example, among the
Kipsigis the amount of time culturally sanctioned for the extreme dependency
326 GINSBURG & RAPP
offspring are at great risk at every stage of the life-cycle: As fetuses they may
be aborted, as children they may be neglected and abused, and as young
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Issues of child survival are central to debates about the "demographic transi
tion" which assumed that traditional patterns of high child mortality and high
replacement fertility would decline in response to "modernization" (including
public health measures and Western biomedicine). Anthropological work has
challenged such unilinear models, insisting on the specific rationalities of
diverse cultures throughout human history (26, 50 , 122, 130, 131). Addi
tionally, reproductive decision-making cannot be understood apart from
socioeconomic phenomena such as ecology, food sources, migration, war
fare, and famine which influence the development of cultural patterns of
childbearing (132).
Western development rhetoric often assumes that societies lacking con
traceptive technology cannot consciously control reproduction. Ethnographic
studies demonstrate that individuals and communities consciously develop
practices to achieve desired feritility, whether low or high. On the one hand,
POLITICS OF REPRODUCTION 327
making (32, 330), especially when children provide primary access to re
sources for their mothers (133)
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NETWORKS OF NURTURANCE
has appeared on fathering (184). While scholars have long been interested in
ritual or informal couvade (29, 246, 295), in the proprietary rights and
obligations of fatherhood embedded in different kin systems, and in the role
of men in initiating young boys into manhood, little attention has been paid to
cultural attitudes toward men's fertility and nurturance, or to the social
practices and consequences of male caregiving to infants and children. One
exception is a recent study of paternal-infant care that systematically demon
strates the intimate, affectionate, and constant nature of father-infant relations
among Aka pygmies (143).
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brought court cases based on the assumption that their nurturance of West
African foster children legitimates adoption, a claim foreign to the West
African practice of fosterage (1 1 4).
Adoption , too, is well-known as a post-natal form of redistributing the
benefits and burdens of children through which the interests and claims of
biological parents may be maintained in non-Western societies (43 , 124,
3 26-28). Historically, Europeans and Americans also circulated children
through wet-nursing, fosterage, apprenticeships, and adoption. In the contem
porary United States, the stress on the importance of biological ties of
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parenthood, along with new hopes for "curing" infertility, has stigmatized
adoption for both the giving and the receiving parents (237). A social move
ment for open adoption and social recognition of birth parents has recently
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MEANINGS OF MENOPAUSE
Biological processes are always mediated not only through cultural un
derstandings and socioeconomic conditions, but also through widely varying
fertility experiences: In societies where high fertility and prolonged lactation
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are the norm, menstrual cycling may be relatively uncommon and its loss
relatively unremarkable to the physical and social body (3, 39, 183). Meno
pause can never be understood apart from other social circumstances
marriage status, fertility history, access to property-through which women's
power and experiences are constructed (20, 332). Our own culture's confla
tion of biological reproduction with mothering, and the loss of biological
fertility with a reduction in status, is challenged by the fact that in many other
societies post-menopausal women may adopt and foster children (62) and
have new authority over kin, especially daughters and daughters-in-law (166,
291, 354). Such research reminds us that no aspect of women's reproduction
is a universal or unified experience, nor can such phenomena be understood
apart from the larger social context that frames them.
CONCLUSION
In this essay, we have noted the conditions in our home societies and
generational experiences that influence the questions about reproduction that
we pose as anthropologists. Reflexivity has informed our argument as well as
some of the research we have reviewed, demonstrating how intellectual
traditions are challenged and reformulated in light of the social conditions
within which they develop. For example, the medicalization of reproduction
emerged as a central issue for many anthropologists due to at least two
historical circumstances. One was the focus of feminist scholars and activists
on women's reproductive constraints and possibilities as sources of both
oppression and power. The other was the profound impact on "traditional
societies" of the uneven global spread of Western medicine. This new
scholarship has given us richly contextualized studies of birth, midwifery,
infertility , and reproductive technologies. Scholars have also analyzed the
discourses that construct different parts of the female life-cycle as medical
problems, rather than as ordinary aspects of social life. Such reflexive energy
POLITICS OF REPRODUCTION 331
could usefully be turned toward other problems not yet sufficiently visible on
the intellectual agenda of anthropologists, such as the internationalization of
adoption and childcare workers; the impact of the "crisis of infertility" on
low-income and minority women who are not candidates for high-tech,
expensive NRTs, and whose lack of children is not considered tragic by
powerholders; the concerns of women from communities at high risk for HIV
whose cultural status and self-definition depends in large measure on their
fertility; questions of reproduction concerning lesbians and gay men, from
access to artificial insemination to homophobia surrounding nurturance of
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children; as well as the study of menopause and fatherhood, two issues that
have become salient in the life-cycles of the "new women" and "new men"
who sometimes inhabit academic institutions. Anthropologists have impor
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help to set an agenda for integrative research and critical policy evaluation in
the rich local, regional, national, and international arenas within which
anthropologists work.
ACKNOWLEDGMENTS
colleagues shared their own scholarship with us; because of space limitations,
we were unable to cite non-English-language sources, or unpublished man
uscripts and dissertations, despite much excellent work-in-progress we were
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sent. We are deeply grateful to Fred Myers for generous personal and
intellectual support, and to Mira Rapp-Hooper and Samantha Ginsburg-Myers
for reminding us of our personal stakes in the politics of reproduction.
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