The topic of reproductive health was introduced to me within the bounds of birth control and abortion (as if that is all the topic could encompass). Everything was about choice and more specifically about arresting women’s bodily autonomy and sexual freedom from the hands of lawmakers by granting women choice. To take contraception or not, selecting which contraception to take, whether to have an abortion or not - these choices were meant to empower women and give them control over their bodies. This rhetoric of choice and self governance is constantly being reified in the media, in commercials for new and improved birth control products, in the ‘pro-choice’ articles I wade through on my social media newsfeed, in the conversations I have or overhear on campus with other students, and so on. While my inclination is to want to believe in it and to support it, I cannot help but be skeptical of it at the same time. With the help of Chikako Takeshita’s book The Global Politics of the IUD, I am better able to better articulate my suspicions and my questions.
In her book Takeskita mentions that “the normalized desire to maintain health and control one’ life and body through the use of medical products guides individuals to take reproductive responsibility. The biopolitical script of a free society consists of the “practice of self,” or self governance, facilitated by the discourse of choice” (Takeshita 29). In simpler words, because choice is something that the woman partakes in privately and individually, it then shifts all responsibility onto the woman for her own reproductive health. This leaves no one else but the woman to blame in the presence of reproductive health complications or failures, in which case the woman is demonized and punished for being “reckless”, for being overly sexually active, for being a “baby killer”, and many other alleged crimes to society.
The societal discourse never transcends scapegoating the woman and never examines crucial questions about the dismal state of reproductive health care and contraceptive access for women as well as the chasmic disparities in access and quality of care among women. What does not always make it into the societal consciousness nor in the narrative of choice is how this scapegoating of the woman is pummeled even harder onto the bodies of poor women of color, whose reproductive behaviors are constantly under scrutiny at best and criminalized at worst, even while they are denied equal access to contraceptive choice. What also leaks out is the history of sterilization or of the birth control campaign with eugenics. Reproductive choice for progressive western middle class women (especially of the pro-choice variety) was bought on the backs of women of color, especially women in the global south upon whom the first innovations of the IUD were imposed and experimented at quite a cost.
The discourse is that women have a wide market of reproductive health care measures created just for them and that they command just as they do their bodies, but the market that is really being cultivated is the market for consumers. Takeshita acknowledges the benefits that birth control medications such as the IUD have afforded women but is simultaneously able to ask the hard question of whether “...the rhetoric of rights [is] another form of governance” (Takeshita, 29). Essentially, to what extent is the “rhetoric of rights” a mightily sharp double edged sword? Takeshita takes to the “scholars of governmentality” like Michel Foucault to determine how it is that ““liberal subjects,” or the citizens of liberal capitalist societies, are being ruled though freedom” (Takeshita 29). According to this train of thought, middle class women are buying and consuming an illusion of freedom, unaware that the apparatuses and tools they are using (contraceptive technologies) and the landscapes in which they are working (choice and rights rhetoric) in the vein of empowerment are all choreographed. A consumer personhood is instituted, wherein women start to believe they can only achieve empowerment and control over their sexuality by purchasing and consuming pharma mediated products - in which case this consumer liberation and personhood is unaffordable for poor women of color.
The pharmaceutical corporations which manufacture birth control are less concerned about women’s autonomy than they are about acquiring consumers and accruing profits. The contraceptives we so happily consume are heavily controlled by pharmaceutical and insurance companies and reproductive health physicians who act as gatekeepers. They choose which kinds of women are worthy to use them and under what circumstances (adolescents seeking birth control outside of family planning purposes are denied access for example), pushing certain contraceptives over others onto women and providing limited (at best) information about the various products at women’s disposal. This is not to mention that, according to Elizabeth Siegel Watkins’ research, even while there appears to be an abundance of birth control technologies on the market, “a closer inspection of the contraceptive landscape reveals a menu of birth control options that relies on science that is more than 50 years old” - either preventing ovulation or fertilization (Watkins).
Research and innovation in the contraceptive industry has plummeted over the past couple of decades as drug companies have attempted to flee the slew of government and FDA regulations/testing requirements as well as consumers’ ability to sue over injuries incurred from use of medical tools, all of which have dwindled the profits to be made from manufacturing contraceptive devices. With fewer and fewer companies investing in this industry, contraceptive choice is quite limited and expenses for these limited choices remains high and unaffordable for poor women.
As I continue to encounter choice rhetoric in my daily life, I am still left with a whole host of questions. We talk about choice as if it is fully autonomous and fully informed, as if reproductive justice is as simple as giving women the right to choose, but is it equipping women with an artificial sense of power control over their bodies and over gendered systems of oppression? Is choice so entrenched in ideas of individualism and consumer empowerment that it is more neoliberal than it is liberatory? Is there something problematic about thinking about the body as something to be controlled and bent to submission with the help of medical technologies, even if the woman is the one behind it? Does the personal nature of choice divest attention away from broader issues of reproductive justice across difference? What about the more nuanced or complex issues that do not fall neatly into the catch all discourse of choice, questions like is access to corporation mediated contraceptives enough to encompass reproductive well being or bodily autonomy?
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