Paper short abstract:

This article is the result of an ethnography conducted in Spain and the United Kingdom. It analyses the relationship between: the use of reproductive medicine as a business, the role played by assisted-reproduction-clinics, their marketing strategies, and the experiences of women as patients.

Paper long abstract:

This article is the result of an ethnography conducted in Spain and the United Kingdom. Its purpose is to analyse the relationship between: a) the use of reproductive medicine as a business, b) the role played by assisted reproduction clinics and their marketing strategies, and c) the experiences of women as patients/clients. This study focuses on women who decided to procreate on their own using assisted reproductive technologies (ART). Some of them travelled internationally to leading reproductive destinations because of waiting lists, donor availability, success rates, cost, donors´ anonymity or embryos available to transfer, and some of them imported gametes. Reproductive treatment is not only a physiological endeavour, it is also a psychological one: struggling to conceive, exploring options presented by a fertility clinic, uncertainty about choosing a donor, suffering as a result of not conceiving with her own eggs, a miscarriage or pregnancy loss, clinics’ promises of treatment success, the economic cost, fear, and judgements by society, friends, family and sometimes oneself. Despite the fact that the literature on mental health has established that psychological support is necessary in reproductive treatment, none of the women interviewed was offered this support. Some of the participants had to pay psychology, coaching or alternative medicine professionals to alleviate the suffering that the treatment caused them. However, both public and private health care and all the industries involved in ART profit from the vast amount of money that the fertility business produces in both countries, ignoring the needs of patients.

Paper short abstract:

Side effects are a key reason why hormonal contraception is discontinued by a user. However, they continue to be dismissed. How can moving from focusing on contraceptive access and choice to bodily autonomy help to reorientate user-reported data as reliable rather than anecdotal?

Paper long abstract:

When first developed, side effects from hormonal contraceptives (HCs) were overlooked as ‘noncompliance’. After 60 years of use, understanding has not significantly increased, despite side effects being the main reason why an individual may discontinue use. The stratified evaluation of HC side effects became plainly obvious in the midst of the COVID-19 pandemic when the AstraZeneca vaccine was scrutinised for its possible side effect of thrombosis, when the same risk from combined HCs is at least 50 times higher. While studies have rarely considered how social, economic and racial identities impact HC side effect experience, their reference carries assumptions about the uneducated, unreliable and marginalised female user who is more likely to discontinue use. Based on ongoing ethnographic research in the UK, I suggest alternative reproductive futures. My research displays how side effects are unacknowledged by clinicians and society, considered necessary collateral damage to save them from the risks of ‘hormonal’ and ‘reproductive’ bodies, and nullified as side effects are considered to be the result of not having found the right HC. There are a number of barriers to contraceptive access in the UK; however, this research highlights that presumed access does not necessarily improve recognition of side effects. This suggests how our priority on choice and access needs to include bodily autonomy, as exemplified by reproductive justice framework. This framework offers a starting point to consider how anthropologists can provide and present user-reported data in ways that encourage investigation rather than its current categorisation as ‘anecdotal’.

Paper short abstract:

Maternity care is intended to ensure effective reproduction and deliver healthy, viable children and sound, fertile mothers. Czech ethnographic research reveals that women whose pregnancy loses such prospects tend to receive discriminating treatment derived from the effectiveness of their pregnancy.

Paper long abstract:

Despite the universality and equity of access to reproductive healthcare in the Czech Republic, certain pregnancies are marginalized in favor of policies that promote particular reproductive outcomes.

Ethnographic research on prenatal and perinatal loss I conducted in 2020-2021 among Czech middle-class women exposes systemic differentiation between “prospective” and “non-prospective” pregnancies and reveals insufficiencies in care for the latter. In order to secure “successful” pregnancies, Czech post-socialist reproductive policies enforce extensive prenatal testing and interventional approach to pregnancy and childbirth, accentuating favorable birth outcomes and competitive national health statistics. My research shows that women whose pregnancies were miscarried, diagnosed with major fetal abnormalities, aborted or resulted in stillbirth were more likely to receive inadequate care. Their treatment often lacked psychosocial support, respectful treatment, and denied individual decision-making in their pregnancies. Moreover, their situation was disregarded in welfare policies and governmental institutions.

Recently, grassroot initiatives have set about to fill the gaps in support to families with pregnancy loss. These NGOs, often founded by lay women with personal experience, gradually professionalize and provide not only services to women, but also hospital training, lobby for policy changes, and raise public awareness.

Based on my experience with sharing research with NGOs, I intend to expand on the unique role that ethnography can serve to not only give voice to unheard women, but also provide unique data that supports arguments for changing reproductive policies and empowering individual choices. No less importantly, ethnography can help balance redefinitions and prevent bottom-up changes from creating new reproductive imperatives.

Paper short abstract:

How do American doulas attempt to help clients achieve reproductive justice by highlighting and mitigating the intersectional precarities around birth? Through ethnography anthropologists can open collaborative conversations with birth workers about the need for reproductive justice in the USA.

Paper long abstract:

Following decades of pathologization of pregnancy and birth and institutional racism within biomedical care in the USA, recent years have seen a small but steadily growing shift amongst marginalized childbearers of color towards embracing alternative and non-medical methods of perinatal care and support, such as the use of a doula. While obstetricians and nurses push to streamline and medicalize the birth process, doulas push back against what they see as unnecessary medical interventions and institutional racism in biomedical care to advocate for their clients and to help childbearers of color achieve reproductive justice. This has been further complicated by COVID-19, as anxieties over infection have reshaped the conceptualization of "good" perinatal care and "essential work" in clinical settings. Using qualitative data gathered during the COVID-19 pandemic in Los Angeles, I will discuss the tensions that erupted between obstetricians, nurses and doulas when doulas were deemed "non-essential workers" in clinical settings. Through this ethnographic data, I highlight how doulas create ideological and moral boundaries around themselves in order to reaffirm their own legitimacy in relation to biomedical birth workers. I argue that it is these boundaries that doulas use in order to help their clients attempt to achieve reproductive justice by highlighting and mitigating the intersectional precarities around birth faced by childbearers of color in US birth spaces. Overall, I demonstrate how ethnographic data can open collaborative conversations with birth workers in order to create space to understand the urgent need for reproductive justice in US perinatal care settings.

Paper short abstract:

This paper has goal to present the perceptions of the indigenous women and girls about planning family from SUS

Paper long abstract:

In 1996, a bill regulating family planning was approved by the National Congress and sanctioned by the Presidency of the Republic. The Law establishes that the managing instances of the Unified Health System (SUS), at all levels, are obliged to guarantee to the woman, the man, or the couple, throughout its network of services, assistance to conception and contraception as part of the other actions that make up comprehensive health care.

SUS and their branch of the Special Indigenous Secretariat-SESAI also apply the programs to the indigenous population without respect for cultural diversity and how they conceive the family and community. However, it is mentioned on the SESA I.

This work will analyze the narratives of young indigenous women about early pregnancy and family planning and how they dialogue with those programs.

Through an interdisciplinary study aimed at interculturally, the young indigenous women held several workshops with the theme of early pregnancy and the imaginary of the family and what pregnancy is like in their view. These workshops were held at Ação dos Jovens Indígenas, AJI/GAPK, in 2022.

Paper short abstract:

Policies and campaigns in Mozambique aim to increase women’s knowledge and autonomy in their sexual and reproductive health. Instead of more, women's autonomy is surrendered to the state, where they suffer reproductive violence. The state is more vested in SDG indicators than women’s autonomy.

Paper long abstract:

Mozambique is alleged to have one of the highest rates of early marital unions, and, consequently adolescent pregnancies. Sexual and reproductive health policies to address this have included legislation against early marital unions, information campaigns targeting adolescents about their sexual health and rights and free contraceptives distributed in public clinics and by mobile teams in schools. Campaigns aim to increase girls’ knowledge and autonomy in their sexual and reproductive health. Despite a consistent decrease since the 1990s, the adolescent fertility rate remains well above the African average.

Based on research conducted for over two decades, I argue that while well-intentioned and supposedly pro-women, most policies have done little to increase girls' and women’s sexual and reproductive autonomy. In many cases, their subordination to their families, parents, or husbands moved to the state. The narrative behind the policies recognizes the role of norms, education, and socio-economic status, but implementation does little to change the structural aspects that decrease women’s autonomy. The Mozambican state is more vested in improving its sustainable development goal indicators than women’s autonomy.

Taking into account Chadwick and Jace Mavuso’s (2021) concept of reproductive violence, instances that should improve women’s reproductive autonomy, instead meet the threshold of reproductive violence. These include, for example, applying contraceptive implants immediately after delivery, with dubious consent. Or advise against a woman’s decision to abort, under the guise of counselling. Both raise the ethical question of whether individual women’s autonomy is being sacrificed in the name of global indicators.