Paper short abstract:

Global health discourse champions the importance of 'choice' in reproductive rights. Yet, this shows how medical workers in Timor-Leste confront and challenge the concept of 'reproductive choice' by highlighting structural inequalities in health and the biomedical approach to reproduction.

Paper long abstract:

Global health discourses champion the importance of 'choice' and freedom in sexual health and reproductive health. However such discourses legitimise Western biomedical science over local knowledge and obfuscate lived experiences and past and present health inequalities.

During the Indonesian occupation, Timor-Leste experienced a state family planning programme that was implicated in claims of genocide. Since independence, however, reproductive rights have been promoted as part of national development. This paper, based on 18 months of ethnographic fieldwork presents how local medical workers challenge global health education on Family Planning over a ten-day family planning training course. Here, whilst facilitators reinforced the importance of client 'choice', the medical trainees highlighted contradictions in the course material, challenging the lived reality of individual choice in reproductive health.

Feminist scholars have labelled the discourse of choice ‘a fantasy’ (Crist 2020) or ‘a magic wand’ (Mol 2008) which disguises a wider range of structural inequalities. This has been particularly highlighted through a reproductive justice framework (Ross and Solinger 2017). This article shows how local medics shatter the ‘illusion’ of choice in the face of structural inequalities and health that extend beyond individual bodies. Simultaneously, throughout the training, the contradictions which this discourse ensued deepened scepticism towards biomedicine, perpetuating inequalities and even reproducing forms of coercion.

What this shows, I argue, is not that choice is undesirable in this context. Rather as a discourse which promises, and fails to deliver, reproductive freedom, the promotion of choice fails within a current neoliberal, neocolonial, biomedical model of global health.