Human Rights and Reproductive Governance in Transnational Perspective

Reproduction emerged as an arena of concerted international concern following World War II, amidst growing anxieties about high fertility rates in the global south. The United Nations Fund for Population Activities (later renamed The United Nations Population Fund) began operations in 1969. A range of global conferences convened in the closing decades of the twentieth century to address the “population problem” and to position gender equality at the center of international development agendas. The 1975 Mexico City Conference on Women launched the Women in Development approach, focusing on women’s economic contribution to development policies (Freedman 1993). However, reproductive rights were not explicitly defined as human rights in a global agreement until the 1990s. This focus became clear at the International Conference on Population and Development (ICPD) in Cairo (1994), in which UNFPA’s role was crucial in leading the agenda of “reproductive rights for all,” and later at the Fourth World United Nations Conference on Women in Beijing (1995) (Freedman 1993). By positioning reproductive decisions within the realm of human rights, these international agreements initiated a sea change in global regimes of reproductive regulation. Earlier demographic targets aimed at limiting population growth were replaced by a commitment to protect and promote reproductive rights and reproductive health as universal moral value (Ginsburg and Rapp 1995).

Since the 1990s, human rights have quickly ascended as the political and moral “idiom” (Willen 2011) par excellence for reproductive policy-making, public health programming, and grassroots activist mobilization. Whereas in 1993, it was plausible for feminist scholars to denounce the fact that international discussion of reproductive rights was “conspicuously limited” (Freedman and Isaacs 1993:18), today this paradigm is ubiquitous. For NGOs and policymakers, human rights offer an effective tool to enforce compliance with existing reproductive laws or else to appeal for national legal reform. For advocates at the grassroots level, human rights provides a globally legible framework to communicate local concerns, and a means to hold their governments accountable to international standards for the protection of women’s health and citizenship (Morgan 2015; Nowicka 2011; Zavella 2016). At the individual level, growing traction of the human rights paradigm has engendered a process of subjective transformation. As women around the world encounter this discourse, their understandings of citizenship are reworked (Amuchástegui and Flores 2013).

Across the globe, the use of human rights arguments in public and legal arenas has facilitated a range of notable legal victories in the past few decades. Abortion rights have been implemented to varying degrees in places such as South Africa (1996), Switzerland (2002), Nepal (2004), Ethiopia (2005), Colombia (2006), Mexico City (2007), Portugal (2007), Spain (2010) (Nowicka 2011), and more recently, Ireland (2018). Human rights concepts have also been incorporated into new social movements that strive for reproductive equity. Beginning in the 1990s, women of color activists in the USA spearheaded a robust movement for “reproductive justice,” which draws on a human rights approach to pair the struggle for reproductive rights with economic, social, racial, ethnic, and environmental justice (Price 2010; Ross and Solinger 2017; SisterSong 2007). Across Latin America, activists have mobilized against institutionalized practices of “obstetric violence” in public and private health institutions as a clear violation of women’s human rights, leading to legislative reforms in Venezuela, Mexico, Puerto Rico, and Argentina. In 2009, the Human Rights Council, a body of the United Nations, passed a resolution defining maternal mortality as a human rights issue (Nowicka 2011). These are just a sampling of the ways in which activists have used human rights to bring about change in the field of reproduction. Such struggles are ongoing.

The human rights framework is no longer the territory of feminist activists alone, as those opposed to reproductive rights have usurped this framework for their own ends (Nowicka 2011). Today, a wide range of actors mobilize human rights, including states, non-governmental organizations, indigenous peoples, conservative activists, and religious fundamentalists, in their efforts to alternatively expand, constrain, or reconfigure reproductive options, behaviors, and patterns at the national and local scale. Tensions in the use of human rights are observable when “pro-choice” and “pro-life” activists simultaneously draw on this platform to advance the rights of women versus those of the fetus, respectively (Ginsburg 1998). In this process of vernacularization, the “appropriation and local adoption of global ideas” (Levitt and Merry 2009:446), social actors bring to light new meanings of human rights as they invest them with locally salient concepts.

Contestation in definitions of reproductive rights is captured in the concept of “reproductive governance,” which calls attention to the ways in which diverse social groups and institutions “use legislative controls, economic inducements, moral injunctions, direct coercion, and ethical incitements to produce, monitor, and control reproductive behaviors and population practices” (Morgan and Roberts 2012:243). Reproductive governance is enacted “from above” – delivered in the form of laws and policies, religious edicts, and state programs – and is also enfolded in clinical care, public discourse, and media messaging.

The recent rise to dominance of human rights concepts in efforts to regulate reproduction raises a number of important questions for anthropology. How does the globalization of the maxim “reproductive rights are human rights” take shape in local settings? Toward what ends do activists and other groups wield this framework? What are the subjective effects of the human rights strategy on reproductive experience and subjectivity among those for whom activists advocate? Does human rights language resonate with women’s understandings of their own relationship to the law, the state, and the medical sphere? What does a human rights perspective on reproduction engender, and what might it elide or foreclose? How, in short, do human rights and contemporary processes of reproductive governance reinforce or disrupt each other?

Taking these questions as a productive starting place, the articles in this special issue examine the implementation and instrumentalization of human rights, including how institutions, social groups, and other actors summon the human rights strategy toward distinct and sometimes contradictory ends in their manifold struggles around reproduction. Building on ethnographic research carried out in different regions of Mexico, as well as the Dominican Republic, Senegal, and Poland, the authors of these articles demonstrate how the emergence of human rights has facilitated a restructuring of the mechanisms of reproductive governance. Contributors analyze these shifts with regard to abortion, post-abortion care, birth, obstetric violence, and assisted reproduction. Taken together, the contributors examine how feminist activists, NGOs, religious institutions, the state, midwives, as well as afrodescendent and indigenous women leverage human rights in the service of distinct and at times oppositional goals.

We take an “ethnographic” perspective, approaching the notion that reproductive rights are human rights as an object of ethnographic inquiry (Goodale 2006; Krause and De Zordo 2012; Wilson 2006). This approach reveals the ways in which human rights both “facilitate social and political mobilization against maltreatment and may – insofar as [they] direct political aspirations toward the established legal process – normalize and legitimize unequal structures of power and authority” (Wilson 2006:108). An ethnographic perspective appreciates the emancipatory potential and practical utility of human rights in the field of reproduction, while allowing for a degree of analytical distance to account for the ways in which this framework may eclipse local processes of moral reasoning. While our academic training allows us to approach human rights as a political and social artifact, each of the authors writes from a feminist perspective and is committed intellectually, politically, and personally to the project of international reproductive justice.

The contributions to this special issue are organized into two broad themes. One concerns the ways in which local actors take up the globalizing language of human rights to resist or rework processes of reproductive governance “from below.” People use human rights, in such cases, as a political tool to contest reproductive injustices embedded in national and local governing processes and religious agendas by appealing to an international set of standards. Elyse Ona Singer shows how a small-scale feminist organization in one of Mexico’s most conservative states has leveraged human rights arguments in an “alegal” domain to directly facilitate at-home abortion in a context of heavy abortion criminalization. This strategy departs from efforts for abortion law reform among the more visible, mainstream and internationally-funded feminist organizations based in Mexico’s capital. By focusing on alternative feminist tactics in a deeply conservative region of Mexico, Singer draws attention to some of the unintended consequences of Mexico City’s historic abortion reform for women and their advocates elsewhere in the country.

Mounia El Kotni demonstrates how state-sponsored training for indigenous midwives in Chiapas, Mexico became a contested site for actors such as state employees, health personnel, and non-governmental organizations to push their conflicting agendas. While government employees argue for every woman’s right to a hospital birth as a means to avert maternal mortality and morbidity, indigenous midwives argue for their group rights to preserve their cultural medical practices. El Kotni addresses tensions in the use of human rights and explores how different groups draw on this discourse to advance their diverging struggles at the national and local level. Thus, groups and organizations leverage human rights to substantiate local cultural practices and forms of advocacy work that are criminalized by medical, legal, and religious systems of reproductive control.

A second theme explored in this collection concerns how the conferral and implementation of reproductive rights may work unexpectedly to extend harmful processes of reproductive governance. Articles in this vein add to budding line of critical analysis at the intersection of medical anthropology and feminist studies (Morgan 2015; Price 2010; Singer 2017). Siri Suh examines Senegal’s post-abortion care program, which was implemented to combat high rates of abortion-related morbidity and mortality in a context of complete abortion criminalization in accordance with ICPD mandates. While the program has succeeded in expanding women’s access to life-saving services, Suh reveals the imbrication of regimes of medical and legal surveillance that infuse the delivery of public post-abortion care. Suh’s analysis of the production and dissemination of post-abortion care metrics shows how reproductive governance occurs through both obscuring and bringing into view particular reproductive subjects, clinical practices and opportunities for abortion law reform. Although post-abortion care metrics convey that the lives of expectant mothers are being saved, they mask practices of discrimination and criminalization to which patients are routinely subjected as health workers negotiate the provision of care within multiple contradictory forms of national and global reproductive governance that simultaneously call for upholding women’s reproductive rights and compel them to report cases of illegal abortion to the police.

Joanna Mishtal takes the watershed 2015 In Vitro Bill as a point of departure to examine the limits and compromises of progressive reproductive rights policy in Poland’s new “ethical order.” Feminist groups, left-wing policymakers, and the Polish public celebrated a major victory for reproductive rights with passage of the legislation, which sanctioned infertility care for the first time in Polish history. Mishtal examines how an emboldened Catholic Church and religious political regime has worked to constrain the reach of the bill, and so strategically structure the future of Polish reproductive governance. The Polish in vitro debate exemplifies contradictions in engagements with competing versions of human rights in processes of European reproductive governance.

Finally, in their article on reproductive violence in the Dominican Republic, Arachu Castro and Virginia Savage analyze the slippage between scholarly formulations of the rights-based framework of “obstetric violence” and local understandings of mistreatment and abuse among women seeking care within a public maternity hospital. They expose the ways in which internationally circulating frameworks of human rights are not easily or seamlessly embraced by those they are meant to serve. Along with explaining these discrepancies and their implications for the future of such academic categories, the authors highlight how women’s resignation to poor quality medical care can be interpreted as a form of “adaptive preference” in the face of stark health disparities and inequitable access to high-quality maternal health care.

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This collection of articles is designed to draw attention to the articulation of human rights and reproductive regulation, and the impact of this marriage on reproductive subjectivity, experience, and health in different parts of the world. Understanding how human rights are mobilized, embraced, resisted, and reworked in the field of reproduction is crucial for making sense of contemporary mechanisms of reproductive control and resistance. But future research is needed in a number of directions. At a moment when reproductive rights are ever-more precarious (Andaya and Mishtal 2017), more studies are needed to examine how groups opposed to reproductive rights utilize the human rights framework to advance their cause, and what this means for the “doctrinal ambiguity” (Wilson 2006:108) of human rights. We need more work on how the reproductive justice framework advances or constrains women’s human rights, and the degree to which this is appropriate outside of the US context (Morgan 2015). Finally, more research is needed on the experiences of men with regard to reproductive rights and health (Dudgeon and Inhorn 2004). Ultimately, understanding how human rights intersect with reproductive governance will permit feminist scholars and advocates to better grasp the limits and potentiality of the framework. This knowledge base is a foundation from which to develop new conceptual models that resonate with the populations they are meant to serve to promote global reproductive health equity.

Additional information

Notes on contributors

Mounia El Kotni

Mounia El Kotni completed her PhD in cultural anthropology at the University at Albany, SUNY (2016). She is a postdoctoral researcher at the EHESS Paris and Foundation de France fellow 2019–2021. She has conducted research on the local impacts of global maternal health policies, indigenous peoples’ rights, and reproductive politics in Mexico. As an applied scholar, she provides trainings on gender discrimination for NGOs and state agencies in France and Mexico.

Elyse Ona Singer

Elyse Ona Singer is an assistant professor of anthropology at the University of Oklahoma. She holds a PhD in cultural anthropology from Washington University in St. Louis, where she also earned a certificate in Women, Gender, and Sexuality Studies. Her research into the beginnings and ends of life in Mexico advances conversations about citizenship, personhood, and the politics of life.