Entanglements of reproductive practices in India: Sex ratios, fertility, birthing and new reproductive technologies

This special issue brings together emerging research around the vicissitudes of the reproductive body, as it comes undone in emerging body politics in India in relation to New Reproductive Technologies (NRT). The articles in this issue (and the second part of this issue) are a collection of compelling exploratory studies that explain the adaptability, resilience, resistance of the reproductive body and its intersection and transformation within a complex of broader societal changes relating to gender, modernization, technological intervention and the norms and values surrounding reproduction. The papers mostly emerged from a conference on “Reproduction, Demography and Cultural Anxieties in India and China in the 21st Century” held in New Delhi, India in February 2020 jointly organized by the Indian Institute of Technology, Delhi; Indian Institute of Technology, Hyderabad; and Indraprastha Institute of Information Technology, Delhi.

The focus here is on the female reproductive body, as it is imagined and experienced through particular practices of embodiment, both as agential and interventionist, while being embedded in concrete socio-economic material conditions and gendered axes of power, both familial and societal. NRT in the form of assisted reproduction and sex-selective abortive technologies continue to add to the “entangled” form of the reproductive body (Murphy, 2012). This idea of entanglement of the reproductive body is analysed at multiple levels. First, women’s bodies are deeply implicated in biology and reproductive technologies with NRT raising new social, ethical, policy, and legal issues around reproduction, birthing, and fertility. Second, we recognize that science and technology need to be seen as a part of, and not above, politics, economics, and gender relations. The papers highlight how reproductive choices and the reproductive body are intertwined with the politics of individual/familial desires. Finally, macro processes of development, such as urbanization, city living, and women’s higher educational levels create further entanglements for the reproductive body as women reimagine their reproductive futures and desires to shape “modern” families.

Engaging with the experience of the entangled female body at pre-natal, natal, and post-natal stages and informed by both qualitative and quantitative methodologies, the contributions highlight how the integration of technology and bodies leads to a reworking of ideas of families, relationships, gender, and the nation. As such, the papers reflect on the macro and micro consequences of the NRT and the gendered nature of the development process as it unfolds in relation to the reproductive domain.

The special issue consists of six papers on these themes and a short commentary piece on the emerging field of Femtech. The papers are spread over two issues. The first issue, Volume 27, No. 4, will contain the papers by Khushboo Srivastava, Sreya Majumdar and Anindita Majumdar and Swayamshree Mishra and Ravinder Kaur. It will also contain the commentary piece on Femtech by Paro Mishra and Yogita Suresh. The following Volume 28, No. 1 will contain the remaining papers. These are by Jyotsna Agnihotri Gupta and Suzanne Kamerbeek, Asmita Verma and Sourabh B. Paul, and Charumita Vasudev and Ravinder Kaur.

Apart from the commentary, all papers are based on new ethnographic studies on various regions of India. Here, we highlight specific themes extrapolated in the papers and the light they shed on issues discussed above as well as on how they speak to each other. The question of reproduction in the twentieth century was formulated as one of high fertility and over-population in particular developing countries, such as China and India. This led to the ushering in of large and sometimes coercive family planning programs that mainly targeted the female reproductive body. Feminist groups responded to such coercive programs of population control by demanding a shift towards women’s rights over their bodies and a focus on reproductive and child health. The last quarter of the century, however, saw a new challenge in the emergence of NRT, later renamed as Assisted Reproductive Technologies. The demand for these was an outcome of various fertility transitions around the world resulting from new technologies of managing fertility, such as the pill, intrauterine devices, in-vitro fertilization etc., as well as the larger canvas of socio-economic development, that resulted in increases in women’s education, greater inclusion in the work world, and the rising age at marriage. Other social changes, spurred by various social movements, especially feminist movements, have led to a transformation of intimacy, visible in greater diversity in the forms of intimate partnerships and cohabitation, resting also on evolving ideas of individuality, agency, self-reflexivity, and the desire to write one’s future. Technologies that enable sperm and egg donation as well as choosing the sex of a child with the aid of ultrasound and pre-implantation genetic diagnosis and surrogacy, have led to increasingly complex ways in which children can be birthed and families formed. Both types of changes—technological and social—have arguably initiated greater control over human reproduction allowing women to choose the timing of childbearing and couples to shape families with the desired size and sex composition. The opening up of choices also creates anxieties as people come to rely more on technologically and medically mediated reproductive processes.

In this collection, two papers explore the phenomenon of surrogacy that has gained traction globally, with India becoming a popular destination for transnational surrogacy, until the recent prohibition of commercial surrogacy. Adding to the burgeoning field of surrogacy studies, Jyotsna Agnihotri Gupta and Suzanne Kamberbeek’s paper “Mothers for life?: Exploring emotional vulnerability of Indian commercial surrogate mothers,” delves deep into the experience of how surrogate mothers cope with the emotional tie that they feel gets inevitably forged with the foetus they are carrying. Through case studies and interviews, they explore surrogate women’s emotional vulnerability and their strategies of dealing with the cognitive dissonance created through birthing a child that is not their own. They argue that the psychological consequences and potential emotional harm to the surrogate, hitherto ignored, need to be addressed by feminists, health advocates and other stakeholders in the surrogacy process. Khushboo Srivastava’s paper raises a different question vis-à-vis surrogacy—one that has emerged in the context of the feminist recasting of reproduction as a form of labor. She interrogates feminist perspectives that either call for the abolition of surrogacy (especially commercial surrogacy) or its regulation that would protect the surrogate mother who is generally seen as exploited. The paper brings voices of these women to shed light on how they make meaning out of surrogacy as both work and labor to reconcile its acknowledged empowering and subjugating aspects.

Three co-authored papers are framed by anxieties around fertility, childbirth and care in the contexts of development, women’s changing position in the work world and urban living. The paper, “The Birth Professionals: Emerging Practices of Birthing in Contemporary India” by Sreya Majumdar and Anindita Majumdar examines the emergence of new categories of birth professionals, such as doulas, professional midwives and lactation consultants, whose assistance is perceived as necessary for a “positive birth experience.” According to them, it is critiques of invasive procedures involved in medicalized and hospitalized childbirth that are paving the way for exploring women-centric birth practices. While still a fledgeling trend, educated, upper class women appear to be turning to such professionals for a liberating birth experience. In another vein, Asmita Verma and Saurabh B. Paul examine caring for the post-natal body by identifying and evaluating the quality of care new mothers receive and the manner in which supply-demand gaps can be addressed. Based on primary data collected in the hill state of Uttarakhand, the authors construct an index of maternal satisfaction to estimate and understand the quality of care received by new mothers. The authors recommend that the government should invest in post-natal care and not stop simply at ensuring institutional deliveries if maternal and infant mortality has to be brought down. Additionally, they argue that the type of care provided must be embedded in local needs for it to add value.

In the paper authored by Swayamshree Mishra and Ravinder Kaur, “‘If I cannot give birth to a child, why would anyone accept me?’: Menstrual anxieties, late marriage, and reproductive aging,” women’s bodies are examined from the vantage point of irregular/absent menstruation in the context of marriage and delayed childbearing and illustrates how menstruation comes to be medically and socially construed as “failed opportunities of production” than just an indication of fertility. A body that is unable to fulfill its “motherhood mandate” (one that is usually desired by the woman also) is seen as a failed body resulting in disruption of the anticipated life-course as wife and mother. The study, located in the eastern state of Odisha, dwells on how women articulate and negotiate anxieties around unanticipated anomalies around menstruation that upend their familial and social lives.

A final paper, “Gender Regimes, Reproductive Strategies and Child Sex Preferences: A Comparative Study of Villages in Jammu and Leh” by Charumita Vasudev and Ravinder Kaur, examines child gender preferences and sex-selection relating to differences in socio-cultural, religious and developmental contexts of Jammu and Leh, two regions in the erstwhile state of Jammu and Kashmir in northern India. This comparison highlights that ways of organizing biological and social reproduction through patriarchal institutions of kinship, marriage, and family in the Jammu villages are rigid and might appear as natural and unchangeable. These arrangements result in strategies that favor the birth of boys and not girls, thereby skewing the sex ratio. The vastly different, non-patriarchal social arrangements in the Leh villages show that there are other ways in which societies may organize themselves, resulting in demographic outcomes that are not necessarily adverse to females. This paper also shows that while ultrasound technology in Jammu is deployed for sex-selective abortion of girls, its availability in Leh has not led to a deterioration in the sex ratio.

With a commentary piece on “Femtech” or technologies that include software, diagnostics, products, and services that use technology to support women's health, this issue reiterates the emerging concerns around the entanglements of transforming terrains of reproduction and emerging technologies. It is not merely the technologization of reproduction that is germane to discussions today but also its “datafication.” If technologies co-shape reproduction with society, so do data techniques with predictive powers, such as algorithms. Thus, most common among femtech technologies are those that track menstruation, ovulation and pregnancy tracking, producing self-help knowledge as well as data. The authors, Paro Mishra and Yogita Suresh argue that while these technologies are intended to facilitate self-monitoring of one’s sexual and reproductive health, the resulting “quantified body” might become vulnerable to breach and misuse of intimate personal data. They also argue that data collected by such technologies and subjected to algorithmic analysis might produce diagnoses that revolve around the “average” or the “normal body” placing at risk bodies that are seen as not “fitting in.”