Reproductive materialism and justice for women with abortion care needs in Uganda

ABSTRACT

While reproductive health justice is often assumed to be inherent in reproductive health interventions, the nature of injustices, and the reasons for and mechanisms of concealment, are often unclear. In this article, we draw on an ethnography of priority setting and healthcare practice in eastern Uganda to illuminate these injustices and the mechanisms of concealement. We focus on discursive practices as the mechanisms through which power is activated and navigated, such that health practitioners are able to evade state surveillance and retribution. While language discourses conceal and normalise reproductive health injustices, discursive practices of care and priority setting enable reproductive controls to be navigated in ways that amplify these injustices and create new ones. In interventions, precarious conditions that impact women's reproductive health and living circumstances are often overlooked or concealed. We illustrate the convergence of biopower and necropolitical strategies to illuminate these conditions. Using the concept of reproductive materialism, we show how neoliberalism cultivates particular conditions of everyday life, in which populations are positioned as instruments for pecuniary motives, and normative controls are used to further financial gain.

KEYWORDS:

• Uganda
• discursive practice
• invisible populations
• policy priorities
• reproductive materialism

Acknowledgment

The research on which this article is based was conducted as part of the author's doctoral study. The research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center (APHRC) and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No–B 8606.R02), SIDA (Grant No: 54100113), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z) and Deutscher Akademischer Austauschdienst (DAAD). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the Fellow. The study was also partially funded through an African Doctoral Dissertation Research Fellowship (ADDRF) award offered by APHRC, in partnership with Ipas, the Guttmacher Institute, Gynuity Health Projects and Ibis Reproductive Health.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Ethical approval was obtained for the study from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand (M180466), the Uganda National Council of Science and Technology (UNCST) (SS4677), and the College of Humanities and Social Sciences Research Ethics Committee of Makerere University (MAKSS REC 05.18.166).