Controlling reproduction: women, society, and state power

I found this a fascinating book – written by a sociologist and an anthropologist, covering their disciplines and a fair amount of politics too. It should be accessible to the general SRHM journal readership. I felt I got a much richer insight into the subject than I would have done from a more demography-dominant perspective. Perhaps, a little more analysis of ethical aspects would have made it even more comprehensive.

The book provides a wide-ranging analysis of the situation vis-à-vis restrictions to reproductive autonomy around the world with in-depth assessments of many countries and regimes. It is up to date, taking into account the overturning of Roe v. Wade. The scope is mainly fertility control but there are sections on assisted reproductive technology, surrogacy and adoption too. The book concentrates on the macro level and does not cover coercive control at the micro level.¹ It includes forms of resistance to interference with reproduction. Covert contraceptive use is described, without explicitly defining it as such.

There is an emphasis on how individuals and their bodies are harmed by undue control and by what mechanism. Religion, state governments and families are presented as major sources of interference with and constraint of an individual’s reproductive wishes/goals. Of course, patriarchy underlies all of this. So too does the prominence given to global capitalism/neoliberalism at the expense of the people; the pervasive adverse effect of neoliberalism runs as a thread throughout the book. There are interesting insights into the part NGOs and corporations play in programmes that purportedly empower women; however philanthro-capitalism is not mentioned.² The frequent imposition of Global North values on the Global South is clearly stated. There are repeated references to the part played by colonialism, racism and gender inequality. However, the flaws in the universally used driver of the “unmet need for contraception indicator” are not mentioned.³ I also felt that more was needed to unpick the voluntariness of programmes and in defining reproductive autonomy.⁴

The particular plight of Filipinas is given as a detailed example: forced by lack of state services and ensuing poverty to migrate and send remittances back to their family – with the resultant loss of personal control over their reproductive goals. Financial aid from the US has dominated programmes such as those in India, Peru, the Philippines and Egypt. This from a country that does not recognise poverty as structural violence. Unfortunately, real choice is only available to those who have genuine options. Aid supplied is often matched to data from surveys that measure a Western view of individuals, ignoring the structural context. Often, “structural adjustment programmes” impose conditions for external funding: specific fertility reduction goals, reduction of state subsidies, increased prices of goods and services – which all shape individual behaviour toward a market orientation and away from acting as part of a community or family. The vast inequalities in society are left unaddressed. It is made clear how damaging it is to separate out family planning programmes from wider general health and social services. The authors describe how education of girls is promoted as having multiple beneficial effects; unfortunately, financial and entrepreneurial skills are emphasised in programmes and girls are encouraged to break free from their cultural beliefs and practices.

The strong alliance between church and state in Poland is, rightly, given prominence, with the symbol of the Women’s Strike movement being featured on the book cover. As would be expected from US authors, there is a good explanation of the Christian Right with its promotion of “family values” extending far beyond the US. The pressure for motherhood is referred to throughout the book – perhaps the concept of being judged as unfit for parenthood could have been explored more.⁵

State motivation for imposition of reproductive policies can be linked to population sizes that are considered either too big or too small. Bearing in mind that 59% of the world’s territories now have a total fertility rate (TFR) of 2.1 or less, useful summaries of the situation in several countries include those whose governments are reacting to such below-replacement level fertility. There are interesting discussions of family policies in these countries, some of which are now in the ultra-low fertility rate bracket (TFR less than 1.3). Incentivisation is covered briefly in relation to India (but omitted from the index) but I felt there could have been more analysis here.⁶ A key point the authors make is that states not only shape the sizes of populations but their composition too. The eugenic origins of laws and policies are well covered. Oppressed people who get targeted include those living in poverty, Indigenous Peoples and people of colour. Minorities are treated differently too, including on the basis of religion and migrant status. For example, foreign workers are deported from Singapore if they have a child.

The last chapter is devoted to feminist dystopia fiction. Although “The Handmaid’s Tale” is the best known, there are many others published, some of which are less extreme but clearly show how worrying interferences with reproductive justice are happening all around us and need constant vigilance and push back.

There are general references in the book to Depo-Provera^™ and Norplant^™. This does not reflect accurately scientific developments and increased choice of the expanding formulations of injectable contraceptives and subdermal implants that are now available. Having said that, there are references to the undue pressure to use long-acting contraceptive methods that has been described in many countries. The term long-acting reversible contraception (LARC) is not used though.

I think this book is a highly significant contribution to the sexual and reproductive health literature, giving a deep and nuanced overview of the subject. I strongly recommend it for individuals and for libraries in the workplace, higher education, NGOs and governments.