Gendered Perspectives on Reproduction and Sexuality: Volume 8

In 2002 when we began reviewing papers for possible inclusion in Advances in Gender Research volume 7: Gender Perspectives on Health and Medicine: Key Themes, and Volume 8: Gender Perspectives on Health and Medicine: Reproduction and Sexuality, the popular press was full of headlines about Hormone Replacement Therapy (HRT) (for references and extended and detailed discussion by researchers and physicians see the editorial by Ronald C. Hamdy, MD, FRCP, FACP (2002) and the letters to the editor (Mikhail, 2003) in the Southern Journal of Medicine).

The central objective of this chapter is to develop a theoretical reading of the international and contemporary discourse of reproductive rights. My hope is that the perspective and analytical proposal set forth represent a contribution to the expansion and consolidation of the field of study, and renders useful for the analysis and evaluation of the situation of reproductive rights within national contexts.

Language is a fundamental and yet extraordinarily powerful medium. Language is more than the primary feature distinguishing humans from other species. As our principle means of communication, language links us to culture, and in so doing, shapes our perceptions and determines the way in which we think (Clark, Eschholz & Rosa, 1981; Thorne, Kramarae & Henley, 1983). Language is inseparable from social life. Through language, individuals learn cultural patterns and political and social values (Mueller, 1973). Language also reflects the prejudices of society, with assumptions about relative status, power or appropriate behavior often built into the words we use to talk about different groups of people. As Frank and Anshen (1983) note, ageism, racism, and most importantly for this discussion, sexism, are all perpetuated by our language, even among those who consciously reject those prejudices.

This chapter is concerned with the varied legitimizing discourses used by midwives to frame their identities in relation to their work. This sociological issue is particularly important in the context of an occupation, such as this one, that exists at the border of competing service claims. Drawing on 26 in-depth interviews, I use narrative analysis to examine the stories that midwives tell about their work. Through these women’s work narratives, I show the complex intersection of narrative, culture, institution, and biography (Chase, 1995, 2001; DeVault, 1999).

In 1920 Margaret Sanger called voluntary motherhood “the key to the temple of liberty” and noted that women were “rising in fundamental revolt” to claim their right to determine their own reproductive fate (Rothman, 2000, p. 73). Decades later Barbara Katz Rothman reflected on the social, political and legal changes produced by reproductive-rights feminists since that time. She wrote: So the reproductive-rights feminists of the 1970s won, and abortion is available – just as the reproductive-rights feminists of the 1920s won, and contraception is available. But in another sense, we did not win. We did not win, could not win, because Sanger was right. What we really wanted was the fundamental revolt, the “key to the temple of liberty.” A doctor’s fitting for a diaphragm, or a clinic appointment for an abortion, is not the revolution. It is not even a woman-centered approach to reproduction (2000, p. 79).

The medical suppression of female sexuality in Victorian society has long been the subject of historical and cultural scholarship, with documentation not only of textual threats by religious and medical “experts,” but also of surgical assaults on female reproductive systems (Longo, 1979, 1986; Scull & Favreau, 1986; Sheehan, 1997). Less well known is the apparent obverse: the use of medical techniques to stimulate the female genitalia as a means of treating hysteria and other mental disorders (Maines, 1999; Schleiner, 1995). In this paper, I trace the cultural history (mainly Anglo-American) of the psychiatric enhancement, as well as repression, of female sexual pleasure, through various genital treatments, including the surgical and the electrical.¹ I then make the case that these “opposite” treatments are, in the context of Victorian society, two sides of the same coin of the patriarchal, medical control of female sexuality.²

Ritual female genital practices, widespread throughout Africa, are essential to gender identification and often are a pre-requisite for marriage. More severe forms of the practice, which are common in parts of Northeastern Africa, are also believed to enhance a woman’s childbearing capacity. Here, we critically review the gender- and class-based theories that explain the origins and persistence of female genital practices and the factors that precipitate social change. We also critically review evidence of the association of certain forms of the practice with various health, demographic, and social consequences. Our review exposes several methodological limitations of existing research that preclude population-based inferences about the medical and social implications of these practices and suggest that existing policies targeting such practices draw more on concerns over human rights than on scientific evidence about their sequelae. This review nevertheless exposes a potential contradiction between local justifications for and consequences of certain forms of the practice. Namely, despite an intended function of female genital practices to enhance a woman’s marital capital, certain forms may ironically lead to marital instability and dissolution through their negative effects on the health and reproductive capacity of women. We conclude with recommendations for research to examine the salience and implications of this potential paradox for women in Northeastern Africa.

I begin my historical analysis of the co-evolution of reproductive norms and desires, approaches to fertility control, and the meaning assigned to contraceptives with an examination of the Grafenberg Ring, the first modern IUD. The Grafenberg ring, developed in the late 1920s by a German doctor, Ernst Gräfenberg, was a small ring made of silkworm gut and coiled silver that can be compressed to be inserted into the uterus. The Grafenberg ring appeared at a time when changes in social attitude towards sexuality had formed a favorable climate for a new contraceptive method. The device was greeted with much interest from the European birth control movement, and Gräfenberg was invited to speak at the Third Congress of the World League for Sexual Reform held in London in 1929 and at the Seventh International Birth Control Conference in Zurich in 1930 (Davis, 1971).

Deborah L. Balk is a social demographer at Columbia University’s Center for International Earth Science Information Network (CIESIN). Her prior work has focused on fertility, marriage, health and gender in Asia and north Africa. Her current work integrates demography with geography, applying both geospatial and demographic data and techniques to one another. Her current research includes a study of climate, health and migration interactions in sub-Saharan Africa, and analysis of the global spatial distribution of population with particular attention to estimates of urban extents.Alejandro Cervantes-Carson is assistant professor of sociology at Mary Washington College. Born in Mexico City, he studied both in Mexico and the United States, obtaining a Ph.D. in sociology from the University of Texas, at Austin. His primary areas of interest and research are political sociology, social inequality, and Latin America. He has written articles on gender, human rights, population policies and reproductive rights in Mexico. He is currently part of a research team studying a transnational community that connects northern Virginia, U.S., and southern Puebla, Mexico, and developing a project on deliberative democracy in the Zapatista movement.Denise A. Copelton is visiting assistant professor of sociology at Franklin and Marshall College in Lancaster, Pennsylvania where she teaches courses on women’s health, medical sociology, and sociology of families. She received her Ph.D. in sociology from Binghamton University (SUNY) in 2003. Her dissertation examined the social experience of pregnancy in the U.S., focusing both on the social construction of prenatal norms in popular pregnancy advice books and on the ways in which pregnant women accommodate and resist these norms in their daily lives.Vasilikie Demos is professor emeritus of sociology at the University of Minnesota-Morris. She has studied ethnicity and gender in the United States and is currently completing a monograph on her study of Kytherian Greek women based on interviews in Greece and among immigrants in the United States and Australia. With Marcia Texler Segal, she is co-editor of the Advances in Gender Research series and Ethnic Women: A Multiple Status Reality (General Hall, 1994). She is a past president of Sociologists for Women in Society and of the North Central Sociological Association, and has been an Honorary Visiting Professor at the University of New South Wales.Lara Foley is assistant professor of sociology and governing board member of the women’s studies program at the University of Tulsa. Among the courses she teaches are Sociology of Medicine and Sociology of Reproduction and Birth. Her work in this volume is based on her dissertation research examining the work narratives of midwives. Another article from this project, co-authored with Christopher Faircloth, entitled “Medicine as a Discursive Resource: Legitimation in the Work Narratives of Midwives” appears in Sociology of Health and Illness, 2003, 25, 165–184. She is currently working on a book project examining the experiences and roles of male partners in pregnancy and childbirth.Jennie Jacobs Kronenfeld is professor in the Department of Sociology, Arizona State University. She conducts research in the areas of health policy, health across the life course, health behavior including preventive health behavior, and research into AIDS in geographically mobile populations. She has recently authored Health Care Policy: Issues and Trends (Praeger, 2002). She has conducted research in a variety of topics related to child health, including recruitment into CHIP (child health insurance program) and has published a book on the impact of school-based health clinics, Schools and the Health of Children (Sage, 2000). She is a past president of Sociologists for Women in Society and past chair of the Medical Sociology Section of the American Sociological Association.Marcia Texler Segal is Associate Vice Chancellor for Academic Affairs, Dean for Research and professor of sociology at Indiana University Southeast. Her research and consulting focus on education and on women in Sub-Saharan Africa and on ethnic women in the United States. With Vasilikie Demos, she is co-editor of the Advances in Gender Research series and Ethnic Women: A Multiple Status Reality (General Hall, 1994). She is a past president of the North Central Sociological Association and past chair of the American Sociological Association Sections on Sex and Gender and Race, Gender and Class.Chikako Takeshita is a Ph.D. candidate in the Graduate Program in Science and Technology Studies at Virginia Tech University. Her research interests include socio-cultural and political aspects of biodiversity prospecting and indigenous rights. She is the author of the article “Bioprospecting and its Discontents: Indigenous Resistances as Legitimate Politics” (Alternatives, 2001, 26, 259–282). More recently, she has been researching the social and scientific development of intrauterine devices, politics of medical representations of female bodies, and reproductive rights and population policies from a gender perspective. She has a M.S. degree from the Science and Technology Studies at Virginia Tech, an M.B.A. from INSEAD in Fontainebleau, France, and a B.A. from Keio University in Tokyo.Carol A. B. Warren is Professor Emerita and former chair of sociology at the University of Kansas. Her former appointment was as associate to full professor of sociology at the University of Southern California. Among her recent publications are Gender Issues in Ethnography with Jennifer K. Hackney (Sage, 2000), “Qualitative Interviewing” in the Handbook of Interview Research (J. Gubrium & J. Holstein (Eds), Sage, 2002), Pushbutton Psychiatry: A History of Electroshock in America with Timothy Kneeland (Praeger, 2002) and “Sex and Gender in the 1970s,” in Qualitative Sociology (Winter 2003). She is working on a book, Discovering Qualitative Methods: Field Research, Interviews, and Images, with Tracy X. Karneer, to be published by Roxbury, and on articles (with Timothy Kneeland) on “Mineral Magnetism in Psychiatric Treatment” and “Natural Electricity in Psychiatric Treatment: Amber, Fish and Eels.”Terri A. Winnick earned a B.S. in psychology at Indiana University-Purdue University, Indianapolis (IUPUI), and an M.A. and Ph.D. in sociology at Indiana University, Bloomington. She is an Assistant Professor at The Ohio State University, Mansfield. Her area of interest is medical sociology, with a focus on professions; she is currently doing research on the reaction of the established medical profession to alternative medicine.Kathryn M. Yount is a social demographer specializing in the measurement of morbidity and mortality in less developed settings and in the integration of qualitative and quantitative data in sociodemographic analysis. She is currently an Assistant Professor in the Departments of International Health and Sociology and Affiliated Faculty of the Department of Women’s Studies at Emory University. Her research focuses primarily on multi-method case studies and comparative analyses of the determinants of disparities by gender in survival, health, and access to care over the life course. Yount has received grants from the National Science Foundation, the University Research Committee at Emory, and the National Institute on Aging to study these issues in the Middle East.