Technologies of Reproduction Across the Lifecourse

This edited collection proposes an interdisciplinary and integrated approach to the study of reproductive technologies (RTs), which reflects the fact that many people use different technologies throughout their lifecourse and resists the disciplinary siloing of research on these technologies. The ever-expanding availability of RTs, the continued roll-out of ‘family planning’ and maternity services across low- and middle-income settings and the rapid development of the fertility industry mean that it is more likely than ever that individuals, especially women and trans* people, will engage with more than one RT at some point in their life. These multiple engagements with RTs will affect users' expectations and uptake, as well as the technologies' availability, commercial success, ethical status and social meanings. We offer this book as part of a wider movement in the study of reproduction and RTs, which takes inspiration from the reproductive justice framework to address forms of exclusion, discrimination and stratification that are perpetuated in the development and application of RTs and the ways in which they are studied and theorised. Here, we introduce the project and outline the structure of the book.

Here we provide a short reflection on the persistent theme of knowledge in reproductive studies which allows us to draw out further insights from each of the chapters.

Sterilisation in India (and globally) has a contentious and deeply politicised history. Despite this troubling legacy, India continues to rely on female sterilisation as the main form of contraception and family planning. Abortion, which has been legal under broad grounds since 1971, intersects with sterilisation at different points over women's reproductive lifecourse. Drawing on three case studies exploring women's abortion trajectories in Karnataka, India (2017), this chapter examines sterilisation as a reproductive technology (RT) in women's abortion narratives. These include experiences of failed sterilisation necessitating abortion, as well as narratives around pre- and post-abortion counselling with sterilisation conditionalities. Women report healthcare workers shaming or scolding them for not being sterilised after their last pregnancy – demonstrating the prominence of sterilisation as an enforced social norm using ‘health’ frames. Using reproductive justice (RJ) as a lens, I analyse how sterilisation interacts with abortion and the narratives of shame and stigma that surround the two technologies and make visible the ways in which it results in the denial and restriction of women's reproductive freedoms.

This chapter investigates knowledge and practices relating to the ‘right timing’ in reproductive biomedicine in Switzerland. More precisely, it focuses on the effects of an anticipatory regime (Adams, Murphy, & Clarke, 2009) on women's experiences of age-related infertility. As assisted reproductive technologies (ARTs) promise to intervene in the fixed ‘biological facts’ of fertility decline to render reproduction and the timing of motherhood more flexible, manageable and controllable, this chapter explores the effects of anticipation on women's experiences and negotiations of age-related infertility and ARTs. It sheds light on an anticipatory regime which can be called ‘motherhood as right timing’. It shows how, in this regime, the temporality of the lifecourse is brought back to a biological temporality and how expectations and injunctions towards managing and controlling time contain the possibility of their failure, as they are associated with a multiplication of uncertain, complex and resisting biologies. At the core of the practices and politics of anticipating fertility decline, there is a tension between acting upon and being acted upon time, which are embedded in a moral economy of responsibility and volition in which women are blamed, or blame themselves, for not anticipating what is by definition beyond individual control and anticipation.

Menopause discourse plays a powerful cultural role in the west, serving to mark a (negative) shift in women's social status, shaping both social norms and women's self-appraisals and dividing women's lifecourse into two: fertile and post-fertile, with value attributed only to the former. However, in 2019 a new ‘solution’ to the problem of menopause entered public discourse in the form of a new surgical technology, offered by the private health provider ProFam, to delay menopause via ovarian freezing techniques. Aimed in the first instance at women seeking to avoid the disruptions of severe symptoms, it also quickly became framed as a way in which (especially childless) women might extend their fertility. In this chapter I explore menopause discourse as it appears in medical and popular sources associated with this new technology, looking at the continuities and discontinuities with earlier forms of menopause discourse. I also take a broader view in placing technologies for delaying menopause in the context of reproductive technologies used by women at all stages of the lifecourse, critically examining the claims that they give women choice, freedom and control over time. I suggest that in fact they are implicated with rather more complex temporal structures, captured in the concept of ‘ambivalence’ and characterised by a mixture of gendered expectation, anticipation and suspension of agency. Finally, I explore whether it is menopause itself, rather than its delay, that, in serving to disrupt such temporal ambivalence among other things, can in fact introduce the possibility of freedom.

For the millions of women living with endometriosis, significant disruption to normative life expectations and a considerable impact on everyday life are common. Whilst for many women concerns about and experiences of infertility may be a central feature of life with the condition, little work has considered the impact that chronic illness has on reproductive decision-making or on the ways in which a medical condition is managed in relation to plans for conception. This chapter considers how heterosexual women with endometriosis and their male partners experience the intersection of fertility desires with the use of reproductive technologies (contraceptive and conceptive) and how these experiences intersect with the medical and surgical management of endometriosis. Three themes drawn from interview data are presented: the first considers how the uncertain and indeterminate character of endometriosis shapes imaginaries about future fertility, conception and childbearing. The second focuses on how endometriosis mediates expectations about the success of fertility treatments and technologies; exploring in particular the manifestation of low expectations in relation to possible success. The third theme considers how endometriosis and fertility pathways intersect, creating specific disruptions whereby fertility treatment may be delayed by endometriosis care, and where endometriosis care may be interrupted or paused by fertility desires. Our data show how endometriosis shapes reproductive desires, decision-making and experiences and has important implications for understanding how for those living with a chronic illness, plans for having children are made within a context of biographical and biomedical contingency.

Here we provide a short reflection on the persistent theme of choice in reproductive studies which allows us to draw out further insights from each of the chapters.

Hormonal contraceptives are complicated reproductive technologies – both biologically and socially. Deeply embedded in global political-economic agendas and historically underpinned by eugenic movements, hormonal contraceptives have a social life often beyond their intended or imagined uses. Because so much of the discussion around contraceptives focuses on their complex history and volatile present, there has been minimal space to talk about the future of hormonal contraceptives. In this chapter I show that while the past and present are complex, the future is even more so!

As the threat of climate change becomes more palpable, two key anxieties (re)surface. First, a fear around growing populations in the Global South (while in reality Total Fertility Rate (TFRs) are in decline) and second, that of a hormonal body out of sync in the face of environmental changes. Similar anxieties have historically mobilised draconian ‘family planning’ measures in countries (like India) in the first instance. And in the second instance, hormonal manipulations to find ‘balance’ in the body, as opposed to balancing (or coming to a reckoning with) contemporary environments with/in which the body exists.

This chapter is an attempt to bring to the fore the importance of studying hormonal contraceptives in environmentally unstable times. To imagine a space beyond coercion or ‘choice’ as variously imagined, when it comes to reproductive justice vis-à-vis hormonal contraception. I suggest that, just as contraceptives have allowed us access to conversations about both women's autonomy and reproductive control, they now allow us to unpack the limits and potentials of hormonal management via the hormonal contraceptive pill.

This chapter discusses an instance of spectacular reproduction that circulated in US media during the late 2010s. Through the use of commercial DNA tests, it was revealed that a fertility doctor, Donald Cline, had used his own sperm to impregnate scores of women who had sought fertility treatment from him during the 1980s. More than 60 biogenetic children, now in their mid to late 30s, were identified by early 2020. This instance illustrates several concepts and concerns that might further guide the social and cultural study of human reproduction and especially the uses of reproductive technologies: (1) Most of us encounter instances of extraordinary reproduction from a mediated distance, yet they may shape and inform our expectations and experiences of ordinary reproduction in our everyday lives. How might the concept of spectacle help us understand what is perceived and understood about reproductive technologies? (2) Reproductive technologies offer ‘fixes’ for disruptions of not only reproduction but also kinship. A focus of this chapter is on genetic genealogy tests as a re(tro)productive technology, which produces children, parents, and kinship in hindsight. (3) The social and cultural study of reproductive technologies ought to take a longitudinal approach that both includes a lifecourse perspective and takes into account the historical contexts in which the technologies become developed and individuals encounter them.

Fertility apps are digital tools for recording menstruation and bodily signs of fertility, with the aim of predicting future ovulation dates. For women trying to conceive, these predictions can be used to time heterosexual intercourse or insemination close to ovulation and thus increase chances of conception. This chapter explores women's use of fertility-tracking apps and the consequences of this for their experiences of trying to conceive in heterosexual relationships. I draw on findings from a thematic analysis of app content and interviews with women in the United Kingdom who had used apps to help them conceive, to show how these apps are often present in the in-between or transitional times and spaces of reproductive life. Apps are used to increase chances of pregnancy, but they are also used to navigate the many uncertainties of trying to conceive. Through a critical engagement with notions of control, anticipation and awareness, I explore how apps shape and are shaped by an increasingly demanding social and cultural context of reproduction.

This essay brings structural intimacies – theorised as the meeting of social structural patterns with interpersonal lives – to the border to consider transnational LGBTQ kinships. Specifically, the paper considers ‘the border’ and its state-driven bio-regulations as a reproductive technology that produces LGBTQ, racial/ethnic and social class inequities through the consolidation of heteronormative, bio-genetic kinship institutions and ideations of family. Structural intimacies harnesses intimacy as both subject and as an analytic lens for queering reproductive sociology that insists on re-conceptualizing institutions central to our lives. Structural intimacies move our analytic gaze from how the border structures sexuality, and vice versa, to consider the border as at once a structural and an affective domain. Structural intimacies is a conceptual tool useful for cross-disciplinary inquiry into the social and structural contexts in which reproductive technologies render meaning, as well as produce families, and to illustrate the analytic necessity of storying both content and method as integral to queer/ing scholarship. Straddling the most proximal forms of daily care and labor patterning everyday intimacies with the policies and practices of the state, the concept of structural intimacies reveals moments of encounter between state institutions with the most intimate components of a person's life and identity, in this case amplified by the bio-politics of the border.

This chapter describes how ambitious, educated, professional women engage with a range of reproductive technologies across their lifetime in an attempt to achieve the much-lauded post-feminist ideal of the perfect ‘work-life balance’ and ‘having it all’. Drawing on interviews, this chapter shares women's experiences of using several reproductive technologies over a 15-year period and how their configurations of bodies, technologies and responsibilities change. In our initial conversations, bodies were seen as a source of disruption to well-laid plans; bodies bled, throbbed, conceived, aborted and were often incompatible with the many social expectations and demands on young women's lives to balance their professional and private lives. At this time, women were attempting to control and direct their malleable bodies using different technologies, a tool, that were accompanied with new gendered responsibilities to make the right choices about if and when to menstruate, to get pregnant, to become a mother and to be intimate. Over time these technologies proved to be imperfect and often failed to deliver the promised future and a counter-narrative emerges in which bodies are not so malleable and technologies are less of tool and more of an additional burden. By looking at interactions of several reproductive technologies over time, experiences of bodies, of technologies and of responsibilities change; they are not static but more cumulative.

Here we provide a short reflection on the persistent theme of relationality in reproductive studies which allows us to draw out further insights from each of the chapters.

This chapter critiques the relationality between care and context to demonstrate how notions of routinised technologies are disrupted when considering the reproductive realities and situated constraints of ethnic and religious minority women. The chapter integrates ethnographic and qualitative data from two minority contexts, including maternity care provision for Orthodox Jews and how providers approach requests for sex-selective abortion (SSA) when caring for women from South Asian backgrounds. By examining responses to caesarean sections and abortion care among ethnic and religious minorities in the United Kingdom, the chapter critiques how routinised interventions are entangled in the anticipation of future reproductive potential. The idea of anticipatory futures serves as a reflection on the reproductive lifecourse, where technologies carry opportunities and implications that women and carers alike are tasked with negotiating. Taking inspiration from the reproductive justice framework, the chapter builds on a body of work that demonstrates how the concept of ‘choice’ is contingent and not inclusive of the situated constraints that can affect the reproductive lives of women from minority backgrounds. By delving into everyday reproductive constraints, the chapter raises implications for what inclusive woman-centred (or person-centred) care can involve, how providers approach ‘choice’, autonomy and justice in practice, and how their considerations reconfigure the otherwise ‘routine’ delivery of reproductive health services and technologies. Technologies increasingly invest the reproductive lifecourse with potential and anticipation, and the chapter calls on feminist scholars to understand the dilemmas posed for inclusive models of care beyond the discourse of ‘choice’.

Men are often considered by the health care system to be a disengaged accessory when it comes to family planning. In reality they act as an equal part in the reproductive equation. Despite qualitative research suggesting some men currently do take primary responsibility for family planning, men are further marginalised being classed as an irrational variable in large national datasets. Reports ignore men in general by failing to record basic demographics, for example, age is not captured and ethnicity has two options: white and non-white. This leaves little ability to analyse men's family planning knowledge, attitudes and beliefs. Technological advancements have resulted in new forms of male contraceptive methods reaching phase III testing (from pills to gels), and the market is moving towards diversified options that will allow even more men to take primary contraceptive responsibility. Other advancements include the sexual enhancement product Viagra becoming available over the counter, and reproductive wellbeing apps have been created to allow men to test their fertility at home. Without research to understand the ever-changing landscape for men we are ill-prepared to understand what these new products and advancements mean for men's role. Using various forms of publicly available online data and previous empirical research, this chapter will review men's response to new contraceptives, sexual enhancement products, and reproductive wellbeing apps. The results will be discussed in relation to updating the Subjective Expected Utility (SEU) Theory, the Theory of Planned Behaviour and the integrated developmental and decision-making contraceptive models used by health psychologists.

The politics of intimate relationships structure innovation for sexual and reproductive health technologies. In this chapter I present three case studies that explore how national political concerns surrounding maternal intentions and the race of sexual women shape the production of sexual and reproductive health technologies. The products I examine are: GONAL-F, a subcutaneous injection of follitropin alpha for ovulation induction; Evra, a transdermal patch containing norelgestromin (NGM) and ethinyl estradiol (EE) for hormonal contraception; and zidovudine (ZDV) for HIV therapy, including the prevention of mother-to-child transmission. Together, these case studies illustrate how the politics of intimate relationships, which are deeply engrained in societies, structure clinical innovation, through conditions of inclusion, exclusion and anticipation.

Although research on reproductive technologies such as IVF and egg freezing has traditionally been rather separated from the work on contraceptives and abortion, analysing reproductive and nonreproductive technologies together, as this volume proposes, can provide the basis for a broader contemporary politics of reproductive control. This chapter analyses this politics of integrating reproductive and nonreproductive technologies by focusing specifically on IVF-based fertility (preservation) treatments and (medical) abortion. More specifically, it explores both technologies' interrelated research trajectories and the financial and platformised dimensions of their clinical implementation. With a dual focus on egg freezing and medical abortion, this project seeks to explore how processes of platformisation and financialisation shape the clinical and commercial infrastructures that govern twenty-first-century reproduction. The chapter's broadened analytic scope that incorporates both reproductive and nonreproductive technologies highlights how a contemporary biopolitics of reproductive control may be expressed through these technologies' interrelated regulatory practices, shared politicised reference points (e.g. the embryo), opposite investment practices and mutually reinforcing social effects.

Here we provide a short reflection on the persistent themes from the volume and relate it to wider reproductive studies.