Realizing Abortion Rights at the Margins of Legality in Mexico

ABSTRACT

I analyze the alternative tactics and logics of Las Fuertes, a feminist organization that has taken an “alegal” approach to realizing the human right to abortion in the conservative Mexican state of Guanajuato. Since a series of United Nations agreements throughout the 1990s enshrined reproductive rights as universal human rights, Mexican feminists have adopted the human rights platform as a lobbying tool to pressure the government to reform restrictive abortion laws. This strategy bore fruit in Mexico City, with passage of the historic 2007 abortion legalization. Las Fuertes has leveraged the human rights strategy differently – to justify the direct provision of local abortion accompaniment in a context of near-total abortion criminalization. By directly seizing abortion rights, rather than seeking to implement them through legalistic channels, Las Fuertes has effectively challenged Mexican reproductive governance in an adversarial political environment.     

Metrics of Survival: Post-Abortion Care and Reproductive Rights in Senegal

ABSTRACT

Drawing on ethnographic fieldwork conducted in Senegal between 2010 and 2011, I demonstrate how health professionals have deployed indicators such as number of women and abortion type treated in government hospitals to demonstrate commitment to global mandates on reproductive rights. These indicators obscure discrimination against women suspected of illegal abortion as health workers negotiate obstetric treatment with the abortion law. By measuring hospitals’ capacity to keep women with abortion complications alive, post-abortion care (PAC) indicators have normalized survival as a state of reproductive well-being.     

Arbitrating Abortion: Sex-selection and Care Work among Abortion Providers in England

ABSTRACT

The UK’s on-going sex-selective abortion (SSA) controversy remains a major obstacle to the liberalization of national abortion governance, and is an issue broadly attributed to a “cultural” preference for sons among South Asian women. We conceptualize how healthcare professionals “arbitrate” requests for SSA by exploring the tension between its legal status and how requests are encountered by abortion providers. SSA is framed in this article as a legitimate care service that can support providers to meet the diverse reproductive health needs of women to the full extent of the law.     

Reproductive Travel to Ghana: Testimonies,Transnational Relationships,and Stratified Reproduction

ABSTRACT

In this article, I address reproductive travel to Ghana, based on research conducted in two private fertility clinics. Both clinics attract clients from West African countries as well as Ghanaian people living in the US and Europe. Their motivations to visit these clinics include positive “testimonies” about treatment results, “bioavailability” of matching donor material and surrogates, lower treatment costs and the circumvention of restricting regulations in the country of residence. Communication technologies are central in facilitating reproductive travel. Finally, I argue that the “international choreographies” of reproductive travel are co-shaped by the unique biographies and transnational relationships of the people involved.     

Obstetric Violence Observatory: Contributions of Argentina to the International Debate

ABSTRACT

In Latin America, over the past decade, the term “obstetric violence” has become part of the legal framework. Specific laws against obstetric violence – gender-based violence and the violation of human rights – exist in Venezuela, Argentina, Mexico, Brazil and Uruguay. In Europe, the issue is raised by human rights organizations, social movements and academics, but no country has yet passed legislation on the matter. In this article, I focus on the contribution of Argentina to this international debate, particularly with respect to the implementation of the Obstetric Violence Observatory.     

The Legal Challenge of Abortion Stigma—and Government Restrictions on the Practice of Medicine

During the 2016 election, Donald Trump won conservative support by promising that he would, if elected, nominate “pro-life” justices to the U.S. Supreme Court. Whether President Trump makes good on his campaign promise to restrict abortion rights may come down to competing impulses of the chief justice, John Roberts. These dueling dispositions—from the man whom many see as the new “swing justice”—hold the key to a blockbuster new case that legal historians call “the most unpredictable the Supreme Court has been on abortion in decades.” The case, June Medical Services v. Russo, turns on arduous new requirements that Louisiana has imposed on facilities and clinicians that provide abortion. But the case is not just about abortion access. The Court will have to decide whether a clinic has a right to challenge the law in the first place.     

Searching for Love and Test-Tube Babies: Iraqi Refugee Men in Reproductive Exile on the Margins of Detroit

ABSTRACT

In this article, I explore the reproductive health problems faced by Iraqi refugees, one of America’s most rapidly growing immigrant populations. Based on anthropological research in “Arab Detroit,” the “capital” of Arab America, I explore the experiences of Iraqi refugee men seeking medical help for their infertility. Most required intracytoplasmic sperm injection (ICSI), a variant of in vitro fertilization (IVF). However, in America’s privatized medical system—where a single cycle can cost more than $12,000—few could possibly afford this assisted reproductive technology (ART). Although Iraqi refugees had diasporic dreams of making a test-tube baby, they were stuck in a situation of “reproductive exile”—forced out of their home country by war, but unable to access costly ARTs in the country that led to their displacement. I elaborate on the concept of reproductive exile, attempting to translate Iraqi refugee men’s reproductive agency and desires, but also their profound disappointments.     

Regulating Traditional Mexican Midwifery: Practices of Control,Strategies of Resistance

ABSTRACT

The institutionalization of Mexican midwifery has a long history. Despite global recommendations moving away from training traditional midwives, training courses still continue. Based on fieldwork in the State of Chiapas, I argue that while ongoing trainings offered to traditional midwives in Mexico aim at teaching them best practices, they also limit midwives’ autonomy and keep poor women’s reproductive behaviors under control. I demonstrate how midwives and medical personnel mobilize discourses of reproductive risk, women’s rights and indigenous cultural rights to reinforce or contest mechanisms of reproductive governance.     

“Human Life is Inviolable”: Costa Rica’s Human Rights Crucible

ABSTRACT

The Costa Rican Constitutional Court banned in vitro fertilization in 2000, citing the inviolability of life. Conservatives hoped the ban would initiate a hemispheric movement to protect the unborn. But in 2012 the Inter-American Court of Human Rights ruled that reproductive rights are human rights and that women’s rights take precedence over embryo rights. The episode precipitated a national identity crisis: how could a country that supports universal health care be labeled a human rights violator as a result of its efforts to protect nascent human life? Expanding the health and human rights framework helps us appreciate how IVF became Costa Rica’s human rights crucible.     

Reproductive Desires and Disappointments

ABSTRACT

In this introduction we consider how people who have difficulties achieving “natural” parenthood seek to form families, and their experiences of reproductive negotiations and losses in this pursuit. We highlight gaps in the literature on infertility and loss globally, and identify how the special edition addresses the dearth of research in this field with men, with non-elites and on loss. We consider the key insights drawn from studies conducted in divergent geographical, cultural, socioeconomic and political contexts, including perspectives from Ghana, Indonesia, Romania, Spain, the United Kingdom, and the United States. In these contexts we explore both high tech and no tech reproductive strategies, encompassing assisted reproductive technologies, third party donation, surrogacy, as well as intra-family and transnational adoption. We illuminate how people attribute meaning to their lived experiences of reproductive disappointments ranging from failed conception (primary and secondary infertility), miscarriage, stillbirths, neonatal death, and failed adoption. We reflect on both local and transnational practices embedded in family making, highlighting the complexity and dynamism of reproductive opportunities, and how these opportunities are embedded in multifarious power relations. We articulate a range of important themes for the anthropology of reproduction, including: the sociality of reproductive desires and disappointments; gender sexuality and emergent masculinities; migration, practices of belonging, and kinship; reproductive stratification and leveling; and reproduction and relationality.     

Rethinking “Elective” Procedures for Women's Reproduction during Covid-19

Common hospital and surgical center responses to the Covid-19 pandemic included curtailing “elective” procedures, which are typically determined based on implications for physical health and survival. However, in the focus solely on physical health and survival, procedures whose main benefits advance components of well-being beyond health, including self-determination, personal security, economic stability, equal respect, and creation of meaningful social relationships, have been disproportionately deprioritized. We describe how female reproduction-related procedures, including abortion, surgical sterilization, reversible contraception devices and in vitro fertilization, have been broadly categorized as “elective,” a designation that fails to capture the value of these procedures or their impact on women's overall well-being. We argue that corresponding restrictions and delays of these procedures are problematically reflective of underlying structural views that marginalize women's rights and interests and therefore threaten to propagate gender injustice during the pandemic and beyond. Finally, we propose a framework for triaging reproduction-related procedures during Covid-19 that is more individualized, accounts for their significance for comprehensive well-being, and can be used to inform resumption of operations as well as subsequent restriction phases.     

Louisiana's “Medically Futile” Unborn Child List: Ethical Lessons at the Post-Dobbs Intersection of Reproductive and Disability Justice

Ableist attitudes and structures are increasingly recognized across all sectors of health care delivery. After Dobbs, novel questions arose in the United States concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. In this essay, we examine the Louisiana Department of Health's emergency declaration, “List of Conditions That Shall Deem an Unborn Child ‘Medically Futile,’” issued August 1, 2022. We raise a number of medical, ethical, and public health concerns that lead us to argue that the declaration should be rescinded. Analysis of this ethically objectionable declaration provides valuable lessons about how to uphold both reproductive and disability justice in a post-Dobbs landscape.     

Restricting Reasons: A New Battleground in Abortion Regulation

The latest trend in abortion restrictions in the United States targets a woman's reasons for terminating a pregnancy. Fourteen states have attempted to enact laws prohibiting abortion on the basis of fetal sex, race, and/or genetic anomaly. These laws are different from regulations tied to a government interest in protecting women's health. Laws that restrict reasons implicate a different set of government interests to be weighed against a woman's constitutional right first recognized in Roe v. Wade. These laws also seek to reframe the nature of the right asserted by the woman. To date, the Supreme Court has declined to address the constitutionality of laws that restrict reasons, and the Court's most recent abortion decisions provide little guidance. It is possible that a conservative majority of the Supreme Court would uphold a law that prohibits reasons for having an abortion that appear discriminatory. But such laws would be difficult to enforce and therefore may be relegated to policy statements rejecting discriminatory norms as opposed to being effective means of restricting access to abortion.     

Gendering the Gift of Life: Family Politics and Kidney Donation in Egypt and Mexico

ABSTRACT

In this article, we demonstrate how living kidney donation is a particularly gendered experience. We draw on anthropologists’ contributions to understanding the globalization of reproductive technologies to argue that kidney donation similarly endangers and preserves fertility, thereby unsettling and reifying gendered familial labor. Based on fieldwork in two ethnographic sites—Egypt and Mexico—we examine how kidney donation is figured as a form of social reproduction. In both settings, kidney recipients rely almost exclusively on organs from living donors. We focus on how particular gender ideologies—as evident, for example, in the trope of the “self-sacrificing mother”—can serve as a cultural technology to generate donations in an otherwise organ-scarce medical setting. Alternatively, transplantation can disrupt gender norms and reproductive viability. In demonstrating the pervasiveness of gendered tropes in the realm of transplantation, we unsettle assumptions about the “family” as the locus of pure, altruistic donation.     

Mixing and Matching: Sperm Donor Selection for Interracial Lesbian Couples

ABSTRACT

The widespread use of assisted reproductive technologies, coupled with processes of demographic and social change, are contributing to the normalization of new family configurations that extend beyond biological kinship. Non-traditional families, increasingly prevalent due to interracial and same-sex marriages, challenge normative expectations of family resemblance between siblings, parents and children. Interviews with interracial lesbian couples about their selection of a sperm donor reveal that despite the new forms of relatedness that non-traditional families enable, within the use of reproductive technologies, biological framings of race and sibling kinship continue to structure decisions about family formation.     

Medical educators: How they define themselves – Results of an international web survey

Background: Little is known about medical educators’ self-definition.

Aims: The aim of this study is to survey an international community of medical educators focusing on the medical educators’ self-definition.

Methods: Within a comprehensive, web-based survey, an open question on the participants’ views of how they would define a “medical educator” was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. The free text definitions were analysed using qualitative thematic analysis.

Results: Of the, 2200 medical educators invited to participate, 685 (31.1%) provided a definition of a “medical educator”. The qualitative analysis of the free text definitions revealed that medical educators defined themselves in 13 roles, primarily as “Professional Expert”, “Facilitator”, “Information Provider”, “Enthusiast”, “Faculty Developer”, “Mentor”, “Undergraduate and Postgraduate Trainer”, “Curriculum Developer”, “Assessor and Assessment Creator”, and “Researcher”.

Conclusions: Our survey revealed that medical educators predominantly define themselves as “Professional Experts” and identified 12 further self-defined roles of a medical educator, several of which not to have been reported previously. The results can be used to further the understanding of our professional identity.     

Keep It Complicated

The lead article in the March‐April 2016 issue of the Hastings Center Report struggles with purported rights. The authors, led by Mara Buchbinder of the University of North Carolina at Chapel Hill, report on a study in North Carolina of physicians and others who were providing care to women seeking abortions and were required by state law to talk to a woman before the abortion about the medical risks of abortions and of pregnancies, the possibility that medical assistance benefits might be available if the woman chose to carry the pregnancy to term, and several other issues. The law is grounded in rights claims—it is motivated by concerns about a right to life and framed in terms of a right to morally important information (it is known as the Woman's Right to Know Act)—but the abortion providers felt that it imposed on the women, on the providers, and on the relationship between them.     

Exploring the feasibility and acceptability of using tactical decision games to develop final year medical students’ non-technical skills

Introduction: Clinical decision-making, situation awareness, task management, and teamwork are key non-technical skills (NTS) required by junior doctors. Tactical decision games (TDGs) are low-fidelity classroom-based activities designed to develop proficiency in NTS. This study aimed to explore the feasibility and acceptability of using TDGs as a novel teaching method for final year medical students.

Methods: Final year medical students at the University of Edinburgh participated in a single TDG session. Focus groups were then used to explore students’ perceptions of participating in the TDG session and transcribed data from the focus groups was thematically analyzed.

Results: Six key themes emerged from the data: “the value of non-medical games”; “giving and receiving feedback”; “observing and reflecting”; “recognizing and understanding NTS”; “dealing with uncertainty and ambiguity”, and “introducing TDGs into the curriculum”.

Conclusions: TDGs are an easy-to-use, low-fidelity method of teaching medical students about the importance of NTS. Medical students view TDGs as a valuable learning activity that appears to increase awareness and understanding of the importance of NTS.     

Fetal Research: Response to the Recommendations

The June 1975 issue of the Hastings Center Report published the Deliberations and Recommendations of the National Commission for the Protection of Human Subjects concerning the regulation of fetal experimentation. The Commission's most controversial conclusions were as follows: First, it voted to allow non-therapeutic research on the human fetus, provided important biomedical knowledge could not be gained in any other way, proper consent had been obtained, and the research imposed “minimal or no risk to the well-being of the fetus” (Recommendation 4). Because interpretations of the last phrase varied in the case of fetuses scheduled for abortion, the Commission recommended that a national ethical review body be able to rule on disputed cases (Recommendation 5). In the case of research during abortion and research on the non-viable fetus ex utero, the Commission's interpretation of permissible “harm” was restricted to the proviso that “no intrusion into the fetus [may be] made which alters the duration of life” (Recommendation 6). The Commission also recommended further research on abortion techniques (Recommendation 12). The Secretary of Health, Education and Welfare accepted the Commission's Recommendations almost without change—the major modification was to request paternal consent rather than to rely on the fact that “the father has not objected.” The DHEW regulations were published in the Federal Register on Friday, August 8, 1975, and written comments on them were invited. Already, however, a number of commentators including several members of the Commission had offered either dissenting or qualifying remarks. Some are printed here.