II The Body Politic and the Infertile Body
Introduction: The Body Politic and the Infertile Body
Tracey Loughran and Gayle Davis
When you conduct a search on the website of online retailer Amazon, a gallery beneath the search result reveals what ‘Customers Who Bought This Item Also Bought’. If you search Amazon for an infertility memoir, you are likely to find that other customers also bought the following products: guides to IVF treatment; ovulation and pregnancy test kits; iron supplements and ‘conception tablets’; and ‘fertility-friendly’ vaginal lubricant (‘Does not harm sperm or interfere with fertilisation and embryo development’, ‘PH balanced to match fertile cervical mucus’, ‘Contains the plant sugar, arabinogalactan, for antioxidant support of sperm’).1
This parade of brightly coloured products is, on the one hand, heart-breaking: it is all too easy to imagine the individual stories behind these virtual shopping-baskets of hope and despair. On the other hand, it is also a salutary reminder that although within contemporary Western culture media narratives consistently portray infertility in individualized terms as a personal tragedy, it is a condition which is always enmeshed in wider political, economic, and social questions, debates and circuits. In using an algorithm to identify the purchases of other customers who bought the same item, Amazon simultaneously helps infertile consumers to locate goods desired for their own quest for reproductive health, and silently integrates their choices into its marketing tools. This is late capitalism operating at maximum efficiency: monitoring individuals’ most
T. Loughran (*)
School of History, Classics and Archaeology, University of Edinburgh, Edinburgh,
G. Davis, T. Loughran (eds.), The Palgrave Handbook of Infertility in History, DOI 10.1057/978-1-137-52080-7_8
intimate desires, and repackaging this information to keep the wheels of consumerism whirring.
The insidious involvement of global corporations in intimate life is a relatively new development, but it would be difficult, if not impossible, to pinpoint any time in history when infertility has been viewed as a purely private affair.2 Since ancient times, the reproductive health of a people, whether their capacity to go forth and multiply, or their ability to limit births, has been an important index of its political health. The fertile body continues to be used as a symbol of national power, and the infertile body as one of failure and vulnerability.3 Western societies are commonly highly pronatalist, meaning that they are characterized by ‘an ideology that incorporates beliefs, attitudes and actions that, implicitly or explicitly, support parenthood and encourage fertility’.4 In Israel, the country with the highest rate of intervention via assisted reproductive technologies (ARTs) in the world, reproduction is defined as a national responsibility because there is a belief that ‘the Israeli-Palestine conflict will be resolved, at least in part, by the collective reproduction of Israeli-Jews to counter the higher reproduction rate of Palestinians’.5 In countries with rigid and formal policies of population control, the state can intervene at virtually every stage of the reproductive process. Under the ‘one-child’ policy in China, which began to be phased out in 2015, prior authorization for planned pregnancies was required in many jurisdictions. It was therefore ‘often strategically necessary to become pregnant with split-second timing: birth control in this case actually means minute control of when there will be a birth, and “family planning” is no euphemism’.6
High-level machinations of power, whether on the part of national rulers or supranational corporations, contribute to determining the experience of infertility in multifarious ways. In the developing world, states and nongovernmental organizations (NGOs) concerned with overpopulation often focus exclusively on measures to limit and control population despite strong pronatalist beliefs among citizens. When infertility is unacknowledged by the state or other authorities, sufferers often find it difficult and expensive to access remedies (biomedical or traditional).7 Meanwhile, in the nineteenth-century Western world, the medicalization of infertility turned sufferers into patients, and in the twenty-first century the unholy combination of free market capitalism, neoliberalism, globalization, and a proliferation of new reproductive technologies has turned these same patients into consumers.8
This section, then, explores the many different ways in which infertile bodies have been situated as objects of political concern in past and present societies. It examines the intersections between medical and cultural constructions of infertile bodies, political understandings of population and the health of the state, and the development and provision of techniques for investigating, managing, and curing infertility. In focusing on infertile bodies as political objects, it adopts a wide-ranging definition of the political as forms of power operating in public life and involving authority and government. This definition incorporates but extends beyond the formal structures of political power, and therefore illustrates the complex power relations within which infertile people are caught, or in which they operate (as will be seen, in the current global context, infertile individuals may be simultaneously victims, agents, and abusers).
The section opens with Penny Roberts’s exploration of the metaphorical and literal role of sterility during the crisis of the French Wars of Religion (1562-98). Since ancient times, the metaphor of the body politic has been used to illustrate ideal state-society relations. In the early modern period, political theorists began to use this metaphor to emphasize the artificiality of the political community, as a construct maintained through deliberate action.9 Sixteenth-century French authors drew on this rhetoric as they made comparisons between the political order and corporeal harmony, and often used images of the kingdom as ‘an ailing body in need of succour’ as a metaphor for the state of the monarchy.10 Yet as Roberts shows, the crisis of the Valois monarchy in this period stemmed from literal rather than metaphorical infertility, as successive rulers took increasingly desperate measures to secure the future of the dynasty. Their inability to provide legitimate heirs at a time of civil strife not only caused a succession crisis, but also undermined their authority and the stability of the kingdom.
Sarah Toulalan’s chapter takes us across the Channel to examine medical discourses on thin bodies and infertility in early modern England. It shifts our focus from the level of dynastic politics to the management of individual bodies. Toulalan shows how at all stages of the reproductive process, the authors of medical and midwifery texts expressed concern about bodies that were too thin, from pre-conception (menstruation), through sexual intercourse and conception, to pregnancy and childbirth. In the humoral model of the body, bodies starved of nourishment could not produce good seed, and an excess of hot, dry humours in the womb would prevent conception. She argues that such concerns should be understood in the context of contemporary perceptions of fertility and the desire for successful reproduction to ensure a strong and healthy nation. As such, these discourses on too-thin bodies can be viewed as having a ‘disciplinary and regulatory function’ in their attempts to enforce behaviour that would secure economic, political, and social stability.
The theme of discipline and regulation is picked up in Fabrice Cahen’s chapter on efforts to establish policies for the treatment of reproductive disorders in early twentieth-century France. In common with many other European states, the strength of pronatalist and eugenic discourses meant that states and medical authorities tended to neglect the infertile, or to implicitly stigmatize the condition as most likely resulting from induced abortion or venereal disease. Cahen traces the history of reproductive medicine in France from the isolated efforts of early pioneers to ambitious mid-twentieth-century plans for a large-scale public system of infertility care, which ultimately foundered on lack of political and financial commitment to such an initiative. He demonstrates how political concerns about the health of the population and the stability of the family shaped medical approaches to infertility throughout this period. The chapter concludes by suggesting that although the failure of reform efforts can be partially attributed to contradictions between the aims of different authorities involved in formulating health and demographic policies, it may also reflect patient preference for private treatment. As this suggests, while we must always be alert to how public agencies can determine citizens’ capacities for certain kinds of action, we should never assume that the influence flows in only one direction.
Hayley Andrew’s chapter, which explores the role of the popular media in articulating the relationship between marriage, the family, and reproductive technology in late 1950s Britain, also emphasizes the multidirectional interactions of different institutions and authorities in the modern period. Andrew uses the sensational MacLennan v. MacLennan divorce case of 1958 as a jumping-off point to examine how the popular media shaped public opinion on the controversial issue of artificial insemination. She argues that media reporting on artificial insemination in the wake of this case not only reflected prevalent anxieties about family stability, but also actively framed new narratives of what it meant to have a ‘test-tube baby’. In doing so, the popular media pushed against public opinion on the issue of artificial insemination by donor (AID) and contributed to redefining the heteronormative family. This nuanced consideration of the different forces influencing moral norms further demonstrates the historical contingency of cultural attitudes to infertility, and how these attitudes are subject to wider concepts of ideal gender behaviour and family life.
Finally, Daniel Grey’s chapter surveys the social context of infertility in contemporary India, paying particular attention to the historical antecedents of the modern fertility industry. India has recently been described as ‘the global champion in providing commercial ART’. The reproductive tourism industry is worth $2.3 billion, and surrogacy alone generates approximately $400 million annually - though the Surrogacy (Regulation) Bill (a diluted version of the Assisted Reproductive Technology [Regulation] Bill which was under discussion from 2007 to 2015), which may ban foreigners from seeking surrogacy in India, will have severe effects on this side of the business.11 Yet while this side of India’s contemporary reproductive landscape is well known, the history of approaches to infertility and reproductive technology within India is still virtually uncharted - perhaps a further indication of the same Western-centric bias that perpetuates stratified reproduction?12 Grey’s chapter, which examines population policies, reproductive medicine, and cultural and religious attitudes towards infertility, performs an important role in shifting historical focus back to Indian ideas, beliefs, and voices.
In their edited collection on contemporary studies of infertility around the globe, Frank van Balen and Marcia Inhorn emphasize the importance of examining the relationship between ‘top down’ and ‘bottom up’ perspectives of infertility in ‘nation-states where fertility regulation is part of national political discourse and policy making’.13 This section aims to provide a historical perspective on some of the same issues. Analysing the diffuse exercise of power and how different political forms have affected perceptions and experiences of infertility helps us to understand the extent and the boundaries of infertile individuals’ capacities for action, and their abilities to enact positive change. Some threads seem constant through time. In terms of power relations, states continue to hold more power than citizens, doctors than patients, men than women, rich than poor, white than non-white people. Likewise, attitudes to infertility are still inseparable from broader debates on population and the family, partly because these are perceived as essential to the success of the state or nation.
Yet if the infertile have often been ignored, stigmatized, or subjected to regulatory procedures, then the justifications for these negative attitudes have also changed over time, as conceptions of the bodily economy have altered, as different actors have assumed more power within the state, and as the form and power of the state itself has fluctuated. Within these moments of change, infertile women and men have seized the opportunities open to them to change their position: they have gone on pilgrimages, offered prayers and supplications; they have sought out medical help when states refused to provide it; they have made their voices heard in newspapers, magazines, and government enquiries; they have resisted and denied the stigmatizing labels imposed on them. These actions have been easier for some to take than others, but when we are considering the formation of the body politic and of political bodies, we might do well to remember that in an era before ARTs, reproductive tourism, and the patient as consumer, a rebellious body could render even the mightiest in the land powerless. Henry VIII could bend the law to his will, divorce or behead wives who displeased him, wage war on France, defy the Pope and declare himself Supreme Head on earth of the Church of England. But he could not guarantee the succession to the throne.
1. Quotations from product description for Pre-Seed Vaginal Lubricant on Amazon.co.uk: https://www.amazon.co.uk/Pre-seed-Vaginal-Lubricant- Multi-Applicators/dp/B001G7QNKM/ref=sr_1_2_a_it?ie=UTF8&qid= 1465477731&sr=8-2&keywords=pre-seed+vaginal+lubricant. The list of items here was obtained from searches for Peggy Orenstein, Waiting for Daisy: The
True Story of One Couple’s Quest to Have a Baby (2008), and Anne-Marie Scully, Motherhoodwinked: An Infertility Memoir (2014): https://www.amazon.co.uk/ Waiting-Daisy-Story-Couples-Quest/dp/0747594295/ref=sr_1_1?s=book s&ie=UTF8&qid=146 5479702&sr=1 - 1&keywords=searching+for+daisy+oren stein and https://www.amazon.co.uk/Motherhoodwinked-Infertility-Memoir- Anne-Marie-Scully/dp/1494291169/ref=sr_1_1?s=books&ie=UTF8&qid= 1465479295&sr=1-1&keywords=infertility+memoir. All websites accessed 6 December 2016.
- 2. For a more extended discussion of infertility as a public/private affair, see Maureen McNeil, ‘Reproductive Technologies: A New Terrain for the Sociology of Technology’, in Maureen McNeil, Ian Varcoe, and Steven Yearley (eds), The New Reproductive Technologies (Basingstoke, 1990), pp. 9-10.
- 3. See Colleen A. Hynes, ‘“A song for every child I might have had”: Infertility and Maternal Loss in Contemporary Irish Poetry’, in Irene Gilsenan Nordin (ed.), The Body and Desire in Contemporary Irish Poetry (Dublin, 2006), pp. 150-7.
- 4. Miriam Ulrich and Ann Weatherall, ‘Motherhood and Infertility: Viewing
Motherhood through the Lens of Infertility’, Feminism & Psychology, 10:3 (2000), p. 323; Stephanie Rich, Ann Taket, Melissa Graham, and Julia Shelley, ‘“Unnatural”, “Unwomanly”, “Uncreditable” and “Undervalued”: The
Significance of Being a Childless Woman in Australian Society’, Gender Issues,
- 28 (2011), p. 228.
- 5. Alisa Von Hagel and Daniela Mansbach, ‘The Regulation of Exploitation’, International Feminist Journal of Politics, 18:2 (2016), pp. 4-5.
- 6. Judith Farquhar, ‘Objects, Processes, and Female Infertility in Chinese Medicine’, Medical Anthropology Quarterly, 5:4 (1991), p. 375.
- 7. Frank van Balen and Marcia C. Inhorn, ‘Introduction. Interpreting Infertility: A View from the Social Sciences’, in Marcia C. Inhorn and Frank van Balen (ed.), Infertility Around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies (Berkeley, Los Angeles, CA, and London, 2002), p. 7.
- 8. See Naomi Pfeffer, The Stork and the Syringe: A Political History of Reproductive Medicine (Cambridge, 1993), p. 28 for a discussion of how the language of consumerism infiltrated representations of involuntary childlessness in the late twentieth century.
- 9. Claire Ramussen and Michael Brown, ‘The Body Politic as Spatial Metaphor’, Citizenship Studies, 9:5 (2006), pp. 472, 475.
- 10. Penny Roberts, ‘The Kingdom’s Two Bodies? Corporeal Rhetoric and Royal Authority During the Religious Wars’, French History, 21:2 (2007), pp. 149-50.
- 11. Raywat Deonandan, ‘Recent Trends in Reproductive Tourism and International Surrogacy: Ethical Considerations and Challenges for Policy’, Risk Management and Healthcare Policy, 8 (2015), p. 111; ‘India Introduces Legislation to Ban Surrogacy Tourism’, International Medical Travel Journal, 7 December 2015: http://www.imtj.com/news/india-introduces-legislation-ban- surrogacy-tourism/. Accessed 10 June 2016; Teena Thacker, ‘Assisted Reproductive Technology Bill Will Focus Only on Surrogacy’, The Asian Age, 6
May 2016: http://www.asianage.com/india/assisted-reproductive-technology- bill-will-focusonly-surrogacy-863. Accessed 6 December 2016.
- 12. For discussion of the concept of stratified reproduction, see this volume’s Introduction.
- 13. Van Balen and Inhorn, ‘Introduction. Interpreting Infertility’, p. 7.