Incongruent Emancipations: Infertility and its Stratifications
As our analysis has demonstrated, since the 1970s feminist discourses around infertility have proliferated and so have the contradictions amongst them. Discourses of emancipation that emerged in the global North were either irrelevant to Third World women, or reliant on the appropriation of their bodies and reproductive power; equally the conditions of infertile women in the global South scarcely figured within global discourses of women’s reproductive autonomy. As Faye D. Ginsberg and Rayna Rapp argue, from the 1970s the idea of a ‘politics of reproduction’ - which demanded examination of the multiple levels on which reproductive practices, policies, and politics were enacted - started to dominate feminist discussions. Analyses of the politics of reproduction considered the social, moral, ethical, economic, and religious interests at stake in reproductive technologies from diagnosis to donation as a set of relationships between multiple actors and agencies: local and global organizations, state and private interests, and different professional groups. Although the differing perspectives revealed by these analyses might be viewed as evidence of ideological fragmentation within feminism, in reality they reflected the multiplicity of feminist perspectives on sociopolitical institutional frameworks which were increasingly underwritten by capitalist interests. In this section, we reflect on the place of emancipation and ‘stratified reproduction’ in feminist conceptualizations of infertility.
Within feminist discourse, the idea of stratified reproduction has been framed in two main ways. At the end of the second wave, it was primarily conceptualized as a means of drawing attention to inequalities in access to reproductive technologies and the importance accorded to infertility between the developed and developing worlds. A body of feminist work from the North and the South highlighted the inequalities in the delivery, accessibility, and affordability of infertility treatments to women in these global regions, concluding that there are ‘two worlds of infertility’, and that the effects of infertility were experienced more severely in the non-Western world.113 In addressing stratifications in reproductive rights, the focus turned to the exploitative relationships between the two worlds, not merely the gaps between them. ARTs, in particular, were identified as both reflecting and contributing to a widening of local and global divisions. Conceptually, stratification offered a heuristic lens to reflect on distinctions between the moral, legal, and religious handling ofARTs and a range ofstructural and economic factors that facilitated the procurement by Western women of the technology or surrogates available in the non-Western world.114 In particular, this work described how global policies and practices in healthcare converged with medicalization processes to potentially increase the patriarchal-capitalist appropriation of medical care, so that infertility has become the ‘latest and most powerful instance in which male doctors and “pharmacrats” use biotechnology to usurp female reproductivity’.115 Finally, this body of work has reiterated the imperial intent of biome- dicalized capitalism in transferring the cultural emphasis on the importance of biological parenthood from the developed to the developing world.
The conceptual framing of infertility and reproductive technologies as ‘stratified’ was successful within the specific discourse of the First World as being in a state of advanced capitalism, distinct from the Third World and its early-stage capitalism. This dialectic between the First and Third Worlds is what Fraser refers to in her account of the misframing of global justice.116 This traditional North-South dialectic is also what we have identified as the Janus face of infertility. Like Fraser, we argue this dialectic has been undermined by the intertwining of consumerism, capitalism, and neoliberalism within the global infertility market. We discuss the effects of this Janus face below.
The dominant lens of stratification failed to encompass the breadth of inequities beyond the North-South divide, effectively ignoring those marginalized or advantaged within each context. Contemporary feminist debates established that low-income, minority, and lesbian women within the First and Third Worlds had unequal access to high-tech, expensive ARTs. Furthermore, little attention had been paid to the differently gendered nature of infertility, including the different causes of infertility or the different applications of reproductive technology to men’s and women’s bodies. Male infertility was hidden due to a combination of factors that included a lack of infertility treatments for men, sensitivities around the collection of sperm, and the conflation of male infertility with impotency and emasculation.117 Additionally, ARTs were recognized as being applied to women’s bodies in more invasive ways. These differences point to inequalities that emerged within the global North and global South. Economic analyses of reproductive choice in the emergent capitalist and biomedicalized world order of infertility treatment suggest that wealth accumulation and purchasing power were not limited to wealthy Western women in the global North alone but were more widespread as a class issue in both the global North and South. For low-income women, at best infertility received attention only when coupled with reproductive health disease.
In the last decade, wider social transformations that have undermined the dialectic of developed-developing worlds have led to challenges to the dominant narrative of reproductive stratification of the ‘two worlds’. In its place, the global South is revisioned as rapidly prosperous and technologically advanced, a world where an insatiable and newly affluent middle class drives markets, including in medical technologies. As John Comaroff and Jean Comaroff argue, the South no longer seeks to emulate the North - ‘old margins are becoming new frontiers’ - but they also caution that ‘it is the South that often is the first to feel the effects of world-historical forces [... ] thus to pre-figure the future of the global North’.118 In this revisioning of the dialectic, reproductive stratification is more complicated than many feminist texts initially conceived.
To contextualize our discussion in light of Fraser’s argument, we conclude that as the politics of recognition has converged with a consumer-driven demand for medically advanced access to reproductive technologies, reproductive stratifications within the global South have assumed greater significance than long-standing asymmetries between the First and the Third Worlds. Notions of women’s emancipation in the global South have taken root within the rhetoric of individual choice and recognition, and in place of a collective response to state-organized programmes and redistribution of resources. The same discourse of emancipation is found in the global North, where infertility treatment is already framed both as an exercise of individual rights and as a lifestyle choice, and has been colonized by private business actors. Infertility is no longer primarily a basis for claims to better public healthcare provision or political accountability. As the state rescinds the responsibilities of a provider, it assumes the role of regulator - often of global biomedical enterprises.