Marcia C. Inhorn & Frank Van Balen (eds.)
Berkeley: University of California Press, 2002
Reviewed by Lisa M. Mitchell, Dept of Anthropology, University of Victoria, Victoria, B.C., Canada
This is one of the most interesting books to come across my desk in some time. The editors have put together a thought provoking interdisciplinary collection of essays interrogating the practices and meanings of childlessness and fertility care in a variety of cultural contexts within and outside the “west.” By moving beyond narrow biomedical definitions to look at infertility as “having fewer children than desired” (206) and by critically examining how fertility treatments are distributed, offered and received, the authors of these 18 essays are able to show how the experiences and implications of childlessness are both personal and political, local and global. Acknowledging that it is often women who are held responsible for fertility problems and on whose bodies the various “treatments” are carried out, many of the essays successfully foreground women’s experiences and perspectives. The examination of infertility in the midst of “hyper-fertility” and nationalist agendas in which population control and declining birth rates are signs of modernity and rationality is a distinctive and valuable contribution to infertility studies.
The essays are grouped into four complementary sections, the first of which contains four chapters which situate and unpack the idioms, metaphors, meta-narratives, and assumptions in scholarly, activist and popular literature on infertility. Sandelowski and de Lacey examine the simultaneous test tube birth of Louise Brown and contemporary “infertility” and the multiple representations of infertility in Western literature. Thompson critically reviews feminist writing/research on infertility and New Reproductive Technologies (NRTs) between 1984 and 1999, laying bare the tensions in those writings and arguing that infertility has been the “perfect feminist text” (53) for examining gender, race, class, sexuality, nation, and religion. Each of the essays in this section lays out a segment of the conceptual and theoretical groundwork which enriches the reading of the remainder of the volume.
Illness narratives, suffering, and silences, as well as resistance, creativity, and agency among women and men who desire children, but have difficulty fulfilling that desire, are the focus of essays in the second section. Becker’s chapter on American parent’s decisions to tell or not tell their children about donor insemination nicely reveals how the rupture of biological and social parenthood is fraught with possibilities and anxieties. Pashigian’s essay moves the conversation outside of the West, pointing out that the experience of childlessness in North Vietnam is not a straightforward or conventional patrilineal narrative of women blamed and ostracized. Jenkin’s case study of a Costa Rican husband and wife uses the lens of social suffering to bring into focus the personal “crisis of desire” felt by this couple, the cultural reverberations of childlessness, and her own overlooking of their pain.
The essays in the third section are united through their ethnographic positioning in the “infertility belt” of Central Africa. Feldman-Savelsberg’s essay on childlessness in Cameroon critiques the “demographic prejudice” which has prevented researchers and policy makers from acknowledging infertility in this region of purported overpopulation. Gerrits’ essay on agency among childless women of the matrilineal Macua of Mozambique is an important addition to African reproductive ethnography which is dominated by studies of patrilineal societies. Not only do these essays provide a rich diversity of personal narratives, cultural interpretations, and vantage points for studying infertility (health services, demography, public health policy), but their attention to the complex connections between infertility, STDs and AIDs are particularly useful.
As NRTS circulate rapidly around the world, they are distributed and received in multiple ways. This globalization and localization of NRTs by non-Western subjects is the subject of the final group of essays. Inhorn, for example, focuses on the meanings of reproductive bodies to elucidate how IVF is embraced by and re-worked by physicians and patients in Egypt. Unsettling what are undoubtedly widely held assumptions about “tradition” among ultraorthodox Jews in Israel, Kahn offers an ethnographically rich and compelling analysis of their inevitable use of high tech fertility treatments such as IVF and donor insemination, and the implications for women’s “choice.”
Overall, Infertility around the Globe is a significant and timely volume with few substantive omissions, although readers will not find much on surrogacy, nor on Western women/couples whose financial situations preclude the use of NRTs. This book provides compelling evidence for re-thinking conventional scholarly and policy approaches to involuntary childlessness and for including infertility in international health and human rights agendas. The volume will be valuable for reproductive health scholars, activists, and policy-makers and is well-suited for upper level undergraduate and graduate courses in feminist theory, medical anthropology, science and technology, international health.
Lisa M. Mitchell is a cultural anthropologist specializing in the cross-cultural study of health, illness and health care. One area of her research focuses on pregnancy and reproductive technology, particularly the uses and meanings of prenatal ultrasound in Canada. She is the author of Baby’s First Picture: Ultrasound and the Politics of Fetal Subjects (Univ. of Toronto Press, 2001). Her second major area of research concerns the health and security of children in an impoverished urban neighborhood in the Philippines. A primary goal of this work is empowering children to have a positive impact upon their health and the health of their environments.