Planning an Indian modernity: the gendered politics of fertility control

Outliers and Rogue Doctors: Manufacturing "Anxiety" Around Older Mothers in India

In this article I focus on media narratives on older women bearing and birthing infants through the intervention of assisted reproductive technologies (ART) in rural north India. I suggest that their portrayal as "outliers" within popular media narratives is gendered, and connected in particular to: the fear of older women past their reproductive prime becoming pregnant and birthing children through ART; the figure of the "rogue doctor," or the emergence of counter narratives around ART and its practitioners; and, the effort to quell anxieties around ART use amongst older women through the use of legitimating tropes such as conjugality.

Modern contraceptive use among women in need of family planning in India: an analysis of the inequalities related to the mix of methods used

OBJECTIVE

To evaluate the type of contraceptives used by women in need of family planning in India and the inequalities associated with that use according to women's age, education, wealth, subnational region of residence and empowerment level.

METHODS

Using data from the Indian National Family and Health Survey-4 (2015-2016), we evaluated the proportion of partnered women aged 15-49 years with demand for family planning satisfied (DFPS) with modern contraceptive methods. We also explored the share of each type of contraception [short- (e.g., condom, pill) and long-acting (i.e., IUD) reversible contraceptives and permanent methods] and related inequalities.

RESULTS

The majority (71.8%; 95% CI 71.4-72.2) of women in need of contraception were using a modern method, most (76.1%) in the form of female sterilization. Condom and contraceptive pill were the second and third most frequently used methods (11.8% and 8.5%, respectively); only 3.2% reported IUD. There was a nearly linear exchange from short-acting to permanent contraceptive methods as women aged. Women in the poorest wealth quintile had DFPS with modern methods at least 10 percentage points lower than other women. We observed wide geographic variation in DFPS with modern contraceptives, ranging from 23.6% (95% CI 22.1-25.2) in Manipur to 93.6% (95% CI 92.8-94.3) in Andhra Pradesh. Women with more accepting attitudes towards domestic violence and lower levels of social independence had higher DFPS with modern methods but also had higher reliance on permanent methods. Among sterilized women, 43.2% (95% CI 42.7-43.7) were sterilized before age 25, 61.5% (95% CI 61.0-62.1) received monetary compensation for sterilization, and 20.8% (95% CI 20.3-21.3) were not informed that sterilization prevented future pregnancies.

CONCLUSION

Indian family planning policy should prioritize women-centered care, making reversible contraceptive methods widely available and promoted.

Infertility as inevitable: chronic lifestyles, temporal inevitability and the making of abnormal bodies in India

In seeking to explore the meaning of chronic and chronicity, the association with infertility is neither immediate nor evident. However, this paper explores this relationship by analyzing the idea of infertility in relation to chronicity. In the linkages that come forth the idea of chronic lifestyle emerging from certain ways of being and living, as well the imaginings associated with the chronic body become important nodes of exploring the relationship between infertility and chronicity. Most importantly, the role that time plays in marking the chronic state is seen to be especially potent in the practice of infertility treatment, and the narratives that emerge around its temporal inevitability. The rhetoric that marks the diagnosis and prescription of treatment is often based on the identification of the body as susceptible to reproductive decline and failure, due to the contingencies of modern living. This often translates into a more sustained involvement with ARTs, which may or may not fulfil the required desire for a child. In this paper I seek to analyse the ways in which practitioners of infertility medicine create an image of an affliction that borders on chronicity. In the process, I question the idea of both chronic diseases and chronicity by looking at how illness is imagined in narratives that IVF specialists create in public, and through the idea of a cure for infertility. By analysing data collected through ethnographic fieldwork, this paper aims to build on the idea of the chronic as inevitable within clinical discourse and practice.

Reproductive Technologies, Care Crisis and Inter-generational Relations in North India: Towards a Local Ethics of Care

This paper reflects on the social consequences of biotechnological control of population for values and ethics of care within the family household in rural north India. Based on long-term ethnographic research, it illustrates the manner in which social practices intermingle with reproductive choices and new reproductive technologies, leading to a systematic elimination of female foetuses, and thus, imbalanced sex ratios. This technological fashioning of populations, the paper argues, has far-reaching consequences for the institutions of family, marriage and kinship in north India particularly in relation to care circulation within the family-household leading to a shifting local ethics of care.

The Gendered Biopolitics of Sex Selection in India

After China, India has the most skewed sex ratio at birth. These two Asian countries account for about 90 to 95% of the estimated 1.2 to 1.5 million missing female births annually, worldwide, due to gender-biased (prenatal) sex selection. To understand this extreme discrimination against girls, this article examines the gendered biopolitics embedded in population policies, new sex selection technologies, and in the social reproduction of patriarchal society. The ethical consequences of advanced reproductive technologies, which remove the moral turpitude around gender-based sex selection by reformulating it into a "modern", "scientific" endeavour, facilitating the rise of "missing girls", make this an issue of gender justice, as noted by the World Population Report 2020. This article argues that unpacking gendered biopolitics within the household is crucial to understanding the reproduction of son preference and daughter aversion since it is here that reproduction and parenthood are subjected to biopolitical governance. We discuss how "biosocial" strategies of the household aimed at producing the "desired" and "right" family of more sons at the cost of daughters are operationalized through women's bodies with a view to family mobility. While women and girls continue to bear the burden and costs of social reproduction that lie at the heart of the patriarchal capitalist system of accumulation, a perusal of more recent studies suggests the beginning of an equalizing trend of parental investments, especially in the health and education of daughters who are "allowed" to be born. We suggest that familial enhancement of girls' human capital can help as a means of developing girls' capabilities and agency, enhancing their power in the biopolitics of the family and increasing their "bio-value" in parents' eyes.

Critical ethnographic respect: womens' narratives, material conditions, and emergency contraception in India

Emergency Contraceptive Pills (ECPs) are increasingly available over the counter as a form of hormonal birth control in India. As use of ECPs is increasing over time, this paper draws on ethnographic research in Dehradun, in Uttarakhand (Northern State) to highlight the everyday material conditions under which women create narrative around choice and agency regarding these ECPs. Women viewed ECPs as better options than abortion, appreciated the sense of empowerment these provided them because they could be consumed in houses where women had limited 'space and privacy;' and finally that ECPs and their advertisements could act as 'agents of social change.' Feminist scholarship on reproduction demonstrates that choice is a form of agency that is enacted within certain constraints. Using this framework, the research here highlights how women create narratives about ideas of contraceptive choice and notions of 'empowerment' when talking about ECPs and their advertisements. In revisiting the dilemma about women's agency and choice, this paper builds on Rosalind Gill's concept of 'critical respect' to propose 'critical ethnographic respect' as an ethnographic tool to help read women's responses and respectfully contextualise the materiality from within which these narratives emerge.

Numbering others: Religious demography, identity, and fertility management experiences in contemporary India

Demographers have carefully analyzed intersecting aspects of identity beyond religious category that influence fertility patterns in India, such as region, access to wealth, sex ratios, and gender dynamics (Padmanabhan, 2015). Drawing on interviews and participant-observation conducted during 15 months of field research on infertility in Lucknow, Uttar Pradesh, north India, between 2005-07 and 2016-17, this study shows how nuances of demographic change categorized by religion, such as changes in fertility and mortality rates, ripple through public discourse and imagination less powerfully than overall shifts in population percentages. This paper connects media and political discourse about religion, demography, and fertility in large-scale reports, such as the 2011 Census of India and the Sachar Committee Report on status of Muslims in India (Sachar et al., 2006), to the health care services and advice provided to Muslim women and children. While the Sachar Report drew attention to economic and social disadvantage among Muslims, political discourse in response to the 2011 Census continues a trend of labeling disparities in fertility rates across religious categories as a social problem. Such discourse renders individual fertility and infertility experiences invisible and reinforces longstanding negative representations of Muslims' fertility, with important implications for health, identity, and ultimately, governance (Sangamoorthy and Benton, 2012). Ethnographic data from health outreach efforts led by and serving Muslim women in Lucknow demonstrate the diversity of Muslim women's positions relative to health and fertility services as well as the intersections of various aspects of identity with fertility management experiences. By bringing these perspectives together, the paper shows how ethnographic work matters for making sense of quantitative population data. The political uses of large-scale quantitative data demonstrate how social science analysis can be used both to create "Others" and argue for neo-eugenics, and to bolster arguments for resources and reform that benefit the disadvantaged.

Construction, Control and Family Planning in Tanzania: Some Bodies the Same and Some Bodies Different

The benefits of family planning for those who desire it, and the possibilities of coercion against those who do not, are well-known aspects of international population policies. Family planning technologies, more than simply a means for preventing conception, are involved as identity artefacts in the construction of bodies and in the reproduction of power relations. As such, modern contraceptives, organized by and implemented through, donor-funded programmes constitute a discursive apparatus through which scattered hegemonies are disseminated. Women's use of family planning, traditional and modern, allows them to counter the expectations of these hegemonies at some times, and to embody them at others. Both service providers and clients, construct identities, referenced through women's bodies, using the discourses of international population control and family planning. This paper uses data collected in Tanzania to understand how notions of modernity in the family planning programme construct Tanzanian female bodies as ‘traditional’ and ‘modern’, how these discursive inequalities reflect and compound material disparities and how these logics come into play in the ways that women construct themselves and each other.

Closing the Womb Door: Contraception Use and Fertility Transition Among Culturally Tibetan Women in Highland Nepal

Objectives Whether in metropoles or remote mountain communities, the availability and adoption of contraceptive technologies prompt serious and wide-ranging biological, social, and political-economic questions. The potential shifts in women's capacities to create spaces between pregnancies or to prevent future pregnancies have profound and often positive biological, demographic, and socioeconomic implications. Less acknowledged, however, are the ambivalences that women experience around contraception use-vacillations between moral frameworks, generational difference, and gendered forms of labor that have implications well beyond the boundaries of an individual's reproductive biology. This paper hones in on contraceptive use of culturally Tibetan women in two regions of highland Nepal whose reproductive lives occurred from 1943 to 2012. Methods We describe the experiences of the 296 women (out of a study of more than 1000 women's reproductive histories) who used contraception, and under what circumstances, examining socioeconomic, geographic, and age differences as well as points of access and patterns of use. We also provide a longitudinal perspective on fertility. Results Our results relate contraception usage to fertility decline, as well as to differences in access between the two communities of women. Conclusions We argue that despite seemingly similar social ecologies of these two study sites-including stated reasons for the adoption of contraception and expressed ambivalence around its use, some of which are linked to moral and cosmological understandings that emerge from Buddhism-the dynamics of contraception uptake in these two regions are distinct, as are, therefore, patterns of fertility transition.

Between the West and Asia: "Humanistic" Japanese Family Planning in the Cold War

This paper studies the formation of Japanese ventures in family planning deployed in various villages in Asia from the 1960s onward in the name of development aid. By critically examining how Asia became the priority area for Japan's international cooperation in family planning and by analyzing how the adjective "humanistic" was used to underscore the originality of Japan's family planning program overseas, the paper shows that visions of Japanese actors were directly informed by Japan's delicate position in Cold War geopolitics, between the imagined West represented by the United States and "underdeveloped" Asia, at a time when Japan was striving to (re-)establish its position in world politics and economics. Additionally, by highlighting subjectivities and intra-Asian networks centered on Japanese actors, the paper also aims to destabilize the current historiography on population control which has hitherto focused either on Western actors in the transnational population control movement or on non-Western "acceptors" subjected to the population control programs.

'Stratified Contraception': Emergency Contraceptive Pills and Women's Differential Experiences in Contemporary India

Available without prescriptions in India since 2005, emergency contraceptive pills (ECPs) and their advertisements have provided women with increased contraceptive options and a vocabulary to talk about their reproductive lives. I draw on long-term fieldwork with women in urban India about ECPs, demonstrating a new form of 'stratified contraception' enabled by these pills and their advertisements. I posit that there are within India spaces that replicate the luxuries and privileges of the global North. These material conditions, I suggest, are replicated when it comes to contraception as there are hubs of women consumers of contraception and contraceptive advertising that participate in an 'imagined cosmopolitanism' within the global South in close proximity to 'contraceptive ghettos.' Moving beyond simplistic binaries, I outline three major stratifications along which women experience this medical technology and outline the implications for women and their contraceptive choices when notions of northern privilege exist in the 'South.'

Men in maternal care: evidence from India

Men's supportive stance is an essential component for making women's world better. There are growing debates among policymakers and researchers on the role of males in maternal health programmes, which is a big challenge in India where society is male driven. This study aims to look into the variations and determinants of maternal health care utilization in India and in three demographically and socioeconomically disparate states, namely Uttar Pradesh, West Bengal and Maharashtra, by husband's knowledge, attitude, behaviour towards maternal health care and gender violence, using data from the National Family Health Survey III 2005-06 (equivalent to the Demographic and Health Survey in India). Women's antenatal care visits, institutional delivery and freedom in health care decisions are looked into, by applying descriptive statistics and multivariate models. Men's knowledge about pregnancy-related care and a positive gender attitude enhances maternal health care utilization and women's decision-making about their health care, while their presence during antenatal care visits markedly increases the chances of women's delivery in institutions. From a policy perspective, proper dissemination of knowledge about maternal health care among husbands and making the husband's presence obligatory during antenatal care visits will help primary health care units secure better male involvement in maternal health care.