{"id":2070,"date":"2022-11-22T22:43:17","date_gmt":"2022-11-22T22:43:17","guid":{"rendered":"https:\/\/modil.io\/rapid-response\/?p=2070"},"modified":"2022-11-30T21:44:16","modified_gmt":"2022-11-30T21:44:16","slug":"women-vanish-again","status":"publish","type":"post","link":"https:\/\/modil.io\/rapid-response\/2022\/11\/women-vanish-again\/","title":{"rendered":"Women Vanish, Again."},"content":{"rendered":"\n

Medical anthropologists attend to how power inequities predispose particular people\u2019s bodies to harm, and render particular people\u2019s interests irrelevant to dominant social institutions. In the wake of the U.S. Supreme Court\u2019s Dobbs v. Jackson <\/em>Women\u2019s Health Organization decision, we can expose the processes that have made pregnant women vulnerable, irrelevant, even invisible.1<\/sup> <\/code>This essay is one effort.<\/p>\n\n\n\n

Our profession offers precedent. Feminist anthropologists in the 1970s recognized that inattention to women\u2019s lives and experiences had produced \u201cdistorted theories and impoverished ethnographic accounts.\u201d<\/a> Women\u2019s invisibility was unsurprising. Anthropologists typically came from societies that excluded women from critical political and economic processes, exclusions often justified by their reproductive roles. When Woman, Culture, & Society<\/em><\/a> was published, one in five U.S. anthropology professors, one in twelve physicians, and one in thirty-three congress members was female. The Supreme Court ruled that year that firing employees who became pregnant, a widespread practice, was not discrimination<\/a>. Rape was legal in every state if a woman was married to the rapist, and violence against women within their homes was widely seen as a matter for private shame, not public policy. In some states, wives\u2014including privileged white women\u2014were invisible to contract law<\/a>: they could not keep a natal surname, maintain a separate home, or operate an independent business without a husband\u2019s permission. Women of color and people living in poverty were even more vulnerable to legal and social structures that kept women from power.<\/p>\n\n\n\n

Social scientists interrogated how institutions maintained these exclusions and blind spots<\/a>, and how women subverted<\/a> them. Leith Mullings showed<\/a>, for instance, that pregnant Black women in Harlem worked creatively within networks of kin and friends to find paths to survival, protection, and joy, even as they lived under constant pressures of discrimination and exclusion. Studies of reproduction often revealed connections between subjugation and silencing<\/a>, inequity and invisibility<\/a>.<\/p>\n\n\n\n

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An empty labor ward bed in a referral hospital in Malawi. Photo by Claire\u00a0Wendland<\/figcaption><\/figure>\n\n\n\n

In 2022, women have been made to vanish again. The absence of women in the Dobbs v. Jackson <\/em>majority opinion<\/a> was so remarkable that three dissenting justices called it out. It was so thorough that the majority concluded that abortion required no heightened scrutiny, because it was not a sex-based issue.<\/p>\n\n\n\n

Pregnant women\u2019s erasure in the Dobbs<\/em> decision has many antecedents. <\/p>\n\n\n\n

Public health erasure<\/strong><\/p>\n\n\n\n

In 1985, an obstetrician and an anthropologist asked \u201cwhere is the M in MCH?<\/a>\u201d Their article\u2019s title indicted \u201cmaternal-child health\u201d specialists who assessed maternal wellbeing only to the extent that it affected infants. The pointed question for a time sharpened public-health focus on maternal survival, and prompted development of new techniques to measure pregnancy-related dangers.<\/p>\n\n\n\n

Maternal-health measurement tools continue to obscure and distort reproductive realities. In Senegal<\/a>, ambiguous pregnancy losses among married and wealthier women are typically documented as \u201cmiscarriages.\u201d Among unmarried young poor women, they are listed as \u201cabortions,\u201d meeting clinicians\u2019 needs to appear appropriately attentive to illegal practices while not causing trouble for the well-heeled. Elsewhere, standard labor-ward records intended to aid decision-making and clarify causes of poor outcomes instead conceal<\/a> negligent obstetrical care<\/a>.<\/p>\n\n\n\n

From Texas<\/a> to Nigeria<\/a>, maternal deaths are made to disappear through counting and record-keeping practices. Such practices create illusions of progress and safety, threatening a return<\/a> to the days when the M in MCH was vestigial.<\/p>\n\n\n\n

Clinical erasure<\/strong><\/p>\n\n\n\n

On labor wards around the world, many anthropologists have shown, the clinical routines of healthcare providers and institutions take precedence over the priorities of pregnant people. Poorer, younger, and racialized women are especially likely to be treated as persons whose needs and desires do not count. In Mexico<\/a>, obstetrics trainees learn to depersonalize indigenous women and women on public insurance as \u201ccases,\u201d to be granted little voice in their care. From Pakistan<\/a> to Peru<\/a>, clinicians often subject laboring women on the social margins both to unwanted over-intervention, such as unsafe injections of oxytocin or unconsented episiotomy, and to neglect of their pain or fear. The pattern holds in the United States<\/a>, where Black women and Medicaid beneficiaries\u2014and especially Black women living in poverty\u2014are surveilled and suspect, managed but not heard, presumed to be \u201cwily\u201d threats to fetal wellbeing.<\/p>\n\n\n\n

Other marginalized people can also feel erased by hospital practices. Trans men and non-binary people<\/a> often report increased social and emotional isolation during pregnancy, and while accessing antenatal or abortion care.<\/p>\n\n\n\n

Many obstetricians say that we are \u201ctreating two patients<\/a>.\u201d One can speak for herself. In this view, the obstetrician must speak for the other. A two-patient model pits the needs<\/a> of parents against the (projected) needs of potential offspring, often at the cost of the pregnant person\u2019s desires<\/a>.2<\/sup><\/code> Perinatal psychologists in urban Turkey<\/a> \u201cspeak for\u201d fetuses, voicing pleas for particular kinds of birth experiences that middle-class mothers should provide (no matter their own wishes). Privilege offers no immunity: well-off white women in the U.S. report \u201cmaternal vanishing<\/a>\u201d and disempowerment during pregnancy care. For Black women, including educated elites<\/a>, the experience of erasure can be pervasive<\/a>, devastating, even lethal<\/a>.<\/p>\n\n\n\n

Erasure from evidence<\/strong><\/p>\n\n\n\n

Some acts of erasure stem from interpersonal sexism, frequently expressed alongside interpersonal racism and class discrimination: \u201cdifferent forms of bigotry often have a high comorbidity<\/a>.\u201d Some erasure is structural, built into the evidence base of medicine. Widely used clinical \u201cbest practices\u201d are constructed from evidence that systematically excludes maternal subjectivity, long-term maternal outcomes, and even maternal bodies<\/a>.<\/p>\n\n\n\n

The field of fetal surgery is notorious in this regard, its practitioners often characterizing mothers as environments, incubators, or workspaces<\/a>. Ethicists have begun to rename<\/a> these procedures as maternal-fetal surgery\u2014since they inevitably require cutting into the pregnant parent\u2014to correct a semantic problem with material effects. Researchers in the field continue to prioritize the fetus, however.3 <\/sup><\/code>Many studies give no data on maternal complications or include only short-term outcomes. A rare longer-term review<\/a> of subsequent pregnancies in people who had undergone maternal-fetal surgery characterized a 10% uterine rupture rate as a \u201cfavorable\u201d outcome. To compare, a uterine rupture rate one twentieth as high in labors that followed prior cesarean section was viewed as so disastrous that it led to a sea change<\/a> in obstetric practice<\/a>.<\/p>\n\n\n\n

Technological erasure<\/strong><\/p>\n\n\n\n

Routine technologies also hide mothers from view. Anthropologists who study ultrasonography have shown that fetal visualization makes the hidden familiar, the sonographer or radiologist the expert on fetal wellbeing<\/a>, and the maternal body the backdrop to a fetus suddenly given public life<\/a>. In ultrasound images, fetuses appear to float<\/a> independently like tiny astronauts in a dark surrounding space. The illusion is produced by a transducer that emits high frequency soundwaves and a software program that turns waves bounced back into pixels on a screen. But every fetus conjured on a screen is materially deep inside a person\u2019s body, an integral part of that body, oxygenated with blood pumped from her heart through her lungs, nourished by food he eats and digests, its bones built from their bones, its wastes processed by her kidneys and liver.<\/p>\n\n\n\n

The illusion of the independent fetus has materially real effects. The Dobbs<\/em> decision refers to the impact of \u201cmodern developments\u201d that lead to \u201ca new appreciation of fetal life.\u201d  After all, \u201cwhen prospective parents who want to have a child view a sonogram, they typically have no doubt that what they see is their daughter or son<\/a>.\u201d The use of \u201cdaughter or son\u201d reifies both the personhood of the embryo, and a gender binary that has no space for beings who are neither he nor she.<\/p>\n\n\n\n

Rhetorical erasures<\/strong><\/p>\n\n\n\n

Just as images can make a fetus appear to float freely, so can words. Rhetorical practices often displace pregnant women.<\/p>\n\n\n\n

Take, for example, the Mississippi Gestational Age Act<\/a> upheld by Dobbs<\/em>. The act refers to fetuses or embryos almost three times as often as gestational parents. Subtler erasures lie beyond this disproportion. The law never uses the nouns \u201cfetus\u201d or \u201cembryo\u201d to characterize the fetus or embryo: it is an \u201cunborn human being\u201d or a \u201cchild.\u201d Unlike the person within whom it grows, who never gets pronouns, the fetus is gendered he<\/em> or she<\/em>, its body parts his<\/em> or hers<\/em>. Again, the language reifies both personhood and binary gender. The word \u201cfetal\u201d appears four times, always in the phrase \u201csevere fetal abnormality,\u201d a rhetorical sleight of hand that differentiates problem fetuses from perfect unborn children. When a mother is referred to at all it is primarily as \u201cthe maternal patient,\u201d a reminder of the two-patient model. Rhetorically, in this law the \u201cunborn child\u201d floats in a vacuum, while the maternal patient is always tethered to the fetal patient.<\/p>\n\n\n\n

A focus on extremes can subtly erase women\u2019s lived experiences of abortion. In responses to Dobbs<\/em>, many commenters described the consequences for pregnant women with advanced cancers, devastating fetal abnormalities, or life-threatening conditions such as maternal sepsis. A small set of clinicians opposed to abortion dismissed these circumstances as rare: they are not<\/a>. But every year, millions of people in the U.S. seek abortions for more mundane reasons. Katie Watson points out that the focus on \u201cextraordinary<\/a>\u201d abortions creates a moral hierarchy: ordinary women who get abortions for ordinary reasons\u2014I don\u2019t want a kid right now, I can\u2019t afford a child, my other children need me, I don\u2019t want a child that ties me to this guy, my special-needs kid takes all the care I have to give\u2014are at the bottom. Mundane reasons for abortion often involve relations of care that cannot be separated from structures of unequal power. Expectations and obligations of care are often highly gendered<\/a>, but that gendering is so thoroughly naturalized it is mostly invisible.<\/p>\n\n\n\n

Neutral language can create a different kind of rhetorical erasure. Many individuals and organizations now use only \u201cpeople\u201d to describe those seeking\u2014or barred from\u2014abortion care. This language acknowledges that not everyone capable of pregnancy is a woman: it is meant as inclusive. A more accurate term is \u201cneutral,\u201d rather than \u201cinclusive,\u201d because this language does not specifically identify anyone<\/em> by gender: not trans men, not gender-nonconforming people, not women.<\/p>\n\n\n\n

Exclusive use of gender-neutral language can make it difficult to specify the contributions of sexism to constraints on reproductive justice. Contrast, for instance, two statements on the Dobbs v. Jackson<\/em> case. One<\/a> uses gender-neutral language throughout. While it includes reference to the roles played by white supremacy, racism, and homophobia in anti-abortion politics, it mentions sexism only once in passing and does not hint at misogyny or patriarchy. Another<\/a> uses diversified terms that include \u201cwomen\u201d and \u201cpregnant people.\u201d That group explicitly defends the rights of people of any gender to safe, respectful care, while pointing out that the overturning of Roe v. Wade<\/em> denies women liberty, autonomy, and full and equal status as citizens.<\/p>\n\n\n\n

Gender remains an extraordinarily powerful social category. In fact, as activists and scholars have long pointed out, strict policing<\/a> of a gender binary<\/a> has been a critical mechanism of social control<\/a> used in many practices of subjugation, including those faced by cisgendered women, transgendered and gender-diverse people. Failure to consider gendered experiences means failure to understand the workings of sexism\u2014structural, interpersonal, or internalized.<\/p>\n\n\n\n

Intersectional Erasures<\/strong><\/p>\n\n\n\n

Like reproduction more broadly, abortion must be understood intersectionally. Consider a historical example. Feminists in mainland France fought for the right to abortion in the 1960s and 1970s. Meanwhile, a scandal over unwanted and unconsented abortions erupted in the French overseas department R\u00e9union. To understand this apparent paradox, Fran\u00e7oise Verg\u00e8s showed<\/a>, one had to understand how both patriarchy and capitalism were racialized. Black women of R\u00e9union threatened the social order as white women of France upheld it: by procreating. Black and white women were expected to subordinate their bodies to state-promoted norms about childbearing. Abortion\u2014whether forced or denied\u2014was central to their subordination.<\/p>\n\n\n\n

The Dobbs <\/em>decision rests upon racialized patriarchy too. It centers upon an interpretation of the 1868 14th<\/sup> amendment<\/a>, through which white men granted \u201canyone born or naturalized in the United States\u201d citizenship. Inserting the word \u201cmale\u201d in the U.S. Constitution for the first time, they limited the vote to male citizens (newly including Black men but excluding \u201cIndians not taxed\u201d). Barred legally from weighing in directly on decisions that directly influenced them, women were to be represented by the fathers or husbands to whom they belonged.<\/p>\n\n\n\n

Saidiya Hartman points out that when someone is understood to be another\u2019s property, the mere exercise of agency appears to be \u201ca contravention of another\u2019s unlimited rights to the object<\/a>.\u201d The laws that upheld slavery, notes Hartman, decriminalized white violence and ensured that white men were legally entitled to Black women. Enslaved women could be held responsible for their \u201cpurported ability to render the powerful weak\u201d and therefore for their own sexual abuse. Slave law has been dismantled, but Black agency is still often interpreted as criminality, as has agency among other non-dominant groups. Surveillance and criminalization of Blackness reinforces<\/a> white supremacy<\/a>. Poverty<\/a> has been surveilled and criminalized<\/a>, reinforcing the dominance of the rich. Surveillance and criminalization of women\u2019s reproductive choices<\/a> and mishaps reinforces patriarchy. These processes intersect in ways that make women of color living in poverty particularly vulnerable to legal overreach and reproductive control<\/a>, layered atop \u201csystematic disregard<\/a>.\u201d<\/p>\n\n\n\n

Why does it matter that women disappear from discourse about abortion? Patriarchy, racism, capitalism, and other \u201cmutually reinforcing systems of oppression<\/a>\u201d injure people<\/a> and constrain human flourishing in complex and intersecting ways. These systems of oppression are at work in the Dobbs<\/em> decision and in the long histories that led to it. Without considering the effects of social structures and cultural norms on Black, Indigenous, and other people of color, we cannot understand the injuries caused by racism, or the power and privilege accumulated through white supremacy. Without considering how social structures and cultural norms affect people in various class positions, we cannot understand the injuries caused by neoliberal capitalism. Public health specialists are only now beginning to study the health effects of structural sexism<\/a>: without talking about, listening to, considering the effects of social structures and cultural norms on women, we cannot hope to understand how sexism and patriarchy work to hurt people. Patriarchy is no less palpable and powerful for being invisible<\/a>. Indeed, its invisibility is part of its power: patriarchy creates the blind spots in which it functions with impunity.<\/p>\n\n\n\n

Hegemony makes practices that maintain one group\u2019s dominance over another seem natural. Violence appears to be medical care. Embryos appear to live independently. Deaths and injuries are made to disappear. Reproductive control appears to be a technical matter of legal interpretation. But all of these misrecognitions require the erasure of women\u2019s lived experiences. Anthropologists\u2019 scholarship can denaturalize the vanishing of pregnant women, showing the practices of power as constructed rather than inevitable. Our efforts are critical to the work of solidarity and scholarship that has long endured and still lies ahead.<\/p>\n\n\n\n

<\/p>\n\n\n\n

Notes:<\/strong><\/p>\n\n\n\n

1.Pregnant trans men and gender-nonbinary people are also endangered by Dobbs v. Jackson<\/em>. For reasons that will become clear, I use mostly gendered and some gender-neutral language here.<\/p>\n\n\n\n

    \n
  1. <\/li>\n<\/ol>\n\n\n\n

    2. A similar imagined obligation to speak for fetuses shapes judicial review<\/a>.<\/p>\n\n\n\n

    3. Marketing practices for \u201cfetal surgery<\/a>\u201d and \u201cfetal treatment<\/a>\u201d centers also commonly render gestational parents invisible.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Medical anthropologists attend to how power inequities predispose particular people\u2019s bodies to harm, and render particular people\u2019s interests irrelevant to dominant social institutions. In the wake of the U.S. Supreme Court\u2019s Dobbs v. Jackson Women\u2019s Health Organization decision, we can expose the processes that have made pregnant women vulnerable, irrelevant, even invisible.1 This essay is […]<\/p>\n","protected":false},"author":7,"featured_media":2071,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"citeas":"","footnotes":""},"area":[],"topic":[],"rr_category":[858],"rr_tag":[],"creator":[869],"class_list":["post-2070","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","rr_category-reproductive-justice-in-the-us","creator-claire-l-wendland"],"_links":{"self":[{"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/posts\/2070","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/comments?post=2070"}],"version-history":[{"count":5,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/posts\/2070\/revisions"}],"predecessor-version":[{"id":2077,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/posts\/2070\/revisions\/2077"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/media\/2071"}],"wp:attachment":[{"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/media?parent=2070"}],"wp:term":[{"taxonomy":"area","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/area?post=2070"},{"taxonomy":"topic","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/topic?post=2070"},{"taxonomy":"rr_category","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/rr_category?post=2070"},{"taxonomy":"rr_tag","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/rr_tag?post=2070"},{"taxonomy":"creator","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/creator?post=2070"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}