Kill or Cure:
Reproduction
Aims
• To introduce the theme of reproduction and
reproductive health
• To think about reproduction as both a scientific
and social issue, at once public and private.
• To think about reproduction as ‘natural’ yet also
‘medicalised’ and ‘technologised’
• To explore three aspects of reproductive health:
maternity; fertility control; and assisted
reproduction.
Part one
• Reproductive health
Introduction to reproductive health
• Reproductive health is defined as a state of physical,
mental, and social well-being in all matters relating to
the reproductive system, at all stages of life.
• Good reproductive health implies that people are able
to have a satisfying and safe sex life, the capability to
reproduce and the freedom to decide if, when, and
how often to do so.
• Men and women should be informed about and have
access to safe, effective, affordable, and acceptable
methods of family planning of their choice.
• Women should have the right to appropriate healthcare services that enable women to safely go through
pregnancy and childbirth.
Part two
• Maternity
Maternal mortality
• Obstetrics had developed significantly by the early 20th
century. Despite these changes the majority of births were
still at home, attended by midwives.
• As the century progressed the medical involvement in birth
grew.
• However giving birth continued to carry risks - and generate
very real fears - for women.
• While from the end of the nineteenth century there was a
steady decline in mortality in general, in infant mortality, and
in mortality from infectious diseases, maternal mortality
was the great exception.
Mortality rates
Infant mortality
per thousand
births 1900-1990
Annual death rate per 1000 total
births from maternal mortality
in England and Wales (18501970)
The medicalization of birth
• In the 20th century childbirth in
the developed world moved from
the home to the hospital.
• Associated with this new birthing
space were childbirth
technologies. Hospitals provided a
hi-tech, highly medicalised birthing
experience.
• Obstetricians began defining
‘normal’ standards for childbirth.
The epitome was Friedman’s curve,
developed by Emanuel Friedman, a
graphic representation of a
‘normal’ labour. Deviations from
normality were seen as reasons for
medical intervention.
Part three
• Fertility control
Reasons for the fertility decline I
1. As the infant death rate declined, more babies survived into adulthood, thus
fewer pregnancies produced surviving offspring. So it was not necessary for
parents to have more children than they expected to survive into adulthood.
2. As methods of efficient birth control improved, access to contraception became
easier and knowledge of them spread.
3. There was a greater willingness to use contraceptives.
4. Men’s attitudes towards women softened so that they have been more willing
to use contraceptives in order to help relieve women of the health risks of
frequent and closely spaced pregnancies, and the hard work associated with a
large family.
5. Simon Szreter argues that abstinence was the English way of adjusting fertility in
response to the perceived relative costs of having children. The perception of the
escalating ‘costs’ of childrearing provided the conscious motivation to control
births. The anti-sexual culture was conducive to the use of abstinence as the
method to achieve that goal, and provided married men and women with a
legitimating, anti-sexual rationale.
Reasons for the fertility decline 2
6. In Britain, Joseph
Banks has argued
that the economic
depression of the
1870s and 1880s
undermined
middle-class
confidence in the
future and
encouraged the use
of birth control to
maintain living
standards.
7. In America, Daniel Scott-Smith has argued that the decline in middleclass fertility offers an indication of ‘domestic feminism’ (the power and
autonomy exercised by women within the family).
Population control movement
Thomas Malthus
(1766-1834)
• In the 20th century, population control
proponents drew from the insights of the
British clergyman Thomas Malthus, who
published An Essay on the Principle of
Population in 1798.
• He outlined the idea of ‘positive checks’ and
‘preventative checks’ to control the
population.
• ‘Positive checks,’ such as diseases, war,
disaster and famine, are factors that
Malthus considered to increase the death
rate.
• ‘Preventative checks’ were factors that
Malthus believed to affect the birth rate,
such as moral restraint, abstinence and
birth control.
Eugenics
• Eugenics, meaning ‘well born,’
was introduced in the 1880s by
Sir Francis Galton, a cousin of
Charles Darwin and the father
of modern statistics.
• Galton pioneered the use of
pedigrees, twin studies, and
statistical correlation for the
purpose of using that
knowledge to improve ‘the
breed of man.’
• During the early 1900s,
eugenics became a serious
scientific study pursued by both
biologists and social scientists.
Pro-natalism
• The Boer War 1899-1902 revealed a shockingly low standard of
health among the male population recruited to fight, forcing
political attention on the actual condition of the Empire’s citizens.
• Infant welfare was included in the campaign to improve physical
efficiency, and this concern became, according to Jane Lewis, even
more explicit during WWI. It would only further increase by WWII.
• By 1939 the British birthrate had dropped to below replacement
levels, even lower than in 1914, and hit an all-time low in 1941. In
response a pronatalist position, whereby women were encouraged
to have more children, was widely adopted by the government and
others, including labour organisations and members of the medical
profession.
Contraceptive pill
• Developed by American biologist Dr
Gregory Pincus, the ‘Pill’ works by
suppressing ovulation.
• It was tested in the 1950s on Puerto
Rican and Haitian women and
launched in the USA in 1960.
• In the USA, around 1.2 million
women used the Pill within two
years of its launch. A decade later
the numbers had risen to ten
million
• Worldwide, around 100 million
women take the Pill.
• Scientific debate about the health
risks of oral contraceptives
continues.
Pharmaceuticals and foreign aid
• The dictates of the market play a major part in family planning and
population control.
• About $5 billion is spent each year on family planning by developing
countries; $1 billion of this is donated by Northern governments,
multilateral agencies and private organizations.
• Pharmaceutical companies have global contraceptive sales of $2.6
billion to $2.9 billion per year.
• This huge economic power of pharmaceuticals enables them to
influence the policies of Southern governments and the priorities of
the medical establishment.
• According to the UN, contraceptive use in the southern hemisphere
has increased five-fold in the past quarter century because of the
intervention of foreign-aid donors and international institutions.
International Conference on
Population and Development (1994)
The ICDP brought to international
recognition two important guiding
principles of reproductive and sexual
health:
1) that empowering women and
improving their status are important
ends in themselves and essential for
achieving sustainable development;
2) that reproductive rights are
inextricable from basic human rights,
rather than something belonging to the
realm of family planning.
Move to reproductive health
• Three developments were of particular importance to the reappraisal
of reproductive health in the 1990s:
• Firstly, the growing strength of the women’s movement and their
criticism of the over-emphasis on the control of female fertility - and by
extension, their sexuality - to the exclusion of their other needs.
• Secondly, the advent of the HIV/AIDS pandemic; suddenly it became
imperative to respond to the consequences of sexual activity other
than pregnancy, in particular sexually transmitted diseases. But perhaps
more important, it became possible (and essential) to talk about sex,
about sexual relations outside of marriage as well as within it, and
about the sexuality of young people.
• Thirdly, the articulation of the concept of reproductive rights. An
interpretation of international human rights treaties in terms of
women’s health in general, and reproductive health in particular,
gradually gained acceptance during the 1990s.
Part four
• Assisted reproduction
Artificial insemination
• Artificial insemination in
humans was first
performed by the famous
English surgeon John
Hunter, in 1785.
• In 1884 the first successful
artificial insemination of a
married woman by donor
sperm occurred in the
United States.
John Hunter (1728-1793)
IVF and Louise Brown
Criticisms and concerns
• Ann Oakley has noted how infertility treatments are often
unpleasant and their success rates remain relatively low.
• Gillian Tindall has demonstrated how babies created through
assisted reproduction are at excess risk at every stage in their
development.
• In the British context, the issue of cost to the NHS has also been an
issue.
• In the development of ever more powerful techniques of assisted
reproduction a number of new ethical questions have emerged.
They lie at the heart of what it means to reproduce, to be a parent,
to be a human being.
• Since 1990 many countries have been setting out to establish
ethical guidelines and laws for reproductive technologies.
Warnock Report
• In 1982 a committee was established to inquire into the technologies
of in vitro fertilisation (IVF) and embryology.
• This was in response both to concern at the speed with which these
technologies were developing and to the 1978 birth of Louise Brown.
• The committee was chaired by the philosopher Mary Warnock.
It concluded that the human embryo should be protected, but that
research on embryos and IVF would be permissible, given appropriate
safeguards.
• The committee proposed the establishment of a regulatory authority
with the remit of licensing the use in treatment, storage and research
of human embryos outside the body. This body would later become
the Human Fertilisation and Embryology Authority.
• The findings of the committee were published in what is now referred
to as the Warnock Report in 1984, and forms the basis for the Human
Fertilisation and Embryology Act.
Conclusions
• Reproduction and the family are central elements in the lives
of people.
• In the 20th C obstetricians began defining ‘normal’ standards
for childbirth.
• There was a move away from ideas of population control and
demographic targets towards a more holistic approach to
reproductive health.
• With new reproductive technologies new ethical questions
have emerged.
• Perceptions about reproduction have shaped medical
practices, public policy, legal rights, technology, and the
contours of everyday experiences.