We and Our Fertility

We and Our Fertility, written by activists from Forum for Women's Health (Bombay, India), explores technological interventions into reproduction faced by women in India. Essentially feminist and critical in their perspective, the three authors, Chayanika, Swatija and Kamaxi, base their comprehensive evaluation of anti- and pro-natal interventions on women's experiences, realities, and health concerns. Identifying a need for written material on the subject, they take on the task of creating a resource that, as they describe it in their introduction, "we can understand, that speaks our language and gives voice to our experience."The original appeared in Hindi and Marathi, two main regional languages in India. Now, published in English, this book will become accessible to more readers, both within India and internationally.

As a woman of color from the United States, I read this book with keen interest. I found it relevant to the situation of minority women in "developed" countries; we also struggle to educate ourselves and others on realities that give rise to our own distinct health problems and issues. As in the Indian situation, these interests are invariably overlooked by mainstream literature on women and health. My thoughts on the book are further influenced by my engagement in international health activism, through which I am familiar with on-going debates on concepts such as self-determination, control, choice, and rights. These concepts are indispensable to discussions on our bodies and health, but are sometimes used without reflection to make or manufacture short-sighted demands, which can be disempowering to women on the whole. The thoughtful and stimulating analyses in We and Our Fertility on the social context of reproductive technologies in India will challenge the international women's health movement to redefine these concepts, in order to do justice to a multiplicity of perspectives.

The book's style demonstrates a strong commitment to feminist principles of information sharing and validation of women's collective experience and knowledge. For example, on the inside of the cover page is written, "Any part of this book may be copied, reproduced or adapted to meet local needs without permission from the authors, provided the parts reproduced are distributed free or at cost, not for profit." This reflects a renunciation of "intellectual property" claims to the thoughts and ideas flowing through the pages, which the authors acknowledge as the result of a process having a variety of origins. Input from users and providers of contraceptive and fertility technologies, other women's collectives, and organizers of community health projects make up part of the contributions. Moreover, the authors use a stylistic approach which gives credence to women's voices. This involves a conscious disregard for the strictures of science which have historically silenced women. Experience is interspersed throughout, sometimes in anecdotal form, sometimes as a quotation, but without the burden of providing exactness, source proof and numerous data. At the same time, in a section on clinical trials, the authors critique aspects of scientific method such as reductionism, objectivity and the manipulation of numbers in a way that obscures the facts. This chapter also describes how a person's subjective experience can be invalidated. The book's style proactively promotes the very principles it aims to express with explicit words.

At the heart of the book's analysis is the understanding that technological interventions into reproduction can not bring about social changes. The social context in which women use and choose high-tech devices and methods becomes central to evaluating them. Not only can these methods cause substantial bodily harm, they tend to exacerbate existing power imbalances between women and men, providers and users, communities, and nations. Consequently, the authors deliberately attempt to "shift the debate (on reproductive technologies) from our biology back to the human interactions that they compromise" (p.230). This basic idea permeates all chapters in the book.

Beginning with an introduction on the authors' own perspective and background, the book then turns to India's family planning program, and national and international population control policy. Addressing these at the outset helps explain the overall context within which women struggle for their health and self- determination. Characterized by "greed and coercion," population control policy has played an overwhelming role in circumscribing reproductive freedom in India (p.27). The development and imposition of contraceptive technologies to reduce human numbers have disregarded all people's, but especially women's, needs. Yet, women have taken decisive steps to struggle against the forces which have made them vulnerable to abuse, and to fulfill their needs, contraceptive and otherwise, in alternative settings. Though the book also includes a critical assessment of infertility management techniques, the Indian population control context necessitated an emphasis on contraceptive technologies. Independent of that context, however, anti- and pro-fertility interventions are presented as two sides of the same coin. For this reason, the authors do not acknowledge a real distinction between "new reproductive technologies", as infertility control methods are normally classified, and methods of fertility control. The main issue is that of control, control by science and politics over the procreative ability of women. This is emphasized in a subsection of the chapter on clinical trials.

There are two chapters that cover the reproductive systems of women and men: sexuality and the process of reproduction. These, and a later chapter on fertility awareness, challenge the readers to observe and learn about our bodies, even about their seemingly complicated processes. In a section on hormonal regulation of the menstrual cycle, for example, the authors insist that we overcome our own prejudices about technical information, to which many of us automatically close our minds for fear that it lies beyond our ability to comprehend. Understanding how the levels of hormonal concentration in our blood signals the start and stop of cyclical processes like ovulation and menstruation enables us to critically evaluate interventions into reproduction and new directions of research. Here we see the authors' commitment to helping us educate ourselves, conveying technical information "in a simple matter without simplifying too much" (p.5). To take control into our hands, it is essential to increase awareness of our own bodies and to develop a consciousness of the human interactions which determine how and from where control is exerted over women and their reproductive capacity. Particularly empowering is the chapter on fertility awareness, which gives clues on how to look for solutions that adapt themselves to the cyclical nature of our fertility, without compromising our health every single day. The authors begin brief explorations into issues of sexuality and redefining sexual intercourse; I felt that the overall analysis of the book might have benefited by giving these issues more weight.

A series of chapters cover a somewhat older set of contraceptive techniques (barrier methods, IUDs, sterilization and abortion), and the more recently developed hormonal methods and anti-fertility vaccines. In addition to explanations on functional particularities, each contraceptive method is evaluated in terms of its invasiveness, the ability of the user to exercise control over its functioning, and the social values and norms which define its usage. A chapter on the history of the Dalkon Shield reveals strong insight into corporate profiteering at the expense of women's lives and health. Though the authors chose to elaborate on each method individually, by no means are these chapter divisions entirely independent of one another. Recurring themes, comparisons, contrasts, and mutually relevant experience or information defy the classification structure, resulting in an interesting mixture of thoughts throughout. For instance, the chapter on IUDs begins with an anecdote that forces us to reflect on the dilemma of making individual choices. Having opted for an IUD against the wishes of her family, a woman suffers from its effects. She lies to her family, saying that the doctors forced it upon her. Caught between opposing forms of coercion, she employs one form (the doctors and state pressurizing women to have IUDs inserted) against the other (the family pressuring women to have children).

The final chapters critically examine techniques of infertility management such as artificial insemination and in-vitro fertilization, which, despite the politics of population control, have found their place in India. Viewing them as "individual answers to a social problem," the authors reflect on the social need to produce one's "own child," bloodlines, and eugenics. In the last chapter on adoption, they delve into the social definitions of womanhood, obtained only through marriage first and motherhood second, and the consequent meaning of childlessness for a woman in society. Adoption and other creative alternatives are considered "social solutions to a social problem." This chapter includes a provocative list of contradictions in the confrontation of individual vs. societal rights and responsibilities. Behind them lies the conviction of the authors that, "there is no absolute, unrestricted free choice for an individual in any society. Individual choice is always an interplay between individual and collective rights" (p.229).

Loaded with information, the book also gives us a perspective, suggesting how to evolve ways to make a difference in our realities. It challenges us to learn about our bodies and about abusive and hazardous high- tech interventions into reproduction. The struggles of women in India highlights to international readers both the universality and distinctiveness of women's health problems.

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