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The Empty Cradle: Fertility and Reproductive
Health
HI278
Term 2, Lecture 4
Themes of the lecture
• Split into two parts:
1. Controlling fertility
2. ‘Seeing’ the foetus
Part One: Controlling Fertility
Managing Fertility before the Pill
Pathway to the Pill• Laying the groundwork
– Physiological research (often in infertility, impotence)– Women’s movements/enfranchisement of women (expanded role
of women in the public sphere, esp. in relation to women’s and children’s health)
– ‘scientific motherhood’
• Show me the money– Who pays, wins: Katherine McCormick (MIT graduate, suffragist,
philanthropist) and Margaret Sanger (nurse, sex educator, eugenicist, feminist)
• ‘Fathering’ the Pill?– Gregory Pincus and Min Chueh Chang (animal models, hormone
research), John Rock (clinical trials), Carl Djerassi (chemist)
Pathway to the PillClinical trials
• Who?– Infertile (often middle class) women in Boston– Poor and ‘excessively fertile’ women in Puerto
Rico, Haiti, India• How?
– Tablets every day, every 6-8 hours or injections or suppositories;
– body temp readings every day; – vaginal smears every day; – chart maintenance; – urine samples over 2 specific 48 hour periods (so
confined to home those days); – endometrial biopsies every month (and in some
cases laparotomies)
Pathways to the Pill
Why?
• Individuals’ desires to control family size, invest more resources into fewer children
• Eugenic drives to reduce birth rates of the poor and of ‘poor genetic stock’
• Fears, by mid-century, of ‘population explosion’
A quick note on chemistry• How does the Pill work to prevent
pregnancy?
– Primary mechanismInhibits ovulation: no egg no pregnancy
– Secondary mechanismsThickening of cervical mucus sperm cannot reach
the egg
• Possible – but NOT proven -- endometrial effects – very controversial
Pathways to the PillWhen?
May 9, 1960: FDA approves the Pill as safe for contraception
‘"The pill" is a miraculous tablet that contains as little as one thirty-
thousandth of an ounce of chemical. It costs 11¢ to manufacture; a month's supply now sells for $2.00 retail. It is little more trouble to take on schedule than a daily vitamin. Yet in a mere six
years it has changed and liberated the sex and family life of a large and
still growing segment of the U.S. population: eventually, it promises to do the same for much of the world.’
Time Magazine, April 7 1967April 7, 1967
Controversies: the Pill and
politics
Sex, Drugs and … Religion?
Protest the Pill Day '08: The Pill Kills Babies.
So: questions to think about
• Are reproductive technologies like the Pill liberating their users, or not?
• Who benefits more? Men or women?
• Who has more control of fertility?
• Is use of the Pill encouraging women to delay reproduction meaning they miss their ‘fertile window’?
Part Two: ‘Seeing’ the Foetus
Seeing is believing: A quick history of medical imaging
1895 Prof Wilhelm Roentgen discovers ‘X-rays’; they quickly become a popular phenomenon and fad; only later are they adopted for medical purposes (eg onlyIn 1920 are 100% of fracture cases examined by x-ray in large US hospitals).
Seeing is believing? Interpreting the x-ray
“The fondest swain would scarcely prizea picture of his lady’s framework;
to gaze on this with yearning eyes would probably be voted tame work!” Punch, Jan 25, 1896
“Whether stout or thin, the x-ray makes the whole world kin.” 1897
“Sight is a much more satisfactory agent of information than hearing or touch.” Philip Mills Jones, 1897
"I will admit that I can see broken bones; that I can see metallic foreign bodies in the extremities, but when it comes to X- rays of the chest and to
some extent of the abdomen, I am much less clear. Frank Williams has just shown you some plates and tells you that the heart is here and the lung is here. Now I can't see a thing in these plates, and to be truthful, I don't think he can." Dr. F.C. Shattuck, after a presentation by Francis Williams, 1899
Seeing the foetus before ultrasound
Hunter, Anatomy of the gravid uterus, 1764
Leonardo daVinci, Sketch-Books, c. 1510
Seeing into the womb: the impacts
of ultrasound
•‘The astonishing medical machine resting on this pregnant woman's abdomen in a Philadelphia hospital is “looking” at her unborn child in precisely the same way a Navy surface ship homes in on enemy submarines. …bombarding her with a beam of ultra-high-frequency sound waves …. Back come the echoes, bouncing off the baby's head, to show up as a visual image on a viewing screen.’
The Foetus in Pop Culture:
Giving the Foetus a ‘Public
Presence’Cover of Life
Magazine (1965)
Foetus in Pop Culture
Art for Arthur C. Clarke,2010 Space Odyssey, novel (1982) and film (1984)
Ultrasound in medicine: 1984 report by joint National Institutes of Health/ Food and Drug
Administration panel on the use of ultrasound in pregnancy:
Results of study:• “no clear benefit from routine use” • “no improvement in pregnancy outcome”• no conclusive evidence either of its safety or harm.
Recommendation: • not for “routine use” or “to view ... or obtain a
picture of the fetus” or “for educational or commercial demonstrations without medical benefit to the patient”
• Approved for use to “estimate gestational age”
Technologies and ideologies:‘The Silent Scream’, 1984
Role of Cinematic technology• Allows widespread electronic
distribution via TV, web… Premiered on a televangelist TV programme.
• Edits image to increase drama (eg. speeding up images to create sense of foetal movement)
• Allows simultaneous ‘interpretation’ of images (which are not immediately transparent without medical expertise) e.g. claiming to show abortion ‘from the victim’s vantage point’;
• Film credited with shifting ‘public focus from the horror stories of women who had suffered back-alley abortions to the horror movie of a foetus undergoing one.’
"Now let's turn to the actual film itself. We are now looking at a sector scan of a real time ultrasound imaging of a 12 week, unborn child. The child is oriented in this direction. You are looking now at the head of the child... here... the body of the child... here.. and this image is the child's hand approaching its mouth. Looking a little more closely at the child, we can discern, the eye or the orbit of the eye, here, the nose of the child, here... and the mouth of the child... here.. and we can even look at the ventricle of the brain, here… Now, we see the heart beating, here in the child's chest …And we can see the child moving rather serenely, in the uterus. One can see it shifting position from time to time. It is still orientated in this manner and the mouth is receiving the thumb of the child. The child again is moving quietly in its sanctuary.“
Narrative of ‘Silent Scream’ 1985
‘Health Warning’: the following image may offend some viewers
Images and the right to choose?
• This is the ONLY image of a foetus I have been able to find used in a pro-choice political context (and it is hardly intended as a tool of persuasion) Why?
• Could pro-choice activists use medical imagery to advance their message?
Images and Informed Choice?
Note that most abortions (in the developed world) take place in weeks 1-8 [pre stage 23] , and less than 2% occur after week 21.
Do technologies (necessarily) create a tension between
maternal and foetal interests?• Womb as ‘hostile environment’ or womb as
foetal ‘sanctuary’: do either of these images benefit women?
• Can we envision a way of imaging the foetus that would not exclude the woman carrying it?
• What do women gain from ultrasonography?• Do men gain more (and if so, do their gains
come at cost to women?)
Seminar Topics
• When does a woman become a mother, responsible socially and legally for the wellbeing of her child?
• Do men become fathers at the same time and in the same way?
• Who qualifies as a ‘person’ in our culture, and what effect have technologies of visualization had on our perceptions of ‘personhood’?
So: What impact has the ‘gospel of genes’ had on
familial and ethnic identities?
If ‘there is no gene for the
human spirit’, why do we have
so much prenatalgenetic testing?
Are we prisoners of our DNA?