Unplanned Pregnancy!

Ethnography, Moral Experience and Unplanned Pregnancy

At times, ethical conjectures about reproductive practices contradict people’s lived experiences in the real world. Through ethnographic work conducted at Naomi’s House, a homeless shelter in the southeastern United States, Seeman et al. came across an unexpected finding: despite living in conditions of poverty that are exacerbated by the responsibilities of motherhood, some Black single mothers view unintended pregnancies as “evidence of a caring and transcendent cosmic order” (42). In a culture with public health practices that emphasize economic stability and family planning, how is it possible for some low-income women to perceive an unplanned pregnancy as a blessing?

As an academic field intended to generate empirical research on medical practices in a vast array of geographic, cultural and social contexts, bioethics faces a methodological dilemma: how to apply ethical theories to existing moral practices and highly individual lived experiences (Kleinman, 70). Conventional research methods often separate individuals’ ethical decisions from their lived experiences, not only ignoring potential data but also producing discourse that may shift public perceptions of blame toward people who have made culturally ‘unethical’ decisions. For example, interviews conducted with some of the women at Naomi’s House demonstrate that the binary categories of ‘intended’ or ‘unintended’ pregnancy in public health policies fail to capture the nuances of low-income womens’ experiences with reproductive contingency (Seeman et al., 30). More knowledge about how low-income women perceive unplanned pregnancies could have a significant impact on public health policies designed to educate marginalized populations about reproductive health.

Kleinman identifies ethnography as a possible solution to bridge the gap between ethical knowledge and lived realities (92). By observing and participating in local moral practices, ethnographers enter into the “ordinary, everyday space of moral processes in the local world”  where they can analyze the ways in which culture and ethical knowledge intersect to influence moral experience (Kleinman, 77). When Seeman et al. engaged in participant observation of daily life at Naomi’s house, they found that some women in the homeless shelter viewed their unplanned pregnancies as blessings because motherhood motivated them to better their own lives (36). In fact, the concept of unintended pregnancy as a blessing “resonated so powerfully for many Naomi’s House [because] it was conceived as an unplanned ‘gift’ holding power to change things for the better” (Seeman et al., 38). Because some of the women at Naomi’s house interpreted an unplanned pregnancy as a form of divine intervention, they chose not to terminate the fetus, instead opting for the hardship of raising a child in poverty. This tradeoff between religious faith and economic difficulty constitutes a moral experience of reproductive agency.

            Moral experiences “cross the boundary of the body-self, connecting affect and emotion with cultural meanings, moral norms and collective identity with sense of self. Thus moral experience and personal experience are interfused: value and emotion” (Kleinman, 71). Some of the women at Naomi’s house were influenced by Christian constructions of pregnancy as a type of “divine agency” that transcends human control (35). However, statements that some women made in life-history interviews reveal that the religious messages they had been exposed to about pregnancy only became meaningful in the context of their individual lived experiences, particularly those related to structural oppression. For example, some women decided to keep their pregnancies because they viewed them as opportunities to reinvent themselves as mothers and leave behind abusive male partners (Seeman et al., 38).

            Personally, I resonate with the concept of unintended pregnancy as a blessing. During my second year of college, I suffered a concussion from a car accident and was rushed to a hospital. There, I found out that I was six weeks pregnant. My ex-boyfriend, the father of the child, was physically and emotionally abusive, and I knew that our child would not have a happy life with him as the father. However, I also knew that I could not give my child the kind of life that I wanted him or her to have if I were a single mother. So, I chose to terminate my pregnancy.

To this day, I still do not know if the decision that I made was ethical. I am pro-choice, but, in the context of my own lived experience, it is difficult to reconcile my ethical and political beliefs with my moral and cultural values. Although I am very much still in the process of making sense of and healing from this experience, I have also come to view my unintended pregnancy as a blessing of sorts. Without it, I would not have been able to eventually separate myself from an abusive relationship. My decision to terminate my pregnancy was, and continues to be, emotionally devastating, but it forced me to examine my life and my spiritual roots for a renewed sense of meaning.

References

Arthur Kleinman, “Moral Experience and Ethical Reflection: Can

Ethnography reconcile them? A quandary for the new Bioethics.” Daedalus

128 (1999): 69-97.

Don Seeman, Iman Roushdy-Hammady Annie Hardison-Moody. “Blessing

Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in

Public Health.” Medicine, Anthropology, Theory 3 (2016): 29-54.

NOTES

Reading One: Moral Experience and Ethical Reflection

• “Bioethics is confronted with an extraordinarily difficult quandary: how to reconcile the clearly immense differences in the social and personal realities of moral life with the need to apply a universal standard to those fragments of experience that can foster not only comparison and evaluation but also action” (70).
  • Unlike philosophy, bioethics must apply ethics to a local context
• “The local” = our networks and communities, defines what we view as at stake in our lives
• “Status, material resources, relationships of exchange, survival, identity, and transcendence are examples of things that are sought collectively and individually” (71).
• What is at stake may differ from community to community, but the human experience of pursuing goals is universal
  • Allows for empirical research, which is necessary for the field of bioethics
• “Moral experience is about the local processes (collective, interpersonal, subjective) that realize (enact) values in ordinary living. These processes cross the boundary of the body-self, connecting affect and emotion with cultural meanings, moral norms and collective identity with sense of self. Thus moral experience and personal experience are interfused: value and emotion” (71-72).
• We need another model of ethics, one that does not separate an individual’s ethical decisions from his or her lived experiences
• Maybe ethics are not based on an autonomous individual’s rational pursuit of objectivity
• “The irrelevance of ethics can be seen when considering universal ethical formulations of justice and equity that do not begin with the local moral conditions of poor people, those experiencing the systematic injustice of higher disease rates and fewer healthcare resources because of their positioning at the bottom of local social structures of power” (72).
• “How could we make the case for human rights and against genocide in such terrible instances based on something called ethics – unless ethics provides translocal values that can criticize local practices from the outside?” (73)
  • Counterargument: Aren’t some local worlds – such as Rwanda and Kosovo during their respective genocides – unethical?
  • Therefore, bioethics requires two approaches: a method that accounts for local moral experiences and a method to apply ethical deliberation to local contexts that we are not a part of
  • Can we synthesize these two approaches?
• Solution one: use the concept of a universal human nature (73)
  • Argument: If human nature is universal, then we can apply ethical deliberation to different local contexts because humans have a shared sense of basic morals.
    • Allows for an objective, prescriptive view of ethics
    • However, no consensus on what exactly “human nature” is; ironically, conjectures of human nature are rooted in cultural beliefs and values
      • For example, how much of human nature is genetically predetermined? How much of human nature is shaped by social experiences?
• Second solution: evolutionary arguments for ethics
  • “History, what we make of the past, is human time – warm, even burning narratives of meaningful experience” (74).
  • However, evolutionary history is different; archeological evidence might provide us with insight into how our ancestors created new technologies, but it does not tell us about their individual moral experiences or cultural ethics
• Third solution: “radical” relativism (75)
  • “No local world, no matter how troubling its practices, deserves to be judged by standards beyond its own” (75).
• Best solution: ethnography (76)
  • This paper: how fully does ethnography answer the methodological dilemma of bioethics?
  • “Ethnography is a method of knowledge production by which the ethnographer enters into the ordinary, everyday space of moral processes in the local world” (77).
    • Position of being an outsider allows ethnographer to observe local practices without being totally enveloped in “what is at stake” for that culture; juxtaposition of local practices to translocal world of ethics allows for ethical deliberation
    • “In this respect, the ethnographer’s position bears a resemblance to the circumstances of those who either belong to several distinct worlds or identify themselves as marginal to the mainstream” (77).
    • In theory, ethnographer becomes critical of her own positioning in the local world which dismantles stereotypes of local practices/ culture and allows her to observe “original and unexpected” processes (77)
    • “Descriptions of kinship relations, religious practices, gendered work, illness experiences, healing activities, legal disputes, material exchange relationships, and the many other facets of everyday social life illustrate the processes of everyday moral experience” (78).
      • For example, you can tell a lot about the moral content of a culture and the social experiences it produces by examining what is at stake for family members when one of their relatives experiences a life-threatening illness
• Basically, ethnographers are in a liminal space between local worlds that allows them to undergo a documented change in their own moral experience, contributing towards translocal knowledge of ethics
  • Ethnography = critical self-reflection
  • “The ethnographer’s own moral/ ethical predicament itself brings the core concerns of reflection” (79).
  • Ethnographic method
    • Ethnographer clarifies moral issue and her own moral positioning in the lived worlds of work and social life
    • Ethnographer describes 3 types of knowledge
      • What is at stake for local stakeholders concerning health, suffering and healthcare
      • How local people use local or global framings to understand moral processes in their own world
      • Knowledge of how ethnographer applies ethical categories to local issues
    • Ethnographer creates a framework to understand how the intersection of moral processes and ethical discourse defines the local human conditions of health equity and the local human consequences of health rights and responsibilities (91)
    • Framework becomes the foundation for community-wide conversations between stakeholders, which will generate an agenda for practical action (92)
      • Ethnographer shouldn’t try to resolve tensions/ contradictions, but make others within a culture aware of them

Reading Two: Blessing unintended pregnancy

• “Our findings confirm that young and disadvantaged women may view pregnancy and motherhood as opportunities to improve their lives in ways that mediate against their acceptance of family planning models. For these women, the notion of ‘blessing’ also reflects an acceptance of contingency and indeterminacy as central to the reproductive experience. We also question the increasingly popular distinction between ‘religion’ and ‘spirituality’ in contemporary public health” (29).
• “Rather than assuming we know what religion means in reproductive settings, we urge scholars to attend to the local moral worlds that women actually inhabit – worlds that are often religiously inflected – and to follow their lead in tracing the complex relationship between shifting perceptions of agency and contingency in reproductive life” (43)
• What is at stake: Correlation between unintended pregnancy and maternal depression, decreased rates of breastfeeding, late entry into prenatal care, maternal smoking, child abuse and developmental delays, low birth weight and maternal impoverishment (30)
  • Low-income women experience unintended pregnancies and abortions at a rate that is five times that of high-income American women (31)
  • “Radical uncertainty and frustration that characterized many aspects of Naomi’s House women’s lives” (42)
• Central tension between two worlds of knowledge: American culture emphasizes family planning; how do low-income single mothers in homeless shelters understand pregnancy?
  • Binary of “intended” and “unintended” pregnancy may be too extreme
    • “Alternative descriptive frameworks must be found” (30)
    • “Our study contributes to this body of knowledge by reframing the discussion of reproductive agency through attention to ‘vernacular religion,’ or everyday religious discourse, practices, and experiences that may disrupt or lend nuance to the binary distinction between intended and unintended pregnancy” (31)
      • Blessing – concept that is “prism through which we might begin to reexamine the construct of intentionality within reproductive health (31)
      • “Blessing… resonated so powerfully for many Naomi’s House [because] it was conceived as an unplanned ‘gift’ holding power to change things for the better” (38)
      • “‘Blessing’ is just one potential formulation, in phenomenological terms, of the need to reckon in some way with the contingency of bodily outcomes, social efficacy, and the ability of women or men to flourish in culturally appropriate ways – including the ability to bear and raise children – even under conditions of scarcity and structural violence” (44)
• “We are pointing to a vernacular sensibility that helps to shape women’s intuitive sense of well-being or ‘rightness’ in relation to the pull of different and sometimes seemingly opposed features of lived possibility: the existential tug between human and divine agency in becoming a mother, for example, or planning and contingency more broadly” (34)
  • Pregnancy as a blessing – in moral practices, some women in the homeless shelter said that their children were their motivation to succeed (36)
• “Religious and spiritual themes relating to pregnancy or motherhood were most powerful when they were related to specific events in the mother’s own life, against which they achieved resonance and meaning” (38)
  • “Two thirds of the women who participated in life history interviews at Naomi’s House interpreted their pregnancies – though unintended by them – as intended by an agency that trumps human planning. These women framed what some might treat as accidental, capricious, or even catastrophic events as evidence of a caring and transcendent cosmic order” (42)
• Oppression
  • Structural: women from disadvantaged backgrounds may not choose to follow practices that emphasize planning because they contend unpredictability and hardship in their economic, social and personal lives (39)
  • “They almost uniformly reported an inability to influence their partners to use contraceptives or contribute to child rearing, and frequently also described a lack of control over their own reproductive cycles and contraceptive use. Anthropologists have argued that public health policies that focus on contraceptive education for women may obscure the extent to which women’s agency is effectively constrained by male economic and social dominance” (39)
  • Discrimination from medical professionals (39)