Month: February 2018

Unit 5: Kimberly Farmer

Access and Agency in Prenatal Testing

Transitioning from our topics on kinship and reproductive technologies, this week’s readings explore women’s outlook on unplanned pregnancy and the use of prenatal testing. Rayna Rapp’s book Testing Women, Testing the Fetus and “Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health” written by Dr. Seeman and colleagues discuss these concepts primarily through the lens of the woman. Together, these ethnographies illuminate the complexity of decisions made after conception and the religious, social, moral, medical, and ethical considerations that accompany women’s decisions and beliefs about reproduction.

Testing Women, Testing the Fetus was the result of Rapp’s extensive research on amniocentesis, or prenatal testing, and the relationship between women and their caregivers. Through interviews with and observation of expecting women, physicians, geneticists, and other professionals, Rapp strives to gain an omniscient understanding of women’s decisions to seek or evade prenatal testing. In addition, Rapp has personal stake in the topic as her study was fueled by her own decision to terminate a pregnancy. Throughout her work, Rapp finds that responses to prenatal testing vary across racial and socioeconomic lines. Rapp writes, “middle-class patients (disproportionately white) usually accept the test while poorer women (disproportionately from ethnic-racial minorities) are more likely to refuse it (168). As Rapp proceeds, she uncovers that there is complexity to this statistic. For example, in two hospitals that each serve low-income areas one, Middle Hospital, had a higher rate of prenatal testing than the other hospital, City Hospital. Rapp explains that, “Middle’s prenatal clinic provides a stable and welcoming environment in which women tend to be very comfortable” while “City Hospital, by contrast, has been a site of struggle over services for many years, and the prenatal clinic is a difficult environment in which to receive healthcare” (169).  This finding of inequity even within the same socioeconomic status brings the concept of access into the discussion. Access to properly funded medical services, professional patient-centered help, and available counseling appointments are crucial factors in determining the prevalence of prenatal testing. In the Dr. Seeman et al piece, the notion of access is furthered by introducing a discussion on agency. The article suggests that access is not always a limiting factor in the prevalence prenatal testing because often times agency is influenced by a spiritual or religious belief that impacts a woman’s view on her pregnancy. The article highlights a group of young African-American mothers in a shelter in the southeastern United Sates. Through interviews and participant observation, the researchers gathered that unplanned pregnancies we not viewed negatively and were actually seen as a blessing leading some to avoid terminating the pregnancy. The authors write that the women in the study, “experienced divine blessing as a kind of life-giving and life-affirming agency beyond their control” (Seeman et al.) which leads them to reject family planning models. This shows that even with access and education about ending pregnancies, a woman’s outlook on the pregnancy, be it a blessing or not, influences the type of treatments or procedures they may undergo.

These two readings attempt to explain the complexity of a woman’s decision regarding her pregnancy. I found the Dr. Seeman et al article to be particularly interesting in the way that it described how an unplanned pregnancy is a way of enriching a woman’s life in the sample population. As a human health and sociology major, I wonder what other societal factors could be responsible for such a finding—particularly that African-American women are able to find comfort in things that are out of their control. African-Americans and individuals of low socioeconomic statuses are often at the mercy of things outside of their control, be it inner city pollution, high unemployment rates, institutionalized racism or an overall lack of power as suggested by sociology’s Conflict Theory. Essentially, in order to survive these women are forced to accept things outside of their control. I wonder if we could view the women in the study’s acceptance of a pregnancy out of their control as an extension of a survival mechanism used in everyday life rather than a religious barrier that limits agency.

Overall, from these readings one can see that the responses to a woman’s pregnancy are not clear cut nor homogenous across demographics. In addition, the concepts of prenatal testing and unplanned pregnancies cannot be understood without addressing societal, religious, moral, medical and ethical implications. Mothers are the ones burdened with the duty of weighing each of these obligations in order to make the best choice for herself, her family, and her child.

 

 

 

 

With a unique ‘inside, outsider’ perspective lens, Susan Martha Kahn explores the connection between rabbinic beliefs about kinship and reproductive technologies in the context of an overarching Rabbinic kinship cosmology. Through ethnographic study conducted in IVF clinics, hospitals, and support groups for unmarried women in Jerusalem, Kahn delves into the overlap between the secular and religious uses of reproductive technologies (ovum donation, artificial insemination, in-vitro fertilization) and examines how rabbinic kinship beliefs paved the way for unmarried Jewish women to make use of these technologies. Furthermore, she examines the legal discourse that depicts Jewish women’s bodies as reproductive resources to warrant the use of these technologies (Kahn 2).

Through interviews and participant observation Kahn explores the dominant Jewish Israeli view on IVF practices. Reproductive technologies are allowed and even encouraged as a means of furthering the Jewish bloodline and realizing God’s command to multiply. Reproduction is an “imperative religious duty,” sanctioned by the very specific economic, political, social, and historical contexts that have given rise to the use of new reproductive technologies as a way to satisfy that duty (Kahn 3). Kahn captures this overarching sentiment through her interviews, “If you’re not a mother, you don’t exist in Israeli society” (9), as stated by a social worker at a fertility clinic in Jerusalem. I personally felt the language surrounding this supposed “duty of woman” to be a bit reductive. It seems the legislation and general attitude toward these Jewish Israeli women reduces them to their baseline femininity, minimizing them to their reproductive capacities. As a non-practicing Jewish-American unmarried woman, Kahn has a unique outsider and insider perspective that allows her to conduct her ethnography from a removed yet group-accepted stance. Nonetheless, she may be subject to some semblance of personal biases, as the societal expectations she faces (or rather, does not face) as an American non-practicing Jew, vary greatly in comparison to her devout Jewish Israeli counterparts.

With our class last week in mind, in which we explored the two Genesis creation stories presented in the Hebrew English Tanakh, it must be noted that the commandment to multiply isn’t actually presented as a commandment. Interestingly, justification for the usage of reproductive practices in Israel are founded on the basis of this (supposed) command. Given that most Israelis communicate in Hebrew, one would assume the Israeli Jews featured in this ethnographical study have read the direct Hebraic version. In the first book of Genesis, “God created man in His image, in the image of God He created him; male and female He created them. God blessed them and God said to them, Be fertile and increase, fill the earth and master it” (Genesis 1.14 line 28 as cited in the Hebrew English Tanakh). Here, this excerpt states that man and woman receive the ability to procreate as a blessing, rather than an obligatory command.

Throughout Kahn’s ethnographical account, a hierarchical ordering of values is present: the need to follow the command to reproduce outweighs the social value of maintaining a normative, nuclear household. Kahn states, “…unmarried Israeli women who have conceived children via artificial insemination can be understood to preserve the honor and prestige of the traditional family at the same time that they comply with the dominant ideology of the family as the center of social life”(45). It seems here that the traditional family style- consisting of two biological parents- is ranked as not as important when considering ideals to strive for, so long as an unmarried Jewish woman is making use of her reproductive capacities in an effort to further the Jewish population and fulfill that specific duty as procreator.

When faced with the topic of reproductive technologies, Michael J. Broyde employs a case-by-case evaluative approach, modeled after the same approach emphasized by those who follow Jewish law, halakhah. While evaluating the case of cloning, Broyde references a duality often found in Jewish thought: on one hand, an obligation for individuals to help those in need, coupled with the command to reproduce, encourages the use of reproductive technologies to reach that end goal of reproduction. However, Jewish law also warns of the “slippery slope” people encounter when they attempt to medal in things out of their scope, as some things are better left in God’s hands. It is worth noting that both Broyde and Kahn reference a moral imperative to reproduce as a core justification often employed to warrant use of reproductive technologies. After a series of analyses regarding cloning, Broyde reaches the bottom-line conclusion that within the Jewish faith, cloning is ultimately a form of “assisted reproduction” (Broyde 296), situated in the same category as other reproductive interventions such as artificial insemination or surrogacy. Cloning is a permissible reproductive interventionist approach, save for the few cases in which a rabbi may override its usage. As seen in the Kahn reading, it appears that the Jewish moral imperative of reproduction trumps controversy regarding reproductive technologies, justified by the Jewish commandment to multiply. Broyde’s discussion of cloning, as viewed by halakhic law, adds to Kahn’s ethnography by detailing verdicts on specific nuanced circumstances in which parenthood may come into question. I found the discussion on gestational mothers (Broyde 316) particularly interesting, as Jewish law would consider the woman who births a child as the proper mother, despite a genetic difference (in the case of surrogacy).

Don Seeman highlights the need to add cultural contexts into the discussion on reproductive technologies. While examining whether a new medical technology is deemed ethical or not, one must closely consider the context in which interpretation occurs, referred to as a “hermeneutic strategy” (Seeman 342). In order to examine how different communities respond to the question of these technologies, we must consider the interpretative variance between communities (Seeman 340), cultural nuance, and lived experience (Seeman 357).

I found Seeman’s discussion of what is “natural” as a foundation to secular law as quite thought provoking. “Natural” as a foundation to law, in the case of France (amongst other nations), invokes the question of the natural as a secular idea. Perhaps, what is envisioned as natural is simply playing off of biblical notions of the “natural” family unit (heterosexual couple and their children) and may not actually be “natural” to us. In line with this thinking, I pose the question: what is truly natural about this nuclear family unit?

The theme of birth mothers as true mothers appears in this text well, similar to the discussion explored in Broyde’s text. Jewish law “…makes no provision for the formal transference of maternal identity from a birth mother to another woman-the birth mother remains the mother for many halachic purposes no matter who may raise the child…” (Seeman 342). However, it seems there is example of a biblical instance in which pseudo-surrogacy is employed in Genesis 16, yet the child produced does not end up belonging to the gestational mother. Here, Seeman highlights the variance in hermeneutic interpretation of a biblical passage, as many scholars of Jewish thought have chosen to selectively ignore this passage, as they feel halakhic law supersedes this biblical account.

Seeman’s inclusion of this passage from Genesis 16 serves as a means of elucidating the widespread, age old preoccupation with reproduction and reproductive technologies, present in a myriad of cultural contexts. Responses and preoccupations with reproductive technologies can only be understood within the distinct social context in which these issues arise. Often the question of kinship- which is regarded differently in each culture- plays a significant role in how reproductive technologies are employed or disregarded. Ultimately, answers to the question of reproductive technologies are inextricably tethered to social reproduction, not simply biological, contrary to beliefs Western minded individuals may assume because we typically rely on biology/bloodlines as a means of determining kinship.

For multiple centuries, there has existed a conflict between religion and science. This conflict has led to multiple debates concerning the influence of religion and science in politics. Specially, these debates have influenced laws pertaining to the use of technological intervention in the process of procreation. Looking at the King James Bible, some see these cosmological and metaphysical questions as being straightforward. The bible is a collection of texts that are at the heart of the Jewish and Christian religion. These texts are designed to explain various topics such as life, death, and social issue. The first chapter, Genesis, sets the stage for the opinion of some religious beliefs. This chapter known as the “creation story” begins directly by stating “In beginning, God [‘elohim] created the heavens and the earth” (Ball, 2000). This one sentences summarizes the entire story. At the center of this story, we are presented a major point: the claim that God, a divine being, is the creator of all things, and without him, life would not be possible. At the same time, this statement story denies any “alternative of generative beginnings” (Ball, 2000).

Cosmological beliefs, such as the ones above, have been incorporated in the various foundation of multiple countries and family’s structures. Any threat to these cosmological beliefs is viewed a threat to the foundations of the social structure. Starting in the 18^th century, The Enlightenment Era led to a rejection of traditional, social, political, and religious ideas. This new way of thinking continued and expanded into the twentieth and twenty-first century. With this new way of thinking brought extreme opposition from more conservative thinkers that have very strong cosmological views. Looking at, Nan t. Ball’s article, The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates, and Shanon, Thomas A. and Lisa Sowle Cahill’s article, Religion and Artificial Reproduction: An Inquiry into the Vatican Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction, one can understand the moral questions raised by technical intervention on human reproduction. These articles help to show how the  complex relationship between science, religion, and politics are heavily dependent on the cultural description.

In Dr. Ball article, she “argue that the action of the Constitutional Council is but one example among many of the ways in which form and language of the legal debates surrounding art in France echo enlightenment ideas. Close analysis of the of the 1994 French bioethics debates suggests that Enlightenment polemics about the interrelationship between family, nature, and society provided much groundwork for those debates” (Ball, 2000). These bioethical laws allowed only individuals no able to produce children, heterosexual couples of age to procreate, and married to use artificial insemination and in IVF procedures.  Both the church and the government in France condemned the use of this technology because it allowed homosexual couples, virgins, and postmenopausal women to have children. Many groups saw ART as a threat to the traditional heterosexual family structure.

Similar to Dr.Ball’s article,  Shanon, Thomas A., and Lisa Sowle Cahill’s article addresses many of the same issues pertaining to technological intervention in the human reproductive process. She addresses three main issues.  First, she explains human beings from the first moment in their existence (Cahill et al, 1988). There are various opinions about qualifies “as a person”. Is it when the ovum is fertilized? Is it when the baby is born? These questions play an important role in the debate of ART. The Catholic Church believes “From the time that the ovum is fertilized, a new life begins” (Cahill et al, 1988). Due to their interpretation of the start of life, one can see their views on certain ART. Next, she explains the moral questions raised by technical intervention on human procreation and some orientation on the relationships between moral law and civil laws. These sections show the various contradictory opinions concerning the use of specific technology in human procreation. Due to various opinions, one cans understand why there is not one simple explanation on how to regulate the use of specific technology that  help with procreation.