Centre for Cultures of Reproduction, Technologies and Health

Publications

by members of the centre

Re-visioning evidence: Reflections on the recent controversy around gender selective abortion in the UK

Maya Unnithan, S. Dubuc 
June 2017

Reports in the British media over the last 4 years have highlighted the schisms and contestations that have accompanied the reports of gender selective abortions amongst British Asian families. The position that sex-selection may be within the terms of the 1967 Abortion Act has particularly sparked controversy amongst abortion campaigners and politicians but equally among medical practitioners and the British Pregnancy Advisory Service who have hitherto tended to stay clear of such debates. In what ways has the controversy around gender-based abortion led to new framings of the entitlement to service provision and new ways of thinking about evidence in the context of reproductive rights? We reflect on these issues drawing on critiques of what constitutes best evidence, contested notions of reproductive rights and reproductive governance, comparative work in India and China as well as our involvement with different groups of campaigners including British South Asian NGOs. The aim of the paper is to situate the medical and legal provision of abortion services in Britain within current discursive practices around gender equality, ethnicity, reproductive autonomy, probable and plausible evidence, and policies of health reform.

Read more: Re-visioning evidence: Reflections on the recent controversy around gender selective abortion in the UK

Parenthood between Generations - Transforming Reproductive CulturesParenthood between Generations - Transforming Reproductive Cultures

Edited by Siân Pooley and Kaveri Qureshi
April 2016

Recent literature has identified modern “parenting” as an expert-led practice - one which begins with pre-pregnancy decisions, entails distinct types of intimate relationships, places intense burdens on mothers and increasingly on fathers too. Exploring within diverse historical and global contexts how men and women make - and break - relations between generations when becoming parents, this volume brings together innovative qualitative research by anthropologists, historians, and sociologists. The chapters focus tightly on inter-generational transmission and demonstrate its importance for understanding how people become parents and rear children.

Read more: Parenthood between Generations - Transforming Reproductive Cultures

Gender, Sexuality and Social Justice: What’s Law Got to Do with It?Gender, Sexuality and Social Justice: What’s Law Got to Do with It?

Kay Lalor, Elizabeth Mills, Arturo Sánchez García and Polly Haste
2016

Member Ciara O’Connel's work on 'Engendering Reproductive Rights in the Inter-American System” features in this publication.

Read more: Gender, Sexuality and Social Justice: What’s Law Got to Do with It?

Monitoring and Evaluation in Health and Social DevelopmentMonitoring and Evaluation in Health and Social Development: Interpretive and Ethnographic Perspectives

Stephen Bell and Peter Aggleton
Routeledge 2016

New approaches are needed to monitor and evaluate health and social development. Existing strategies tend to require expensive, time-consuming analytical procedures. The growing emphasis on results-based programming has resulted in evaluation being conducted in order to demonstrate accountability and success, rather than how change takes place, what works and why. The tendency to monitor and evaluate using log frames and their variants closes policy makers’ and practitioners’ eyes to the sometimes unanticipated means by which change takes place.

Read more: Monitoring and Evaluation in Health and Social Development 

After surgery: the effects of life-saving caesarean sections in Burkina Faso

Véronique Filippi,  Rasmané Ganaba, Clara Calvert, Susan F. Murray and Katerini T. Storeng

In African countries, caesarean sections are usually performed to save mothers and babies’ lives, sometimes in extremis and at considerable costs. Little is known about the health and lives of women once discharged after such surgery. The authors, including member Katerini Strong,  investigated the long-term effects of life-saving caesarean section on health, economic and social outcomes in Burkina Faso.

Read more: After surgery: the effects of life-saving caesarean sections in Burkina Faso

What Constitutes Evidence in Human Rights-Based Approaches to Health? Learning from Lived Experiences of Maternal and Sexual Reproductive Health

Maya Unnithan
Health and Human Rights Journal, Vol 17 No. 2 December 2015

Health and Human Rights JournalThe impact of human rights interventions on health outcomes is complex, multiple, and difficult to ascertain in the conventional sense of cause and effect. Existing approaches based on probable (experimental and statistical) conclusions from evidence are limited in their ability to capture the impact of rights-based transformations in health. This paper argues that a focus on plausible conclusions from evidence enables policy makers and researchers to take into account the effects of a co-occurrence of multiple factors connected with human rights, including the significant role of “context” and power. Drawing on a subject-near and interpretive (in other words, with regard to meaning) perspective that focuses on the lived experiences of human rights-based interventions, the paper suggests that policy makers and researchers are best served by evidence arrived at through plausible, observational modes of ascertaining impact. Through an examination of what human rights-based interventions mean, based on the experience of their operationalization on the ground in culturally specific maternal and reproductive health care contexts, this paper contributes to an emerging scholarship that seeks to pluralize the concept of evidence and to address the methodological challenges posed by heterogeneous forms of evidence in the context of human rights as applied to health.

Read more: (HTML version)  and  (PDF version)

Targeting sexual health services in primary care: A systematic review of the psychosocial correlates of adverse sexual health outcomes reported in probability surveys of women of reproductive age

Natalie L. Edelmana, Richard O. de Visserc, Catherine H. Mercerd, Lucy McCabee, Jackie A. Cassell
Preventive Medicine, Dec 2015

Preventive Medicine

Women using primary care vary in need for sexually transmitted infections (STIs) testing and contraception. Psychosocial correlates of these needs may be useful for targeting services. The authors, including members Natalie Edelman and Professor Jackie Cassell, undertook a systematic review to identify psychosocial correlates of STI acquisition, unplanned pregnancy (UP), abortion and risky sexual behaviours in general population samples of women of reproductive age.

Read more: Targeting sexual health services in primary care: A systematic review of the psychosocial correlates of adverse sexual health outcomes reported in probability surveys of women of reproductive age

In dialogue with self and the world: Cape Verdean migrant pregnancy in Portugal

Elizabeth Pilar Challinor
2015

Women’s Studies International Forum

The voices of Cape Verdean migrant student mothers in Portugal are examined in the light of Archer's (2003) theory on the “inner dialogue”. The article frames the mothers as complex social actors who respond to the uncertainties surrounding unplanned pregnancy through self-reflection and dialogue with and about the world, turning the disorientation of unexpected motherhood into a meaningful project. The analysis reveals how the women's agency is located within the wider influences of kinship and gender norms and how these are already negotiated in the case of unconfirmed pregnancy.

Read more: In dialogue with self and the world: Cape Verdean migrant pregnancy in Portugal

Population Dynamics and the Sustainable Development GoalsPopulation Dynamics and the Sustainable Development Goals

July 2015

Corth members Maya Unnithan and Sajida Ally have contributed to the new report of the UK All Parliamentary Party Group on Population Dynamics and Reproductive Health report launched at the House of Lords on July 8th 2015. The report on Population Dynamics and the Sustainable Development Goals examines the interplay between population dynamics and urbanisation, climate change, migration and conflict. It will be used to guide discussion, funding and programmes of the post 2015 development agenda.

Read more: Population Dynamics and the Sustainable Development Goals [PDF 9.17MB]

International Journal of Mobile and Blended LearningMobile Game Based Learning: Can it enhance learning of marginalized peer educators?

Roy, A and Sharples, M
International Journal of Mobile and Blended Learning, 7 (1): 1-12. 2015

Read more: Mobile Game Based Learning: Can it enhance learning of marginalized peer educators?

Seventy years of sex education in Health Education Journal: a critical review

Padmini Iyer and Peter Aggleton
Health Education Journal, 74 (1). pp. 3-15. 2015

Read more: Seventy years of sex education in Health Education Journal: a critical review

Litigating Reproductive Health Rights in the Inter-American System: What Does a Winning Case Look Like?

Ciara O'Connell
Social Science Research Network, Dec 2014

Remedies and reparation measures emerging from the Inter-American System of Human Rights in reproductive health cases have consistently highlighted the need to develop, and subsequently implement, non-repetition remedies that protect, promote, and fulfill women’s reproductive health rights. Litigation outcomes that result in violations of reproductive rights are a “win” for health rights litigation, but when implementation fails, is a “win” still a win? Although there has been considerable success in litigating reproductive health rights cases, the Inter-American Commission on Human Rights and the Inter-American Court of Human Rights are not adequately equipped to follow up on cases after they have been won. Successful and sustainable implementation of reproductive health rights law requires incorporation of non-repetition remedies in the form of legislation, education, and training that seeks to remodel existing social and cultural practices that hinder women’s enjoyment of their reproductive rights. In order for a reproductive health rights case to ultimately be a “winner,” case recommendations and decisions emerging from the Commission and Court must incorporate perspectives provided by members of civil society, with the ultimate goal of developing measurable remedies that address underlying obstacles to domestic implementation.

Read more: Litigating Reproductive Health Rights in the Inter-American System: What Does a Winning Case Look Like?

Culture, Health & Sexuality - special issue on the relationship between rights and justice

Culture, Health and SexualityMaya Unnithan & Stacy Leigh Pigg,  including articles by Kalpana Ram, Paul Boyce, Lynn Morgan among others.

Vol 16, issue 9-10, Oct-Nov 2014

Special Issue: Themed Symposium: Sexual and reproductive health rights and justice -- tracking the relationship

Read more: Culture, Health & Sexuality

Challenges in ‘Translating’ Human Rights: Perceptions and Practices of Civil Society Actors in Western India

Maya Unnithan and Carolyn Heitmeyer
Development and Change, Volume 45, Issue 6, pages 1361–1384, November 2014

Development and ChangeRights-based approaches have become prevalent in development rhetoric and programmes in countries such as India, yet little is known about their impact on development practice on the ground. There is limited understanding of how rights work is carried out in India, a country that has a long history of indigenous rights discourse and a strong tradition of civil society activism on rights issues. In this article, we examine the multiple ways in which members of civil society organizations (CSOs) working on rights issues in the state of Rajasthan understand and operationalize rights in their development programmes. As a result of diverse ‘translations’ of rights, local development actors are required to bridge the gaps between the rhetoric of policy and the reality of access to healthcare on the ground. This article illustrates that drawing on community-near traditions of activism and mobilization, such ‘translation work’ is most effective when it responds to local exigencies and needs in ways that the universal language of human rights and state development discourse leave unmet and unacknowledged. In the process, civil society actors use rights-based development frameworks instrumentally as well as normatively to deepen community awareness and participation on the one hand, and to fix the state in its role as duty bearer of health rights, on the other hand. In their engagement with rights, CSO members work to reinforce but also challenge neoliberal modes of health governance.

Read more: Development and Change

The Cultural Politics of Reproduction: Migration, Health and Family Making

The Cultural Politics of Reproduction: Migration, Health and Family Making.Edited by Maya Unnithan-Kumar and Sunil K. Khanna.  Includes chapters by Kaveri Qureshi, Elizabeth Challinor *, Sajida Ally, Laura Griffith, Catherine Locke, Mirabelle Fernandes, Rachel Olson, Maya Unnithan, Sunil Khanna.
Oxford: Berghahn. November, 2014.

*Elizabeth Challinor’s chapter:  "To Be or not to be? Cape Verdean Student Mothers in Portugal"

Charting the experiences of internally or externally migrant communities, this book examines social transformation through the dynamic relationship between movement, reproduction and health. The chapters examine how healthcare experiences of migrants are not only embedded in their own unique health worldviews, but also influenced by the history, policy and politics of the wider state systems. The research among migrant communities provides an understanding of how ideas of reproduction and ‘cultures of health’ travel; how healing, birth and care practices become a result of movement; and how health-related perceptions and reproductive experiences can define migrant belonging and identity.

Link to publisher: The Cultural Politics of Reproduction: Migration, Health and Family Making

MATER SEMPER INCERTUS EST: WHO'S YOUR MUMMY?

Rita D'alton-Harrison
Medical Law Review, Summer 2014

In English law, the legal term for father has been given a broad definition but the definition of mother remains rooted in biology with the Roman law principle mater semper certa est (the mother is always certain) remaining the norm. However, motherhood may be acquired through giving birth to a child, by donation of gametes or by caring and nurturing a child so that the identity of the mother is no longer certain particularly in the case of surrogacy arrangements. While the law in the UK may automatically recognise the parental status of a commissioning father in a traditional surrogacy arrangement, the parental status of the commissioning mother is not automatically recognised in either a traditional or a gestational surrogacy arrangement. Thus the maxim mater est quam gestation demonstrat (meaning the mother is demonstrated by gestation) is also not approached consistently in the legal interpretation of parentage or motherhood in surrogacy as against other assisted reproduction methods. This raises questions about the extent to which motherhood should be affected by the method of reproduction and whether the sociological and philosophical concept of motherhood should, in the case of surrogacy, give rise to a new principle of ‘mater semper incertus est’ (the mother is uncertain). This article will argue that the time has come to move away from a legal definition of ‘mother’ that is based on biology to one that recognises the different forms of motherhood.

Available at:  Oxford Journals

Reproductive ageing and conflicting clocks: King Midas’ touchReproductive ageing and conflicting clocks: King Midas’ touch

Irenee Daly and Susan Bewley
Article in Reproductive Biomedicine Online, September 2013

The population attempting pregnancy and having babies is ageing. Gynaecological and obstetric complications worsen with age. Maternity services are struggling. Increasing rates of infertility and complications are not matched by the marvels in the laboratory. This paper argues that assisted reproduction treatment has had a damaging social impact. Despite its public acclaim, it helps few and fails many more. The assisted reproduction industry could take a new and revolutionary direction towards empowering men to experience pregnancy, producing babies from artificial gametes, with a final goal being the liberation of both women and men from the burdens and dangers of pregnancy through the development of artificial wombs.

Read more: Reproductive ageing and conflicting clocks: King Midas’ touch

Thinking through Surrogacy Legislation in India: Reflections on Relational Consent and the Rights of Infertile Women

Maya Unithan
in Journal of Legal Anthropology (2013) Vol. 1. No.3:287-313

Thinking through Surrogacy Legislation in IndiaAs its main focus the article is concerned with explaining the proposed Indian Assisted Reproductive Technologies (ART) Bill 2010 (2008), and in particular discusses some of its limitations using a relational conception of consent and autonomy. It is argued that two major limitations arise from, firstly, the way the Bill attempts to introduce ‘universal’ notions of informed consent into a cultural context of socially determined decisionmaking, resulting in the failure to safeguard the welfare of Indian surrogates. A second limitation is that the proposed law entitles only some poor women (surrogates) in India to realise access to quality medical healthcare services compared to others (poor, infertile women). Given the significant class and gender based inequalities which frame reproductive healthcare service delivery in the country, legally guaranteed access to health services for surrogates becomes a privilege where the rights of some individuals and couples to reproduce and exercise procreative agency is valued and not others. The article argues that the Bill must give due consideration to the complex, relational and highly stratified contexts in which women undertake childbearing in India to understand why legally comprehensive consent procedures can co-exist with violations of personhood in practice. Without such consideration the article suggests that injustice toward infertile women can become part of the same legal process wherein overcoming infertility is recognised as a right.

On reproductive justice: ‘domestic violence’, rights and the law in India

culture-health-sexuality

Sumi Madhoka, Maya Unnithan & Carolyn Heitmeyer
In Culture, Health & Sexuality: An International Journal for Research, Intervention and Care

In this paper we draw attention to the difficulty of accessing reproductive rights in the absence of effective state and legal guarantees for gender equity and citizenship, and argue that if reproductive rights are to be meaningful interventions on the ground, they must be reframed in terms of reproductive justice. Drawing on multi-sited ethnographic fieldwork conducted in Rajasthan, Northwest India, we track two dynamic legal aid interventions on reproductive health rights in India, concerned with domestic violence and maternal mortality respectively, that have sought to fill this existing gap between ineffective state policies and the rhetoric on reproductive rights. Through an analysis of these interventions, we propose that requirements of reproductive justice cannot be met through discrete or private, albeit creative legal initiatives, pursued by individuals or civil society organisations but must involve comprehensive policies as well as strategies and alliances between state, non-state, transnational organisations and progressive political groups.

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Sexually Transmitted InfectionsSexually Transmitted Infections

Sexually Transmitted Infections is the world's longest running international journal on sexual health. It aims to keep practitioners, trainees and researchers up to date in the prevention, diagnosis and treatment of all STIs and HIV. The journal publishes original research, descriptive epidemiology, evidence-based reviews and comment on the clinical, public health, translational, sociological and laboratory aspects of sexual health from around the world. We also publish educational articles, letters and other material of interest to readers, along with podcasts and other online material. STI is an official journal of the British Association of Sexual Health and HIV and the Australasian Chapter of Sexual Health Medicine.

Women’s and Children’s Health: Evidence of Impact of Human RightsWomen and Children’s Health: Evidence of Impact of Human Rights

Women and Children’s Health: Evidence of Impact of Human Rights is a monograph produced by WHO in 2013 (in which Maya Unnithan was a co-author) and launched at the World Health Assembly in May by lead author, Dr FLavia Bustreo, Assistant Director General, Family, Women’s and Children’s Health, WHO.

 See related Sussex news item

The Health of Women and Girls in Urban Areas with a Focus on Kenya and South Africa: A Review

Hawkins, K., MacGregor, H. and Oronje, R.
Evidence Report 42
Publisher IDS

The Health of Women and Girls in Urban Areas with a Focus on Kenya and South AfricaThis thematic review focuses on a range of health challenges faced in particular by women and girls living in low-income urban settlements in expanding cities in Kenya and South Africa.

The review has been compiled as part of a larger body of work being conducted by the Institute of Development Studies (IDS) and its partners on gender and international development and financed by the UK Department for International Development (DFID).

The review was preceded by a literature search (using keywords to reflect the thematic focus) of key databases of published literature, as well as a search for grey literature and documents describing interventions aimed at addressing these health challenges. An online discussion hosted by IDS gave a further indication of current debates and assisted in the identification of interventions.

Further details

Sexual and Reproductive Health Rights of Women Living with HIV in South Africa

Muller, A. and MacGregor, H.
IDS Evidence Report 3
Publisher IDS

Sexual and Reproductive Health Rights of Women Living with HIV in South AfricaSouth Africa's constitutional and legal framework reflects the country's commitment to women's Sexual and Reproductive Health and Rights (SRHR) in line with international commitments. Nevertheless, women's rights are still abused and overlooked.

Numerous policies detail the provision of services around sexual and gender-based violence, fertility, maternal, perinatal and newborn health, sexually transmitted infections (including HIV), and cancers of the reproductive system.

However, these policies exist in a social climate of extreme inequality, with high rates of poverty and unemployment. Despite almost equal representation of women in government and other high-profile areas, women in South Africa experience unprecedented rates of sexual and gender-based violence, and women's autonomy is all too often compromised by poverty, limited access to education, limited access to health care, and ongoing gender inequality that is bolstered by patriarchal norms.

Further details

Fatness and the Maternal Body: Women's Experiences of Corporeality and the Shaping of Social Policy

Fatness and the Maternal BodyMaya Unnithan-Kumar and Soraya Tremayne (eds)
Berghahn, 2011

Obesity is a rising global health problem. On the one hand, a clearly defined medical condition, it is at the same time a corporeal state embedded in the social and cultural perception of fatness and body shape and size. Focusing specifically on the maternal body, contributors to the volume examine how the language and notions of obesity connect with, or stand apart from, wider societal values and moralities to do with the body, fatness, reproduction, and what is considered “natural.” A focus on fatness in the context of human reproduction and motherhood offers instructive insights into the global circulation and authority of biomedical facts on fatness (as "risky" anti-fit, for example). As with other social and cultural studies critical of health policy discourse, this volume challenges the spontaneous connection being made in scientific and popular understanding between fatness and ill health.

Further details

Sexual behaviour

Medecine, May 2010

Recognition of sexual behaviours and needs is essential for all doctors in diagnosis, care after major illness, and humane management of social needs. The majority of adults are heterosexually active from adolescence into old age, while a minority of individuals have homosexual relationships throughout their lives, or during shorter periods. Among adults aged 16–44 years, a third of men and a fifth of women report a new partnership in the past year, and this proportion is higher among younger adults and men who have sex with men (MSM). Anal intercourse is practised by a significant minority of heterosexuals, as well as among MSM for whom it is a major route of HIV transmission. A small minority of individuals have large numbers of partners (a ‘core group’), and contribute disproportionately to the transmission of STIs and HIV. Behavioural interventions to reduce sexual risk among MSM can be effective, as in other groups, but attention to wider social determinants is also important in controlling STI and HIV transmission.

Read more: Sexual behaviour

Who Are ‘Informal Health Providers’ and What Do They Do? Perspectives from Medical Anthropology

Who Are ‘Informal Health Providers’ and What Do They Do?Cross, J. and MacGregor, H.
IDS Working Paper 334
Publisher IDS

This paper explores gaps and limitations in the conceptualisation, methodology and policy implications of debates about informal health care providers by examining a cross section of empirical studies.

Drawing on a tradition of critical medical anthropology, we argue that existing debates hinge on a particular understanding of what constitutes appropriate knowledge and on particular expectations of how economic actors in the medical marketplace will behave.

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Reproductive Agency, Medicine and the State: Cultural Transformations in Childbearing

Reproductive Agency, Medicine and the StateMaya Unnithan-Kumar (ed.)
Berghahn, 2005

Recent years have seen many changes in human reproduction resulting from state and medical interventions in childbearing processes. Based on empirical work in a variety of societies and countries, this volume considers the relationship between reproductive processes (of fertility, pregnancy, childbirth and the postpartum period) on the one hand and attitudes, medical technologies and state health policies in diverse cultural contexts on the other.

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Banner image: credited to Unnithan Res-062-23-1609