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?