Assisted Reproduction and Distributive Justice

The Canadian province of Quebec recently amended its Health Insurance Act to cover the costs of In Vitro Fertilization (IVF). The province of Ontario recently de‐insured IVF. Both provinces cited cost‐effectiveness as their grounds, but the question as to whether a public health insurance system ought to cover IVF raises the deeper question of how we should understand reproduction at the social level, and whether its costs should be a matter of individual or collective responsibility. In this article I examine three strategies for justifying collective provisions in a liberal society and assess whether public reproductive assistance can be defended on any of these accounts. I begin by considering, and rejecting, rights‐based and needs‐based approaches. I go on to argue that instead we ought to address assisted reproduction from the perspective of the contractarian insurance‐based model for public health coverage, according to which we select items for inclusion based on their unpredictability in nature and cost. I argue that infertility qualifies as an unpredictable incident against which rational agents would choose to insure under ideal conditions and that assisted reproduction is thereby a matter of collective responsibility, but only in cases of medical necessity or inability to pay. The policy I endorse by appeal to this approach is a means‐tested system of coverage resembling neither Ontario nor Quebec's, and I conclude that it constitutes a promising alternative worthy of serious consideration by bioethicists, political philosophers, and policy‐makers alike.     

Discourses of Loss and Bereavement in Tigray,Ethiopia

Western trauma frameworks, such as PTSD-focused inventories and interventions, are embedded in a psychosocial discourse saying that highly distressing experiences must be expressed and confronted. This study, which is based on six months of focused ethnographic research in postwar Tigray, Ethiopia, reveals authoritative Tigrayan discourses that encourage people to avoid disclosing and expressing emotional pain. Dogmas of the Ethiopian Orthodox Church, saying that grieving and crying would have negative physical and spiritual consequences, were found to have a broad consensus in the society. The ethnography suggests that the Tigrayan psychosocial discourses make sense and may be functional in their context, as the marginal socioeconomic conditions of Tigray force individuals to concentrate on their day-to-day struggle for survival. Findings are discussed in terms of implications for the cross-cultural applicability of conventional frameworks of Western trauma psychology.     

Ethiopian Church Forests: A Hybrid Model of Protection

Protection of forests because of their association with religious traditions is a worldwide phenomenon. These sacred forests play a key role in maintaining ecosystem services in regions affected by land system change. In the northern highlands of Ethiopia, the Ethiopian Orthodox Tewahido Church controls the majority of the surviving native forest. However, the reasons why communities value the forests and the ways they use and manage them are not well understood. We use data and analysis from an interdisciplinary project and ethnographic research, in particular, to explain how Ethiopian church forests function. Church forests represent an unusual form of community-based protection that integrates locally controlled common property with external institutional arrangements: this hybrid system is highly effective at protecting the forest while maintaining cultural practices. Our results inform theoretical debates about models of tropical forest protection and question assumptions about church forests being the product of a nature conservation imperative.     

Sacred Conceptions: Clinical Theodicies, Uncertain Science, And Technologies Of Procreation In India

This article argues that the rapid transfer of assisted conception technologies, such as in vitro fertilization, to India is not restricted merely to the modalities of offering potential biomedical resolution of infertility but includes, more crucially, how clinicians and infertile consumers assimilate the “Western technoscience” of conception. The article draws on a larger multisite ethnographic study of infertility and assisted conception in India’s five major cities and is principally based on narratives of clinicians and infertile couples and on clinic-based ethnographic observations. In this article I contend that the success or failure of assisted conception, when situated in the universe of Hindu faith, becomes a powerful critique of the “incompleteness” of the “Western” science of conception. Situating this contention in the broader context of a clinician’s faith, I assert that assisted conception—by conjoining seemingly disparate domains of the traditional and the modern, the sacred and the profane, the human and the superhuman, science and religion—produces clinical theodicies that help explain and contain the tentativeness permeating the conception technologies. The article concludes by arguing that this enchanted version of a thoroughly disenchanted worldview of biomedicine is part of a larger cultural process of indigenization of biomedicine in India.     

Redrawing the boundary of medical expertise: medically assisted reproduction and the debate on Italian bioconstitutionalism

In 2004, the Italian Parliament passed a controversial law on medically assisted reproduction (Law 40/2004). The Law obliged clinicians to create a maximum of three embryos during one in vitro fertilization (IVF) cycle and transfer them simultaneously into the patient’s uterus. With this “three embryo” standard, the Parliament sought to secure the realization of rights of IVF embryos. Drawing on the concepts of boundary-work [Gieryn, T. F. 1983. “Boundary-Work and the Demarcation of Science from Non-Science: Strains and Interests in Professional Ideologies of Scientists.” American Sociological Review 48 (6): 781–795] and bioconstitutionalism [Jasanoff, S., ed. 2011. Reframing Rights: Bioconstitutionalism in the Genetic Age. Cambridge, MA: MIT Press.], this article explores the role that the constitutional obligations of the Italian State towards its citizens, including IVF embryos as its new “citizen subjects,” played in how it envisaged and demarcated the professional boundaries of medical expertise. It argues that the latter depended upon how it balanced its commitments to protect the rights of IVF embryos and those of adult citizens. As such, the demarcation of the jurisdictional boundaries of medical expertise, and the definition of constitutional rights, formed two sides of the same governing project.     

God’S Laboratory: Religious Rationalities And Modernity In Ecuadorian In Vitro Fertilization

Catholicism is the only major world religion that unequivocally bans the use of in vitro fertilization (IVF). Nevertheless, in Ecuador, Catholic IVF practitioners declare God’s dominion over their IVF laboratories and clinics in explaining pregnancy outcomes. My analysis of this routine combination of spiritual and material causal models in Ecuadorian IVF contributes to two ongoing discussions about (1) the tensions between “institutional” and popular forms of Catholic religiosity and (2) the proper boundaries of science in modernity. The Catholic Church’s historical and contemporary struggle to determine control of the miraculous has usually been characterized as a conflict between educated clergy and humble peasants. In the case of Ecuadorian IVF, we find, instead, educated elites and middle classes participating in this same contestation with the Church, proclaiming their direct ability to harness the power of God to effect material change on earth. This spiritual power to affect clinical outcomes does not take place just anywhere, but in clinic and lab, disrupting another set of presumptions about modern scientific practice and subjectivity. Like other Ecuadorian elites and middle classes, IVF practitioners are heirs to Enlightenment thought, and experience themselves as modern in their participation in these high-tech endeavors. But their spiritual approach to laboratory rationality does not trouble these IVF practitioners’ experience of themselves as moderns, prompting a reevaluation of the narratives of scientific modernity that limit their scope to Europe and North America.     

Charismatic Catholic Renewal in Bougainville: Revisiting the power of Marian devotion as a cultural and socio‐political force

This article explores the interplay between culture and Christianity by detailing the history, experience, and impact of the Charismatic Catholic Renewal in the Autonomous Region of Bougainville in Papua New Guinea (PNG). In 1985, the PNG Catholic Bishops' Conference approved the charismatic movement as one of the authentic movements for spiritual renewal of the Catholic Church in PNG. However, the conference stressed this renewal not to be made independent or outside of the Church. In this article I discuss how in Bougainville the Catholic Charismatic Renewal (CCR) has been predominantly operating ‘outside’ the institutional Catholic Church, drawing upon both Catholic and cultural logics to mobilise devotees across Bougainville towards renewal and political change. In particular, I will focus on various local Marian movements, elucidating the power and force of the CCR in contexts of Bougainville's civil war (1988–1998). In doing so, this paper will explore what Catholicism and CCR may contribute to discussions about the positioning of culture within Christianity, at the same time showing how charismatic Marian devotion invites reassessment of recent prevailing discussions on cultural ‘continuity’ versus ‘rupture’, as well as doctrinal boundaries held so dearly by the CCR and the Roman Catholic Church in general.     

"A disease of frozen feelings": ethically working on emotional worlds in a Russian Orthodox Church drug rehabilitation program

In a Russian Orthodox Church drug rehabilitation program in St. Petersburg, drug addiction was often described as a disease of frozen feelings. This image suggests that rehabilitation is a process of thawing emotional worlds and, thus, allows the emotions to flow once again. In this article I argue that "frozen feelings" is better understood as the unsocial emotional worlds many drug users experience, and that rehabilitation in this church-run program particularly focuses on the cultivation of an emotional world that supports sociality. This is done, I argue, by means of ethically training rehabilitants to learn how to control and manage their emotional worlds, and in so doing, rehabilitants become new moral persons better able to live in the social world.     

Animal bells as symbols: sound and hearing in a Greek island village

This article deals with the cultural construction of sound and hearing in a mountain village in the Greek island of Naxos, in the Cyclades. The analysis is based on the ethnographic presentation and discussion of the cultural meanings and symbolism of animal bells. I further explore the relation of bells and their sound to the issues of social reproduction and the cultural constitution of social order. By focusing on the indigenous conceptualizations of sound and noise and the metaphoric language concerning the sense of hearing, I also consider some wider aspects of sound, sound symbolism, and hearing in this community.     

Improving ovarian stimulation protocols for IVF in baboons: lessons from humans and rhesus monkeys

The aim of this review paper is to provide a scientific basis for the development of ovarian stimulation (OS) protocols for in vitro fertilization (IVF) in baboons. Firstly, the evidence available regarding OS for assisted reproduction in baboons is reviewed based on available published data, assessed by a Pub Med search of papers published between 1970 and 2008 using the following key words: baboon, assisted reproduction, IVF, embryo, oocyte. Secondly, we discuss how state-of-the-art or potentially new OS protocols used in humans and in rhesus monkeys may offer guidance for the development of standardized and reliable OS protocols for IVF in baboons. Based on this review and discussion, we conclude that more randomized trials are needed to improve standardization of OS protocols for IVF in baboons with respect to gonadotrophin type, dose, duration of stimulation, ultrasound monitoring, and time interval between ovulation trigger and oocyte retrieval.     

Global Health Care Justice,Delivery Doctors and Assisted Reproduction: Taking a Note From Catholic Social Teachings

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution.     

Tickets to the Opera: A Negotiation of Western Knowledge—Beyond Resistance or Reproduction

What are the prices of "must knowledges?" Does the study of English impose Anglocentric control on its learners or can English as an icon for "must knowledge" enable disempowered populations to empower themselves? This article examines these questions through an ethnographic study of middle-/lower-class Orthodox and Sephardic Jewish women in an adult education course. The women did not resist "Western knowledge," yet its potential for empowerment was not realized. This study offers anthropologists of education an opportunity to reexamine the relations between local cultural systems and external knowledges beyond the binary prism of resistance versus reproduction.     

Materiality and Cosmology: Old Georgian Churches as Sacred,Sublime, and Secular Objects

Discourses about Georgian churches have since the nineteenth century treated the material quality of'ancientness’ associated with existing churches as being among their essential defining properties. This paper first explores how different material qualisigns of churches, including oldness and qualisigns attendant on oldness, allow churches to be interpreted as secular objects, by ordering them with theatres (as expressive of'civilization'), the natural landscape (expressive of an aesthetics of the sublime) or other monuments, including texts (expressive of culture). One result of such discourses is that the contemporary Orthodox Church finds it difficult to have ‘new’ churches accepted as being churches at all. These nineteenth‐century discourses thus provide a context for the complex and contested reception of old and new Orthodox churches, as well as other religious structures, such as mountain shrines, which have a more ambiguous relation with Orthodoxy.     

Lawful Sinners: Reproductive Governance and Moral Agency Around Abortion in Mexico

The Catholic Hierarchy unequivocally bans abortion, defining it as a mortal sin. In Mexico City, where the Catholic Church wields considerable political and popular power, abortion was recently decriminalized in a historic vote. Of the roughly 170,000 abortions that have been carried out in Mexico City's new public sector abortion program to date, more than 60% were among self-reported Catholic women. Drawing on eighteen months of fieldwork, including interviews with 34 Catholic patients, this article examines how Catholic women in Mexico City grapple with abortion decisions that contravene Church teachings in the context of recent abortion reform. Catholic women consistently leveraged the local cultural, economic, and legal context to morally justify their abortion decisions against church condemnation. I argue that Catholic women seeking abortion resist religious injunctions on their reproductive behavior by articulating and asserting their own moral agency grounded in the contextual dimensions of their lives. My analysis informs conversations in medical anthropology on moral decision-making around reproduction and on local dynamics of resistance to reproductive governance. Moreover, my findings speak to the deficiencies of a feminist vision focused narrowly on fertility limitation, versus an expanded framework of reproductive justice that considers as well the need for conditions of income equality and structural supports to facilitate reproduction and parenting among women who desire to keep their pregnancies.     

Machos and Sluts: Gender, Sexuality, and Violence among a Cohort of Puerto Rican Adolescents

During the past decade, interpersonal violence increasingly has become a public health concern. As a result, prevention programs now aim to decrease violence among diverse populations. This article describes the beliefs and rationale for gender-based violence among a cohort of low-income, predominantly second-generation, mainland Puerto Rican adolescents. Based on a three-year (1989-91) ethnographic study, the findings describe how these young people, through the use of gender-based social constructs such as "machos" and "sluts," justify violence by linking it to beliefs about gender roles, sexuality, and biology, and thus perpetuate gender-role conformity, particularly heterosexual male dominance. The findings suggest that if the public health community is going to reduce gender-based violence among Puerto Rican youth, it needs to acknowledge that gender and sexuality are important ingredients that support violence and avoid a simplified and stereotypical model of culture that ignores other social factors and changes in traditional Latino gender roles.     

The spiritual commons: Some immaterial aspects of community economies in eastern Indonesia

Informed by anthropologist Stephen Gudeman’s dialect between the interacting realms of community and market economies, I seek in this article to focus on aspects of the commons and the shared values of a community that might be referred to as the ‘spiritual commons’. The phrase speaks specifically to the ideas and practices that guide the ritual and spiritual elements of social life. I argue that the spiritual commons is not a realm set apart from economic life but integral to its reproduction. Gift exchange, sacrifice and commensality enacted as expressions of religious sociality represent economies of symbolic goods that serve both material and ideational ends. The article draws upon ethnographies of eastern Indonesia and the comparative possibilities expressed in case studies from Islamic southeast Sulawesi and Catholic Flores.     

Re-Bordering the Nation: Neoliberalism and Racism in Rural Greece

Over the last several decades, rural Greek society has undergone rapid changes. In large part these changes are due to two interrelated developments: the integration of Greece into the European Union and the arrival of large numbers of Eastern European migrant laborers. Social organization in Greek villages has been influenced by global systems of production and exchange for hundreds of years, if not longer, but since the early 1980’s, with the accession of Greece into the European Union, these relations seem to have been altered in novel ways. As Greece has become integrated into the transnational and global markets through the E.U., social relations are increasingly shaped by a pervasive global trend toward neoliberalism, that is, by a new round of market liberalization that has in effect redefined the way that local communities and international markets interact. This change has had a profound effect on the ways that rural Greeks participate in international markets as both producers and consumers. A related development, in fact a by-product of neoliberal policies in the formerly socialist countries of Eastern Europe, is the introduction of large numbers of immigrant laborers into rural Greece, which has significantly altered rural labor markets and allowed for important changes in patterns of the social reproduction of labor. While these changes have been for the most part not of their own making, except perhaps in an indirect way, Greek agriculturalists are not hapless victims in these developments. Globalization has indeed brought changes to rural society, but not exactly in the ways that policy-makers or others with a “top -- down” perspective have imagined. During ethnographic fieldwork that I conducted in several Greek villages between 2000 and 2004 I found that rural people have engaged these changes in the global political economy through an active process of adaptation, manipulation, resistance and accommodation. Here I will focus on changes in the mobilization of labor and the production of national identity, and the relationship between the two. I will argue that there has been a transformation in how national identities are being produced within the new configuration of nation and state that has important implications for understanding how inequality is structured and reproduced under global capitalism.     

Translation, Value, and Space: Theorizing an Ethnographic and Engaged Environmental Anthropology

In this article, I argue for placing the politics of translation and theories of value and spatial production at the center of environmental anthropology. For the past ten years, the Gimi-speaking peoples living in Maimafu village, Papua New Guinea, have taken part in an integrated conservation and development project attempting to foster a local system of valuing "nature" by tying biological diversity to economic markets through the creation of "eco-enterprises." However, the project fails to consider how Gimi produce, theorize, transmit, and express knowledge. Using ethnographic material concerned with hunting and song composition, I show that Gimi understand their forests to be part of a series of transactive dialectical relationships that work to produce identity and space. I also demonstrate that, as part of this project, Gimi social relations with their forests have been translated in ways that fit their beliefs into generic and easily understandable categories. This has been detrimental to the conservation project and it is politically problematic for an engaged environmental anthropology.     

Life,unlimited: Russian archives of the digital and the human

Since the end of the Soviet Union, questions of memory and history have been at the centre of public debates, often focused on the institutions of archives and libraries. This article considers a particular incarnation of arkhivnaia bolezn’ (archival disease, roughly archival fever) with genealogies going back to the pre-revolutionary writings of the visionary nineteenth-century philosopher-librarian Nikolai Fedorov. Specifically, I examine practices among contemporary techno-futurists seeking to combine Fedorov's ideas with modern information technologies – both existing and speculative – with the aim of overcoming death and, for some, of surviving posthumously in virtual spaces for now. Based on original ethnographic fieldwork in Russia, the article chronicles immortalists’ efforts to overcome ‘the violence of the archive’ by envisioning and producing a utopian version that is as totalizing as it is personal, designed to satisfy both Orthodox Christian and secular desires for eternal life. In this archive, old and new media like oral histories and genomic data exist alongside each other, both material and virtual, frozen in a vial or uploaded into cyberspace. I interpret the Russian episodes recounted here, attending to the ways in which new archival imaginaries and technologies reconfigure notions of the human self and embodiment.     

Assisted existence: an ethnography of being in Ecuador

In Ecuador, reproductive assistance, whether from God, extended family, or medical technologies, is emphasized and desirable in a precarious and unequal world with a minimal social safety net and chronic economic insecurity. Assistance is the very grounds of being. In better‐resourced realities like parts of the United States, assisted reproductive technologies can trouble the biological and social autonomy of individual heterosexual couples. Juxtaposing assisted reproduction in these divergent sites demonstrates that resources can make autonomy easier to establish and assistance between people and things difficult to perceive. Through an insistence on the material specificity of assisted reproduction itself, this ethnographic contrast contributes to anthropological approaches to ontological questions of being. In particular, ethnographic observation of the material realities of reproductive treatments in Ecuador demonstrates that medical care is one means to instantiate race. Private assisted reproduction makes whiter babies and patients in the face of a crumbling public health care infrastructure whose patients are by definition poor and Indian. The framework of assistance might serve then as a means to ethnographically trace the constitution of racial being in better‐resourced nations, as well as allow for a more comprehensive recognition of the interdependence of existence.