University of Cambridge
In reproductive studies, there are two broad approaches to reproductive technologies. One is focused on describing and analyzing the details of a particular technology and how its users and practitioners engage with it, and the other approaches these technologies as a lens for reflecting on what their use can tell us about the broader contexts in which they are developed and taken up. Of course, these approaches are not mutually exclusive, and studies that combine both probably offer the most to scholarship. Charlotte Kroløkke’s book, Global Fluids, falls more under the second approach, though her powerful insights about the political, economic, and ethical workings of the fertility sector and its allied industries are illustrated throughout this fascinating account, with striking examples of how urine, eggs, and placentas move through regimes of waste and value.
Kroløkke is a professor of cultural studies, and this is reflected in her analytical approach (pp. 22–27), though she also draws on interdisciplinary research projects that used qualitative research methods, a number of which have already been published in different forms. This book brings the three case studies of urine, oocytes, and placentas together in an “assemblage ethnography,” incorporating analysis of relevant medical, legal and media texts with interviews and ethnographic fieldwork across Denmark, Spain, Japan, the Netherlands, and the United States (p. 8). In this, Kroløkke writes, she is influenced by multi-sited ethnography, queer and literary studies, and previous studies of science, technology, and biopolitics within anthropology and sociology. She explains: “To prioritize assemblage thinking as an analytical as well as an empirical tracking device means recognizing the multiple and heterogenous ways that reproductive donations come to be enacted in discursive, affective, technological, and situated practices, as well as how they frequently entangle” (p. 9).
The book has four chapters in addition to the introduction and conclusion. The three case studies (urine, oocytes, and placentas) each get their own chapter, preceded by another called “Scholarly Conversation.” In this chapter, Kroløkke extends her introductory discussion by theorizing how reproductive substances go from being conceptualized as waste products to becoming valuable bioproducts (p. 21). In doing so, she engages with the “mobility turn” (p. 21), an analytical response to the globalization of the fertility industry. As she says, scholars of reproduction must engage with the ways in which the donation, circulation, and use of reproductive substances are implicated in the global fertility industry—and indeed help make it possible. In the three case study chapters, Kroløkke makes analytical incisions into the data presented, interrupting the flow of these substances to consider how they move in and out of gift and commodity, waste, and value states. This resonates with her call for scholars to look beyond what is exchanged to how particular substances (and, by extension, reproductive labors) become mobile and exchangeable, or not (p. 18). This will, she points out, help us see that markets in reproductive substances and technologies not only create wealth but also reconfigure ethical values (p. 18).
As someone very familiar with the literature in reproductive studies, I was pleased to see that Kroløkke foregrounded urine and placentas, two substances that have been rather overlooked in the field. Both are compelling cases, complementing Kroløkke’s skillful discussion of oocyte donation between Spain and Denmark and egg freezing in the United States and the United Kingdom. The urine case study follows a Dutch program in which women who are six- to 16-weeks pregnant collect their urine and donate it to be transformed into pregnancy testing kits and fertility drugs. The final case tracks the various journeys of placentas, some of which are ingested by mothers according to spiritual and medical rationales. Kroløkke also discusses how placentas from humans and from Danish pigs also make their way into the Japanese beauty industry, where they are used in products that promise anti-aging and skin whitening.
Kroløkke explains her approach to the global nature of reproductive donation not only as a reflection of the mobility of substances, patients, practitioners, pharmaceuticals, and money across national borders, but also as imbricated in neoliberal and neocolonial ideologies that both stratify reproductive technologies and replicate racialized and gendered inequalities. Kroløkke argues that “Reproductive substances are not only global; they are also made to appear mobile,” and that “Mobility concerns not only the ways that fluids flow (or are blocked from flowing) but also the ways that reproductive fluids mobilize particular understandings of the reproductive body” (p. 45).
Shortly after I gave birth to my daughter and following a syntocinon shot, I delivered our placenta. The midwife subsequently held it aloft while asking if my partner and I wanted to see it; we both murmured a “not really,” but it was already too late. Perhaps still a little under the influence of the gas and air, I thought how her silhouette resembled Salome with John the Baptist’s head, pre-dish. I mention this somewhat grisly personal experience to give some background to why I struggle to think of such a fleshy, weighty object as a fluid. I think there are intellectual, as well as visceral, reasons to question this characterization. While I agree with Kroløkke’s approach in its broad intellectual and political dimensions, I was left wondering as I read on how placentas and oocytes are (and are not) fluid, or to put it another way, what the difference is between mobility and fluidity in Kroløkke’s thinking. She provides some answers to this, but not until the penultimate section of the book. There, she explains that in treating her case study substances as fluids, she is following Annemarie Mol and John Law’s conceptualisation of fluid spaces (p. 161). Kroløkke extends this to describe how reproductive substances move in and out of commodity status. While I agree that fluidity is good to think with when it comes to the mobilities, flows, and assumptions of globalized capitalism (and it might have been interesting here for Kroløkke to engage with the concept of liquid modernity), I wonder what it does to a substance such as an oocyte or placenta to conceptualize it not only as fluid (an adjective), but also as a fluid (a noun).
Despite my hesitations about whether Kroløkke is describing global fluids or global fluidities—and whether they can, as she suggests, be both—this book represents a timely, insightful, and valuable contribution to reproductive studies. It offers a good example of how to do interdisciplinary, comparative work that critically engages with both the contexts and the consequences of the global fertility industry, which is a booming and influential part of the contemporary economy that medical anthropologists would be unwise to ignore. Global Fluids provides a sophisticated understanding of how class, gender, race, and sexuality intersect in the global flows of reproductive substances, though I was surprised that despite her critical attention to these inequalities, Kroløkke often cited “attractiveness” as if it were an unproblematic or universal category. In addition to presenting some less familiar aspects of this industry, Kroløkke’s case studies show the continued importance of multispecies relations in the development of reproductive science and fertility treatments, which are sadly often overlooked in social scientific accounts of human reproduction. The work presented in this book would not only provide a useful and enlightening teaching tool, it could also help guide further research into other reproductive substances as various as breastmilk, culture media, and stem cells.