Fertility, Health and Reproductive Politics: Re‐Imagining Rights in India By Maya Unnithan, London: Routledge. 2019. pp. 233.
Holly Donahue Singh
University of South Florida
For scholars and advanced students interested in shifting landscapes of sexual and reproductive health experiences and advocacy over time, Maya Unnithan’s book, Fertility, Health and Reproductive Politics: Re-Imagining Rights in India, has much to offer. This book centers social inequality as a key driver of not only health outcomes among marginalized women in rural and periurban Rajasthan, northwestern India, but also as a crucial basis for, and fault line of, struggles over reproductive and sexual health rights in contemporary India. It draws on ethnographic research conducted over nearly 20 years working with poor Hindu and Muslim women whose homes have, over decades, been absorbed into the periurban sprawl of Jaipur in India’s desert state. Their accounts demonstrate how they negotiate and navigate power, agency, and emotion in intimate spaces among kin and as they encounter institutions. The book highlights how their reproductive histories have been influenced by people working in civil society, planning and policy, health, and legal systems to enact power over fertile bodies. It demonstrates how people in local civil society organizations (CSOs) working toward more reproductive rights in the legal realm have used evolving arguments for reproductive rights and justice, shifting away from emphasis on population to focus on bodily integrity. Overall, the book documents the fascinating journeys of the families who have been Unnithan’s longstanding interlocutors and of the advocates who have been working to secure more expansive reproductive rights as global priorities. As such, Unnithan offers global theorizing about how the underpinnings of reproductive rights have changed over time.
The scope of the book encompasses multiple periods of research, including two years of fieldwork in 1998 and 2009, with shorter periods of research in between and continuing until 2016, creating an opportunity to reflect on transformations that have taken place in global sexual and reproductive health and rights over the span of Unnithan’s career, starting from her first field research in southern Rajasthan, India, in the 1980s. This research program blossomed since the 1990s in areas around Jaipur, where Unnithan herself grew up, and has continued there for the long term. Thematically, Unnithan gives most sustained and recurring attention to government reproductive health programs, such as the Janani Suraksha Yojana (Safe Motherhood Program), which has dramatically shifted the place of birth for women in Rajasthan, from 93 percent of urban births and 97 percent of rural births taking place at home in 1998 to only 12 percent of urban births and 25 percent of rural births taking place at home in 2012 (Unnithan, 2019, 122). As Unnithan’s interlocutors taught her over time, cash incentives for institutional birth initially made the move to hospitals attractive. Subsequent shifts in cultural norms, combined with a growing dearth of dais or traditional birth attendants (TBAs) willing to perform tasks associated with home birth and an emerging sense of a right to cash, have sustained hospital birth (128). This is a particularly compelling aspect of the book, demonstrating how the program has transformed local birth ideologies and practices, from who tends to people in labor and birth to what happens to the physical stuff of birth (placentas are full of meaning) and how these changes have brought with them both choices and compulsions. This is despite limitations in hospital capacity that result in institutions that cannot guarantee risk-free birth for birthing people or for newborns (141) and a heavy reliance on community health workers (ASHAs) who often share local biases about methods of birth control and their own financial incentives to refer birthing people to particular facilities, most often favoring more expensive private hospitals over subsidized public ones (136, 138).
Unnithan engages with a range of interrelated topics on kinship and familial dynamics as they pertain to fertility and infertility, maternal risk, surrogacy, sex-selective abortion, and domestic violence. The book connects them through the lenses of kinship and family relations, as well as through ever-changing reproductive rights advocacy. These are all areas in which there have been sustained programs addressing associated challenges. Among these, infertility is the issue that has been least attended to by government and nongovernmental programs, although Unnithan argues that it is one that looms large for women in this context and that it influences many other aspects of family life and fertility behavior (69). The perspectives on conceptions of infertility and poor women’s methods of dealing with it by turning to local healers and kin networks are especially robust and important.
The book concludes with an epilogue that demonstrates how the core insights of ethnographic health research can travel into other spaces to influence global health policy and, perhaps, to direct some focus away from numbers and toward lived experience. Unnithan’s account of being invited to participate in a 2012 World Health Organization steering committee on human rights approaches to health for women and children offers an example of how to highlight the value of and the need for the fruits of ethnographic inquiry beyond comfortable anthropological spaces. It also posits a frame for anthropologists to communicate our work to broader audiences who are interested and would benefit from learning more about how in-depth, local, and necessarily partial accounts provide needed insight beyond what statistical tools alone can yield.
Fertility, Health and Reproductive Politics includes rich longitudinal ethnographic accounts from an established expert in the field and provides inspiration for cross-cultural advocacy work in legal and policy spaces. The style of writing makes the book most approachable for scholars, advanced graduate students, and global health practitioners who are broadly familiar with reproductive health, rights, and justice conversations and/or with ethnographic and demographic contexts of northern India. Selected sections focused on one of more of the interlinked topics could be excerpted for use in undergraduate teaching, with appropriate preparation and framing discussion. Unnithan’s account shows the value of long-term, sustained ethnographic research for documenting the effects that theoretical shifts and implementation in policy have in particular places. It provides a basis for imagining paths forward toward securing greater reproductive well-being for people in South Asia and toward expanding attention to infertility in movements for reproductive justice. In this sense, the book contributes to larger conversations about the multiple and particular forms that reproductive justice could take in the Global South and what this new framework might mean for marginalized people around the globe.