Medical anthropologists attend to how power inequities predispose particular people’s bodies to harm, and render particular people’s interests irrelevant to dominant social institutions. In the wake of the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, we can expose the processes that have made pregnant women vulnerable, irrelevant, even invisible.1 This essay is one effort.
Our profession offers precedent. Feminist anthropologists in the 1970s recognized that inattention to women’s lives and experiences had produced “distorted theories and impoverished ethnographic accounts.” Women’s invisibility was unsurprising. Anthropologists typically came from societies that excluded women from critical political and economic processes, exclusions often justified by their reproductive roles. When Woman, Culture, & Society was published, one in five U.S. anthropology professors, one in twelve physicians, and one in thirty-three congress members was female. The Supreme Court ruled that year that firing employees who became pregnant, a widespread practice, was not discrimination. Rape was legal in every state if a woman was married to the rapist, and violence against women within their homes was widely seen as a matter for private shame, not public policy. In some states, wives—including privileged white women—were invisible to contract law: they could not keep a natal surname, maintain a separate home, or operate an independent business without a husband’s permission. Women of color and people living in poverty were even more vulnerable to legal and social structures that kept women from power.
Social scientists interrogated how institutions maintained these exclusions and blind spots, and how women subverted them. Leith Mullings showed, for instance, that pregnant Black women in Harlem worked creatively within networks of kin and friends to find paths to survival, protection, and joy, even as they lived under constant pressures of discrimination and exclusion. Studies of reproduction often revealed connections between subjugation and silencing, inequity and invisibility.
In 2022, women have been made to vanish again. The absence of women in the Dobbs v. Jackson majority opinion was so remarkable that three dissenting justices called it out. It was so thorough that the majority concluded that abortion required no heightened scrutiny, because it was not a sex-based issue.
Pregnant women’s erasure in the Dobbs decision has many antecedents.
Public health erasure
In 1985, an obstetrician and an anthropologist asked “where is the M in MCH?” Their article’s title indicted “maternal-child health” specialists who assessed maternal wellbeing only to the extent that it affected infants. The pointed question for a time sharpened public-health focus on maternal survival, and prompted development of new techniques to measure pregnancy-related dangers.
Maternal-health measurement tools continue to obscure and distort reproductive realities. In Senegal, ambiguous pregnancy losses among married and wealthier women are typically documented as “miscarriages.” Among unmarried young poor women, they are listed as “abortions,” meeting clinicians’ needs to appear appropriately attentive to illegal practices while not causing trouble for the well-heeled. Elsewhere, standard labor-ward records intended to aid decision-making and clarify causes of poor outcomes instead conceal negligent obstetrical care.
From Texas to Nigeria, maternal deaths are made to disappear through counting and record-keeping practices. Such practices create illusions of progress and safety, threatening a return to the days when the M in MCH was vestigial.
Clinical erasure
On labor wards around the world, many anthropologists have shown, the clinical routines of healthcare providers and institutions take precedence over the priorities of pregnant people. Poorer, younger, and racialized women are especially likely to be treated as persons whose needs and desires do not count. In Mexico, obstetrics trainees learn to depersonalize indigenous women and women on public insurance as “cases,” to be granted little voice in their care. From Pakistan to Peru, clinicians often subject laboring women on the social margins both to unwanted over-intervention, such as unsafe injections of oxytocin or unconsented episiotomy, and to neglect of their pain or fear. The pattern holds in the United States, where Black women and Medicaid beneficiaries—and especially Black women living in poverty—are surveilled and suspect, managed but not heard, presumed to be “wily” threats to fetal wellbeing.
Other marginalized people can also feel erased by hospital practices. Trans men and non-binary people often report increased social and emotional isolation during pregnancy, and while accessing antenatal or abortion care.
Many obstetricians say that we are “treating two patients.” One can speak for herself. In this view, the obstetrician must speak for the other. A two-patient model pits the needs of parents against the (projected) needs of potential offspring, often at the cost of the pregnant person’s desires.2 Perinatal psychologists in urban Turkey “speak for” fetuses, voicing pleas for particular kinds of birth experiences that middle-class mothers should provide (no matter their own wishes). Privilege offers no immunity: well-off white women in the U.S. report “maternal vanishing” and disempowerment during pregnancy care. For Black women, including educated elites, the experience of erasure can be pervasive, devastating, even lethal.
Erasure from evidence
Some acts of erasure stem from interpersonal sexism, frequently expressed alongside interpersonal racism and class discrimination: “different forms of bigotry often have a high comorbidity.” Some erasure is structural, built into the evidence base of medicine. Widely used clinical “best practices” are constructed from evidence that systematically excludes maternal subjectivity, long-term maternal outcomes, and even maternal bodies.
The field of fetal surgery is notorious in this regard, its practitioners often characterizing mothers as environments, incubators, or workspaces. Ethicists have begun to rename these procedures as maternal-fetal surgery—since they inevitably require cutting into the pregnant parent—to correct a semantic problem with material effects. Researchers in the field continue to prioritize the fetus, however.3 Many studies give no data on maternal complications or include only short-term outcomes. A rare longer-term review of subsequent pregnancies in people who had undergone maternal-fetal surgery characterized a 10% uterine rupture rate as a “favorable” outcome. To compare, a uterine rupture rate one twentieth as high in labors that followed prior cesarean section was viewed as so disastrous that it led to a sea change in obstetric practice.
Technological erasure
Routine technologies also hide mothers from view. Anthropologists who study ultrasonography have shown that fetal visualization makes the hidden familiar, the sonographer or radiologist the expert on fetal wellbeing, and the maternal body the backdrop to a fetus suddenly given public life. In ultrasound images, fetuses appear to float independently like tiny astronauts in a dark surrounding space. The illusion is produced by a transducer that emits high frequency soundwaves and a software program that turns waves bounced back into pixels on a screen. But every fetus conjured on a screen is materially deep inside a person’s body, an integral part of that body, oxygenated with blood pumped from her heart through her lungs, nourished by food he eats and digests, its bones built from their bones, its wastes processed by her kidneys and liver.
The illusion of the independent fetus has materially real effects. The Dobbs decision refers to the impact of “modern developments” that lead to “a new appreciation of fetal life.” After all, “when prospective parents who want to have a child view a sonogram, they typically have no doubt that what they see is their daughter or son.” The use of “daughter or son” reifies both the personhood of the embryo, and a gender binary that has no space for beings who are neither he nor she.
Rhetorical erasures
Just as images can make a fetus appear to float freely, so can words. Rhetorical practices often displace pregnant women.
Take, for example, the Mississippi Gestational Age Act upheld by Dobbs. The act refers to fetuses or embryos almost three times as often as gestational parents. Subtler erasures lie beyond this disproportion. The law never uses the nouns “fetus” or “embryo” to characterize the fetus or embryo: it is an “unborn human being” or a “child.” Unlike the person within whom it grows, who never gets pronouns, the fetus is gendered he or she, its body parts his or hers. Again, the language reifies both personhood and binary gender. The word “fetal” appears four times, always in the phrase “severe fetal abnormality,” a rhetorical sleight of hand that differentiates problem fetuses from perfect unborn children. When a mother is referred to at all it is primarily as “the maternal patient,” a reminder of the two-patient model. Rhetorically, in this law the “unborn child” floats in a vacuum, while the maternal patient is always tethered to the fetal patient.
A focus on extremes can subtly erase women’s lived experiences of abortion. In responses to Dobbs, many commenters described the consequences for pregnant women with advanced cancers, devastating fetal abnormalities, or life-threatening conditions such as maternal sepsis. A small set of clinicians opposed to abortion dismissed these circumstances as rare: they are not. But every year, millions of people in the U.S. seek abortions for more mundane reasons. Katie Watson points out that the focus on “extraordinary” abortions creates a moral hierarchy: ordinary women who get abortions for ordinary reasons—I don’t want a kid right now, I can’t afford a child, my other children need me, I don’t want a child that ties me to this guy, my special-needs kid takes all the care I have to give—are at the bottom. Mundane reasons for abortion often involve relations of care that cannot be separated from structures of unequal power. Expectations and obligations of care are often highly gendered, but that gendering is so thoroughly naturalized it is mostly invisible.
Neutral language can create a different kind of rhetorical erasure. Many individuals and organizations now use only “people” to describe those seeking—or barred from—abortion care. This language acknowledges that not everyone capable of pregnancy is a woman: it is meant as inclusive. A more accurate term is “neutral,” rather than “inclusive,” because this language does not specifically identify anyone by gender: not trans men, not gender-nonconforming people, not women.
Exclusive use of gender-neutral language can make it difficult to specify the contributions of sexism to constraints on reproductive justice. Contrast, for instance, two statements on the Dobbs v. Jackson case. One uses gender-neutral language throughout. While it includes reference to the roles played by white supremacy, racism, and homophobia in anti-abortion politics, it mentions sexism only once in passing and does not hint at misogyny or patriarchy. Another uses diversified terms that include “women” and “pregnant people.” That group explicitly defends the rights of people of any gender to safe, respectful care, while pointing out that the overturning of Roe v. Wade denies women liberty, autonomy, and full and equal status as citizens.
Gender remains an extraordinarily powerful social category. In fact, as activists and scholars have long pointed out, strict policing of a gender binary has been a critical mechanism of social control used in many practices of subjugation, including those faced by cisgendered women, transgendered and gender-diverse people. Failure to consider gendered experiences means failure to understand the workings of sexism—structural, interpersonal, or internalized.
Intersectional Erasures
Like reproduction more broadly, abortion must be understood intersectionally. Consider a historical example. Feminists in mainland France fought for the right to abortion in the 1960s and 1970s. Meanwhile, a scandal over unwanted and unconsented abortions erupted in the French overseas department Réunion. To understand this apparent paradox, Françoise Vergès showed, one had to understand how both patriarchy and capitalism were racialized. Black women of Réunion threatened the social order as white women of France upheld it: by procreating. Black and white women were expected to subordinate their bodies to state-promoted norms about childbearing. Abortion—whether forced or denied—was central to their subordination.
The Dobbs decision rests upon racialized patriarchy too. It centers upon an interpretation of the 1868 14th amendment, through which white men granted “anyone born or naturalized in the United States” citizenship. Inserting the word “male” in the U.S. Constitution for the first time, they limited the vote to male citizens (newly including Black men but excluding “Indians not taxed”). Barred legally from weighing in directly on decisions that directly influenced them, women were to be represented by the fathers or husbands to whom they belonged.
Saidiya Hartman points out that when someone is understood to be another’s property, the mere exercise of agency appears to be “a contravention of another’s unlimited rights to the object.” The laws that upheld slavery, notes Hartman, decriminalized white violence and ensured that white men were legally entitled to Black women. Enslaved women could be held responsible for their “purported ability to render the powerful weak” and therefore for their own sexual abuse. Slave law has been dismantled, but Black agency is still often interpreted as criminality, as has agency among other non-dominant groups. Surveillance and criminalization of Blackness reinforces white supremacy. Poverty has been surveilled and criminalized, reinforcing the dominance of the rich. Surveillance and criminalization of women’s reproductive choices and mishaps reinforces patriarchy. These processes intersect in ways that make women of color living in poverty particularly vulnerable to legal overreach and reproductive control, layered atop “systematic disregard.”
Why does it matter that women disappear from discourse about abortion? Patriarchy, racism, capitalism, and other “mutually reinforcing systems of oppression” injure people and constrain human flourishing in complex and intersecting ways. These systems of oppression are at work in the Dobbs decision and in the long histories that led to it. Without considering the effects of social structures and cultural norms on Black, Indigenous, and other people of color, we cannot understand the injuries caused by racism, or the power and privilege accumulated through white supremacy. Without considering how social structures and cultural norms affect people in various class positions, we cannot understand the injuries caused by neoliberal capitalism. Public health specialists are only now beginning to study the health effects of structural sexism: without talking about, listening to, considering the effects of social structures and cultural norms on women, we cannot hope to understand how sexism and patriarchy work to hurt people. Patriarchy is no less palpable and powerful for being invisible. Indeed, its invisibility is part of its power: patriarchy creates the blind spots in which it functions with impunity.
Hegemony makes practices that maintain one group’s dominance over another seem natural. Violence appears to be medical care. Embryos appear to live independently. Deaths and injuries are made to disappear. Reproductive control appears to be a technical matter of legal interpretation. But all of these misrecognitions require the erasure of women’s lived experiences. Anthropologists’ scholarship can denaturalize the vanishing of pregnant women, showing the practices of power as constructed rather than inevitable. Our efforts are critical to the work of solidarity and scholarship that has long endured and still lies ahead.
Notes:
1.Pregnant trans men and gender-nonbinary people are also endangered by Dobbs v. Jackson. For reasons that will become clear, I use mostly gendered and some gender-neutral language here.
2. A similar imagined obligation to speak for fetuses shapes judicial review.
3. Marketing practices for “fetal surgery” and “fetal treatment” centers also commonly render gestational parents invisible.