Category Archives: sexual and reproductive health

Control of reproduction

I’ve been watching with horror and disbelief the debates in the US state of Virginia about a proposed new federal law which would mandate that all women wishing to have an abortion, regardless of the reason, would first have to have an ultrasound scan. Given that many abortions take place before 12 weeks, when it is difficult to detect a foetus using transabdominal ultrasound, this effectively mandates the use of transvaginal ultrasound, a considerably more invasive procedure, whether or not the woman consents to this. There has been a lot of debate about how this wrests control of reproductive choices from women, referred to by some commentators as “state-sanctioned rape”, and in effect “dictating a medical procedure to a physician”. There are a couple of articles here and here with more detail.

Meanwhile, in Hungary, where in 2011 the government tried to introduce anti-abortion legislation using EU funds earmarked for gender equality projects (see here and here), a renowned obstetrician and midwife who has for some years championed home births in Hungary had her appeal against imprisonment not only refused, but her ban on practice lengthened. There is background to the case of Dr Agnes Gereb here and a Guardian report of her unsuccessful appeal here. Home birth is not illegal in Hungary; however it appears that legislators are fearful of an intervention which, in the case of women of low obstetric risk, is at least as safe (and in many cases arguably safer) than hospital births, and this state-sanctioned censuring of the choice to give birth at home is another attempt to reign in choice and increase control over reproduction.

These depressing stories put me in mind of my PhD research, which looked at sexual and reproductive health in Romania and Moldova. Romania in particular had particularly repressive policies around reproduction during the communist era, particularly under Ceausescu – from 1966 abortions were outlawed in all but certain restrictive circumstances, and whilst not banned all methods of contraception were very difficult to obtain, and propaganda against hormonal contraception in particular was so strong and all-pervasive that more than two decades after the end of Ceausescu’s regime in Romania there is still a deep-seated suspicion of it, amongst both public and the medical profession. Women were subject to compulsory gynaecological examinations, doctors and women performing or requesting abortions risked imprisonment and official figures suggest that between 1966-1989 nearly 10,000 women died from the complications from illegal abortions (the real figure is undoubtedly higher, as many deaths will have been illictly recorded as being from other reasons). One of the legacies of this state-sanctioned interference in women’s fertility and reproduction is an ongoing suspicion in Romania of any governmental attempts to promote any national campaign relating to sexual and reproductive health (a recent example would be the disastrous and failed campaign in 2009 to vaccinate school girls against Human Papilloma Virus).

I would recommend anybody who is interested in the consequences of extreme pronatalist and anti-choice legislation read Gail Kligman’s The Politics of Duplicity. This is a masterly, seminal book about Romanian reproductive policy under Ceausescu which details the inevitable outcome of banning abortion, making contraception in effect unavailable, and seeking to control fertility and reproduction so ruthlessly. Policy makers in Virginia in particular, but also elsewhere including Hungary, would do well to learn its lessons.

All about my thesis

My thesis

My thesis

I realise I haven’t said much here about the biggest bit of research I have done to date, namely my PhD thesis. It is a qualitative study of sexual and reproductive health in Romania and the Republic of Moldova, looking primarily at the contexts in which sexual and reproductive health services are provided and the barriers and opportunities identified by people working in this area in a number of sectors (state medical, voluntary sector, international donor, etc). The thesis also incorporated a review of media coverage in the two countries around sexuality, reproduction and sexual and reproductive health. I chose to work in Romania and Moldova for initially quite practical reasons (I speak the language, and had previous contacts and experience in both countries), with the focus on health reflecting my professional background in nursing. The end result is very different from my original research proposal, which was much more rooted in social policy, mainly as a result of the eventual decision to focus more specifically on sexual and reproductive health. This led me down a number of fascinating roads, relating to gender, nationalism, sexuality, religion and morality alongside the original health/policy focus, and caused me to reflect towards the end of the process that the thesis chose me as much as the other way round – I don’t think I could have got as passionate and committed to my originally proposed research as I did to the thesis as it ended up.

The thesis itself can be found in the University of Glasgow thesis repository – this link is to the thesis abstract and the thesis is accessible from there (pdf format). I chose not to place the thesis under embargo, as I have decided that although I do think there is an academic book in me somewhere I feel that practically it would make more sense to concentrate on writing shorter journal articles for now. I am planning on reducing my clinical hours in the new year so I can spend some time writing a number of articles drawn from this thesis, in order both to try to make my list of publications more attractive to potential employers, and to give me the opportunity to write in depth about a number of quite random and disparate issues which although of considerable interest could only be touched upon briefly in the thesis itself. One of the advantages of my thesis and its findings is that it is applicable in a number of academic fields – sociology, public health, development studies, area studies, social policy, gender studies, media studies/discourse analysis as well as qualitative research methodology and other academic sub-areas (sociology of health and illness being a particularly obvious one) – which means that I have a number of articles on several different topics just waiting to be written. One of the disadvantages of that is that I could write for journals which are important and high-impact in one discipline but which for other disciplines are much less relevant and impactful, so over the next couple of months I am going to sit down and plan a strategy for prioritising my writing. As for that book – well, I have ideas for a future research project which I think would ultimately lend itself much more easily to an academic monograph. The other priority for next year is to investigate possible funding for that future research, something else which having more publications under my belt will help, of course.

Yesterday via the #phdchat discussion on Twitter I came across a blog post where the author summarised his work in 100 words. That is a challenge I might think about for a future post, as I know one of my writing problems is not using 1 word when 10 will do!