Regulating Reproduction: Fetishes of equality, democracy, and universal education

Eugenics is understood as a movement in the early 20th century intended to improve human heredity. On its face, the movement is a noble one, concerned that public policies to improve the lives of the weakest of our species (which they defined as the mentally ill, disabled, and degenerate) were dramatically influencing the Darwinian evolution of the human race in such a way that might lead to the inferiority of our species. It was on the movement’s influence upon the accepted public discourse and integration within government bodies that led to some of the century’s most heinous legislation, resulting in the loss of bodily choice and integrity for many of our nation’s most marginalized and therefore vulnerable individuals.

The very terms segregation and sterilization were originally used in eugenic and bacteriologist literature to mean selective isolation or quarantine and “to eliminate the agents that reproduced disease,” respectively, prior to their use in more recent common vernacular (Pernick, 1997, p. 1769), which implies the original intentions with which these terms were used colloquially.

Ellsworth Huntingdon, scientist and one-time president of the board of directors of the American Eugenics society (Text Book History, N.D.), claimed that “America is seriously endangering her future by making fetishes of equality, democracy, and universal education (as quoted in Roberts, 1997, p. 51) by looking to care for our most vulnerable citizens.  This paper will show how the aims he sought in these three areas have continued to hold strong through the last hundred years, despite decades of activists’ efforts to the contrary.

Fetishes of Equality

Financial Inequality  

The fact that people of color are disproportionately accused of and found guilty of a variety of criminal acts despite their proportionate rates of illegal actions compared with whites has been well-established as the legal behavioral precedent in the United States. This conversation tends to focus upon black men, as they are so overrepresented within the prison population. Much less discussed are the accusations against women of color for perceived harm against their fetuses or newborns, despite the lengthy history that privileged people have of making such accusations.

The situation created by slavery whereby women would frequently lose their babies and children either by death, by their sale to others, or by the mother’s own sale to others caused a circumstance whereby it made sense that these women would practice a certain level of emotional detachment from their family. This detachment was used as evidence by whites of the degenerative nature of these women (Roberts, 1997), though it seems obvious that it would be self-protective to maintain some level emotional distance from loved ones by these women; it would be incredibly devastating to face the reality of being separated from one’s family during a time of such horrific abuse and oppression. What was borne from this emotional detachment from blood relatives was a new type of family structure for enslaved people that came from their neighbors; one that was unfamiliar and vilified by whites who thought a two-parent nuclear household was the right way to exist. This flexible family structure served the enslaved people as a method of managing the social injustices they faced (Roberts, 1997), offering emotional support and relative consistency for these marginalized people.

Black women who were slaves in our country were prized for their fertility and their worth equated with the number of children they could bear for their masters; indeed, if she could have many children then she was more likely to be able to stay with them through their early childhood years (at least until they were old enough to sell as slaves to others, or work for the same master as the mother) as the master would keep breeding her as long as she bore children (Collins, 2004). It would behoove the enslaved woman, then, to behave as though she were consenting in this interaction whenever possible. This, coupled with the jealousy of the masters’ wives, led to an enduring (white) social perception of black women being sexually promiscuous.
These misperceptions have remained strong through the years and continue to marginalize these women today. Black women who have children in single-parent households (regardless of whether the reason they are raising children alone is because of the disproportionate incarceration of their partners) and thus receive welfare continue to be unjustly targeted much like their grandmothers of the past had been. Their perceived sexual promiscuity and degenerative nature had become justification for seeing them as undeserving and therefore a problem for the state to address in the eyes of the Puritanistic white American society (Collins, 2004).

Healthcare Inequality
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The three largest medical organizations (The American Medical Association, American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists) have unequivocally stated that the threat of punishment for child abuse deters women from seeking prenatal care and from being open and honest with their medical care team (Patrow & Flavin, 2013), and it is widely understood that patient honesty is crucial in healthcare. However, the efforts of women – especially black women– to seek help for an addiction or for experiencing physical abuse during pregnancy can result in her arrest, though the official grounds for arrest are often documented as other things such as the use of an illegal drug or alcohol while pregnant (Paltrow & Flavin, 2013) despite the lack of empirical data showing that a single or even occasional use of a drug or alcohol can cause adverse impact upon a fetus.

Documented factors described in arrest warrants for pregnant women include actions that are not prohibited by law, such as consuming alcohol, having a sexually transmitted infection, having HIV, smoking cigarettes, not obtaining prenatal care, had mental illness, had gestational diabetes, or were planning an out-of-hospital birth (Paltrow & Flavin, 2013). Indeed, it is more likely that the fetus would suffer from the stress of the mother being unjustly arrested, detained, and/or incarcerated for the infraction (Huizink, Van den Bergh, Buitelaar & Visser, 2002).

Fetishes of Democracy

Erroneous Vilification of Black Mothers

Black enslaved women were “often falsely accused of smothering their babies, either deliberately or carelessly, by rolling over them in bed (p. 36) when in some plantations, the mortality rate of infants within their first year was sometimes up to roughly half of all babies born to slaves, who were generally kept in close quarters, deprived of medical care, and forced back into manual labor soon after delivering their children with no reliable childcare options to be dreamed of (Roberts, 1997). We can easily see how this notion connects with the most recent data available from the Centers for Disease Control and Prevention (CDC) which shows that sleep-related infant deaths as a whole among Native Americans and African Americans at more than double the rate of Non-Hispanic white Americans between 2014 and 2018 (CDC, 2021). Even the American Academy of Pediatrics reports “racial/ethnic differences in [these] biological factors” such as genetic polymorphisms, brainstem abnormalities and metabolic disorders as being associated with an increased risk of risk of Sudden Infant Death Syndrome (SIDS) (Parks, Lambert & Shapiro-Mendoza, 2017), which serves as evidence which could be twisted to support the eugenic concepts of nonwhite (specifically indigenous and African American) populations being genetically inferior to white Americans and surely contributes, at least in part, to the perception that these inferior populations should be more carefully monitored during the neonatal period. Indeed, Paltrow and Flavin (2013) documented a case whereby the police were already called and present while the parent of color was informed that she’d lost her pregnancy, after which she was immediately interrogated, assumed to be at fault for the death of her fetus, and asked whether she had done everything in her power to ensure she’d have a healthy baby.
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This increased monitoring, combined with implicit racial biases, may be a contributing factor to the increased rate of legislative regulation and judicial intervention in cases of perceived wrongdoing of families of color, and the attribution or accusation of parental implication in infant deaths. In case studies done on the punitive use of the legal system against pregnant women for mistreatment of their fetuses and newborns, nearly half of those reported to law enforcement were African American (and their reports were more likely to be made by their medical care team), with less than one-third being white women. Further, the white women were significantly more likely to have their cases reported by other means of law enforcement such as those on probation or parole and their arrests being unrelated to their pregnancy (Paltow & Flavin, 2013).

Looking at the care and treatment of pregnant women of marginalized races, we can see a myriad of problematic referrals to law enforcement. The refusal of unwanted medical care by pregnant women has frequently resulted in the loss of privacy of personal health information, as evidenced by women with physical abuse histories being punitively punished for objections of being touched by medical staff or for refusing planned cesareans for births now known to have a very low risk of complication such as a VBAC (Vaginal Birth After a Cesarean), or the birth of multiple children such as twins; these arrests were made under the guise of  “protecting children from harm.” It seems unnecessary, legally speaking, for prosecutors to present any evidence whatsoever of harm done to the child before or after birth. Additionally, no law has ever been passed in any state making it a crime for a woman to carry her pregnancy to term when she’s got a drug problem, or to make women liable for their own pregnancy losses (Paltrow & Flavin, 2013).

            Obstetric violence is defined and legislated in several countries, but not the United States. The literature presented by the Organization of American States, which includes all 32 countries in North, Central, and South America and is intended to provide policy guidance to improve the quality of life for all their respective citizens, defines obstetric violence as it it is legally defined in Venezuela:

​   The appropriation of a woman’s body and reproductive processes by health personnel, in the form of dehumanizing treatment, abusive medicalization and pathologization of natural processes, involving a woman’s loss of autonomy and of the capacity to freely make her own decisions about her body and her sexuality, which has negative consequences for a woman’s quality of life.
(OAS & MESECVI, 2012)

The widespread and legally acceptable domestic example of obstetric violence perpetrated against women of color is perhaps best represented by what became known as the “Mississippi Apendectomy” during the 1970s. During this time period, poor black women frequently found themselves receiving hysterectomies without their informed consent (and sometimes without even knowing it was going to happen at all) when admitted to the hospital for birth, birth control such as a tubal ligation, or other gynecological procedures in order to provide practice for medical residents in conducting these procedures.

Aside from the obvious ethical concerns, there were financial incentives for physicians to continue this practice. Physicians were financially motivated by receiving more than triple the payment from Medicaid- an insurance provider known for paying very low premiums- for hysterectomies compared to the reimbursement for tubal ligations, thus encouraging them to perform this unnecessary procedure. Hysterectomy carries with it a 2000% increased risk of death compared to tubal ligation (Roberts, 1997).

Fetishes of Universal Education

Educational Inequities and the Right to Informed ConsentPaltrow & Flavin (2013) document a case in which a woman was laboring at home with the attempt to have a VBAC by laboring at home as long as possible to maximize her ability to have a vaginal birth by depriving the hospital of time to prepare a surgical birth. When her doctor learned of her TOLAC (trial of labor after cesarean delivery) at home (which is common practice in many hospitals now for women seeking a VBAC), law enforcement was sent to her home, forcibly tied her legs together to prevent the baby from exiting the birth canal (at great risk to the birthing baby) and was brought to the hospital to have an unwanted and unnecessary surgical birth. The same woman went on to have multiple uncomplicated VBACs outside of the oppressive hospital system.

            It is now widely accepted by the medical establishment and ACOG that vaginal births after cesareans are relatively safe and should be encouraged when the hospital in which the woman is giving birth is sufficiently equipped to deal with the small risks inherent with birthing after having had a cesarean (ACOG, 2019). The evidence that a VBAC is a safer alternative to an elective repeat cesarean in subsequent pregnancies was not new when this guidance was released. It is a logical assumption that in the case study described above, the birthing woman may have been better educated about the evidence-based risks and benefits of her birthing choice than her provider, who had not yet been the recipient of the above-mentioned clinical guidance from their credentialing body. She was subjected to what is now colloquially known as “obstetric violence” as the result of her having a differing opinion on her medical options than her provider, because her provider had law enforcement on their side to force this medical procedure and all its inherent risks upon her. Had the state and her physicians been as educated on the risks and benefits of VBACs as she was, that baby would have been brought into the world under far less traumatic conditions.

The myriad State campaigns against women’s bodily autonomy have resulted in some truly horrific outcomes. Pregnant women have been prevented from leaving the state during pregnancy, have been secretly searched, had their private health information disclosed without consent, been coerced into unwanted abortions, and punished for experiencing pregnancy losses or still births (Paltrow, 2013). Indeed, might doesn’t make right.
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Conclusion

Roberts (1997) purports that the pseudoscience of eugenics shaped the very meaning of reproductive freedom by way of defining the purpose of birth control and using it to control the population at large, but especially shaping it as a tool to control women of color. We can see how blatantly entities of power continue to use eugenic principles to marginalize the most vulnerable of the already vulnerable: pregnant black women.

Prosecutors have frequently twisted the precedent set by way of the of Roe v. Wade decision to justify that viable fetus should be treated as legal persons, separate from their pregnant parents. This misstatement has been used repeatedly as justification for the state’s use of the legal system to deprive pregnant people of their liberty (Paltrow & Flavin, 2013). This gross mischaracterization of the intention of this Supreme Court decision has and will continue to result in horrific miscarriages of justice for women and their babies throughout our country unless we can figure out how to clear the weeds of injustice from our legal system.



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References:
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American College of Obstetrics and Gynecology. (2019). Vaginal Birth After Cesarean Delivery. Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/02/vaginal-birth-after-cesarean-delivery
Centers for Disease Control and Prevention (CDC). (2021). Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. Retrieved from https://www.cdc.gov/sids/data.htm
Collins, P. (2004). Black Sexual Politics: African Americans, Gender, and the New Racism. New York: Routledge.
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Parks, S.E., Erck Lambert, A.B., Shapiro-Mendoza, C.K. (2017). Racial and Ethnic Trends in Sudden Unexpected Infant Deaths: United States, 1995-2013. Retrieved from https://pediatrics.aappublications.org/content/139/6/e20163844
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