Dana-Ain Davis the POLITICS of REPRODUCTION:THE TROUBLING CASE of NADYA SULEMAN and ASSISTED REPRODUCTIVE TECHNOLOGY

Dana-Ain Davis THE POLITICS OF REPRODUCTION:THE TROUBLING CASE OF NADYA SULEMAN AND ASSISTED REPRODUCTIVE TECHNOLOGY

On January 26, 2009, Nadya Suleman gave birth to mother and the children were doing wellFdespite the nation’s second set of octuplets. Over the course of the infants being two and a half months premature. 30 days Ms. Suleman became the subject of outrage Initially the story possessed all the elements of a and outrageous representations over her choice to have mediagenic success, possibly whetting the public’s in vitro fertilization since she already had six children. appetite for distraction from the worldwide eco- Embedded in Suleman’s public construction and rep- nomic downturn including the plummeting stock resentations are subtle transcripts of race, class, and market, massive job loss, and increased home fore- reproduction. This article examines these intersections closures. Since during hard times diversions are as they relate to stratified reproduction, neoliberal re- sometimes necessary, the birth took center stage. It ification of choice in the reproductive marketplace and seemed that what interested most people was: Who the silence of mainstream reproductive rights groups in were the parents of these children? challenging the discourse surrounding Suleman. This Riveted by the story, over the course of 29 days discourse is similar to that which has historically been Ffrom January 26 to February 24, I followed blogs, used to justify restricting the reproductive trajectories newspaper articles and television news coverage;1 of women of color, poor and low-income women. my interest fueled by friends who e-mailed articles KEYWORDS: assisted reproductive technology, they thought I might have overlooked. In unpacking reproductive justice, stratified reproduction, women of the story I found that the blogging public viewed the color, neoliberalism, Nadya Suleman event as a joyous miracle. Simultaneously, medical and bioethical professionals’ appearance on news programs tempered the public’s elation by conjec- The USA’s first set of octuplets was born in Hous- turing how Suleman became pregnant. Embryolo- ton, Texas, in December 1998 to Nkem and Iyke gists thought it unlikely that the octuplets were the Chukwu. The Nigerian-born couple, who were US result of natural conception, but rather the product citizens, had used fertility drugs to achieve the preg- of assisted reproductive technology (ART). The nancy, and all but one of the children survived range of ART options that might have been used (Lyman, 1998). Just as with the Chukwu octuplets, included in vitro fertilization (IVF) or intrauterine the global media trumpeted the arrival of another insemination (IUI), with partner or donor sperm.2 As high-order multiple birth on January 26, 2009, when answers to various questions unfolded, there was a Nadya Suleman gave birth to the nation’s second rising tide of sentiment against Suleman, and as the set of octuplets in Bellflower, California, at Kaiser din of chastisement grew louder, I began to wonder Permanente Hospital. Following the delivery the why so few mainstream reproductive rights groups weighed in on the discussions.3 My interest was pi- qued since Suleman’s utilization of ART quite clearly Dana-Ain Davis is an Associate Professor of Urban reflects the reproductive rights movement’s goals of Studies at Queens College and Associate Chair of access and choice. But there was more to this story Worker Education. She is the author of Battered than meets the eye. Although there was a seeming Black Women and Welfare Reform: Between a Rock absence of race and class making in the story’s media and a Hard Place (SUNY Press 2006) and a con- representation, I want to argue that a race and class tributor to the recently published book, Beyond vernacular lay just beneath the surface of rhetoric Reproduction: Women’s Health, Activism, and Public that claimed to be about morality and self-regulation. Policy by Karen L. Baird (Fairleigh Dickinson Uni- My goal is to make sense of the messy represen- versity Press 2008). tation of Nadya Suleman in thinking about issues of

Transforming Anthropology, Vol. 17, Number 2, pp. 105–116, ISSN 1051-0559, electronic ISSN 1548-7466. & 2009 by the American Anthropological Association. All rights reserved. DOI: 10.1111/j.1548-7466.2009.01061.x. 105 race, class, marital status, family formation, and the Among the health-related concerns, according idea of choice within the realm of reproductive poli- to Chavkin (2009), are the unclear implications on tics. Therefore this article draws on the public the neurocognitive development of children born of discourse around Ms. Suleman and her use of ART these technologies. Another is the uncertain conse- to situate several concerns about the politics of re- quences of multiple and high-order multiple births production. The first concern reiterates scholarly (more than two) on women since health risks may and activist critiques of the ways in which reproduc- include increased cardiovascular risks and chal- tive stratification is asserted through ART. In lenges on the respiratory system. With regard to interrogating this aspect of the story I uncover subtle equity issues a major question that ART raises is its systems of racialization and classism in the biased inaccessibility to all women given the often-high representations of Ms. Suleman and her reproduc- costs that can run into and beyond tens of thousands tive choice. The second issue I explore is what I view of dollars. And finally, there are regulatory issues. as the perversity of neoliberal reification of con- Comparatively, Europe regulates ART to a far sumption when it sits in the realm of reproductive greater degree than the USA. For example surrogacy choice. Then, in light of those two issues, I use Sule- is illegal in most of Europe. Additionally, in Europe man’s story to trouble the implications of her choice IVF is limited to the implantation of two embryos. as this choice relates to the broader reproductive While ART guidelines have been developed by the concerns of women of color, low-income women, fertility industry in the USA, it is not illegal to not and others whose reproduction is organized hierar- follow the standards. Consequently some have called chically in relation to White heterosexual women this lack of regulatory oversight the ‘‘Wild West’’4 of and those who can afford to pay for health services. assisted reproduction (Spar 2009). It is within the context of this last concern that I Not surprisingly the phrase Wild West in many examine Ms. Suleman’s lack of support from main- ways illustrates the startlingly biased representations stream reproductive rights organizations. of Ms. Suleman that circulated. The media, blogging public, and fertility professionals used Ms. Suleman THE LANDSCAPE OF ART to police reproductive boundaries similarly to how An extensive discussion of the impact of ART is marginalized women have been scrutinized, at al- beyond the scope of this essay, but let me briefly most every stage of their reproductive lives. The highlight some of the issues these technologies raise ways in which Suleman was cast, as unfit, and the before settling into my overall discussion. From the possible policies that may be implemented as a con- low-tech strategies of artificial insemination (using sequence reflects a striking resemblance to the racial turkey basters) to surrogate mothers as the solution and class discourses controlling the ‘‘untamed’’ re- for mostly White middle-class infertility, the breadth production of marginalized or unqualified women in of the reproductive technology landscape has prolif- the past. Going back to 1939, for example, the Birth erated over the last 30 years. The technologies hold Control Federation developed the Negro Project, both promise and challenge as their implications are which sought to restrain Black women’s fertility and being critiqued in global and domestic contexts. On childbearing based on the racist assumption that the global front as women’s infertility rises, there is ‘‘Negroes’’ might outpopulate Whites. Moreover, it the concomitant rise of consumptive motherhood, was argued that control was necessary to prevent dramatically articulated in the transnational adop- those less intelligent and less fit from having and tion market (Taylor et al. 2004), through the utiliza- rearing children (Ross 1993). Clearly fecundity con- tion of fertility technology (Braff 2009), as well as in tinues to echo earlier tensions at the intersection the sphere of transnational surrogacy (Vora 2009). of race, class and reproduction. Paradoxically that Domestically analyses of ART encompasses, among angst, deepened by ART, encompasses both the fer- other issues, ethics, health-related concerns, equita- tility and infertility of Black and other women of ble access, and regulatory matters. From an ethical color, poor and single women. This point is clarified standpoint one central focus is to assess the meaning by such comments as one made by Spar (2009) who of life when money is involved in its creation (Spar wrote, ‘‘as reproductive technologies continue to ex- 2006). As ART has developed into an industry many pand, they are bringing us options that push the scholars have centered their work on the sometimes notion of personal choice to terrifying limits. Do we problematic role that biotechnologies play in facili- really want single, unemployed mothers of six (or tating the exchange and consumption of human anyone, really) to produce eight more babies?’’ (1). tissues, organs, and biological information (see, e.g., There is a profound incoherence concerning Franklin and Lock 2003). reproductive technology and its relatedness to race

106 TRANSFORMING ANTHROPOLOGY VOL. 17(2) illustrated in the 1999 Fasano-Rogers case, aptly sexuality, and reproduction. Thus, the lens through described by Robyn Wiegman (2002). This case ex- which I consider the meaning of Suleman’s repre- emplifies a twist on the racial complexities of ART. sentation is based on familiarity with the distinction Wiegman discusses the dramatic story in which two between mainstream reproductive rights and repro- women; one White and the other Black underwent ductive justice. IVF in New York City. Only the White woman, Let me make clear from the outset that I refer to Donna Fasano, became pregnant and gave birth to this story to neither justify nor condemn Ms. Sule- twins one of whom, was White and the other Black. man’s use of ART, nor to speculate on the logic of She had been ‘‘mistakenly’’ implanted with the eggs her maternal impulses. However, Suleman’s scathing of the Black woman, Deborah Perry-Rogers, as well public treatment elucidates some of the broader im- as her own eggs. What ensued was a custody battle plications of who ART is intended for, as well as the initiated by the Rogers’ for their genetic son Akiel. meaning of choice, which is inflected with race and Wiegman points out that the case is unique for two class reproductive normativity. reasons, one of which is that it reflects how ‘‘black women’s infertility is culturally illegible in a domi- STRATIFIED REPRODUCTION nant imaginary overwritten by notions of hyper On the day the octuplets were born, the LA Times reproductive and socially vampiristic black mater- reported in an update that the ‘‘event’’ was unbe- nity’’ (860).5 I would elaborate on her observation to lievably rare. One medical professional claimed that include that the very fact that the Rogers’ even the arrival of the eight infants, if it had been achieved had to litigate to secure custody of a child born of by ART, was not a medical triumph but rather a se- Deborah’s eggs, demonstrates that Black women’s rious complication. While the first blog responses on mothering is also culturally illegible. The main January 26 were positive, by 10:54 am on January reason the situation was viewed as a mistake was 27Fjust one day after the birthFsuspicions sur- because of race. This imbrication of race and repro- faced regarding the mother’s intentions. Questions duction illustrates both the cultural illegibility of arose about why she would want so many children. infertility and the general problematic of reproduc- By the 28th bloggers inquired if the woman had tion and maternalism among certain women that plotted to have that many children for monetary I argue, by extension, surfaces in the Suleman case. gainFa´la Angelina Jolie or Jennifer Lopez; sug- Nadya Suleman’s story cannot and should not gesting that she may have wanted to be paid for be separated from interrogating ART and the re- magazine exclusives which come with substantial productive rights movement, since Ms. Suleman compensation.6 Because the process by which Sule- ostensibly actualized the movements’ stated goals of man had conceived was still unconfirmed through choice. What is of concern though is the apparent January 28, newspaper reports increasingly incor- silence of mainstream reproductive rights group porated medical professionals’ assessment of the from public debates about Suleman. Their omission risks associated with high order multiple births, with or self-imposed exile from commenting on the issue many emphasizing how unethical it would be for an left it to the media, fertility specialists, and the blog- IVF specialist to implant a large number of em- ging public to shape Suleman’s denigration. My bryosFif in fact that was what happened. One critique of their absence is influenced by my partici- clinical embryologist in Atlanta noted that this kind pation with reproductive issues since 1974, as an of event gives the fertility world the ‘‘heebie jeebies’’ activist, as Coordinator of the Reproductive Rights (Roan and Gottlieb 2009). Education Project at Hunter College, working with Then on January 29, the mother, Nadya, was the National Network of Abortion Funds (The Net- ‘‘outed’’Fshe already had six children at home be- work), and as the former co-Chair of NARAL Pro- ing cared for by her mother while she was at the Choice New York. I left NARAL somewhat jaded hospital. Upon this revelation, one blogger wrote: because there seemed to be resistance to embracing ‘‘Who know who the dads are?’’ [of the other six]. a broad reproductive justice approach in favor of a Another wrote, ‘‘Now she brings a [liter] litter of reproductive choice perspective. While the latter eight kids into an already over populated world. centers on legal protections for women to obtain Those babies will cost taxpayers millions. I think this abortions, the former includes addressing housing is criminal’’ (Posted by Joe 1/29/09 6:13 pmFLA and employment, among other issues. A reproduc- Times Blog). But still there was too little information tive justice approach emphasizes reproductive about who the parents were, allowing Ms. Suleman health, as well as the social, economic, and political to escape the full denunciation based on her marital power to make healthy decisions about one’s body, status. On February 9 Suleman’s mother Angela

Dana-Ain Davis 107 confirmed that her daughter had undergone IVF. Suleman was African American. Cumulatively the Professionals asked such questions as: Had she been inferences were that ‘‘illegal’’ and African American appropriately counseled regarding reductive abor- women are hyperreproductive. Another blogger tion of some of the fetuses since she already had six hoped that the Superbowl would overshadow the children? Which doctor might have assisted her? ‘‘welfare baby momma’’ news. From there it did not Medical professionals’ concerns about the concep- take long for an ideological default to be asserted: tion process and the medical risks continued to she was on welfare. In fact, Ms. Suleman received center on the questionable ethics of any fertility $460 a month in food stamps8 and disability pay- clinic that did not follow industry standards which ments for two of her six children. It should be limit implantation to two embryos.7 However, this pointed out that welfare includes government pro- discussion only lasted as long as it was assumed grams that provide benefits and economic supports Suleman was married; an assumption based on the to no and low-income people. But the negative imagined social script that ART is only for people in shroud of welfare, erroneously associated as it is sanctioned heterosexual relationships. When it was with people of color and single mothers who pre- discovered Suleman was a single mother (although sumably take advantage of the system by having previously married) criticism against her crystal- more children, overrode any possibility that Sule- lized. Initially, the fact that Suleman had a large man might have just wanted to be a mother. By using number of children did not necessarily define her as the welfare card to justify denigrating Suleman’s de- an imperfect mother in the eyes of medical profes- cision to have children using IVF, what was also sionals. But trajectory of their questions revealed accomplished was that the right to use ART was in- a sea change. It was only after the accrual of Sule- extricably linked to White middle-class normativity man’s non-normative statuses came to light, that her in the construction of family making. childbearing decisions constituted bad judgment and Oddly neither Ms. Suleman’s race/ethnicity nor bad mothering. In thinking about the children’s her citizenship status was remarked upon on the birth and health, the potential cause of harm was news programs, except a passing mention that her redirected away from the ethics of the fertility clinic father is Iraqi.9 Once it became clear that she had and directed toward Ms. Suleman for her irrespon- been a stay-at-home mom with an unknown source sibility and moral ineptitude. of income, Suleman’s ‘‘achieved’’ a level of toxicity As for some members of the blogging public replicating a decades old stereotype that single and ‘‘the miracle’’ turned into disgust, which seemed to low-income or poor women are bad mothers (Ladd- be fueled in part by an inability to ‘‘profile’’ the Taylor and Umansky 1997). This logic led to the woman who gave birth. On February 5, for example, view that she should be punished, and Suleman even in a Good Morning America interview Suleman’s received death threats. Thus it was no surprise when newly hired publicist Joanne Killeen was asked by bloggers and media personalities such as Bill O’Re- Diane Sawyer ‘‘Who is this woman? We know illy and radio host Dr. Carole Lieberman demanded nothing about her.’’ Since no pictures of Suleman either Suleman’s arrest or that she have her children had been released, newscasters had no idea what she removed based on the argument that although hav- looked like, making it difficult to use visual cues ing 14 children was not abuse, there is bound to be to determine class status, educational achievements some form of neglect in the future. and race or ethnic categories. Seemingly, her un- Essentially Suleman, vis-a` -vis her childbearing, known identity frustrated attempts to establish the was vilified in much the same way that low-income legitimacy of both her maternal aspirations and her and women of color have been in the past for their use of ART. reproductive acts. As is so often the case, assess- Interestingly, for bloggers, the missing informa- ments of women’s childbearing is related to race and tion about Suleman’s class and race, resulted in class. For example in a response to a Salon.com indexing her citizenship status and then her race. It inquiry about Suleman, Lynn Paltrow, Executive was her fertility that became the marker identifying Director of National Advocates for Pregnant Wo- Suleman as an illegal alien evidenced by this blog men,10 remarked that when a pregnant woman is not entry ‘‘Does anyone know if the mother is ‘Legal’? brown or black and the drugs/technologies are pro- I still remember the last story the Los Angeles Times vided by big pharmaceuticals the discussion (of ran about the illegal alien mom who used fertility reproduction) focuses on questions of ethics. She drugs and ended up with 10 kids, all at California went on to say that when drugs/technologies are re- [T]axpayer expense’’ (Posted by Skip 1/27/09 at 11:29 lated to low income, and women of color and their am). Shortly thereafter another blogger claimed that reproduction, the focus is on punishment through

108 TRANSFORMING ANTHROPOLOGY VOL. 17(2) the criminal justice or child welfare system. Take as and reproduction. Ms. Suleman’s Iraqi–Latvian one example the rising arrests of pregnant women background, although identified later during the who test positive for drugs and are then charged with media blitz, came too late to rescue her from being child abuse (reinterpreted as fetal abuse) for deliver- maligned relative to the dominant racial privilege ing drugs to a minor either through the umbilical associated with ART. She had already been cord or breast milk. In some cases women are ‘‘marked,’’ if you will, as a ‘‘particular other’’ despite charged with homicide if the baby is stillborn or is her ethnicity. Or, maybe even because of it for born and then dies. Yet there is differential treat- in some ways she does not necessarily represent ment of mothers at the intersection of race and the whiteness, but rather skates across a postmodern drugs used. Campbell (2000) concludes that the type ‘‘other’’ who is not quite White. of drugs White women use (such as methamphet- One might even argue that her marital status, amine) does not register the same portrayal or the number of children she had, and her Middle castigation as mothers of color who use such drugs Eastern/Eastern European parentage conspired to as crack. Legal scholar Dorothy Roberts (1997) also ‘‘primitivize’’ her as against the celebrated White points out that most of the women arrested while middle-class standard of motherhood, making her pregnant and criminally charged are poor and Black. culturally ineligible for IVF.11 These observations are clearly congruent with the Further, in terms of kinship, Ms. Suleman, as a reproductive control, stigmatization and criminal- single woman was not viewed as having a ‘‘real’’ ization of what I call ‘‘particular others’’Fthose family, and there was broad acceptance that her who are valued differentially based on race, ethnic- transgression reflected the ways in which family ity, citizenship, class, nationality, sexuality and formation and kinship are believed to be immu- gender (Silliman et al. 2004:4). tably normative. Nadya Suleman may be seen as a Backlash against ‘‘particular other’’ women and casualty in the process of stratified reproduction, their reproductive desires are evident in the repre- whereby her right to reproduce and nurture was de- sentational and linguistic repertoires often used to nounced because she was single, had no verifiable describe them. One example is when they are refer- source of income, and was an inadequate represen- enced in nonhuman terms such as ‘‘brood mare’’ tative of whiteness. This, despite Ms. Suleman’s (Lister 2004). A similar repertoire was directed at constant claim of wanting a large family and saying Suleman whose moniker ‘‘octo-mom’’ can be used that all she wanted in life was to be mother (Garrison interchangeably to describe the fact that she had and Yoshino 2009). In the court of public, medical eight children and to summon up an image of the professional, and elite media opinion, Suleman vio- notorious invertebrate with eight arms. Deploying lated the stratified privileges associated with ART the term octo-mom generated images of Suleman’s and maternalism, leading to calls for measures to supposedly questionable subhuman qualities mak- circumscribe the choice she made. How is choice re- ing it easier to condemn her reproductive decisions. cast in this case? It is to this issue that turn to next. Additionally, public calls to punish Suleman rein- force several points made by many in critical NEOLIBERAL CONSUMPTION AND scholarly and activist circles about reproduction REPRODUCTIVE CHOICE generally: That there are aims of social convention Kathryn Pauly Morgan (1996) notes that the auto- related to ‘‘stratified reproduction’’ which is the biography of reproduction was supplanted by tech- power that gives some groups access to reproductive nological treatments whereby choice in the domain choices while limiting the choices of others (Colen of the natural became technologically mediated, and 1986; Ginsburg and Rapp 1995) especially when they the knowledge, power, and control of ART was are not the standard bearers of normativity. expertized and commodified. In lockstep with neo- Technologies associated with infertility, accord- liberal mandates reproductive choices and ART ing to Quiroga (2007), are often directed to creating exists in the context of neoliberal expectations that families that reproduce the heteropatriarchal norm. individuals engage in the exchange of goods and Many feminist scholars have critiqued how ART has services independently with no barriers (Kingfisher been used toward this end, but much less attention and Goldsmith 2001:716). But reproductive rights has been paid to the ways in which race operates in and choices operate in a marketplace characterized the delivery and utilization of ART. One notable ex- by consumption, marketing, and commercialization ception is Roberts (1997) who argues that keeping geared to White women (Craven 2007). To illustrate whiteness pure is one goal of American law and social this point a recent Newsweek.com article titled ‘‘Have convention related to genetics, racial classification, Another Fertilitini’’ (Kalb 2009) is accompanied by

Dana-Ain Davis 109 a photo of a young White woman wearing a belt choice in reproductive ethics . . . it is a misunder- with a clock for a buckle. The article reports on the standing of reproductive rights to claim she did . . . Fertility Association’s launch of a series titled The right to choose is the right to choose to terminate, ‘‘Manicures and Martinis’’ at the upscale Dashing it does not confer a right to choose anything . . . ’’16 Diva Nail Salons in New York City.12 It is hoped In arguing that choice is restricted to decisions about that the program will go national and is being billed termination, which we know is not available for all as a series of 1-hour conversations about reproduc- women, not conception the doctor’s perspective tive health targeting women in their 20s and 30s. consecrated ART for the culturally legitimate. Participants will learn from leading fertility experts Ms. Suleman’s choice and her access to ART about the reality of the biological clock and other generated ire which was fueled by questioning her risk factors for infertility. Narrow in scope, the in- judgment and denaturalizing her, a project in which formational series on reproductive health is limited her mother and to a lesser degree her father parti- to infertility issues, obscuring other reproductive cipated. Her mother commented that instead of justice concerns, such as childcare, that might also ‘‘becoming a kindergarten teacher or something, she be germane in ones reproductive health decision started having them, but not the normal way’’ (As- making. But this focus makes a highly probable bet sociated Press 2009). There were further insinuations that the target audience will in fact only need to that Ms. Suleman had mental health issues, and make decisions about delaying pregnancy as a result some television broadcasters made provocative of prioritizing their careers, and how they might be comments saying that Suleman would not be able to able to address that problem later on. love 14 children; she has an Angelina Jolie fetish; Given the location of the salons and the content and that her priorities were mixed up because she of the workshops, the women attending the ‘‘Fertili- got her nails done after the delivery and release from tini’’ events are likely to be White with either the hospital. By demonizing the woman, it is easy to earnings or potential earnings that will enable them see the way that presumptive rationalizations em- to afford fertility treatments, which routinely cost boldened in neoliberalist ideology was reshaped to $10–15,000.13 Such costly treatments almost guar- rescind ‘‘choice.’’ antees stratification in the direction of those with Interest in restricting Suleman’s choice repre- ‘‘means’’ the definition of which coalesces around sents a clumsy backlash against the valorization of race and affluence. For those without the means, individualism and the coherency of choice. How was ART, specifically IVF can be prohibitively expen- this achieved? By constructing a neurotic profile of sive. And, since there are 35 states that do not Suleman. It was suggested that she was psychologi- provide insurance coverage for ART, there is geo- cally and economically incapable of raising children graphic stratification as well.14 These very facts and should therefore be prevented from actualizing prompt a falsity about participating in the market- the choice she made. Inadequacy as the rationale for place of reproductive services. Touted as an open controlling reproduction sits in contradistinction to market accessible to all, ART is in fact highly re- neoliberal assumptions of free choice and the role stricted both economically and geographically. Here that race plays therein. To get the relationship be- again, Ms. Suleman’s story is instructive. She took tween the two one must ask: Are questions about advantage of a reproductive option using a portion using ART and the possibility of having to raise of a $165,000 settlement received after a work- large families being asked of married White middle- related injury, to pay to have six embryos implanted class women? Evidently race, marital status, and Ftwo of which split. Ironically, while she complied class results in varying degrees of acceptance with with two constructed ideologies that of maternalism regard to having large families especially when they and consumption, some saw Ms. Suleman’s choice are formed through reproductive technology. We see to participate in the reproductive marketplace to ac- this in the more positive depiction bestowed upon tualize her maternalist impulse, (whatever the two large families, the first being Jon and Kate Go- reasons) as an abomination of science and morality. sselin, a married couple with eight children and the Suleman became the face of a crisis in repro- stars of their own TLC show Jon and Kate Plus ductive technology, linked to neoliberalisms focus Eight. Kate underwent fertility treatments, first on ‘‘choice’’ that many say requires more regula- having twins, followed by more treatments which tion.15 In fact, commenting on Suleman’s ‘‘choice’’ resulted in the birth of sextuplets. For several years one medical professional, an OB/GYN, made the the public has watched this reality TV show with argument that ‘‘choice is the decision to have an great interest, and although the tides of public sup- abortion, and it does not extend to any possible port have turned somewhat against the Gosselins

110 TRANSFORMING ANTHROPOLOGY VOL. 17(2) due to infidelity and other issues, questions about personal ethics. Benitez said it was because she was a their rights to have used ART have not been as vir- lesbian. According to the American Society of Re- ulent as against Suleman (see Stelter 2009). A second productive Medicine (ASRM) ‘‘the doctors had example of a circumstance in which large families are argued that First Amendment issues were involved, deemed acceptable, even valorized rests with Mi- and that their refusal to perform certain infertility chelle and Jim Bob Duggar who have 18 children services were protected under freedom of speech and and are also the subjects of a TLC program, 18 and religious principles and should be considered an ex- Counting. In the Duggar’s case, their religious beliefs emption to the state’s Civil Rights Act (the Unruh justify the number of children they have. At the same Act)’’ (ASRM 2008). While ultimately the court time their source of income, primarily from rental affirmed that lesbians cannot be refused fertility property, helps solidify the construction of White treatment, the fact that Benitez was denied repro- heteronormative families achieved through marital ductive services in the first place demonstrates that and class status. medical professionals do attempt to control access to Normativity as a defining feature of choice was ART based on marginal status. This case reveals ‘‘expertly’’ manipulated in a February 10 CNN in- that Caplan’s almost moral view of restricting access terview between host Anderson Cooper, and Dr. to ART has a ‘‘legitimating’’ legal history in which Arthur Caplan of the Center for Bioethics at the access to ART has been seen as a privilege for White University Pennsylvania. The conversation revealed heterosexual couples, and that lesbiansFlike poor quite a different set of expectations around actualiz- women or women whose identity rests in any other ing choice when what is thought to be a bad ‘‘choice’’ categorically subordinate domainFmay not be intrudes upon a market-based logic. After Cooper seen as being legitimately infertile (Mamo 2007). asked Caplan if fertility doctors should be more en- It is clear that professionals hold views about the gaged in determining who should have IVF, Caplan intended consumer of reproductive technology. Cu- replied that such questions as ‘‘Do you have mon- mulatively Caplan’s argument and the Benitez case ey?’’ and, ‘‘Do you have a home?’’ should be asked. underscores at least one problem with the choice The answers, Caplan indicated, should factor into framework: that ART choices can be guided and re- decisions to implant. Caplan’s position merges voked by biomedical practitioners who control the professional prerogative in managing ART’s con- technology (Quiroga 2007). sumption with family formulation that replicates dominant class norms. His ‘‘recommendation,’’ if THE REPRODUCTIVE CHOICE CONUNDRUM you will, extends way beyond the scope of assess- The Suleman case exemplifies what a politics of re- ments conducted prior to implantation, which production can descend into when reproductive typically include an interview with the woman to justice is not front and center in framing issuesFis- identify any red flags in her decision to be implanted sues centered on the complete physical, mental, such as coercion and abuse, and identifying any po- spiritual, political, social, environmental, and eco- tential stressors of going through the IVF process. If nomic well-being of women and girls based on the we take Caplan’s opinion to heart, then it seems full achievement of women’s human rights.17 In the perverse to claim that markets, in this case the mar- context of the broad themes that emerged from ket of reproductive services, are open because his Nadya Suleman’s story, it is curious that no main- position diminishes consumer’s right (if one wants to stream reproductive rights organization participated pursue the logic of neoliberalism). Simultaneously, in the debates. I am not deploring them for not de- Caplan’s position proposes developing controls that fending her, per se. But the silence rendered despite almost fly in the face of free market ideology since he how the story was represented in the media and on implies restricting the availability of ARTs by using blogs is disturbing because the conclusions that cir- professional privilege to determine women’s access culated in the public sphere included Suleman being to something that often they have to pay for. marginalized, symbolically criminalized, and casti- Certainly there is precedent for denying ART gated for her maternalism and her reproductive based on race, ethnicity and sexual citizenship, for decisions and process. instance in the California case Benitez v. N. Coast These conclusions speak to some of the ideo- Women’s Care Medical Group. In 2006 Guadalupe logical and political incongruencies surrounding the Benitez received some treatments at the North Coast politics of reproduction. As Andrea Smith (2005) Women’s Care Medical Group to enhance her fer- argues much of that politics depends on the language tility. But later the physicians refused to perform of ‘‘choice’’ narrowing the broad focus of reproduc- intrauterine donor insemination (IUI) based on tive justice politics. This is the case because ‘‘choice,’’

Dana-Ain Davis 111 as I have argued earlier, can be conditional. It is work can entail. Reproductive justice is certainly ‘‘choice’’ that is of concern to the mainstream re- concerned with pointing out stereotypes that cir- productive rights organizations, and the problem cumscribe women’s reproductive options, such as is that the lure of ‘‘choice’’ obscures the legitimate those stereotypes leveled against Suleman. More- needs and concerns of women who do not have any, over, reproductive justice workers can speak to a point cogently made by Solinger (2002). In other developing policy and organizing efforts that ensure words ‘‘choice’’ rests on the availability of resources comprehensive treatment of women’s reproductive and sanctioned status; without resources and status circumstances (Silliman et al. 2004). A reproductive some women are unable to actualize ‘‘choice’’ in the justice approach does not condemn Suleman for her same way that others might. Prochoice language has choice but asks what supports does she have a right framed the work of mainstream reproductive rights to as a person raising 14 children? organizations, which have historically engaged in In the absence of principles and politics guided single issue organizing: Abortion. My reading of by reproductive justice, few mainstream groups op- prochoice groups, as a former participant in that posed Suleman’s public condemnation, and few movement, is similar to Smith’s argument (2005) challenged the harmful discourse, which was the which is they focus on the moral culpability of peo- very same discourse that has dominated marginali- ple who have children but may not have the power to zed women’s reproductive rights. This left an protect the life of their children. This is why pro- awkward opening to undermine political projects choice groups for example have not challenged the seeking to secure the full articulation of rights to in- criminalization of pregnant women of color, dis- formation, birth control, economic resources, and cussed earlier. the multitude of supports needed to control fertility, Further the ‘‘choice’’ framework rests on con- activate fertility, raise children, select birthing op- sumerist ideas of free choice that operates neatly tions, and live in fundamentally good housing, with the neoliberal stance of individualism. In the among other concerns. With too few critiques for Suleman case, it was her right not as a citizen but as a example, of the call for state regulatory agencies to consumer of goods and services that was challenged. investigate and remove Suleman’s children, other Challenging her decision to use IVF and then to womenFpoor and low-income, women of color, carry all of the implanted eggs to come to term illus- disabled women and lesbiansFwere put at risk for trates one problematic of neoliberalism. It creates being subjected to similar punitive demands. By not a hierarchy among women based on who is capable challenging the media’s obsession on the ‘‘failure’’ of of making ‘‘legitimate’’ choices (made by Solinger one woman to make good choices, the possibility 2002:6). In the marketplace of reproductive services, of creating panics that result in marking others as then, ‘‘choice’’ serves in the interest of those with having made bad choices, was reinvigorated. In re- access and the privilege of legitimacy, trumping the maining silent about the negative representations, an ‘‘choices’’ of those in need. Because choices can be opportunity slipped away to disentangle the complex reined in, it is consistent to withdraw reproductive web in which a perverse elision between choice and options from any number of categorically margin- pathology quickly emerged. alized women including poor women who, for Indeed what was so stunning was that in ne- example, have experienced the consequences of re- glecting to challenge the demonizing strategies, strictive reproductive policy in the form of the Hyde mainstream reproductive rights groups were comp- Amendment, which eliminated federal funding for licit in perpetuating ideological and political consent abortion (Smith 2005:128). on two points, reifying who in fact should have ac- This is where reproductive justice is more efﬁca- cess to ART and ceding control over one more point cious because it is concerned with rights that are on the axis of reproductive decisions to pundits, accessible regardless of the woman’s resources. The not necessarily as a fait accompli, but certainly as a justice approach is organized around the particular possibility. understanding that women of color have of their re- In concluding I want to ask a somewhat similar productive needs and operates within a political question as that which Robyn Wiegman asks about agenda that seeks to make linkages between all wo- the Fason v. Rogers case (2002). What critical under- men’s oppression, their agency, and reproductive standing maps the complexity of this situation? Some rights. For example, asking what are the reproduc- of it rests on what Wiegman calls the crisis of signiﬁ- tive implications for Asian women being exploited cation, in which the discourse surrounding a through sweatshop labor policies and then organiz- circumstance emerges as if no critical attention is nec- ing around labor issues is what reproductive justice essary and as if there is no historical precedent for

112 TRANSFORMING ANTHROPOLOGY VOL. 17(2) analyzing the situation. One historical precedent of other’’ women as one of having to control their re- the intersection of race/ethnicity and reproductive reproduction in terms of preventing conception or strictions is the eugenic supremacy that resulted in birth. But also the fact remains that illegible women Puerto Rican women being sterilized (Lopez 2008). are subjected to a discursive failure in the domain of Sometimes a crisis of signification emerges as one choice. They neither possess legitimate claims to the story accrues disproportionate power. Magnifying a choice to have children through ART nor legitimate story can create the kind of reaction that precipitates claims to not have children (specifically abortions). the circulation, passage and implementation of This is the story that was so spectacularly erased in detrimental policies. One need only recall Reagan’s the troubling case of Nadya Suleman. use of the Welfare Queen, whose story of supposed abuses of state resources ultimately led to the con- Acknowledgments: My deepest thanks go to traction of the welfare safety net (Davis 2006; Andrea Queeley, Andrea Williams, Aisha Kahn, Lee Zucchino 1997). Or, we might consider what has now D. Baker, Peyton Gibson, Deborah Thomas, John been identified as the exaggerated story of the crack Jackson, Jr. and the reviewers for their readings, baby crisis that led to, among other policies, adoption critiques, and intellectual engagement as I wrote this reform instituted by President Bill Clinton (Ortiz and paper. Audience response at the thirty-fourth Scho- Briggs 2003). Finally we can recall the teenage preg- lar and Feminist Conference: The Politics of nancy crisis that ushered in a rash of punitive policies Reproduction: New Technologies of Life, where this such as forced contraception and restrictive measures paper was first delivered, provided the motivation for receipt of welfare (Luker 1997). and courage to expand my argument. I want to es- The same is true of Suleman who magnified a pecially thank Iris Lopez, Kim Hall, Leith Mullings, crisis of ART, which generated a panic that turned and Loretta Ross for their encouragement. I also into a bill introduced by State Senator Hudgens of owe a debt of gratitude to the amazing women of the Georgia. The bill titled the ‘‘Ethical Treatment of National Network of Abortion Funds, especially Human Embryos Act’’ sought to regulate IVF. But it Toni Bond and Stephanie Poggi for helping me think also identifies embryos as human beings, setting the through the problematics of the reproductive rights stage (yet again) to undermine access to abortion. movement and for helping me find my way back to In troubling the Nadya Suleman story, again reproductive justice work. this is not condemn or reify her decision. Rather, it demonstrates the fragility of the choice framework NOTES and complicates the implications of ART, where 1. I draw my information on Suleman from the race, class, marital status, and family formation in- articles posted on the Los Angeles Times webpage tersect. As such, it intervenes as a critical assessment (http://www.latimes.com), the LA Times blog, in acknowledging the complex web of who is encour- http://www.biopoliticaltimes.org blogsite, CNN and aged to do what. For example in terms of underlying MSNBC news coverage, ABC Good Morning Amer- assumptions about the achievement of perfect ica, Oprah, and The Today Show. motherhood, Suleman was portrayed as a ‘‘bad’’ 2. ART, according to the Centers for Disease mother. In contradistinction to Suleman, a ‘‘good’’ Control, includes all fertility treatments in which mother would not choose to have a child if she were both eggs and sperm are handled. In general, ART poor or low-income, and/or single. As well no procedures involve surgically removing eggs from a ‘‘good’’ mother would choose to have a child if she woman’s ovaries, combining them with sperm in the were not White, or White enough. Using this logic, laboratory, and returning them to the woman’s body poor, low-income, single and non-White women or donating them to another woman (http:// should not seek to have children. www.cdc.gov/ART/). The typical procedures in- Suleman’s case also reveals two crises, both clude the following: IVF in which eggs and sperm are imagined. One is that White middle-class women mixed in a Petri dish under optimal conditions for have fertility problems that should be addressed. fertilization. IUI is the process by which sperm is The other is that women of color, or women marked deposited in a woman’s uterus through artificial as being of color, poor or low-income women, and means. For many couples, this is a less invasive and single women do not have fertility problems that more affordable alternative to IVF. Intracytoplas- should be addressed. While arguing for the ‘‘choice’’ mic sperm injection (ICSI) is a procedure in which a to use ART by deserving White middle-class women, single sperm is injected directly into the egg and then this construct simultaneously limits the understand- the fertilized eggs are transferred to the uterus. Con- ing of reproductive justice issues for ‘‘particular trolled ovarian hyperstimulation is generally used to

Dana-Ain Davis 113 achieve pregnancy in women who do not ovulate. It alternating between civil and savage. Much of this stimulates the ovaries to produce a number of eggs treatment examines cultural representations of and as the eggs near maturity the patient has artificial Eastern Europeans in Western Europe, owing to insemination. Some patients opt to try controlled migratory flows. While there have been increasingly ovarian hyperstimluation instead of IVF because it is more positive representations of Eastern Europeans, far less expensive costing approximately $2,000– there is still an overreliance on homogeneity and $3000. ART also includes surrogacy. stereotype (see Gephardt 2005). 3. Mainstream reproductive rights groups in- 12. Dashing Diva is a franchise operation with clude the National Abortion and Reproductive Rights locations primarily in New York. In Brooklyn the Action League (NARAL) and Planned Parenthood. salons are located in the neighborhoods of Brooklyn 4. Deborah Spar, President of Barnard College, Heights, Park Slope, and Cobble Hill. In Manhattan wrote an editorial response to Nadya Suleman’s there are locations on Madison Avenue, the Upper IVF. The article ‘‘Taming the Wild West of Assisted West Side, the East Side of Manhattan, and in the Reproduction’’ points out, among other issues, that East and West Village. Dashing Diva salons are also ART is regulated in Europe but is largely untamed in in Pasadena, CA, and Hickory, NC. the USA. 13. The Southern California Center for Repro- 5. A second, but somewhat different example of ductive Medicine estimates the costs at between the intersection of race and reproductive technology $10,000 and 15,000. http://www.socalfertility.com/ is exemplified in the story of Laura Howard, a Black ivf-cost-information.html. woman who in 2004 was inseminated with the 14. The 15 states in which there is some insur- ‘‘wrong’’ sperm, the sperm of a White man (see ance coverage for ART are Arkansas, California, Salzman 2004). Connecticut, Hawaii, Illinois, Louisiana, Maryland, 6. Entertainment magazines reported that Jen- Massachusetts, Montana, New Jersey, New York, nifer Lopez was shopping around for best offers to Ohio, Rhode Island, Texas, and West Virginia. In- publish the first pictures of her twins. It is speculated terestingly of these states, eight have anti-abortion that she received $6 million. http://www.hollyscoop. laws and three have restricted access to abortion. com/jennifer-lopez/jennifer-lopez-sells-baby-photos- 15. David Magnus of the Stanford Center for to-ok-_14767.aspx. People Magazine reportedly Biomedical Ethics, Art Caplan of the Center for paid $14 million for first rights to the pictures of Bioethics at the University of Pennsylvania, and Angelina Jolie and Brad Pitt’s twins, Knox and Linda MacDonald Glenn a scholar with the Women’s Vivenne. http://latimesblogs.latimes.com/thedishrag/ Bioethics Project are just some of the professionals 2008/08/check-out-brad.html whohaveweighedinontheSulemanstory.Mostdis- 7. For further information on ART guidelines, cussed the need to regulate the fertility industry. http:// see the Society for Assisted Reproductive Technol- www.biopoliticaltimes.org/article.php?id=4503 ogy website at http://www.sart.org/ 16. This comment was made by Amy Tuteur, 8. As of October 1, 2008, Supplemental Nutri- an OB/GYN in response to the birth of the octup- tion Assistance Program (SNAP) is the new name lets: http://www.biopoliticaltimes.org/article.php?id= for the federal Food Stamp Program, which pro- 4503 vides assistance to low income families. The new 17. I take this definition from Asian Communi- name reflects the changes made to meet clients’ needs ties for Reproductive Justice http://www.reproduc which, includes a focus on nutrition and an increase tivejustice.org/reproductive.html. in benefit amounts. State programs may have different names. 9. One newspaper report noted that her mother REFERENCES CITED was Latvian. American Society for Reproductive Medicine 10. National Advocates for Pregnant Women 2008 California Supreme Court Unanimously provides litigation, litigation support, advocacy, and Confirms Right to Treatment. ASRM organizing for pregnant and parenting women who News. Fall 2008 Vol. 42(3). Electronic experience criminalization. document, http://www.asrm.org/Media/ 11. I owe an intellectual debt to Christa Craven LegallySpeaking/vol42no3.html, accessed for this point on how non-Western European wo- April 30, 2009. men may be viewed as ‘‘primitive. Some literature on Associated Press the representations of Eastern Europeans at the turn 2009 Grandma: Octuplets Mom Obsessed with of the 20th century exists, but within a narrow range Kids. MSNBC.com, January 31. Electronic

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