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Controlling fertility, reproducing shame: UK policies and reproductive injustice

Many people think that government interference into peoples’ reproductive choices is largely a thing of the past, or only occurs in countries with repressive governments. Given this widespread assumption, you might be surprised to read some recent UK headlines:

Guidance to induce minority ethnic pregnancies earlier condemned as racist” [The Guardian, July 2021]

DWP’s Universal Credit two-child limit branded ‘a breach of human rights’” [Birmingham Mail, May 2021]

Almost half of those using long-acting reversible contraception (LARC) felt pressured to accept this method, research finds” [British Pregnancy Advisory Service, June 2021]

IVF postcode lottery: officials using BMI and relationship status to block fertility treatment” [iNews, Aug 2020]

These stories reflect not just the injustice of these reproduction-related guidelines, but also how many of these policies are targeted according to peoples’ race and ethnicities, social class, sexualities and fertilities. Framed as benign interventions to provide support or offer medically necessary care, policies like these build on and reinforce existing inequalities in our society.

 

How so?

Many of these policies and interventions frame adverse outcomes, such as poor maternal health or infertility, as the individual’s responsibility, or as a reflection of their individual shortcomings. These policies create shame and stigma by implying that individuals are responsible for not being able to fulfil their reproductive desires, and that certain reproductive decisions, such as not using contraception, are harmful for society. They also build on and reinforce existing social stigma and shame around these topics— e.g., stereotypes of who is a bad mother.

Often, these same decisions are not seen as harmful to society when made by others with more financial resources (e.g., having more than two children) . Whether or not reproductive decisions or desires are considered harmful or irresponsible by society is informed by power differences, stemming from structural racism, capitalism, unequal gender systems, ableism, heterosexual and cis-gender normativity.

 

Let’s explore the headlines and policies highlighted earlier.

Black women in the UK are four times more likely than White women to die in pregnancy or childbirth. A policy proposing early induction of minority ethnic pregnancies creates shame by effectively suggesting that racialised bodies are defective in some way, requiring biomedical management to reduce risk. The risk is understood as individual, distracting from the structural reasons responsible for maternal and newborn health inequalities between white and Black women in the UK: the chronic and cumulative experiences of racialisation and everyday violence that shapes Black women’s interactions with the health system (e.g., stress caused by structural and social racism resulting in low newborn birth weight or miscarriage, healthcare workers’ racist beliefs of pain thresholds).

The two-child benefit cap shames and stigmatises low-income families for having additional children. Stemming from anti-poor discourses like “benefit scroungers”, it punishes and shames parents for experiencing poverty and difficulties. It views benefit recipients as lazy and draining resources from other hard-working people and implies that fertility – not structural inequalities- are the root cause of poverty. It also shames women for not controlling their fertility through contraception use.  These ideas reinforce stigmatising portrayals of benefit recipients as being irresponsible — irresponsible with their fertility and their use of benefits.

Public health officials have framed LARCs as a responsible alternative. Despite their advantages, Black and Brown women, disabled or younger women, those with previous use of abortion or emergency contraception, drug and alcohol users, and those who have had children taken into care, report pressure to use LARCs. This practice draws on racist, ableist and classist stereotypes of who is a good parent.

Differing levels of IVF funding across the country imply that it is a luxury treatment rather than a right. Implicit within these approaches is the idea that infertility is a problem attributable to individual choice: the choice to leave reproduction until “too late” in life or, for gay couples, their “choice” of sexual orientation. The CCG-specific individual eligibility requirements like age and BMI, reinforce this narrative of personal responsibility. While policy-makers justify these rules via cost-benefit calculations (IVF is less successful at older ages or higher BMIs), it is implied that success factors (age & BMI) are under personal control.

Such policies and ideas limit peoples’ lives and options by shaming and blaming them— they restrict reproductive justice (RJ). RJ, developed by Black feminist activists in the USA, is the right to have children, to not have children, and to raise one’s families in a safe and healthy environment and under conditions of one’s own choosing.

Why does RJ matter for our understanding of shame and stigma surrounding reproductive experiences in the UK? This concept challenges the historically violent conditions that give rise to persistent inequalities. It doesn’t just explain adverse health outcomes but imagines new possibilities for how care can be provided, accounting for peoples’ lives and the environments that shape them. Many activists and rights groups, including doctors and nurses, are fighting back against these practices and policies (e.g., MBBRACE, Decolonising Contraception, Birthrights) and challenging policies. People’s human rights and dignity depend upon it.

 

Authors: Rishita Nandagiri, Laura Sochas, Leigh Senderowicz





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