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“Preconception Care” and the Transformation of Women’s Health Care into Reproductive Medicine
- 1. “ Preconception Care” and the Transformation of Women’s Health Care into Reproductive Medicine Rebecca Kukla Professor of Philosophy and Obstetrics and Gynecology University of South Florida [email_address]
- 21. Why is all this a problem? Isn’t it good for us to make addressing all these health needs a priority? Won’t women benefit? Well, they often will benefit, but…
Editor's Notes
- Two main arguments and a conclusion: Pregnant women’s bodies are already interpreted and treated as maternal bodies whose primary purpose is to minimize risk to their future children – thus the project of intensive parenting has already been extended backwards through pregnancy. With the advent of the “preconception care” movement, this project has been extended even farther backwards, prior to pregnancy, and arguably throughout much of women’s lives. THUS women’s health care is being increasingly subsumed under reproductive medicine – medical care for women is increasingly transforming into medical care and risk management for future children, including merely imaginary future children.
- SPEAK FROM THIS SIDE: It is not surprising that when women are pregnant, their health care is typically dominated by reproductive health care. When we think of pregnant women and health care, the first thing we think about is trying to make it to a good birth outcome, having a healthy baby. But women continue to have health needs of their own during pregnancy – these aren’t put on hold. During pregnancy, women may need not just ‘prenatal’ care but oncology, psychiatry, cardiology, substance abuse treatment programs, etc. Indeed, there is a large amount of information available about various health conditions and concerns that face pregnant women: HIV, depression, diabetes, etc. Here are some images of pregnant women from these health information sources. See if you notice a subtle similarity between the women who show up in these sources...
- During pregnancy women may need information about or treatment for… Diabetes and asthma
- Lupus, MS, cancer
- obesity
- Dependence on cigarettes, alcohol, drugs. Headless pregnant bellies about to take a big drink or a puff on the cigarette.
- Depression – headless pregnant belly in melancholy darkness! You can tell the belly is depressed because of the lighting.
- Dental problems
- Domestic abuse As you may have noticed these women have no heads– their independent identity as subjects of medical need and care is erased. (Go look – I am not cherry-picking!) At least imagistically, pregnant women’s medical needs are all seen through the lens of their reproductive function, the impact on the fetus. Invisibility of woman is particularly striking for dental care (can’t even see the relevant body part), domestic abuse (direct victim of abuse erased). In several slides, the pregnant belly is labeled, locating the problem for us – HIV slide (4) – it is the belly labeled as having HIV. In the other slide the womb is transparent. Substance abuse slide (7): the belly is ‘fragile’ Lupus slide (5): the footprint calls attention to fetal subjectivity though the head is absent.
- The instrumental understanding of women’s health care extends beyond prenatal care The ‘purpose’ of women’s health care is the protection of babies and society.
- I want to talk about the preconception movement… Recent widespread advocacy and support for ‘preconception’ care supported by various government agencies, professional health organizations, and charity groups – strong, explicit example of a concerted initiative to bring more of women’s health care under the umbrella of reproductive health care. You know the preconception care movement is gaining traction now that there’s a new What to Expect book just for it! Released 2009. POSSIBLE conception is directly conflated with PREconception.
- Even lack of pregnancy is taken as sign that pregnancy is immanent – this is a bit like taking declaration of homosexuality as a good time to discuss contraception because heterosexual sex could have happened instead.
- Well-woman care – care for the woman herself – is here a marketing ruse – explicitly not what they care about, but want to get women who don’t plan to be pregnant in the door for reproductive care by promising them care for themselves.
- Remember – must put this expansion across the lifespan together with the idea that every primary care visit (plus others) is supposed to be treated as a ‘preconception’ care visit. Vs. ACOG, which only recommends a preconception visit when you plan to become pregnant – much more moderate and woman-centered. (ASTHO: Association of state and territorial health officials)
- I want to spend the rest of my time looking at several reasons why this shift is problematic for women.
- Instrumentalization of body begins well before pregnancy. Design behavior in terms of ‘optimizing’ pregnancy outcomes. Do lesbians, women who are carefully contracepting and not interested in having children, 13 year olds, women done having kids, really want their bodies seen as pre natal, understood in terms of reproductive function? (Journal of the American Academy of Physician Assistants)
- How you choose to treat an about-to-be-pregnant body is not necessarily the same as how you choose to treat another body.
- SEE last two quotes on slide 22. Second quote: ‘lifespan’ and ‘reproductive years’ explicitly equated! Older women here disappear from the rhetorical health radar, no direct attention or prioritization, even though they live longer and have special medical needs.