CHAPTER FIVE
The Ideology of Choice: The Norplant® Condition
and Voices of Resistance
1. Introduction
“Between equal rights, force decides” (Marx 1990, 344).
To this point, the contributions of Foucault and Arendt in understanding Norplant® as a problem in political power have been introduced and briefly examined. Foucault’s compelling notions of disciplinary power, power/knowledge, as well as his elaboration of power in The History of Sexuality, Volume I, all highlight the hegemonic components of power – a form of power which is held in place from the bottom up and the top down. Because power is not only located in force, but is also discursively imbricated in the structures of knowledge itself, ruptures in power relations are not only possible - they seem likely. The omnipresence of power can set power against itself. Yet, Foucault’s articulation of resistance (despite his focus on the microcomponents of power) remains somewhat abstract. What is it about human political action that makes resistance and change possible in hegemonic power relations? Foucault’s healthy skepticism towards humanism may have contributed to his reluctance to more fully entertain the corporeal aspects of change and resistance at the human level. Arendt’s focus on natality through the category of action provides an ontological basis for an anti-foundationalist inquiry into the origins of resistance and change.
Any work of political science (or social science in general, for that matter) that critiques the ideological function of positivism in a field of research encounters the perilous dilemma of providing a research design that does not fall prey to the same criticisms. While there is no “outside” to ideology, the instrumental rationality that organizes positivism, that prosthetic limb of the disciplinary State, is not a “natural” or inherent condition of political science. My intersubjective model collects the contributions of Foucault, Arendt, traditional medical specialists, “alternative” medicine practitioners, and recipients of Norplant® from various cultural settings. Because of the small “N” in the research design, according to standard social science, the generalizability of the model is limited. But, the smaller number of interviewees affords the opportunity of opening a depth hermeneutics between “text” and “subject” that could not easily be attained with data from a large-scale survey. A synthetic model can be derived through a hermeneutic analysis of the Norplant® problem. In order to arrive at a point where such an analysis is possible, it was necessary to provide a political history of Norplant®. The historical account interpolates with the following case studies, throwing the experiences of individuals into broader historic relief, making an understanding of hegemony and resistance possible.
The matrices of gender, class, race, and locale intersect with and through Norplant’s discursive framework, formulating hegemonic relationships. Not only do socio-cultural indicators (e.g. gender, race) mark power relations, but power is also embedded in the structures of scientific inquiry and technological practice. If power is located within the framework of knowledge, the Norplant® Condition is also a matter of the structures and structuration of perception. Here, epistemological questions of subject and object, knower and known are simultaneously scientific, medical, and political. How then are Norplant’s discursive regimes of power/knowledge shaped by medical communities?
2. The Medicalization of the Political: Norplant® as Disciplinary Apparatus
This section addresses the manufacture and perpetuation of medico-political ideologies. An important component in understanding how Norplant® operates as a disciplinary social apparatus is an account of Norplant® beyond its trial phases. It is important to address in greater detail the proposed role of Norplant® in United States’ welfare policy, its role in criminal sentencing in the United States, and how these judicial and social historical conditions of Norplant® interrelate discursively both nationally and internationally.
While some policy analysts and critics have objected to Norplant® in the United States on grounds of invasion of private rights, such a criticism remains ensconced within a traditional liberal ideology of the sovereign self. By affirming the body through rights discourse, one may reinscribe the exclusionary ideology of liberalism by atomizing social and political discourse. Put differently, the meaningful social and political articulations of Norplant® (and of rights discourse) are avoided through an appeal to individual sovereignty. While individual sovereignty has its utility, it has become the means and the ends of politics in disciplinary liberalism. Can there be a politics of bodily autonomy that does not slide into subjectivism? It is vital to construct alternate paths of self-identity - paths which move beyond the subjectivism of the “unencumbered self” but do not fall into the reification of “consensus” that plague communitarian discourses. These paths locate actors not only in matrices of power/knowledge//resistance, but also in natality and plurality. My feminist rendering of Arendt and Foucault in the context of reproductivity in this chapter and the next aims to speak to this question.
A. Norplant® and Sentencing in the United States
In one sense, the policy of offering Norplant® as an alternative to prison could be considered as the least problematic of all Norplant® policies. After all, the surrendering of rights comes with the territory of criminal offense. When faced with the inevitable reality of the rights and privileges one loses in prison (freedom of movement, expression, autonomy, reproduction), convicted child abusers and other criminals might gladly accept the option of Norplant® as an alternative to prison. While Callahan observes that selecting Norplant® as an alternative to prison is hardly a free choice, she also observes that it may be a desirable option: “Refusing to allow Norplant as a condition of probation because women are or would be “compelled” to accept it as an alternative to incarceration is like preventing a mugging victim from handing over her cash on the grounds that her choice to do so is not free, thereby forcing her to accept the other alternative. This is unjustifiable paternalism at its worst” (Callahan 1995-1996, 71). In a rare event, I take exception to Callahan in this compelling essay. Callahan’s reasoning retains viability only when one examines the abstract generality of alternatives to prison without focusing upon the substantive aspects of the Norplant® alternative. Along with its political and social ramifications, Norplant® is a medical device with specific medical side effects. It is contraindicated for people with diabetes, may cause seizures, and causes menstrual irregularity in approximately half of its users – among other things. A judge who presents this option blurs an increasingly nebulous boundary between law and medicine.
Moreover, Callahan’s reasoning works from the two options that are presented: Norplant® or prison. Judges and critics might also consider the possibility of creating non-medically invasive probation conditions. This either/or conundrum is in fact one that is artificially manufactured by the State in an effort to “get tough” on child-abuse. Virginia Blum makes an important observation in noting that such a policy only protects “imagined” or “future” children (Blum 1995, 259-261). In itself, such a policy does nothing to protect the abused, while establishing and protecting the rights of the (imaginary) unconceived. Rather than resorting to the either/or scenario, parole conditions that limit the abuser’s contact with living, actual children might be more effective.
Moreover, as Steinbock notes such a policy carries with it broader political and social implications: this “choice” (however justifiable by the context it may be) is more often likely to be presented to minorities and women in poverty (Steinbock 1996, 53-78). While Callahan does accurately observe that reproductive restrictions are an inherent part of incarceration, the fact that they are does not in itself legitimate such restrictions. They still may have the net effect of continuing to disproportionately limit the reproduction of minorities and women in poverty. When reproductive restrictions are expanded into the field of probation, the potential social and political impact expands to include the incarcerated, probationers, and potentially parolees. I focus on Callahan’s piece not to single her out for criticism but rather because her piece signifies the problematics of liberalism; once the premises set by the State are accepted, the argument flows naturally. Indeed, Norplant® is better than prison for many. But by what political logic have we come to these two options?
I will get to this problem by way of the most famous case of Norplant® sentencing: The People of the State of California v. Darlene Johnson. However, before turning to this case, it must be noted that while Johnson’s case is the most frequently cited, it is not the only case of its sort in the United States. In 1988, Debra Ann Forster agreed to lifetime probation for abandoning her eighteen-month and six-month-old sons in a sweltering Phoenix apartment. The sons had to be hospitalized in serious condition for over a week. Judge Lindsay Budzyn included lifetime proof of contraception in Mrs. Forster’s probation. A more extreme precursor to the Norplant® cases involved Melody Baldwin, a thirty-year-old woman with a history of personality disorders who killed her four-year old son with an overdose of her prescription medications. Baldwin, at the court’s encouragement, agreed to sterilization in Indiana (Lewin 1/10/91, A-20). Lynn Smith and Nina J. Easton document several other cases involving the use of Norplant® in sentencing:
Judges in several states have ordered women to be implanted with Norplant as a condition of probation. In July, a Florida woman who pleaded guilty to child abuse agreed to have Norplant inserted in addition to going to jail and receiving counseling. In February, a mildly retarded Illinois woman, who also pleaded guilty to child abuse, was ordered to have Norplant implanted and to obtain a court order before ever having it removed. The judge denied an objection by the American Civil Liberties Union, saying “How many children should a parent be allowed to abuse before the state has the right to say, ‘You can’t have any more children until you can show you are not likely to abuse another child?’ And how many children of a parent should the taxpayers of this state have to support in foster homes or alternate care before the state has the right to say, ‘You can’t have any more children until you take care of the ones you already have?’ Child-abusing mothers in California, Texas and Nebraska have also been ordered to be implanted with Norplant (Smith and Easton 9/26/93, 27).
Perhaps the case of The People of the State of California v. Darlene Johnson gained the greatest notoriety of all these cases due to Judge Harold Broadman’s history of controversial sentencing, particularly with regards to women and reproduction. In 1988, Broadman ruled in a divorce case that Virginia Davison must undergo a hysterectomy in order to receive full spousal support. She “consented” and the hysterectomy was performed that same year (Alexander 1-10-91, A1;12). While Broadman denied that this was his intent, Davison stated she was “coerced into having it” (ibid.). In September of 1990, just a few months after the approval of Norplant® by the FDA, Broadman ordered Linda Zaring, who pleaded guilty to heroin use, to have the device implanted. However, Zaring arrived ninety minutes late for a hearing and was sent by Broadman to prison (ibid.).
When Harold Broadman of the Tulare Superior Court on January 2, 1991 ordered Darlene Johnson to select either Norplant® or prison for her crimes of child abuse (The People of the State of California v. Darlene Johnson), the decision received extensive media coverage, placing the Norplant® problem into American public discourse. While it may be useful to detail various critiques of Broadman’s decision, it seems more productive to examine how the case produced and was produced by a particular discourse of liberalism. Here, a relation of power produces a mode of subjectivity at non-corporeal and corporeal registers. On a spatial level, this mode of subjectivity is delinked from what Foucault calls the “heterotopia of deviation” (e.g. the prison) and set “free” into the public realm. Yet, the freedom offered Darlene Johnson (and that freedom is unequivocally real) – and its ontological significance – is haunted by the disciplinary production of new and/or alternately configured spaces of power relations. Callahan’s logic encapsulates the conundrum of the Norplant® condition in this sense: We are “free” if we are not in prison.
Yet the parameters of Darlene Johnson’s (albeit rightfully) limited freedom were further constrained by the way in which she was introduced to Norplant®. At the time of the sentencing (January 2, 1991), the FDA had approved the device for use in the United States less than a month ago (December 10, 1990). The application of the “Norplant Condition” was the first of its kind. According to the Appellant’s Opening Brief for the Tulare Superior Court, the Court did not fully inform Johnson of the nature of the device:
The only information it (the Court) provided was that, “it’s a thing that you put into your arm and it lasts for five years,” that “it’s like birth control pills, except you don’t have to take them every day,” and that it had been approved by the FDA, was not experimental, and was not permanent (C.T. at 44-45). When Johnson asked whether the device was harmful to the body, the court’s only reply was, “well, it’s like a birth control pill” (Id. at 45).
The Court never informed Johnson of surgical aspects of insertion and removal, medical contraindications, or of the device’s potentially deleterious side effects. Ironically, while the Court went out of its way to protect “future” or “imaginary” children, the Court abstained from denying Johnson of the custody of the very children she was convicted of abusing (The People of the State of California v. Darlene Johnson 4/24/91, 10).
Broadman’s sentencing elicited immediate criticisms – not only from civil liberties advocates, but also from those that designed and developed the Norplant® device. Dr. Philip Darney, whose research on Norplant® led to FDA approval, stated his explicit disapproval on record:
Norplant was developed for the purpose of expanding available methods of contraception and for the purpose of insuring access of reproductive choice for all women. It was developed out of a respect for human dignity and out of a belief that women should be able to have the number of children they want, when they want them. These principles, as well as basic standards of medical practice and medical ethics, are antithetical to this Court’s imposition of Norplant as part of a criminal sentence The People of the State of California v. Darlene Johnson, Appellant’s Brief citing Darney 4/24/91, 13).
Embryologist Sheldon Segal, who developed Norplant®, echoed Darney’s sentiments: “I just don’t believe in restricting human rights, especially reproductive rights. And I’m also bothered because this is a prescription drug, with certain side effects and certain groups of women for whom it may not be appropriate. How does the judge know if the woman is diabetic or has some other contraindication to the drug? That’s not his business” (Lewin 1/10/91, A13).
All parties involved are operating from a rhetoric of choice. From the perspective of the State, Darlene Johnson could choose Norplant® or prison and pregnancy or smoking. From Johnson’s perspective – as well as her attorneys – at issue here is a violation of her access to an informed decision. A choice without access to knowledge is not a choice. From the perspective of Norplant’s developers, the foundational concept behind the device is the expansion of individual choice and freedom. A woman has the right to choose. Lastly, from Callahan’s perspective, while there may be coercion in the process of using Norplant® in legal sentencing, the option of choosing between two undesirable alternatives is better than no option at all, i.e. prison. It is an understatement to say that the issue of choice is a foundational and crucial component of the politics of reproduction. In a broader sense, it would be an understatement to suggest that individual choice is a foundational component of the disciplinary liberal state. The notion is so entrenched in American political culture that “choice” is often synonymous with freedom.
Corrêa speaks on the ideology of choice, developing a pertinent marxian analysis of the quandary that the notion of choice presents in the Norplant® case:
The major divergences defining the debate can be described as the opposition between those advocating “choice” as the privileged approach to fertility regulation, and those asserting that the powers of technology largely prevail over the ability of women to preserve freedom and autonomy of decision. The first approach suggests the individual women (sic) is a consumer, facing the product without any social mediation. Power is attributed to the individual as if she can overcome social constraints and technological pitfalls. The existing “safety net” of mediating mechanisms which permit a first decision, occasional changes of mind and complaint against risk or abuse remains subsumed within the fetichism of choice (Corrêa 1994, 11).
Corrêa develops this notion of the fetishism of choice from Marx’s concept of the fetishism of the commodity (Corrêa 1994, 14;18). Corrêa takes what Marx applied to the realm of production into the realm of reproduction. In so doing, she delves into the ideological grounding point for subject-formation. In the case of Marx, the fetishism of the commodity obscures the political and social context of its production. In the case of the fetishism of choice, the allure and viable significance of the very notions of autonomy obscure the ways in which the subject is socially, politically, economically, and culturally produced.
The rhetoric of choice and the establishment of identity through rights discourse are the supporting structures of the very ideology that led Broadman to sentence Johnson to either prison or Norplant® and that lead others to encourage the mandate tying Norplant® to welfare. These forms of judgment that seek to produce a normalized, calculable and predictable individual originate in the assumption that action either has no epistemic and material grounding or that the conditions of action are irrelevant to its judgment. Born of a logic that “brooks no dissent,” Broadman’s decision succeeds in detaching itself from the human condition altogether. This loss of common sense is not an aberration or an outlier within the state of disciplinary liberalism. Rather, it is a condition of the (re) production of instrumental rationality. Instrumental rationality performs a perverse double function, simultaneously rendering the subject “invisible” by disappearing contingent aspects of human difference while doubling back upon itself a cold light of reason that illuminates the full accountability of the atomized self.
Disciplinary liberalism affirms choice but does not affirm a comprehension of the conditions and context of choice. In the somewhat different context of discussing the nature of “negative freedom” in Berlin’s work (for Broadman’s decision cannot be seen to be either solely an expression of “negative” or “positive” freedom), Thomas Dumm articulates this problematic from the field of the politics of space:
In presenting space as neutral, Berlin makes it the ground of freedom. To establish this space as the ground is to render it outside of contestation or struggle. Space is uncontestable as a neutral ground to the extent that one is prevented from questioning its production or recognizing that the production of space is always already an architectural enterprise. But when one remembers that space itself is produced, or, more provocatively, insists upon investigating the ways in which it is produced, one is better able to see the manner in which the neutrality of space operates as an architectural metaphor for grounding (Dumm 1996, 48).
Johnson could either choose Norplant® or prison. Like Berlin in this respect, Broadman makes the either/or space of that decision uncontestable. To contest the decision on the grounds that she was not well informed (as both Johnson and her attorneys did) reifies the illusion of neutrality. Rather than being restricted to the field of judicial politics, the politics of disciplinary liberal neutrality is also manifested in programs aimed at providing incentives for women to use long-lasting contraceptives.
B. Norplant® and Welfare in the United States
In 1991, State Representative Patrick of Kansas proposed House Bill 2089. This bill aimed to provide cash incentives to public assistance recipients who were 1) female and 2) receiving aid to families with dependent children (Kansas 1991). These recipients would receive a “grant” of $500 for the implantation of Norplant® and an additional annual sum of $50 “during the period that the contraceptive remains implanted and continues to be effective in preventing pregnancy”(Kansas 1991). Examinations for recipients by health care providers were also to be subsidized under this bill. The bill also stipulated that the secretary of social and rehabilitation services would notify all eligible public assistance recipients of this program of this grant option.
Other states joined in the effort to make the Norplant® “option” more attractive. Former Ku Klux Klan Wizard and Republican State Representative David Duke, made a similar proposal in Louisiana – suggesting a $500 cash bonus to welfare recipients in exchange for their consent to have Norplant® implanted in their bodies. A vast array of factors – including the United States’ deeply problematic history of involuntary sterilization/contraception, the racially charged aspects of the Philly Inquirer incident, Duke’s former membership in a right-wing hate group were among the factors that contributed to rising criticisms of the Norplant® condition. Despite criticisms from the American Civil Liberties Union, the American Medical Association, the Black Women’s Health Project, and for that matter, the Director of Biomedical Research at the Population Council, proposals to tie Norplant® to welfare in some form in the United States exploded onto the political scene at the state level. Corrêa cites an Alan Guttmacher Institute report “of approximately twenty bills, amendments and welfare reform proposals involving Norplant” in thirteen legislatures from 1991 to 1992 alone (Corrêa 1994, 9).
Significantly, none of the proposals have been enacted. That being said, the fact that women in poverty remain the focal point for the discourse of reproductive “irresponsibility” (few of the measures aim at limiting male procreation, for example) remains highly significant. The gender, class, and race dimensions of the Norplant® condition necessitate an analysis that goes beyond the problematics of the ideology of population control and into the ways in which subjectivity is reproduced and literally contracepted in the capitalist disciplinary liberal state. If Norplant® (and other long-acting contraceptives) were solely a matter of population control, it is likely that their popularity and marketing would be limited only to areas with high fertility rates.
Attempts to link Norplant® to welfare underscore a pronounced rhetoric of “responsibility, the Janus-face specter of the fetishism of choice. Here, reproduction is not something people do, but a privilege of affluence. When poor people reproduce, women are labeled as “irresponsible.” Steinbock details what may constitute the most egregious proposed bill to date in her “The Concept of Coercion and Long-Acting Contraceptives,” a bill which does provide a sort of perverse gender equity on this policy matter. At the time of the essay’s publication, the Ohio bill was pending. It stipulated the following:
A bill is pending in Ohio that would provide a new welfare mother with a one-time payment of $1,000 and would increase her monthly cash assistance to 150% of her base subsidy if she is sterilized by tubal ligation. If she agreed to have a long-acting contraceptive such as Depo-Provera or Norplant, she would get a $500 payment and a 10% increase of her base subsidy every six months until she reached the 150% level. Under the bill’s provisions, the welfare mother would be required to identify the father of the child. He could elect to pay child support, perform community service work, be sterilized and receive $1,000, or be sent to prison for two years. Also, a new welfare mother would have to pass a test prepared by the state Department of Human Services to show she has appropriate parenting skills. The newborn of a person who refuses to take the test or who fails could be placed with relatives in a foster home (Steinbock 1998, 66-67).
Steinbock’s essay proceeds to separate the excesses of the Ohio measure from less coercive measures, such as the Kansas measure. From this point of separation, she considers the potential legitimacy of such incentives using the “compelling State interest” test of Skinner v. Oklahoma (Steinbock 1998, 66-70). After all, “Norplant bonuses are not conditioned on anything so drastic as organ donation or serving as a surrogate mother. They merely require women to suspend procreation temporarily” (Steinbock 1998, 70 emphasis mine). Others have argued that such a requirement is hardly banal and might also point out that such measures (with the Ohio sterilization/prison/community service option excluded) do require women and only women to undergo such medical treatment. However, the saving grace of the “cash incentive” program is that the State has a “compelling interest” in limiting the reproduction of women who are not financially equipped to raise any more children. Moreover, cash incentive programs – when small enough – are a matter of choice (Steinbock 1998, 71). When they are too large, they constitute a threat to “the values of autonomy and equality and should be rejected for these reasons” (ibid.). Despite her rejection of many of the proposals, by grounding that rejection in the balancing of the State’s compelling interests with a quantification of individual autonomy, the analysis frames the policy not in terms of women’s needs, nor in terms of the needs of people in their inscrutable particularities, but in terms of the needs of the State.
To follow Arendt, Steinbock’s argument - like that of the legislators who have proposed linking Norplant to public assistance – is well on the way of making everything possible once the premise of the State’s compelling interest is accepted. It does follow a certain logic that those who depend on State resources for sustenance should refrain from increasing the consumption of those resources. The State, indeed, does have a compelling interest. However, who decides that policy should be framed in terms of the interests of the State? Are the interests of the State consonant with the welfare of its people? By framing reproductive and distributive policy in terms of the State’s interests, the accountability of the State is dispersed onto individuals.
This act of framing emerges from a representation and understanding of the State as neutral, as a space and place beyond ideology. Once the State is conceptualized as an embodiment of neutrality, criticism and resistance to policy initiatives are circumvented. The State hypostatizes its own ideological contours, solidifying them as part of the laws of Nature. In this realm, the compelling interest of the State takes precedence over the compelling interests of the public, of human pluralities. Yet, there is more to the policies involving cash incentives than the discernable inscription of the State as outside “itself.” Cash incentive programs also fix and produce predictable forms of subjectivity. Both the voluntary welfare program proposals and the Planned Parenthood “Dollar-a-Day” program represent not only a re-location of human accountability, but also an attempt to create a predictable, normalized, routinized subject. It is with this in mind that I turn to Planned Parenthood’s Dollar-a-Day Program.
C. Norplant® and Teen Pregnancy: the Dollar-a-Day Program
In Denver, Colorado a Planned Parenthood program aimed at stemming the rise of repeat teen pregnancy – particularly teenage girls, “mostly black and Hispanic” who have given birth before the age of sixteen (Steinbock 1998, 71). In response, the Dollar-a-Day Program was introduced: “The program requires girls to come to one meeting a week, where they receive their seven dollars, paid out for symbolic reasons in one dollar bills. Girls who become pregnant must drop out of the group” (Steinbock 1998, 71). Girls were introduced to Norplant®; long-lasting contraception was encouraged, but not a precondition for participation. Steinbock notes the success of the program:
After five years, the program was judged a success. Only 17% of the girls in the program became pregnant; this compares very favorably to a 50% risk of repeat pregnancy within two years for girls who have become pregnant before age sixteen. In addition, the program is claimed to have saved Colorado in excess of a quarter of a million dollars in welfare and Medicaid payments. Despite these advantages, President Faye Wattleton and a majority of the board of Planned Parenthood Federation of America denounced the program as “coercive.” Paying teenagers not to get pregnant, they felt, went against the organizations long-standing and deeply held policies advocating reproductive choice and individual rights (Steinbock 1998, 71).
Steinbock draws a distinction between the Planned Parenthood Program (which she terms “liberty-enhancing”) and the proposals to give “rewards” for accepting Norplant® (which undermine the values of autonomy and equality) (Steinbock 1998, 73). I seek to unpack this distinction because Steinbock’s analysis carries with it the hallmarks and problems of the practice of liberalism, particularly in relation to the field of new reproductive technologies.
For Steinbock, the reason why this is an acceptable program while other incentive programs are not is that it satisfies for her, “the choice prong” (Steinbock 1998, 73): “The girls are not threatened or forced or pressured into avoiding pregnancy. Rather a small financial incentive is offered…if they decide not to join, they are not thereby made worse off”(Steinbock 1998, 71-72). This reasoning is flawed internally (i.e. by her own logic) and externally (i.e. the logic as a whole problematizes the very notions of autonomy and equality that she champions).
First, Steinbock suggests that the former examples (offering $500 for Norplant®), as well as this example, are distinct in that the latter involves only a small financial incentive. The Dollar-a-Day program was a two-year program, which supplied young teenagers with seven dollars a week or $365 a year – or $730 per successful program participant. This is $230 higher than the amount offered in many of the bills presented in state legislators tying Norplant® to welfare that Steinbock eventually found problematic. Recall that Steinbock opposed the welfare measures on the grounds that women in poverty would be unduly influenced by the $500 financial incentive. Why is it that a sixteen-year-old mother of at least one child would not be unduly influenced by the potential benefit of $730? Because the cash flow is incremental and is presented in a symbolic fashion, the value of the currency is diminished in this analysis.
This problem in the essay highlights the broader problem of positivist attempts to quantify the notions of coercion and autonomy. At what juncture does pressure dissipate into support? At what juncture is reward actually coercion? Steinbock’s essay is excellent in that it begins to ask these questions, but in founding her analysis on the ambiguous and problematic notion of choice, the social, political and cultural complexities of reproductive policy are bypassed. Thus, the complexities of gender discrimination and racial discrimination simply do not enter into her discussion. Yet, her account stated the program targeted only girls. By her own account participants were “mostly black and Hispanic” (Steinbock 1998, 271). Yet, in the same essay that places a premium on “the values of autonomy and equality,” questions of gender and racial (in)equality were not discussed. This is due primarily to the primacy that Steinbock, Robertson, and the architects of many of these policies (e.g. Representative Patrick of Kansas) place on the concept of choice. If the “choice prong” is satisfied, if the “subject” is ostensibly free and autonomous – then the values of equality and autonomy are ensured. The liberal self is a hypothetical, faceless subject – without a body, without geography, without history. The “reward” system of a dollar a day for Norplant® – or any contraception – carries markedly different significations for groups of people whose reproductive rights have been systematically denigrated, as Dorothy Roberts succinctly points out (1997). Race, gender, class and reproduction can not be separated – particularly when one aims towards the values of equality and autonomy.
In their essay, “Other “isms” Aren’t Enough: Feminism, Social Policy, and Long-Acting Contraception,” Hilde Lindemann Nelson and James Lindemann Nelson also analyze the “Dollar-a-Day” program as a case that complicates the “choice” paradigm. The Lindemann Nelsons are quick to note that perhaps such a program should at least be augmented by a similar program aimed at increasing boys’ sexual responsibility. Their point here is that approaching reproductive policy through feminist perspectives enables the analyst to encounter ways in which programs can be both more effective and egalitarian. By integrating the standpoints of those who are most likely to be directly impacted by policy, feminist policy analysis points to ways in which the compelling interests of those impacted by State and social policy are not neglected.
Feminist policy analysis, when taken another step further, might point to the questions above and beyond the significant issue of coercion implicit in the Dollar-a-Day program. Such an analysis could elucidate the ways in which girls and boys are being made. While the Lindemann Nelsons’ do implicitly allude to this by suggesting that boys be integrated in these programs (excluding boys gives them the wrong message – a social inscription that marks their reproductive behavior through and through), the bulk of their work and most of the literature on this topic fixates on the topic of coercion. Steinbock notes the high rate of physical and/or sexual abuse among participants and champions the sense of self-esteem that the program instills in participants (Steinbock 1998, 73). Robertson labels the dollar-a-day reward as “symbolic” and both Robertson and Steinbock consider the reward to be low enough that those who enter the groups do so for non-monetary reasons. Yet, if the “symbolic” realm is so significant, why is it not attended to in greater detail?
On the whole, it seems that the work that is being done is good work. Teens are getting “support,” not “pressure.” Indeed, there is something to be said for a network of people who can mutually provide support for issues as difficult and challenging as teenage pregnancy and child-abuse. But, there is also something to be said about the process of normalization, an institutional inscription of a particular vision of human reproduction – a vision that is disproportionately inscribed on black girls and Latinas. Perhaps most importantly of all, there is something to be said about who is excluded. If the group were actually a support group, then other provisions would be made for those girls who became pregnant. In the Dollar-a-Day program, the solution is exodus. If anything, more support is needed for these girls, instead of exclusion from their support group. The Planned Parenthood of Denver has created a “heterotopia of deviation.” This space (or non-space) of exclusion constitutes the parameters through which normalcy is defined and instantiated. The Dollar-a-Day program may not only have the “happy” consequence of reducing the rate of teen pregnancy, it may also make pregnant teen mothers feel worse than ever. For seventeen percent or close to one out of every five participants (Steinbock 1998, p. 71), there is no support, just exclusion. For the remaining eighty-three percent, there is the act of excluding an other. This may be helpful as a means of reducing the rate of pregnancy, but it may also have unintended consequences – consequences which include socializing young girls to exclude.
The Dollar-a-Day program is particularly interesting because it points to and has the potential to be what Foucault terms, a “crisis heterotopia” – a “privileged or sacred or forbidden place(s) reserved for individuals who are in a state of crisis with respect to society” (Foucault 1994, 179). Foucault notes however, that these spaces are increasingly rare – that they are being replaced by heterotopias of deviation: “those in which individuals are put whose behavior is deviant with respect to the mean or the required norm” (Foucault 1994, 180). The Dollar-a-Day program functions in part as a crisis heterotopia that depends heavily upon the construction of a deviancy. This is part of a process of
creating a different space, a different real space as perfect, as meticulous, as well-arranged as ours is disorganized, badly arranged, and muddled. This would be the heterotopia not of illusion but of compensation, and I wonder if it is not somewhat in that manner that certain colonies functioned (Foucault 1994, 184).
In the well-arranged spaces of the Dollar-a-Day program, everyone is paid for their “good” behavior and those who are bad are excluded. In this act of “compensation,” a divided and rationalized subjectivity is produced. I am not saying that aspiration of preventing teen pregnancy is right or wrong, but rather delineating how this particular program contributes to a socialization process – a process that answers to predictability and hyper-rationality. The program is so dedicated to the prevention of pregnancy, that the physical, emotional, and mental health of those who become pregnant is not only not a non-priority, it is a non-issue. This process of creating successful people and disappearing others has been missed not only by the creators of the program, but by many of its supporters and critics – including Planned Parenthood’s national center. As long as the issue of choice is satisfied, few questions are raised. Ironically, the issue of “choice” often clouds further inquiries into the meaning of reproductive liberty and freedom.
Foucault’s notions of power present ways of understanding the problematics of Norplant® beyond the contributions of more positivistic policy analysis. In conjunction with feminist perspectives on reproductive technologies, Foucault’s analysis underscores the medicalization of the political realm. The case of Darlene Johnson, legislative proposals to link Norplant® to welfare and the Dollar-a-day program highlight the production of predictable, normalized identities through exclusionary and disciplinary tactics. I have argued thus far that Foucault’s notions of resistance and action are, however, more limited. Below, I turn towards the topic of resistance with attention being paid to women who were the recipients of the Norplant® trial phase and to women whose medical practices lie outside the parameters of “traditional” modern medicine. Through these accounts, an appreciative critique of Foucault’s concepts of power is provided.
3. Resistance and Feminist Action: The Case of Abigail Odam and the Women’s Health Movement
The case of Abby Odam is particularly complex in that it engages the rhetoric of choice - its institutional, disciplinary grounding not by interrogating choice per se but through a radicalization of the concept. Odam’s anarchist feminist praxis both points to the possibilities and dangers inherent in Arendt’s accounts of action and natality. In presenting the following account of what led to Odam’s arrest, it is important to indicate that this is not intended to be an “objective” account for an objective account would delineate little to nothing about Odam’s understanding of the situation.
To put it differently, I have asserted the values of human particularity – especially how that is expressed and passed down through narrative. It has been argued that such “storytelling” constitutes a fundamental aspect of the maintenance of human plurality in a fragile world. While considerable attention has been given to the disciplinary construction of subjectivity, my attention is directed towards ways in which “subjects” inscribe upon the social their own vision, which frustrates and redirects forms of disciplinary power (Grosz 1994). Thus, some care must be taken to be “true” to the subject, in this case Abigail Odam. Yet, additional care and recognition must be paid to the multiplicity of subjectivity(s). In their analysis of qualitative data collection techniques (using women’s experiences of motherhood and postnatal depression as key examples), Natasha Mauthner and Andrea Doucet detail the complexities of attending to the complexities of “voices,” “stories,” and “self” (1998, 119-146). In addition to a multiplicity of voices and identities, each self or “voice” contains a multiplicity. Mauthner and Doucet point to the literature on the discursive construction of the self and acknowledge the difficulty of re-presenting a knowable subject (Mauthner and Doucet 1998, 136). While to some, such a framework would seem to lead to the impossibility of valuable social research, this important theory of subjectivity can inform a practice of humility on the part of the researcher: “We pay attention to what we think this person is trying to tell us within the context of this relationship, this research setting, and a particular location in the social world, rather than making grand statements about just who this person or ‘voice’ is (Mauthner and Doucet 1998, 136-137). The tension between the desire to know and the impossibility of knowing the subject can produce valuable results when a certain self-reflexivity comes into play. In the cases of Abby Odam, I am looking at how and in what ways these figures inform and resist disciplinary liberal power relations.
Abby Odam is a direct entry midwife “who practiced for 10 years in San Diego, California. She was convicted of five counts of "practicing medicine without a license" and one count of child endangerment on Feb. 14, 1997 but was free on bail pending sentencing April 2. On March 21, she was jailed for "conspiracy" based on a sealed indictment, with bail set at $1,000,000.” The conspiracy indictment resulted from her refusal to resist the request for assistance in home birthing upon her February 14 release. Due to the fact that Odam had been arrested for practicing without a license, the indictment of “conspiracy” could be and was, handed down. Odam’s sentence of four years and eight months was eventually reduced to a release date scheduled for September 13, 1999. It has been noted by supporters in the midwife community (and it must be noted that the community is sharply divided over Odam’s case to this day) that Odam’s sentence was above and beyond what could be considered typical for this sort of violation. At this point I turn to an account of the events surrounding her arrest:
The case that caused so much furor was a lady who had a previous classical Caesarean – To shortly sum up – this type of incision is more likely to rupture during another birth. Routinely these women have planned Caesareans before their due-dates: Colleen came to me wanting a vaginal birth with a previous incision of this type – We researched the risk of rupture and found it to be two to four percent. She decided she wanted to take the risk. Her uterus ruptured – the baby was stillborn. It was tragic. She is very thankful for having the choice that I didn’t defend myself first and not take her on. This infuriated the other midwives: How dare I allow such a choice? My job as I saw it was to support families – sharing my knowledge and my limitations…I have briefly tried to summarize my thoughts. It has been fun. I’ve never written before – as I’ve never read Foucault and Arendt. I’ve been addictively serving families day and night – didn’t even read the mail – no (Odam, 10/1/97).
Is Odam’s account of the events leading to her imprisonment “accurate?” Indeed, other midwives, doctors, members of the jury found the case to be more (or perhaps, less) complex. Yet, the point of this moment of criticism is not the construction of a judgment or an attempt to hand down (yet another) sentence.
Rather, I want to emphasize how Odam perceives her role as a midwife/activist and as a member of the human community. Odam sees her case as something of a political referendum on the practice of midwifery, contextualizing it in a long-standing tension between modern medical models of birthing and midwife-assisted models: “The OB sees birth as a crisis about to happen, as the midwifery model sees the woman as going through a healthy process – her job being to facilitate.” (letter, 4/17/98). Medicine, for Odam, seems not to be a matter of health care, but rather a problematic imposition of power. Medicine here, is not a matter of making people better, but of establishing a relationship of dependency, a muting of women’s autonomy.
Nor is this model of midwifery solely a matter of women’s autonomy. Odam understands her practice as a mode of respecting the life process in all its complexity, choosing to offer “non-doing” or action through non-action as often as modern obstetricians may offer medical intervention. For Odam:
the medical model takes one away from the life process. It serves to distract from the true sense of health and well being. In a sense I was practicing medicine by using any tools at all – so I have come full circle – maybe the courts are right – using tools of any kind is medicine – even the listening to the heartbeat of the baby causes a separation of baby from mom – separation being the imprinting that all of us are trying to heal (ibid.).
Odam’s critique of medical technology is particularly interesting in the context of what expecting mothers lose through ultrasound:
Few OB’s ask a woman what she thinks. Technology only feeds into this – i.e. ultrasound – in which you can see the baby on the screen and the doctor decides if the baby is perfect, is worth keeping. When women see the baby they have lost the fantasy, the dreaming of the child, the wonderment – to have a fixed image raises expectation – then the reverse = disappointment, then lawsuits…the lack of accepting what is, that we are perfection and whatever we are is divine (letter, 4/17/98).
Whatever difficulty one may (or may not) have with other aspects of Odam’s praxis, the notion of wonderment at who we are serves as a vital (in the literal sense) moment in confounding and resisting the instrumental rationality of the disciplinary liberal state. Disciplinary liberalism aims to produce the good subject.
Odam sees the practice of midwifery as a fundamentally political practice, a practice that refuses State interests in favor of the compelling interests of “the family in intimacy” (ibid.). This intimacy was shared by the community of people who had participated in homebirths on a regular basis. Odam writes of the loneliness and sense of community experienced by these families:
They have a wonderful network – that was the most rewarding part of my work. Every Friday night I had “classes” which were really networking nests. The house was filled with mothers, fathers, and babies sharing and passing on information. Homebirthing is considered so “alternative” that it is lonely for the one percent who do it…I was always putting women in touch with others in their neighborhoods (ibid.).
Given these understandings of some of Odam’s basic ideas as to the meaning and function of midwifery and modern medicine, the value of alternative communities, and the dangers of technology, how do these ideas reflect Foucault’s concepts of power, knowledge and resistance? Furthermore, to what extent or how can her work be conceptualized within Arendt’s framework? Is it resistance? Is it natality-in-action, rooted in a deeply embedded sense of human plurality? Or is it a vision that looks in one direction, all the while darkened by its own shadow?
In the context of Foucault’s work, the modern medical model can be considered a mode of domination where “an individual or social group succeeds in blocking a field of power relations, immobilizing them and preventing them any reversibility of movement by economic, political, or military means…In such a state, it is certain that practices of freedom do not exist or exist only unilaterally or are extremely constrained and limited” (Foucault 1997, 283). Odam’s critique of the problems that modern medicine – particularly modern medicine in the field of reproduction – highlights this process of blocking a field of power relations (recall here that for Foucault, freedom exists within power relations) and echoes the process of minimization of Norplant® recipients’ experiences. For her, the medical model portrays a univocal conceptualization of the Truth. Those who fall outside that notion of the truth must be corrected or disappeared, literally. In this respect, Odam’s work echoes certain aspects of the Foucauldian critique of the disciplinary apparatus of the State – as it relates to new reproductive technologies, but does it qualify as a form of resistance and/or Action?
Approaching Odam’s practices in the context of Foucault’s contributions would not result in handing down another sentence. It would not sit in judgment, but would seek to open doors – new possibilities for thought and action. It is in this vein that I continue. For Foucault, power is relational and has no point of exteriority or point of origin. This seems markedly divergent from Odam’s scheme in many respects. For Odam, while power does have a relational aspect (power is not the sole possession of “technodocs” but is dispersed and present in every man, woman, and child), it seems that in her fixing the moment of birth the site for “imprinting” locates power in one specific space and time. This is particularly important because there is a risk of occluding or dissolving the importance of other sites of power relations in conjunction with the birthing moment. Moreover, once power is conceptualized as being fixed in a specific space and time, politics and the transmission of meaning itself are actually put at risk. The vitality of the unpredictability of action is rooted in the unpredictability of birth – that we are newcomers. Within Odam’s framework, there is a potential for reading the unpredictability of birth as predictable. Ironically, in its own way, action is routinized – albeit in a form and fashion that is critical of contemporary social, medical, and political values.
But, perhaps I am too quick to hand down a sentence. Foucault makes a vital observation in his construction of the notion of resistance as “distributed in an irregular fashion” (Foucault 1990, 96). They are “mobile and transitory…fracturing unities and effecting regroupings, furrowing across individuals themselves, cutting them up and remolding them, marking off irreducible regions in them, in their bodies and minds” (ibid.). While the construction of this form of resistance may indeed have strategic and significant implications, Odam’s work attempts to and does, cut across the constructed unities of Sovereignty and Law. This much, it seems, can be agreed upon by the prosecutor, the jurors, Odam, and members of the midwifery community. Odam’s investment in “natural” birthing processes opens the door for others to consider the possibility of reproductive health outside the modern OB/GYN model. This is no small task. Practices that stand in contradistinction to the tenets of scientific method can and do work to problematize the constructed univocity of science’s rhetoric of neutrality. They ask and demand a standpoint on human action that is located not outside the realm of human affairs, but deeply embedded within them.
It is in this sense that Odam’s practices are consonant with important aspects of Arendt’s concepts of plurality, action and natality. The concept of natality, that each person is a beginner – works from a revelatory sense of being-born-into-the-world. It is not that a sense of the miraculous and the revelatory is absent from Foucault’s work, but that it is central to Arendt’s work. It is from this notion of the miracle of the new that a politics of recovery is delivered. Seen in this light, Odam’s celebration of the “natural” realm where “whatever we are is divine” is not a passive capitulation to the forces of domination – but a celebration of every one of us who has been born:
The miracle that saves the world, the realm of human affairs, from its normal, “natural” ruin is ultimately rooted in the fact of natality, in which the faculty of action is ontologically rooted. It is, in other words, the birth of new men and the new beginning, the action they are capable of by virtue of being born. Only the full experience of this capacity can bestow upon human affairs faith and hope, those two essential characteristics of human existence which Greek antiquity ignored altogether, discounting the keeping of faith as a very uncommon and not too important virtue and counting hope among the evils of illusion in Pandora’s box. It is this faith in and hope for the world that found perhaps its most glorious and most succinct expression in the few words with which the Gospels announced their “glad tidings”: “A child has been born unto us” (Arendt 1958, 247 emphasis mine).
The notion each of us is and can never be again is a powerful notion – one that formulates a politics based on distinction and difference. This celebration of distinction, which might be mistaken for a politics of contention, is balanced by a sense of recognition of a divinity not in singularities but in pluralities. These pluralities intersect, adumbrate, frustrate the monological trajectory of normalization – a normalization process that is technologically instituted and enforced.
On the whole, much of the politics of midwifery (including much of Abby Odam’s career) is a matter of what Leo Strauss calls “writing between the lines” (Scott, citing Strauss 1990, 183). The politics of resistance is not only a matter of guerillas and insurgent groups, but also of the transmission of meaning. Alternate forms of signification are not devoid of political content. Rather they serve as the wellspring of political action, as opposed to political behavior. Radical forms of midwifery, such as those espoused by Abby Odam, challenge the Norplant® Condition in many significant respects. The revelatory character of birthing, that each of us is revealed in the world as miracle presents a demonstrable challenge to the rising tide of biopolitics that has been expressed in the eugenic components of new reproductive technologies. Odam’s construction of technology as problematic is more than the mere statement that it is “bad” – after all, she acknowledges her use of technology on a regular basis. It is consonant with readings of the ideological basis of technology, that technology and ideology go “all the way down.” There is an ideology in the use of any instrument. Lastly, Odam’s community of home-birthing “participants” delineates the ways in which narrative and “nesting” comprise support in a fragile political order. These “networking nests,” constitute what Benhabib calls “the redemptive power of narrative” (Benhabib, 1990). As I noted in Chapter Four Benhabib writes, “for who we are is revealed in the narratives we tell of ourselves and of our world shared with others. Even when tradition has crumbled, narrativity is constitutive of identity” (Benhabib 1990, 187 emphasis mine). Traditional medical models of birthing and health – and political models of community did indeed “suffer a sea change” in the storytelling that went on every Friday night at Odam’s. Moreover, Odam continued to narrate her experiences and beliefs from a most desolate space, the prison. And, it is through narration (in part) that her arrested time and space was recovered and reclaimed. Odam wrote to a larger public (her accounts being posted on the World Wide Web), her supporters (published in a newsletter, Letters from Abby), and privately. Odam’s narratives are sites of remembrance reclaiming meaning and I would argue, power (as in Arendt’s potentia). This re-member-ing rearticulated the dividing practices of the disciplinary apparatus of the penitentiary. Odam’s story indicates the ways in which the powers of memory and narrative function to begin anew – in dire circumstances.
The notions of plurality, alternative communities, storytelling, and critiques of technology found in Odam’s practice are, in many respects, part of a broader movement. The women’s health movement can also be considered in this light. While it enjoyed a broader popularity during the 1960s and 1970s, it has hardly disappeared. The Chicago Women’s Health Center stands as one of the few remaining facilities in the U.S. entirely dedicated to the principles of self-empowerment that guided the American women’s health movement of the 1970s. A staff member noted:
it is a nonprofit, women-controlled center - women-owned and operated involved in the health and health-related education of the clientele regardless of their ability to pay. It has been in existence for 22 years. It seeks to generate self-help, self-empowerment, and preventive care. It is the last collectively operated facility of this sort in the United States (7/17/97).
Like Odam’s practice in some respects, the Center aims to provide a wide array of health care options, maximizing each woman’s autonomy by encouraging and supporting women: “There is definitely room for more alternative holistic approaches, even though the traditional medical practice is available. In addition to making the goals accessible by making the different technologies and techniques accessible, there is the function of outreach - which educates the clientele. This education informs women to listen to their bodies” (7/17/97).
While the Center is “more open to women-center reproductive technologies (cervical caps and fertility awareness)” and is “less open to more invasive procedures (Norplant® and Depo-Provera),” both are made available at the Center. The availability of these technologies hardly represented a wholly receptive attitude towards new reproductive technologies, however. She noted:
Reproductive technology is simply not done for men. It is done by men for women. (Modern male medicine treats the woman’s body as a crisis) A lot of what goes on in your body is not an emergency, a medical crisis. Traditional medicine treats women’s bodies like there is always a crisis going on. The Chicago Women’s Health Center seeks to create the “informed consumer” - to work with women, to empower them to listen to themselves. For example, pelvics are easier sitting up at 45 degrees, rather than prone, at the physician’s mercy (7/17/97).
Both Odam and the Health Center representative see the “traditional” model of medicine as treating women’s bodies as crisis. Informed by a feminist ethic of care of the self, learning to listen to our bodies, refusing the hysterical notion that women’s bodies are in crisis by definition, and enacting this ethic through practices that do not put a woman at a physician’s mercy – all of these practices could be read solely as “health care” matters (albeit important ones) or they could be read as a political engagement with our bodies and the world.
I have noted that we cannot understand the full force of reproductive technologies without confronting not only what happens to our bodies (via Foucault), but also how our bodies literally participate in the production of power relations. The act of lying prone that the women’s health center worker discussed could easily (and often does) constitute part of the production of a particular masculinist power relationship. Yet, within the posture is an “I can,” a physical insertion of the self – a listening to one’s body – whereby “I-can-raise-myself-up.” While we are by definition, possibilities, these possibilities are enframed and configured “from below” (Foucault 1990, 94). Power relations operate and function in our bodies. It is no small task to create a space of appearance whereby those power relations are reconfigured, challenged, and frustrated.
Odam’s practice and the women’s health movement provide avenues for resistance and evidence of counterhegemonic action in the field of reproductive health. Both point to ways in which health care professionals can and do provide methods of care of the self that stand in opposition to the modern medical paradigm of health care. The political ramifications of these practices are significant because they present a valuable and compelling critique of technology and a liberation of women’s body’s from male-dominated medico-political orders. This critique and this “listening to our bodies” is achieved in part through the construction of alternative communities of storytellers – people who listen to each other and themselves, despite what they are told. This has ramifications for understanding resistance within the disciplinary liberal State – a topic marking the conclusion of my research.
