Full transcript
0:04[music]
0:09[music]
0:17>> Hello everyone. I welcome you to the
0:18lecture 12 of our course introduction to
0:21medical humanities. And like I mentioned
0:24earlier in this particular lecture, I'm
0:26going to talk about one of the
0:28theoretical frameworks which we will
0:30employ to discuss some of the cinematic
0:34and literary narratives in the
0:36subsequent unit.
0:38So the lecture title is reproductive
0:41justice and its threads. And what do we
0:44mean by this that I am going to talk
0:46about the right of reproduction and how
0:50it is an important issue in the case of
0:53medical humanities.
0:55A quick overview of what I will be
0:57discussing. I straight away come to the
1:00introduction of it. Now, why is
1:03reproductive rights important? What is
1:05the meaning of reproductive rights? So,
1:07if you look at reproduction, which is
1:10the decision to have a child uh
1:14and related aspects, this particular
1:17right emerged in
1:19during the
1:211960s
1:22and 70s, which is also a very seminal
1:26moment in the history of feminism, which
1:29is when the second wave of feminism
1:32began.
1:33Now, in this particular time, women were
1:37advocating for control over
1:40reproduction. What does this mean? That
1:42they wanted to decide, they wanted to
1:44have a bodily autonomy in which they
1:47were the decision makers of
1:50whether they wanted to have a child or
1:52not.
1:53Now, this focus
1:56primarily on the legal aspect on
2:00contraception and abortion. This was
2:03primarily framed around individual
2:05choice and legal protection of that
2:08choice. So, reproductive rights focused
2:12primarily on the legal access to
2:14contraception and abortion.
2:17Now, what does it
2:19contain? The components were right to
2:23access reproductive health care, which
2:25is again, whatever was necessary in
2:28terms of reproduction that was im-
2:30important, right to information and
2:33health care education. The information
2:36became the source of knowledge. The
2:38right to bodily autonomy, right to safe
2:41pregnancy and childbirth, right to
2:43equality and non-discrimination. Now,
2:46all these five components together
2:49became the important markers of what
2:52constitutes reproductive rights.
2:55However, it was later identified that
2:58there was limitation to because it did
3:01not fully address the social and
3:03economic barriers to reproductive health
3:06care. It left many of the intersections
3:09unnoticed and therefore the marginalized
3:12communities often lacked real access
3:16despite legal rights and that is where
3:19we will have other aspect coming up,
3:22which is the reproductive justice
3:24aspect. Now, when you think of
3:27reproductive rights, we assume that if
3:30there are legal rights, it is available
3:32to everyone. Now, reproductive justice
3:35discourse is in certain sense an
3:38advancement of what we can think of
3:40reproductive rights. It's a more
3:42inclusive way of thinking about
3:45reproduction because in this particular
3:47framework, the reproductive justice
3:49framework, a term coined in 1994 by
3:53black feminist activist in the United
3:55States. About 12 women also called as
3:58founding mothers of reproductive
4:00justice. They combined reproductive
4:03rights with social justice and human
4:05rights framework. Which means that they
4:08emphasized that the reproductive freedom
4:11requires equitable access to health care
4:15resources and supportive environments.
4:18Which means that different women will
4:21have different kind of information and
4:24resource and therefore the justice
4:28component, the accessibility
4:31versus resources
4:34dynamics also have to be taken into
4:36consideration and that is why we talk
4:39about reproduction through the framework
4:42of reproductive justice. Even here there
4:44were five components. What were they?
4:47The first one was the right to have
4:48children or not to have children.
4:52So this was the first. The second was
4:54the right to parent child in a safe and
4:59sustainable environment.
5:01So that also became important in
5:03reproductive justice. Other than that,
5:06access to comprehensive reproductive
5:08health care, respect for bodily autonomy
5:11and human rights and socio-economic and
5:14environmental justice also became part
5:18of the reproductive justice theoretical
5:21framework.
5:23If you look at different elements of
5:26reproductive health and care,
5:28I am trying to broadly categorize it but
5:31this is not a watertight
5:32compartmentalization.
5:34They are sometimes overlapping and then
5:36can there can be more that you can
5:39discuss but for the understanding of uh
5:43you, I have tried to bifurcate it a
5:45little bit because these are some of the
5:48issues that we will be dealing with
5:50while we are analyzing the cinematic and
5:52literary narratives. So, the first one
5:54is the menstrual health. In this
5:56particular space, we are looking for
5:59access menstrual hygiene, education, and
6:02stigma-free health care. So, different
6:05cultures respond to menstruation in a
6:08different way. And this particular
6:11element says that it is essential for
6:15women or girls to have dignity, health,
6:18and gender equality when it comes to
6:21menstruation, because it's a natural
6:24aspect of
6:26women's life.
6:28The second important element of
6:30reproductive health and care is
6:33fertility and infertility. Now, medical
6:37support is very much there for the
6:40fertility treatments and infertility
6:42care, but there are two things that we
6:46have to take into consideration when we
6:48talk about infertility treatments. What
6:50are they?
6:52The first thing is if the social
6:55apparatus in which you are,
6:57if it is ready for that, because there
6:59is a lot of stigma associated around
7:02infertility.
7:03The second aspect is that of the
7:06accession of resources. Now, most of the
7:08times,
7:09the socio-economic factors are not taken
7:12into consideration. In this case, uh
7:15this particular aspect, where
7:17infertility treatment is accessible to
7:20everyone, is an important advocate or an
7:23important point that reproductive
7:26justice framework tries to make.
7:28The third thing is around contraception
7:31and family planning. Again, a very big
7:34issue.
7:35This promises
7:37access to safe, affordable, and informed
7:39contraceptive choices. And it enables
7:42individuals to plan pregnancy and
7:44exercise reproductive autonomy. Like it
7:47is
7:48the body of a woman and she makes the
7:50choice whether to have a baby, not to
7:53have a baby, what time she wants to have
7:55a baby, if she's mentally ready for
7:57that, if the resources are right, all
8:00those things are taken into
8:01consideration within this point which is
8:04contraception and family planning.
8:06The fourth and important point is
8:09pregnancy and maternal health care. Now,
8:13some of you must be aware of the term
8:15postpartum depression and
8:18other related anxieties around
8:21pregnancy. These were not the terms that
8:24we had heard of say even 10-15 years
8:27back. But over a period of time, you see
8:30a lot of consciousness
8:32behind uh
8:34these aspects also of
8:37maternal health. And this is all because
8:40of the reproductive justice framework
8:42that came into play, which took account
8:45of different other aspect of pregnancy
8:48than just pregnancy itself. And when it
8:52says maternal health care, it includes
8:54even that. So, what else does it
8:56include? Prenatal, childbirth, and
8:58postnatal health services. And this is
9:02critical for reducing maternal mortality
9:05and improving maternal well-being. So,
9:07if you see in the context of India, I
9:09was discussing so many schemes that are
9:12running across the country of
9:14maintaining nutrition for the women who
9:17are pregnant and
9:19when they are lactating. So, all this is
9:21part of ensuring maternal well-being
9:24even in the context of India. I mean,
9:26technology is growing and therefore
9:29assisted reproductive technology is also
9:31something which is very important these
9:34days. Technology such as IVF, artificial
9:37insemination, and egg freezing are terms
9:40of the day when it comes to how
9:42technology has got into the reproductive
9:45space, but
9:47this also should be made available to uh
9:51infertile women if they want to have a
9:54child, that is something reproductive
9:56justice ensures. Finally, abortion and
9:59surrogacy, they are important part of
10:02reproductive health care. In fact, uh if
10:05you look at the surrogacy regulation
10:07act, which I will discuss in due course
10:08of time, we will find that how there
10:11were several policies that came into
10:14existence because they identified that
10:18the space of surrogacy had become a
10:21space of violence, a space of uh
10:24torture. There was an amendment made to
10:27ensure that no exploitation happens of
10:30women
10:31on the name of labor.
10:36Uh before we begin, I think it's
10:38important that we understand the concept
10:41of bodily autonomy because it is about
10:43uh women's body, and that is the
10:45important discourse in uh the area of
10:49reproductive rights. So, there are when
10:51you talk about bodily autonomy,
10:53primarily, if you look at the
10:55combination of the word, it means
10:57autonomy of the body, which means the
11:00right over body. Now, the principal idea
11:03is that individuals should have the
11:05right to control their own bodies and
11:07make reproductive decisions. So, for
11:10women, it is all the more important
11:12because I will discuss it in the Indian
11:14context as well.
11:16This was a foundational feminist thought
11:19because uh
11:20it incorporated not just the right to
11:23body as a feminist thought, but also as
11:28an individual human right.
11:31And it's ethical too, like a woman was
11:34going to bear a child and therefore
11:37because it it involved a huge amount of
11:40time, a huge amount of other aspects to
11:44be taken care of, it had to be her
11:46decision. It's something that bodily
11:48autonomy talked about globally. Two
11:51important events we can talk about, the
11:531973 Roe v. Wade in USA. This recognized
11:59abortion not just as a
12:01human right, but as a constitutional
12:04right. Which means that constitution
12:06should ensure this. And additionally in
12:091994 we had international conference on
12:12population and development that reframed
12:15reproductive health as a human right
12:18issue. So these two important events are
12:21to be taken into consideration when we
12:23talk about bodily autonomy in the global
12:26space.
12:27Uh
12:27why it is important in India? I make
12:30four points. One,
12:32and primarily
12:34encompassing all these four points,
12:36there is one point because we are a
12:37community living and therefore when it
12:40comes to the bodily autonomy of a woman,
12:43it's not a singular kind of a line you
12:45can think of. In fact, it's a family
12:47decision. Many times you must have
12:50noticed also in um
12:51films or in sometime takes the moment a
12:54woman gets married and there are few
12:57months that have passed or a year or
12:59two, immediately people will start
13:01asking uh what is the good news, uh when
13:05is the good news and things like that.
13:07Clearly indicating that the choice does
13:09not completely lie with the woman who's
13:12going to bear the child. So the first
13:14point I make in this case is the
13:17freedom of reproductive choice. On your
13:19screen uh
13:21everybody, you will see that uh what
13:24does freedom of reproductive choice
13:26mean? it enables individuals to decide
13:29if and when to have children without
13:32family or societal coercion. So, the
13:35idea of freedom around reproduction is
13:39important when it comes to
13:42Indian women as well because there are
13:44challenges of expectations
13:48in which women must marry early and bear
13:51children soon after marriage. So,
13:54therefore when bodily autonomy
13:57comes into play in the Indian discourse,
13:59it ensures that there is a freedom of
14:01reproductive choice. The other aspect
14:04that I think is important and we can
14:07discuss is the
14:09sun preference or the gender norms. So,
14:11you will also see that there is a
14:13societal pressure to produce male heirs,
14:16which often shapes reproductive
14:18decisions. So, there are sometimes women
14:21who are forced to, you know, go for more
14:24children or to access abortion or
14:26something like that, which count which
14:28counters the practice of
14:31reproductive autonomy because what it
14:33does is that there are repeated
14:35pregnancies and selective reproductive
14:36choices driven by gender bias. So, many
14:40cinematic narratives which I will
14:42discuss a film like Matrubhoomi, A
14:45Nation Without Woman, or for that matter
14:47Jayeshbhai Jordar and I'm sure you can
14:49think of many that talk about or that
14:53raise this issue in the reflection that
14:56they make.
14:58The third point is that of addressing
15:01social and economic inequalities. And
15:04in a country like India where the
15:06demography is very different,
15:08and when I say demography, I mean just
15:10everything but primarily social and
15:13economic aspect, we find that
15:17the accession becomes an important
15:20issue. Many times, in fact, when I do
15:24these
15:25field works, I come across women
15:28who are uninformed about the government
15:31policies. They There are policies for
15:33their benefit, but they are just not
15:35aware. So, in that sense, information is
15:38the resource, and that is something that
15:41they are not aware of. So,
15:43if you look at how this works, it
15:46recognizes how poverty, caste
15:49hierarchies, and rural-urban divides
15:51affect access to reproductive care. Many
15:54women lack the autonomy to seek health
15:57care. So, if somebody is in a very rural
15:59area and wants to access the clinic or
16:02the hospital, it's so far, it's not
16:05possible. So, you know, there is a lot
16:07of infrastructural intervention as well
16:10that we have to take into consideration.
16:12So, this is one point which matters in
16:16the context of India. And finally,
16:18bodily autonomy is also important to
16:20ensure the consent and agency in health
16:24care. Now, health care is a very private
16:26matter as well.
16:29While we look at different cultures
16:32responding to individual choices
16:34differently, but at the same time, we
16:36cannot forget that in matters of
16:39reproduction, the individual is central
16:42to the narrative.
16:46We
16:47look into bodily autonomy.
16:50Like I said, there are two things we can
16:52think about. One is the aspect of human
16:55right, and the other is the aspect of
16:58legal right. Now, within this, we find
17:01this framework of pro-life, pro-choice
17:04debate
17:06important because
17:09across the world, you will see that the
17:13idea of reproductive right or
17:15reproductive justice
17:17delves within the debate of these two.
17:20So, what is a pro-choice perspective?
17:22Please look at your screen and you
17:24please try to follow this. It supports
17:27legal and safe access to abortion and
17:30reproductive health care. It emphasizes
17:33women's bodily autonomy and
17:35decision-making rights. It argues that
17:38decisions about pregnancy should
17:39primarily rest with the pregnant
17:41individual. It often supports access
17:45abortion access within medically defined
17:48gestational limits, especially in early
17:51stages of pregnancy, and highlights
17:53concern about unsafe abortion and
17:55women's health risk when abortion is
17:57restricted. So, pro-choice, your choice
18:01is what is important. But, there is
18:03other aspect as well, which is a
18:05pro-life perspective, which is from the
18:08perspective of the fetus. What does it
18:10say? That
18:12protection of fetal life from
18:14conception.
18:16So, you have to think about it. It is
18:19often grounded in religious, moral, or
18:22ethical about the sanctity of life. Now,
18:24there is a life, and if you want to have
18:27an abortion, primarily it is the killing
18:30of the fetus.
18:32Now, it questions the morality of
18:33terminating a pregnancy, particularly
18:36after certain ages of fetal development.
18:38It supports greater restrictions or
18:40regulation on abortion practices, and
18:43emphasizes primarily on the ethical
18:46aspect. So, if you look at pro-life,
18:48primarily it is about whether or not to
18:52be ethical, because it is concerning a
18:54life. If [snorts] you look at it in the
18:57global context, you will find that
18:59there are three points you will come
19:02across
19:04how reproductive injustices have been
19:07there. So, primarily unequal access to
19:10reproductive health care, that is how it
19:12has operated because reproductive
19:15justice can only be ensured if there is
19:17equal access to reproductive health
19:19care.
19:20Uh it has also been used in terms of
19:22population control and state regulation,
19:25which means that administrators
19:28uh historically used sterilization
19:31programs and fertility policies to
19:33regulate population. And finally, the
19:36socioeconomic and cultural barriers I
19:38have emphasized upon it off and on, but
19:42this is something that is also globally
19:45true. What is then in the case of India?
19:48In the case of India as well, uh the
19:51first of its instances come from how
19:55India adopted a sterilization-centered
19:57approach, which means that
19:59uh family planning historically became
20:02heavily dependent on female
20:04sterilization, often targeting poorer
20:07population. And this is not something
20:09that I am saying uh just like that.
20:12There are many articles you can read uh
20:14which claim such things uh
20:17or
20:18there are many articles you can read
20:20which make such inferences.
20:23Now, the second uh point in terms of
20:27structural inequality is the inequality
20:30of space,
20:32spatial inequality. So, you know that
20:35India is a a lot of agriculture and
20:38there are the rural-urban divide is
20:41immense. And therefore, this disparity
20:44leads to reproductive health care
20:46infrastructure being unequally access to
20:49these people. Now, these regional
20:52variations in social norms and practices
20:54across state also shape reproductive
20:56choices and access to health care.
20:59What next follows is the cultural gender
21:02norms. And what this means is that many
21:06times reproductive decisions are
21:08influenced by patriarchal family
21:10structures and strong son preference.
21:13And therefore, practices such as sex
21:16selection abortion and pressure for male
21:18children reflect deep-rooted gender
21:20bias. Finally,
21:22uh social stigma and invisible barriers
21:25is a point I would like to make because
21:27in India, these barriers are intensified
21:30by deep social stigma around
21:33menstruation, infertility, and
21:35contraception, which discourages open
21:38discussion and care seeking.
21:41Uh quickly, I will take up the
21:43theoretical framework of
21:46intersectionality and feminist
21:48bioethics.
21:49I will quickly talk about
21:51intersectionality. I think I'll talk
21:53about it a little later as well in the
21:56subsequent lectures, but quickly I'll
21:57brief you what I mean here and some of
22:00you might already be aware of it. Uh
22:02it's a concept introduced by Kimberlé
22:04Crenshaw. And in this concept, she
22:08highlights that multiple identities
22:11shape reproductive experiences and
22:13access to health care. Intersectionality
22:16primarily believed that
22:18if there is one rule or if there is
22:21something one resource, it means that
22:24just by being there,
22:26it also has access.
22:29Different women will have different kind
22:31of access to that particular resource is
22:34something and that depends on different
22:36intersections like race, class, caste,
22:39sexuality, and stuff like that. And
22:41therefore, that has to be taken into
22:43consideration while reading reproductive
22:47justice framework. So, that is one
22:48theoretical framework that is important
22:50in the context of reproductive justice.
22:52The other is feminist bioethics. So,
22:55most of the times, uh you know, when we
22:57talk about the creation of knowledge,
22:59it's said that bioethics was primarily
23:02about
23:04bio and ethics, people and what is
23:07ethical. But, feminist bioethics say
23:10that many
23:13times
23:14the traditional medical ethics ignore
23:17gendered power relations in health care.
23:20Therefore, they advocate for patient
23:23autonomy, informed consent, and
23:26equitable reproductive care.
23:28This engages with broader questions of
23:30how medical institutions and state
23:32policies regulate reproductive bodies,
23:36resonating with Michel Foucault's idea
23:38of biopolitics. Uh you can read this in
23:42great detail. I have given this in the
23:43reference text as well. Therefore, when
23:46you think of reproductive justice
23:48through the lens of medical humanities,
23:50you come across three aspect. One, the
23:54interdisciplinary understanding of
23:56health where
23:57you have to think about health in terms
24:00of medicine, ethics, sociology, and
24:02cultural studies. And bind it with the
24:05number two, lived experience of
24:07reproductive bodies, which means that
24:09what are the ways in which these
24:12narratives are actually placing
24:15themselves in society, whether it is
24:17menstruation, pregnancy, infertility, or
24:19childbirth. How do the cultures in which
24:23they are existing shape the reproductive
24:26experiences? And amidst this, I think
24:30ethics
24:31power, and representation becomes
24:34important because this involve systems,
24:37laws, policies, and other related
24:40aspects. And that is the reflection we
24:43are going to see in literature, cinema,
24:45and narratives.
24:47I will discuss these three important
24:50reproductive laws and policies in India.
24:52I will discuss about them in great
24:54detail a little later. But for the time
24:57being, I think I also discussed this uh
25:00MTP Act
25:021971 and its subsequent amendment in
25:052021. I will discuss it in the sense
25:08that these are seminal reproductive laws
25:12we have to take into consideration. The
25:14first one is around the regulation of
25:17abortion and maternal health care, and
25:19we know that MTP Act in 1971 was
25:22introduced to reduce maternal mortality
25:25and to provide a right to abort for
25:28women.
25:30You and importantly limitation of the
25:321971 Act was
25:36that it allowed abortion up to 20 weeks
25:40and
25:41had very specific cases for abortion.
25:452021 was very progressive in its move in
25:49the sense that it extended the
25:51gestational limit up to 24 weeks and in
25:55certain cases 28 weeks. Now, the second
25:59point which is very progressive in terms
26:03of abortion rights in the context of
26:04India and it has globally gained a lot
26:07of attention. In fact, there are so many
26:09articles you can read on it where not
26:12only the gestational limit was
26:14increased, but within the scope of
26:17abortion
26:18anyone
26:20had the right to abort.
26:23What does this mean? That Earlier, there
26:25was this provision for only married
26:27women, but 2021 amendment allowed this
26:31for all women.
26:33Other than that, the PC PNDT Act which
26:37came out in 1994 is also significant to
26:40discuss. So, when ultrasound machines
26:42came to India,
26:45they were supposed to be a very
26:47important medical intervention, but if
26:50you look at the way it was implemented,
26:54uh we find that at the same time when
26:57these ultrasounds started happening, uh
27:00uh there was a decline in the sex ratio.
27:03It was very alarming. And therefore, we
27:06come across this particular act that
27:08prohibits sex determination and
27:10sex-selective abortion. It's called the
27:12PCPNDT Act, Pre-Conception and Pre-Natal
27:16Diagnostic Techniques. So, if you go to
27:18any of these hospitals and clinics where
27:21ultrasound is being done, you must have
27:23seen uh we do not determine the sex,
27:26something like that. And it is sex
27:27determination is a punishable offense.
27:29Um you must have seen already. That is
27:31because of this act. So, each
27:34clinic or hospital that had the
27:36ultrasound facility had to declare this.
27:39Bec- And sex selection was uh any
27:42ultrasound that led to uh
27:45you know, identifying the sex of the
27:47fetus was prohibited.
27:50The other two important acts that I can
27:53discuss at this moment is Surrogacy
27:55Regulation Act 2021, which restricted
27:58commercial surrogacy. I mean, it was
28:01quick off the Indian government to
28:04analyze and realize that the space of
28:07surrogacy had become rife with
28:09exploitation. And therefore, Surrogacy
28:12Regulation Act came in 2021 to only
28:15ensure that the surrogacy practices, the
28:18altruistic surrogacy practices will be
28:20continued, whereas uh
28:22the restriction was placed on commercial
28:24surrogacy. Additionally, Assisted
28:27Reproductive Technology also came in
28:302021. This was an act that regulated
28:33fertility clinics and reproductive
28:35technologies. So, there were a lot of
28:37guidelines related to that. Uh the
28:39limitation, of course, includes that
28:41there is limited awareness and
28:42accessibility. There are implementation
28:44gaps. It restricted somehow autonomy in
28:48practice. And uh uh uh of course there
28:50is always a challenge when there is
28:52technology as to whether the use of
28:54technology is ethical or not.
28:58These are some of the narratives I will
28:59quickly mention but I will take up all
29:02of them in detail when I'm discussing
29:05the unit on literary and cinematic
29:08reflections say around menstrual stigma
29:11and bodily awareness I will take up
29:14films like Padman and the documentary
29:16period end of sentence both these
29:19address menstrual taboos and activism.
29:21So
29:23around infertility and reproductive
29:25technologies I will discuss uh Mimi and
29:28Filhaal which depict surrogacy and
29:30complexities of reproductive labor and
29:33finally we think of abortion choice and
29:36women's autonomy through the example of
29:38a married woman by Manju Kapur which
29:41explores abortion and reproductive
29:43agency within marriage. So it's a very
29:45interesting novel in the sense that it
29:47talks about three generations of women
29:50and it's not primarily about them going
29:54for abortion but all these three women
29:56make reproductive choices and it's very
29:59interesting to note how these three
30:01women make this choice
30:04in a different context
30:06in a different way. So
30:09I mean there is a quotient of women's
30:12autonomy over there at some point of
30:13time you will see that perhaps it's a
30:16kind of a coercion that is happening in
30:18some maybe you will see that there is a
30:21compulsion that is taking place for
30:22women to abort and then in the case of a
30:26character you will also find that she's
30:28making a choice. So primarily if you
30:30look at these Indian narratives
30:33they will reflect on
30:36destigmatizing menstruation. They will
30:39talk about uh different kinds of uh
30:42stigma associated with infertility and
30:44also abortion. So, these are some of the
30:47narratives that I am talking about. In
30:50fact, uh
30:51you know, there is a limited time and
30:53hence I can't discuss everything, but
30:55you can choose your own narratives.
30:58See, uh you have to understand that my
31:01job as an instructor is to analyze a few
31:05films and leave the rest for you. And uh
31:09that is what probably I would want you
31:11to do, to look into different other
31:14narratives that you can take up and
31:16analyze within the course of medical
31:18humanities.
31:20Thank you so much.