Lecture 19

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0:17>> Hello everyone. I welcome you to my

0:19course Introduction to Medical

0:21Humanities. This is lecture 19 and if

0:24you remember, this is the part two of

0:26the lecture entitled Understanding

0:28Surrogacy and its politics.

0:31Before I ended the last lecture, I

0:34introduced you to a term called

0:35reproductive justice. So in this

0:38lecture, I will begin with the concept

0:41of reproductive justice and move ahead

0:43with that. So broadly speaking, if you

0:45look at the reproductive justice

0:48framework, you will find that it is a

0:51match between rights and resources.

0:55Broadly speaking, that is the bottom

0:56line of it. But before we go ahead and

0:59discuss it in detail, let me quickly

1:01show you how the lecture will move. We

1:03will have reproductive justice and the

1:05politics of choice. Whether in the

1:08course of reproductive justice, is it

1:10the right kind of choice that we make or

1:14the choice is just on a very surface

1:17level. What it is, I deal with it in a

1:20little detail.

1:21I also discuss the ART Act 2021 which

1:25regulates fertility in the Indian

1:27context. I talk about the surrogacy

1:30market and the cultural narratives. I

1:32pick up some portions of Mimi again and

1:35put it in contrast with another short

1:39narrative which is called I am Afia and

1:42then talk about the dilemma between

1:45choice and constraint and go on to

1:48discuss this choice and constraint

1:50within the aspect of neoliberalism.

1:54So if you look at the reproductive

1:58justice discourse,

2:00initial before reproductive justice

2:02framework was introduced, we had the

2:05reproductive rights discourse. Now, what

2:08did reproductive rights discourse said?

2:11That whether you want to have a child,

2:15whether you do not want to have a child,

2:17or

2:18the conditions in which you will raise

2:22your child, all these three should be

2:25treated as part of reproductive rights.

2:29Now, there were 12 black women who are

2:32also referred to as founding mothers of

2:35reproductive justice discourse, who

2:38engaged with an idea that perhaps rights

2:42was not the right kind of a term which

2:44was used. In fact, it should be justice.

2:47And

2:48therefore, they came up with this

2:50discourse, which is

2:53a more appropriate discourse,

2:55so to say. In this context, Loretta

2:58Ross,

3:00a feminist, became more prominent in the

3:03sense that she went on to theorize the

3:06entire reproductive justice discourse.

3:09So, if you look at what Loretta Ross

3:12argues, she says that

3:15reproductive politics must include these

3:18fundamental rights, the rights that I

3:19talked about. I reiterate the

3:23right to have a child, the right not to

3:26have a child, and the conditions in

3:29which a person

3:31looks after a child. So, this were very

3:33fundamental to the understanding of what

3:36Ross was theorizing.

3:39Now, this framework becomes extremely

3:43relevant in the context of ART.

3:46Why? Because

3:47technological possibilities do not

3:51automatically

3:52ensure access. Just because there is a

3:56technology available, this doesn't mean

3:59that there is also an access to that

4:02because access depends on many aspects,

4:05but primarily let me think of two

4:07things.

4:09One is information about that

4:12particular resource. And the two is

4:16economic uh potential to avail that

4:20resource. So, I think there are many

4:21that we can discuss of, but uh these two

4:24becomes

4:25in my opinion central to how the

4:28accession of resource works.

4:31Additionally, if you look at this

4:33aspect, uh it does not treat

4:36reproduction as a private matter sealed

4:38inside the home.

4:40It rather brings reproduction as

4:42something shaped by law, clinics,

4:45families, location, stigma, and also

4:49something which is at the distribution

4:51of risk.

4:53That is why I mean, I am what I'm going

4:56to do in this particular uh

4:59lecture is that I am placing the legal

5:02framework and analyzing these two films,

5:06part of Mimi and uh

5:09I Am Afia, through the socio-legal

5:12framework.

5:15If you look at uh the Assisted

5:17Reproductive Technology Act 2021,

5:20I just spoke about Surrogacy Regulation

5:23Act 2021. It almost came the same time

5:26because if you look around, there were

5:28so many IVF centers coming up at that

5:30point of time, and there was definitely

5:33a regulation which was required. We had

5:37just seen so much of exploitation

5:39happening within the surrogacy space,

5:42and with the intervention of technology,

5:44the space with technological

5:46intervention was becoming all the more

5:49fertile for exploitation and hence when

5:51you read ART Act, you find that it

5:55responds to the rapid expansion of the

5:58fertility industry by standardizing and

6:01regulating ART clinics and banks. So,

6:03they set very clear guidelines as to

6:06what will happen in these clinics, how

6:09they are going to regulate, what are the

6:12standard mechanisms they will follow and

6:14at all point of time, sex selection

6:18should not be there, any kind of

6:20exploitation should not be there was

6:22ensured. Now, other than that,

6:25what else was part of

6:27assisted reproductive technology act?

6:30That the regulation will be done through

6:32institutional visibility, which means

6:35that there will be a registration of the

6:38clinic, there will be national databases

6:41and inspection mechanism. So, there was

6:44a

6:45very clear

6:48chart in the sense that how

6:50administrative process will

6:53regulate these ART clinics. It is

6:57important to point out here that it was

7:00still a mechanism of state control.

7:03Whereas,

7:05it looked like the person was going to

7:07make a choice, still

7:10the control was left at in the hands of

7:13the administration. And the act quickly

7:16shapes who can access reproductive

7:18technologies. Now,

7:21who by regulating, by setting out who

7:24who could be the donor, who could be the

7:27receiver, who can be intending parents,

7:30all this was a way of also controlling

7:34and that is what probably is one of the

7:37critiques of ART Act 2021. If you look

7:41at the market, IVF market in India, the

7:45chart is right on your screen. You find

7:47that

7:49it is growing and by 2030,

7:52it is going to increase by 7.8%.

7:57So, clearly from 2020 to 2030, you see

8:01almost more than a double that is going

8:04to increase.

8:07Uh the ART Act also relies on

8:11registration of clinics and ART banks

8:14along with a national registry to

8:16monitor assisted reproduction. So, there

8:20is

8:21a uh

8:22registration that is required. This

8:24became mandatory.

8:26The inspection mechanism was set out. A

8:29clear-cut guideline on who can be an IVF

8:34center, who can carry out ART practices,

8:38and how professional

8:41they will be in terms of their

8:43execution, this was

8:46clearly laid out in the ART Act.

8:49The system

8:50also made reproduction as a kind of a

8:53legible and auditable institution,

8:56turning fertility care into a

8:58bureaucratic practice. So, something

9:01which had so much of social and cultural

9:05meaning attached to it became

9:07bureaucratic in its nature. And in

9:10biopolitical terms, the state started

9:13managing the reproduction through

9:16records, monitoring, and compliance

9:19check, shaping how reproductive care

9:21works. So, within the discourse of

9:25reproductive justice, you find that ART

9:28Act highlights how technology

9:32is

9:33who owns technology also is crucial to

9:38the exercise in which reproductive care

9:41is being implemented.

9:44This is a particular term that I had

9:46introduced to you earlier as well, which

9:48is called biopolitics and

9:51it is a useful interpretative key to

9:55analyze the reproductive choice

9:58discourse.

9:59So when you imagine

10:02power like a ban or a police action,

10:06biopolitics

10:08helps us see how power works through

10:10normal procedures. Normal procedures as

10:13in counseling scripts, medical

10:15authority, family pressure, stigma, all

10:18these things. And more often than not

10:22when you look at these practices,

10:25you find that something that appeared to

10:28be a choice of yours

10:30which often exists more as a language

10:33than a lived freedom is shaped actually

10:35by

10:37different kind of power bargain,

10:40economic pressure, and the moral

10:44judgment of being a good woman. So

10:48what appears to be on the surface is

10:51actually a very complex reality. It's

10:54layered with different kind of social

10:57tenets. In this case, there is power,

11:00there is economic pressure, moral

11:01judgment, all those things attached to

11:04how a body responds. So if you look at

11:07these this term bio and politics, bio

11:10means physical, politics means of course

11:13the

11:14way in which system works. So system

11:16ensures that your body remains

11:18regulated. In this case,

11:21it can be stigma, it can be shame, and

11:24sometimes it can be just you have to be

11:26a good woman. So

11:28that is the illusion of choice that gets

11:31created in this space. Now, reproductive

11:34technologies also show that women's

11:37consent is frequently negotiated within

11:40constrained circumstances. Now, these

11:42constraints could be of any kind. They

11:45can be economical, they can be

11:49social, they can be also family

11:51oriented. So, how do

11:54I mean

11:56how do you exercise your choice when you

11:58are already surrounded by different kind

12:00of constraints is what the illusion is

12:03getting created around biopolitics. And

12:05cinema definitely takes up these issues

12:09in which it becomes a crucial site

12:12because it stages the fragile moments

12:15where agency is asserted, questioned, or

12:18withdrawn, revealing how reproductive

12:21autonomy is socially managed than being

12:24purely individual. So, cinema

12:27in its reflection of these issues

12:30highlights the vulnerable moments in

12:33which an individual makes that kind of a

12:36decision.

12:39It also brings into account the

12:41neoliberal agency

12:43neoliberal culture sells the illusion of

12:47equal risk. So, many times if you are

12:51buying a product on

12:54any of these websites, you come across

12:57two products left, one product left.

13:00What is this illusion

13:02being created in your head space that if

13:05you don't buy this product, you will

13:07lose out on an opportunity of buying

13:10that product because only two products

13:11are left. So, in a country which is so

13:13large

13:15with population, if there are only two

13:17products left of that, you want to be

13:20one. That is what neoliberal culture

13:22ensures. It sells the illusion. So,

13:25society promotes the entrepreneur of the

13:28self, which is a Foucault's idea, in

13:31which you can optimize your body and

13:34hustle your way through poverty. So, in

13:36this case, in the case of surrogates, a

13:39woman's body becomes that product. So,

13:42time is running out and she wants to

13:44maximize on her body, on the product

13:48that she has, and capitalize on that so

13:51that she is no more poor. And therefore,

13:55these economic structure, the the

13:59economic vulnerability that she is in is

14:01actually creating a compulsion. So, the

14:05illusion of choice is there. She's

14:07making a choice, but

14:09it is actually an economic

14:10vulnerability, coercion, or compulsion

14:13that is making her make that choice. So,

14:16that is how this whole neoliberal agency

14:20works. If you look at uh earlier films

14:24like Doosri Dulhan

14:26portrayed surrogacy as taboo,

14:29while Chori Chori Chupke Chupke was the

14:31first mainstream Bollywood film to

14:34engage with commercial surrogacy. Now,

14:38uh

14:40it was

14:4118 1983 when this film came out, Doosri

14:45Dulhan. Chori Chori Chupke Chupke, they

14:48both these portrayed infertility and

14:50surrogacy through emotional and

14:52altruistic narratives. So, the good part

14:56was that they both were

15:00in

15:01the space

15:03and time when these were very personal

15:06issues.

15:07So, there was not much of discussion or

15:12much of reflection of these kind of

15:15issues around surrogate. So, these films

15:18were very new subjects that were

15:21projected at that point of time.

15:23However, if you see the recent films,

15:27films like Badhaai Ho, Good News and

15:30Mimi, Good News which is a narrative of

15:32IVF, it's a mix mix-up case, but still

15:36it is a case of IVF, you find that new

15:38liberal aspect being promoted.

15:41>> [snorts]

15:41>> Now,

15:42in

15:43Mimi and I Am, they engage with ART

15:47ethical dilemmas. Both these films, if

15:50you see them, they will help us

15:53understand that if choice is made under

15:55economic desperation, under unequal

15:58information, or under a contract where

16:01one side holds the right to exit and the

16:04other side holds the burden of

16:05continuity, that then

16:08choice is functioning as a moral cover

16:11for inequality. So,

16:14new liberal agency celebrates the brave

16:17individual. And what do you mean by a

16:20brave? That whosoever takes the maximum

16:23risk is going to gain also maximum. So,

16:27in the case of Mimi or

16:30I Am, you find that

16:34the component of choice is shown till

16:38they become very vulnerable in the

16:40decision they have made. And uh Hindi

16:44films, I use the word Bollywood here,

16:47though I do not completely agree with

16:49the term because Mendes and Lao has used

16:53this particular term and they say that

16:55Bollywood increasingly interrogates

16:57traditional gender, class, and family

17:00structure, while also raising bioethical

17:03concern around the expanding

17:06reproductive industry. So, there are

17:08many examples that you can see. I am

17:10choosing some of them and you can pick

17:12any of these for further analysis. I am

17:15going ahead with Mimi and I Am, but any

17:18of these films you uh, take up for

17:21analysis, you will find the thread of

17:24uh, sometimes uh, reproductive choice,

17:26sometimes uh, the idea of reproductive

17:29labor, sometimes surrogacy, biopolitics,

17:32all these issues being very recurrent

17:35theme around how they are uh, reflected

17:37and represented.

17:40Uh, quickly let me come to what I have

17:42been discussing, the two films that I I

17:45thought I will pick up. Uh, the first is

17:48uh,

17:49the uh, film uh, Afia, I Am Afia and

17:53Mimi and both of them appear, like I

17:56said,

17:57making decision

18:00on their reproduction. So, on the

18:03surface level, they are seeking donors

18:06or becoming surrogate. In the case of I

18:09Am Afia, she has uh, divorced her

18:12husband

18:13and after that, uh, she decides to have

18:17a child.

18:18So, she says that uh, motherhood's I

18:21have heard is the biggest bliss in a

18:24woman's life, so I want to enjoy

18:26motherhood, I want to become a mother,

18:28but I do not want to get married. And

18:31therefore, she's looking for a donor and

18:34in fact, in one of the scenes, she

18:36becomes so desperate that she wants to

18:38ask her friend's brother if he would

18:40like to become a donor. Uh, so it's a

18:43very uh, complicated film in the sense

18:45that she is now uh, wanting to have

18:50a baby, but the choices that are

18:53available to her are very limited

18:55because everybody is questioning

18:58her intent. I mean, she's she's also

19:00morally judged as to why she wants to

19:03take that course which is

19:06which she can otherwise also go ahead

19:08with. So, if you uh, look at this

19:11particular film, you will find that in

19:13our reading of uh, Mimi, the film's

19:15sharpest political revelation emerges

19:18when the commissioning parents withdraw

19:21from arrangement following a prenatal

19:23diagnosis and insist on terminating the

19:26pregnancy. So, uh

19:28I earlier also mentioned that uh the

19:31Mimi is left with the

19:33pregnancy and she

19:35just doesn't know what to do with it,

19:37but retains that pregnancy because she

19:40ultimately thinks that motherhood is

19:44something that cannot be compromised at

19:45that point of time and therefore she

19:47just goes ahead. At this moment, uh

19:51the conflict that is shown in the film

19:53is not just physical, emotional, and

19:56social,

19:57but also

19:59an individual in which she's pregnant

20:02and

20:03what choice she will make,

20:06that dilemma is pretty much there.

20:10So, uh

20:11when you look at the film, the

20:15it looks to be a very cruel kind of a

20:17narrative, but the cruelty lies in the

20:19structure. There is no mechanism in

20:23which uh she can sustain the decision

20:27that she has made. So, the option to

20:29terminate collapses under fear of being

20:32ostracized. In that moment, Mimi is

20:37rendered very explicitly as a body

20:40expected to absorb the fallout almost

20:43like a machine that must continue

20:46because stopping carries punishment.

20:49And therefore, uh

20:51despite

20:53the morality question, despite the

20:56family honor,

20:57and institutional authority, all those

21:00things working hand in hand, she makes

21:03the choice of keeping that pregnancy.

21:06A little bit on I Am, though I have

21:08already said that it follows a divorced

21:12woman. It follows a divorced woman who

21:15chooses single motherhood through

21:17artificial insemination, challenging

21:20social norms around family and marriage.

21:22Now, this is a very progressive kind of

21:24a film in the sense that the decision

21:27Afia makes to have a child, she has to

21:31face a lot of social flag, social

21:34judgment, because

21:36an unmarried woman, what will she do

21:38with a child? What does she know of a

21:40child? But

21:42technology has enabled her.

21:45The reproductive technologies enable new

21:49family forms, but laws and social norms

21:52often privilege heterosexual marriage

21:55couples, which means that there has to

21:56be a family. It says it there should be

21:59a husband and a wife. So, in the absence

22:02of a husband for Afia to have a child

22:05becomes problematic.

22:07Therefore, what looks like a choice

22:11she's making appears to be

22:15rife with social taboos, social burden,

22:18and social ostracization, as well.

22:22But the film projects Afia as the new

22:25woman who reflects the contradiction of

22:28the new woman balancing independence

22:31with traditional expectations. So,

22:34there is an expectation that she has

22:35that she wants to be a mother,

22:37uh but at the same time, she also has to

22:40do the moral bearing of whether she Why

22:43does she want to have a child outside uh

22:46marriage? And what is this kind of a

22:48situation? Many people around her make

22:50that face in which they question that.

22:53So,

22:54moving ahead, uh

22:56we also think of Mimi in which

23:00reproduction is fundamentally a

23:02phenomenon of power. So, Mimi highlights

23:05structural inequalities in the sense

23:08that you if you map the timeline, the

23:11film came out somewhere in 2021 when the

23:13law was not in place. So, the film was

23:17trying to highlight the space of

23:19exploitation that was happening for

23:21surrogates in the absence of any legal

23:24support that they could go for.

23:28So, if you see the film, it privileges

23:31Western commissioning parents because

23:33that is where more money, more economic

23:36power lies and nothing there is no power

23:41almost with low-income Indian women

23:44reflecting how

23:46you know, global South is most of the

23:50times victim of global North because

23:53there is economic control or economic

23:56power lies with the North. The contract

24:00that Mimi signs ultimately grants legal

24:02custody to the commissioning parents.

24:04So, when commissioning parents come in

24:06towards the end of the film, if you see

24:09the child has to go because law says the

24:12child is that of commissioning parents.

24:15In that sense, commercial surrogacy

24:17operates with profound inequities of

24:21power between commissioning parents,

24:23brokers, and surrogate mothers. So, if

24:26you go back to the image in

24:29part one of the discussion that I was

24:31doing on surrogacy,

24:34you will see that there were three

24:35parties that I mentioned, the surrogate,

24:38the broker, and the commissioning

24:40parents. So, Rudrappa also talks about

24:43it wherein she says that there is power

24:46balance amidst them is lacking. So, the

24:49commissioning parents and clinics can

24:51withdraw the terms and conditions at any

24:54point of time. They can renegotiate, but

24:57the body, which is the most vulnerable

24:59of all, doesn't have that kind of a

25:02power. Unlike most of the work that one

25:05does, commercial surrogacy or surrogacy

25:08involves intense corporeality, where the

25:12person has [clears throat] to be

25:15mentally and physically fit.

25:18And therefore, when we talk about Mimi,

25:21all these

25:23reflections are put out in for our

25:26display.

25:29Finally, when we come to both these

25:31texts,

25:33the idea of choice

25:35or constrain

25:37becomes very evident in

25:40these cinematic realities. While both of

25:43them, both the films, whether it is

25:45Mimi or I Am, show that reproduction is

25:48not simply about choice, but also about

25:52legal,

25:54economic conditions

25:56that exercise that choice. It clearly

25:59indicates of different intersections in

26:02which we live.

26:04So, how law is formulated and what is

26:07the lived reality of that law in

26:11society, they may be two different

26:13things. That is what the film projects.

26:16If Mimi exposes stratified reproduction

26:19and global surrogacy market, Afiya

26:22highlights how single women face stigma

26:24and exclusion from reproductive health

26:27care. So,

26:29ART starts with a vision that anyone who

26:32is

26:34can have a child through the help of

26:36technology if they cannot bear a child.

26:39But, in reality, in practice, that is

26:42not there because there are other

26:45conditions also that have to be

26:47fulfilled.

26:48Therefore, when you think of ART

26:50technologies, they do expand

26:53reproductive possibilities, but also

26:57restrict it. And that restriction is

27:00demonstrated by both these films that

27:03access to these technologies remain

27:06uneven and shaped by class, gender

27:09norms, and institutional rules. So, you

27:12find Afia declaring, "If I can survive

27:15alone, then I can raise a child by

27:17myself." And this becomes a very

27:20political claim of independence, a new

27:22woman,

27:23a very important term used in the

27:25feminist movement in 21st century, where

27:28reproductive autonomy and right to build

27:31family has been done once own terms and

27:33conditions.

27:35Together, if you look at both these

27:37films, you find that the real struggle

27:40is not

27:41only to access reproductive technology,

27:44but to do so without stigma,

27:47exploitation, or unequal power

27:50structures claiming that outcome.

27:53Thank you so much. I'll see you in the

27:55next class. Thank you.