Reflecting on Puerto Rican women’s reproductive constraints in the news media, women’s health organizations, and opinion pieces and blog, the differences between the news analysis and Dr. Lopez’s analysis are clear. In the news and blogosphere, women’s health issues and reproductive rights are reported daily by organizations and institutions. However, the specific topic of Puerto Ricans in New York and their lack of reproductive freedom is severely underreported, and when mentioned is referenced as another example of the ways in which women worldwide are dealing with limits placed on their personal health. Dr. Iris López delves into specific cases and asserts that the constraints dealt with by these women are, in combination with other factors, the result of flaws in overarching structures of the healthcare and health education systems.
Anthropological Framework of Reproductive Health Influences
Dr. Iris López’s work on reproductive rights among Puerto Rican Americans in Brooklyn, New York presents several underlying causes that influence women’s health choices and constrain their reproductive freedom, usually contributing to women deciding to get sterilized.
Many of these women, by little fault of their own, are misinformed regarding sterilization procedures and other birth control options. When tubal litigations were first performed in Puerto Rico and the United States, the new procedures were not always fully effective, and many women were able to get pregnant after being “sterilized.” While the medical technologies have changed to make these surgeries highly effective, the misconception that women can become pregnant after the procedure still exists. The language used to describe sterilization procedures among families and friends as well as in medical settings also contributes to misinformation stemming from euphemisms such as “getting tubes tied,” which implies a certain reversibility to the operation, when in reality tubal litigation reversals have a low success rate and can cause many other complications. Nearly 50% of the women in Dr. López’s survey stated that looking back, they regretted having been sterilized, because they wished to have more children or for other reasons (López 2008: 67).
Many of the Puerto Ricans in Brooklyn live close to or below the poverty line in the United States. As a result, most women receive healthcare from public hospitals. These hospitals often deal with a very large patient volume and do not have adequate resources to handle every patient’s needs effectively or ethically. This unequal distribution of doctors and resources inevitably leads to poor patient care and, in this case, care provided on a basis of convenience. For example, doctors tend to recommend reproductive surgery more often because it is a one-time procedure with the goal of removing a patient from the healthcare system. Experiences in these public hospitals are often negative for immigrants, people of color, and women in general. Bias and discrimination on the basis of race or socioeconomic status, while illegal and unethical, are prevalent. Many women in Matters of Choice described awful experiences interacting with doctors and hospital staff. Bureaucratic indifference to the concerns of specific female patients contributes to the silencing of certain groups, in this case Latina women. They are only some of many patients cycled through the municipal system each day, and the cemented hierarchal policies in place throughout healthcare systems don’t typically allow for the hearing and resolution of personal negative experiences, especially when patients hold little to no power to force change.
Socioeconomic status further limits birth control options available for a majority of Puerto Rican women in Brooklyn. Most hormonal or temporary birth control is not covered by insurance companies, and can be extremely expensive to pay for out of pocket. This leaves very few options available for women living near the federal poverty line. Sterilization, which is often covered through Medicaid and other public aid programs, is therefore an appealing financial choice. Access to affordable birth control is currently being discussed and debated frequently in American political and social spheres, with the introduction of a new 2012 federal mandate for health insurance coverage of contraceptives. Even so, as demonstrated in our news analysis, news media has not reported on birth control challenges faced by Puerto Rican women, instead typically focusing on young, middle-class, college-aged women.
Concepts of Choice
Dr. López discusses in depth how the ideology of choice is rooted in binary constructs of victimization and agency. This categorization process doesn’t work well when analyzing Puerto Rican women’s health choices for two reasons. Not all Puerto Rican women who get sterilized are victims. Rather, they willingly and perhaps enthusiastically make the choice to be sterilized. The common interpretation of women’s health through a binary model doesn’t recognize personal agency. Conversely, although most make the active decision to get sterilized (differentiating from forced sterilization and abuse), this should not be interpreted as total reproductive freedom because the “choice” does not include other safe, affordable, or effective birth control options. This binary analysis of what a victim is oversimplifies the issue and further silences these women.
Anthropological Analysis Discussion Questions
The following questions are meant to spark dialogue and further discussion.
- Women’s health rights are currently an extremely “hot” topic in media outlets in the United States; within a broad frame of reproductive health, these news sources must choose what specific demographics, situations, and stories to focus on. Is a lack of reporting media coverage on Latina reproductive choice a continuation of structural violence? Is this an issue of oppression or just that there is nothing “new” to report?
- Dr. Iris López dicusses typical binary constructs of victims, free choice, and agency in great detail in her work Matters of Choice. How might the standard binary model of choice vs. constraint contribute to the continuation of structural injustices in the case of women’s reproductive rights? Do you consider these women to be victims?
- Global health inequities can be analyzed using countless sociological, political, and scientific methods. What can be gained by evaluating these inequities within a framework of cultural, social and historical influences from an anthropological perspective?