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A Portrait of Assisted Reproduction in Mexico: Scientific, Political, and Cultural Interactions

Open AccessPublished:November 18, 2019DOI:https://doi.org/10.1016/j.rbms.2019.11.001
      González-Santos’ book begins with a poem that likens counting sperm to counting moving stars. She alludes to the significance of the book’s title when she describes the portraits painted by Milanese artist Guiseppe Arcimboldo, and the power of portraits to convey the social position, psychological characteristics, personality, mood, and historical context of the person being depicted. The analogy of painting a portrait is indicative of González-Santos’ methods and the organization of the book. González-Santos paints through words a 'repronational portrait' (
      ) of Mexico’s system of assisted reproduction. González-Santos began her research in 2007. In the following 12 years before the book’s publication, assisted reproduction in Mexico proliferated and diversified. Likewise, in the process of conducting research for and writing A Portrait, González-Santos was herself transformed from an observer to a participant observer, and finally, to an ethnographer.
      González-Santos explains that, taken together, elements such as '… a postal stamp circulating in the early 1930s, the symbols of public healthcare institutions and of medical associations, advertisements of fertility clinics displayed in public spaces like highways, buses, and backstreets; newspaper clippings and magazine articles telling the successful stories of people’s experience with different assisted reproduction techniques; scientific articles reporting the changes of these techniques; promotional materials like USBs in the shape of a sperm or a pen with a translucent capsule where plastic sperm and ova are swimming… ' create a composite portrait of assisted reproduction in Mexico (p. 2). Through critical analysis of different symbols possessing relevance for reproduction in Mexico, González-Santos identifies the commonality among these symbols as the overwhelming power of the State and the absence of a father. She argues that these symbols suggest that it is not the father who will take care of the mother and her child, but the male state. Furthermore, Mexico’s modernizing project held science as a key pillar, and this primacy of science is expressed through visual narratives.
      The portrait González-Santos paints, and the visual narratives she unpacks, are far from description for the sake of description. She describes epistemic and material transformations in assisted reproduction, including how infertility in Mexico has transitioned from being viewed as a medical condition in need of a cure to a problematic situation for which assisted reproduction is the solution. However, González-Santos furthermore uses assisted reproduction in Mexico as a lens for analyzing not only how Mexicans conceive, but also how they engage with health care, social media, the global market, kinship, and family.
      González-Santos’ analysis also takes socioeconomic inequality into account. She is aware that potential users of assisted reproduction are among the wealthiest Mexicans, and while she recognizes that the wider sector of the population may not have the economic means to attain these services, they are nonetheless influenced by their presence. In an ethnographic anecdote, González-Santos describes her surprise upon seeing assisted reproduction advertisements in the metrobus, billboards in motorways, and in lower-income neighbourhoods. She writes, 'Many of these spaces were where low- to middle-income people lived, so they were not exactly the consumers of assisted reproduction, but where high-income people transited to go to the airport, to their weekend getaway town, or to the expensive private hospitals.' (p. 246) This inclusion/exclusion aligns with socioeconomic inequality, not need.
      Using assisted reproduction technology (ART), González-Santos tracks the shift from a Malthusian-style population project to a neoliberal project 'where the politics of reproduction openly defend and heighten individual rights and well-being (including the rights of the unborn) together with the marketisation of reproduction' (p. 11).
      Due to the broad array of elements that make up the practice of assisted reproduction in Mexico, González-Santos suggests that instead of talking about assisted reproduction technologies, we refer instead to assisted reproduction systems. Her focus on systems begs the question of how 31 male physicians studying infertility in the 1950s evolved into a system of over 100 in-vitro fertilization (IVF) clinics at the time of her book’s publication. The particular socio-technical system that has formed around assisted reproduction in Mexico exhibits unique local features while also sharing similarities with assisted reproduction systems around the globe.
      In Part I, Origin, González-Santos describes the establishment of the material and epistemic infrastructure of assisted reproduction in Mexico. It is, in essence, the origin story of medical specialization and professionalization in assisted reproduction in Mexico. To do this, González-Santos also details the story of Mexico’s healthcare system. González-Santos signals three distinct historical moments that laid the groundwork for present-day assisted reproduction. The first moment, spanning the 1940s to 1960s, is characterized by an emerging interest in sterility. Esterilología, the study of sterility, contributed to the medicalization of infertility. This paved the way for the second moment, which traces an epistemic shift from focusing on sterility to becoming interested in managing reproduction. Through the development of puericulture, reproduction was paradigmatically reframed as medically manageable and no longer predetermined and unalterable. Finally, the most recent moment was a second epistemic shift during which growing interest in biotechnology fueled a boom in assisted reproduction across Mexico.
      Part II, Reproducing Assisted Reproduction, documents the 25 years after the first successful birth resulting from assisted reproduction treatment in Mexico in 1988. During this time, the discursive landscape of ART, including the associated sociopolitical and moral aspects, was being negotiated. Furthermore, information about ART was communicated to a larger sector of gynecologists. In this section, it becomes clear how González-Santos approaches ART as both technological innovation and cultural novelty.
      The primary contribution González-Santos makes in this section is demonstrating how assisted reproduction became socially, technically, and legally usable in Mexico. That is, her focus is not on the techniques themselves, but rather, on how the technologies have been 'assembled and reassembled, transformed…to make them socially useable and useful in Mexico' (p. 8). González-Santos examines the discourses and narratives circulated through media spaces (such as press, television, and radio), public spaces (for example, the advertisements she describes on public transport), and semi-public spaces (support groups, trade shows, recruiting events, and informational talks) in order to elucidate how assisted reproduction became an acceptable way of forming a family.
      González-Santos identifies how the discourse surrounding assisted reproduction characterized its technologies as 'paranatural'. 'Paranatural technologies are those which are framed as imitating nature while simultaneously going beyond it to improve where it fails.' (p. 253). This framing was used primarily by physicians when attempting to recruit potential patients. Through this framing, the assisted reproduction system in Mexico became a resource for producing what González-Santos refers to as 'Marianistic mothers' — mothers who sacrifice everything for their children and husband — while also creating heteronormative families in the process. González-Santos argues that, given the importance of motherhood in Mexican culture, the 'paranatural' framing of ART was key to facilitating its acceptance. Thus, while assisted reproduction introduces scientific technology into the process of conception, it does so in a way that re-inscribes existing gender expectations. Women who turn to assisted reproduction do everything possible to become mothers, thus earning the status of Marianistic mothers. At the same time, assisted reproduction was not framed as producing fathers, thus avoiding a focus on men as infertile beings, and creating no contest against macho culture. In presenting this critique, her book is particularly influenced by the field of science and technology studies (STS).
      González-Santos analyzes the commercialization of ART. In doing so, she contributes to the scholarship on commodification. González-Santos notes that a large number of private clinics are competing for a limited sector of users. The discursive landscape of publicity campaigns — emerging on social media platforms such as Facebook, Instagram, and Twitter — combines alluring messages concerning discounts and payment schemes with emotional messages of hope for future parenthood. The result has been the commodification of infertility and the marketization of assisted reproduction.
      My criticisms of A Portrait are few, as González-Santos’ book has many strengths (identified in further detail, below). However, I have identified moments when, to my reading, González-Santos could have been even more ambitious in her suggestions for future research. González-Santos argues that more attention should be paid to women’s life histories and their bodies beyond matters related only to hormones and reproduction. Furthermore, she insists, 'The same question is applicable to men: why are their bodies, health histories, lifestyles, etc. not considered?' González-Santos fails to connect these questions with her assertions about Marianistic mothers and macho culture. A follow-up question would query what effects viewing women as complex individuals (instead of perpetuating a myopic focus on their reproductive capacity) and fathers as equal contributors to the reproductive process (instead of auxiliary actors in the assisted reproduction choreography) would have on gender norms in Mexico.
      González-Santos also suggests more research on the roles of embryologists, lawyers, marketing experts and content developers, equipment and supplies distributors, and administrators in building the assisted reproduction system. Similar to my response in the last paragraph, I would have liked González-Santos to identify why this further research would be valuable. Obviously, this future work would add nuance to the portrait that González-Santos has painstakingly painted throughout her book, but what theoretical contributions might this additional research also add? González-Santos closes her book by invoking Donna
      • Haraway D.J.
      Simians, cyborgs, and women: the reinvention of nature.
      , asking what makes us human, and likening assisted reproduction to the 'cyborgification' of our bodies and societies. Instead of closing with the question of what makes a human collective, I would have appreciated reading González-Santos’ response to this question.
      As I have already mentioned, the theoretical and methodological contributions of González-Santos’ Portrait are many. In fact, her work is likely to serve a broad readership, including those who are not strictly interested in assisted reproduction. Her book traces how her object of study became socially, technically, and legally usable. Furthermore, by focusing on epistemic shifts, she reveals how ideas and practices concerning health and illness, kinship, gender, and the relationship between science and religion have been contested, explored, reproduced, and reconfigured. These techniques can be applied by researchers with interests in other topics. In making this comment, my intent is not to minimize the importance of assisted reproduction as an object of subject, but rather, to emphasize the broad reach of González-Santos’ work and the applicability of her methods for a variety of researchers.
      In closing, González-Santos’ prose is lyrical and evocative. The 'trips in time' she weaves throughout the pages of her book are rich in detail. Through her portrait-writing, González-Santos proves herself to be a vivid storyteller. At the same time, González-Santos’ analytical perspective extends far beyond the realm of assisted reproduction itself. A Portrait of Assisted Reproduction in Mexico is appropriate for undergraduates and advanced readers interested in reproduction, gender, class inequality, Mexico, discourse analysis, commodification, and Science and Technology Studies. A Portrait is beautifully written and offers many layers of methodological and theoretical insights to its readers.

      References

      1. Franklin S. Inhorn M.C. Introduction, IVF - Global Histories Symposium. Reproductive Biomedicine & Society Online. 2. 2016: 1-7
        • Haraway D.J.
        Simians, cyborgs, and women: the reinvention of nature.
        Routledge, New York1991