Stratified reproduction

Infertility is just one aspect of stratified reproduction. Although it is estimated that 186 million people worldwide are affected by infertility, technology can be able to assist those who are infertile.[8] In-Vitro-Fertilization (IVF) is one assisted reproductive technique (ART) that is used. IVF was developed over 30 years ago to help women with blocked or damaged fallopian tubes. IVF has helped many couples achieve their dreams of having a child. However, IVF is extremely expensive and/or inaccessible to many globally. In Central and Southern Africa "two-thirds of infertile women have diagnoses of tubal blockage attributable to sterilizing RTIs [Reproductive Tract Infections]" which is exactly what IVF was developed for.[9] The high costs and inaccessibility keep infertility as a major aspect of stratified reproduction. According to a study done by Marcia C. Inhorn and Pasquale Patrizio, regions such as South Asia, sub-Saharan Africa, the Middle East and North Africa, Central and Eastern Europe and Central Asia have high infertility rates.[8] While infertility is a global phenomenon, other issues within those regions play a role in their high infertility rates. Secondary infertility, being unable to conceive after a previous pregnancy, is the most common form of infertility in women.[8] Typically secondary infertility comes from RTIs. In countries where abortions are illegal, women will choose to have unsafe abortions. These unsafe abortions can lead to RTIs and secondary infertility if left untreated. Studies show that in places where laws are lifting the ban on abortions, secondary infertility rates are decreasing.[9]

Racial disparities and socioeconomic status also play a role in infertility as well as the reported use of medical services for infertility. Data from the National Survey of Fertility Growth (NSFG) showed that infertility rates for black (19.8 percent) and Hispanic women (18.2) were much higher than those rates for white women (6.9 percent).The same study revealed that although women of color experience higher infertility rates, they reported having not received medical services for infertility at higher rates than their white counterparts.[10] Socioeconomic status also provides barriers for women who do not have the flexibility to take off work and schedule appointments that higher socioeconomic status women do.[10] Without public or even insurance company funding for these ARTs, this suggest that those in a higher socioeconomic standing should be able to reproduce, while those who cannot afford these treatments should not have the same ability to do so. This notion is furthered by policies such as the welfare reform act of 1996 which denies benefits to children who are born to mothers on welfare.[4] However, race and class disparities in infertility treatment remain even in states that have mandated infertility insurance coverage suggesting that the issue of stratified infertility options go beyond political policies.

Adoption is another infertility option that hosts many barriers to underrepresented populations. Cost is one factor that is a barrier for people with a low SES status. There is also a devaluation of children of color within the adoption system. The demand for white children is higher than that for children of color, thus leading some adoption agencies to charge more to adopt white children. This practice suggests that white children are of higher value than children of color.[4]

Sheoran uses Shellee Colen's 'stratified reproduction' conceptual framing to propose that contraception is experienced hierarchically in places like India. Sheoran, when writing of Emergency Contraceptive Pills in India writes, 'ECPs in India thus make visible the reality of ‘stratified contraception,’ even as these technologies make inviting claims of eradicating stratification by providing all women with access to these pills at the local pharmacy'(pg. 250).[11]

Sterilization is a relatively permanent form of contraception that can be used to give women reproductive control; however, this form of contraception has a history of blatant misuse. Sterilization was used to reinforce the social hierarchy where wealthy, white families were genetically superior to other groups of people. In this hierarchy, people of color, people with mental illnesses, criminals, those on welfare, single mothers and addicts were all seen as genetically inferiors; therefore justifying forced sterilization for the common good. The main target of forced sterilization were poor women of color.[12]

In more recent history, there is still subtle and covert forms of coercion for certain groups to undergo sterilization. Sterilization rates still remain unequal between poor women of color and their white counterparts with Black and Native American women being twice as likely to have received a tubal sterilization. This data is found to be surprising taking into consideration that women of color are less likely to receive reproductive care or have health insurance to cover the costs of this procedure. A few explanations of this discrepancy is negative stereotypes of women of color as poor mothers and assuming women of color cannot afford children without being on welfare. These assumptions often lead to coercion and more invasive surgeries for reproductive issues that lead to sterilization.[12] With women of color still at the forefront of this misuse of sterilization, the prison system has become a large target for coerced sterilizations. It was discovered that over 150 women were forcibly sterilized in prison between 2006 and 2010 because these women were deemed likely to return to prison. Even though sterilization was a costly procedure, physicians claimed that it would be better to pay for the procedure than pay for the welfare of these women's children.[13]

Recent scholarship has investigated the history of conflict around Latinas and fertility in the United States. These stories provided evidence that the United States had funded forced sterilization of Latino people and other ethnic groups. In their article, Elena R. Gutiérrez and Liza Fuentes study two communities, Puerto Rican women in Puerto Rico and New York and Mexican-origin women in Los Angeles.[15] Once Puerto Rico became an American colony in 1898, people began to talk about Puerto Rico being overpopulated. By 1965, over 34% of mothers aged 20–49 had been sterilized.[15] Not all women chose to be sterilized.[15] Many of these women were used for contraceptive testing without their knowledge.[15] Mexican-origin women were another community that experienced forced sterilization. Some women were forced into nonconsensual sterilizations, including as they were giving birth.[15] Scholar Leo Chavez argues that these sterilizations came from the idea that Latinos are over-populating the U.S.[16]

In his article, Leo Chavez discusses Latino fertility in the United States. He writes that their presence promoted anti-immigration sentiment and advertising suggesting that they should leave the United States and that their fertility was not welcome in the country.[16] Puerto Ricans, such as those discussed in the article by Gutiérrez and Fuentes, were a part of this larger Latino community that was being targeted. In Chavez's article, he collects data to discuss fertility rates among Latinas, showing that, though Latina women were more fertile than their non-Hispanic white counterparts, they had fewer lifetime sexual partners.[16]

Nearly one in four African-American women live below the poverty line, which greatly increases the risks associated with bearing children.[17] Black women are two and a half times more likely to die during pregnancy, and their children are two times more likely to die as infants.[18] Many attempt to view this issue as a biological issue of African-American women; however, black women residing in other countries have less reproductive complication than their American counterparts. Black women are less likely to be given medical advice, to be warned of possible medical complications, and to receive helpful prenatal therapies.[19] This differential treatment from medical health professional leads to more birth complications, adverse birth outcomes and fetal death thus contributing to the system of stratified reproduction.[19]

Residential segregation may indirectly harm health through harmful living environments and limited access to resources. Segregated communities often are characterized by more crime, greater pollution, higher population densities, more poverty, and fewer and lower-quality services, leading to infant mortality.[19] This includes forms of environmental injustice, which incorporates the unfair plotting of landfill facilities and the deliberate targeting of minority and low-income communities as repositories for hazardous waste sites.[20] Even though residential segregation affects various minority groups, in the United States there are stark health discrepancies between black woman and their white counterparts. Flint, Michigan is a predominately black area that exemplifies the harmful impact low environmental quality can have on healthy reproduction: The Flint water crisis decreased fertility rates by 12 percent and raised infant mortality by 58 percent among Flint residents.[21]