Evaluating Technologies: Women, Medicine and Choice

— Varda Burstyn

WHEN THE COMMITTEE for Reproductive Freedom invited me to speak to you this evening, they felt that I might bring an interesting perspective to the specific matter of a relatively new "technology"—RU486 [the so-called French abortion pill—ed]. I explained that I was not an expert on RU486—and that, at present, in the Canadian context, I am abstaining from taking a position pro or con. This is because I am caught in a conflict between two central values: on the one hand, the value of seeking to make reproductive medicine as safe as possible; on the other, the value of making women's access to abortion easier and more secure.

To explain why I cannot easily support this new technology, and why I am also not opposing it, I want to place RU486 and the contradictions I experience with respect to it within the larger sphere of reproductive health and reproductive politics. I'd like to do that by sharing with you a few thoughts on the history and present relation of women and medicine.

The history of women's reproductive health and the history of Western (allopathic) medicine are not one and the same, except for the last one hundred and fifty years of Western history. Nevertheless, they have been profoundly linked in our time and in our minds; so much so that now when most of us think of women's health, it is within the assumptions of allopathic medicine that our questions and answers are formulated. Irregular periods and horrible PMS? Take Depo Provera. Repeated uterine infections? Have a hysterectomy. And so forth.

In this sense, medical technologies and our attitudes to them are both expressions of, and embedded in, a larger context, a larger dynamic, a larger set of problems: humanity's relationship to human-created technology and the impact this technology has had, is now having and will have in the future on the naturally created, organic material of our biosphere, including our own bodies.

Anyone living in the nuclear age, the pesticide age, the chemical age, knows that technology can be lethal on a mass scale (Chernobyl, Exxon Valdez, DDT); that it is and will be lethal, potentially destroying the very sustainability of life as we know it.

I don't know about you, but when my mind dwells on these matters, as it does on most days, certain nagging questions have a habit of coming back over and over again. One of the really big ones I have been grappling with for some years now is the following: What exactly is responsible for the technological carnage committed around us? Is the whole story of biological destruction a function of the exponentially increased, shall we call it "carnage capacity" of industrial production, as it rips huge chunks of matter and energy from the biosphere and deposits the refuse that its primitive distribution and disposal systems spit out as poison? Individual arms (crossbows and guns) can only do so much damage. But nuclear bombs are in a qualitatively different category of carnage capacity. Is the biosphere a dying testament to an order of rapacious greed—capitalism—only a few hundred years old?

Or is the technological impulse more ancient than that? Is it rather a function of patriarchy, of masculine gender hierarchy within horticultural and agricultural societies, which predates and substructures capitalism, in which women's life-bearing capacities are the objects of systemic mechanisms of masculine control through sexual morality and social prohibitions? For certainly many extraordinary technologies were developed during thousands of years of agrarian patriarchy.

Or is the impulse to technology older sifil than that? Is the impulse to take what you need from the environment by making things in fact apart of whatever it is that makes every single one of us, women and men, children and adults, uniquely human?

I think that making a distinction between the technological impulse and the term more commonly used—the technological imperative—is a useful way to approach this question. In my view, the technological impulse is constitutive of humanity, part of the baggage we have inherited organically and socially. (Along with that baggage, also an inherent quality, is our tendency to devise explanatory mythologies. I will return to this.

The technological impulse is part of us. We're stuck with it It is what enabled us to use fire and kill large mammals (massively modifying major ecosystems in our gathering-hunting days); what enabled us to codify language, create horticulture, build shelters, heal one another by use of plucked and processed substances from the environment long before capitalist industrialization or indeed patriarchal agarianization, came along. This is the impulse that has helped us make our way through the biosphere. Ignorant, overgrown, and greedy rather than directed, contained and balanced, it is part of what has gotten us into the mess we are in.

In my view, this impulse is gender neutral. I take my cue from anthropology, which rejects a vision of men as bearer of technology and culture and woman as somehow non-technological and "natural." Women are credited by many in anthropological speculation with having been the most likely gender to tame fire, domesticate animals, develop plant cultivation, elaborate language. Homo Sapiens and Homo Fabricans are one and the same; human knowing is a product of human making, which in turn is itself a product of knowing—and so the spiril builds—Homo Technicans.

However: to state that the impulse to technology is innate is not the same thing as saying that our actual present state of technological development is the direct product of that innate capacity. It is not to say that our present state was in any sense inevitable, nor that it is inescapable. The question of direction in technological development is a question of choice—what choice do we make to allow certain imperatives and not others to drive the deployment of our impulse to technology?

What societies do with the technological impulse, how they use it (consciously and unconsciously), what they make of, and with, our human technological ability—these are matters of social and economic choices made by any human group (or sets of groups) at any point in time. These choices, in turn, are deeply conditioned for any given individuals and groups, by pre-existing and fundamental social hierarchies and by the technologies which embody the knowledge the dominant strata have sought. In our own time, technological proliferation is also driven—and here its exponential growth rate is at issue—by the internal momentum of an economic system (capitalism) that has an built-in need for continual expansion.

How will this economic system continue to expand? Its only mechanism is the creation and exploitation of new markets. How are these markets constructed? By the way in which social arrangements produce certain kinds of needs and by the way industry responds to those needs in creating manufactured commodities that are advanced as solutions—the only solutions—to these needs. What then are the needs thrown up by our own social arrangements?

First, of course, we live in a society of gender hierarchy, still psychologically and institutionally rooted in patriarchal ideas and social organization. The essence (if one may still use that word in the age of the "social constructionists") of patriarchal social relations, as I have written at length elsewhere, is to control women's sexual capacities in order to contain woman as breeder for affiliated man.(1) Patriarchal technology, then, might be understood as technology that serves to reduce women's agency and subjectivity in fertility control and childbearing.

Are there pristine examples of patriarchal technology? How about ova maturation for artificial fertilization, using the eggs of female fetuses and female cadavers so you can dispense with the need for consent from live women to make embryos with their sex cells? Such technologies literally construct women as raw material for procreation. Or how about artificial uterus technology—so that the scientists will be able to finally gestate a fetus without living female bodies?

Or, rhetorically, how about cloning an in-vitro-fertilized (IVF) embryo, until this month an act that was taboo even among technodocs, as they like to call themselves? At a conference of the American fertility Association in Montreal, a George Washington University doctor announced that he has successfully cloned human embryos. Most "proceptive" (distinct from "contraceptive") technologies bear the clear mark of the patriarchal or masculinist imperative.

The essence of capitalist social relations, on the other hand, is to create woman as consumer, buying commodified technologies for her and her family's sexual and reproductive functions and problems much as she consumes other technologies for other purposes. Insofar as she has any sense of agency, a woman in industrial society will feel her ability to "control" her life embodied in her ability to purchase or obtain various such technologies. In this way, our consciousness of "choice" as a major form of agency and self-expression takes shape as a sense of our individual abilities to obtain certain enabling, or apparently enabling, technologies.

In our own time it is these two imperatives, the patriarchal and the capitalist, that drive the development of medical technologies and the shape of the research agenda in the scholarly and commercial sectors. These are the imperatives that masquerade as the relentless, undeniable "technological imperative." We accept that technology is somehow out of control, buying into the displacement maneuver, and forgetting that it is human economic and ideological interests that are driving technological proliferation. By giving technology an agency of its own, we make the real agents invisible.

These two imperatives have a set of affinities for, and a set of differences with, each other. Capitalism can develop and sell patriarchal technology for a handsome profit, and so it does, thus accentuating societal tendencies and technologies that seek or achieve patriarchal ends. For example, the so-called right to life movement is openly discussing the use of embryo-flushing technologies as a way to "rescue" embryos from abortion-minded mothers.

At the same time, capitalism can also develop and market technologies that more directly express the consumerist imperative—the contraceptive technologies, the ones that construct women as consumers of sexual pleasure for its own sake, and not attached to procreation. At the ideological level these technologies clash with the values of the patriarchal imperative—witness the Catholic and fundamentalist objection to many of these reproductive technologies, old and new.

The fact is that the growing resources required for the raising of children in industrial society mean that women need to limit the number of their offspring. This is the fundamental world-wide shift in demographics that accompanies industrialization. Within two generations of industrialization, family size drops dramatically.

Women have sought help in achieving this drop—not least because a culture that validates the notion of men's sexual access to women regardless of women's will (patriarchal sexual norms) means that women have not been able to count on men to take their share of responsibility for birth control or disease prevention. So women have gladly bought manufactured artifacts that help them to control pregnancy and birth, and they have looked to the services of medical professionals to help them apply the technologies.

From these, among other considerations, I derive my own basic ideas about women, medicine and technology: To begin with, I do not think that women have any particular gender or species interests in a priori rejecting technology, which in any case would be impossible. There is nothing to be gained in a search for some natural a-technological state, for that is not the natural state of humans. There can be no a-technological eco-feminist utopia.

Equally, however, there is no need and no socially defensible reason to accept all technologies by virtue of accepting and developing some. The question, rather, at any given point in time, is what technologies are being socially deployed, economically developed, publicly supported and educationally encouraged and what technologies are not? And—even more to the point—what technologies should be socially deployed, economically developed, publicly supported and educationally encouraged, and what technologies should not?

In the area of women's reproductive health, the answer to the first question is the virtual opposite of the answer to the second. That is to say, as I will explain momentarily, we have our priorities completely ass backwards. Which brings me to my second fundamental premise: We must devise mechanisms to evaluate technology—according to social and ecological criteria, not according to whether or not a short-term market exists (even a market of longing fertile or infertile women) or a profit can be turned.

What we must seek is not "no technology" or "all technology" but "appropriate technology," whether in the manner in which we heat our homes (solar versus nuclear, for example), or in which we approach our reproductive health. From this point of view, then, what—does the history of women's relationship to medicine have to teach us today, and what can we learn from it?

It is well known that during the six hundred or so long years of feudal disintegration and the development of capitalism, through religious turbulence (Reformation and Inquisition), through colonization, through urbanization and then through professionalization, local women healers and midwives, trained in traditional bodies of knowledge of herbal medicine and hands on healing were persecuted, hunted, discredited and then banned from what became the legitimate practice of medicine. Women healers were systematically displaced by male physicians, who held gender exclusivity in the new professions of science and medicine for almost two centuries.

The result of this phenomenon is that the science and medicine which developed as dominant and defining institutions during the last two centuries did so almost entirely independently from the ideas and knowledge of women as a group. So while it is not correct to say that all technology is patriarchal—technology can be gender neutral or, theoretically, matriarchal (for example, do away with the need for sperm and therefore men, though nobody is working on that)—it is correct to say that the medical technologies produced by the science and medicine of capitalist industrialization are indeed patriarchal in purpose and effect.

How are we to take the measure of women's exclusion, until recently, from the driving power apparatuses in science and medicine? It is difficult to quantify an absence, rather than multiple presences; harder to account for what was missed than for what has been accomplished and registered. But it should be possible, providing one takes the extra time to imagine what the inclusion of women might have meant, to account for how our attitude to sexual and reproductive health and technologies would have been different had women's concerns driven the development of science and medicine and the deployment of the social reproductive and sexual health dollar.

What we lost from general medical practice was the knowledge of non-invasive treatment through herbs and hands-on healing practiced and taught by traditional women healers. A Western physician cannot do anything to cure the common cold, (or other viruses for that matter). But mustard footbaths and plasters, combined with garlic, cayenne and ginger, are cross-culturally identified anti-viral plants that were the province of the once female "naturopath." Lost to most physicians is an elementary knowledge of these and thousands of other natural substances.

But there was an even greater loss—the loss to the legitimated practice of mainstream medicine of the approach to healing that values the non-invasive orientation. In India and China, where capitalism and its science were much later in coming, did not develop organically over a long period time and therefore did not fully displace existing bodies of knowledge, traditional medicines of equal or superior effectiveness (in many, not all) respects to our own still exist intact.(2) In Western medicine, we treat, problematize and study illness and forget health. Traditional Chinese medicine developed as a preventive discipline and associated technologies—the very kind of prevention that one hundred years of epidemiology have told us we have to publicly fund in our own communities.

In the West, the codification of the study of hands-on healing and the non-invasive use of plants and other natural substances has survived in a number of less dominant health disciplines: the profession of midwifery; the nursing profession. The use of natural substances can also be found in the development of homeopathy, an extremely powerful and effective form of treatment when practiced by a skilled practitioner.

Much maligned by ignorant and venal medical doctors and their professional associations especially in North America, homeopathy has a phenomenal track record in keeping the European ruling class in the pink of health. As well, the broader discipline of naturopathy—the use of natural nutritional substances less refined than pharmaceutical drugs to aid the body's recovery from a given condition or ailment—has developed. But these in-fact medical disciplines were consciously and offensively marginalized by a medical-industrial (pharmaceutical)-government coalition in the early twentieth century, and relegated to the non-legitimate world of quackery and snake-oil in the dominant discourse on health.

Western medicine excels in emergencies. It is good at massive pharmaceutical bombardment to allow the body relief from dire symptoms long enough for its immune system to kick in. It is good at surgery, amputation or reconstruction, making functional again what had been shattered or corroded. It is, in that sense, life-saving, and, in that sense, it is important to us.

But that is not all there is.

The problem with Western medicine and science is that, allied and supported by capitalist industry, they have imperialized the whole sphere of health care, from—the services insured by government and commercial companies to the research agenda in industry and the academy. (In 1983, 80% of the medical/scientific research in U.S. universities was directly underwritten by the pharmaceutical industry; I am sure the percentage is even higher today.)

This has the effect of marginalizing other holistic approaches and, even more important, the need for population health policies—clean air and water, economic stability, close community and family ties, i.e. stable gender relations, decent diet and physical exercise, and a sense of control. These are the factors—more than any number of doctors and hospitals, more than any number of homeopaths and acupuncturists—that are correlated with health, including reproductive health.

It seems the greatest indicator for health is a sense of control, and that is directly correlated to socioeconomic status. The emerging medical discipline of "psychoneuroimmunology" explains in Western medical terms what Indian Ayurvedic and traditional Chinese medicine have proposed all along.

The results of the marginalization of the holistic and non-invasive orientation, unfortunately, are poorer health and a reduced quality of life for all, with a great deal of serious physical and emotional suffering for many women—most women—at one or many points in their lives.

Take, for example, the infertile woman of 37 who does two years of Clomidcycles at the Fertility Clinic. In addition to the thousands of dollars she must find, the drug sends her mind and body on a jagged roller coaster of emotions that destabilize her professional and personal relationships. She is more than likely to remember in recurring flashbacks and agonizing detail how, twenty years earlier, she lost consciousness with pain when her gynecologist inserted the Dalkon shield that caused the pelvic inflammatory disease (PID) that had blocked her tubes.

But she had microsurgery three years ago, and the doctor said everything should work again. Still, cycle after cycle, she is not getting pregnant. After ten cycles, she is just about to give up—her job is on the line, her marriage is on the rocks, she feels like an alien being is occupying her body—when, presto! she's pregnant. She's thrilled, until her doctor advises her to have an amnio. She refuses, saying it's too late in the pregnancy, and they compromise on a CVS (chorionic villus sampling —a test of fetal tissue to determine genetic predispositions).

Two days after the test she starts spotting. She's put on bed rest. For two months she tries to save the pregnancy, then loses it. She becomes desperately depressed, unsure whether or not to go on to IVE when her husband leaves her. She attempts suicide. She survives, and then faces her future alone, hoping that she won't be one of the ones the feminists say are going to develop ovarian cancer in fifteen years.

This is a composite portrait of four women I know personally. All of them knew about so-called alternative medicine when they began fertility treatments and IVF, but because of its marginalization, they did not believe that it had anything real to offer them. They might have instead gone to a naturopath and asked for homeopathic and nutritional support for healing scar tissue, regularizing their cycles and balancing their vaginal pH; gone to an acupuncturist/shiatsu therapist for work on the energy meridians that seem so directly linked to immune and regenerating systems in the body.

Such treatment would have strengthened their entire physical, emotional and mental condition (psycho-neuroimmunology), permitting them to ovulate more regularly, provide a hospitable environment to an implanting embryo and growing fetus. Failing pregnancy, such treatments would have enabled the women to make better decisions in their own interest, even had they then decided to pursue allopathic fertility treatments with other supports.

These women are middle class, and so was their composite. How does her working-class counterpart fare? Infertile as a result of undiagnosed chiamydia or gonorrhea and attendant PD; possibly nutritionally and hormonally deficient due to toxic and stressful working and living conditions and poor diet, even more likely than her middle-class sister to suffer the harmful effects of male violence, with their consequence for fertility and healthy pregnancies, she is unlikely to be able to afford prolonged infertility treatment—allopathic or otherwise—to begin with, and the economic (and therefore emotional) stress she undergoes when she does try such treatment is even greater.

Our infertile working-class woman grew up in the east end of Toronto, where the lead levels in the soil the kids played in were subsequently found to be so lethal that huge cleanups were later ordered; or in Sudbury, Ontario where she ran with all the other kids on the slag heaps; or she got pregnant after high school and had an abortion then, but after ten years of work on video display terminals neither her eyes nor her periods are right. And though she wants a child desperately, she doesn't know how she's going to raise it, because last week, after ten years of work, her hospital just announced that half the clerical staff was going down to part-time work and no benefits because of health cutbacks; and that half includes her.

Meanwhile, her unemployed husband, crushed by his idleness and poverty, wants children too, and maybe she'll lose him if she can't conceive. They've fought about it before when he stays out late, comes back drunk and says to her, "what's there to stay home for?" She worries so much these days that she's smoking and drinking more, which she knows is making it harder for her to get pregnant And so it goes.

For this woman's basic fertility and for the health of her children—understand that infant disability is 95% caused by socio-economic, not genetic factors—it is public policies of population health that are most important, polices that address the social determinants of health: let me repeat—clean, safe environment, economic stability, supportive community and family relationships, adequate nutrition.

Given the feminization of poverty in North America over the past thirty years, population health policies are an urgent priority for vast numbers of women. As I said before and cannot emphasize enough, it is these, far more than the presence of doctors and their heroic technologies, that are associated with normal fertility (male infertility too—now accounting for about 50% of the cases in infertility programs) and healthy babies.

Dr. Etienne-Emile Baulieu, the French physician who invented RU486, spoke in Toronto a couple of years ago, and I went to hear him at the University of Toronto. He began his pitch for support for the drug in Canada by appealing to the feminists in the audience. He said that in the nineteenth and early twentieth centuries women had turned to medical science to help them plan and control their pregnancies—a fundamental necessity in a time when women did not want any longer to repeatedly procreate throughout most of their adult lives.

Contraception, planned parenthood and easier childbirth were the planks on which women's alliance with medicine were built And further, he claimed, medicine had served women loyally and well in these respects. Nevertheless, he admitted, all the available abortion technologies are still invasive and traumatic. As a less invasive abortifacient RU486 represented the next forward step for the women/medicine partnership in the field of post-fertilization contraception.

So how would we, as reproductive rights activists, evaluate the benefits and losses of women's "alliance" with medicine from the point of view of the two composite women I have sketched? I think the picture is far from uniformly positive.

First, as I indicated, the major gains of medical technology in Western medicine have been in helping to deal with life-threatening situations: a birth with major complications, an ectopic pregnancy, a massive infection.(3)

If we took the whole social expenditure on infertility and new-born disability and broke it down, we would see that 90% goes into after-the-fact, invasive and individual approaches, and less than 10% goes into preventive, supportive and population health approaches, even though in reality, the proportion of the causes is precisely the reverse. What is often referred to these days as the "geneticization" of illness—the barrage of scientific propaganda that suggests everything from alcoholism to political views is the result of genetic predispositions—is both a major result and a major agent of this approach.

This contemporary tendency in science is an expression of its need to create explanatory accounts—myths in fact—that explain in emotionally resonant ways how science will answer our greatest needs, so as to enable the continued proliferation of medical technologies while diverting attention away from the most important health need of our time: the redistribution of wealth.

Second, this alliance has hurt as well as helped women because our present medical approach does not seek, even as an auxiliary or support to its own treatments, the non-invasive, non-toxic enhancement of women's health to create within women themselves the capacity for conceiving and carrying healthy babies to term. Immune-enhancing and strength-building modalities have been relegated to marginal status, and made inaccessible except to the knowledgeable and relatively affluent.

Third, with respect to reproductive functions, our present medical approach has developed and marketed a series of mechanical and hormonal pharmaceutical technologies aimed at controlling women's reproductive capacities that appear to be very bad for women. Whether it's the milder symptoms of heart disease and blood clotting and predisposition to cancer involved in the contraceptive pill, or their more violent manifestations in Depo Provera and Norplant, or in fertility drugs, my assessment of the long foray in women's hormonal manipulation is negative from the point of view of women's health, therefore children's as well.

The research on IVF, in Australia, Canada, France and the United States, indicates major problems for women and for children, which I and many others have documented at length in a variety of publications.(4)

Fourth, then, is the matter of all effects, including "side effects," long as well as short term, and how little they are ever factored in to the social cost-benefit analysis. Hormones regulate all the functions of the body, on which the well-being of the "mind" is based. They are created and secreted by glands located in different parts of the body—pineal, pituitary, thymus, thyroid, pancreas, adrenals, gonads.

Changing the behavior of a gland by providing for the body an artificial version of the gland's secretions is a powerful way to affect the whole body's behavior. While it is made up of distinct parts, the glandular system is highly interrelated. Intervention into one gland or glandular function affects the whole system, which in turn affects the whole woman. Hence mood swings, weight gain or loss, disorientation, heart palpitations, swelling of limbs, depression, loss of memory, blood clotting as short-term "side effects;" the possibility of cancer and heart disease, among others, later on.

An extremely insidious but little discussed outcome of hormonal intervention (true of corticosteroids as well as contra- and proceptive drugs) is their effect on the gastrointestinal tract. Certain hormones are associated with certain pH (acidity) levels; and certain hormones act as "nutrients" for intestinal flora. Most problematically, they increase the growth of intestinal yeast (candida albicans), which is already overgrown in most people today due to the ubiquitous use of antibiotics, the hormones in the meat we consume, the environmental stresses on our immune system and our degraded (pesticides, refined sugars, etc.) diets.

Because of women's monthly hormonal cycles and their greater production of progesterone (a favorite nutrient for yeasts), women are more vulnerable than men to these problems. The result has been a mass epidemic of candida albicans overgrowth in women —manifested in recurring and debilitating yeast infections, serious food and chemical allergies and Epstein-Barr syndrome among millions of women.

Women who have been on the pill, or undergone fertility drugs, or otherwise ingested a lot of progesterone are more prone to these often debilitating conditions than others, particularly if they have taken large numbers of antibiotics and/or work in toxic environments. Not incidentally, this syndrome also brings major fertility problems.

Not only have women suffered an overall deterioration in their health due to extended periods of hormonal intervention; many have lost their fertility to allopathic medicine as well. DES and the Dalkon Shield (which claimed my fertility when I was twenty-three years old) are the most infamous horror stories of technologies which have harmed, in some cases, at least two generations of fertility.

In general, the story of the IUD is an ugly one, as is the story of pharmaceutical intervention into pregnancy. The only reasonably effective means of artificial contraception that do not harm women to date are the condom and diaphragm. The most effective way to avoid unwanted pregnancy is not to have genital sex when the woman is ovulating. If there is no egg available for fertilization, no embryo can be created. Recent studies among couples taught simple but sensitive measurement techniques show that their results in avoiding pregnancy are as high as for those people who rely on the contraceptive pill or condoms.(5)

The problem is, in fact, first a social, not a technological one. How can we teach people (a) to recognize the signs of ovulation—easy, and (b) to have enough communicative ability and responsibility to avoid inter course on dangerous days—extremely difficult. There is no commodity as such involved here, no magic bullet, oi and no medical technology that can substitute for social—solutions. Maybe good educational videos and pamphlets; maybe more work for teachers and counselors; but no profits for corporations and no work for doctors.

The same can be said for education needed to prevent sexually transmitted diseases (the major cause of infertility). Here the condom industry has a market, but again, the technology is simple, controlled by the users, and the main issues are those of relationships, communication and power.

So where does all this put us with respect to RU486? Reproductive rights specialists whom I trust in Canada claim that while RU486 does in fact have serious effects, overall it is less invasive—at least in the short term—than any form of mechanical extraction.

I am not sure that there have been the kind of follow-ups I would want for long-term effects, and I hope I do not live to regret my words. But for the time being and on the basis of this advice, I am willing to remain neutral on the matter of the drug despite my suspicions about a hormonal technology. I will not actively support it; but I will not oppose it either.

I take this neutral position for another reason as well: particularly in the United States, but also in Canada, women's access to safe abortion is continually threatened.

I take the feminist philosophical position that until it is born, the fetus is part of the woman's body, and its existence is subject to her needs and choices. Woman must be sovereign over her own body just as man is. We do not compel a father to donate a vital organ to his sick child; we must not compel a woman to give of her body to carry a fetus to term against her will. I take this position because having this much control over my fertility is the sine qua non of my ability to survive in my society, and this is true for the vast majority of women.

In this sense, I perceive the attack on women's embattled right to safe access to safe abortion as an attack against my fundamental human rights, and one I will do a great deal to defend. For this reason as well, I will not oppose an abortion technology that is arguably no more harmful than others and better than some.

I do not support, however, the continued exploration of hormonal intervention—pro- or contraceptive—in the research agenda. I don't think we should keep traveling down that road. The women's movement should assert an agenda for women's reproductive health grounded in preventive and immune-enhancing paradigms and modalities, in which allopathic intervention has an important but strictly delimited place; and demand that the imperatives of this agenda guide all government policy, public research subsidy and medical research.

From this perspective, I'm not cheering RU486. Above all, I fear long-term consequences in cancer and gastrointestinal and immune disruption. But RU486, it seems to me at this time and on the basis of available knowledge, does not constitute any major setback to women's health status with respect to existing technologies for abortion. Nor does it take us into qualitatively new realms of invasion, appropriation and fabrication (as IVF and preimplantation genetic diagnosis do).

For the time being, if it has other major advantages, such as potentially easy availability and minimization of trauma, perhaps it can be supported in the United States.

I think however, that it is time feminist and public health reformers looked much more seriously at the "historic alliance" between our gender and medicine; at how this affiance was imposed on women as well as sought after by them; and at what was lost, as well as what was gained. We need to evaluate what, out of this masculine, industrial medicine still dominating the mainstream, we want to work with and elaborate farther; and what to leave behind or move beyond.

This means that in addition to fighting to make safe abortion technologies safely available, we also have to look at the larger field of reproductive health and reproductive medicine, and shape our views and policies to correspond to the whole field, including the advanced genetic and procreative applications that have now entered human reproductive medicine. We need full evaluations of them from the point of view of appropriate technology defined in terms of social and physical criteria, that take into account the main social goals of society, the health of women, men and children, and address the real causes, not only the symptoms of sexual and reproductive ill-health.

To accept one technology—say artificial insemination with a turkey baster, a low-tech, low-invasion, low-cost technology amenable to user control—is not an automatic permission for the development of any and all technologies, nor should it be. It is incorrect to argue that any challenge to some reproductive technologies is a threat to women's reproductive self-determination, as many abortion-rights activists have argued.

We must pick and choose among technologies, along coherent and conscientious criteria. To object to some technologies and argue for some rather than others is not the same thing as taking an anti-technological position, but an appropriate technology position, supported by all the major premises of population health and epidemiology, as well as risk-assessment methods.

What I am suggesting is that in addition to specific struggles for specifically appropriate, or at least more appropriate technologies, such as the fight for access to RU486, women’s reproductive rights and health reformers need to start thinking more seriously, more systematically about the question of medical technologies as such, of modalities of treatment, of population health issues, and asserting these as central to the feminist project, and the criteria for appropriate technology.

Women and men now—in the presence of technologies that were unavailable and unthinkable twenty years ago when the women's movement adopted the notion of "choice" as the central premise on which to build a reproductive rights movement—need to evolve a more inclusive and more perceptive set of feminist guidelines ("ethics") by which to evaluate specific technologies, and dusters of technologies.

I say clusters and aggregates as well as specific technologies, since it is the aggregate procedures of multiple technologies that produce the most frightening activities today. It was IVF technology that made the human embryo available for manipulation outside the maternal body for what is known as "preimplantation diagnosis." It was computer technology that made the sequencing of the genome possible. It is aggregates of technologies and their interactions that have now opened the door to human intervention into the human gene pool.

As Germaine Greer has so succinctly put it: "They didn't get it right with rice and wheat. What makes them think they're going to do it properly with human beings?"

"Germ line" genetic intervention in humans is far more sinister than the "simple" creation of an embryo outside the maternal body, because it knowingly—though ignorantly—seeks to change future generations according to the plan of arrogant and hubristic scientists who play with other human beings—women and children of both sexes—as athletes play with basketballs.

While the majority of scientists still agree with the need to ban human germ line work, or at least still feel obliged to say so in public, the women's movement must force the development of public policy to

• develop guidelines to evaluate technologies and clusters along physical and social criteria; and

• put a moratorium on further proliferation and new development of women's hormone and gene-based reproductive technologies for five years, so that funds can immediately be redirected into priority areas of spending to compensate for the now inverse relationship between seriousness of cause and size of funding; and to permit a major public policy debate about future directions in reproductive medicine and women's health.

Technology is not an all or nothing proposition, unless we delude ourselves into thinking so. It's just damn hard to control when it is being driven by industrial and masculinist imperatives. The task before humans is to find ways to make green, feminist, social justice and anti-racist imperatives assume the driving force.(6)

Notes

  1. "Masculine Dominance and the State," Socialist Register, Merlin Press, London, U.K., 1983.
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  2. Ayurvedic medicine (Indian) is the basis of the work of Deepak Chopra, the Quantum Health best-selling MD/Naturopath who combines this approach with Western diagnostic techniques. Traditional Chinese medicine, in variations from Tibet to Japan, based on many of the same principles as ayurvedic medicine, has incredibly sophisticated herbal and energy (acupuncture, t'ai chi) technologies These are health disciplines that support women and their pregnancies in non-invasive ways. In traditional Chinese medicine, physicians were considered to have three general levels of skill. The best were able to cure through diet and herbs alone; the second through performing acupuncture and related energy interventions; the third through surgery. The highest goal was to stimulate healing without disrupting the flow of the energy meridians, to enhance the immune system, in Western terms, to produce health by itself. In traditional Chinese medicine the patient paid the physician when well, rather than when sick.
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  3. For the 5% of women who would lose their lives or their babies' lives in vaginal delivery, the perfection of cesarian section has been a life-giving blessing. For the other 20% of all women on whom it is inappropriately performed, it is a curse. So even these major contributions are not without serious cost in and of themselves.
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  4. The author discusses some of these issues in an interview published in Against the Current 37, MarcEilApril 1992, 28-33, See also Varda Burstyn, "Making Babies," Canadian Forum, March 1982; numerous articles in Gwynne Basen, Margrit Eichler, Abby Lippman, eds., Misconceptions The Social Construction of Choice and the New Reproductive and Genetic Technologies, Vol. I, Voyageur Publishing, Hull, Quebec, 1993; Vol.11 forthcoming Winter 1994.

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  5. This makes sense. I know several sexually active women who have used almost no artificial contraception for more than ten years as a result of monitoring their cycles and—absolutely key—relating to conscious, supportive partners (condoms come into service on danger days from time to time).
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  6. In our brief to Canada's Royal Commission on the Status of Women, the National Action Committee on the Status of Women (a roughly analogous organization to NOW, except membership is by 350 major women's organizations from every province, including womens services, women's committees in trade unions, as well as professional women's organizations). NAC spelled out certain principles by which it thought the Commission should evaluate the technologies. First and in the defining position, is women's control of their bodies. Second, a fetus is part of a woman's body as long as it is inside her body. She and ultimately she alone must make decisions concerning medical and other forms of treatment. The third principle NAC enunciated was prevention of infertility and disability: The priority of and proportion of public funding must be redirected to prevention. The fourth principle was informed choice—not informed consent, since the practice of this notion makes a travesty of the right to know about what will be done to your body and possibly that of your child. NAC added two otherprinciples which I do not have space to discuss here, but which are equally important—no commercialization of reproduction; public control of new reproductive and genetic technologies and equality of access to publicly sanctioned technologies. (Such ideas are normal in Canada because of the role of government in health care.).
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April/May 1994, ATC 49

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