Menstruation and menopause are reproductive health experiences, aren’t they? At least that’s what I think. But I’m starting to wonder how many people agree. I’ve been thinking a lot lately about how people define the things they experience and how researchers define the things they research. The last blog entry I wrote was on the confusing and frustrating definitions of the menopause transition. Today I thought I’d zoom out a bit more and think about what “reproduction” and/or “reproductive health” means. I personally think of reproductive health as encompassing a woman’s entire life course and including a whole range of experiences (and the pursuit and achievement of individual wellbeing throughout all of these experiences) but I don’t know if others do. For instance, about two weeks ago I was on the phone with a potential coauthor, and she and I had a misunderstanding because I was talking about “reproductive health” as including prevention of HIV and other STDs and she was thinking of “reproductive health” as just about conception, pregnancy, and birth. I’ve been studying what I think of as women’s normal reproductive processes and experiences (e.g., menopause, menstruation, pregnancy, childbirth, and breastfeeding) for a long time, so I thought I would use this blog entry to tell readers what I think about “reproductive health” and see if anyone agrees with me.
Adrienne Rich, in her 1986 edition of Of Woman Born, proposes that biological reproduction has been defined narrowly by most people (feminist or otherwise). Thus, for many, “reproduction” is equated with just two female processes: pregnancy and childbirth. While it may not have been the goal of any one person to define reproduction so narrowly, this seems to be a reality. At various points throughout history, conception and contraception – at times, even abortion – have been added to the definition of what “reproduction” meant, or what “reproductive rights” women were owed, but “reproduction” and “reproductive health” still refers to a very short list of experiences.
I believe we should acknowledge, however, that women’s “reproductive” experiences include more than just conception, contraception, pregnancy, and birth. Reproduction includes an entire range of reproductive experiences, including: menstruation and menopause, use of and problems with contraceptives, choosing whether to become a mother/father, breastfeeding, HIV and other sexually-transmitted diseases/infections, prostate and breast cancer, awareness of and access to reproductive health care, protection against sterilization abuse, vasectomy and hysterectomy experiences, the rights of single and/or lesbian mothers, the rights of single and/or gay fathers, donor insemination, cloning and other new advancements in reproductive technology, adoption, infertility treatments and experiences, gynecological practices, alternative reproductive health movements, decisions over whether to engage in heterosexual intercourse, and making informed “choices” in any of these instances. This is just a partial list, and I could go on and on. I propose that we think of “reproduction” (and, by default, “reproductive health” experiences) as the collection of (a) biological, physiological and/or embodied processes and (b) emotional, social, economic, and political decisions and/or actions that individuals — along with their families and other social groups — participate in (either voluntarily or sometimes through some sort of coercion), as they transition in and out of certain stages of their life course, decide whether or not to be sexually-active, and/or decide whether or not to become genetic, gestational and/or social “parents” or caregivers of children. Any one reproductive experience – for example, menstruation or menopause – can also really be a set of processes and decisions and actions that women make/take/experience/pass through over an indefinite period of time – usually not happening in just one moment. Thus, menstruation or menopause are full-fledged and complicated reproductive experiences in and of themselves, as much as pregnancy or childbirth or any other “reproductive” experiences are, that the majority of women pass through, albeit in different ways, throughout their lifetimes. So are all of the other processes and experiences I’ve named above, and more I haven’t named. “Reproductive health” would then refer to a state of physical and mental wellbeing, indeed biopsychosocial wellbeing, while experiencing any of these sets of processes or decisions or actions.
So, this is my position on women’s “reproduction” or “reproductive health.” I argue that we have to think about it as a much broader life course entity, rather than anchored to one process or set of moments. To me, you can’t understand any one reproductive moment without understanding the broader context of a reproductive life and a cumulative set of experiences that women (and their partners and whomever else they’re around or influenced by) inevitably have across their life courses.
I know I’m making reproduction and reproductive health more complicated, but why think of it as simple or narrow when it’s not?