http://www.hsph.harvard.edu/rt21/medicalization/balsamo.html

Pregnant women, as the material sign of the Reproductive Woman, can-not easily avoid the scrutiny of a fascinated gaze. A recent article in SELF magazine unselfconsciously gushes that "in the office, on the street, it's everybody's baby":

A woman who is pregnant immediately knows that her body is no longer her own. She has a tenant with a nine-month lease; and should he spend every night kicking or hiccuping ... there is nothing she can do. Sharing one's body with a small being is so thoroughly wondrous, though, that one can generally overlook the disadvantages. The real problem is sharing one's pregnant body with the rest of the world.^[1]

Here we can read the three key features of our culturally determined "magical thinking" about reproduction: (1) a pregnant woman is divested of ownership of her body, as if to reassert in some primitive way her functional service to the species -she ceases to be an individual defined through recourse to rights of privacy, and becomes a biological spectacle. In many cases she also becomes an eroticized spectacle, the visual emblem of the sexual woman; (2.) the entity growing in her, off of her, through her (referred to variously as a pre-embryo, embryo, fetus, baby, or child), ^[2] has some sort of ascendant right (to produce pain, to be nourished properly, to be born) that the maternal body is beholden to; (3) that the state of being pregnant is so "wondrous"- or, variously, thrilling, fulfilling, and soul-fully satisfying -for a woman that she would endure any discomfort, humiliation, or hardship to experience this "blessed event."^[3] This passage also demonstrates how easily the female body is "deconstructed" into its culturally significant parts and pieces: -here the womb serves as a metonym for the entire family body. Not only does this fragmentation culturally reduce a woman to an objectified pregnant body, it also supports the naturalization of the scientific management of fertilization, implantation, and pregnancy more broadly.

To establish a context for a more detailed discussion of public pregnancies, I want to pose a question that will be familiar to those informed by the history of cultural studies: what is the relationship between cultural narratives and the social conditions of women? During the course of doing the research for this chapter, it became clear that the question of the relationship between literature and society, one of the abiding questions for scholars and students of cultural studies from the mid-1960's, has transformed into a much different concern about the relationship between mass-mediated cultural narratives, medical discourse, and material bodies. Although it is beyond the scope of this essay to rehearse the specific intellectual genealogy of this transformation - that is, the movement from a concern with literature and society, to one of language and materialism, to one of the material effects of cultural representations- I want to suggest that such questions are at the heart of what it means to me to do "cultural studies of science and technology." In this sense, the polemic of this chapter concerns the tensions and contradictions that emerge from a specific intellectual practice. Studying women and the deployment of new reproductive technologies involves asking questions that are theoretically interesting and intellectually gratifying to investigate, but which also illuminate cultural conditions that require immediate, critical political intervention. Is this not also the case for many other cultural studies of science and technology, whether or not they are framed by an explicit commitment to feminist politics? The question that grounds this chapter concerns the relationship between discourse and material bodies that pre-occupies both feminist theory and feminist politics.

I begin with an extended discussion of Margaret Atwood's novel The Handmaid's Tale, which narrativizes current anxieties about reproductionin a technological age.^[4] When the Handmaid Offred describes her public encounter with the pregnant Handmaid Ofwarren, we hear the echoes of SELF magazine: "She's a magic presence to us, an object of envy and desire, we covet her. She's a flag on a hilltop, showing us what can still be done: we too can be saved" (3 5). This reverence is also evident in medical discussions about new reproductive technologies. E. Peter Volpe, an expert in reproductive medicine, subtitles his 1987 book Test-Tube Conception: A Blend of Love and Science (figure 21). He too refers to the passage in Genesis (with Rachel, Jacob, and the maid) as the Ur-narrative of surrogate motherhood. The difference, though, between the surrogate story in Genesis and the ones we read about in Volpe's book and in our news-papers, is that in late capitalism "The surrogate performs the unusual service for a substantial fee."^[5] Conceptualizing the relationship between a woman and her body as one between an individual and personal property offers some measure of liberty and economic freedom for women. "Be thankful," as Offred reminds us, "for small mercies" (127). But what is the quality of this mercy?

Reproductive technologies provide the means for exercising power relations on the flesh of.the female body. These power relations are in turn institutionalized in several ways -not only through the development of medical centers that offer reproductive services, but also through the establishment of reconstructed legal rights and responsibilities of parents, donors, fetuses, and resulting children. Specific technological practices further augment such institutionalization; for example, the application of new visualization technologies - such as laparoscopy - literally bring new social "agents" into technological existence. In this way, the material applications of new technologies are implicated in, and in part productive of, a new discourse on maternal identity, parental responsibilities, and the authority of science.^[6] At the heart of this discursive formation of reproduction are evocative cultural narratives about motherhood, the family, the role of techo-science, and the medicalized citizen. To illuminate the different levels at which a logic of surveillance informs the deployment of new reproductive technologies, I follow my discussion of Atwood's novel with an examination of the use of laparoscopy (a visualization device commonly used in egg retrieval and embryo implantation) as it belongs within a particular history of obstetrics. This technology has emerged at the same historical moment when the mass media (in the U.S. at least)have become preoccupied transforming "problem pregnancies" into public spectacles. This articulation of instruments, professional histories, and mediated discourses has created cultural conditions in which- new reproductive technologies are used to discipline material, female bodies as if they were all potentially maternal bodies, and maternal bodies as if they were all potentially criminal.^[7] The issue under consideration in this chap-ter is the relationship between fictional narratives, medical discourse, and the formulation of reproductive health policy that significantly impacts the material conditions of women's lives.

The Handmaid's Tale:
A Speculative Ethnography of the Present

Published in 1985, Margaret Atwood's novel The Handmaid's Tale from early on was identified as a dystopian projection of some future society, in the tradition of Orwell's 1984 and Huxley's Brave New World^.[8] The novel is set in the fascist Republic of Gilead, which succeeds contemporary U.S. society sometime in the late 1980's or early 1990's. The Gilead regime assigns every female to one of five classes of women: wives, econowives,aunts, marthas, and handmaids. The classes of wives and econowives include the spouses of free men. Wives are married to men with military rank, which allows them a measure of privilege, including the right to employ a handmaid and marthas; econowives are coupled with the younger men who form the rank and file of the military regime and who do not have enough status to obtain a handmaid or a martha. Aunts function as religious teachers and trainers of handmaids, and the marthas are a class of serving women - housekeepers, cooks, and nannies. Handmaids serve as surrogate wombs for infertile heterosexual (in identity but not necessarily in practice), privileged couples (wives and military leaders). Two other classes of women exist: "jezebels," women who are used as unofficial prostitutes at the military club; and un-women, the women who resist their class assignment, are nonfunctional for the society, and/or are potentially or actively subversive of the regime.

Handmaids are socialized to perform their reproductive service for the state through an intense religious program of indoctrination, which begins with instruction by the aunts at the Rachel and Leah Center and is more widely supported by a system of social rituals. The central preoccupation of the Gileadean society is human reproduction, because most members are sterile or infertile due to the buildup of toxic wastes and nuclear fallout. All potentially fertile young women are forcibly drafted into service as handmaids or banished to the toxic waste "colonies" if they refuse. Thus, the central symbolic figure of the society is the potentially reproductive woman, the handmaid.

The point of Gileadean rituals is always the same for women -the complete destruction of individual identity and the social reproduction of collective identity. The most central ritual, called simply "The Ceremony," invokes a biblical passage in which Rachel offers to her husband Jacob her maid Bilhah to bear him the children that Rachel cannot. In a symbolic repetition of this offering of a fertile, surrogate womb from one woman to her husband, the handmaid lies between the legs of the wife as the husband penetrates the handmaid's exposed sex in an attempt to impregnate her. Any child born of a handmaid is given over to the wife as if it were her own. Other rituals reinforce the depersonalization of handmaids: "testifying" establishes women's primary guilt for licentious sexuality, "birthday" involves all handmaids in the collective Lamaze-like coaching of a handmaid in labor, "salvaging" requires handmaid participation in a collective execution of transgressive citizens.

The novel is organized in two parts; the first and longest part forms the bulk of the book and is divided into 15 chapters, which alternate between chapters titled "Night" or "Nap" and chapters that describe the focal rituals of the Gileadean society. The episodes are related from the point of view of a woman who was abducted by military guards as she, her husband, and daughter were trying to escape the country. In the first chapter, the narrator describes the gymnasium-turned-dormitory at the Rachel and Leah Center where she and other handmaids-in-training sleep on old military cots and are watched continuously by Aunts with cattle prods. The narrator reads the gymnasium as a palimpsest layered with the many histories of generations of teenagers who played and danced there. This opening chapter establishes the key tensions that will develop throughout the rest of the novel. Private moments of nostalgia for an earlier era, which at a distance seems somehow lonely and expectant, intertwine with an insatiable romantic fantasy of a future. The willful belief in their individuality and the fantasy of release provokes these handmaids-in-training to

learn to whisper almost without sound.... [to] stretch out our arms, when the Aunts weren't looking, and touch each other's hands across space. We learned to lip-read, our heads flat on the beds, turned sideways, watching each other's mouths. In this way we exchanged names, from bed to bed. Alma. Janine. Dolores. Moira. June. (4)

Except for Moira, these subversive moments never quite congeal into an act of resistance, attesting to the totalitarian control effected by the Gilead regime. These internal dramas are counterpoised to more realistic descriptions of the public situation of women in the new regime: women watched, guarded, intimidated, and policed. Thus, in the opening section, we read a description of the structural tension between private rituals of individuality and public performances of collective identity that will organize the narrative to follow.

The second part, titled "Historical Notes on The Handmaid's Tale," formally stands as an epilogue or retrospective framing device in which the first part of the novel is revealed to be a "text" at the center of a future "symposium on Gileadean Studies held as part of the International Historical Association Convention, held at the University of Denay, Nunavit on June 25, 2195." The "Handmaid's Tale" is a historian's reconstruction of a collection of primary materials that come in the form of an (audio)taped account of a 33 -year-old handmaid, who, we learn, is the narrator of the first part of the book. Ostensibly we know her only as "Offred," the handmaid in the service of a commander whose first name is "Fred."^[9]

Offred's account gradually elaborates the repressive system of the republic of Gilead. The narrative she tells is limited to her severely restricted point of view, but as a picture of Gilead is pieced together through her description of rituals, the reader also witnesses the piece-by-piece assembly of the subjectivity of a handmaid. In these fragments, Offred offers readers a sense that the demoralization of handmaids is a well-orchestrated social phenomenon-. accomplished both through public rituals, such as the mandatory monthly visit to the gynecologist to determine her fertility status, and in more private moments - in her clandestine visits to the commander to play Scrabble, and even during her subversive act of intercourse with the commander's chauffeur. A second series of events interrupts this account of her Gileadean life; these are scraps of personal memories and of cultural history -of her husband, her radical feminist mother, the origin of the Regime's takeover, and her early schooling with the Aunts at the Rachel and Leah Center.

Atwood inverts the contemporary associations between religion and ritual on the one side, and reproduction and technology on the other, so that in her novel religion is technologized (The Soul Scrolls) and reproduction is highly ritualized and radically detechnologized. This inversion sets the stage for two lines of critical analysis of contemporary society: one that addresses the quasi-religious belief in the benevolent power and application of technology, and a second that refers to a vehement denouncement of reproductive technologies, ostensibly by radical feminists of an earlier generation.

Although Atwood has consistently asserted that every indignity that the handmaids suffer in her novel has actual historical precedent (some during colonial New England, others in Europe during World War), the importance of the novel lies not (solely) in its relation to those historical precedents nor in its offering of a dystopic projection of some future version of the United States, but rather in the fact that it helps narrate and make manifest the often obscured situation of reproductive-age women in contemporary U.S. culture. For some women, the regime of surveillance described in humiliating detail in the novel is less fiction than biography. In this sense, we could read it as ethnography rather than as science fiction. The novel focuses critical attention on the cultural rearticulation of the meaning of reproduction and provides a narrative frame through which to read the meaning of the interaction between the female body and new forms of reproductive technologies that are subtly but unmistakably being used as surveillance devices.

In Gilead, no less than in the United States during the 1980's and 1990's, women are defined primarily in terms of their reproductive facility. In the process, the female body is deconstructed into its functional reproductive parts. When Offred describes her first "Ceremony" ritual with the Commander and Serena joy, she articulates the subjectivity of a fractured female body:

My red skirt is hitched up to my waist, though no higher. Below it the Commander is fucking. What he is fucking is the lower part of my body. I do not say making love, because this is not what he's doing. Copulating too would be inaccurate, because it would imply two people and only one is involved. Nor does rape cover it: nothing is going on here that I haven't signed up for. There wasn't a lot of choice but there was some, and this is what I chose. (94)

As a womb with legs, Offred understands her importance for the society: "I am a national resource" (65), a "sacred vessel," an "ambulatory chalice". She recalls that she used to think of her body as an instrument

of pleasure, or a means of transportation, or an implement for the accomplishment of my will.... But now ... I am a cloud, congealed around a central object, the shape of a pear, which is hard and more real than I am and glows red within its translucent wrapping. Inside it is a space, huge as the sky at night and dark and curved like that, though black-red rather than black. Pinpoints of light swell, sparkle, burst and shrivel within it, countless as stars. Every month there is a moon, gigantic, round, heavy, an omen. It transits, pauses, continues on and passes out of sight, and I see despair coming toward me like famine. To feel that empty, again, again. (7 3 -74)

But as a "national resource," she must be vigilant about taking vitamins and eating healthy food. Aunt Lydia instructs her: "You must be a worthy vessel. No coffee or tea though, no alcohol. Studies have been done" (65). Studies done, no doubt, earlier in her lifetime that resulted in policies requiring warning messages posted on cigarette packages, tavern cash registers, and computer monitors that read: "Warning to pregnant women -smoking, drinking, working may be hazardous to the health of your fetus."

A second line of critical analysis takes up the position of some feminist critics of reproductive technologies. These passages in the novel are in many ways the most frightening for a feminist to read, because in a different context, in our context, the beliefs seem so benign and so reasonable. But articulated to the system of repression institutionalized in Gileadean society, these beliefs form the links of the chains that bind handmaids to their reproductive service for the state. During her account of the "Birth Day," Offred remembers her mother's feminist convictions. We find out that machines have been banned from the birth room; the technologized birth situation that was controlled by male doctors and technicians-the source of some feminist outrage in the 1980's-is outlawed in Gilead. Although a fully equipped (with machines and men) Birthmobile stands ready in case of a handmaid birth emergency, most of the time the men aren't needed, and they certainly aren't wanted:

It used to be different, they used to be in charge. A shame it was, said Aunt Lydia. Shameful. What she'd just showed us was a film, made in an olden-days hospital: a pregnant woman, wired up to a machine, electrodes coming out of her every which way so that she looked like a broken robot, an intravenous drip feeding into her arm. Some man with a searchlight looking up between her legs, where she's been shaved, a mere beardless girl, a trayful of sterilized knives, everyone with masks on. A cooperative patient. Once they drugged women, induced labor, cut them open, sewed them up. No more. No anesthetics, even. Aunt Elizabeth said it was better for the baby, but also: I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth thy conception; in sorrow thou shalt bring forth children. (114)

But for the ritualistic return to the biblical passage on birth and sorrow, this scene describes a birth situation that sounds similar to the ones advocated by feminists and others who lobbied in the 1980's for "natural" birth methods.^[10] Offred is ambushed by another memory, this time of the movies the handmaids were shown to reeducate them about the benefits of the new society. The movies might be ethnographic films of primitive women or old porno flicks

from the seventies or the eighties ... [that showed] women kneeling, sucking penises or guns, women tied up or chained or with dog collars around their necks, women hanging from trees, or upside-down, naked, with their legs held apart, women being raped, beaten up, killed. Consider the alternatives, said Aunt Lydia. You see what things used to be like? That was what they thought of women then. (118)

In one of the films, Offred sees her mother at a "Take Back the Night" march. She reiterates her mother's feminist convictions about "freedom to choose," a woman's right to control her body, and her expectations of younger women. As Offred is mentally brought back to the scene of the collective handmaid birthing, she offers the most damning recollection yet: "Mother, I think.... You wanted a women's culture. Well now there is one. It isn't what you meant, but it exists. Be thankful for small mercies"(127).

The key for understanding this line of criticism comes from Offred herself in another chapter. After she has met with the commander secretly to play games in his study, she wonders how to make sense of this all: "What I need is perspective. The illusion of depth, created by a frame, the arrangement of shapes on a flat surface. Perspective is necessary. Otherwise there are only two dimensions. Otherwise you live with your face squashed against a wall, everything a huge foreground, of details, close-ups.... Otherwise you live in the moment" (143). The perspective she seeks comes to her as a simple understanding. "Context is all," she thinks as she fits her Scrabble playing into a framework of the forbidden. "Context is all," we should remember as we read familiar feminist criticism rearticulated within a seemingly distant future when women are protected as reproductive machines and reviled as threatening subversives.

The Reign of Technology

Although there are several interested histories of the profession of obstetrics, most would agree, according to William Ray Arney (writing in 1982),that the most "recent period of obstetrical history was characterized by exponential advances in technology."^[11] Arney suggests that the orientation of obstetrics shifted after World War II from intervention into the process of childbirth to the monitoring and surveillance of the obstetric patient. In his view, in the late 1940s the "organizing concept in obstetrics changed from 'confinement' to 'surveillance,'. . . the hospital became the center of a system (of obstetrical surveillance that extended throughout the community" (113) and eventually into women's personal lives. In our contemporary world, he asserts, "every aspect of a woman's life is subject to the obstetrical gaze because every aspect of every individual is potentially important, obstetrically speaking" (153). Protection of the fetus is often offered as a commonsensical and, hence, ideological rationale for intervention into a woman's pregnancy, either through the actual application of invasive technologies or through the exercise of technologies of social monitoring and surveillances.^[12]

Arney goes on to argue that the increased monitoring of childbirth not only has brought the maternal body and fetus into a broader system of surveillance, but it also functions to control and monitor the obstetricians themselves. Several control "devices" developed over the last 40 years are designed to enhance fetal monitoring: intrauterine pressure catheters that measure contractions, a subcutaneous electrode that reads fetal blood pH, and, ultrasonic devices that monitor fetal respiratory movement. With the deployment of these new technologies, a dominant, traditional definition of obstetrics as a specialized practice that involves the exercise of professional judgment comes into conflict with the redefinition of obstetrics as scientistic clinical and technological protocol. Obstetricians themselves claim that the scientific studies that describe what to monitor and when to intervene inhibit professional "subjective" judgment. It is important to remember here, as Paula Treichier elaborates, that this earlier definition of the proper, authoritative role of the obstetrician is itself the outcome of a historical struggle.^[13] Whereas some of the obstetrician's scope of authority may be curtailed with the advent of new monitoring technologies, such that technological monitoring becomes a system of obstetric control that promotes, for example, institutional concerns for cost containment over the practice of clinical judgment, it does not fully dislodge the authority of the obstetrician that has been "historically" accomplished. Thus, although in one sense the new monitoring technologies contribute to thefeeling that the sovereignty of the obstetrician is gone, replaced now by the notion of a technologically enhanced clinical practice, in another sense the range of the obstetrician's authority has been expanded to include responsibility for interpreting the output of monitoring devices.

Situated within another historical context, the use of such technologies in the obstetric field is just another stage in the incorporation of technology into all fields of medicine -a process that has been going on for well over four centuries.^[14] In keeping with this narrative, the introduction of new monitoring technologies has the consequence of bringing both the obstetrician and the pregnant women into a system of normative surveillance -although, as noted above, the range of agency of the obstetrician remains culturally and institutionally broader.

An equally significant consequence is that these monitoring devices also construct new bodies to watch. The most obvious is the body of the fetus, which is visualized through new imaging technologies.^[15] This leads some obstetricians to claim that the fetus is actually the primay obstetrics patient. Less obvious is the creation of new identities for the female body. As a potentially "maternal body" even when not pregnant, the female body is also evaluated in terms of its physiological and moral status as a potential container for the embryo or fetus.^[16] Clearly the use of technology in the service of human reproduction and maternal health has political consequences for all participants. As demonstrated by those who argue on behalf of fetal rights, it also has the consequence of constructing entirely new participants, who now play a role in the obstetric en-counter. And as Barbara Duden convincingly argues, "the public image of the fetus shapes the emotional and the bodily perception of the pregnant woman."^[17]

In the 10 years since Louise joy Brown, the first "test-tube" baby was born in Britain (25 July 1978), more than 88 in vitro fertilization (IVF)c linics have opened in the United States - and these represent only one of several kinds of organizations offering technological reproductive services. In 1987, the first anonymous egg donor program was established atthe Cleveland Clinic (officially called the Oocyte Donation Program). Administrators of this program claim that they can match "human eggs to their future parents by hair and eye color, by body size and blood type, even by national origin."^[18]Is In its first year, the clinic, reported being deluged with offers from women who wanted to donate eggs; a deluge no doubt due in part to the fact that the clinic pays a woman $1200 for each egg donation. The technologies that these services use, what are called the"new reproductive technologies" (NRT), enable a range of egg manipulation: (1) unfertilized eggs can be retrieved from fertile wombs and the neither placed in an infertile womb to be "naturally" fertilized, or fertilized outside of any womb and then implanted in another; or (2) fertilized eggs or embryos can be transferred from fertile womb to infertile womb. In fact, the extended degree to which the physiological process of reproduction is medically and technologically managed has prompted people to begin thinking of birth as an industry in itself, where, according to some critics, fertility clinics are nothing more than "commercial babymaking services."^[19] Indeed, the cost of such reproductive services is quite expensive for the average American: in ig1989 for example, the going price of surrogacy was $ 10,000; IVF usually costs between $3,000 and $7,000 for one implanted viable embryo; and artificial insemination ranges in price from $500 to $5,000. Not surprisingly, these services are usually marketed to upper-middle-class (infertile) couples who can afford to spend more than $35,000 trying to conceive a child.^[20]

The technological isolation of the womb from the rest of the female body promotes the rationalization of reproduction, such that the process of reproduction itself can be isolated into discrete stages: egg production, fertilization, implantation, feeding, and birthing. In this way, the new reproductive technologies include several biotechniques that literally en-act the objectification and fragmentation of the female body by isolating and intervening in the physical processes of human reproduction that normally occur within the female body. These technologies may include the administration of ovulation-inducing drugs, artificial insemination, laparoscopy, in vitro fertilization, cryopreservation of embryos, ultra-sound scans, and the use of instruments such as a specially designed catheter that can pass through the cervix into the cavity of the uterus, which is used to transport an ex vitro fertilized embryo.

Several of these procedures actually allow researchers and physicians to view the internal physiological state of the female body and the developing embryo/fetus. Patrick Steptoe and Robert G. Edwards, the two British scientists responsible for Louise Brown's "test-tube" conception, modified a surgical technique called laparoscopy to obtain ripe eggs from a woman's ovary (figure 22). E. Peter Volpe describes the procedure of egg retrieval in which a laparoscopy is used as a visualization instrument:

A clear view of the ovary is obtained with a slender illuminated telescope-like instrument, or laparoscope, which is inserted through a small incision made in the navel. The viewing device illuminates the ovary, enabling the surgeon to examine the surface of the organ. The rounded follicle (containing the ripe egg) is readily detectable on the surface of the ovary as a thin-walled pink swelling. A specially de-signed hypodermic needle is then passed through a second incision in the abdomen, and the contents of the bulging follicle are aspirated.^[21]

As the abdomen is pierced to insert the laparoscope, the technological gaze literally penetrates the female body to scrutinize the biological functioning of its reproductive organs. In the process the female "potentially maternal" body is objectified as a visual medium to look through.

After implantation of an IVF embryo is achieved using these sophisticated techniques, "the pregnancy" is carefully monitored. Given all the work, money, and physical discomfort involved in such conception, promoting a healthy developing embryo/fetus is of great concern:

... the pregnancy is monitored using all resources of the present state of the arts. The elaborate protocol includes continual office visits, hormonal analysis, ultrasound scans, serum alpha-feto protein testing (for spina bifida), amniocentesis (for prenatal biochemical and chromosomal analyses), routine obstetric laboratory tests, and two-hour postprandial glucose tests for signs of maternal diabetes.^[22]

Some experts unabashedly agree that part of the new concern for the fetus is due to advances in visualization technologies and the promise of fetal medicine as a new medical specialty; a recent newspaper article quote done physician as saying: "We can now view the fetus; we can determine its size and its sex. If it is ill, we can give it blood transfusions; nutrients can be offered in utero. And we now know that nutrition and lifestyle can harm the unborn."^[23] Thus, the same technological advances that foster the objectification of the female body through the visualization of internal functioning also encourages the "personification" of the fetus.

Assessing the Political Consequences of New Reproductive Technologies

Many feminist-informed histories of the practice of obstetrics and gynecology see in the application and deployment of new reproductive technologies the continuation of an old campaign on behalf of the medical profession to consolidate its cultural authority by wresting control over the act of childbearing away from women. Although Margaret Mead long ago suggested that this desire is a result of "mate jealousy of woman's ability to make a new life," others have argued more recently that men's participation in the development and application of new reproductive technologies represents an invigorated desire to control and conquer "nature." Following this, some feminists argue that birth control should be redefined as womb control. Gena Corea, for example, argues in her book The Mother Machine: Reproductive Technologies from Artificial Insemination to Artificial Wombs that the current situation of the application of new reproductive technology extends far beyond mere concern with "un-ruly" and infertile wombs; in her words, "it is a war against wombs."^[24]  This leads other feminists to redefine birth as "reproductive engineering "in which the primary objective is not to assist the female body in its body business, but to eliminate paternal uncertainty.^[25] Rebecca Albury describes how IVF programs already overtly test for the "fitness" of a woman who offers her body for such services.

A woman must demonstrate her worthiness to become a part of a technological conception programme; she must fit the practitioner's notion of a "good mother." First she must be married.... in addition she must demonstrate the suitability of her skills and motives for parenting.^[26]

In The Mother Machine, Corea informs us:

The overwhelming majority of reproductive engineers are male. The overwhelming majority of persons on whose bodies these men experiment are female. The technology used emerges from a science developed by men according to their own values and sense of reality... Reproductive technology is a product of the male reality. The values expressed in the technology -objectification, domination -are typical of male culture. The technology is male-generated and buttresses male power over women. (3-4)

Following this line of analysis, the patriarchal objectives served by the application of new reproductive technologies include the consolidation and maintenance of scientific authority, as well as paternal privilege, pro-motion of the institutions of heterosexual marriage and the traditional family structure, the continued accumulation of profit for medical institutions, and the reproduction of men's objectification of women's bodies for cultural and social gain. Women's objectives for birthing a healthy baby or for better birth management are subjugated goals often employed as rhetorical alibis for the application of new birth technologies, but rarely- considered in their own right.^[27]

As the new reproductive technologies developed during the decade of the 1980's, so too did the feminist response. In fact, certain positions have been staked out that are themselves being treated as important issues for debate among feminist scholars. For example, both Judy Wajcman and Jana Sawicki summarize what they identify as the "FINRRAGE" position, as it is supported and directed by the writings of Gene Corea, Jalna Hamner, and others^.[28] (FINRRAGE is the acronym for Feminist International Net-work of Resistance to Reproductive and Genetic Engineering.) Advocates of the FINRRARE position criticize the development and use of reproductive technologies on several counts, but the central focus of their critique is that these technologies embody and institutionalize the patriarchal domination of women and of scientifically managed reproduction. As a gross simplification, the sign "FINRRAGE" often is invoked, at least semiotically, as the identity of the antitechnological feminist response. While there are no doubt differences even among FINRRAGE members about the role of women in science and technology, what is less contestable is that these feminists advocate the use of "women-centered" approaches to the development and application of scientific knowledge, especially as it concerns the issues of reproduction, maternity, and women's health. In line with this position, Patricia Spallone asserts:

Feminist resistance to the new reproductive technologies is not a negative stance, but a positive one, where we can re-assert a women's power and knowledge and experience to ask our own questions about fertility, fertility problems, childbirth, childrearing, mother-hood, abortion.^[29]

Having said that, though, it is true that the strongest line of FINRRAGE analysis focuses on the way that reproductive technologies exploit women for men's gain. To this end, Corea advocates an interventionist strategy of resistance, where the plight of the few (the infertile) is not used to deter-mine the wide-scale application of these technologies for the many. Fundamentally, she advocates the development of a new value system, where women "speak out against any injustice suffered by women, an in so doing contribute to the crystallization of women's well-being as a value"(322). This will happen when women break out of their culturally induced confusion about these new technologies and begin to assert their sense of dignity and worth.

As both Wajcman and Sawicki note, there is feminist opposition to the FINRRAGE position. The crucial issue centers on whether or not re-productive technologies (and the scientific knowledge embodied by them) are inherently patriarchal and oppressive of women, as those associated with the FINRRAGE position assert. Opposed to this position are writings and research by other feminist scholars, most notably Michele Stanworth, who argue that the FINRRAGE position gets caught in an overly romantic view of "natural" reproduction and that FINRRAGE spokeswomen totalize the impact of reproductive technologies.^[30] This position urges feminists to resist a version of technological determinism that suggests that technological knowledge somehow overdetermines human choices. As Stanworth counters, there are benefits for some women from the application of new reproductive technologies, which indicates that these technologies do not have the same impact on all women. Artificial conception and surrogate maternity offer hope to childless people (who are not always heterosexual couples) and to women who are physiologically incapable of having children.

Both Wajcman and Sawicki offer their own way out of the impasse generated by the debate between these seemingly incompatible feminist positions. Where Sawicki returns to her broader argument concerning the usefulness of what she calls Foucault's politics of difference, Wajcman writes a reasoned account of the crucial insights gleaned from both positions. In the end, both Sawicki and Wajcman offer a reasonable assessment of this debate: that although technologies and scientific knowledge are shaped by and indeed embody political and ultimately patriarchal interests, they are not monolithic structures that impose a singular reality or set of consequences on all women equally. When Wajcman asserts that in order to assess the political meaning of any technology, feminists should pay attention to both the social and economic forces that inextricably link certain technologies to "particular institutionalized patterns of power and authority" (63), she articulates the guiding impulse of this book.

Building on Wajcman's insight, I suggest that feminists think about technologies as formations in and of themselves -not as isolated processes or material artifacts. Furthermore, if we understand technological formations as cultural formations, we will be able to grasp the fact that analysis of such a multidimensional cultural arrangement will require the work of many feminists who are likely to have divergent political aims. One consequence of this shift of understanding is that there will be less pressure to produce and defend a "bottom-line" evaluation of a given technology. It encourages feminists to think more complexly about the interrelations between technological devices, specialized knowledge, scientific practices, and a broader cultural context that is both historically determined in various ways and materially embodied. Perhaps a more critical concern for feminist scholars is how to gain access to the relevant information about technological use and development of reproductive technologies, how to disseminate such information to the women who are most likely to be the subjects of such expert knowledge, and how to enable people to make informed decisions about their own use of such technologies.

While I do not want to rehearse the various planks of these two emergent feminist positions, I do want to amplify what I consider to be of central importance here: the fact that feminists with various theoretical and political investments are "keeping watch" on the development and application of these new reproductive technologies. To the extent that reproductive technologies are articulated as part of a broad technological formation that takes shape in diverse geopolitical locations, there are many issues to track and monitor -issues related not only to ethical, legal, and policy debates, but also to issues of education, women's health, and the regulation of women's sexuality. In sidestepping a direct discussion of the issues of ethics and social policy, I am not suggesting that these are unimportant concerns for feminist analysis. On the contrary, several books by feminists and others have begun to dissect the issues regarding the ethics not only of reproductive technologies but also of genetic engineering more broadly.^[31] Instead, I will discuss several examples taken from popular media, where the use of new reproductive technologies produce "cases" of public pregnancies that are transformed into media spectacles. I do this to suggest that one of the key cultural forces determining the meaning of these new reproductive technologies are the mass-mediated narratives about the relationship between women's bodies, technologies of surveillance, and threats to public health.

Maternal Surveillance and Public Health

Once an egg is fertilized, it becomes an embryo. But now that it is technologically possible for an egg to be obtained from one source, fertilized by sperm from another source, frozen for posterity, or implanted in a surrogate womb to produce a baby for an adoptive couple -who could have supplied either the egg, the sperm, the womb, or none of these-whose embryo is it? This is the issue at the heart of one well-publicized legal battle over custody rights.^[32] Early in 1980's, as part of her divorce proceedings, Mary Sue Davis sued for custody of seven fertilized and frozen embryos that she and her estranged husband had in cold storage at a Tennessee IVF clinic. In this celebrated embryo custody battle, Mary Sue Davis wanted custody so that she could fulfill her desire to have a child. Her husband wanted custody so that he would not become a father. Although these are perfectly logical positions, both represent unnatural re-quests in many respects: Mary Sue Davis was suing for the right to determine her ex-husband's future reproductive effects, while her husband was suing for the right to determine what happens to the embryo after conception. Here is an example where the use of new technologies produce unprecedented "conditions of possibility." Mary Sue Davis's ex-husband testified that he "would feel raped of [his] reproductive rights" if the embryos were implanted without his consent, thus opening the door for a new precedent in the legal definition of the concept of rape. In fact, the case pivoted on the legal definition of the beginning of life: were the embryos children or not? The judge in the case ruled that human life begins at conception, therefore the embryos, as "little people," have the right to be implanted and carried to birth^.[33] Thus custody was awarded to the mother. Although this judgment seemingly promoted a woman's right of ownership, it was transcoded and heralded by "pro-life" advocates as "a victory for unborn children.^[34]

Although ownership of the embryo was awarded to the potentially maternal body in the Davis vs. Davis case, there is no guarantee that this judgment will establish an effective precedent for women's rights. In fact, it has already engendered a backlash of sorts. In May 1989, the Illinois State House of Representatives entertained a measure that would give a father the right to seek a court injunction to prevent a woman from terminating a pregnancy. One representative claimed, "We have recognized a woman's rights and ignored the father's rights. This amendment gives the father some rights." Rob Schofield, a representative of the American Civil Liberties Union of Illinois, urged lawmakers to oppose the amendment. As he argued, "Under this bill, a convicted rapist would have the right to ask that the rape victim's decision to seek an abortion be enjoined. You never know what a judge will do" (Rick Pearson and Jennifer Halperin, "Abortion Rights Gain for Fathers," Chicago Tribune, 5 may 1989, sec. I,7).

New reproductive technologies do not, in a singularly deterministic sense, construct these new social tensions. But they are implicated in the production of a new set of possibilities, wherein the rights of a pregnant woman are set against the "rights" of other people either to intervene in her pregnancy or to act on behalf of the unborn fetus.^[35] Whereas the "fathers' rights" amendment was eventually defeated in Illinois, another measure approved by the state's House of Representatives gave the state more power to gain court-ordered custody of children who are born addicted to cocaine or other illegal drugs.

Of all the legal cases in the late 1980's that sought to establish a precedent for fetal legal rights, none received more media attention than the spectacle that came to be identified as the problem of "Cocaine Mothers and Crack Babies." In May 1980, a 24-year-old woman, Melanie Green of Rockford, Illinois, was charged with involuntary manslaughter and delivery of a controlled substance to a minor for allegedly taking cocaine shortly before her daughter was born.^[36]  The infant, Bianca Green, died two days after birth from fatal brain swelling due to oxygen deprivation before and during birth. Paul Logii, the Illinois state's attorney who filed the charges against Green, held a press conference to publicize his request for the development of tougher laws that would make it a crime to take illegal drugs while pregnant. As he explained, the voluntary ingestion of drugs by a mother results in the involuntary ingestion of substances by the fetus. From the very beginning, he framed the issue in terms of the rights of the fetus to state's protection.^[37] It is not surprising then that the picture of Melanie Green accompanying her newspaper story looks like a police line-up photograph. She's black, pregnant, and addicted to cocaine. The Law, in the person of a state district attorney, intervenes to save her child from her, and failing that, to save society from her. In effect, Logli was mounting a "politics of surrogacy" that would grant rights to fetuses at the expense of maternal rights; as happened with the Green case, these politics are often enacted by anonymously appointed bureaucrats who function as public health guardians. The Green case has the trappings of what Anna Lowenhaupt Tsing calls, in her study of women charged with perinatal endangerment, a "Monster Story."^[38] In terms similar to the ones elaborated by Valerie Hartouni in her analysis of the mass-mediated narrative context of a black woman who served as a surrogate mother for a white couple, Green is "a densely scripted figure, positioned in and by a crude, if commonplace, set of racial caricatures and cultural narratives about 'the way black women are.'"^[39] The color of her skin activates certain cultural narratives about her questionable moral character. Her story was, in many respects, already written before she ever delivered her baby; the "welfare mother" is a mass-mediated controlling image, to use Patricia Hill Collins's term, of black mothers that elevates racist beliefs about black women and motherhood into an ideological narrative of mythic proportions.^[40]

Indeed, in the words of Cynthia Daniels, a feminist scholar who studies the emergence of fetal rights:

The very attempt to prosecute pregnant women for addiction has created a powerful social mythology about women. The power of this mythology may at times eclipse the power of law. Although women's rights may ultimately be upheld in the courts, a broader public culture may continue to endorse resentment toward women and more subtle forms of social coercion against those who transgress the boundaries of traditional motherhood. Social anxiety and resentment are most easily projected onto those women who are perceived as most distant from white, middle-class norms. Political power may ultimately rest not on the technical precedent of legal rights, but on the symbols, images, and narratives used to represent women in this larger public culture.^[41]

Although all charges were dropped against Green, this case offers a warning about the scope of the campaign to establish the connection between maternal liability and fetal health -a campaign that is being waged not only in the courtroom but also in the dissemination of "official" statements about the dangers of maternal excesses. Consider the following example: a governmental booklet published in 1990 by the U.S. Department of Health and Human Services (DHHS) lists the well-known hazards for "the unborn" - "alcohol, tobacco, marijuana, cocaine, heroine and other opioids or synthetic narcotics, phencyclidine, tranquilizers and barbiturates." It also lists those licit drugs known to have adverse effects on prenatal infants: antibiotics, anticonvulsants, hormones, and "salicylates including Bufferin, Anacin, Empirin, and other aspirin-containing medication."^[42] In short, the point of the booklet is to educate public health officials and pregnant women about the dangers of maternal behavior. In the introduction to the booklet, authors Cook, Peterson, and Moore outline the "extent of the problem" of maternal influences on fetal health, which they see as a multidimensional problem related to the unrellability of information acquisition. They inform us that pregnant women are unreliable in reporting drug use, remembering the extent of drug use, and in truthfully admitting to illicit drug use. Although they point out that "urine testing is a more reliable method," they note that "it is not sufficient to track changing drug patterns throughout the pregnancy" (14), suggesting perhaps that if they could perform multiple urine tests throughout a woman's pregnancy they could circumvent her duplicity. This conceptual as well as technological separation of the woman from her body is certainly consistent with other cases of "urinal politics," where the material body is used against the person," who is now understood to be an unreliable source of the truth. In the absence of reliable information about actual drug use in actually pregnant women, these authors suggest that "surveys of current drug-using behavior among women of childbearing age" are useful indicators of the "scope of the problem" of prenatal drug exposure. In a subtle move, the behavior of women of childbearing age is transformed into a sign of a "potential problem," and the female body of childbearing age is redefined as the "potentially pregnant" body. In a similar way, the pregnant woman is constructed as unreliable and duplicitous, while the pregnant female body is invoked as a guarantee of drug-use truth.

Historically this increasing interest in teratology, the study of causes of birth defects, is due in part to the high incidence of birth defects inbabies born to women who had taken the drug thatidomide, a drug pre-scribed (routinely before 1960) to soothe the nausea of pregnant women. According to the DHHS booklet, this led to an increase in research efforts to determine the safety of fetal exposure to prescription medications, over-the-counter drugs, industrial chemicals, and pesticides. Another consequence of the public's growing concern with "thaildomide babies" was its interest in the impact of "social" drugs on developing fetuses. In the intervening 20 or so years, the booklet explains, the scope of teratology was expanded to include research into "more subtle behavioral and develop-mental abnormalities in offspring that only become apparent later in an infant's life" (6). Thus not only was the range of potentially dangerous substances targeted for research expanded, but so too was the range of time over which the behavior of the female body could be scrutinized for its influence on a developing fetus or eventual child.

In a telling absence, the behavior of fathers is rarely mentioned in the DHHS booklet. Other than a reference to a study in which the "male-to-female sex-ratio of offspring increased if either parent was a heavy marijuana smoker" (25-26), the influence of drug use among fathers on result-ing fetuses or children is not discussed in any detail. There is some evidence to suggest that interest in the possibility that paternal health conditions might have an impact on developing fetuses and resulting children is growing: studies of paternal drinking and of paternal-occupation/ cancer associations in workers in petroleum and chemical industries are examples of recent research in male-mediated teratogenesis and child-hood cancers.^[44]

One of the key differences in the cultural context of the reception of these medical studies of male-mediated defects is that there are few, if any, cultural narratives about paternal culpability. For example, in recent mass-mediated reports about "The Gulf War Syndrome" the responsibility for birth defects (manifesting in children born to male Gulf War veterans) is subtly transferred from the fathers who served in the Gulf to the military medical authorities who prepared them to serve. What emerges is a narrative about the destigmatization of male soldiers' (possible) contribution to a range of birth defects. In a complex rhetorical move, the U.S. military becomes the responsible agent of toxicity due to its failure - as one hypothesis suggests - to fully understand the consequences of the vaccinations it administered to Gulf-bound troops. In contrast to the portrayal of cocaine mothers, male soldiers and their afflicted offspring are cast as victims of the military's ignorance.

This new interest in paternal biological influences notwithstanding, it remains the case that the maternal body is overscrutinized in its relation-ship to the developing fetus. Having said that, though, it is important to remember that the issue of maternal health care has many sides. Many women who would like to get pregnant don't because of limited access or lack of access to prenatal care. Other women who do get pregnant and do not have access to prenatal care run the greatly increased risk of bearing low-birth-weight infants (less than 5.5 pounds). Low birth-weight is the single most predictive characteristic of infant mortality. As has been noted in the media many times, the United States ranks nineteenth among industrialized nations in terms of its infant mortality rate -9.7 deaths per 1,000. Black women in the United States have a higher incidence of bearing low-birth-weight babies than do white women; the infant mortality rate for black babies is almost double the national rate - 18.0 deaths per 1,000.^[45] Prenatal care is the single most important factor in preventing low-birth-weight babies; but while more than 82 percent of white women receive early pregnancy care, only 61 percent of Hispanic women and 60 percent of black women do.^[46] These treatment rates are consistent with the history of maternal and child health (MCH) programs of the U.S. Public Health Service, which traditionally were designed to serve the needs of minority populations who are understood to be "medically underserved."^[47] Indeed, as the range of minority populations has expanded in the United States to include groups from Asia and Central America, new grant programs target the health needs of these new underserved populations.^[48]

Whereas the development of public health programs designed for the special needs of certain populations, especially minority women who are or would like to be pregnant, seem entirely beneficial and moral, there are unintended consequences of course. We are led to wonder about the con-sequences of the articulations among (1) medical research that establishes a broader list of substances and behaviors that endanger a fetus, (2) an expanded argument about the relationship between maternal behavior and fetal development, (3) new public health programs that seek to in-crease minority patient/client participation and institutional/clinic surveillance, and (4) the criminalization of certain forms of drug consumption in the invigorated "war on drugs." This articulation identifies and structures the set of possibilities for the technological management of the potentially pregnant female body. In her article "The Body Invaded," which elaborates the political significance of "medical surveillance" practices for women of childbearing age, Jennifer Terry points out that the dual emergencies of AIDS and drug use "allow for the emergence of discourses and practices that place women of childbearing age in particular jeopardy."^[49] The warning Terry illuminates is being tracked by other feminist scholars who are interested in different aspects of "maternalist" politics. For some, this means transforming "motherhood from women's private responsibility into public policy."^[50] For others, this means investigating and analyzing social welfare activities that, in effect, criminalize pregnancy. Lisa Maher calls this an example of the "juridogenic power of law":

The collusion between medical and legal discourse in relation to newreproductive technologies presents the potential for a more persistent intrusion into women's lives. As more areas of women's lives are colonized by medical interventions, they are also staked out as legal territory... The interrelation between the current discourse surrounding crack pregnancies and historical attempts to regulate and control women's lives through their bodies serves to illustrate the "juridogenic" power of law. ^[51]

Maher thoroughly discusses the consequences of punishing and regulating drug-using mothers and concludes that "punishing pregnant women for the good of the foetus is not only paternalistic, but demonstrates how concerns such as public health can have a very punitive downside" (179).This confusion about how to treat the pregnant woman, as victim or criminal, ties at the heart of public health policy and accounts in part for the limited success in "treating" pregnant women who use drugs.

Early in 1994, several news sources reported that the Centers for Disease Control and Prevention (formerly the CDC) were going to take a new look at violence as a "critical health problem." As an extended example of how the logic of criminality conflicts with the logic of epidemiology - of public health - consider the following report by Teri Randall in the May 16, 1990 issue of the Journal of the American Medical Association. Randall quotes Linda Saltzman, the first and only criminologist hired by the CDC, who predicted that public health and the CDC must examine the problem of violence "or [they are] going to be avoiding one of the most significant health problems."^[52] This is a case where the conjunction of two "logics" has important consequences for women. As Saltzman explained, whereas a criminal justice approach emphasizes the criminal, a public health approach focuses on the victim. Analyzing violence from an epidemiological perspective means asking certain questions about the incidence of violence: who is the population at risk? and what are the causes/vectors of risk? Following this, "a public health model," according to Saltzman, "asks which women are most likely to be battered" (2612). Yet Saltzman was clear to assert that one would need to ask "additional questions . . . [as to] who are the batterers and what is the interaction between partners" (26l4). These kinds of questions are implied by a criminal justice model. And yet, in a report on a study of the incidence of physical violence against women in the 12 months preceding childbirth, researchers failed to mention any study of the agents of the physical violence. Instead, the study focused on the relation between violence and maternal characteristics. Using data from a surveillance system called PRAMS (Pregnancy Risk Assessment Monitoring System), researchers suggested that a certain subgroup of pregnant women, those with fewer than 12 years of education, may be at increased risk for physical violence. As the editorial analysis of the report points out, one of the significant limitations of this study is that it cannot ascertain the specific vector of education level: level of education involves issues of race, economic status, and ethnic background. It was clear, in this case, that the issue of maternal health and physical violence was not conceptualized through a "maternalist" logic that would see the issue of violence against pregnant women as a social and systemic problem, tied closely to the characteristics of violent men, rather than an individual problem somehow tied to characteristics of the woman herself.^[53]

Jennifer Terry also reminds feminists of the racial politics enacted in the articulation I described above, where medical research, public health initiatives, and surveillance practices have differential effects on women of color of a lower economic class than on white women more broadly. In "The Body Invaded," Terry writes:

[T]he surveillance and punishment that potentially endangers all women is applied selectively to poor women and women of color. These women constitute the majority of patients in public clinics and are among the most likely to be brought into the criminal justice system of social welfare systems on grounds unrelated to their pregnancy... In such instances it is impossible to distinguish the suspicion of certain women from the criminalization of poverty operating in the U.S. in the past decade. (21)

The real issue in the Melanie Green case, following Terry's analysis, is the "hidden" damage of drug abuse and the inadequate national resources for developing treatment programs, especially for pregnant women. Terry's note about the "suspicion of certain women" is evident in discussions about the racial disparity in the type of prenatal care advice women receive from health care providers. Although, as noted above, black women have a higher risk of bearing low-birth-weight infants, they are less likely to receive the same level of prenatal advice about their risk status as white women. Moreover, according to one study, they are less likely to receive specific advice about drinking and smoking.^[54] Other factors confound the issue of the adequacy of prenatal care advice; for example,

advice about two risk behaviors, smoking and drug use, was skewed towards poorer women, whereas advice about alcohol use and breast-feeding was skewed toward wealthier women. [in this case,] Healthcare providers may be giving advice based on their stereotypes of who is involved in what type of behaviors and not on a principal of equity.^[55]

The sample population for this study showed significant differences between black women and white women: "Black women were more frequently single, less likely to be educated beyond high school, and had lower incomes." But the study indicates a set of complex findings. On the one hand, black women report receiving less advice overall about the dangers of smoking, alcohol, and illegal drug use, unless they had a lower income, in which case they received more advice about illegal drug use.^[56] A lack of advice is ill-treatment; but when the advice is delivered about a specific risk behavior, it is likely to be based on "suspicion" and the stereo-type of poor black women as illegal drug users. In any event, the study supports what feminists have long suspected, that black women do not receive the same level of prenatal care advice from public health providers as do white women. In this sense, more programs do not necessarily ensure better care for all women.

It is well documented that there are several barriers that prevent women from seeking prenatal care, especially if they are using illegal drugs. As Norma Finkelstein points out, although there are undoubtedly psychological issues at work - such as denial of the problem of substance abuse - it is also likely that the social stigma attached to drug use as well as the lack of gender-specific treatment services are equally prohibitive.^[57] But if we look at the issue of cocaine use among pregnant women and at the documented effects of cocaine ingestion on the developing fetus, we find that the medical and scientific findings do not warrant the kind of surveillance that interferes with a pregnant woman's search for treatment. For example, several articles in a 1993 special issue of the journal Neurotoxicology and Teratology outline the difficulties in obtaining reliable information about the specific toxicity of cocaine on the developing fetus. Problems include the determination of toxic dosage, the unreliability of self-reported drug use, the wide lack of confirmation of catastrophic effects, and the methodological design of research studies. Noteworthy are, several observations offered by medical researcher Donald E. Hutchings on the cultural context in which studies of cocaine "abuse" were con-ducted. In a discussion of recent research on humans and cocaine use, Hutchings reports on a study of the Society of Pediatric Research acceptance rate for medical research abstracts that discussed the effects of pre-natal exposure to cocaine: "of the studies that reported adverse effects associated with cocaine, 5 8 % were accepted, whereas only 11 % of those that found no effects enjoyed a similar fate."^[58]  He argues that this indicates a selection bias on the part of medical journals and suggests that this selection bias is influenced by the wider media and political attention paid to the scandalous new drug menace. Throughout his detailed assessment of the methodological design and review of the findings, Hutchings is careful to assert that the toxicity of cocaine is a complex issue that is confounded by the fact that many users actually ingest a number of other potentially toxic substances, including alcohol, tobacco, and marijuana. He cautiously suggests that dosage level may be the more clearly deter-mining factor of toxicity; at the same time he points out that in most studies, especially those that sample subjects from outpatient drug treat-ment programs, it is difficult to measure dosage level precisely.^[59] It is far less possible, based on the current research, to formulate conclusions about the interactive effects of cocaine with other substances. Researchers simply have not made such studies.

Given this debate in the medical literature about the scientific facticity of cocaine toxicity, how are we to make sense of a study conducted in 1991 that tested for the presence of cocaine in the blood system of every infant born in Georgia's public hospitals? As reported by Adam Gelb on page 1, of the Atlanta Journal Constitution: "Every baby born in Georgia over a one-year period will be tested for cocaine in the most extensive study in the nation of the drug problem among pregnant women."^[60] The article goes on to assert:

The epidemic of "crack babies," the underdeveloped, quivering infants who have become a tragic symbol of addiction, is well known. But estimates of its scope range widely, from 100,000 born annually, the federal government's figure, to 375,000, the number cited by in-dependent medical experts. "The bottom line is nobody really knows how common this is," said Dr. Paul M. Fernhoff, an Emory University pediatrics professor, who is director of the study. (Al)

This is an encapsulated version of the dominant narrative of maternal excess and fetal victimization. When Gelb cites the director of the study, Dr. Fernhoff, he commits the grave error of leading readers to make an erroneous inference about the gravity of the "problem." It is true, at some level, that no one knows the dimensions of the "problem," but it is also true, given the discussion among medical researchers summarized above that there is a great deal that researchers don't know about cocaine and its impact on fetal development. Although they have no official relationship to the study, researchers from the Centers for Disease Control and the Georgia Department of Human Resources say that they plan to use "the findings to develop education, intervention and treatment programs and boost prenatal care." It is this combination of journalistic sensationalism and public health rhetoric that makes the media treatment of "crack babies" so pernicious.^[61] As Nancy L. Day and Gale A. Richardson ask in their essay "Cocaine Use and Crack Babies" (also published in the special issue of Neurotoxicology and Teratology discussed earlier), "how did it happen that an epidemic of such proportions was declared so quickly?" They go on to raise several other issues about the spectacular increase in the concern about cocaine dangers: namely, "What were the other forces within science and our society that propelled the early reports of cocaine effects to such prominence, and that still in large part continue to propagate the belief that cocaine is a terrible scourge visited on the unborn?"^[62] They rightly point out, as do others in that special issue, that cocaine has enjoyed a special place in the history of American culture -from its alleged use in Coca-Cola (which remains a great unspoken secret in the official history of the company), to its use as an entertainment chemical by rich yuppies in the Reagan era, to its current demonized status as the drug of addicted, Welfare mothers. They beseech scientists and medical researchers to "correct the damage that has been done.... [damage that has been done to women and to the 'crack babies' who have been given a label for which there is no cure and little hope" (293). They implore medical researchers to assume the responsibility to educate other professionals about the complexity of the issue of determining causality and to remember that "behaviors do not exist in isolation, but are part of and determined by the fabric of a woman's life" (293). But such an admonishment is likely to fall on deaf ears, in the sense that it really requires medical practitioners and researchers to rethink and retool their relationships to various social entities such as the press and other media that seize upon "first case" examples as signs of a crisis, and to journalists who are not equipped to discuss the subtle nuances of published medical findings. More importantly, this would also require medical professionals to reconsider women as a social class who are differently and complexly positioned at the nexus of broader social forces such as poverty, violence, and demoralization.

Among the other precipitating conditions for the wide-scale enactment of an apparatus of surveillance is the historical evolution of medicine as an agent of social control. In one of the few explicit discussions of this topic in the professional literature on public health policy, Stephenson and Wagner summarized the situation of reproductive rights and medical con-trol in 1993:

Since 1987 there have been approximately 6o criminal cases in the U.S. (many involving physicians) against women who have either taken illegal drugs during pregnancy or have failed to obey doctor's orders. The charges have ranged from prenatal child abuse to man-slaughter. Several women have been convicted. Others have been forced against their will into drug treatment programs or have been "detained" (a euphemism for imprisonment).... Advocates for fetal rights have proposed a reporting system where pregnant women would be identified and monitored by state officials. Women would be forced to attend their prenatal visits and obey doctor's orders; and women could be prosecuted and punished for smoking or using drugs and alcohol during pregnancy. While this does not reflect predominant medical opinion, one survey did indicate that 46% of the heads of obstetrical and perinatal training programs thought that women who refused medical advice and thereby endangered the life of the fetus should be taken into custody.^[63]

Although they are not concerned to discuss specific physician culpability, Stephenson and Wagner point out that physician coercion of pregnant women is of a piece with the differential denial of reproductive health care to certain social groups - in their view these cases demand a return to the consideration of basic medical ethics. The coercion of pregnant women to undergo certain procedures on behalf of the fetus is unethical in the same way as would be forcing a father to undergo a bone marrow transplant to save a son; and they remind us that the international code of medical ethics expressly forbids such coercion of a patient. But they also argue that there is "little reason to believe that medicine, on its own accord, will relinquish its privilege to determine (ad hoc) reproductive policy" (180).When one considers that such ad hoc policy is being established by those in the position to make decisions at the scene -where the agents whoestablish this policy are predominantly white, middle-class and male -itis likely that the policy will reflect the "dominant culture's beliefs about morality and motherhood" (180). They call for the intervention of courts and legislatures to "begin the difficult but essential task of formulating explicit reproductive health policies" (180); to assist this project they suggest the guidance of several international human rights treaties.

In an article in Trial that discusses the criminal law implications of prosecuting pregnant women for fetal abuse, Dorothy Roberts itemizes how such action violates the rights of women; not only does it infringe on fundamental guarantees of reproductive choice and bodily autonomy ... (but] applying drug-trafficking and child-abuse laws to conduct during pregnancy also violates the defendants' due-process right to fair notice. Criminal penalties may not be imposed for con-duct that is outside the plain contemplation of the penal code.^[64]

More broadly, such prosecution establishes unequal treatment of women in that there is no corresponding scrutiny of men and male body behavior. In legally restricting women's agency while pregnant, a discriminatory system of surveillance is established. One California woman was charged with criminal neglect of her fetus because she engaged in sexual inter-course while pregnant (against her doctor's instructions); her husband, who also knew about the doctor's orders, was not named as a collaborator in the criminal act.^[65] Prosecuting pregnant women for fetal negligence compromises their fundamental reproductive choice and establishes the precedent for the state to determine who has the right to bear children.

These events and discussions establish the fact that a foundation has been set in place to de-individualize the notion of pregnancy and to make women's reproductive health a matter of public health policy. Mass-mediated narratives establish the pregnant woman as the agent of a new public health crisis: the pregnant woman is both disempowered and held responsible at the same time. As the guilty culprit, she requires additional surveillance in order to protect her babies and society from her criminal excesses. So when a professor of obstetrics and gynecology writes, "the active management of labor attempts to address a problem that is of great public health relevance in North America," we witness the process whereby women are interpolated into a very convoluted narrative that defines wombs as unruly, childbirth as inherently pathological, and women of childbearing age as unreliably duplicitous and possibly dangerous.^[66] This narrative foregoes the possibility that drug use by pregnant women may be a consequence of other social forces. This situation requires a careful analysis -one that does not inadvertently delimit women's agency by reifying their identity as victims, and also does not bestow upon them exaggerated powers of contamination and infection. Seeing this issue through a "maternalist" logic would suggest the investigation of the social forces that influence women's drug use, the conditions under which drug use becomes abusive to self and other, and the institutional arrangements that support women's stigmatized identity as public health offenders. This reflects a deeper philosophy that seeks to establish a partnership between women and their health care providers in which the objective is to increase the information women have about their choices for self-care, fetal care, and birth, and where the care provider is treated as a consultant for the mother, not an executive of the birth process and of public health morality.

Writing History, Telling Tales

In the 1990 DHHS booklet Alcohol, Tobacco, and Other Drugs May Harm the Unborn, a section on "Counseling Women about Childbearing and Childrearing Risks" repeats the recommendation of an expert panel on prenatal care:^[67]

Because healthy women are more likely to have healthy babies, assuring good health prior to conception simply makes good sense and should be standard care. Diagnosis and interventions to treat medical illness and psychosocial risks prior to conception will eliminate or reduce hazards to the mother and baby. Care is also likely to be more effective prior to conception because evaluation and treatment can be initiated without harm to the fetus. (50)

In the context of this booklet, in the chapter on counseling women about childbearing risks, this advice sounds caring and responsible to the interests of women. But in a slightly different context, like The Handmaid's Tale, or as part of an assessment interview for an insurance program, this advice takes on a much more ominous tone. And yet, as the booklet's authors summarize the situation for pregnant women in the 1990's, it is not always clear that women's interests are driving the development of public health policy: "Because of legal and social interest in protecting babies, a pregnant woman who continues to take drugs against medical advice risks losing custody of her baby after it is born. In some States, she also risks criminal prosecution". Indeed, the booklet reports, the Centers for Disease Control and Prevention identify these goals as part of their priorities for women's health: "to prevent illness and death associated with reproductive occurrences, practices, and choices, and to pro-mote adoption of healthy reproductive behaviors and environments, including work settings" (18). These goals are to be accomplished through various surveillance systems that identify causes of maternal death, infant mortality, and pregnancy complications:

CDC serves as one of the primary federal resources for technical assistance in the epidemiology and surveillance of pregnancy and its outcomes. Working collaboratively with agencies and organizations at all levels, the agency evaluates the nation's pregnancy-related health problems, programs, and policies in an effort to improve the health of pregnant women and their infants. (20)^[68]

In the vocabulary of epidemiology, the term "surveillance" carries no pejorative connotations. It is a technical term for the organized practice of observing the development of health-related phenomena. And yet, the semiotic context of a particular term is not so easily delimited. The technical use of this term in the epidemiological literature also invokes other connotations of discipline, normative evaluation, and moral judgment.

In the process of constructing an analysis of the "official" public health discourse on the surveillance of pregnant women, I learned to read between the lines by reading those statements through an interpretive framework provided by fictional accounts of the treatment of reproductive body. This is one of the contributions that science fiction literature in general makes to our understanding of contemporary situations. As works of fictions that generically extrapolate from the current moment to fictional futures (or pasts), these narratives offer readers a framework for understanding the preoccupations that infuse contemporary culture. In this sense, Atwood's novel provided a sharply focused lens through which to view the emerging situation of women of reproductive age in the U.S.

Interspersed within The Handmaid's Tale are fragments of yet an-other discourse, one that articulates Offred's self-reflexive thoughts on the act of storytelling, in which the reader is addressed directly. At one point Offred tells the reader that it is a pretense to believe that she is telling a story because that would imply that she has some measure of control over the ending. At another moment we are told "this is a reconstruction. All of it is a reconstruction." And indeed at different points in her tale, readers get different versions of the same events: a narrative technique that foregrounds the reconstructive act of narrative itself. Near the end of the novel, she "[wishes] this story were different. I wish it were more civilized"(267). And she apologizes to us, the readers:

I'm sorry there is so much pain in this story. I'm sorry it's in fragments, like a body caught in crossfire or pulled apart by force. But there is nothing I can do to change it... But I keep on going with this sad and hungry and sordid, this limping and mutilated story, because after all I want you to hear it, as I will hear yours too if I ever get the chance, if I meet you or if you escape, in the future or in heaven or in prison or underground, some other place. What they have in common is that they're not here. By telling you anything at all I'm at least believing in you. I believe you're there, I believe you into being. Because I'm telling you this story I will your existence. I tell, therefore you are. (267-68)

This passage must be juxtaposed with the concluding section titled "Historical Notes," because both of them foreground the impossibility of the narrative situation that we have just read. Here Offred's telling poses a similar narrative dilemma to the one of the narrator in Charlotte Perkins Gilman's short story "The Yellow Wallpaper."^[69] How is it that we come to get the story of a woman forbidden to read or write? The explanation offered in the "Historical Notes" section solves some of the mystery: The Handmaid's Tale is a historian's reconstruction based on narrative material discovered on audiotapes. What we are never told, though, is how the tapes came to be made -that is, the relationship between the historical account of the discovery of the tapes and the historical reconstruction of the ending of The Handmaid's Tale. Are these tapes of Offred or someone else? Whose voice tells whose story?

In the final analysis, I want to suggest that the "Historical Notes" section offers the most interesting statement about the contemporary situation of reproductive-age women. Some readers have interpreted this section as a splendid send-up of an academic conference or, as one reviewer describes it, "a desperately needed and hilarious spoof of an academic convention in the year 2195, at which time Gilead is a defunct society, regarded by all as a trivial aberration in cultural history."^[70] Ironic as it clearly is, it is also the most utopian part of the entire novel. Set against the more didactic warnings against feminist techno-criticism on the one hand and patriarchal technology lust on the other, this ending offers a false promise of hope and transcendence. It enacts a belief we hear in Offred's recollection of her mother's feminism: "history will absolve me." What it suggests is that something fundamental will change about people's willful acts of ignorance. Offred, herself, describes the fog we live within now, surrounded as we are by such seemingly isolated instances of technologically enhanced reproductive surveillance:

But we lived as usual. Everyone does, most of the time. Whatever is going on is as usual. Even this is as usual, now. We lived, as usual, by ignoring. Ignoring isn't the same as ignorance, you have to work at it. Nothing changes instantaneously: in a gradually heating bath tub you'd be boiled to death before you knew it. There were stories in the newspapers, of course.... The newspaper stories were like dreams to us, bad dreams dreamt by others. How awful, we would say, and they were, but they were awful without being believable. They were too melodramatic, they had a dimension that was not the dimension of our lives. We were the people who were not in the papers. We lived in the blank white spaces at the edges of the print. It gave us more freedom. We lived in the gaps between the stories. (276-68)

There are two messages in this passage. The first concerns our contemporary relationship to technology and the danger of an uncritical belief in technological progress. This we can understand as an act of "ignoring," rather than a quality of ignorance. Contemporary U.S. culture is completely saturated with technology; we must actively work to disregard the long-term consequences of such a saturation. In this case, Atwood's novel provides the perspective we need to understand the relation between seemingly isolated instances of technological surveillance. "Perspective is necessary," Offred tells us, "otherwise you live with your face squashed against a wall."

The second message addresses the place of women in cultural history. People who live on the margins, "in the gaps between the stories," women whose entire lives never make the news are not remembered. Their stories, the everydayness of their lives, are not the stuff of history. In this sense, the story we read in The Handmaid's Tale is a utopian vision of the development of a historical practice that would promote the importance of re-cording women's histories. This is not generally the trend within contemporary historical practice. It is, though, the project of feminist cultural studies. As I have argued elsewhere, ethnography can be reclaimed as a feminist practice in which we work to intervene in the production of the history of the present by writing the narratives of women's everyday lives.^[71] In this light, I propose that we consider Atwood's novel as something generically different from a science fictional dystopia^.[72] I want to read it "against the grain," perhaps as a speculative ethnographic account of our collective life in a technological era, where transcoded from one generic framework to another, it offers us a critical framework of analysis that will counteract our propensity to ignore the probable consequences for the female body of the application of the new technologies of reproductive surveillance. Such a reading requires that we forgo our willful acts of ignoring those "disturbing" newspaper stories as if they were inconsequential to our real work as scholars and critics.

My aim has been to investigate the narrative construction of reality accomplished through the articulation of cultural practices and cultural narratives. "Articulation" describes the process whereby meaning is constructed and assigned to a particular configuration of practices; it is a complex process in the sense that meaning is both an effect of practices and a determining condition of those practices. In this chapter I have described a select set of cultural stories about the maternal body that include scientific discourse about pregnancy and the development and application of medical protocols, as well as a fictional narrative of maternal surveillance. Throughout the analysis of these discursive sources, I have tried to elucidate the connection between these narratives and other social structures and institutional practices. I have also tried to examine the process of cultural analysis itself, whereby literary narratives are "interpreted" in the service of illuminating the meaning of other cultural discourses, which in turn are used to describe and critique the organization of social practices and material effects. As a map of the relationship between a particular configuration of discursive moments and a set of cultural practices, this chapter suggests not only the critical issues that I believe should be attended to by feminist cultural scholars, but also a critical framework for the analysis and intervention into such politically charged situations.

1. Janice Kaplan, "Public Pregnancy," SELF April 1989: 155. 
2. Particia Spallone discusses the significance of naming the fetal entity and the politics of decididng when an embryo becomes an embryo in her review of hte Warnock Report on human embryo research. Particia Spallone, "Introducing the Pre-embryo or What's in a Name," Beyond Conception: the New Politics of Reproduction (Granby, Mass.: Bergin & Garvey, 1989): 50-55. 
3. Although I am walking dangerous ground here, my iconoclastic rhetoric about the "romance of motherhood" is offered as an attempt to assert that for some women, motherhood holds no magical promise or wonderment. Survivors of childhood violence, for example, know the haunting shame of growing up in a family where children were not treated as "blessings" of any sort. For a discussion of different models of the mother-fetus relationship, see Barbara Katz Rothman, In Labor: Women and Power in the Birthplace (London: Norton, 1991). 
4. Margaret Atwood, The Handmaid's Tale (Boston: Houghton Mifflin, 1986). All page numbers of quoted passages refer to this edition. 
5. E. Peter Volpe, Test-Tube Conception: A Blend of Love and Science (Macon, Ga.: Mercer UP, 1987) 63-64. In a footnote, Volpe reports the going rate: "Typically, the commissioning couple will need at least $22,000: $10,000 for the surrogate mother's fee, $5,000 for medical expenses, $5,000 for legal fees to draw up the contract and arrange the eventual adoption of the baby, and about $2,000 for miscellaneous exexpenses" (65). 
6. For a related study of the role of ultrasound as a technology of the gendered body, see Lisa Cartwright, Screening the Body: Tracing Medicine's Visual Culture (Minneapolis: U of Minnesota P, 1995). See also Carole Stabile, "Shooting the Mother: Fetal Photography and the Politics of Disappearance," Camera Obscura 2.8 (1992): 179-205; and Jennifer L. Stone, "Contextualizing Biogenetic and Reproductive Technologies," Critical Studies in Mass Communication 8 (1991): 309-39. 
7. For a discussion of the way in which legal decisions and policy statements fail to differentiate between the female body and the mother's body, see Zillah R. Eisenstein, The Female Body and the Law (Berkeley: U of California P, 1988). 
8. Reviewers disagree about the quality of Atwood's dystopia. See, for example, Christopher Lehmann-Haupt, rev. of The Handmaid's Tale, by Margaret Atwood, New York Times 27 Jan. 1986: C24; Joyce Johnson, "Margaret Atwood's Brave New World," Washington Post 2 Feb. 1986, "Book World": 5; Mary McCarthy, "Breeders, Wives and Unwomen," New York Times Book Review 9 Feb. 1986: 1, 35; Peter S. Prescott, "No Balm in this Gilead," Newsweek 17 Feb. 1986: 70; Jane Gardam, "Nuns and Soldiers," Books and Bookmen Mar. i986: 19-30; Barbara Ehrenreich, "Feminism's Phantoms, New Republic 17 Mar. 1986: 33-35; Bruce Allen, rev. of The Handmaid's Tale, by Margaret Atwood, Saturday Review 12. 2 (May-June 1986):74; Gayle Greene, "Choice of Evils," Women's Review of Books 3. 10 (July 1986):14. 
9. As many reviewers point out, a close reading of her "Tale" reveals that the handmaid's name is probably June, one of the names listed in the opening chapter and the only one not attached to another handmaid in the novel. 
10. See Paula Treichler, "Feminism, Medicine and the Meaning of Childbirth," Body/Politic: Women and the Discourses of Science, ed. Mary Jacobus, Evelyn Fox Keller, and Sally Shuttleworth (New York: Routledge, 1990): 113-38. 
11. William Ray Arney, Power and the Profession of Obstetrics (Chicago: U of Chicago P, 1981) l23. Although their review is not as detailed, Samuel Osherson and Lorna Amara-Signham explore the cultural role of the machine model in the history of childbirth practices in America in their essay "The Machine Metaphor in Medicine," Social Contexts of Health, Illness and Patient Care, ed. Elliot G. Mishier, Lorna R. Amara-Singham, Stuart Hauser, Samuel D. Osherson, Nancy E. Waxier, and Ramsay Liem (London: Cambridge UP, 1981): 118-49. 
12. This is the argument at the heart of Emily Martin's essay "Ideologies of Reproduction" -- namely, that reproduction is an area of social life saturated with ideological forms of thought about the "naturalness" of certain predispositions. She especially challenges feminists to scrutinize our thinking about reproduction for class-biased ideological beliefs. Emily Martin, "The Ideology of Reproduction: The Reproduction of Ideology," Uncertain Terms: The Negotiation of Gender in American Culture, ed. Faye Ginsburg and Anna Lowenhaupt Tsing (Boston: Beacon, 1990): 300-14. 
13. Paula Treichler illuminates how the earlier definition of obstetrics that I refer to here -- that is, as "a specialized practice that involves the exercise of professional judgment" -- is itself a consequence of a power struggle between midwives and early physicians, which established the institutionalized authority of those newly professionalized obstetricians over the pregnant female body. For a fuller discussion of this cultural struggle, see Treichler, "Feminist, Medicine and the Meaning of Childbirth." 
14. In his 1978 book, Stanley Joel Reiser traced the historical development of "technological advances in the art and practice of medicine during the past four centuries" (ix). Although his study was concluded before the wide-scale use of new reproductive technologies, he claimed even in the 1970s that "modern medicine was now evolved to a point where diagnostic judgments based on 'subjective' evidence -- the patient's sensations and the physician's own observations of the patient -- are being supplanted by judgments based on 'objective' evidence provided by laboratory procedures and by mechanical and electronic devices" (ix). Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge: Cambridge U P, 1978). 
15. For a discussion of the politics of fetal imaging, see Rosalind Pollack Petchesky, "Fetal images: The Power of Visual Culture in the Politics of Reproduction," Feminist Studies 13.2 (Summer 1987): 263-92. For a discussion of the dimensions of a "fetal teleology," see Sarah Franklin, "Fetal Fascinations: New Dimensions to the Medical-Scientific Construction of Fetal Personhood," Off-Centre: Feminism and Cultural Studies, ed. Sarah Franklin, Celia Lury, and Jackie Stacey (London: HarperCollins Academic, 1991). Faye Ginsburg discusses the role of the public fetus in the abortion debate: "The 'Word-Made' Flesh: The Disembodiment of Gender in the Abortion Debate," Uncertain Terms: Negotiating Gender in American Culture, ed. Faye Ginsburg and Anna Lowenhaupt Tsing (Boston: Beacon, 1990): 59-75. See also the special issue of Science as Culture 3.4, no. 17 (1993) on "Procreation Stories," with related essays by Sarah Franklin, "Postmodern Procreation: Representing Reproductive Practice" 522-61; Barbara Duden, "Visualizing 'Life'" 562-600; and Janelle Sue Taylor, "The Public Foetus and the Family Car: From Abortion Politics to a Volvo Advertisement" 601-18. 
16. Jana Sawicki offers an insightful appraisal of the consequence of new monitoring devices when she writes that new reproductive technologies "facilitate the creation of new objects and subjects of medical as well as legal and state intervention.... infertile, surrogate and genetically impaired mothers, mothers whose bodies are not fit for pregnancy ...mothers whose wombs are hostile environments for fetuses" (84). Jana Sawicki, Disciplining Foucault: Feminism, Power and the Body (New York: Routledge, 1991). 
17. Disembodying Women: Perspectives on Pregnancy and the Unborn (Cambridge: Harvard UP, 1993) 52. See Duden for an elaboration of the historical antecedents of the construction of the public body and the public fetus. 
18. Timothy J. McNulty, "Growing Pains Afflict Birth Technology," Chicago Tribune July 1987, sec. 1:1, 9. Quotation is from page 9. 
19. Although not the subject of this study, the rise of biotechnology as a lucrative new industry represents the broader context for the economic and policy impact of the development of new reproductive services. See Edward Yoxen, The Gene Business: Who Should Control Biotechnology? (New York: Oxford UP, 1983); David J. Webber, ed. Biotechnology: Assessing Social Impacts and Policy Implications (New York: Greenwood, 11990); Robert Teitelman, Gene Dreams: Wall Street, Academia, and the Rise of Biotechnology (New York: Basic, 1989). 
20. Price information from an article by Timothy J. McNulty, "Science Turns Birth into New Industry," Chicago Tribune, 9 Aug. 1987, sec 1: 1, 10. 
21. Volpe, Test-Tube Conception 4. In other cases, ultrasound scans are used to visualize mature eggs in the ovary; the process of retrieval is similar to that using a laparoscopy, but only one abdominal incision is required. In place of an optical device for viewing the ovaries, the ultrasound scanner provides a visual guide for inserting the hypodermic needle that is used to aspirate the egg. 
22. Volpe, Test-Tube Conception 33. 
23. Marney Rich, "A Question of Rights," Chicago Tribune 18 Sept. 1988, sec. 6: 1, 7. 
24. Gena Corea, The Mother Machine: Reproductive Technologies from Artificial Insemination to Artificial Wombs (New York: Harper & Row, 1985) 303. The Mead quotation is reported on page 35. 
25. Elkie Newman also describes how reproductive technology is implicated in a struggle for control over woman's childbearing facility. Elkie Newman, "Who Controls Birth Control?" Smothered by Invention: Technology in Women's Lives, ed. Wendy Faulkner and Erik Arnold (London: Pluto, 1985): 35-54. Robyn Rowland argues that in the process of trying to appropriate procreation and birth from women in the development of new technologies of human reproduction, men organize the procreative alienation of women, turning them into "the experimental raw material in the masculine desire to control the creation of life; patriarchy's living laboratories" (14). Robyn Rowland, Living Laboratories: Women and Reproductive Technologies (Bloomington: Indiana UP, 1992). 
26. Rebecca Albury, "Who Owns the Embryo?" Test-Tube Women: What future for Motherhood? ed. Rita Arditti, Renate Duelli Klein, and Shelley Minden (London: Pandora, 1984) 58-72. Quotation is from page 14. 
27. See Treichler, "Feminism, Medicine, and the Meaning of Childbirth." 
28. In Wajcman, Feminism Confronts Technology, see especially the chapter titled "Reproductive Technologies: Delivered into Men's Hands," 54-80. In Sawicki, Disciplining Foucault, see especially the chapter "Disciplining Mothers: Feminism and the New Reproductive Technologies," 67-94. 
29. Spallone, Beyond Conception, 190. Spallone elaborates a critique of new reproductive technologies grounded in a "women-centered ethics." 
30. Michelle Stanworth, ed., Reproductive Technologies: Gender, Motherhood, and Medicine (Minneapolis: U of Minnesota P, 1987). 
31. Feminist treatments of these issues, again by some of the feminists named above, such as Corea, are offered in Rita Arditti, Renate Duelli Klein, and Shelley Minden, eds. Test-Tube Women: What Future for Motherhood? (London: Pandora, 1984); Ann Oakley, The Captured Womb: A History of the Medical Care of Pregnant Women (Oxford, Eng.: Basil Blackwell, 1984); and H. Patricia Hynes, Reconstructing Babylon: Essays on Women and Technology (Bloomington: Indiana UP, 1991). A representative sample of nonfeminist work includes Amitai Etzioni, Genetic Fix: The Next Technological Revolution (New York: HarperCollins, 1973); Philip Reilly, Genetics, Law and Social Policy (Cambridge: Harvard UP, 1977); Yvonne M. Cripps, Controlling Technology: Genetic Engineering and the Law (New York: Praeger, 1980); R. C. Lewontin, Steven Rose, and Leon J. Kamin, eds., Not in Our Genes: Biology, Ideology, and Human Nature (New York: Pantheon, 1984); Daniel J. Kevies, In the Name of Eugenics: Genetics and the Uses of Human Heredity (New York: Alfred A. Knopf, 1985); Ruth F. Chadwick, ed. Ethics, Reproduction and Genetic Control (London: Routledge, 1987); Anthony Dyson and John Harris, eds. Experiments on Embryos (London: Routledge, 1990); Joel Davis, Mapping the Code: The Human Genome Project and the Choices of Modern Science (New York: John Wiley, 1990); Derek Chadwick, Greg Bock, and Julie Whelan, eds., Human Genetic Information: Science, Law and Ethics -- Proceedings from the Ciba Foundation Symposium (Chichester, Eng.: John Wiley & Sons, 1990); Daniel J. Kevies and Leroy Hood, eds., The Code of Codes: Scientific and Social Issues in the Human Genome Project (Cambridge: Harvard UP, 1992). 
32. A 1989 ruling by an Australian state government decided the fate of embryos that had been frozen since 1981. The donor parents of the frozen embryos died in a plane crash in April 1983. The couple, who were unable to conceive "naturally," used in vitro fertilization and were storing the embryos for future implantation. The legal status of the embryos was debated because someone raised the possibility that they (it) may have a legal claim to the dead parents' estate. In this case, the judge ruled that the embryos have no legal claim and that any children born from the implanted embryos in other mothers likewise have no legal claim to the estate. "Ruling Takes Frozen Embryos Out of a 4-Year Legal Limbo," Chicago Tribune 2 Dec. 1987, sec. 1:14. 
33. Ellen Goodman takes issue with the judge's ruling, especially his definition of the "frozen seven" as embryos, variously identified by him as "children," "little children," and once as "little people." The embryos are factually, pre-embryos: a group of undifferentiated cells, that "deserve respect because it can become a child, not because it is one." Goodman rightly argues that this judgment leads to murky waters: what about the six that are left if the first one "takes"? What about birth control devices that inhibit implantation but not fertilization? Of course, pro-life advocates fully supported this decision. Ellen Goodman, "The Frozen Seven: Judge Misses Larger Picture in Microscopic Ruling," Chicago Tribune 1 Oct. 1989, sec. 5:8. 
34. Associated Press, "Woman Gets Custody of Frozen Embryos" Chicago Tribune 1 Oct. 1989, sec. 1:3. This repsonse is consistent with the antiabortion rhetoric that argues that "abortion on demand laws give one person (a mother) the legal righ to kill another (an embryo) in roder to solve the first person's social problem." Quotation taken from an antiabortion pamphlet, "Did You Know?" distributed by the Hayes Publishing Co., Inc., 6304 Hamilton Ave., Cincinnati, Ohio, 45224. 
35. One Chicago obstetrician/gynecologist described the impossible situation that results when a woman refuses to allow surgery on her fetus: "If you preform a surgical procedure despite the explicit refusal of a competent adult, you could be liable for battery or assault on the woman. If, on the other hand, you respect the women's refusal and do not intervene and some harm happens to the baby, you might be sued by the woman's husband or family for neglect of the fetus. The only way to get out from under that double liability is to give it to somebody else to decide. So the incentive to go to court is very big in these cases." Rich, "A question Of rights" 7. The moral status of the embryo is discussed in Volpe, Test-Tube Conception. 
36. Green was the first woman charged with manslaughter due to delivery of a controlled substance to an infant in the womb. People of the State of Illinois v. Green, 88-CM-8356, Cir. Ct., filed 8 May 11, 1989 (cited in Cynthia Daniels, At Women's Expense: State Power and the Politics of Fetal Rights (Cambridge: Harvard UP, 1993). 
37. Patrick Reardon reported on the case in a series of articles in the Chicago Tribune. "'I Loved Her,' Mother Says: 'Shocked' Over Arrest in Baby's Drug Death," 11 May 1989, sec 1: 1, 5; "When Rights Begin: Baby's Cocaine Death Adds to Debate on Protection of the Unborn," 14 May 1989, sec. 5: 8-9; "Drug and Pregnancy Debate Far from Resolved," 28 May 1989, sec. 2: 11, 5. 
38. Anna Lowenhaupt Tsing, "Monster Stories: Women Charged with Perinatal Endangerment," Uncertain Terms: Negotiating Gender in American Culture, ed. Faye Ginsburg and Anna Lowenhaupt Tsing (Boston: Beacon, 1990): 282--99. 
39. Valerie Hartouni, "Breached Birth: Reflections on Race, Gender, and Reproductive Discourses in the 1980s," Configurations 1 (1994): 73-88. Quotation is from page 85. 
40. Patricia Hill Collins, "Mammies, Matriarchs and Other Controlling Images," Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment (New York: Routledge, 1990): 67-90. 
41. Cynthia R. Daniels, At Women's Expense 7. 
42. Paddy Shannon Cook, Robert C. Petersen, and Dorothy Tuell Moore (ed. Tincke Bodde Haase), Alcohol, Tobacco, and Other Drugs May Harm the Unborn , U.S. Department of Health and Human Services (DHHS), Office of Substance Abuse Prevention, DHHS Publication #(ADM) 90-1711 (Rockville, Md.: U.S. DHHS, 1990) 45. 
43. In the foreword to the booklet, Elaine M. Johnson, director of the Office for Substance Abuse Prevention, states, "ultimately, this booklet is intended for women of childbearing age and their partners. I include the father because, through his own abstinence, a man can make a major contribution to a woman's drug-free lifestyle and safe pregnancy and to their child's health" (iii). Other than this remark, the booklet makes no mention of paternal contribution to the welfare of the fetus. 
44. See Ruth E. Little and Charles F. Sing, "Father's Drinking and Infant Birth Weight: Report of an Association," Teratology 36 (1987)' 59-65; David A. Savitz and Jianhua Chen, "Parental Occupation and Childhood Cancer: Review of Epidemiological Studies," Environmental Health Perspectives 88 (1990): 325-37; Devra Lee Davis, "Fathers and Fetuses," The Lancet 337 (12 Jan. 1991): 122-23; Christine F. Colie, "Male-Mediated Teratogenesis," Reproductive Toxicology 7 (1993): 3-9; Andrew F. Oishan and Elaine M. Faustman, "Male-Mediated Developmental Toxicity," Reproductive Toxicology 7 (11-993): 191-202. 
45. When people discuss the distressing factor of low-birth-weight babies,ic is not so much in the context of concerns about the baby's or the mother's quality of life, but related to the fact that these are very expensive babies to keep alive. As the authors of one report state: "Not only has concern been generated because the United States has a much higher rate of low birth-weight babies than other developed countries ... but because these are 'expensive babies,' in monetary, familial, and societal terms. The initial cost of hospitalization for a low birth-weight baby is estimated to be over $13,000" (288). J. Brooks-Gunn, Marie C. McCormick, and Margaret C. Heagarty, "Preventing Infant Mortality and Morbidity: Developmental Perspectives," American Journal of Ortho-psychiatry 58.2. (April 1988): 288-96. 
46. Statistical information taken from the Report from the Assistant Secretary for Health, James 0. Mason, MD, Journal of the American Medical Association 262.16 (27 Oct. 1989): 2202. Other sources for information on infant mortality rates of different races include: Edward G. Stockwell, David A. Swanson, and Jerry W. Wicks, "Economic Status Differences in Infant Mortality by Cause of Death," Public Health Reports l03.2 (Mar.-Apr. 1988). 135-41; Frank Dexter Brown, "Expanding Health Care for Mothers and Their Children," Black Enterprise (May 1990): 25-26, Teri Randall, "Infant Mortality Receiving Increasing Attention," Journal of the American Medical Association 263.19 (16 May 1990): 26O4-06; Priscilla Painton, "$2.5,000,000: Mere Millions for Kids," Time (8 Apr. 1991): 29-30. 
47. "From the beginning, MCH (Maternal and Child Health) activities have focused on medically underserved women and children -- people barred from receiving health services by poverty, ignorance of how to enter the health care system, inability to communicate, lack of transportation, and lack of facilities and providers. And people from minority populations have been disproportionately affected by these barriers" (62.1).Vince Hutchins and Charlotte Walch, "Meeting Minority Health Needs through Special MCH Projects," Public Health Reports 104.6 (Nov.-Dec. 1989): 621-26. 
48. For example, in Honolulu, HI, a project is underway to screen Asian American families for hereditary anemia, as distinguished from simple iron deficiencies, so that future health needs of this group can be assessed. Vince Hutchins and Charlotte Walch, "Meeting Minority Health Needs." 
49. Jennifer Terry, "The Body Invaded: Medical Surveillance of Women as Reproducers," Socialist Review 19.3 (July/Sept. 1989): 13-43. Quotation is from page 14. 
50. Seth Koven and Sonya Michel, eds., "Introduction: 'Mother Worlds,'" Mothers of a New World: Maternalist Politics and the Origins of Welfare States (New York: Routledge, 1993) 2. 
51. Lisa Maher, "Punishment and Welfare: Crack Cocaine and the Regulation of Mothering," The Criminalization of a Woman's Body, ed. Clarice Feinman (New York: Harrington Park, 1993) 174. 
52. Teri Randall, "Coping with Violence Epidemic," Journal of the American Medical Association 263-19 (16 May 1990). 2612-14. Quotation is from page 2612. 
53. Reported in the Morbidity and Mortality Weekly Report (MMWR) under "Current Trends." M. VandeCastle, J. Danna, and T. Thomas, "Physical Violence During the 12 Months Preceding Childbirth: Alaska, Maine, Oklahoma, and West Virginia, 1990-1991," MMWR 43-8 (4 Mar. 1994): 132-37. 
54. Michael D. Dogan, Milton Kotelchuck, Greg R. Alexander, and Wayne E. Johnson, "Racial Disparities in Reported Prenatal Care Advice from Health Care Providers," American Journal of Public Health 84.1 (Jan. 1994): 82-88. 
55. Dogan et al., "Racial Disparities" 86. 
56. This was counterindicated only in the case of white single women, who reported receiving more advice about illegal drug use than did black single women; income level was not discussed. Untangling the "facts" of risk is confusing, especially in light of more recent reports that smoking cigarettes may do more harm than ingesting cocaine. See the report by Paul Cotton, "Smoking Cigarettes May Do Developing Fetus More Harm Than Ingesting Cocaine, Some Experts Say," Journal of American Medical Association 271.8 (23 Feb. 1994): 576-77. 
57. Norma Finkelstein, "Treatment Issues for Alcohol- and Drug-Dependent Pregnant and Parenting Women," Health and Social Work 19.1 (Feb. 1994): 7-15. Finkelstein is the director of the Coalition on Addiction, Pregnancy and Parenting in Cambridge, MA. 
58. Donald E. Hutchings, "The Puzzle of Cocaine's Effects Following Maternal Use during Pregnancy: Are There Reconcilable Differences?" Neurotoxicology and Teratology 15-5 (1993): 281-86. Quotation is from page 286. 
59. Ira Chasnoff, whose work has reported the most adverse effects of cocaine use among pregnant women patients at a drug treatment center, is the author of one of the studies that Hutchings discusses in great detail. Chasnoff's commentary immediately follows the Hutchings article in the same issue of Neurotoxicology and Teratology. Both agree that cocaine dangers to fetal health are a media-amplified phenomenon and that there are many missing pieces of the puzzle, due in part to the vicissitudes of "drug culture," which "guides [different] city's [and hence populations'] availability of drugs, use patterns, polydrug use patterns, and the role women are allowed to play within the culture." "As researchers," Chasnoff claims, "we have no idea what impact these issues can have on pregnancy and neonatal outcome" (287). Ira J. Chasnoff, "Commentary: Missing Pieces of the Puzzle," Neurotoxicology and Teratology 15.5 (1993): 287-88. 
60. Adam Gelb, "State's Newborns to Get Cocaine Tests," Atlanta Journal Constitution 12 Mar. 1991: A1. To date there have been no follow-up reports. Funding for the study came largely from the March of Dimes. 
61. This corresponds with Robyn Rowland's assertion that language, specifically "reprospeak," powerfully shapes the attitudes of a society. See her chapter "'Reprospeak': The Language of the New Reproductive Technologies," Living Laboratories: Women and Reproductive Technologies (Bloomington: Indiana UP, 1992) 130-45. 
62. Nancy L. Daly and Gale A. Richardson, "Cocaine Use and Crack Babies: Science, the Media, and Miscommunication," Neurotoxicology and Teratology 15.5 (1993). 293-94. 
63. P. A. Stephenson and M. G. Wagner, "Reproductive Rights and the Medical Care System: A Plea for Rational Health Policy," Journal of Public Health Policy (Summer 1993):174-82. Quotation is from page 176. Stephenson and Wagner cite the following article in their summary of the position of fetal rights advocates: M. A. Field, "Controlling the Woman to Protect the Fetus," Law & Medical Health Care 17 (1989): 1114-29. 
64. Dorothy E. Roberts, "Drug-Addicted Women Who Have Babies," Trial April 1990:56-61. Quotation is from page 58. 
65. The case reference is People v. Stewart , no. M508097 California, San Diego Mun. Ct. 23 Feb. 1987, slip op. Cited in Dorothy E. Roberts, "Drug-Addicted Women Who Have Babies." 
66. The quotation is from William Fraser, associate professor of obstetrics and gynaecology, Laval University and Hospital St, Francois d'Assise, Quebec, in his article "Methodological Issues in Assessing the Active Management of Labor," Birth 20.3 (Sept. 1993) 155-56. Fraser's article was part of a roundtable discussion of the benefits and risks of the active management of labor. Other articles, all published in the same issue of Birth, included the following: Karyn J. Kaufman, "Effective Control or Effective Care?", 156-58; Barbara Katz Rothman, "The Active Management of Physicians," 158-59; and Marc N. C. Keirse, "A Final Comment ... Managing the Uterus, the Woman, or Whom?" 159-61. 
67. The recommendation is from the 1989 Report of the Public Health Service Expert Panel on the Content of Prenatal Care , "Caring for Our Future: The Content of Prenatal Care," discussed in Shannon Cook et al. 
68. This work is in addition to other passive national surveillance systems set up to monitor cases of menstrual illnesses and the reproductive health effects on women due to occupational and workplace exposures. Priorities for Women's Health: A Report from the Centers for Disease Control and Prevention (Published by the CDC and the U.S. Department of Health and Human Services, Public Health Service, Spring 1993). For a history of the CDC and its role in the development of a practical science of epidemiology, see Elizabeth M. Etheridge, Sentinel for Health: A History of the Centers for Disease Control (Berkeley: U of California P, 1992). 
69. "The Yellow Wallpaper," in The Charlotte Perkins Gilman Reader: "The Yellow Wallpaper" and Other Fiction , ed. Ann J. Lane (New York: Pantheon Books, 1980) 3-20. 
70. Elaine Kendall, rev. of The Handmaid's Tale, Los Angeles Times Book Review 9 Feb. 1986: 15. 
71. See Anne Balsamo, "Rethinking Ethnography: A Work of the Feminist Imagination," Studies in Symbolic Interactionism 11 (1990): 75-86. 
72. Amin Malak situates the novel within a broader dystopian tradition in his article "Margaret Atwood's The Handmaid's Tale and the Dystopia Tradition," Canadian Literature 112 (Spring 1987): 9-16. David Ketterer calls it a "contextual dystopia" in his article "Margaret Atwood's The Handmaid's Tale: A Contextual Dystopia," Science-Fiction Studies 16 (1989): 209-17. Harriet F. Bergmann also classifies it as a dystopian novel in her article "'Teaching them to Read': A Fishing Expedition in The Handmaid's Tale," College English , 51.8 (1989): 847-54. Patrick D. Murphy explores its dystopic genre characteristics in his article "Reducing the Dystopian Distance: Pseudo-documentary Framing in Near-Future Fiction," Science-Fiction Studies 7 (1990): 25-39.

Balsamo, Anne. "Public Pregnancies and Cultural Narratives of Surveillance" in Technologies of the Gendered Body: Reading Cyborg Women. (Durham: Duke University Press, 1996) pp. 80-115

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