Birth Control and Controlling Birth WOMEN-CENTERED PERSPEGIVES

CONTEMPORARY ISSUES IN BIOMEDICINE, ETHICS, AND SOCIETY

Birth Control and Controlling Birth, edited by Helen B. Holmes, Betty B. Hoskins, and Michael Gross, 1980

The Custom-Made Child?, edited by Helen B. Holmes, Betty B. Hoskins, and Michael Gross, 1980

Medical Responsibility, edited by Wade L. Robison and Michael Pritchard, 1979

Contemporary Issues in Biomedical Ethics, edited by John W. Davis, Barry Hoffmaster, and Sarah Shorten, 1979

BIRTH CONTROL AND CONTROLLING BIRTH

Women-Centered Perspectives

Edited by

Helen B. Holmes, Betty B. Hoskins, and Michael Gross

The HUMANA Press Inc. • Clifton, New Jersey

The present work is one of two thoughtfully enhanced and carefully edited volumes that emerged from the conference on Ethical Issues in Human Reproduction Technology: Analysis by Women, held in June 1979 at Hampshire College in Amherst, Massachusetts.

Copyright © 1980 by H umana Press Inc. All rights of any nature whatsoever reserved. Softcover reprint of the hardcover I st edition 1980

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the copyright owner.

"This book was prepared with the support of NSF Grant #OSS 78 24508. However, any opinions, findings, conclusions, and/ or recommendations herein are those of the authors and do not necessarily reflect the views of the NSF, The Federation of Organizations for Professional Women, or the Editors."

Library of Congress CataJo&lng in Publication Data Main entry under title:

Birth control and controlling birth.

(Contemporary issues in biomedicine, ethics, and society)

Bibliography: p. Includes index. I. Contraceptives-Research-Congresses.

2. Contraception-Congresses. 3. Obstetrics­Technological innovations-Olngresses. 4. Obstetrics­Social aspeclS-Congresses. S. Childbirth-Congresses. 6. Women's health services-United States-Olngresses. I. Holmes, Helen B. II. Hoslc.ins, Betty B. III . Gross, Michael, 1948- IV. Series. RGJ36.A2BS4 614.9'4 80-82173

ISBN-I3: 978-0-89603-023-7 e-ISBN-I3: 978-1-4612-6005-9 DOl: 10.10071978-1-4612-6005-9

CONTENTS

Preface, Helen B. H obnes, Betty B. Hoskins, and Michael Gross

Acknowledgments, Helen B. Holmes

Reproductive Technologies: The Birth of a Women-Centered Analysis, Helen B. Hobnes

Ethics of Contraceptive Development and Deployment

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3

Introduction, Michael Gross 23 Historical Styles of Contraceptive Advocacy,

Joyce A vrech Berkman 27 Ethical Problems in Government-Funded Contraceptive

Research, Belita Cowan 37 Value Conflicts in Biomedical Research into Future

Contraceptives, Carol Korenbrot 47 Status of Contraceptive Technology Development,

Linda E. Atkinson and Jacki Ans 55 Women-Controlled Research, Laura Punnett 61 Woman-Controlled Birth Control: A Feminist Analysis of

Natural Birth Control, Women's Community Health Center 71

Response, Rosa Cuellar 79 Response, Kristin Luker 81 Response, Judy Norsigian 85 Contraceptives Discussion, moderated by

Margaret A. Kohn and Michael Gross 89

Depo-Provera and Sterilization Abuse

Depo-Provera and Sterilization Abuse Overview, Marie M. Cassidy 97

Depo-Provera: Some Ethical Questions about a Controversial Contraceptive, Carol Levine 101

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vi Contents

The Depo-Provera Weapon, Gena Corea Response, Helen Barnes Sterilization Abuse and Hispanic Women,

Sandra Serrano Sewell Concluding Remarks, Helen Rodriguez Depo-Provera and Sterilization Abuse Discussion,

moderated by Renee Rosiland Jenkins

Childbirth

Childbirth Overview, Norma Swenson

Section 1: Childbirth Technologies

Man-Midwifery and the Rise of Technology: The Problem

107 117

121 125

129

143

and Proposals for Resolution, Dorothy C. Wertz 147 The Electronic Fetal Monitor in Perinatology,

Henry Klapholz 167 Drugs, Birth, and Ethics, Yvonne Brackbill 175 Benefits and Risks of Electronic Fetal Monitoring,

David Banta 183 Response, Hilary Salk 193 Ethical Issues in Childbirth Technology, Sheryl Burt Ruzek 197 Childbirth Technologies Discussion, moderated by

Margaret O'Brien Steinfels 203

Section 2: Social Control of Childbirth

Introduction, Barbara Hilkert Andolsen 211 A Report on Birth in Three Cultures, Susan Cope Ekstrom 213 Community Alternatives to High Technology Birth,

Ina May Gaskin 223 Contrasts in the Birthing Place: Hospital and Birth Center,

Byllye Y. Avery and Judith M. Levy 231 Ethical Issues Relating to Childbirth as Experienced by

the Birthing Woman and Midwife, Judith Dickson Luce 239

Contents vii

Midwives in Many Settings, Helen Swallow 245 A Native American Response, Katsi Cook 251 An Obstetrician's Perspective, Mary Jane Gray 259 Response, Norma Swenson 261

Policymaking and Projections

Policymaking and Projections Overview, Helen B. Holmes 267 Forces Impacting on the Policymaker, Joyce Lashof 269 Response, Ilene Wolcott 275 CjSEC: A Special-Interest Interpersonal Group Brings about

Change, Beth Shearer 277 The Ethicist in Policymaking, Karen Lebacqz 283

Appendix: Action Possibilities, Margaret A. Kohn 289 Notes and References 293 Biographies 319 Index 329

Preface

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss Itthem " : the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by men. So often the input of women is neither sought nor listened to. The privileged insights and perspectives that women bring to the consideration of technologies in human reproduction are the subject of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by W omen" (EIR TAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts.

Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some.

The conference displayed the power of intense thought, motivated by passionate commitments-to other women, to free and rational inquiry, to the urgency of political action. The most carefully textured philosophical analyses were informed by felt experiences of pain and joy, anger and pleasure, frustration and satisfaction. The most impassioned calls for action were grounded in searching analysis. Yet across barriers, including age, class, race, status, training, sexuality, and politics, women talked together in mutual appreciation.

Early during the Workshop, members of each topic subgroup met together. These new colleagues, most of whom had never met each other in person, discussed the contents of each others' papers and planned together for the session that their subgroup would present. The Workshop was structured around eight sessions: contraception; Depo-Provera and sterilization abuse; diethylstilbestrol (DES); childbirth; prenatal diagnosis; neonatology; sex preselection; and such manipulative reproductive technologies as in vitro fertilization, egg fusion, and cell manipulation. A session on policy became devoted

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largely to balloting on specific resolutions. Each session here occupies a chapter that includes a brief summary overview of the topic in relation to the work of the panel, followed by the panel's technical, interpretive, and ethical papers. Each chapter concludes with panelists' formal responses to papers and the ensuing (edited) discussion.

Speakers and respondents were asked to direct their remarks toward the specific goals of the Workshop. These goals are:

1. To identify the ethical issues involved in setting priorities in research on human reproduction and in the application of such research.

2. To determine which values have heretofore been considered in resolution of conflicts.

3. To discover any alternative applicable social values that are now being offered by women.

4. To recommend new approaches for assessing values and determining policy.

As befitted a woman-planned, woman-oriented, and woman­conducted conference, the organization and format departed significantly from established practice. In the selection of participants, conventional academic qualifications weighed no more than deep concern, demonstrated interest, and previous personal experience. Each person had a place on the program and received the same honorarium. So that financial status would be less a factor in determining who could come, travel, board, and room were furnished to all. In the same spirit, participants provided for the conference directory a brief biography with suffficient personal background to acquaint participants with one another beyond their specific occupation or credentials.

The aim of many conferences and their ensuing proceedings is to reach closure and to arrive at a level of consistency and agreement. However the principles underlying both this Workshop and these volumes differ from such conventional practice. For decades men have been making decisions in the area of human reproduction technology: women have not been heard from. Hence, the purpose of the Workshop was not to resolve issues but, quite the contrary, to begin the discussion. It aimed to bring forth differences that heretofore had remained unexpressed and, in particular, to highlight the diversity of views that emerges from the varied experiences and situations of women. Therfore, in editing materials for publication, we guided ourselves primarily by the principle of remaining faithful to all contributors' intentions and, insofar as it allowed for a readable and coherent volume, to their exact language. For that very reason we

Preface xi

considered but rejected the alternative possibility of a shorter, highly synthesized volume derivative from the mUltiplicity of views and approaches in the conference.

We intend that the completeness of this work will enhance its interest and usefulness. The technical papers have been written in such a way as to communicate expert information to the layperson, and we hope thereby to reach a wide audience, especially women and readers interested in women's studies. Yet these volumes will have particular interest as well for such professionals as providers of health care and social services, philosophers, and bioethicists. Beyond their immediate topical interest, these books become a critical historical document reflecting the development, at this time, of women's thought. Of most immediate practical importance, however, is that they make available to ethicists and policymakers women's views that hitherto have been ignored. Furthermore, this work establishes the urgency of incorporating many more women into all ethical and policy deliberations on issues of human reproduction.

Helen B. Holmes Betty B. Hoskins

Michael Gross

Acknowledgments

The EIRT A W workshop climaxed four years of planning, starting with a small group of women who met for the first time at the Workshop on Medical Ethics at Manhattanville College, in June 1975 [sponsored by the Institute of Society, Ethics and the Life Sciences (The Hastings Center), Hastings-on­Hudson, NY]. I am grateful for the inspiration and impetus from those women. The Program in "Ethics and Values in Science and Technology" (EVIST) of the National Science Foundation (NSF) and the National Endowment for the Humanities co-funded the workshop. The Ford Foundation agreed to add supplemental funds as we sought to increase minority representation among the prospective participants. The NSF also funded editorial and clerical work toward the preparation of these volumes. The keen interest and encouragement of the EVIST Program Directors, first Dr. William Blanpied and, recently, Dr. Arthur Norberg, meant a great deal. Criticisms and suggestions by anonymous reviewers of the proposal contributed to the outcome of the project. Dr. Linda Atkinson and Ms. J acki Ans of the Ford Foundation facilitated discussions with that organization.

Concrete assistance from officers of the Association for Women in Science-Dr. Judith Ramaley, Dr. Anne Briscoe, and Dr. Ellen Weaver­helped get the project rolling at its commencement. Later, our sponsor, the Federation of Organizations for Professional Women, gave indispensable aid: its officers, Dr. Naomi McAfee, Dr. Julia Lear, Ms. Ilene Wolcott, and Dr. Margaret Dunkle; and those who handled our finances so expertly, Ms. Louise Ott, Ms. Carolyn Feinglass, and Ms. Ruth Scott. Dr. Marie Cassidy, who served as the official representative of the Federation, handled critical paperwork in Washington, DC, which was crucial to the success of this project.

Useful suggestions in composing the grant proposal came from Dr. Malcolm Willison, Ms. Melissa Fountain, Dr. Mila Aroskar, and Dr. Judith Ramaley. From the Hastings Center Dr. Daniel Callahan, Ms. Margaret Steinfels, and Dr. Rosalind Petchesky gave useful advice during early planning stages. Dr. Robert Murray, Jr., Dr. Charles Lance, Dr. Joan Sieber, and Dr. Sally Kohlsted also helped in early shaping of the project. During the workshop, at its conclusion, and in a post-conference followup report, our evaluators-Dr. Ben Barker-Benfield, Dr. Claudia Card, and Dr. Maureen Flannery-offered keen insights and useful criticisms.

I am especially indebted to the dedication and creativity of Co-Director Dr. Janice Raymond, and the devotion and hard work of my interdisciplinary advisory planning and executive committee: Dr. Michael Gross (history of science), Dr. Betty Hoskins (biology and bioethics), Ms. Gerene Major (nursing), Ms. Norma Swenson (women's health and sociology), and Dr. Caroline Whitbeck (philosophy). Committee members, joined by Dr. Marie Cassidy, organized the panels, playing a principal role in the selection, and at

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times the recruitment, of its members, and in the advance coordination of their presentations. In addition, the convener of each panel gathered the papers for this publication, undertook their initial editing, and contributed a summary overview.

The creation and execution of the Workshop and the preparation of these books would have been literally impossible without the dedicated labor and loyalty of Ms. Flora Johnson Josephs, Administrative Assistant. Her enthusiasm and spontaneous contributions went far beyond any reasonable expectations. Our Conference Assistants, Ms. Vivian Gabor and Ms. Julie Melrose, gave competent assistance during the Workshop, transcribed Workshop discussions, and typed early drafts of many manuscripts. Ms. Gale Storum's help with final manuscript preparation was indispensable. We are also grateful to the people at Humana Press for their kind assistance throughout the period of the book's accouchement.

Associate Editors, Dr. Michael Gross and Dr. Betty Hoskins, devoted long hours of painstaking, dedicated attention to each and every manuscript, with deep concern that each author's own ideas would come across clearly to our readers. Despite all this good advice, in a controversial, developing area such as this, errors, indiscretions, misinterpretations, and awkwardnesses invariably slip in. For them I take responsibility.

Finally, this project would have been tQtally impossible without the dedicated support and loyalty of my husband, Francis. Besides such customary husbandly duties as preparing meals, keeping the household running, and typing, he became a cheerful and competent volunteer whenever there was a deadline or jo b to do and no one to do it: providing office assistance before imminent deadlines, chauffering, advancing funds, proofreading, and reviewing of proposals and manuscripts. Whenever there were rejections, frustrations, disappointments, or cutting criticisms, his encouragement spurred me on and raised my spirits.

Helen B. Holmes

Birth Control and Controlling Birth WOMEN-CENlt:RED PEPSPECTlVES