Book Review: Marginalised Reproduction - Ethnicity, Infertility and Reproductive Technologies

When Professor Susan Golombok says a book is 'important and highly illuminating' and 'it should be read by everyone with a connection to the field', I thought I should add it to my 'to do' list.

The book pulls together research from the UK, Eire, the Netherlands, Germany, Australia and the US. Common to all those countries is the stigmatisation of those unable to have children. However, the social consequences vary widely and people's different reactions to infertility shine a spotlight on the impact of gender equality, family networks, access to medical treatment and the ability to adapt to a new culture. There is a stark contrast between richer societies, where the provision of medical solutions and valued alternatives to motherhood provide women with choices, and less economically developed communities where access to medical treatment may be limited and motherhood perceived as a woman's only role.

The chapters in the book are from a range of disciplines, including anthropology, psychology, social science, public health and endocrinology. This means that, although when read in quick succession the chapters can seem somewhat repetitive as many of the authors set out their understanding of the terms used, authors do bring their own nuanced interpretation of the role of culture or cultures. Also, the chapters can be read individually or out of sequence.

Part one of the book - titled 'Researching, Infertility, Ethnicity and Culture' - determines the boundaries of knowledge of ethnic differences in access to infertility services in Western societies. It discusses culture and religion, and the failure of healthcare providers to engage with differences in ethnic backgrounds and institutional racism. It includes discussion of the lack of research that could enable ethnic inequalities in accessing healthcare to be grappled with in a meaningful way. The book does not shy away from addressing the question: 'What difference does our difference make in social research?' Yasmin Gunaratnam suggests that attentiveness to difference can improve 'conceptual frameworks, methodological approaches and ethical standards'.

Karl Atkin, in his chapter, cites research from Karlsen (1), which depressingly indicates that, if cultural diversity is recognised, it is more often used against ethnic minority populations. One example of this is how poor health among children in Pakistani families is often attributed to consanguineous marriages when it is more likely poor socio-economic conditions are the cause. (2) Another well made point by Atkin is that some young Muslims, whose families originate from the Punjab, are critical of their parents' interpretation of Islam 'as embodying cultural practices which have nothing to do with faith' (3).

The second part of the book uses primary research to shed light on the relationship between ethnicity, culture and assisted reproduction. Of this research, I am most familiar with that of Lorraine Culley, and Nicky Hudson, into British South Asian communities. I agree with their argument that gender, generation and social class are key factors when debating the cultural differences in attitudes to infertility.

In the final chapter, Marcia Inhorn, Rossario Ceballo and Robert Nachtigall present findings from their studies of infertility among African Americans, Latino Americans and Arab Americans. These groups face higher levels of reproductive problems, yet are simultaneously 'despised as reproducers in a racist/classist/xenophobic society'. The devastating effect of infertility is compounded by poverty, lack of health insurance, lack of awareness about treatment options, and language barriers.

One of the highlights of the book for me was research in Germany into knowledge about female genitalia conducted by Borde et al in 2002 (4). This was a comparative study into the quality of care for Turkish migrant women and German women in a gynaecological ward, and included asking the women to identify the ovaries, uterus etc. on an illustration. The team found thirty per cent of Turkish women were unable to answer, as were ten per cent of German women. I have long wanted to conduct such a test on women in the UK and would be fascinated to know if any BioNews readers have done or know of any such research.

The contributing authors do not agree on all the issues, but they appear to be united in calling for more research into and further discussion of the issues raised. So, with that overarching theme, how can the director of the Progress Educational Trust not recommend this book. Should it be read by everyone with a connection to the field as Susan Golombok states on the cover? The answer has to be yes, if we are to improve the lot of minority groups and work towards better access to assisted conception.

Buy Marginalised Reproduction: Ethnicity, Infertility and Reproductive Technologies from Amazon UK.