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Introduction
Reproduction, Women, and the State
By the time the family doctor clinic opened its doors to the waiting line of patients at eight thirty in the morning, the streets were already bustling in this densely populated Central Havana neighborhood. Flower sellers set up their brightly colored stands on the broken pavements. Convivial groups of people on their way to work gathered under the peeling, wrought-iron balconies of nineteenth-century homes while they drank small shots of strong, sweet coffee sold from the street-level windows. Adding a constant level of noise to this scene, battered American Fords and Chevrolets—that pre-date the 1959 revolution and now serve as collective taxis—clattered and banged their way down the street, stopping frequently to pick up and discharge passengers, while the boxy, Russian-made Ladas imported during Cuba’s Soviet-subsidized 1970s and 1980s wove briskly between them.
The health clinic where I observed weekly neonatal and prenatal health consultations was unremarkable. Except for the fact that the wall sported a now-faded revolutionary slogan—“Lies may go a long way, but in the end the truth prevails. Viva Fidel!”—the building was virtually indistinguishable from the concrete houses and state-run businesses surrounding it. Its windowless and graying cinder-brick walls were interrupted only by a narrow band below the roof, where latticed bricks permitted the circulation of both air and extremely high levels of street noise. Today was Wednesday, a day supposedly reserved for prenatal health consultations, although when I entered the waiting room, I noted that as usual the wooden benches were filled with elderly patients hoping to receive immediate medical attention. Smiling at the people I recognized from the neighborhood, I passed into the sparsely furnished office.
At the desk sat Dr. Janet Torres,1 a plump, dark-skinned woman whose gentle manner and quick smile made her a favorite among patients. Despite the fact that the clinic had just opened, she was already with a patient whom I recognized, Gisela Navarro, a slight woman in her mid-thirties who was now in the twenty-sixth week of her second pregnancy. I sat as Janet continued with the standard physical examination of pregnant women that included blood pressure reading, comparison of uterine measurements against gestational age, weight gain, and other routine tests. She carefully recorded each number in the patient’s clinical chart, while I helped by recording the results for the file that Gisela would keep with her.
When Janet reached the line of numbers that charted Gisela’s weight gain over the course of her pregnancy, she paused, frowning. “Are you eating well?” she asked. Gisela responded in the affirmative. Janet shook her head in disbelief, and told Gisela that her weight gain continued to fall under desired norms. “I’ll give you a couple more weeks,” she went on, “But if your weight gain continues to be below normal I’ll have to admit you to a hospital until your weight improves.” Gisela nodded, and promised that she would pay more attention to her diet. After she had carefully slipped her patient file into a tattered ziplock bag and departed, Janet shook her head again. She knew this family; Gisela worked in a nearby government ministry and her husband, stepfather to Gisela’s daughter from a prior relationship, was a state-employed chemist in a Cuban pharmaceutical factory. They were gente humilde (“humble people”), Janet told me, who lived entirely on their low state salaries without support from remittances or work in the informal entrepreneurial sector with which many Cuban families supplement their wages.
Like all pregnant women in Cuba, Gisela received special prenatal rations that included additional milk and yogurt allotments. Yet given Gisela’s continued insufficient weight gain, Janet suspected that she was giving away her supplementary rations rather than consuming them herself. The recipient, Janet believed, was Gisela’s daughter, who had recently turned seven years old and had thus become ineligible for the additional dairy rations that the state provides to young children. While most families were able to supplement their older children’s diet with food purchased outside the ration system, this family’s tight household economy forced Gisela to choose between nourishing herself and her daughter. “It’s true, her daughter is very thin, probably not well nourished,” Janet acknowledged. “But what can I do? I can’t have her giving up the food she needs for her [unborn] baby to care for her daughter.”
Such reproductive difficulties and decisions are played out in untold numbers of families throughout the world. Yet unlike most countries, Cuban health policy gave Janet the ability to intervene, however temporarily, in this strained situation. By admitting Gisela to a hospital or maternity home where she would receive an enriched diet and weight monitoring, Janet hoped to both enhance Gisela’s caloric intake and relieve her from the responsibility of nurturing her existing child, at least long enough to produce a baby of a healthy birth weight.
Janet made a note in the medical chart and signaled in the next patient. The day continued: this was for her a minor interruption, a slightly worrying but otherwise fairly mundane episode in her routine care of the neighborhood. Yet this book argues that such small dramas powerfully capture the multivalent tensions and contradictions of reproduction, as families and the state struggle to nurture children who are both members of kin groups and future citizens of socialist society. In turn, these moments delineate a shifting relationship between the state and its citizens in post-Soviet Cuba.
I initially conceptualized this research project as a study of the policy and practice of reproductive health care in Havana. But over the months in which I participated in the flux and flow of life in a busy neighborhood health clinic, women’s narratives and practices constantly pushed the self-imposed boundaries of my topic. As women carried pregnancies to term or chose to end them, they exchanged updates and gossip about familial tensions and household struggles. The tendrils of their reproductive narratives were enmeshed with commentaries about household economies and social stratification, the gendered burdens of productive and reproductive labor, and migration and transnational kinship networks.
Tracking these stories led me to sites far beyond the medical clinic, pushing me to recognize the dilemmas of reproduction as key moments in which to view debates and anxieties over the reproduction of children and socialist citizens, as well as the role of the state in sustaining each. Such a focus necessarily expands the traditional understanding of reproduction as a primarily biological process: at the level of the family, the women with whom I spoke time and again framed reproductive difficulties not as the struggle to facilitate or curtail biological fertility, but in terms of the problems of nurturing children and providing for them given shifting familial circumstances and embattled familial and national economies. At the same time, their choices and decisions about reproductive matters have ramifications for the future trajectory of Cuban society.
In this multi-level conceptualization, at stake is not simply the reproduction of children as members of families but also the reproduction of the socialist state and its revolution. The 1959 revolutionaries held out the promise of a radically egalitarian society in which the state would satisfy the needs of all of its citizens. It would eradicate entrenched gender, racial, economic, and regional inequalities that the revolutionaries viewed as the legacy of Spanish colonialism (1515–1898) and American capitalism (1898–1959). Bolstered by economic subsidies from the Soviet Union, the new state guaranteed support for all citizens through, among other measures, guaranteeing full employment and equal pay for equal work; establishing a rationing system to ensure universal and egalitarian distribution of household necessities; desegregating public spaces; and inaugurating free and accessible systems of social services, education, and health care.
Such wide-ranging social and economic policies were conceived as a means to equalize the terrain for the production and reproduction of a new socialist citizen—el hombre nuevo, or the socialist “new man.” Cuba’s ability to sustain this new society, however, foundered with the collapse of the Soviet Union in 1989. As the Soviet-subsidized market for Cuban sugar vanished, the island was plunged into intense and unprecedented austerity, with shortages that authorities had imagined only in the context of wartime hostilities. This initiated a period known as the Special Period in Peacetime. Frequently referred to simply as the crisis, the Special Period meant the end of the world as Cubans had known it. In the face of near-complete economic collapse, the Cuban government was forced to retreat from its earlier promises of full provision for all citizens from cradle to grave. It opened the previously strictly controlled remittance, tourist, and entrepreneurial economies, and these new apertures drove the development of a dual economy founded on the Cuban peso (in which the vast majority of Cuban state workers are paid) and the U.S. dollar, which was largely available only through the newly opened economic sectors.2 With many goods becoming available only in the dollar markets, the reemergence of social stratification and economic inequality in post-Soviet Cuba profoundly threatened socialist ideals of a fully egalitarian society.
The effects of these dramatic changes are encapsulated in the reproductive crisis surrounding Gisela and her family. Gisela and her husband, both of Afro-Cuban descent, were in many ways beneficiaries of the revolution’s social and economic policies: both had been able to pursue professional degrees and secure positions in occupations where Cubans socially identified as black or mulato (one of the local racial categories designating a person of mixed descent) have been historically underrepresented. Yet despite their professional status, their earnings in the peso-remunerated state sector are now insufficient to cover many basic necessities. Moreover, they lack the connections to the remittance or entrepreneurial economies that have become increasingly necessary to obtain what the state can no longer provide. Caught between economic crises at the level of both the family and the state, it was Gisela who struggled to bridge the gap by depriving herself in order to nurture her existing child, embodying in her underweight frame the tensions surrounding the reproduction of household and national economies.
Moving from the intimate space of prenatal consultations and abortion clinics to household economies and transnational kinship strategies, my fieldwork and this book track the multivalent meanings and practices of reproduction as they resonate through family politics and public policies. In so doing, I make explicit the entanglement of biological and social reproduction in post-Soviet Cuba. The book has two central aims: first and most obvious, my argument insists that reproduction is never simply contained within individual fertile bodies. In post-Soviet Cuba, reproductive politics encompass tensions and anxieties not only about the birth of children, but the reproduction of families, citizens, and the socialist revolution. In the intertwined lifecycles of individuals and states, concerns around sustaining children and households have become crucial nodal points for reflections, tensions, and conflict around the stability and transformation of state claims to a superior socialist morality in a new local and global order. In this context, reproductive dilemmas refer not only to biological issues pertaining to fertility and its management. They also encompass debates, both within families and between the state and its citizens, about the responsibility for nurturance across the generations and the gendered organization of reproductive labor. At the heart of social contestations about the conception and care of children and citizens are thus broader social questions about the legacy of socialism in the twenty-first century.
Second, and more broadly, this book contends that the social organization of reproduction comes most clearly into view when reproductive practices are situated within the multiple and intersecting realms of policy that shape family-building strategies. Reproduction is not only enabled and constrained by policies explicitly conceived as regulating health or fertility, but also by policies around labor, housing, migration, and so forth, that often have uneven and contradictory consequences for decisions about bearing and nurturing children. Through close attention to the ever-present slippages and gaps between policy and practice, I foreground reproduction as a lens onto the unpredictable and often unintended consequences of interactions among state policies of population management, international geopolitics and economic processes, familial politics, and personal aspirations as they shape, and are also shaped by, practices of bearing children and caring for dependents.
Conceiving Cuba thus contributes to a small but growing number of ethnographies by outside observers of Cuban life inside the revolution. While Cuba has its own tradition of applied social science, the relationship between the revolutionary government and foreign anthropologists has been a fraught one. After American anthropologist Oscar Lewis was unceremoniously ejected in 1970 while conducting the research on which his compendium Living the Revolution (1977) is based, the island was virtually closed to outside ethnographic investigators. (Mona Rosendahl’s 1997 description of life in Soviet Cuba stands alone, and her writing vividly depicts the difficulties of conducting ethnographic research at the time). Since the economic and ideological opening that accompanied the Special Period, a number of anthropologists (many U.S.-based) have conducted rich ethnographic research on the island. Reflecting the anthropological interest in subaltern identities, work on groups that the revolution has historically considered problematic or marginal—such as sexual minorities, sex workers, and Afro-Cuban religious practitioners—has been particularly well represented in this research.3 More broadly, a smaller and diverse set of ethnographies has picked up the questions around the legacy of the revolution and the changing relationship of the state to its citizens through examination of interracial relationships (Fernandez 2010), the politics of health and health care (Burke 2013; Brotherton 2012), and social struggles around consumption (Pertierra 2011; Weinreb 2009). In examining the concerns of ordinary Cubans, this book builds on these ethnographies of daily life in post-Soviet Cuba. Yet in tracking dilemmas of reproduction as they unfold in the gendered labor of bearing and nurturing children, it provides a unique ethnographic and theoretical lens for perceiving the connections and tensions between local practices of providing for children and households and the reproduction of the revolution and its ideals in a new political-economic global order.
Such an analysis transcends the Cuban context. Many citizens of the former Soviet Union, as well as residents of countries whose economies have collapsed under the pressures of structural adjustment or the current global economic crisis, have also been forced to negotiate harsh new realities that have reshaped their understandings of their past, present, and possible futures.4 For these families in many international contexts, the urgency of issues of household reproduction and familial nurturance, and the often gendered pressures that accompany them, form the lens through which they interpret personal, political, and economic crises and imagine—for better or for worse—the shape of a new society.
Theorizing a Multilevel Analysis of Reproduction
In their pioneering work, Conceiving the New World Order, Faye Ginsburg and Rayna Rapp argued that reproduction, long assigned to the biological realm, was a critical entry point for exploring broader social struggles. Broadening the theoretical field, they urged scholars of this newly defined politics of reproduction to consider the ways in which “reproduction, in its biological and social senses, is inextricably bound up with the production of culture” (Ginsburg and Rapp 1995, 2). Rethinking anthropology’s traditional focus on reproduction as the continuity of cultural and social forms transmitted from generation to generation, they contended that debates over reproduction also revealed the social contestations as families, social groups, and nation-states imagined the reproduction and transformation of society.
The past three decades have seen a blossoming of incisive work in the anthropology of reproduction, particularly in topics from prenatal care and the social effects of diagnostic technologies to infertility and surrogacy.5 This important work notwithstanding, assessments of the state of the field have noted the tendency to focus on the processes of conception and birth, especially with respect to the social meanings of the new reproductive technologies and the global biomedicalization of pregnancy (Browner and Sargent 2011; Greenhalgh 2003). Yet reproduction and politics are entangled in other ways as well; debates around reproduction are a key means by which “the morality and desirability of political institutions is imagined, and claims for the ‘goodness’ of state forms are made” (Gal and Kligman 2000, 28). As this book contends, when people bear children or terminate pregnancies, make life choices around the necessities involved in caring for children, or strategically manage fertility and kin relations in the context of migratory aspirations, these ordinary dramas also reveal contested visions of nurturance, gendered citizenship, and the “goodness” of policy.
As the literal nexus between the reproduction of biological and social bodies, reproduction in this expanded sense offers a fertile site through which to understand the relationship between the individual/familial practice and the work of states, as the latter are instantiated and experienced through policy and its effects. In volume 1 of The History of Sexuality (1978), Michel Foucault argues that modern states govern through two polar modes: the disciplining of the individual body and the shaping of behaviors, dispositions, and desires, as well as through the exercise of biopower, defined as the proliferation of techniques and professional disciplines aimed at knowing and regulating the social body, or population. Anthropological analyses of the former have flourished: scholars of the field have persuasively illustrated how reproduction is interwoven with culturally and historically specific ideals of gender and personhood, as well as beliefs about the morality and modernity of persons and societies.6 As Susan Greenhalgh (2003) points out, however, a far smaller body of work has focused directly on the role of the state in managing reproduction through population surveys and interventions designed to shape the size and quality of the population.7 The effect of non-reproductive state policy, such as migratory or labor regulations, on reproductive practice also remains relatively uncharted terrain within anthropology. Instead, this sphere of analysis has been ceded to the top-down perspective of policy experts and demographers who ignore or naturalize the state’s power to create new forms of social life that often subvert the goals of state planners.
Attention to reproduction in this sense is particularly generative in the context of socialist states where reproduction became central to the state rational planning that would demonstrate the superiority of socialism over capitalism. Early socialist revolutionaries imagined a top-down modernity comprehensively planned by the state: socialist development would not result from haphazard growth but from carefully monitored and regulated interventions into the lives of its subjects. Viewing all economic and social life as falling under its purview, socialist rational planning sought to manage both production and reproduction by directing citizens into desired occupations, influencing reproductive practices and demographic profiles, managing population movements, reshaping gender roles and ideologies, and so forth. In consciously acting to produce the “new man,” socialist states thus clearly articulated the relationship between population management and new forms of subjecthood. In this process, as this book tracks, socialist states also produced the “new woman,” sometimes through overt...