Stratification in Reproductive Healthcare: An Analysis of Pathways of Inclusion among Sexual Minorities, Substance Users, and Women Who Use Midwives

Abstract

This chapter explores processes of stratification in reproductive healthcare and considers the ways in which mechanisms of inclusion/exclusion shape reproductive opportunities and experiences. First, I consider the process of “selective inclusion” among sexual minority women. This examination questions the schisms that exist within the sexual minority population in regard to their visibility and legibility in medical, scientific, and public health discourses and constructions of reproductive health. The second process I examine is that of “exclusionary inclusion” among substance using pregnant women who have been collectively deemed “bad breeders” by medical and state authorities and whose reproduction is explicitly monitored, regulated, and criminalized. The final process I discuss is “side-stepping inclusion” which describes the healthcare and consumer decisions of women who circumvent medicalized childbirth experiences by employing the services of a midwife for their pregnancy and birth care. This chapter examines how medicalization, biomedicalization, and de-medicalization dynamically work together to expand and delimit inclusionary processes, emphasizing the spectral and interconnected quality of these processes. By exploring various processes of inclusion that shape reproductive experiences of these disparate and differentially marginalized populations, this chapter provides a conceptual and critical meditation on the ways in which “respectable reproduction” is deployed in reproductive care. In considering these processes of inclusion and the ways in which they are co-produced by medical discourses and practices, scholars may more clearly grasp some fundamental mechanisms of stratification in reproductive healthcare and knowledge production.