Addressing Infertility in Emergent Reproductive Markets: An Anthropology of Cross-Border Reproductive Care in Contemporary Central Asia
Situated at the intersection of medical anthropology, critical migration studies, and economic geographies of health, this project examines how responses to involuntary childlessness in Central Asia have been shaped by the transformation of the social and medical landscape over the last two decades, including the revival of previously-devalued forms of non-biomedical healing, the growing salience of Islam in daily life, and the development, transnational spread and commercialization of Assisted Reproductive Technologies (ARTs).
Health systems in contemporary Kyrgyzstan, Kazakhstan, Tajikistan, Georgia and Uzbekistan have been dramatically altered by the withdrawal of universal, state-funded medical care after the collapse of the Soviet Union. Alongside the growth in high-tech and often foreign-owned clinical and diagnostic facilities, there has been a significant increase in the provision and use of traditional, non-biomedical forms of healing and a proliferation of sites in which such therapies are offered. The project will draw on ethnographic research within and across the borders of Kyrgyzstan, Kazakhstan, Tajikistan, Georgia and Uzbekistan to examine how ARTs are incorporated into vernacular strategies to address involuntary childlessness, and how they emerge as public objects of concern at the intersection of religious and secular debates about national futures.
Methodologically, rather than treating sacred sites, pilgrimages, or visits to the homes of non-biomedical healers as vestiges of a magico-religious worldview that is necessarily in tension with practices of biomedical healing, the project rather seeks to understand how individuals, couples and wider kin groups navigate a heterogeneous healing landscape by combining diverse forms of authority, expertise and assistance across multiple sites, and often across international borders. This will be achieved through a tripartite focus on sites of reproductive care, itineraries of reproductive assistance, and debates about the (bio)ethics of emergent reproductive technologies.
Kazakhstan, Kyrgyzstan, Tajikistan
Through this series of focused comparisons, the project aims to:
- Analyse the changing economic geography of health in Central Asia through the lens of reproductive care. Central Asia remains largely un-researched in the growing scholarly study of reproductive care, and little is known about health-seeking practices that traverse state, ethnic, or religious borders in the region. The project situates the development and commercialization of ARTs in Central Asia within a broader economic geography of therapeutic settings that include religious and lay ethnomedical sites, as well as biomedical facilities. A core aim of the project is to document this landscape so as to understand how health-seeking practices to address infertility have been shaped by the withdrawal of universal, state-funded medical care.
- Examine how biomedical and non-biomedical health-seeking practices are integrated, combined and contested in new reproductive markets. It does so in two ways: first, through close ethnographic attention to particular healing practices and itineraries for seeking care, the project will explore the ways in which biomedical and non-biomedical interventions and sources of authority are negotiated and combined in daily life by individuals, couples and their wider kin networks to address reproductive needs. Second, through an examination of public debate, government legislation, expert medical commentary and religious pronouncements it will examine how the bioethics of reproductive care are debated in divergent post-Soviet settings.
- Situate the study of cross-border reproductive care within a critical analysis of stratified im/mobility. Studies of cross-border reproductive care (CBRC) have tended to focus on the health-seeking practices of relatively privileged populations seeking fertility treatments in medical clinics overseas. While there have been important studies of return migration among diaspora populations seeking reproductive care, little is known about the reproductive itineraries, including cross-border itineraries, of economically marginalised populations. The project will innovate, empirically and methodologically, by studying reproductive trajectories in the context of larger strategies of individual and family mobility in two highly migration-dependent societies (Kyrgyzstan and Tajikistan) and one state of considerable in-migration (Kazakhstan), the government of which has explicitly sought to market it as a centre of reproductive ‘tourism’ for clients from Europe, China and other Central Asian states.
In developing this analysis, it will extend the nascent anthropological discussion of inequality in the context of reproductive travel, by addressing the ongoing scholarly divide that separates studies of CBRC from critical geographies of stratified im/mobility.