Healthcare systems in many southern African countries have historically failed to meet public demands, leading to a system stratified along class, gender and racial lines. The poor, often bearing the brunt of mass unemployment, not only rely on a failing system, but resort to parallel systems. Building on theoretical and political standpoints that emerge as feminist scholars interrogate and engage with the body, this chapter explores notions of reproductive violence and stratified access to reproductive health. It argues that southern African countries domesticate international policies governing reproductive health in a way that perpetuates reproductive violence, defined here as the institutional or structural, physical, and emotional violence that women suffer in attempting to access pregnancy termination services. Through domestication, the international policies emerge as ‘soft law’, not binding on governments. The way poor migrant and South African women are lured by illegal adverts to put themselves at risk of maternal death or longstanding reproductive health complications – in a country celebrated for its progressive constitutional position on termination – opens space for conceptual and empirical interrogations. The chapter argues that illegal services illuminate the realities of institutional reproductive violence that stem from limited and inaccessible public healthcare services. It further exposes the realities of transnational care evident in the huge influx of regional migrants to South Africa in search of reproductive justice. It concludes with a discussion calling for decolonised and reformed healthcare systems that speak to contextual specificities and necessities in southern Africa.

In this chapter, three feminist and Science and Technology Scholars discuss the idea of biological politics within the South Asian context. The concepts of biopower and biopolitics emerged within a western frame of Foucauldian theorisations on the technologies of power. As the introduction to this volume suggests, Charles Darwin and Thomas Malthus have played important roles in navigating our conversations regarding bodies and populations in colonial and post-independent India. Yet, the chapter cautions against any easy deployment of biopolitics as a universal theory of how the entanglements of biology and politics play out in the South Asian context. All three scholars have been part of an ongoing project on thinking about biological politics in a South Asian context. The chapter highlights the key issues that emerge, and the many elisions and erasures in the complex histories of science in South Asia. Recent work challenges us to think beyond enlightenment logics in postcolonial contexts. Rather, during colonial and postcolonial times, the colonies have always resisted the imposition of western science resulting not in a pure or universal science but rather complex and hybrid sciences in the postcolony. We explore these tensions and, in particular, the new formations of reproductive labour that are emerging in South Asia.

South Africa’s growing presence in the global bioeconomy for reproductive material and services has attracted recent attention, both in media and in academis. At least in the pre-covid context, egg provision in South Africa was propelling a multi-million-rand market in IVF and drawing reproductive travellers from numerous countries, including the UK, Germany and Australia. This chapter explores the local histories, regulatory conditions, and the political economy of access to assisted reproductive technologies as they intersect with racial imaginaries in the making of South Africa as a ‘repro-hub’. Drawing on long-term ethnographic research on IVF and egg provision in South Africa, it situates white egg providers as subjects of scarcity, whose subjectivity emerges alongside the market framing of their seemingly scarce biogenetic material and historical racial imaginaries of respectable whiteness. This reflects that whiteness operates paradoxically as both global, on the one hand, and scarce and particular on the other.

This chapter is based on a unique and new set of data, which explores tensions within Indian feminist discourses on reproductive technologies, rights and justice. It builds on in depth interviews with Dalit feminists on reproductive technologies, in particular, commercial surrogacy and egg donation, to argue that these voices challenge hegemonic discourses of reproductive technologies through an insistence on the wider socio-economic context of women’s lives. Inspired by African American feminists and the Sister Song collective, the chapter conceptualise these conflicting perspectives as reproductive rights versus reproductive justice and points to the complex dynamics between caste, class, patriarchy and neo-liberalism in the contemporary Indian setting.

The Introduction provides the main premise that connects the various chapters – that as fertility rates decline worldwide, the fervour to control fertility, and fertile bodies, does not dissipate; what evolves is the preferred mode of control. The preface introduces connections between the debates around eugenics, Malthusianism and selective reproduction. It provides an overview of the book by outlining the various chapter contributions as well as highlighting the interdisciplinarity of the volume. The final section connects these debates to the Covid-19 pandemic and the crisis of reproductive health and justice.

In his seminal work of 2018, Fatal Misconception, Mathew Connelly surmises that the global campaign for population control is a neo-colonial attempt to control the world. What are these neo-colonial projects that attempt to control the world? What shape do these projects take in an era where population control has become a taboo phrase in policy making? This chapter draws on the concept of birth projects to demonstrate that as fertility rates decline worldwide, the fervour to control birthing bodies, especially of poor and Black women in the global south, does not dissipate. The twentieth-century top-down population control projects, embedded in state propaganda and policies, were easily identifiable because of their starkness and brutality. What we have today are birth projects that are diffuse and couched in the frame of individual choice, which absolve the state of its responsibility. These neo-eugenic birth projects are based on a subtle form of eugenics that depoliticises issues and justifies systemic inequalities by couching them in the frame of choice. The chapter compares the history and presence of population control policies in South Africa and India to two other modes of delimiting the fertility of a certain demography – obstetric violence and repro-genetic technologies – to argue that forced contraceptive, limiting (legal) access to contraceptive, exposing women to violence during pregnancy and birthing, and the inherent stratifications of new repro-genetic technologies, although seemingly contrasting, belong to the same neo-eugenic continuum.

This chapter interrogates the utility of the term obstetric violence in the Indian context using ethnographic insights from research conducted between 2015 and 2019 in two geographically distinct areas of India, as well as the scholarship on obstetric violence, disrespect and abuse and respectful maternity care. It argues that the circumstances under which institutional births became widespread in India, the conditions under which rural Indian women give birth, the excessive focus on individual provider responsibility while ignoring the systemic and normative mechanisms that routinise disrespectful and abusive treatment, and poor health that is an outcome of exclusion due to social identities and remoteness in terms of geography, make it difficult to capture these inequities within the conceptual category of obstetric violence. It problematises the role of transnational and global health initiatives (GHIs) that have reduced maternal health to a set of technological fixes instead of using a framework that privilege the social determinants of health and/or strengthen health systems. These GHIs have not been attentive to the quality of care that women receive unless they have causative impacts on reducing infant and maternal mortality. A case study of Shaheed hospital, a worker’s hospital in Chhattisgarh, central India, is used to demonstrate that alternative institutional possibilities may exist, which keep service users at the centre of care. This analysis reveals that a different vocabulary, taxonomy, and imagination is essential for a safe and dignified childbirth experiences in low- and middle-income countries that are rooted in their contextual realities and constraints, rather than importing blueprints that work in the developed countries of the global north, as is currently the case.