Artikelen
Katz Rothman is Professor of Sociology at Baruch College
American lessons
for the Netherlands
Katz Rothman analyseert
de sociale constructie van
moederschap in de Ameri-
kaanse maatschappij aan
de hand van drie ideolo-
gieën; het kapitalisme, het
patriarchaat en de techno-
logie.
De ideologie van het patri-
archaat maakt het fysieke
moederschap, de zwanger-
schap en de opvoeding
betekenisloos terwijl vader-
schap, de genetische band
juist allesoverheersend
wordt, aldus de schrijfster.
De technologie is gebaseerd
op drie principes; voor-
spelbaarheid, rationaliteit
en controle. Moederschap
wordt gereduceerd tot
werk, het lichaam een
machine en kinderen het
produkt. Kapitalisme. Over
moederschap wordt ge-
dacht in termen van eigen-
dom, welke een vertaling
vindt in het recht hebben op
een kind en op een vrouwen-
lichaam. In Amerika wordt
een kwart van de kinderen
door middel van een keizer-
snede geboren.
Schrijfster onderstreept het
grote belang van het be-
staan van vroedvrouwen en
vrouwengezondheidscent
ra in Nederland omdat zij
ervoor zorgdragen dat de
verdere medicalisering van
de voortplanting wordt te-
gengegaan.
* Aletta Jacobslezing, gehouden
8 maart 1993, te Groningen
Barbara Katz Rothman
and at the Graduate Center of the City University of New York,
where she also serves on the faculty of the Women's Studies Program.
Recreating
motherhood
Something has, I do believe, gone seriously awry in our cultural under-
standing of motherhood in America. I find myself surrounded by contradic-
tions. I live in a world that makes no sense.
We in the United States have seen the return of de midwife. And the rise of
the cesarean section. For fifty years there were almost no midwives to be
found in most of America. Then, in the same period that saw the nurse-mid-
wife introduced into American hospitals, that saw the introduction of 'birth
rooms', to replace some of our operating-room-like delivery-rooms, that saw
an enormous 'natural childbirth' movement, we also saw the cesarean section
rate rise to an astonishing 24 procent. Almost one out of every four births in
the U.S. is now by Cesarean. While there has been much talk of birth as a
'healthy, natural event,' each individual birthing woman has been acquainted
with her personal 'risk factors,' factors that she is told make her birth less
than healthy and far less than natural.
Cigarette ads, clearly aimed at young wömen, the fastest growing market for
cigarettes, carry a warning about smoking harming fetuses. Alcohol compa-
nies too have discovered the modern women as a new market. And bars, beer
cans and wine and liquor bottles now carry warnings about the dangers of
alcohol use in pregnancy. The advertising is a governmentally acknowledged
legitimate business expense; the warnings a government requirement.
The infant formula companies distribute sample packages of formula for new
mothers labelled 'In support of your decision to breastfeed.' Hospitals, where
virtually all of our births take place, hire lactation consultants, show breast-
feeding videotapes, and send all mothers including breastfeeding mothers,
home with packages of formula ready-packed in disposable bottles.
While white babies are worth their weight in silver if not gold, some darker
skinned children linger for their entire childhood in foster care. And however
much children may be valued, the nurturance and fostering of them is not. I
heard an angry black social worker on television say of a grieving white
woman whose foster child was taken away after three years - its first and
only three years - because the woman was white and the child black, 'She
had no right to love that child. It was just ajob.' And pretty much the same
thing is said of a pregnant woman who is not, I am supposed to believe, the
mother of a baby in her belly because in a 'surrogacy agreement,' the baby
was contracted to be there.
Childbearing at forty is now considered chic, childbearing at fifty and up is
the new frontier of procreative technology, but childbearing at eighteen is
pathetic, chances lost. And we have one of the highest teenage pregnancy
rates in the developed world.
In the name of 'family values' family needs have gone unmet: we may just
now be starting the recovery from a twelve year administration that vetoed
every attempt to provide family services, from day care to maternity leave
to universal prenatal care to increases in child welfare payments for despa-
rately poor people, all the while calling for a return to 'family values'.
There are the contradictions I live with daily. This is the world in which I
study motherhood, mother my children, live my life.
1993 nr 4 123
 Recreating motherhood
To understand it, to explain it, to find some reason in
the unreasonable, I have to step back from it and try
to disentangle the contradictions. When I do so, I find
myself unweaving the strands of a fabric, under-
standing the pattern as I work it backwards to the
underlying threads.
I believe that American motherhood rests now on
three deeply rooted ideologies that shape what we see
and what we experience, that these are the three
threads which compose the fabric of motherhood in
America today: an ideology of patriarchy, an ideology
of technology and an ideology of capitalism. As these
three come together, with all of their multiplicity of
meaning, they give us the shape, and the discordance,
of the American experience.
An ideology is the way a group looks at the world, a
way of organizing our thinking about the world. An
ideology can let us see things, but it can also blind us,
close our eyes to our own lived reality, our own
experiences, our own bodies. These three ideologies,
of patriarchy, technology, and capitalism, give us our
vision while they block our view, give us a language
for some things while they silence us for others. In
what follows, I will speak first of each of these as
separate ways of thinking, but what I understand most
clearly is the way they weave together to create a
pattern, a fabric, both a curtain and a cage.
The ideology of patriarchy
The ideology of patriarchy is perhaps the easiest to
understand of the three ideologies that shape Ameri-
can motherhood, the ideology that brings us together
in celebration of International Women's Day.
Women's reality, in the United States as in the Nether-
lands, as in most of the world, is not the dominant
reality, and women's view of the world is overruled
by men's view. Motherhood in patriarchal societies is
what mothers and babies signify to men. For women
throughout the world this has meant too many preg-
nancies or too few; 'trying again' for a son; covering
up male infertility; having some of our children called
'illegitimate;' not having access to abortions we do
want and being pressured into abortions we may not
want.
The term 'patriarchy' is often used loosely as a
synonym for 'sexism,' or to refer to any system where
men rule. The term technically means 'rule of
fathers', and it is in that sense that I use it. Male
dominance and patriarchal rule are not quite the same
thing, and when the subject is motherhood, the diffe-
rence is important.
Patriarchal kinship is the core of what is meant by
patriarchy: the idea that paternity is the central social
relationship. A very clear statement of patriarchal
kinship is found in the book of Genesis, in the
'begats'. Each man, from Adam onward, is described
as having 'begot a son in his likeness, af ter his image'.
After the birth of this firstborn son, the men are
described as having lived so many years and begot
sons and daughters. The text then turns to that first-
born son, and in turn his firstborn son after him.
Women appear as the 'daughters of men who bore
them off spring.' In a patriarchal kinship system, chil-
124
Barbara Katz Rothman
dren are reckoned as being born to men, out of wo-
men. Women, in this system, bear the children of men.
In some societies, in contrast, the line of descent is
not from father to son, but along lines of the women.
These are called 'matrilineal' societies: it is a shared
mother that makes for shared lineage or family group.
Men still rule in these groups, but they do not rule as
fathers. They rule the women and children who are
related to them through their mother's line. Women
in such a system are not a vulnerability, but a source
of connection: people are not men's children coming
through the bodies of women, but the children of
women.
In a patriarchal system the essential concept is the
'seed,' the part of men that grows into their likeness
within the bodies of women. Such a system is inevi-
tably male dominated, but it is a particular kind of
male domination. Men control women as daughters,
much as they control their sons, but they also control
women as the mothers of men's children. It is wome-
n's motherhood that men must control to maintain
patriarchy. In a patriarchy, because what is valued is
the relationship of a man to his sons, women are a
vulnerability that men have: to beget these sons, men
must pass their seed through the body of a woman.
In a patriarchal system, when people talk about blood
ties, they are talking about a genetic tie, a connection
by seed. In a mother-based system, the blood tie is the
mingled blood of mothers and their children: children
grow out of the blood of their mothers, out of their
bodies and being. The shared bond of kinship comes
through mothers. The maternal tie is based on the
growing of children. The patriarchal tie is based on
genetics, the act of impregnating.
Each of these ways of thinking leads to different ideas
about what a person is. In a mother-based system, a
person is what mothers grow: people are made of the
care and nurturance that brings a baby forth into the
world, and turns the baby into a member of society.
In a patriarchal system, a person is what grows out of
men's seed. The essence of the person, what the
person really is, is there in the seed when it is planted
in to mother. Early scientists in Western society were
so deeply committed to the patriarchal concept that it
inffuenced what they saw. One of the first uses of the
microscope was to look at semen and see the little
person, the homonculus, curled up inside the sperm.
Out of the patriarchal focus on the seed as the source
of being, on the male production of children from
men's seed, has grown our current thinking about
procreation.
One direction this has taken us is the focus on genetic
determinism, whether in its most horrifying eugenics
form under the third Reich, or in its contemporary
forms. In the United States, in the face of enormous
and obvious social problems causing disease and
illness, the search for genetic causes of disease and
illness has captured the support. The United States
has launched the Human Genome Project, a pheno-
menal effort to track the genetic bases of human life
and human illness. A belief in genetic determinism,
the seed as the cause of our being, continues to
flourish.
Modern technology of procreation and modern gene-
NEMESIS
 Recreating motherhood
tics have been forced to go beyond the sperm as seed.
Modern science has had to confront the egg as seed
also. But that does not mean that we no longer conti-
nue to think of the seed as the essence of being. It is
not the end of the belief that the seeds, the genes are
everything, that they are what really matters in the
making of a baby, the unfolding of a person, that they
are what real kinship is based on.
The old patriarchal kinship system had a clear place
for women: they were the nurturers of men's seeds,
the soil in which seeds grew, the daughters who bore
men offspring. When forced to acknowledge that a
woman's genetic contribution is equal to a man's,
Western patriarchy was in trouble. But the central
concept of patriarchy, the importance of the seed, was
retained by extending the concept to women. Valuing
the seed of women, the genetic material that women
too have, extends to women some of the privileges of
patriarchy. Specifically, this has given women some
rights to their children, rights based not on their
nurturance and care of these children from conception
onwards, but rights based on their genetic connection.
This does not end patriarchy, and it does not end the
domination of the children of women by men. Inste-
ad, by maintaining the centrality of the seed, the
ideology maintains the rights of men in their children,
even as it recognizes something approaching equal
rights of women in their children. In the United States,
since men's control over women and the children of
women is no longer based simply on men's (no lon-
ger) unique seed, men's economie superiority and the
other privileges of a male-dominated social system
have become increasingly important. Children are,
based on the seed, in American law 'half his, half
hers,' - and might as well have grown in the backyard.
American men win custody battles for children be-
cause they are equally entitled to the children based
on the genetic connection, but better equipped, based
on the economie advantages.
This is the context in which the elaborate new tech-
nologies of procreation are understood. We have, for
example, a technology that takes Susan's egg and puts
it in Mary's body. And so we ask, who is the mother?
Who is the surrogate? Is Mary substituting for Susa-
n's body, growing Susan's baby for Susan? Or is
Susan's egg substituting for Mary's, growing into
Mary's baby in Mary's body?
In the United States we have used the technology both
ways. When Mary's husband wants a child, he and
Mary can purchase Susan's egg, use Mary's hus-
band's sperm and Mary's body, and grow their 'own'
baby. But when Susan's husband wants a child, he and
Susan can rent space in Mary's body, use Mary as a
vessel for their baby. In the United States people with
money can contract for pregnancy. The brokers have
books of pictures of women for potential parents to
choose from, to take this women or that woman to
carry the pregnancy to nurture the seed.
Just as upper class men and women historically have
been able to use the milk of poor women to raise their
children, upper class men and women are now using
the bodies of these poor women. Upper class women
can have some of the privileges of patriarchy, using
the bodies of poorer women to 'bear them offspring.'
1993 nr 4
Barbara Katz Rothman
And upper class women can, as they so often have,
be bought off with these privileges, and accept men's
world view as their own. And so in the United States
we have women, right along with men, saying that
what makes a child one's own is the seed, the genetic
tie.
The ideology of patriarchy thus shapes women's as
well as men's view of motherhood. Physical mother-
hood, the nurturance and intimacy of pregnancy, is
made meaningless, while paternity, the genetic con-
nection, becomes all-meaning.
The ideology of technology
In a technological society, we apply ideas about ma-
chines to the physical and social world. In the Nether-
lands, the outsider is struck by your passion for con-
trol and order of the land: never in my life have I seen
a countryside, a landscape, with so many straight
lines, so many right angles. No creek meanders, no
path twists. You put seas where you want them, in
awe-inspiring displays of rational control.
Technological ideology asks people, like the land, to
be more efficiënt, productive, rational and controlled.
A technological society treats our bodies as machines,
hooking them up to other machines, monitoring and
managing bodily functions. When a doctor manages
a women's labor, controlling her body with drugs and
surgery, it is to make her labor more efficiënt, predict-
able, rational.
And so it is when mothers and fathers push their
babies onto a schedule, so that feeding the baby
meshes with the workday. Books like 'Toilet Training
in One Day' have become best sellers in the United
States, showing us how to 'train' our children effi-
ciently. When we think of parenting, or raising our
children, of our relationships with our children as a
job to be done well, then we have invoked the ideo-
logy of technology.
The most obvious application of technological ideo-
logy to American motherhood has occured in the
medicalization of pregnancy and childbirth. From the
medical management of pregnancy with the new
quality control technology of prenatal diagnosis,
through the rigidly monitored and controlled labor
typical of an American hospital birth, the focus is on
the 'mechanics' of production, and not the social
transformation of motherhood.
In the American management of childbirth we see the
ideology of technology played out in all its humane
absurdity. Pregnant women become seen as workers
in an unskilled assembly line, conceptualized as ma-
chines, containers holding precious genetic material.
One of more ultrasound sessions have become fairly
Standard practice in American obstetric care. It is no
longer quickening that marks the first realization of
the baby as a separate being within: it is now the
moment it is first seen on the screen.
Women report that in that moment of seeing the fetus
on the ultrasound screen, it suddenly becomes real to
them: real is probably the most often used word to
describe the fetus on the screen. It is not so surprising
that the first generation of women to grow up wat-
ching television now feel their first real connection
125
 Recreating motherhood
with their pregnancies and their coming babies when
they see them on a television monitor. Like starvation
in Somalia or the earthrise from the moon, television
makes the unimaginable real for people. The screen
visually disconnects the woman from the fetus: the
woman herself and her doctor look away from the
belly to the screen to see the baby. The feeling of
direct contact with the fetus that ultrasound gives the
physician changes the relationship between the wo-
man and her physician, between the fetus and the
physician. American obstetricians now routinely
speak of the fetus as their patiënt, and of the mother
as the 'maternal environment,' of even 'maternal
barder.'
The conceptual separation of mother and fetus conti-
nues in the management of birth. Virtually all Ameri-
can woman go into the hospital, where the medical,
obstetrical, mechanical reality overrides the human
drama of birth. In almost a parody of itself, the
management of a birth in America means hooking the
laboring woman up to a machine, a 'fetal monitor'.
Fetal heart tones can be read from a central location,
with less and less need for direct contact with the
laboring woman.
American obstetricians are entranced with the idea of
'managing' labor. The earlier focus was on the control
of pain in labor; more interest is now aroused by
controlling the length of labor. Studies report the
wondrous advantages of agressive management, the
use of drugs to keep contractions coming every two
minutes, to have the woman birth the baby within
twelve hours or do a Cesarean section.
None of the studies even ask the women how they feel
about any of this.
Fort the majority of American women, the physical
experience of pregnancy and birth thus becomes
transmuted from an expression of power, to one of
dependency, as the woman experiences her body as a
recalcitrant machine.
In a technological ideology, it is not only the body that
is treated as a machine, as mechanical, but everything
from the physical world around us to the social order.
Carolyn Merchant, in The death of nature, traces the
development of a mechanical order in Western socie-
ty to replace the organicism of earlier times. Whereas
in the time of the Renaissance the earth was perceived
as alive and considered to be a beneficient, nurturing
female, by the end of the seventeenth century the
world view had changed and the machine became the
metaphor. Merchant writes: 'Nature, society and the
human body are composed of interchangeable atomi-
zed parts that can be repaired or replaced from the
outside.' This she says, is the ideology that has per-
meated our consciousness. You can move a sea, trans-
plant a liver, contract a pregnancy.
With this shift in the vision of the body and the land,
came a shift in te image of human relationships: 'A
new concept of the self as a rational master of the
passions housed in a machine-like body began to
replace the concept of the self as an integral part of a
close-knit harmony of organic parts united to the
cosmos and society.' Liberal philosophy, the intellec-
tual underpinning of the American revolution and of
American government, is the articulation of this tech-
126
Barbara Katz Rothman
nological ideology in the social order. When the
authors of the American constitution declared 'All
men are created equal,' they were drawing on this
philosophical insight. The equality they spoke of was
of the mind, the rational being. Certainly some were
weak and some strong, some rich and some poor -
but all share the human essence, the rational mind.
The extension of such equality to people of color and
to women is based on the claim that these groups too
share the essence of humanity, the rational mind -
housed in the 'accident of birth' in the body of the
black, the body of a woman.
If we belie ve, then, as this philosophic tradition holds,
that what is especially valuable about human beings
is the capacity for rationality, then the ordering, ratio-
nalizing and purposeful efficiency of technology will
be seen as a good. But hand in hand with the valuing
of rationality is a theoretical disdain for the signifi-
cance of the body, and a disdain for physical work in
preference for mental work. The latter, dividing the
physical from the menial work, and then using ma-
chines and people interchangeably to do the menial
physical work, is the essence of technological orga-
nization.
This division of labor is a particular problem for
women as mothers: mothers do the physical work of
the body, we do the mental work of body maintenan-
ce. Thus women become identifies with the physical,
the body, and men with the higher, the rational. This
distinction between menial physical labor and the
highly valued rationality goes a long way toward
explaining the utter disdain with which an American
laboring woman is strapped down, ignored or even
insulted, while the doctor who 'manages' her labor -
reading her chart and ordering others to carry out his
decisions - is held in such high esteen. Or similarly,
why the women who produces perfect nourishment
from her body for her baby is seen as 'cow-like' and
the pediatrician who 'prescribes' a formula receives
such respect - and high pay.
If it is the mind that is so clearly valued, and the bodily
work equally disdained, then using one's body as a
resource make sense. The liberal tradition can thus
support prostitution, so long as it is done on the basis
of ostensibly free choice. The notion of 'surrogate
motherhood' is an even better example: the American
liberal focus turns to the issue of informed consent,
legal representation and rational and deliberative
choice. If the woman freely chooses to use her body
as a rentable commodity, the Liberal tradition in
American law would uphold any surrogacy contract
into which she may enter. The baby, the product of
seed, is merely planted within her body, and she is
making rational use of her body.
In sum, the ideology of technology has as its basic
themes order, predictability, rationality, control. It
brings with it the rationalization of life, the systema-
tizing and control of things and of people as things,
the reduction of all to component parts, and ulimately
the vision of everything, including our very selves, as
resources.
NEMESIS
 Recreating motherhood
The ideology of capitalism
I will be speaking of capitalism in two ways here: fïrst
as an ideology, like technology and patriarchy, which
explains the practices and the contradictions surroun-
ding American motherhood. But later I will also
discuss capitalism as a practice, as a mechanism, as
the way that American motherhood and American
ideas about motherhood are marketed throughout the
world.
Capitalism, like the other ideologies, is complex; and
I am forced to be brief, and inevitably must simplify.
Here I will focus on only one essential aspect of the
capitalist ideology's contribution to the meaning of
motherhood: the idea of ownership of the body.
Capitalism as an ideology as well as a system encou-
rages the extension of ownership or property relations
in ways that are at best inappropriate, and too often
morally wrong. There is a great deal of contemporary
social criticism that makes exactly that claim, inclu-
ding for example, the ecologists. They argue that it is
inappropriate to think we can own the land, the wa-
ters: the earth, they claim - significantly - is our
mother, not our property.
But what happens when we start thinking of mother-
hood itself in terms of property? As wrong as it is to
think of the human relation to the earth this way, it is
worse when we start thinking about our relations with
each other in the language of property. People do not
often use the actual word 'property' in discussions of
human relations. More often the key term is rights,
with the concept of property kept as implicit. There
are two directions in which property rights have ex-
tended that are directly relevant to motherhood: rights
of ownership over one's children, and rights of ow-
nership over one's own body. It is the latter on which
I will now focus.
In American society, as a capitalist system, one cannot
legally force or forcibly prevent people from doing
something with their own property without very com-
pelling reasons. The right to won, and therefore to
control, property is among the most valued of rights.
In technological society, I have argued, the body is
treated as a thing and as a resource. In capitalist
society, where the emphasis is on private ownership,
the body is viewed not as a resource for the commu-
nity or the society, but as a private property, a personal
resource. Rights of privacy are in a sense just a
variation on other rights of ownership, of private
control.
Given the view of the body as owned property, the
extension of ownership to all of our body parts allows
women some measure of control over the use of our
bodies in procreation. If women are full persons, then
we are moved out of the category of owned property,
and into the category of owners of our own bodies.
Men can no longer entirely legally barter in women's
bodies.
American feminists have made good use of this con-
cept of bodily ownership. Within the American legal
system, intelligent feminist use of the individualist
ethos has been invaluable in assuring women's rights
in procreation. Once women themselves are recogni-
zed as full citizins, then individual women must be
1993 nr 4
Barbara Katz Rothman
accorded the same rights of bodily autonomy and
integrety that men have. For women, that has meant
sexual and procreative autonomy. Because it is her
body, she cannot be raped. Because it is her body, she
cannot be forced to bear pregnancies she does not
want. Because it is her body, she cannot be forced to
abort pregnancies she does want.
This does not mean that American women are not
forced by circumstances into these very situations en
eventualities. It only means that the society will not
use the official power of the state to force her. Women
are in fact prevented from having abortions they
might want by family pressure, by economie circum-
stances, by religious and by social pressures. And
women in America are forced into having abortions
they might not want to have because of poverty,
because of lack of services for children and mothers,
because of lack of services for disabled children and
adults. By offering amniocentesis to identify fetuses
who would have disabilities, and by cutting back on
services for disabled children and their families, for
example, we do effectively force women to have
selective abortions.
But we have held the line on adding to that pressure
of official power of the state. In American society,
when we bring it back to the simple legal questions -
who can force an abortion o5r forcibly prevent one,
force a woman to have sex or stop her from doing so,
to use contraception or not - we wisely retreat to
safety, calling forth our most sacred value. It's her
body, We invoke a higher power, the power of ow-
nership.
This then is the way that American women have been
able to combine the dominant American liberal phi-
losophy with capitalist ideology to our benefit. We
have made use of the mind-body dualism, to allow a
view of the body as owned, like a shelter which
houses the more important mind. The high value of
ownership, of property rights to their own bodies. In
the name of ownership, American women have de-
manded access to contraception, sterilization, and
abortion. And given the prevailing liberal philosophy,
we've gotten rights to control our fertility - although
given the capitalist class system, we have fared less
well with access to the necessary means.
While the 'owned body' principle has worked for
women in avoiding motherhood, it is less clear how
it can be made to work to empower women as mo-
thers. Our bodies may be ours, but given the ideology
of patriarchy, the bodies of mothers are not highly
valued: the bodies are just the space in which genetic
material matures into babies. In a patriarchal system,
even if women own their bodies, it may not give them
any real control in pregnancy. Women may simply be
seen to own the space in which the fetuses are housed.
This is the argument on which attempts to control
women's behaviour have been successfully based:
owning her own body is not enough to assure a
woman her civil liberties if her body is believed to
contain the property of someone else, someone else's
baby. Thus American women have been literally jai-
led for using drugs in pregnancy, literally been drag-
ged against their will into operating rooms for cesa-
rean sections. A woman's claim of ownership and thus
127
 Recreating motherhood
control over her body cannot withstand the competing
claim of the fetus or the state's claim on behalf of the
fetus, for its ownership rights in its own body.
Weaving the fabric
From the standpoint of the ideology of technology,
we have seen that motherhood is perceived as work,
and children as a product by the labor of mothering.
Mother's work and mother's bodies are resources out
of which babies are made. From the standpoint of the
ideology of patriarchy, it is men's babies that are
being made. From the standpoint of the market, not
all work is equally valuable, and not all products are
equally valued. There is not a direct relationship
between the value of the worker and the value of the
product. What is essential to capitalism is the accu-
mulation and investment of capital, of wealth, by
people who are in a position to control others. Under
capitalism, workers do not own or control the pro-
ducts of their own labor.
Babies, at least healthy white babies, are very preci-
ous products in the United States these days. Mothers,
rather like South African miners, are the expendable,
cheap, not-too-trustworthy labor necessary to produ-
ce the precious product. This is the end result of the
evolution of these three ideological perspectives. This
is what ties together the new technology, the legal, the
medical, the political and the psychological creation
of motherhood in American society.
From these three ideologies, that of patriarchy, tech-
nology and capitalism, we get the supportive fabric
for the strange patterns we see emerging in the United
States, patterns which may already begin to threaten
the Netherlands. In combinations, sometimes with
one thread dominating and sometimes another, these
three ideologies explain the contradictions with
which Ibegan.
These ideologies also explain the direction that the
development of new technology of procreation is
taking us: further and further towards treating babies
as commodities to be produced out of precious gene-
tic material, mothers as 'cheap labor,' untrustworthy
workers on a reproductive assembly line.
It is the nature of a hegemony - this complex world
view constracted of interlocking ideologies - that we
cannot see through it clearly. And so we fear to piek
at the fabric, fear to pull at individual loose threads
for fear of falling straight through into some abyss. If
we challenge any piece of the system, other pieces
rise to block our way. When I challenge technological
ideology, people hear the sound of the baby being
chucked out with the bathwater, fear of return of the
angel of death hovering at every birth, fear unchecked
fertility, untreatable infertility, women captured and
held hostage to some mad biology. When I challenge
ownership models of bodily integrity, I hear the enor-
mous fear of someone else claiming ownership. So
deep the ownership model lies in American society
that the only askable question is whose property. And
when I challenge the patriarchal models of genetic-
based parenthood, I hear the fears of women of privi-
lege who have gained for themselves some of the
privileges of patriarchy - often at the expense of the
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women, often in America at the expense of women of
color. If I talk about nurturance, daily acts of caring,
of tending, of raising children as constituting mother-
hood, then women who hire other women to perform
those acts in their absence, as babysitters, housekee-
pers and nannies, feel their motherhood claims threa-
tened.
Thus we in the United States find ourselves trapped
in a fabric whose weave tightens, comes to appear
seamless. We have come to think about motherhood
and about our children in certain ways, and we have
developed technologies out of that thinking. The tech-
nologies in turn act back on us, further encouraging
the way of thinking. We think of the body as a
machine, and so develop machines to attach to the
body until finally the body - the laboring body of a
woman with child - appears to be an extension of the
machinery. We think of the woman's body as a barrier
to access to the child planted within, and develop
technology that makes the woman visible, opens up
the fetus to our eye, makes it appear as the trapped
child we thought it was. We think of seed as precious,
and develop techniques for harvesting it, for culling
it, for selecting the most precious seeds. We think of
the site of growth of those seeds as interchangeable -
and we interchange them. We create a world in our
image.
And then we sell it.
Selling the vision
It begins in a way that generally makes some sense,
that pulls on your heart strings, that captures your
imagination. We start with some woman in a very
high risk situation: the technology offers her a chance,
maybe her only chance, to have a baby. But then very
quickly the technology begins the spread to people at
lower and lower risk, until virtually every woman is
caught up in the net. In the United States the cycle
may take just a few years. Often, once the technology
is in fact routinized, the problems with it - the pro-
blems it causes rather than solves - are discovered,
and the technology is abandoned. Often it is abando-
ned in favor of some newer technology, and the cycle
starts anew.
Such was the story of X-ray use in pregnancy: from
a few women with abnormal pelvic structure to rou-
tine use in the population, to discovery of the link to
childhood cancers, to replacement with ultrasonogra-
phy. It is the story of weight control programs for
pregnant women, of prenatal diagnosis, of fetal mo-
nitors. Always it begins with some heart-rending
crisis. Always it ends with the routinization of the
technology.
I met a physician here in the Netherlands at a confe-
rence on the. use of prenatal diagnosis. I was critical
of the introduction of the technology for routine use.
Ah, she said, but don't you see: She had just come
from the bedside of a woman who was recovering
from her second selective abortion following prenatal
diagnosis. She and her husband were carriers of a
dreadful condition, something no one would wish on
their child. The decision to test for that condition in
the fetus and to terminate the pregnancy if the condi-
NEMESIS
 Recreating motherhood
tion was found was their only hope of having a
healthy child. Didn't I see how fine a thing these tests
were, how valuable they could be?
They were carriers, I asked? For a child to be affected,
the genes had to be present in both the sperm and the
egg? Yes, yes, she assured me, that's what punt them
at such a high risk. Did you offer them donor insemi-
nation, I asked? If they used donated sperm they
would have no risk of this condition. The physician
was silent for a long moment. I never thought of it,
she said, I just never thought of it. When she had left
them earlier that day, the man was sitting at the
bedside with his head bowed over his wife's empty
belly, weeping. He might have accepted donor sperm,
she thought.
The couple was using the technology of prenatal
diagnosis in this case not simply to have a healthy
baby. They were using this technology, this particular
technology to have a healthy baby, in order to main-
tain the husband's paternity. And it was not even
necesarilly out of the husband's desire to do so: it was
the doctor's decision to offer this technology. Donor
insemination is an expensive, low technology, low
risk, low profit treatment. There is no international
marketing program for donor insemination. The tech-
nology of prenatal diagnosis that the physician was
offering is a technology that is being aggresively
marketed throughout the world. It is a technology that
grew out of the complex weave of ideologies I have
been describing, but wherever these technologies
come from, whatever ideology or way of life they
grew out of, they are marketed throughout the world.
The conference at which I met this physician was
sponsored in part by the pharmaceutical companies
that make the prenatal diagnostic kits. The audience
was obstetricians: those who would be doing the
testing. The specific test under discussion was to be
used in low risk pregnancies, possibly eventually in
all pregnancies, to screen people for whom further
testing would be advised. The doctor was showing me
the path, from the tragic couple at high risk to the
whole population, the path by which acceptance of
this technology could be routinized in this society.
The technology that is developed in any particular
society is no longer simply a reflection of the cultural
values of that country. It is also a product, an object
subject to multinational development, international
marketing. Once we have an object, a marketable
commodity, the power of the multinational industries
in the global economy begins to enter the picture. All
of the physical means of production of motherhood
in the United States - fetal monitors, screening kits
for the prenatal detection of fetuses with Downs
Syndrome, ultrasound machines, infant formula, all
of the products used from the lowest technology baby
bottle to the highest technology DNA probe - are
subject to international marketing. Many of these
objects have been developed in the United States;
some are imports. The culture of science, the world
of reproductive technology, is itself an international
world, and products and people move around quickly.
The case of in vitro fertilization and the other inferti-
lity research is a good example. As one country after
another, including the United States, imposed various
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Barbara Katz Rothman
restrictive bans on fetal and embryo research, the
scientists and researchers moved their laboratories
from country to country. The technologies they then
developed, no longer considered 'research' or 'expe-
rimental' are then marketed throughout the world.
The conferences are held internationally, the science
develops its own international culture. But the mar-
keting gets targeted, like all international marketing,
addressed to the local market. IVF Australia, which I
think of as McConception, or the McDonalds of
infertility treatment, opens up branche outlets where-
ver rich people with infertility problems can be found,
and now in the states calls itself 'IVF America.' IVF
clinics now blanket the world.
Some technology inappropriate marketing across the
globe costs lives: this has been the well-documented
case with the marketing of infant formula to underde-
veloped countries. As the mother of one child by
adoption, I deeply value the availability of good
infant formula. But clearly the inappropriate marke-
ting of the formula for profit has cost lives. I am not
arguing against these technologies I am not opposed
to all uses of IVF, of prenatal diagnosis, any more than
I am opposed to all cesarean sections. But I am very
aware that these technologies are not always used in
the best interests of women, that they often grow out
of an ideology that makes them dangerous. A needed
cesarean section is a life-saver. A 24 procent section
rate is madness. To know where a technology is
headed, it helps to know where it is coming from.
You in the Netherlands are not in much danger of
losing lives - but perhaps it is a way of life you must
think to protect. Maternity care in the Netherlands
stands as a model for the rest of the world. Midwifery
has remained as a developed, respected and most
significantly independent profession. Obstetricians
have worked with midwives but in marked contrast
to most of the rest of the world, professional bounda-
ries have remained standing: your midwives work
with, not under, obstetricians. Home birth remains
very much alive and well here. Maternal and infant
mortality are among the very lowest in the world.
And into this system the new technologies of procrea-
tion are being marketed. Your obstetricians are being
wooed by an international scientific community, tar-
geted by international marketing and multinational
industries. I see your way of birth, and by extension
your ways of motherhood, being treathened.
Some of the patterns and contradictions that plague
American motherhood can be found in the Nether-
lands, and some not. We have much in common in our
ideologies, and we have our differences. But the
greatest strength you have is resisting all that is wrong
with the Americanization of birth and of motherhood
lies with your midwives. Underpaid and overworked,
treasured and valued, yes, but maybe taken-for-gran-
ted also, it is your midwives that distinguish you, your
midwives who protect your vision of birth and of
motherhood. As we in the United States seek to
reweave the fabric, seek an alternative vision, one
place we turn to for inspiration is the Dutch midwives.
Many of us, feminists in the United States and in the
Netherlands, are seeking a new tapestry, woven from
the threads of different ideologies. We want to replace
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patriarchy with a woman centered, woman grounded
vision of motherhood, a vision that values nurturance,
the work and the care of mothering. We want to
replace mechanistic, technological models with a va-
luing of the body, the organic oneness of the human
body and mind, the interconnectedness of the human
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Barbara Katz Rothman
community. And we want to remove all images of
ownership, of property and of profit from the realm
of mothers and children.
This is a fitting vision to share on International Wo-
men's Day, and I thank you for this opportunity.
NEMESIS