Abstract
Mexico has a complicated history when it comes to contraception. Malthusian concerns about population growth have shaped national imperatives to reduce fertility by pushing contraception —especially on Mexico’s rural, poor, and indigenous. Providers have often had to comply or risk their employment. Despite signing onto the 1994 International Conference on Population and Development’s (ICPD) plan to promote reproductive choice for all, forms of contraceptive coercion still occur in Mexico. I draw on ethnographic research in a public hospital delivery ward to examine contemporary practices of contraceptive counseling. While ostensibly no longer utilizing outright force, providers continue to employ persistent pressure, urging women to choose long-term or permanent contraception by the time they leave the delivery ward. I argue that providers may view this persistence as a form of caring, as they cast women as irresponsible for what they see as their inability or refusal to “cuidarse (care for themselves).” Such refusals are framed as symptoms of national concerns, from poverty to education levels to machismo; women’s genuine desires to have more children are rarely seriously considered. I ask: how do such moral regimes of responsibilization shape women’s interactions with providers, as well as their choices, experiences, and health outcomes?
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Data Availability
The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research, supporting data is not available.
Notes
All names used in this article, including the name of the hospital where research was conducted, are pseudonyms to protect patient and provider confidentiality.
In Mexico, about 40% of people can access health insurance programs through formal employment, while the other 60% can access public healthcare through the Secretary of Health. However, a 2022 study showed that, for various reasons, only about 34–41% of people reported using these sources for their medical needs, instead seeking out private clinicians or doctors associated with pharmacies (Bautista-Arredondo et al. 2023).
While in this paper, I am discussing contraceptive counseling during and after birth, the same has been documented in Mexican post-abortion care (Singer 2017).
This kind of goal was not limited to this hospital (see Smith-Oka 2013).
During the period of research, 36% of parents of newborn boys did not select a contraceptive method compared to 43% of parents of newborn girls. However, this was a small sample size; future research may want to examine whether this pattern persists across sites and over time and whether it indicates any preferences on the part of the parents.
Dr. Rosales’ linking of the federal conditional cash transfer program, once titled Oportunidades, with rising fertility rates seems to conflict with a central goal of such programs to reduce fertility through contraceptive access and education, though studies are mixed on whether Oportunidades was effective in this way (Doskoch 2009).
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Acknowledgements
I would like to acknowledge the hospital employees who were willing to talk with me and explain their work, as well as the patients who allowed me to stand witness to their experiences.
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This work was funded by California State University, Channel Islands, through a Research and Scholarly or Creative Activities grant.
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Dixon, L.Z. “No se Cuidan (They Don’t Take Care of Themselves)”: Reframing Reproductive Rights as Contraceptive Responsibility in Post-ICPD Mexico. St Comp Int Dev (2023). https://doi.org/10.1007/s12116-023-09409-9
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DOI: https://doi.org/10.1007/s12116-023-09409-9