Bodily Interventions and Intimate Labour: Understanding Bioprecarity 9781526138569

Table of contents :
Contents
List of figures
Acknowledgements
Introduction • Gabriele Griffin and Doris Leibetseder
Part I: Theorizing bioprecarity and the body
1 Intimate labour and bioprecarity • Gabriele Griffin
2 Bi oprecarity as categorical framing • Doris Leibetseder
Part II: Precarity in the making of kin
3 Precarious labourers of love: queer kinship, reproductive labour and biopolitics • Ulrika Dahl
4 Precarious bodily performances in queer and transgender reproduction with ART • Doris Leibetseder
5 Bi oprecarity and pregnancy in lesbian kinship • Petra Nordqvist
Part III: Bioprecarity and bodies as pi eces
6 Precarious pregnancies and precious products: transnational commercial surrogacy in Thailand • Elina Nilsson
7 ‘It’s just sperm. That’s all you’re giving’: men’s views of sperm donation • Gabriele Griffin
8 Bodily disrepair: bioprecarity in the context of humanitarian surgical missions • Nancy Worthington
Part IV: Bioprecarity in the transgression of boundaries of intimacy
9 Transgressing boundaries: seeking help against intimate partner violence in lesbian and queer relationships • Nicole Ovesen
10 Precarious subjectivities: understanding the intimate labour involved in seeking clitoral reconstruction after female genital cutting • Malin Jordal
Part V: Bioprecarity and eugenicist histories
11 ‘My body, my self’: indigeneity, bioprecarity and the construction of the embodied self – an artist’s view • Katarina Pirak Sikku and Gabriele Griffin
12 The intimate labour of non- normative bodies: transgender patients in early Swedish medical research • Julian Honkasalo
Conclusions • Gabriele Griffin and Doris Leibetseder
Index

Citation preview

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Bodily interventions and intimate labour

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Bodily interventions and intimate labour Understanding bioprecarity

EDITED BY GABRIELE GRIFFIN AND DORIS LEIBETSEDER

MANCHESTER UNIVERSITY PRESS

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Copyright © Manchester University Press 2020 While copyright in the volume as a whole is vested in Manchester University Press, copyright in individual chapters belongs to their respective authors, and no chapter may be reproduced wholly or in part without the express permission in writing of both author and publisher. Published by Manchester University Press Altrincham Street, Manchester M1 7JA www.manchesteruniversitypress.co.uk British Library Cataloguing-​in-​Publication Data A catalogue record for this book is available from the British Library ISBN 978 1 5261 3856 9 hardback First published 2020 The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-​party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Cover image: Torso of a Crouching Woman. Camille Claudel (French, 1864–1943). Digital image courtesy of the Getty’s Open Content Program.

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CONTENTS

List of figures 

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Acknowledgements 

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Introduction  Gabriele Griffin and Doris Leibetseder

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Part I  Theorizing bioprecarity and the body 

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Intimate labour and bioprecarity  Gabriele Griffin

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Bioprecarity as categorical framing  Doris Leibetseder

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Part II  Precarity in the making of kin 

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Precarious labourers of love: queer kinship, reproductive labour and biopolitics  Ulrika Dahl

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Precarious bodily performances in queer and transgender reproduction with ART  Doris Leibetseder

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Bioprecarity and pregnancy in lesbian kinship  Petra Nordqvist

Part III  Bioprecarity and bodies as pieces  6

Precarious pregnancies and precious products:  transnational commercial surrogacy in Thailand  Elina Nilsson

95 111 113

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7 ‘It’s just sperm. That’s all you’re giving’: men’s views of sperm donation  Gabriele Griffin

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8 Bodily disrepair: bioprecarity in the context of humanitarian surgical missions  Nancy Worthington

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Part IV  Bioprecarity in the transgression of boundaries of intimacy  9 Transgressing boundaries: seeking help against intimate partner violence in lesbian and queer relationships  Nicole Ovesen 10 Precarious subjectivities: understanding the intimate labour involved in seeking clitoral reconstruction after female genital cutting  Malin Jordal Part V  Bioprecarity and eugenicist histories 

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11 ‘My body, my self’: indigeneity, bioprecarity and the construction of the embodied self –​an artist’s view  209 Katarina Pirak Sikku and Gabriele Griffin 12 The intimate labour of non-​normative bodies:  transgender patients in early Swedish medical research  Julian Honkasalo Conclusions  Gabriele Griffin and Doris Leibetseder Index 

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FIGURES

11.1 Här börjar Sápmi –​häar slutar Sverige, 2004 (Here begins Sámiland, here ends Sweden) (Source: Katarina Pirak Sikku)  219 11.2 First encounters with eugenicist instruments in the archive (Source: Katarina Pirak Sikku) 

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11.3 Dollet, 2006 (Source: Katarina Pirak Sikku) 

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11.4 Suojehis ruokto –​Värnlöst hem, 2015 (Suojehi’s Ruokto –​ homeless home) (Source: Katarina Pirak Sikku) 

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ACKNOWLEDGEMENTS

This volume is the result of many discussions the editors of this volume have had with colleagues, friends, experts and others about the ways in which people are rendered bioprecarious through both the opportunities and constraints that contemporary biotechnologies afford. We would therefore, in the first instance, like to thank our colleagues at the Centre for Gender Research, Uppsala, for being consistently both supportive and inspiring –​ you’ve brightened our intellectual horizons and enriched our lives in many different ways! In May 2018 the editors of this volume ran a lively international workshop on ‘Queer and Transgender Reproduction with Assisted Reproductive Technologies (ART):  Legal, Cultural and Socioeconomic Challenges’. This workshop was funded by the Riksbankens Jubileumsfond (No. F17–​1394:1), Sweden, to whom we are very grateful for having enabled us to bring together an inspiring group of international scholars in the field, some of whose work has contributed to this volume. In parallel we were having many conversations about bioprecarity as a concept and a condition of being, and out of these grew the current volume. The Riksbanken-​funded workshop arose from research Doris Leibetseder was doing as part of her Marie Skłodowska-​Curie Action Individual Fellowship (Horizon 2020, No. 749218; 2017–​19) on ‘Queer and Transgender Reproduction in the Age of ART:  Towards an Inclusive Common European Framework for ART’ and we would like to thank the European Commission for funding this work. This was recognition for the necessity of engaging with the bioprecarious conditions of our lives as a matter of some urgency. The editors would also like to thank Tom Dark at Manchester University Press and the editorial team there for their input and their support –​much appreciated!

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INTRODUCTION G a br i e l e Gr iffin and D or i s L ei betseder

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he body has long been a concern in feminist work. Its imbrication in intimate labour has been documented through the ways in which various forms of care work, domestic labour and sex work involve bodies, the bodies of those doing the work and of the recipients or beneficiaries (customers, clients) of that labour. However, little research has been undertaken to discuss how bodies in intimate labour are precarized, or made vulnerable. This volume is therefore concerned with the ways in which bioprecarity, here understood as the vulnerabilization of people as embodied selves, is created through regulations and norms that encourage or require individuals to seek or provide bodily interventions of different kinds, in particular in relation to intimacy and intimate labour, such as in the making of families and kin, in various forms of care work and in the making of identities. In thinking through the ways in which embodied selves are precarized in intimate labour we draw on the work of Michel Foucault, Roberto Esposito, Nikolas Rose, Judith Butler and a number of other theoreticians who have explored the relation between body and power, or biopolitics. We emphasize ‘the centrality of the body as the genesis and termination of sociopolitical dynamics’ as well as ‘the configuration of juridical-​institutional orders’ and ‘finally the function of resistance as the necessary counterpoint to the deployment of power’ (Esposito, 2008: 85). We do this because discussions of ‘life’ –​as bio/​s is often translated –​tend to abstract embodied experiences into the domain of categories. Categories themselves are, of course, a key technology in biopolitics. But they are only one dimension, ‘the juridical-​ institutional orders’, of that politics. The other is bodies themselves, the somatic entities that are organized through and in the orders of modern

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society. In this volume we foreground these bodies and their experiences in intimate labour so as to elucidate how they become precarized in the sociopolitical dynamics that structure the everyday. We recognize, with Foucault (2003: 253) that biopower ‘has taken control of both the body and life … with the body as one pole and the population as the other’. And, with Esposito (2008), we view the two not as distinct but as interrelated. This becomes very obvious when one considers the bodily transformations of trans people, which concerns both their individual, particular bodies on the one hand and questions of populations (however large or small) on the other, through the ways in which access to trans surgeries are regulated, for example. As Foucault argues (2003: 252–​3), bodies are disciplined and populations are regulated, both through norms. Such norms enact what Karen Barad (2007) has termed the ‘agential cut’, the division between that which is included and that which is excluded. And it is these divisions that produce inequalities and hierarchized differences. Such inequalities pertain to a large number of dimensions in people’s lives: sexual, social, economic, religious, ethnic and racial ones. These intersect in various ways in every individual’s life, rendering them precarious in some situations but not in others depending on context. One major source of inequality is race. As Foucault states: ‘one [cannot] make biopower function … without becoming racist’ (2003:  263). This is evident in a number of chapters in this volume that deal with the interplay of race-​based and other material precarities. We cannot discuss surrogacy arrangements in the ‘global South’ for those from the ‘global North’, or the construction of Sámis as a race, without understanding the abuse of biopower in the interests of social divisions. But there are also many other forms of social divisions that are equally discriminatory and destructive in their effects as racism (e.g. homo-​and transphobia) and we address these in this volume in equal measure. In doing so we open up discussions of biopolitics and biopower to a broader range of discriminatory regulations and precarizations that need to be the subject of much wider public debate. Below we briefly discuss the core issues addressed in this volume and its structure. SHIFTING UNDERSTANDINGS AND REGULATIONS OF THE BODY AND BODILY INTERVENTIONS Feminist work on the body has long been concerned with questions of intervention and agency. Early feminist writings such as the classic Our Bodies, Ourselves (Boston Women’s Health Collective, 1970) or Fat Is a Feminist Issue (Orbach, 1978) encouraged women to ‘take back’ their bodies, to seek

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to gain control over their bodies –​in other words, to exercise agency and autonomy in relation to their bodies and bodily processes. This encouragement stemmed from an understanding that women’s bodies had become over-​medicalized, that a male medical profession was determining women’s health and well-​being, and that women were being socialized into shaping their bodies to patriarchal requirements. That was then. In the now, questions of the body and body management have changed considerably. This has been made possible by a number of developments. One of these is the rapid biotechnologization that has occurred over the past twenty years or so. That development has changed possibilities of bodily intervention through, for example, the opportunities to remould gendered bodies and through enabling diverse forms of assisted reproduction. This biotechnologization has been accompanied by the ‘digital revolution’, which has made social media a key source of information, knowledge, social pressure and exploration in the process of thinking about body and body management. Social media exert both new forms of enticement and new forms of control that create the possibilities for seeking and providing bodily interventions. Many people nowadays routinely consult the Internet if they want to seek treatment or find out how to get help with particular (bodily) issues. This is as true of those seeking clitoral reconstruction following female genital cutting as it is of those wanting to undergo fertility treatment or wanting to change their gendered body. Through the Internet information about treatments in countries other than one’s home country becomes available, as well as associated differences in regulation (e.g. surrogacy is illegal in some countries but not in others; trans surgeries may be cheaper and done differently elsewhere). Digital information then promotes movement across countries for those who can afford it, to seek what they want. Bodily intervention has thus become a globalized phenomenon, where possibilities of travel for treatment are realistic if circumscribed by regulations and resources. A third factor here has been the rise of the service sector, which has led to the wide-​ranging globalized commodification of women’s bodies, for instance in the context of fertility treatment and the provision of ova and wombs in cases of surrogacy. This commodification has been extensively explored in relation to the so-​called care chains and the globalization of domestic labour (e.g. Ehrenreich and Hochschild, 2002). One issue raised by that literature has been the way in which the globalized service sector replicates colonial histories and uneven relations between different geopolitical spaces. Conventionally described in terms of the global North and the global South, with an emphasis on the exploitation of the global South by the global North, this binarism has gradually been succeeded by a recognition that inequalities extend beyond the North–​South dynamic to intra-​country

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differences (e.g. women from rural areas having to migrate to urban areas within their own countries to offer their embodied services in the interests of their own and their families’ survival) but also to different migration flows, from Vietnam to China, for example, or from Indonesia to the Arab peninsula. Here a certain ‘availability’ of bodies to provide bodily labour is key. Altogether, the combination of changes in biotechnologization, the rise of social media and of the service sector, together with a neo-​liberal regime of encouragement to see the self as a project, to treat opportunities for seeking bodily interventions as forms of empowerment and sources of new forms of equality, has encouraged many people to seek such interventions. Such changes of opportunity in bodily interventions, be this around fertility or around gender identity, have also gone hand in hand with greater and changing regulations around these practices, both within countries and across countries. Michel Foucault (1977, 2002, 2008) has shown, as Chapter 2 in this volume by Doris Leibetseder on ‘Bioprecarity as categorical framing’ elucidates, how state regulation through categorization serves as a means to structure the population in ways that marginalize certain groups while preferencializing others. Such structurations are not neutral. They cast some people into positions in which help and support are not readily available to them while others get ready access. The well-​known so-​called ‘postcode’ lottery in the UK, which signifies that medical treatment opportunities depend on where you live, is but one example of this. Historically, eugenicist categorizations that are based on ascribed bodily particularities have served to marginalize and demonize some people, such as ethnic minorities like the Sámis in Sweden, or to remove permanently reproductive possibilities for people categorized as disabled or transgender, as still occurs in some countries in Europe today (see Chapter 12 by Julian Honkasalo). Bodily regulation involves legal and medical regimes, and state regulation, but also cultural prescriptions and norms, which structure understandings of what a body can and/​or should do or be. These different regulatory regimes do not necessarily map readily on to each other or on to the bodies of those who seek or provide interventions as we shall discuss below. BODILY OWNERSHIP AND AGENCY:  INTIMATE LABOURS In the process of advancing biotechnologization, bodies have become commodities, put to work through intimate labour. This labour can take many forms. Historically and still today in certain countries, it may have meant having to perform a specific identity in order to be accepted as a potential trans patient, or having to expose your body to medical scrutiny for

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eugenicist categorization purposes. In contemporary cultures it means that sperm donors, for example, have to put up with intimate genital examinations and masturbate in the semi-​public space of a fertility clinic to provide sperm or that a surrogate has to nurture a foetus in her womb for other people. Intimate labour thus extends to both those seeking bodily interventions and those providing services for that purpose. This is a complex situation in which questions of bodily ownership and agency play an important role. As Chapter 6 by Elina Nilsson shows, the Thai surrogates she spoke to had no say in issues that affected their bodies and selves immediately, such as how many foetuses would be implanted in their wombs, who the prospective parents of the foetuses they carried were, etc. In undertaking this labour the surrogates took on considerable bodily and other risks. Once they had agreed to be surrogates, they effectively lost agency and control over their bodies. Intimate labour thus involves (often intentionally hidden) costs to the labourer. Here the exploitability of bodies from countries and regions that are materially disadvantaged becomes very evident. Intimate labour also involves diverse regulations, often contradictory, regarding, for example, who can access fertility treatment and who can provide it. In these contexts certain social groups are almost always disadvantaged in some way, in particular if they do not represent the social norm of the heterosexual, nuclear family. Trans and queer people, for instance, almost always confront obstacles and difficulties in trying to make kin, whether this be in relation to their own body (e.g. if and under what circumstances they can reproduce) or in getting assistance from donors and surrogates. In each case bodily vulnerabilization or bioprecarity is at play, for instance around the question whether or not trans people are allowed to freeze their own gametes or the issue of how a surrogate is treated in terms of her work conditions. BIOPRECARITY AND VULNERABILITY Bioprecarity, as we discuss it in this volume, and vulnerability are interrelated, as we explain below. However, we think bioprecarity is a more useful analytical tool, as we elucidate here. To do so we briefly go back to the academic and activist origins of the term precarity before linking it to bios, as we do here. In Precarious Life (2004), Judith Butler explains the notion of precariousness in terms of the concept of vulnerability, which, according to her, constitutes a basic human condition that allows us to make common ground in a potential political community. According to Butler, precariousness is an ontological dimension of lives and bodies (Lorey, 2012: 25). Our volume is specifically concerned

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with precarious bodies that engage intimate labour, i.e. those who seek the help of others in relation to body work, and with those who do that labour. We also focus on bodies that are vulnerable because their opportunities to undertake or resist bodily interventions depend on state regulations. For example the distribution of the genetic reproductive material of queer, transgender, intersex and differently abled people is often not wanted, not legalized or depends on the goodwill of medical personnel. However, bodily vulnerability, or bioprecarity, is not a condition or ontological state of a particular group of people. Rather, the possibility of becoming the object of punitive or restrictive state legislation or of being bodily impaired through accident, war or bodily degeneration, for example, is a persistent possibility in everybody’s life. This is evident in the selective persecution of particular ethnic groups at different points in time, for example. The repeated intermittent pogroms against Jews over many centuries in diverse European countries testify to this. At times closely integrated into the communities in which they lived, they would nonetheless find themselves the objects of persecution on spurious grounds again and again. At present such persecution is on the rise again and in many parts of the world. We see it in the anti-​Semitism taking renewed hold in Europe, in the ways in which minorities are persecuted in China and in Burma or Myanmar. In this sense bioprecarity, the embodied self as threatened in its somatic ontology, is an integral aspect of every human’s life, which may be more or less evident at a given point in time. However, there is still a crucial difference between precariousness/​ vulnerability and precarity. In Frames of War (2009) Butler introduces ‘precarity’, emphasizing its political aspect. She makes clear that given an overarching precarity some people are made more precarious than others (meaning that the everyday vulnerability of a certain groups is enhanced). However, she also suggests that the analysis of precarity can serve as a transformative political tool, since there are interdependencies among the people living in precarity (Butler, 2009: 61; Puar, 2012: 166). Precarity as a term has been present in political-​theoretical and activist discourses for several decades now. It goes back to the labour movements in 1970s France. Then in 2001, the EuroMayDay began in Milan and in their manifesto, people in precarity termed themselves ‘precariat’  –​in an evocation of Marx’s ‘proletariat’ (Lorey, 2012: 107). In 2002, a feminist activist group in Madrid calling itself ‘Precarias a la deriva’ (Precarious Women Adrift) stated: It is complicated for us to express ourselves, to define ourselves from the common ground of precariousness: a precariousness which can do without

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a clear collective identity in which to simplify and defend itself, but in which some kind of coming together is urgent. We need to communicate the lack and the excess of our work and life situations in order to escape the neoliberal fragmentation that separates, debilitates and turns us into victims of fear, exploitation, or the egotism of ‘each one for herself ’. Above all, we want to enable the collective construction of other life possibilities through the construction of a shared and creative struggle. (Precarias a la deriva, 2004: n.p.)

Our concept of bioprecarity follows on from their intent to communicate their precarious work and life positions, as we analyse different situations dealing with bioprecarity and how those thus precarized handle their precarious situations. The concept of the precariat became widely known during the massive protests in France in the winter of 2006 against the dismantling of the French and European welfare states (LaVaque-​Manty, 2009). Guy Standing (2011) popularized the term to describe new labour conditions (see Griffin, Chapter 1 this volume). Part of these new labour conditions is the use of, and investment in, actual bodies as projects of self or for others. This is where the prefix ‘bio’ becomes important because it is the relation between precarious employment and embodied labour that carries with it risks for the ‘mindbody’ (Ehrenreich, 2018:  xiii), that is for the somatic entity that is the body as much as for its associated (un)conscious self. Bioprecarity articulates the interrelation between body or embodied self and precarity. Here precarity is not only a matter of precarity of employment but of the embodied self as it is employed, most obviously perhaps, in intimate labour. ‘Bio’ thus stakes a material terrain in this volume –​that of the body. Its use in terms such as biopower and biopolitics simultaneously points to the important fact that the body put to work and precarized through that process is also a political entity, the subject and object of politics and policies. Esposito (2008: 84), discussing Nietzsche’s work, summarizes it thus:  ‘No politics exists other than that of bodies, conducted on bodies, through bodies’. Given this emphasis on the body we suggest that bioprecarity is an appropriate term to express the particular conditions of life and labour we seek to explore in this volume. In this context we also make a distinction between the notion of vulnerability and bioprecarity. Bioprecarity serves as an analytical and political tool: first, in pointing out that and where certain people and their bodies are made more vulnerable than others; and second, in highlighting interdependencies of bioprecarious people. These interdependencies can be used as a common ground for transformative politics. People living in precarity have no common identity but common experiences as they have to take on diverse professional, gendered, sexual, ethnicized positions and statuses at

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the same time or successively (Lorey, 2010). Therefore, as Butler and Lorey conclude (Butler, 2009:  18–​33; Lorey, 2011), only an ontology that takes these interdependences into account, and not an ontology of individualism, is capable of recognizing and acknowledging what we term bioprecarity, and thereby suggesting the possibility of change. POWER AND UNEQUAL RELATIONS IN THE SEEKING AND PROVIDING OF HELP AROUND BODILY INTERVENTION Bioprecarity then points to the unequal relations that characterize interactions around bodily interventions. Nowhere is this more obvious than in relation to the humanitarian medical missions discussed by Nancy Worthington in Chapter  8 of this volume. Here the limits of altruism become very evident as humanitarian missions attend to those in need, in this instance, children with heart conditions, in a one-​off fashion that largely ignores the contexts in which the children that are operated on have to continue to survive following the intervention. These conditions may mean that they ultimately do not survive because there is no appropriate aftercare. The same unequal relations are at play when Sámis are made to submit to being categorized through having their bodies exposed and measured, or when lesbians who seek help when they experience intimate partner violence, cannot get appropriate support because the dominant model of intimate partner violence involves a man being violent towards a woman, and when the lesbian, gay, bisexual, transgender and queer (LGBTQ) community has difficulty recognizing violence within that community. They are also at play when same-​sex couples struggle with their status as parents around their children, not least if one of them has a ‘biological’ connection to that child while the other has predominantly a social one, as is discussed in Chapter  3 by Ulrika Dahl. And they are at play when states refuse to legally acknowledge the parent status of same-​sex couples in relation to a child adopted from or created abroad. Here unequal relations emerge on multiple levels: between macro-​level authorities such as the state and legislation relative to the individual; at the meso level between organizations such as clinics or communities (of practice) and the individual; and finally, between individuals in various kinds of relation to each other. These unequal relations belie the rhetoric of agency and choice that has become so prominent in neo-​liberal regimes. The supposed responsibilization of the self or the individual that goes with this has its limits; the empirical data discussed in this volume clearly show this.

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THE MEANING AND RISE OF BIOPRECARITY AND THE BIOPRECARIAT What these data indicate in fact is the rise of bioprecarity and the bioprecariat.1 Bioprecarity is a new word in our vocabulary, though as Part I of this book makes clear, it has antecedents in a number of theoretical, sociopolitical, cultural and economic concerns. Chapters 1 and 2 elucidate this more fully. Briefly, here, the term bioprecarity conjoins three concerns: the biopolitics described by Michel Foucault, which sees the state using, ordering or categorizing the people in ways that enable distinctions, differences and inequalities between groups of people to emerge and become legitimate (e.g. why some people can have access to certain treatments but not others); the notion of bios as referring to the bodily self on the basis of which distinctions are made and discrimination practised; and finally, the ways in which discriminations enacted through and on the body render people vulnerable, bodily and in other ways. This rendering vulnerable produces certain groups of people as a bioprecariat, people who are made vulnerable because of their bodies and embodiment. This applies to ethnic minorities as much as to those whose bodies are exploited in intimate labour and those classified as falling outside dominant categories because they do not respond to the logics of state or other classificatory regimes, e.g. medical ones. The analyses of bioprecarity in this volume highlight how bioprecarious situations arise through certain categorizations and challenge the uses to which such categorization is put. Biotechnologization, globalization, the rapid expansion of social media, the increasing commodification of the body and body parts, the rise of the service sector industry and the construction of the self under neo-​liberal regimes as self-​responsible, autonomous, enticed and required to make choices, have all led to growing numbers of people who are precarized in their somatic selves. However, Chapters  11 and 12 in Part V of this book that look at eugenicist histories and at the co-​construction of trans patients in Swedish clinics in the mid-​twentieth century, also show that such precarization is not new and has affected ethnic minority groups in major ways. Countering such bioprecarity is not an easy matter, as our volume also shows. It requires intervention –​and often from those suffering bioprecarity. The lived experiences of lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) families, for example, and new forms of kin-​making push at the boundaries of what is considered ‘the normal family’. Advances in biotechnologization mean that definitions of ‘normal family’ come under pressure, both personally in terms of the roles individuals in divergent families may have but also in terms of the state-​sponsored documentation

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necessary to legitimate parental status. In a related manner, Chapter 11 by Katarian Pirak Sikku and Gabriele Griffin asks what it means to challenge bioprecarizing classifications by transforming them through art work. To put it another way, how might one challenge the bioprecarities that are emerging here? And what happens when the sides involved, or opposing forces, are not necessarily structured in quite that straightforward an oppositional or binary manner? In Chapter  12 by Julian Honkasalo, for example, it is clear that trans patients and doctors in Sweden co-​constituted trans identities, mutually reinforcing stereotypes and roles, thus enabling the delineation of the identities to be performed by potential trans patients. This chapter reveals certain interdependencies that emerge in unequal power relations –​which is why they are called relations. At the point of seeking and providing help interdependencies become evident and these need to be negotiated. But different groups of people have diverse degrees of input into these negotiations –​they do not occur on a level playing field. This is evident throughout this volume. STRUCTURE OF THE VOLUME This volume is divided into five parts. Part I centres on theorizations of bioprecarity. In Chapter  1, Gabriele Griffin elaborates the notion of bioprecarity as it is utilized in this volume by drawing on three theoretical concepts that have not been ‘thought together’ before. They are intimate labour as discussed in Boris and Parreñas’ work (2010); bios, as understood in Michel Foucault’s writings (2008); and precarity as originally developed in France in the 1970s, then taken up by Judith Butler (2004) in the context of war, terrorism, survival and grievable lives and popularized in the relation to new forms of labour by Guy Standing (2011). The chapter develops these three concepts in the context of bodily interventions prompted by opportunities for bodily labour, meaning labour on and with the body, in order to investigate bioprecarity, a new form of vulnerability that is associated with providing and seeking intimate bodily labour in cross-​ cultural contexts. Chapter 2 by Doris Leibetseder focuses on bioprecarity in terms of two dimensions of Michel Foucault’s biopolitics, categorization and subjectivization (Foucault 1977, 1982, 2002, 2008). With examples drawn from the precarious lives of trans people, especially those of colour, Chapter 2 engages with the conceptual arguments of Foucault, Judith Butler (1997, 2009) and Kimberlé Crenshaw (1991) regarding the relation between categorical framing and bioprecarity. The chapter explores how subjects as bodily selves are bound into population control and therefore normalized

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and regulated (Spade, 2011), how norms and regulations create bioprecarious situations for these bodily selves (Butler and Athanasiou, 2013), the role of intersectionality (Crenshaw, 1991) in creating such precarious positions and, finally, how such bioprecarity might be avoided. Following on from these theoretical elaborations, Part II focuses on ‘The precarity in the making of kin’. Here the contributors explore how bioprecarity structures kin-​making both through how kin are categorized as such and through associated medical, legal and sociocultural processes. In Chapter 3 Ulrika Dahl argues that different forms of reproductive labour create different precarities within LGBTQ parenting and kin-​making in contemporary Sweden. She focuses on the precarization of biological labour in a setting where intimate labour is the foundation for kin-​making and where the necessary making, gestating and breastfeeding of a child is downplayed in relation to parenthood status. Drawing on ethnographic research, the chapter also illuminates how ‘biology’ produces strong feelings, even in a kinship structure that departs from the notion of intent and intimate labour as equally shared matters. Framing queer reproduction as both a biopolitical question and a question of gender labour the chapter then discusses how gendered and racialized ideas of parenthood and kinship are reproduced and reworked in imaginaries of LGBTQ parenthood. Chapter 4 by Doris Leibetseder takes up the issue of ‘Precarious bodily performances in queer and transgender reproduction with ART’ to explore the use of assisted reproductive technology (ART) by queer and transgender people and how they have to perform particular bodily and intimate selves in the processes of seeking bodily interventions in relation to their fertility. She argues that the bioprecarity of queer and transgender people is produced by the enactment of certain kinds of categorical framing (Foucault 1966, 1976; Somerville, 1995) in the laws regulating ART. Thus prohibitive laws regarding access to ART in some states are often circumvented by queer and trans people through going abroad for such treatment. This in turn creates its own precarities. This chapter argues that queer and trans people’s bioprecarity inter alia results from the intimate labour queer and transgender people have to undertake to overcome prohibitive laws and hetero-​and cisnormative medical institutions as shown in studies about trans people’s experiences with ART (e.g. Armuand et al., 2017; James-​Abra et al., 2015). In Chapter 5 Petra Nordqvist specifically focuses on lesbian experiences in kin-​making. Culturally speaking in the context of Euro-​American societies, being related as kin is perceived as a self-​evident, given and ‘fixed’ relationship. Reproduction lies at the heart of making such relationships; the birth of a biological child is conceptualized as the beginning of the next generation in a long line of generations going back through time. However,

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Nordqvist, like Leibetseder, suggests that ‘making kin’ is harder for some than for others. Based on original empirical data (cross-​ generational interviews), this chapter investigates how kin relation comes into being in relationships between lesbian daughters and their parents in the context of childbirth through donor insemination. The chapter looks specifically at the role of genes, biology and pregnancy in shaping and making kinship affinities in such family contexts. It highlights that the making of the next generation might, for some, be a bioprecarious and uncertain pursuit, rather than a given, self-​evident process. In Part III of this volume, ‘Bioprecarity and bodies as pieces’, we consider how the construction of body parts as separate from those whose bodies they ‘belong’ to in the process of the intimate labour of providing offspring for others creates bioprecarities for donors and surrogates, as well as for those created through this process. In Chapter  6 Elina Nilsson discusses the bioprecarities involved in being a surrogate in Thailand. She explores the intimate labour performed by surrogate mothers in the globalized fertility market. Using their bodies, wombs, blood and sweat, these surrogate mothers engage in a highly embodied labour (Pande, 2014). At the same time, the non-​genetic relation between the foetus and the surrogate is used by clients and clinics to reduce the woman to a ‘gestational carrier’ and a ‘mere vessel’ (Pande, 2010). By drawing on interviews with Thai women engaged in transnational commercial surrogacy, this chapter highlights the surrogate mothers’ precarious and vulnerable position in a process of cross-​ cultural biotechnological intervention with inherently differential power relations among the stakeholders. Chapter 7 by Gabriele Griffin on sperm donation centres on the sperm donor as stakeholder and the ways in which men negotiate that process. Much research on in vitro fertilization (IVF), assisted reproduction and gamete donation has centred on the medical, legal and sociocultural processes and meanings involved. Here, quite frequently, little attention is paid to the donors themselves other than in the context of their selection. However, donation is a corporeal process in which body parts are produced and given or sold (Mohr, 2018). This chapter analyses the bioprecarities that derive from the process of sperm donation. It draws on empirical online and social media materials, as well as other texts, in which men who donate sperm for the purposes of assisted reproduction articulate their sense of the meaning of this process. Further, the chapter considers responses to the revelation of sperm donation from people both known and unknown to the donor. These responses show how sperm donation as a form of intimate labour in which a man also parts with somatic material produced by his body, and involving negotiated journeys, is managed and talked about. The responses to sperm donation indicate deeply gendered views of reproductive

 13

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13

intimate labour in which a sense of bioprecarity masks strongly gendered views of sexuality, intimacy and reproduction. A different form of bioprecarity is at stake in Chapter  8 by Nancy Worthington on ‘Bodily disrepair:  bioprecarity in the context of humanitarian surgical missions’. Here the meaning of conducting humanitarian missions to give people in crisis zones medical assistance is the focus, in particular paediatric heart surgery missions. These define an emergent, high-​ tech form of medical humanitarianism characterized by their focus not on populations in crisis (Redfield, 2013), but on broken body parts  –​in this case, damaged paediatric hearts. Comprised of specialists from the world’s most elite medical centres, mission teams make brief visits to poor countries to perform highly specialized and otherwise prohibitively expensive surgical procedures on children with few alternatives for survival. A team’s success is measured in terms of patient volume, surgical complexity and the probability of the patient being well enough to leave the hospital within thirty days. This chapter explores the forms of bioprecarity that both precede and follow mission visits and that inadvertently affect the very patients whose surgeries are publicly billed as ‘successes’. That is, as much as surgical missions aim to repair paediatric bodies in distress, they, too, produce new anxieties, uncertainties and biological vulnerabilities for patients and their families that are often visible only long after missions depart from the host country. From issues of bodies in and as parts, Part IV moves on to consider ‘Bioprecarity in the transgression of boundaries of intimacy’. Here questions of intimacy and bioprecarity relate to issues around intimacy in relationships and intimate body parts. In Chapter 9 Nicole Ovesen explores the concept of bioprecarity in the context of intimate partner violence (IPV) in LBTQ relationships by focusing on help-​seeking as a form of crossing encounters. Judith Butler discusses the body as a site of human vulnerability, emphasizing that ‘this vulnerability is always articulated differently, that it cannot be properly thought of outside a differentiated field of power and, specifically, the differential operation of norms of recognition’ (2004:  44). This differentiated field of power is evident in Eve Sedgwick’s description of invisibility sustaining the figure of the closet as the defining structure of gay oppression (1990: 71). Following this line of thought Leslie Moran and Beverly Skeggs address the need to produce ‘new visibilities’ claims for protection against violence (2004: 5). Drawing on these theorizations and on original empirical data, the chapter analyses the concept of help-​seeking as crossing encounters of intimacy, not only in the sense of the private–​ public realms, but also regarding community and cultural boundaries, as the embodied LBTQ-​victim-​survivor transgresses the cultural perceptions of victimhood when meeting help providers in an institutional context.

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Introduction

Such crossing of boundaries  –​bodily, cultural, social  –​is also evident in Chapter 10 by Malin Jordal in which circumcised women’s experiences of bioprecarity in the context of seeking clitoral reconstructive surgery in Sweden is explored. Female genital cutting (FGC), significant in marking the supposedly mature, desirable and marriageable woman in some cultures (Johansen, 2017), is today a significant phenomenon in Europe due to recent migration patterns (van Baelen et  al., 2016). Transcultural migration and societal changes create new perceptions of the body, self and identity. At the same time, new notions of bodily rights, what is perceived as legitimate claims and needs and advances in biotechnology have enabled circumcised women in some European countries to have their clitoris reconstructed (Foldés et al., 2012). Based on original empirical data in the form of interviews with FGC-​affected women, this chapter investigates how migrant women who have undergone FGC perceive their bodies and selves, how they construct and negotiate their identity within new social structures and gender norms and how they understand clitoral reconstructive surgery after FGC, in the Swedish context. Part V engages with histories of bioprecarization as these have occurred within eugenicist contexts and through its attendant categorizations. This indicates that bioprecarity as a phenomenon has a long history and that the concept might usefully be applied to past as well as present phenomena. Chapter  11 by Katarina Pirak Sikku and Gabriele Griffin on the eugenicist treatment of indigenous people, the Sámi, in Sweden analyses the long shadows cast by official categorizations of people as these come to be expressed in Pirak Sikku’s body-​centred artistic work. Using two voices, that of the artist and that of the academic, the chapter explores bioprecarity and racifying science in the context of eugenicist practices in Sweden in the early to mid-​twentieth century related to the indigenous Sámis’ treatment by Swedish race biologists. Sámis, like many indigenous people or people who at different points in history and across diverse countries/​cultures, have been deemed inferior, have been subjected to racist scientific research, such as the measuring of their bodies for eugenicist purposes and the taking of naked pictures of even small schoolchildren. Here the body becomes an object of the colonizing gaze. That gaze produces bioprecarity through not only refusing the bodily integrity, autonomy and agency of those who are thus objectified, but also through gesturing towards the notion that some bodies occupy different orders from others. While the artist’s work is concerned with reappropriating the body of those rendered precarious by eugenicist biopolitics, that process itself draws her into questions of whether and how such reappropriation is possible. Finally, in Chapter  12, Julian Honkasalo examines the paradoxical interplay of humanist and eugenic ideology underlying early Swedish psychiatric

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15

and medical studies on transgender persons. Bioprecarity is here theorized as generated through a disciplining double-​bind of inclusion and exclusion. The chapter conceptualizes transgender patients in psychiatric institutions in the 1960s as persons who exchange their intimate labour in return for receiving medical care, and a promise to be viewed as legally, politically and socially intelligible. Drawing on Foucault, the chapter contends that disciplinary power operates through invasive examinations, such as anatomical and intelligence measurements, genital examinations, the recording of personal history, family history as well as confessions of fantasies, desires and fears. And yet, the patients are not merely passive subjects of power/​knowledge. Rather, they actively engage in intimate labour by producing raw material and data for medical studies. Although intimate labour is usually theorized in the context of care work, sex work and domestic work (e.g. Parreñas, 2001), this chapter expands the notion of intimacy to include the labour of non-​normative, superfluous bodies. As the adjective ‘intimate’ originates in the Latin verb intimare (to make known) and the noun intimus (inmost, innermost, deepest), the term is particularly suitable for problematizing the interplay between the transgender patient’s own agency and the normalizing power of medical research. Drawing on archival material, the chapter argues that this interplay generated the scientific expert knowledge, circulated and reiterated in public, official investigations that functioned as the basis for the world’s first legislation on the legal status of ‘transsexuals’ and simultaneously the first state-​enforced sterilization legislation of transgender persons in 1972. Chapter 12 emphasizes that the intimate labour of transgender patients is the condition for the possibility of both their own self-​actualization as well as for the state’s biopolitical, administrative project of documenting, quantifying, regulating, circulating and reproducing the binary category of gender. It offers an account that focuses on the patients’ agency in the midst of normalizing power. Such a perspective is crucial, as it has significant contemporary implications for understanding which transgender lives are rendered intelligible and worthy of inclusion today and which ones are not. Bioprecarity, then, has long histories through the emergence of institutional classification systems for people. These, as the last two chapters show, have always been linked to bodies –​sexed, raced, gendered, classed bodies –​that have been enticed and regulated through those processes. CONCLUSIONS The somatic and emotional work involved in intimate labour produces bioprecarity, the rendering vulnerable of groups of people and individuals through the ways in which their bodies and lives are put to work. Discussions

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of biotechnologization have largely involved the celebration of biovalue (Rose, 2007) rather than the counting of biocosts. But, as the chapters in this volume demonstrate, both are equally involved and in complex ways. This is well exemplified in Chapters  9 and 12, but also in other chapters. In Chapter 9, Ovesen’s interviewees had to bear the costs of a bioprecarity brought about by their status as lesbian or queer women, involved in violent relationships that they find hard to name and seek redress against because they want to protect their own communities against violence from outside, but also because those communities do not readily recognize violence within them. In Chapter 12, Honkasalo’s trans people both have to establish their identity as a way of gaining access to body modification procedures and at the same time negotiate the stereotyping that comes with this. These and other chapters in different ways explore some of the issues involved in seeking visibility, in trying to establish recognition through engaging with identity-​based categories that offer opportunities for establishing an intelligible self while at the same time bringing with it the drawbacks of such categorization. The Thai surrogates that Elina Nilsson interviewed in Chapter 6 and the sperm donors Gabriele Griffin discusses in Chapter 7 may derive financial benefits from putting (parts of ) their bodies to intimate labour but the resulting costs in terms of somatic regimes and biosocial subjectivation (Mohr, 2018) produce a bioprecarity that these intimate labourers may not have foreseen and are unlikely to welcome. However, not everybody who engages in, or is made to engage in, intimate labour, profits from that work. Some simply count the cost. An obvious example are the Sámi, discussed in Chapter 11, precarized through eugenicist practices and without recourse to redress at the time. Here the power imbalances that enable such biocosts become only too apparent; there are no level playing fields for those who are bioprecarized. The children benefitting from humanitarian medical interventions have no say in the conditions of their lives pre-​or post-​operatively. Good intent, as Chapter 8 shows, is not enough. Further, as Chapter 4 on queer and trans people’s access to ART and Chapter 3 on parenting in queer families indicate, good intent needs to translate into robust sustainable measures at legal, medical and sociocultural as well as economic levels to counter bioprecarity through inclusive processes and procedures. NOTE 1 During her research stay at UC Berkeley (2013–​ 16) Leibetseder had several conversations with Charis Thompson about her Marie-​Skłodowska-​Curie-​Action (MSCA) project proposal on queer and trans reproduction. Thompson pointed

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17

out she could focus on the bioprecariat involved in these assisted technologies. She took this on and used it in a previous funding application.

REFERENCES Armuand, G., Dhejne, C., Olofsson, J. I. and Rodriguez-​Wallberg, K. A. (2017) ‘Transgender men’s experiences of fertility preservation:  A qualitative study’, Human Reproduction 32(2): 383–​90. Barad, K. (2007) Meeting the Universe Halfway:  Quantum Physics and the Entanglement of Matter and Meaning. Durham, NC: Duke University Press. Boris, E. and Parreñas, R. S. (eds) (2010) Intimate Labors:  Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press. Boston Women’s Health Collective (1970) Our Bodies, Ourselves. Boston:  New England Free Press. Butler, J. (1997) The Psychic Life of Power:  Theories in Subjection. Palo Alto, CA: Stanford University Press. Butler, J. (2004) Precarious Life: The Powers of Mourning and Violence. London: Verso. Butler, J. (2009) Frames of War: When Is Life Grievable? London: Verso. Butler, J. and Athanasiou, A. (2013) Dispossession: The Performative in the Political. Cambridge, UK: Polity Press. Crenshaw, K. (1991) ‘Mapping the margins: Intersectionality, identity politics, and violence against women of color’, Stanford Law Review 43(6): 1241–​99. Ehrenreich. B. (2018) Natural Causes:  Life, Death and the Illusion of Control. London: Granta Books. Ehrenreich, B. and Hochschild, A. R. (eds) (2002) Global Woman: Nannies, Maids and Sex Workers in the New Economy. London: Granta Books. Esposito, R. (2008) Bios:  Biopolitics and Philosophy. Minneapolis:  University of Minnesota Press. Foldès, P., Cuzin, B. and Andro, A. (2012) ‘Reconstructive surgery after female genital mutilation: A prospective cohort study’, Lancet 380(9837): 134–​41. Foucault, M. (1966) The Order of Things:  An Archaeology of the Human Sciences. Paris: Editions Gallimard. Foucault, M. (1976) The History of Sexuality. Paris: Editions Gallimard. Foucault, M. (1977) Discipline and Punish:  The Birth of the Prison. New  York: Vintage-​Random  House. Foucault, M. (1982) ‘The subject and power’, in Dreyfus, H. L. and Rabinow, P. (eds) Michel Foucault:  Beyond Hermeneutics and Structuralism. Brighton, UK: Harvester, pp. 208–​26. Foucault, M. (2002) The Order of Things:  An Archaeology of Human Sciences. New York: Routledge. Foucault, M. (2003) Society Must Be Defended. London: Penguin Books. Foucault, M. (2008) The Birth of Biopolitics: Lectures at the Collège de France 1978–​ 79, ed. Senellart, M. Basingstoke, UK: Palgrave Macmillan. James-​Abra, S., Tarasoff, L. A., Green, D., Epstein, R., Anderson, S., Marvel, S., Steele, L. S. and Ross, L. E. (2015) ‘Trans people’s experiences with assisted reproduction services: A qualitative study’, Human Reproduction 30(6): 1365–​74.

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Johansen, R. E. (2017) ‘Virility, pleasure and female genital mutilation/​cutting:  A qualitative study of perceptions and experiences of medicalized defibulation among Somali and Sudanese migrants in Norway’, Reproductive Health 14(1): 2–​12. LaVaque-​Manty, M. (2009) ‘Finding theoretical concepts in the real world:  The case of the precariat’, in de Bruin, B. and Zurn, C. F. (eds) New Waves in Political Philosophy. Basingstoke, UK: Palgrave, pp. 105–​24. Lorey, I. (2010) ‘Becoming common:  Precarization as political constituting’, e-​flux Journal 17. Available at www.e-​flux.com/​journal/​17/​67385/​becoming-​common-​ precarization-​as-​political-​constituting (accessed 6 November 2016). Lorey, I. (2011) Figuren des Immunen:  Elemente einer politischen Theorie. Zürich: Diaphanes. Lorey, I. (2012) Die Regierung der Prekären. Vienna: Turia + Kant. Mohr, S. (2018) Being a Sperm Donor:  Masculinity, Sexuality and Biosociality in Denmark. New York: Berghahn Books. Moran, L. J. and Skeggs, B. (2004) Sexuality and the Politics of Violence and Safety. London: Routledge. Orbach, S. (1978) Fat Is a Feminist Issue. New York: Paddington Press. Pande, A. (2010) ‘Commercial surrogacy in India: Manufacturing a perfect mother-​ worker’, Signs 35(4): 969–​92. Pande, A. (2014) Wombs in Labor: Transnational Commercial Surrogacy in India. New York: Columbia University Press. Parreñas, R. S. (2001) Servants of Globalization: Women, Migration, and Domestic Work. Palo Alto, CA: Stanford University Press. Precarias a la deriva. (2004) ‘Adrift through the circuits of feminized precarious work’, April. Available at http://​eipcp.net/​transversal/​0704/​precarias1/​en. (accessed 6 November 2016). Puar, J. (2012) ‘Precarity talk: A virtual roundtable with Lauren Berlant, Judith Butler, Bojana Cvejić, Isabell Lorey, Jasbir Puar, and Ana Vujanović’, TDR: The Drama Review 56(4): 163–​77. Redfield, P. (2013) Life in Crisis:  The Ethical Journey of Doctors Without Borders. Berkeley: University of California Press. Rose, N. (2007) The Politics of Life Itself: Biomedicine, Power and Subjectivity in the Twenty-​First Century. Princeton, NJ: Princeton University Press. Sedgwick, E. K. (1990) Epistemology of the Closet. Berkeley: University of California Press. Somerville, S. (1995) ‘Scientific racism and the emergence of the homosexual body’, Journal of the History of Sexuality 5(2): 243–​66. Spade, D. (2011) Normal Life: Administrative Violence, Critical Trans Politics, and the Limits of Law. New York: South End Press. Standing, G. (2011) The Precariat: The New Dangerous Class. London: Bloomsbury. van Baelen, L., Ortensi, L. and Leye, E. (2016) ‘Estimates of first-​generation women and girls with female genital mutilation in the European Union, Norway and Switzerland’, European Journal of Contraception and Reproductive Health Care 21(6): 474–​82.

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Part I

THEORIZING BIOPRECARITY AND THE BODY

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1

INTIMATE LABOUR AND BIOPRECARITY G abr ie l e Gr iffi n

INTRODUCTION: UNDERSTANDING BIOPRECARITY

T

his chapter elaborates the notion of bioprecarity as it is utilized in this volume by drawing on three theoretical concepts that have not been ‘thought together’ before. They are intimate labour as discussed in Boris and Parreñas’ work (2010); bios, as understood in Michel Foucault’s writings (2008); and precarity as originally developed in France in the 1970s, then taken up by Judith Butler (2004) in the context of war, terrorism, survival and grievable lives and popularized in relation to new forms of labour by Guy Standing (2011). The chapter develops these three concepts in the context of bodily interventions prompted by opportunities for bodily labour, meaning labour on and with the body, in order to investigate bioprecarity, a form of vulnerability that is associated with providing and seeking intimate bodily labour, not least in cross-​cultural contexts. While separating out intimate labour, bios and precarity for analytical purposes, we recognize and argue that they are deeply imbricated. Bioprecarity conjoins the notion of bios as derived from Michel Foucault’s (2004) work on biopower and biopolitics and precarity as this has been developed in the works of Judith Butler (2004) and Guy Standing (2011). Foucault’s writings on the topic, as elaborated in the section on ‘Thinking about bios’ later in the chapter, concern the governance or regulation of life (= bios) at individual and institutional levels. This regulation structures subject positions in differential and discriminatory fashion. Such subject positions are entangled with the bodies of those they seek to regulate since individuals as people with certain bodily traits are regulated according to those bodily specificities. Foucault (2004:  249) talks of two technologies

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of power in this context: ‘Both technologies are obviously technologies of the body, but one is a technology in which the body is individualized as an organism endowed with capacities, while the other is a technology in which bodies are replaced by general biological processes’. Biological processes such as sexuality, fertility, health, etc. become the objects of regulation or control through regimes and institutions such as medicine. These categorize individuals –​as healthy or ill, for ­example –​and thus exercise regulatory force. This force produces norms that ‘can be applied to the body one wishes to discipline and a population one wishes to regularize’ (Foucault, 2004: 253). In this volume we are interested in the meaning of bios both as it relates to the Foucauldian idea of biopolitics and biopower, and in bios as it references ‘life’, ‘bare life’ or life itself (Rose, 2009). But we conjoin this with precarity since we want to foreground the fact that the regulation of bodies and of life brings with it certain precarities. Precarity, as we discuss it below, has its roots in labour politics and refers to the casualization and generally rendering insecure of workers and their livelihoods in capitalist cultures. This is important for us because in this volume we relate bioprecarity specifically to one form of casualized and insecure labour: intimate labour. We are interested in particular forms of intimate labour, as detailed in the next section of this chapter, and in how those who engage in and benefit from intimate labour, are put into and find themselves in bioprecarious positions. We interpret bioprecarity as a form of vulnerability, vulnerability in one’s embodied self as this is used in intimate labour. The demand on sex workers to perform sex acts they are not willing to undertake and the threat that they may be bodily harmed or not paid if they do not comply constitutes such bioprecarity. The appeal to ‘being needed’ from nannies’, carers’ and domestic workers’ employers to their workers, which pressurizes such workers to put in unreasonably long hours, constitutes another example of such bioprecarity. That embodied self has both somatic and psychosocial components. As we show below, sex workers as much as carers, for example, are exposed to bioprecarity through the manner in which they have to put their bodies to work. INTIMATE LABOUR Intimate labour and bioprecarity, the latter a concept to be developed theoretically in this and the next chapter, are closely intertwined. In their path-​ breaking anthology Intimate Labors: Cultures, Technologies, and the Politics of Care Eileen Boris and Rhacel Salazar Parreñas (2010) discuss the notion of intimate labour in relation to three particular kinds of work that are normally treated discretely but have become increasingly co-​discussed:  sex

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work, care work and domestic work. They define intimate labour as ‘tending to the intimate needs of individuals inside and outside their home’, where intimate needs include ‘sexual gratification but also our bodily upkeep, care for loved ones, creating and sustaining social and emotional ties, and health and hygiene maintenance’ (Boris and Parreñas, 2010: 5). This tending to the intimate needs of individuals is what binds together the three work arenas that Boris and Parreñas’ volume addresses. It involves, importantly, corporeal as well as psychosocial dimensions, both for those conducting intimate labour and for those on the receiving end. This is evident in the boundary work done by sex workers, for example, to secure a distinction, albeit a precarious one, between their private and their professional selves. Elizabeth Bernstein (2010: 153–​4), for example, cites a Swedish street prostitute who said: ‘If you work like this, you need to have unseen borders you don’t let people trespass. If you do [let them trespass], then you start to drink or use drugs … There are things that you allow and … things that you won’t do for money. There has to be a private place inside you.’ Sex work involves intimate bodily labour for the worker as well as the client. From the sex worker’s perspective, who acts here in a professional capacity, that corporeal intimacy has to be off-​set by ‘unseen borders’, possibly both bodily ones (such as not allowing mouth-​on-​mouth kissing) and psychological ones that maintain the worker in the worker and the client in the client position, relative to any other kind of relational situation. In the quote above the maintenance of borders between self and client is articulated as crucial to the maintenance of the self. That maintenance of the self is tied to the notion of ‘a private place’, a spatialized sense of inviolability. Violation, the occurrence of trespass, is also explicitly and directly connected by the sex worker to the production of self-​harm in the form of drinking alcohol or taking drugs. Negotiating boundaries with clients is evidently a tricky process; a lack of boundaries is experienced as a violation of self that in turn promotes self-​violation. Intimate labour in the form of sex work, but not only in that form, renders the labourer vulnerable to the client and to self-​exploitation. This is because of the primary dyadic scene that work entails, because of the intimate, often bodily proximity between worker and client and because of the limited regulation or unregulated nature of the work. Vulnerability is here corporeal but also psychosocial, created in the interpersonal exchange between worker and client where being vulnerable to the client also entails becoming vulnerable to the self. The worker’s vulnerability may be matched by that of the client who is also potentially vulnerable to exploitation and injury, for instance in the context of institutional elder care where client abuse has been widely documented (see Aitken and Griffin, 1996). It is the combination of bodily engagement and one-​on-​one labour that is largely unregulated in

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intimate exchange, which promotes what we term bioprecarity through the attendant vulnerabilization of the worker. In dictionary definitions of intimacy such as that of the Oxford English Dictionary the word is consistently linked to notions of the ‘innermost’, closeness, the personal, the private, the familiar, the informal but also in respect of sexual relations, sometimes described as ‘illicit’. These notions spatialize intimacy both geo-​ socially and metaphorically, as involving engagement with others and proximity. Such proximity is, however, not necessarily associated with direct body contact: communication technologies and social media allow intimacy through the sharing of virtual space as Kalini Vora (2010) discusses in relation to long-​distance call centre workers. It is further a proximity that is not neutral –​it is invested, as Lauren Berlant (2000), for example, makes clear, with fantasy, attachment, optimism and emotion. Intimacy is hence associated with a range of emotions and dispositions, and one question to be addressed below is what happens to these associations when intimacy becomes linked with labour. Conventionally associated with the private sphere, a sphere characterized in modernity by being unregulated, beyond the state and individualized, intimacy has co-​occupied the personal and domestic sphere, supposedly separate from the public, collective (state-​)regulated domain. But, not least since Anthony Giddens’ (1992) The Transformation of Intimacy: Sexuality, Love and Eroticism in Modern Societies has that idea of intimacy been called into question. A series of processes ranging from women’s increasing participation in the workforce globally, the dramatic expansion of the service sector, globalization itself and the mobilities this has engendered, technologization in all its forms, the gradual neo-​liberalization of Western and non-​ Western societies alike with its emphasis on individualism, choice, marketization, monetarization and the decline of welfare, have all contributed to shifts in the labour market that have resulted in conventional binaries such as private/​intimate–​public, regulated–​unregulated, close–​ distant, being challenged and indeed collapsing into each other. Obvious manifestations of this are phenomena such as air bnb and uber, which utilize the worker’s private or privately owned space (home, car) in an almost wholly deregulated manner (i.e. without public safeguards for workers or clients) for the conduct of business. Boris and Parreñas (2010:  14) argue that the processes described above have led to new forms of intimate labour among which they include ‘call center work, gender labor in the making of transsexual identity, surrogate mothering, and egg and sperm donation’. What these new forms of labour have in common is that they involve monetary reward for the performance of work that involves one-​on-​one contact and mobilizes direct bodily and psychosocial involvement on the part of the worker for the benefit of the receiving party.

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Viviana Zelizer discusses the interrelation between ‘economic rationality’ and ‘intimate ties’ and suggests that there are three views of that relation: one that regards them in terms of ‘separate spheres’, indeed ‘hostile worlds’ (i.e. diametrically opposed to each other); a second view that regards the comingling of intimacy and economy as ‘nothing but … another version of normal market activity’; and a third view that takes a ‘connected-​ lives’ approach, suggesting that economic rationality and intimate ties are a matter of interpersonal negotiation (Zelizer, 2005: 11, 21, 33). What is, however, particularly striking when one reads both Zelizer’s and Boris and Parreñas’ work is the asymmetry that governs intimate labour of any kind. In performing intimate labour, people’s –​and this is actually mostly women’s  –​choices are seriously circumscribed. Parreñas’ (2010) account of hostess work in Tokyo, for example, while attempting to show the agency of the women involved (they can, she argues for example, always leave and work somewhere else) indicates very clearly how economic necessity, peer pressure and employer coercion coalesce into a powerful incentive to do the things you do not want to do. As one such hostess, forced together with other hostesses against her will to bare her breasts to clients, said: ‘We would dance for an hour. Then it became ugly. We all started crying. We had to show our breasts … I’m getting upset just remembering it’ (Parrenãs, 2010: 143). Parreñas makes clear that these women felt coerced and unable to refuse to show their breasts because they were on six-​month contracts that they did not know how to get out of. Asymmetry of this kind, with unequal power relations between those conducting the intimate labour, those employing them and those who receive that labour, is a shared trait across all intimate labour situations. It arises from the issue of boundaries, how these are drawn and who draws them –​boundaries between the labour conducted and the intimacy associated with such labour. Due to its association with the private and domestic sphere, intimate labour encourages the propagation of certain ideas of intimacy. Domestic help, for example, is often constructed in terms of the relevant person being ‘part of the family’. As such it is expected that intimate labour in domestic settings is conducted in a quasi-​familial manner in which, however, differences between those employed and those employing continue to be maintained. Seemin Qayum and Raka Ray (2010), for instance, give a striking example of Indian professionals in New York employing domestic help from ‘back home’, paying them, as is common, minimal wages and at the same time seeking to extract maximum labour. When the employee in one case begins to create boundaries around this exploitation the employer reads it as ‘a betrayal of friendship’ (Qayum and Ray, 2010: 110), a notion that is laughable from the point of view of the reader, as the blatant inequality in economic, social and all other terms between the employer and the

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employee is only too obvious and makes the idea of ‘friendship’ between employee and employer, assumed by the employer, seem presumptuous and naïve at the same time. The processes that produce intimate labour mould intimacy itself and intimate labour in particular and situationally differentiated ways. For one thing, in contrast to the ‘factory paradigm’ of the worker that relies on large numbers of individuals co-​working, much intimate labour is, at the point of the actual labour, dyadic, involving the person who does the work and the one worked for or upon. Boris and Parreñas (2010) argue that such labour de facto often involves a triad, including a commissioning entity, for instance the child of elderly parents employing a carer or parents employing a nanny for their infant. Indeed, more than one commissioning entity may be involved, namely a gatekeeping or regulatory body. Such is the case in the context of surrogacy, for example, where a person or couples seeking to engage someone to act as a surrogate mother for them, may have to deal with both an agency providing surrogates and the regulatory framework(s) that determine the legality or illegality of the process as well as the official status of the resulting child relative to the commissioning individuals and the birth mother. Several issues come together here that begin to illustrate the relation between intimate labour and what we term bioprecarity. The first is that, as Berlant (2000) indicates, intimacy is linked to desire –​in this last example, the desire for a child. As such, and in this instance, intimate labour is associated with an affectscape driven, on the part of the commissioning individuals, by a desire for and an optimism about becoming parents. Affect1 both structures and complicates intimacy. Boris and Parreñas (2010: 5–​6) distinguish intimate labour from emotional labour, which they regard as one potential dimension of but not a necessary precondition for intimate labour. They argue, for example, that ‘surrogate mothers do not engage in emotional labour’, then concede ‘though their jobs may involve emotional labour that would occur in private and not public spaces’ (Boris and Parreñas, 2010: 7). It is unclear what to make of these statements but we would argue, very strongly, that all intimate labour involves emotional labour, whether expressive or suppressive. The notion that surrogate mothers do not do emotional labour is itself somewhat exploitative of the notion that acting as a ‘mere incubator’ does not affect the woman in question. However, as anybody who watched the 2013 BBC4 documentary ‘House of Surrogates’ or who has read ‘Womb for Rent: A Tale of Two Mothers’ (Anon., 2011) can testify, this is absolutely not the case. In ‘Womb for Rent’ the surrogate, Sonal, is reported as saying: ‘When I had my first surrogate baby, I fed her for three days, it felt as if it were my baby. When they took her away I cried for three days. I  missed her so much’ (Anon., 2011:  n.p.). In her case much of the

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emotional labour she conducted was about suppressing her feelings for the daughter she had given birth to in order to be able to give her up to the social mother. The text details the surrogate’s and the social mother’s significant differences of expectation, with Carolina, the social mother, seeking to distance herself from the surrogate as soon as she had received the child, while the surrogate mother wanted to maintain relations, for example. The text also indicates some of the vulnerabilities the process of surrogacy gave rise to regarding the surrogate mother whose aim in undertaking the surrogacy was to get enough money to educate and house her own children. One such vulnerability was the social one, associated with the stigma in the surrogate’s community of doing this work at all. Not only had her husband not wanted her to do it but her wider in-​law family was an issue: ‘Although Sonal was careful not to tell anyone where she had been, her in-​laws found out about the surrogacy. She says that when she sees them, she will deny having been pregnant’ (Anon., 2011: n.p.). As the text suggests, ‘as she comes to accept the loss of the baby she carried, she is defiant. “I have no regrets, even if society casts me out or does not invite me in, I don’t care. I am not doing a bad thing, I am doing this for my children,” she says. “I don’t want anything else now, I just want my kids” ’ (Anon., 2011: n.p.). Sonal becomes socially vulnerable through her act of surrogacy, risking social exclusion and isolation, an act justified by her concern for her own children. Social stigmatization is just one potential vulnerability that surrogate mothers are exposed to; others include health complications, failure for the surrogacy to take, non-​payment, refusal of the clients to take the child, lack of control over who the prospective social parents are and a host of others. Health complications make their appearance in another intimate labour context:  nail salons. In ‘Manicuring Intimacies:  Inequality and Resistance in Nail Salon Work’ Miliann Kang (2010) discusses work in nail salons in California, done predominantly by Vietnamese women. Kang’s concern is with the ways in which the specific triadic relations between employer, employee and customer in this context of intimate labour facilitate or disable labour organizing to improve the workers’ conditions of service. Almost inadvertently, halfway through the text, the issue of the workers’ health makes an appearance. One Vietnamese interviewee is reported as saying, ‘I worry most about my health here –​because I don’t know how bad it is, sometimes I just feel dizzy –​there’s nothing you can do’ (Kang, 2010: 220). And a worker from the Asian Health Services, discussing the limited regulation of cosmetics manufacturers, points out, They regulate themselves –​they have their own Cosmetic Industrial Review Panel … they argue that the carcinogenic material is minimal, but they are looking at just one product. There’s no study of accumulated exposure to

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And this in a context where cervical cancer among Vietnamese women living in California is higher than among the indigenous population (Kang, 2010: 220). Here we arrive at the question of bios or ‘human life’.

THINKING ABOUT BIOS The Greek root of bios refers to (human) life.2 Such life is the subject of all manner of formal and informal regulation (legal, medical, social, economic), and it is through the regulation of life (and by implication death) that biopower and biopolitics, as discussed by Michel Foucault, are exercised. In his 17 March 1976 lecture on biopower and biopolitics Michel Foucault (2004) talks about the rise of a new technology of power, comprised of two dimensions, which begins to take shape in the second half of the eighteenth century. This new technology relates to ‘problems of reproduction, the birth rate and … mortality rate’, as well as ‘accidents, infirmities, and various anomalies’ and ‘control over relations between the human race … and their environment’ (Foucault, 2004:  244, 245). Here it is population, rather than individual-​as-​body that is at stake, and life in terms of ‘taking control of life’ so as to ‘optimize a state of life’ (Foucault, 2004: 246) that is to be regularized. Foucault argues that in this process of taking control over and regularizing life two technologies or techniques3 of power effectively come together: One technique is disciplinary; it centers on the body, produces individualizing effects, and manipulates the body as a source of forces that have to be rendered both useful and docile … [the] second technology … is centered not upon the body but upon life:  a technology which brings together the mass effects characteristic of a population … protect[ing] the security of the whole from internal dangers. (Foucault, 2004: 249)

Foucault (2004: 250) describes the former as ‘the body-​organism-​discipline-​ institutions series’, the latter as the ‘population-​ biological processes-​ regulatory mechanisms-​ State’. This produces what he describes as ‘the normalizing society’ in which ‘the norm of discipline and the norm of regulation intersect’ (Foucault, 2004: 253). In Foucault’s imaginary, the biopower established through disciplinization and regulation may get out of hand ‘when it becomes technologically and politically possible for man not only

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to manage life but to make it proliferate, to create living matter, to build the monster, and, ultimately, to build viruses that cannot be controlled and that are universally destructive’ (Foucault, 2004: 254). Here biopower grows ‘beyond all human sovereignty’, threatening life as such, making it precarious because vulnerable to failures of disciplinization and regulation (Foucault, 2004: 254). We might argue that this moment has arrived in contemporary culture in that humans now can create matter even if, as in the case of surrogacy, for example, they still need humans as providers of matter and, as the anthrax attacks that occurred repeatedly in 2001 in the United States showed, man can certainly build viruses that once unleashed are difficult to control and are potentially universally destructive. But this apocalyptic vision of humanly abused biopower, which is of course a common trope of science fiction, is a rather extreme version of how bios, life, might be threatened, rendered vulnerable and precarious. Foucault is in many ways right in arguing that problems with disciplinization and regulation may threaten bios. But such threats, we would argue, occur at a much more insidious and commonly overlooked manner in the dailiness of human interactions in the context of intimate labour. When Foucault discusses biopower and biopolitics one’s sense is always of a unitary entity, not unlike the sovereignty he invokes, where institutions and states, for example, act in a particular, quasi-​unitary manner that impacts on those associated with or affiliated to the institutions and states in question. There is little sense that, on the one hand, states and institutions may produce multiple, mutually contradictory forms of regulation and disciplinization and, on the other, that such disciplinization and regulation interacts with regulations and disciplinizations operating via other states and institutions that create entanglements of multiple possibilities for those who are in positions to make choices between these states and institutions or those who are driven to take particular positions in relation to these states and institutions as an effect of their circumstances. Such is the case, for example, when trans people seek gender-​affirmative surgery (see Nord, 2018) and decide to have different kinds of surgery in different countries due to differential procedures in the diverse countries but also, for instance, for financial reasons. Thus one country may prescribe the need for successive surgeries with particular processes of psychosexual counselling to be undergone and mandatory sterilization versus another country offering all-​in-​one surgery and making no demands for sterilization. Here bios –​the life of both the individual, of whole populations and of subgroups within populations –​ is affected in differential ways through the medico-​legal regulation of how certain bodies are to be treated. However, the fact that countries differ in what exactly they prescribe and proscribe means that opportunities and

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constraints arise for those able to move between such countries to make choices about their lives. We might argue the same for people who migrate in order to take on care work in other countries either for elderly people or for children or for domestic or health environments (see Ehrenreich and Hochschild, 2003). Driven by economic opportunity and need, such people decide to move to another country to attempt to gain employment and through their earnings to improve the lives of those dependent on them and of themselves. The work they engage in requires them to work both bodily and psychosocially in the manner already described in Hochschild’s (1983) The Managed Heart through putting immaterial dimensions of themselves such as their ‘relational, emotional and cognitive faculties’ (Morini and Fumagalli, 2010: 235) to work. Cristina Morini and Andrea Fumagalli (2010: 236) describe this in terms of ‘putting life to work’, which in their thinking refers to the ‘experiential, relational, creative dimensions’ of ‘subjectivity itself ’. They argue that the body is explicitly incorporated into productive mechanisms, thus resulting in ‘biolabour’ defined by ‘relational activities (relational labour); … imaginary and sense-​making activities (symbolic labour); corporeal and sensuous activities (corporeal and sensorial labour); affective and caring activities (affective labour)’ (Morini and Fumagalli, 2010: 240). Morini and Fumagalli (2010: 240–​1) also argue that in this biolabour, the separation between working-​time and life-​time, between working-​place and life-​place, between production and reproduction and of production, reproduction, circulation and consumption is largely overcome. Here we see the collapse of separate spheres already referred to above that characterizes intimate labour and that, we would argue, results in what we term bioprecarity. Coming at the question of life from a Marxist analysis of labour and capitalism, Morini and Fumagalli’s concern is with rethinking the Marxist theory of value to take account of the current post-​Fordist phase of labour in which, they suggest, ‘life itself [or bios] is put to work and the role of working relations is emphasized, directly incorporated within the productive activity’ (Morini and Fumagalli, 2010: 236). In this they are quite different from Foucault whose preoccupation is with governance. But they both, and Foucault previously, recognize that the management of the self and its integration into public processes that are increasingly indistinct from what was previously considered private or beyond the realm of regulation puts bios or life into a new position. Nikolas Rose (2009) discusses this in terms of The Politics of Life Itself, and the phrase ‘life itself ’ keeps recurring in these contexts to signal the preeminence of bios in the new socio-​economic arrangements in which

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we labour. Rose’s work brings Foucaultian preoccupations with biopower together not with biocapitalism so much as bioeconomics. His interest is in ‘contemporary biological citizenship’, the move from regarding biomedicine as the means for curing the ill body to seeing biomedicine as part of a ‘promissory culture’ that is interested in the ‘customization’ of (preventive) medical intervention in the interests of enhancing the capabilities of others (Rose, 2009: 223, 87, 20, 40). This has produced significant biomedical and pharma-​ industries that enable individual citizens to become so-​called responsible biocitizens4 through checking, for example, via DNA tests, the likelihood of their carrying certain genetic diseases or through maintaining an optimal weight by taking diet pills or other slimming devices. Such measures signal what Rose terms ‘economies of hope’ in an ‘ethopolitics’ where biomedical self-​techniques hailing the ‘self-​government of the autonomous individual’ conjoin with ‘the imperatives of good government’, identified at least partly in terms of the optimization of life itself (Rose, 2009: 167, 27, 82). However, Rose’s biocitizen, intent on maximizing his (choice of pronoun deliberate here) life chances and quality of life, operates in an attendant world in which biovalue and biocapital reside, for example, in others’ bodily tissues that can be biotechnologically separated from their bodies and transferred to others. Referencing blood and blood products, organs and ‘the elements of reproduction –​eggs, sperm, and later embryos’, Rose acknowledges that there may be difficulties in ‘free[ing] [these tissues] from their marks of origin and re-​utiliz[ing] them in other bodies’ (Rose, 2009:  14). He also acknowledges that organs are, or were, ‘potent and controversial objects of commodification’ (Rose, 2009:  14). But in his focus on the receivers of such mobile vital organs (vitality here referring to ‘life itself ’ or ‘lively matter’) Rose obliterates those who provide them and their somatic individuality, experience and costs.5 For biovalue, as conceived here, does not come without biocosts, for instance. In his striking film Pretty Dirty Things (2003), for example, Stephen Frears explores these biocosts in his depiction of illegal organ farming from sans papier migrants who sell their kidneys and other organs for money, at risk to their own life and limbs. The enhancement of others and the optimization of their lives thus does not only constitute biovalue but also entails biocosts, and this potentially both for those who provide and those who seek to acquire biovaluable goods and services. For those seeking biovalue in the form of tissue transplants, survival and success rates may be simultaneously the most crucial biovalues and biocosts, as may be the need for life-​long medication such as immuno-​ suppressants and their attendant risks. For those providing biovalue as goods and services other biocosts are involved and it is these, in the form of precarity, that I turn to now.

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Theorizing bioprecarity and the body PRECARITY AND BIOPRECARITY

The term ‘precarity’ as Kathleen Millar (2017: 1) notes, though considered by some ‘a relatively recent new concept’, has de facto a long history and diverse trajectories to contemporary consciousness. She indicates that Pierre Bourdieu (1998), Guy Standing (2011) and Judith Butler (2004) are commonly cited in discussions of the term (Millar, 2017: 2) but also, that they come from very different directions. Bourdieu and Standing are concerned with labour conditions and class identity, with the ways in which the rise of temporary, part-​time, casualized low-​waged work within neo-​liberal, globalized economies together with the erosion of social benefits and opportunities for collective bargaining have generated worker insecurity and led to the emergence of a new kind of class, the precariat who ‘liv[e]‌and work … in insecure jobs and conditions of life’ (Standing, 2012: 589). Although the issue of whether the precariat is a class in the classic Marxist or Weberian sense or reflects conditions of labour has been much contested (e.g. Frase, 2013), Standing’s depiction of contemporary working conditions that, some argue, are not class-​specific (Kalleberg, 2009; Thorkelson, 2016), nonetheless strikes a chord across a whole range of work scenarios, particularly in north-​western countries. Butler, in contrast to Bourdieu and Standing, interprets precariousness or precarity as an ontological condition. Discussing precarious life within the contexts of US interventions in and responses to war and terrorism, Butler (2004: 146) is concerned with the ‘normative schemes of intelligibility [that] establish what will and will not be human, what will be a livable life, what will be a grievable death’. Reading precarity in terms of human vulnerability because of ‘our social existence as bodily beings who depend upon one another for shelter and sustenance and who, therefore, are at risk of statelessness, homelessness, and destitution under unjust and unequal political conditions’ (Butler cited in Puar, 2012: 170), Butler proposes an ethics that proceeds from that understanding of a shared humanity, interpreted as ‘a social condition of political life’ (cited in Puar, 2012: 170). Here the economic questions of labour and class are less prominent than an ontoethics, which seeks to revitalize contemporary frayed understandings of interdependence and politics. The more universalized claim of precarity as ontology made by Butler is of course distinct from the notion of the precariat as a particular, albeit large, class or group of workers suffering seven kinds of insecurities (Standing, 2011: 17). The difference between these two terms is further complicated by the notion of precarization. Indeed, Isabell Lorey (2015:  11–​13) distinguishes between three dimensions of the precarious: (1) precariousness as ‘the socio-​ontological dimension of lives and

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bodies’; (2) precarity as ‘a category of order’ that ‘denotes the striation and distribution of precariousness in relations of inequality, the hierarchization of being-​w ith that accompanies the process of othering’; and (3) ‘governmental precarization’ relating to ‘modes of governing’ through biopolitical subjectivation. ‘Governmental precarization thus means not only destabilization through employment, but also destabilization of the conduct of life and thus of bodies and modes of subjectivation’ (Lorey, 2015:  13). This attempt to ‘capture the relationship between precarious labour and precarious life’ (Millar, 2017: 5) is, according to Millar, particularly useful because it combines the insights of a Butlerian approach to precarity with that of political economists and labour theorists. Such a combined approach is also useful for this volume because it is concerned with the ways in which certain forms of current intimate labour that are precarious in a variety of ways constitute, in Millar’s words, ‘affect, subjectivity, psychological interiority, and lived experience’ (2017: 5) and render those who are the providers and recipients of this labour bioprecarious. By this we mean that their lives are rendered vulnerable through the labour they provide or the labour they are the objects of, and this in often quite specific ways. One example of this is detailed in Maria de la Luz Ibarra’s (2010) chapter ‘My Reward Is Not Money’ about female Mexican end-​of-​life care workers. Ibarra presents two case studies of workers who formed ‘deep alliances’ with their wards. She wants to suggest, contrary to the commonplace notion in domestic labour literature that ‘personalism on the job  –​close personal relations between employer and employee … allows employers to continually add tasks and exploit workers’, that personalism also highlights ‘the cultural and moral imperatives that define the job’ from the worker’s perspective (Ibarra, 2010: 18). Ibarra constructs personalized care at home in opposition to work in care homes, which her interviewees and those in other studies left because of the paucity of the care they were supposed to perform and the ways in which both they and their wards were mistreated. One might argue that this constitutes a form of ‘institutionalized bioprecarity’ where both residents and carers are placed in positions of vulnerability, physically (‘a sadistic nurse would “punish” wards by leaving them to lie naked on the floor or by putting sugar in their eyes’ (Ibarra, 2010: 121)), emotionally and professionally (Ibarra cites a protest suicide by a nurse). This is vulnerabilization at work, in every sense of that phrase, a vulnerabilization that affects every aspect of the lives of those involved and beyond. This is partly because of the collapse of certain boundaries that intimate labour frequently involves. One of Ibarra’s informants said of her care of an elderly woman: ‘I lived there in the house with her, and her son would visit about three times a year … I knew that I could ask for more money, but I never did.

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The less you ask for, the more God will give you’ (Ibarra, 2010: 128). Ibarra’s informants in certain ways reject the salarization that intimate labour as labour entails in favour of God-​given rewards. The mobilization of religion as a mediating instance is very evident here. Ibarra recognizes that this is ‘deeply costly to workers’ (Ibarra, 2010: 129). Ibarra describes one worker relating how her care scenario developed:  ‘I took care of [my client] as if she were my mother. But her condition grew worse, and her son put me in charge of hiring other people’ (Ibarra, 2010:  128). The carer’s new role to act as employer-​representative puts additional demands on her, which she meets by hiring members of her own family:  ‘I didn’t want anybody to hit [my client] or yell at her, which is very common. I couldn’t just hire any person for my own peace of mind’ (Ibarra, 2010: 128). Here the carer gets drawn into questions of care way beyond her job description; identifying with her charge, her own peace of mind is at risk. A  new type of substantial dependency emerges here on ‘individual persons in the work relationship’ (see Lorey, 2015: 74–​5), which indexes the interdependencies that constitute the vulnerability of the human an sich in Butler’s terms and simultaneously rewrite labour relations as a personalized social process that generates insecurities and bioprecarities in both employee and employer. As another informant told Ibarra: ‘[My charge] was fearful because he always asked me, “When will you return?” I was the only person who saw him every day, and he was lonely, but he did not want to go into a nursing home. My conscience ate me up, but I  could not be in two places at the same time’ (Ibarra, 2010: 126). This strain on the carer, her vulnerabilization, or what we would term the bioprecarity it exposed her to, led to her sleeping at the old man’s house, enacting her subjectivation to him. Indeed, she said: ‘From the moment I submitted to him, everything changed. I felt much more calm … I did not ask him to pay me for sleeping at his home; what I was paid was enough to send to my children’ (Ibarra, 2010: 126). The carer’s narrative reveals the ‘intra-​action’, as Karen Barad (2007) would call it, between the vulnerabilities of the cared for and those of the carer, their mutual imbrication and interdependency that manifests itself in their affectscape, which constitutes something of a closed system of interrelation at multiple levels. The effect of the carer’s submission to her charge in terms of reducing her own emotional turmoil highlights this entanglement but also goes some way towards explaining the carer’s exploitability. One issue that Ibarra only partly addresses in her text is the role that religion plays in the attitudes and behaviours of the carers she interviewed. But as the title of her piece makes clear, the carers’ line is that ‘my reward is not money’ even as they clearly need money to sustain themselves and their families. Ibarra analyses the carers’ service as arising from the ‘deep alliance’ they

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form with their charges and this is clearly the case. However, that alliance is quite specific and does not necessarily extend to the wider family of the cared for; in one of her two case studies Ibarra (2010: 127) reports ‘a severe estrangement’ following the death of the man cared for, with the carer not taking part in the funeral service organized by the man’s children and not being able to share in the grieving and mourning. The carer finally got help from her church with coming to terms with his death. Here it is evident that the vulnerabilities of the carer are not confined to the immediate engagement with her charge but extend beyond that interaction to the management of her emotions after his death. Those vulnerabilities, however, are not taken into account by those who employ her to do the caring. She is left to manage them herself. Here the problematic of the salarization of care becomes evident, with the man’s children who employed the carer treating the arrangement solely as a matter of employment, while the carer had to negotiate the immaterial dimensions of the work, her emotional investments, herself. One might argue that this is indicative of what Boris and Parreñas (2010: 11) call the ‘devaluation thesis’, where care work is devalued in its commodification and where, as in the instance just described, the demands on the carer to invest beyond the employment situation are not necessarily recognized by those employing her. The collapse of the public and the private, of paid labour and care requirements as experienced by the carer, lead to a terrain of ambiguity in which it is not clear who determines and circumscribes the meaning of the work engaged in. In this particular case, there was little relation by the carer to the carer’s employers who therefore treated the carer solely as an employee. The second carer Ibarra discusses found, in contrast to this one, that on the death of her charge, the charge’s family ‘insisted that Lupe sit in the front pew [at the funeral service] with the family’ (Ibarra, 2010: 129) and Lupe was also fully involved in other associated rites. In many ways these two examples indicate something of the range of ways in which carers can experience their work but also the ways in which their vulnerabilities may, or may not be, accounted for. Interestingly, although Lupe was invited to participate in her charge’s funeral, Ibarra found that on asking if she would consider caring for another elderly person Lupe said: ‘I don’t know. The truth is that it hurts one a lot, when one loves’ (Ibarra, 2010: 129). The emotional costs to the carer were such as to make her question the continuation of earning her livelihood as a carer. This constitutes another form of bioprecarity since earning a livelihood is key to one’s life and the quality of one’s life.6 Bioprecarity, then, has many shapes and I shall now briefly explore these before coming to some conclusions.

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Theorizing bioprecarity and the body BIOPRECARITIES

Bioprecarity as understood in this volume arises in the interaction between the disciplinary and regulatory dimensions of life as discussed by Foucault with the socio-​ontological dimensions of lives and bodies as elaborated by Butler, as these manifest themselves in different kinds of precarious employment in the context of intimate labour. Here the experience of bioprecarity is distributed across the employer, employee and charge or recipient of the intimate labour, but in diverse ways and to different degrees that are situation specific. They all have to do with the relationality, sociality and interdependence that characterizes such labour arrangements and that manifest themselves as those arrangements are recognized, remunerated and taken care of in only partial ways, with those who provide the care or service often being left to carry significant burdens and bear excessive costs corporeally, psycho-​emotionally and socially. This constitutes extensive forms of disempowerment and vulnerabilization within the intimate labour market. An Indian surrogate, for example, will not only have to compromise her family life (by having to leave it behind for months on end), her social standing (acting as a surrogate is often viewed as a stigma in her own community), her physical health, her emotional well-​being (missing her family and mourning the giving up of the child she has carried), but she may also have no say in, or even knowledge of, the prospective parents of the child she carries, may be able to be a surrogate only once or twice (in other words, have a strictly time-​ limited and physically circumscribed period of making a livelihood) and may not be successful in being impregnated in which case she often earns no money at all despite having already born significant costs in relation to the possibility of surrogacy. A carer may be required to be on duty way beyond ‘normal’ working hours, for less than minimal pay, without any training for tasks that may include heavy lifting and body care and being the object of the cared-​for person’s and her employer’s whims. A person seeking surgical intervention abroad, whether this be a trans patient or someone seeking cosmetic or other medical interventions, will be the object of national and transnational regulations that circumscribe her ability to decide what is appropriate for her, that make her vulnerable to cultural specificities and procedures that she may not understand and whose long-​term effects she may be in no position to calculate. A relevant study carried out by Valorie Crooks et  al. (2013:  n.p.) found that a focus group of seven professionals ‘representing the domains of tissue banking, blood safety, health records, organ transplantation, dental care, clinical ethics and infection control’ identified ‘five dominant health and safety risks for outbound medical tourists … (1)  complications; (2)  specific concerns regarding organ transplantation; (3) transmission of antibiotic-​resistant organisms; (4) (dis)continuity

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of medical documentation; and (5)  (un)informed decision-​making’. These risks indicate some of the bioprecarities that arise in the context of medical tourism or cross-​border medical help-​seeking as we might term it for those seeking services to their bodies for medical reasons. While one might argue that the bioprecarities identified here mainly affect the help-​seeker or service recipient herself, this is not the case in the context of sex tourism where, as the texts cited early on in this chapter show, those providing intimate sex labour suffer a variety of bioprecarities in the provision of their labour, ranging from humiliation and bullying to the unwanted invasion of their bodily space, violence from clients, risk of employment termination, etc. Bioprecarities then take many forms, affect both intimate labour providers and those who seek intimate labour. However, in discussions of intimate labour such bioprecarities are frequently under-​addressed, producing vulnerabilities through that very fact. CONCLUSIONS The growth of intimate labour, not least transnationally through the migration of care, sex and domestic workers, but also through cross-​border medical help-​ seeking, has produced new forms of vulnerabilities, and in particular bioprecarities, for both those engaged in such labour and those who employ it or seek to benefit from it. One reason for this is the collapse of certain boundaries (e.g. private–​public) that had safe-​guarding properties for those providing intimate labour. Another reason is the individualization of labour that characterizes intimate labour and that makes worker organizing for protection purposes difficult (see part III of Boris and Parreñas, 2010). A third reason that is largely undiscussed in the relevant literature is that disciplinization and regulation as well as expectations of self-​ management are quite differently constituted across diverse countries and cultures, and may, even within a given context, be contradictory and conflictual, thus leaving the worker in a vulnerabilized position that commonly takes bioprecaritized forms such as not being able to earn enough to guarantee a livelihood, being required to undertake tasks and work hours that go beyond reasonable expectation. Such bioprecarity is not coterminus with Butler’s notion of precarious life as stemming from a basic human condition of interdependence. This is because the bioprecarities we address here arise in contexts of manifest inequality and power imbalances where the economic power to pay (for care, for sex, for domestic labour, for example) empowers employers to make bioprecaritizing demands on their employees, and where the deep alliances that may develop between carers and charges may exercise their own pull to encourage self-​exploitation by the workers.

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Those seeking intimate labour in pursuit of medical and/​ or reproductive goals for example may find themselves the objects of quite different bioprecaritizing scenarios, the result of a potential lack of cross-​cultural understanding and know-​how, for instance, or of the pressures exerted by differential regulations in diverse contexts. These scenarios raise political, economic, sociocultural, but also ethical issues, not least around what are reasonable expectations in intimate labour situations and to what extent do the labour contexts, indeed the employers, take into account the demands of intimacy made by those labour contexts. A call centre worker who spends significant amounts of time engaging with lonely clients (see Vora, 2010) when she is paid for the numbers of calls she makes and the numbers of deals she closes is as much bioprecarized (here through the threat to her livelihood and her economic survivability) as a sex worker who is asked to do things with/​for clients she does not want to do. The costs to the workers as much as to service recipients are potentially high, their bioprecarity almost a given. But we have little understanding of this phenomenon as yet, not least because the issues of biovalue and biocost are often treated entirely discretely and only from one side of the equation. This volume is intended to make a first intervention in this field, to suggest the need for approaches to intimate labour that take seriously the bioprecarities involved.

NOTES 1 There is no space here to elaborate on affect and emotion but for an excellent discussion of this see Wetherell (2012). 2 For an extended history of the term see Esposito (2008). 3 Foucault seems to use the terms technology and technique interchangeably in this text. 4 ‘So-​called’ here denotes the fact that this responsibilization makes demands on citizens in terms of medical knowledge and self-​management that may well exceed citizens’ capacity. We need only think of the very elderly here who may well be fully compos mentis and legally adult but find it difficult to make choices about medicines administered to them because of the difficulty of understanding the bio-​implications of what they are asked to or encouraged to take. 5 For an account of ‘legally’ acquired organs and their associated values and costs see the Milliman 2017 Research Report U.S. Organ And Tissue Transplant Cost Estimates And Discussion (Bentley and Phillips, 2017). See also Addley (2003). 6 I make this point despite the fact that critics of the notion of the precariat argue that ‘pro-​worker politics must move beyond the workplace … [in a] world of diminishing long-​ term employment’ (Frase, 2013:  13) and that notions such as a universal basic income without conditions should be considered to avoid pauperism.

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REFERENCES Addley, E. (2003) ‘A kidney costs $100,000:  The donor gets $2,000’, Guardian, 4 December. Available at www.theguardian.com/​society/​2003/​dec/​04/​health. medicineandhealth (accessed 18 December 2017). Aitken, L. and Griffin, G. (1996) Gender Issues in Elder Abuse. London: Sage. Anon. (2011) ‘Womb for rent: A tale of two mothers’, BBC News, 28 July. Available at www.bbc.co.uk/​news/​world-​14138394 (accessed 3 January 2018). Barad, K. (2007) Meeting the Universe Halfway:  Quantum Physics and the Entanglement of Matter and Meaning. Durham, NC: Duke University Press. Bentley, T. S. and Phillips, S. J. (2017) 2017 U.S. Organ and Tissue Transplant Cost: Estimates and Discussion. Milliman Research Report. Available at www.milliman. com/​uploadedFiles/​insight/​2017/​2017-​Transplant-​Report.pdf (accessed 10 January 2018). Berlant, L. (ed.) (2000) Intimacy. Chicago: Chicago University Press. Bernstein, E. (2010) ‘Bounded authenticity and the commerce of sex’, in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 148–​65. Boris, E. and Parreñas, R. S. (eds) (2010) Intimate Labors:  Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press. Bourdieu, P. (1998) Acts of Resistance: Against the Tyranny of the Market. New York: The New Press. Butler, J. (2004) Precarious Life: The Powers of Mourning and Violence. London: Verso. Crooks, V. A., Turner, L., Cohen, G., Bristeir, J., Snyder, J., Casey, V. and Whitmore, R. (2013) ‘Ethical and legal implications of the risks of medical tourism for patients: A qualitative study of Canadian health and safety representatives’ perspectives’, British Medical Journal Open 3: e002302. Available at http://​bmjopen.bmj.com/​ content/​bmjopen/​3/​2/​e002302.full.pdf (accessed 12 January 2018). Ehrenreich, B. and Hochschild, A. R. (2003) Global Woman: Nannies, Maids and Sex Workers in the New Economy. London: Granta Books. Esposito, R. (2008) Bios:  Biopolitics and Philosophy. Minneapolis:  University of Minnesota Press. Foucault, M. (2004) ‘17 March 1976’, in Society Must Be Defended:  Lectures at the Collège de France, trans. Macey, D. London: Penguin Books, pp. 239–​63. Foucault, M. (2008) The Birth of Biopolitics: Lectures at the Collège de France 1978–​ 79, ed. Senellart, M. Basingstoke, UK: Palgrave Macmillan. Frase, P. (2013) ‘The precariat: A class or a condition?’, New Labor Forum 22(2): 11–​14. Frears, S., dir. (2003) Pretty Dirty Things. Distr. BBC Films and Celador Films. Giddens, A. (1992) The Transformation of Intimacy: Sexuality, Love and Eroticism in Modern Societies. Palo Alto, CA: Stanford University Press. Hochschild, A. (1983) The Managed Heart:  Commercialization of Human Feeling. Berkeley: University of California Press. Ibarra, M. de la Luz (2010) ‘My reward is not money: Deep alliances and end-​of-​life care among Mexicana workers and their wards’, in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 117–​47.

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Kalleberg, A. (2009) ‘Precarious work, insecure workers: Employment relations in transition’, American Sociological Review 74(1): 1–​22. Kang, M. (2010) ‘Manicuring intimacies: Inequality and resistance in nail salon work’, in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 217–​30. Lorey, I. (2015) State of Insecurity: Government of the Precarious. London: Verso. Millar, K. M. (2017) ‘Toward a critical politics of precarity’, Sociology Compass 11(6): e12483. Morini, C. and Fumagalli, A. (2010) ‘Life put to work: Toward a life theory of value’, Ephemera 10(3/​4): 234–​52. Nord, I. (2018) ‘Pathways in transition: Gender-​affirming surgeries, navigations and negotiations in times of biomedicalization’, in Griffin, G. and Jordal, M. (eds) Body, Migration, Re/​constructive Surgeries: Making the Gendered Body in a Globalized World. London: Routledge, pp. 209–​24. Parreñas, R. S. (2010) ‘Cultures of flirtation:  Sex and the moral boundaries of Filipina migrant hostesses in Tokyo’, in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 132–​47. Puar, J. (2012) ‘Precarity talk: A virtual roundtable with Lauren Berlant, Judith Butler, Bojana Cvejić, Isabell Lorey, Jasbir Puar, and Ana Vujanović’, TDR: The Drama Review 56(4): 163–​177. Qayum, S. and Raka, R. (2010) ‘Travelling cultures of servitude:  Loyalty and betrayal in New York and Kolkata’, in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 101–​16. Rose, N. (2009) The Politics of Life Itself: Biomedicine, Power and Subjectivity in the Twenty-​First Century. Princeton, NJ: Princeton University Press. Standing, G. (2011) The Precariat: The New Dangerous Class. London: Bloomsbury. Standing, G. (2012) ‘The precariat: From denizens to citizens?’, Polity 44(4): 588–​608. Thorkelson, E. (2016) ‘Precarity outside:  The political unconscious of French academic labor’, American Ethnologist 43(3): 475–​87. Vora, K. (2010) ‘The transmission of care: Affective economies and indian call centers’, in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 33–​48. Wetherell, M. (2012) Affect and Emotion:  A New Social Science Understanding. London: Sage. Zelizer, V. A. (2005) The Purchase of Intimacy. Princeton, NJ: Princeton University Press.

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2

BIOPRECARITY AS  CATEGORICAL FRAMING D or is Le ibe tse der

INTRODUCTION

T

he production of bioprecarity through categorization can be seen very readily in the experiences of a particular group of people who, in recent years, have become very visible in public discourse:  transgender people. Despite glamorous images of trans women as starlets in the media, the vast majority of trans women, especially if they are of colour, have to fight for their survival. This is, I shall argue, due to their categorical gendered and raced framing. It is evident from the fact that more trans-​than cisgender1 people end up in prison; in the United States it is 16 per cent of transgender adults compared to 2.7 per cent cisgender adults (Calazza, 2016; Marksamer and Harper, 2014). This precariousness gets even worse in prison itself.2 One of the most prominent recent cases is that of Chelsea Manning, a US soldier3 convicted in 2013 of leaking confidential military documents. Manning4 transitioned during her imprisonment and was released in May 2017. For most of her prison sentence she was forced to stay in an all-​male prison; she tried to commit suicide twice and went on hunger strike in order to demand access to treatment (hormones) for her transgender status. This chapter analyses, theoretically and with concrete examples, how bioprecarity is created and reinforced through categories. Thus, its purpose is to analyse bioprecarity in terms of two dimensions of Foucault’s biopolitics: categorization and subjectivation (Foucault, 1977, 2002, 2008). Both are crucial for creating bioprecarity in bodily selves (Butler, 2009). The chapter addresses the following issues: the imbrication of bodily and emotional labour of the self in population control and hence its normalization

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and regulation (Spade, 2011); the creation of bioprecarious situations for these selves through norms and regulations (Butler and Athanasiou, 2013); the role of intersectionality (Crenshaw, 1991) in creating these precarious positions; and, finally, how bioprecarity might be countermanded (Lorey, 2010; Shotwell, 2016; Weheliye, 2014). In all this I argue that bioprecarity, though built into the normatization of contemporary cultures, is not a foregone conclusion. BIOPOWER: CATEGORIES AND CONTROL Being classified as transgender leads to a higher exposure to vulnerability, as the Transgender Law Center (2015) report documents. Given this scenario, one might ask: what do such classifications do and why do some categories lead to greater exposure to vulnerability than others? Governmental institutions and procedures utilize and create categories to manage populations. From birth, human beings are subjected to various administrative classification systems, starting with the birth certificate that details their gender classification and their often gendered first name. These categories do not only exist on paper, but also constitute identities and have consequences for people’s daily lives. They determine the choices that people are allowed or enabled to make. Foucault (2008) identified this, meaning the controlled management of populations through categorizations, as biopower. Biopower consists of two major dimensions:  one, an anatomo-​politics of the human body (classifications) and two, regulatory controls and management of populations concerning birth rates, morbidity, mortality, longevity, etc. The second component of biopower, the control and management of populations, requires categorizations ‘of the living body as an object of knowledge and politics’ (McCormack and Salmenniemi, 2016: 4). These categorizations establish hierarchized distinctions that through that very fact generate precarious positions and identities. These hierarchized distinctions produce social in-​and exclusions, and mean that some population classifications generate greater vulnerability than others. Social exclusion on the basis of disability or an illness is one relevant example here (Coughlan, 2010) since what constitutes disability or illness has changed over time. Just like the category ‘transgender’, disability as a category has a specific history. Disability as a category was created to manage the people thus designated. Through this labelling disabled people are placed –​symbolically and literally –​in particular ways that can mean that they are kept in marginal spaces and hence become more excluded than they were before the

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category was invented or applied to them. The two dimensions of biopower indicated above merged in the nineteenth century and gave rise to new political struggles focusing on life as a political object and claims to rights to life, bodily health and needs (Rabinow and Rose, 2006: 161). Categories are about the structuring of differences. In The Order of Things Foucault suggests that differences in categories tend to be established in relation to something already known (2002: 60 f.). Thus, differences are instantiated in relation to what we knew before. Foucault argues that categories deliberately exclude differences that cannot be linked to a specific system. Systems are hence, paradoxically, based on sameness rather than difference as Foucault explains using Linnaeus’ Philosophie Botanique (sections 155, 256) who ‘conceived the project of discovering in all the concrete domains of nature and society the same distributions and the same order’ (Foucault, 2002: 84). If categorizations are based on what we already know and on sameness rather than on difference, this means that if the science and language creating such categorizations are inflected by sexist, racist, homo-​and transphobic thinking, the resultant categorizations will perpetuate these biases. Since technologies of population management employ categories, they thereby perpetuate social inequalities and higher vulnerability for those who are classified within the parameters of vulnerability. Not only do the existing hierarchies contribute to the precarization of certain social groups, but so do categories that are not available as such in all institutions or (administrative) processes, for example ‘transgender’ or ‘intersex’. Further, identities that reference more than one category become particularly vulnerable because in systems of categorizations indeterminacy or multiple classification can lead to contradictions and exclusions from the systems in question.

When categories fail The challenges of these categorizations are therefore not only that some people are categorized in ways that make them particularly vulnerable, but also that others might fall outside any categories. This can be the case for intersex people, as they are often not officially recognized as such, e.g. on birth certificates or other official documents. Although they do not fit into gender-​binary categories, in official contexts they may well be forced to choose one category –​male or female. The use of categories is restricting and restrictive as this example of intersex people shows. Much of contemporary medicine continues to operate on the basis of a binary view of gender, involving two different sets

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of genitals and organs. Judith Butler highlights the arbitrariness and historical determinations of these anatomical gender norms: It means only that any sexual organ that is recognized as such has passed through a perceptual process of delimitation or demarcation. Since any delimitation follows from a practice of delimitation that is itself the result of a history of such practices, it seems to follow that our sexual organs are saturated with historical interpretations. (Butler and Athanasiou, 2013: 52)

Current established norms determine, for example, how large a female baby’s clitoris should be; if it is larger, but also shorter than a male penis, an intersex status (‘disorders of sex development’ in medical terms) is diagnosed and in most cases the clitoris is still surgically reduced to an assumed female size (Klöppel, 2016). This surgery often has painful and life-​changing or life-​ threatening (risk of suicide) consequences for intersex people. The exposure to such bioprecarity is higher if an individual fits into two or more categories but at the same time not into a single one. At a theoretical level this challenge has been addressed through the notion of intersectionality. In her classic essay on intersectionality, Kimberlé Crenshaw (1991) points out that ignoring differences within a given group is common, especially in the case of violence against women where class, race and other issues may also be involved. ‘Although racism and sexism readily intersect in the lives of real people, they seldom do in feminist and antiracist practices’ (Crenshaw, 1991: 1242). The fact that ‘rapes of Black women are less likely to result in convictions and long prison terms than rapes of white women’ is traced back by Crenshaw to the sexualized images of Africans (Crenshaw, 1991: 1242). Science has played into repeating these stereotypes, classifying African women as highly sexed (Crenshaw, 1991: 1270 f.).5 If the rape of black women leads to convictions less often than is the case when white women are raped, it seems that black women’s lives matter less, and hence are less ‘grievable’, in Butler’s (2004) terms, than white women.6 As Butler (2009:  25) explains, every human being is exposed to vulnerability and precariousness, but ‘[p]‌recarity designates that politically induced condition in which certain populations suffer from failing social and economic networks of support and become differentially exposed to injury, violence, and death’. The reason for this is that ‘[w]e are at least partially formed through violence. We are given genders or social categories, against our will, and these categories confer intelligibility or recognisability, which means that they also communicate what the social risks of unintelligibility or partial intelligibility might be’ (Butler, 2009: 167). Bioprecarity describes the situation where certain bodies are subjected to danger to a higher degree than others. As contemporary Greek philosopher,

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Athena Athanasiou, argues: ‘In designating the politically induced condition in which certain people and groups of people become differentially exposed to injury, violence, poverty, indebtedness, and death, “precarity” describes exactly the lives of those whose “proper place is non-​being” ’ (Butler and Athanasiou, 2013: 19). A crucial factor for bioprecarization is the economic system we inhabit because biopower is strongly linked to the emergence, formation and development of capitalism: ‘[b]‌io-​power was without question an indispensable element in the development of capitalism; the latter would not have been possible without the controlled insertion of bodies into the machinery of production and the adjustment of the phenomena of population to economic processes’ (Foucault, 1990a: 140 f.). In The Birth of Biopolitics: Lectures at the Collège de France 1978–​79 (2008) Foucault refined his thoughts about the imbrication of biopolitics and capitalism. The notion that society needs to be protected and requires more control leads to a situation where the most precarious populations experience their everyday life as the management of constant threats: risks of illness and accidents, job insecurity, economic crises, etc. These fears are often intensified by governmental surveillance or media reports reinforcing the idea of threat and embattlement: ‘Such a sense of vulnerability may lead to … an exhaustion from constant change, uncertainty and unpredictability of economic, social, cultural and biological life’ (McCormack and Salmenniemi, 2016: 4). The fear of precariousness has become dominant in our age of economic crisis; it has been used for managing populations in times of austerity. However, not every person is equally exposed to precariousness. Butler (2004) uses the concept of ‘grievability’ to determine how precarious a life is. If you are not grievable, your life has no value and therefore it is at risk or precarious. This raises the questions: ‘Who counts as human? Whose lives count as lives? And, finally what makes for a grievable life?’ (Butler, 2004: 20). Governments often control what and who is valued enough to be entitled to public grieving. The consequences of being designated ‘ungrievable’ are evident in the high and still rising rate of transgender women of colour being murdered:  in 2016, 24 US trans women were killed, most of them of colour (95 per cent). The actual numbers might be even higher since the police, family and the media often misreport the gender of the victims (Thompson Reuters Foundation, 2016). By June 2017 already 13 US trans women of colour had been killed (Ennis, 2017). If you are ungrievable you become vulnerable to attack since nobody supposedly cares if you live or die. McDonald (2017) reports her own case of being a black trans woman who was insulted in racist and homophobic terms and then, fighting for her survival, killed someone in self-​defence. The police were convinced that she and her black friends had started the fight and took her to the station

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without paying attention to her injuries. After five hours of interrogation, she finally received medical attention. Having received a prison sentence, she had to stay in a men’s state prison (McDonald, 2017: 258 f.). Her injuries and that she had to defend her life did not count. This indicates that her life somehow counts less, is less valuable than others’ and is not grievable. To be less grievable has consequences in everyday life. I turn to this issue now. SUBJECTIVATION: CATEGORIES DETERMINE EVERYDAY ACTIVITIES Black trans men are not much better off than black trans women; moreover, they experience the same criminalizing discrimination as cisgender black men, as Trystan Theosophus Cotton’s story, for example, shows. He almost froze to death in a dumpster because he could not get a taxi during a cold winter’s night in New York. During his transition he had to learn very quickly what cisgendered black men learn during their whole life growing up as black men: how to stay alive in a male black body. Cotton describes how his movements in public places changed to accommodate this: he had to learn to walk more slowly and not to make abrupt movements, to avoid engaging with unfamiliar white people, especially white women. He deliberately tried not to look white women in the eye as they might see him as a threat. His clothing style changed from casual hoodies to smarter looking outfits. If pulled over by the police in his car, he did ‘not dare to speak back anymore in fear of provoking them’ (Cotton, 2014:  133–​44). Cotton changed his daily activities (clothes, movements, gaze, not speaking back at the police) as an effect of transitioning. However, his new identity as a black man obliged him to adjust his everyday habits and actions further in a racist society where black men and boys are more likely than whites to be subjected to police violence. Cotton’s case confirms in everyday detail how subjectivation in a biopolitical society works and how biopolitical structures sustain inequalities. According to Foucault’s model of the disciplined society, everyday interactions with individual people working in different institutions (factories, hospitals, schools, universities, etc.) are the hubs of power, where individuals control and discipline each other and themselves. Control is a supposed tool against danger and/​or precarious situations. At the same time precariousness is produced and employed for governmental aims in order to increase control. Institutional disciplinary techniques (e.g. medical check-​ups, the police patrolling the streets, surveillance cameras controlling the movements of people, etc.) influence the everyday behaviour of individuals. In Cotton’s case, the specific control of his black masculinity led

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him to change his demeanour and his clothes. Such internalization of self-​ discipline is an effect of technologies of surveillance. Self-​d iscipline and normalization Disciplinary power in the form of self-​disciplining and normalization sustains bioprecarity. Dean Spade (2011: 139) has analysed the administrative violence of gender norms and its harmfulness for transgender people. Spade highlights three problematic realms:  identity documentation, sex-​ segregated facilities and health care (143). For instance, in some countries proof of gender reassignment surgery or medical and psychiatric treatment is required to change one’s gender in identity documentation. In Canada sex workers are excluded from having access to transgender surgery because they cannot provide a ‘real-​life test’, meaning working in the chosen sex, as their job does not count as a proper workplace (Namaste, 2005: 31). Segregated facilities such as public toilets often lead to confrontations when used by those for whom they are not designated, and some trans people avoid going to public toilets. This can lead to health problems (e.g. urinary infections). Spade reminds us that population-​level programmes should take care of the more vulnerable members of the population and address certain risks. However, those programmes also always determine who is protected and who is a threat. Thus, at the same time as providing care for certain populations, governments include population surveillance as a core function (Spade, 2011: 140). For Spade this simultaneous taking care and surveillance illustrates Foucault’s ‘apparatuses of security’. These are aligned with knowledge-​producing institutions such as medical and educational institutions and their discourses. Importantly, the body (or the matter of the body) ‘does not precede this knowledge but the living bodies as subjects and objects of this knowledge are constituted through these discourses’ (Thiem, 2008: 30). For Foucault the subjectivation of bodies happens not through ideology (such as the ideological state apparatuses in Althusser) and violence, but through this knowledge production that forms both subjects and objects. In the case of the panopticon it is therefore not so much the gaze of the guards controlling the inmates that leads to their subjectivation but the prisoners’ own knowledge that there might be the possibility of the gaze. In their self-​reflections they therefore duplicate the norm, meaning the rules they have to obey to, and the power of (self-​)surveillance is thus passed on to them (Foucault, 1977: 202 f.; Thiem, 2008: 32). Individuals become subjects through this process. The process is reciprocal: subjects have to recognize this knowledge and others have to recognize the subjects. Thus subjects are always tied to their ‘own identity by a conscious self-​knowledge’ (Foucault, 1977: 202).

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Foucault does not see this process as purely restrictive. It is also a practice of liberation or of the liberty to accept being a subject and how to be a subject (what kind of subject), although based on a number of cultural ‘rules, styles, inventions’ (Foucault, 1988a: 51). In a late interview, he makes a short statement on subjectivation:  ‘I will call subjectivisation the procedure by which one obtains the constitution of a subject, or more precisely, of a subjectivity which is of course only one of the given possibilities of organization of a self-​consciousness’ (Foucault, 1988b: 253). Although there exist certain restrictions –​regulations in the process of subjectivization –​Foucault still acknowledges possibilities of being otherwise, derived from self-​conscious practice. In her critique of Althusser’s concept of interpellation7 Butler highlights the paradox in this situation, where the hailed individual seems to exist already to be able to hear and respond to the call (Butler, 1997: 1–​4). Through this prior existence in language the individual, as is the body, is already burdened with history and memory, participating in performative processes, meaning that the subject and the body are not produced in a single instant but repeatedly over time (Thiem, 2008: 33). For example, many trans people try to avoid being hailed by the police, given the history of police violence and the law not protecting them. Interpellations can thus have very different meanings, depending on the bioprecarious status of the body involved (Bunch, 2013: 47). This implies both the variability and the relative fixity of norms and regulations concerning subjects and their bodies. The body, and society with its rules and regulations, are both constituted and sustained by the process of subjectivization; neither exists a priori. In Butler’s thinking materiality is not independent of signification: matter ‘comes to matter not prior to social norms and relations of power but as social practices and institutions render matter intelligible’ (Thiem, 2008: 36). However, subjectivization comes at a price because coercive norms constrain us and our bodies. The materiality of certain body parts (genitals) or processes and activities (e.g. sexual acts) are ‘forcibly produced’, for example in heteronormative hegemony (Butler 1993, 2004; Davis, 2012:  885 f.). In the constraining processes of subjectivization bioprecarity is produced in relation to the material body, body parts and the individual as a whole. For Butler, desires play a crucial role in this. Differently from Foucault, she draws on psychoanalytic ideas for her concept of subjecti(vi)zation.8 For her, just like bodily materialities, desires and passionate attachments do not pre-​exist society. Social norms not only constrain desires, but also form and fuel them and therefore produce desires, even though they are sometimes repressed or reoriented (Thiem, 2008: 37). However, consistent with Foucault’s more positive view of subjectivization, Butler too asserts that possibilities for change exist. Subjectivization requires repetition (like other performative

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acts), and already subjectivated subjects can subjectivate others. In her performative politics, Butler suggests working with repressed desires and the willingness to change the norms that are constraining them. These desires can make use of iterative acts to change norms (as Derrida suggests with his use of ‘différance’). An example of this is the change in public discourse on gender-​binary norms in some Western heterosexual societies: the iterative performance of gender has enabled the (en)actment of gender in non-​ binary ways, as some genderqueer people do. One can also resist subjecting others to gender-​binary norms or categorizations. Thus, not judging others in gender-​ binary terms is a tool for not passing on gender-​ categorial biopower. The subjectivization of trans people to medical categorizations of transgenderedness provides another example of what resistance to a subjectivating process might look like. Here resistance usually involves significant emotional and intimate labour to produce certain changes in this process. In the first instance, trans people have to adjust to medical criteria to be able to access surgery or hormones. They need to self-​discipline themselves to fulfil all the diagnostic norms and to go through the different stages of the standard medical treatment for transgender people such as psychiatric therapy. Like the prisoners surveilled by the panopticon, who internalize the disciplining gaze of the (potential) guards, individuals in a (neo-​) liberal society internalize social norms. Some trans people have to internalize the medical gaze in order to access the treatment they want. Therefore they have to subject themselves to particular ways of enacting transgender, corresponding to the criteria for gender dysphoria in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual, DSM-​5 (2013). This diagnosis requires a certain kind of intimate labour from the transgendered person, for whom coming out is already challenging as it consists of the emotional labour of explaining to others how they feel about their gender. This often involves referring to intimate experiences in relation to their own secondary and primary genitals and their possible desire for other gender characteristics. The intimate labour in maintaining kin and community ties for transgender people may entail asking others iteratively to make use of appropriate pronouns and names. Such daily routines in the care of others (maintaining kin and community ties) and the care for the self require ‘embodied and affective interactions in the service of social reproduction’ (Boris and Parreñas, 2010: 7). The suicide rates among trans people in the United States show how much hard work is required just to be able to survive in everyday life; between 41 per cent and 46 per cent of transgender and gender-​nonconforming people in the United States have attempted suicide (Haas et al., 2014).

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Contact with medical staff requires another kind of intimate labour for trans people since disclosing details about the self ‘leave[s]‌one vulnerable if others ha[ve] access to such a knowledge’ (Boris and Parreñas, 2010: 5). To reveal oneself as transgender is a risk for trans patients, because of the possibility that medical staff are ignorant about transgender issues and mis-​ gender them or use traditional medical vocabulary for their genitals or do not value their sexuality or relationships. The process of dealing with medical classifications thus requires much emotional and intimate labour to display the relevant criteria effectively. Butler (1997) described this process as the performativity of subjectivization. CONCLUSIONS: STRATEGIES AGAINST BIOPRECARITY Foucault (1990b, 1990c) points out that resistance to biopower (and therefore bioprecarity) is possible and even intrinsic to his model. Such resistance might consist of not applying any categories, of finding and creating commons and interdependencies, of focusing on ‘habeas viscus’ and relationality and of an open normativity. By way of a conclusion I shall discuss each of these strategies in turn. Not applying any categories One strategy is to refuse using categories. This may avoid certain kinds of bioprecarities. For example, sometimes having to declare one’s gender online, e.g. when one is just shopping, is not necessary, as the trailer of the Copenhagen Pride 2017 shows.9 This short film shows real-​life situations where people buying something in shops are asked at the cashiers what their gender is. This defamiliarizes such behaviour as the question appears strange in this context and raises the issue why the gender of the shopper should be asked for. As a tool against this, one can download an extension for a certain browser, which eliminates all gender boxes. ‘Gender Free Internet’ helps to surf the Internet and shop online without being asked about one’s gender.10 Transport security administration (TSA) body scanners at airports are another context where gender-​binary categories are applied, as gender-​ specific buttons need to be activated before a person enters the scanner. These scanners expose intersex, genderqueer and transgender people. A more inclusive scanner could be developed that does not have gender-​ binary buttons (Pham, 2017). In sum, one should always think about what purpose the mobilization of gender categories serves and refuse it when the categories serve no obvious purpose.

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Commons and interdependencies Lorey (2010) suggests that everyday-​life resistance to bioprecarity for precarious people means avoiding being categorized as ‘other’ or different since the basic human condition of vulnerability and precariousness is shared by everyone. It could therefore be used as basis for solidarity (Butler, 2004: xiii). Hence the becoming ‘common’ of precarious people is accompanied by arguments about what counts as common (Lorey, 2010) for focusing on strategies for alliances (Lorey, 2012:  137). Common experiences among precarized people then serve as a ground for forming alliances. Focusing on interdependence in precarity and still recognizing differences among individuals helps to construct such alliances. A concrete historical example of such alliances was ‘Lesbians and Gays Support the Miners’ in the UK during the 1980s. Both sections of the population –​lesbian, gay, bisexual and transgender (LGBT) people and miners –​ were fighting against Thatcher’s politics of closing down the mining industry and using AIDS to demonize the gay movement. The shared interests of both oppressed groups derived from their common experience of police harassment and violence and biased media representation. LGBT activists started collecting money for the miners in 1984 at the Pride demonstrations and at a benefit concert called ‘Pits and Perverts’. In return, miners supported the next LGBT events and the political campaign against Section 28 (a local governmental amendment prohibiting the promotion of homosexuality in distributing materials and teaching) in 1988 (Kelliher, 2014). Habeas viscus and relationality A third strategy to combat the bioprecarity derived from categorical framing is to make use of what Weheliye (2014: 2) describes as habeas viscus, ‘You shall have the flesh’. With this phrase Weheliye builds on Hortense Spiller’s division between body and flesh and uses it ‘on the one hand, to signal how violent political domination activates a fleshly surplus that simultaneously sustains and disfigures said brutality, and on the other hand, to reclaim the atrocity of flesh as a pivotal arena for the politics emanating from different traditions of the oppressed’ (Weheliye, 2014: 2). This politically constructed fleshly surplus is exactly what constitutes bioprecarity –​it is the material of bioprecarity, the matter as the place where bioprecarity is located and originates from. Habeas viscus is the understanding of this subjection and a strategy against it, as ‘habeas viscus does not obey the logic of legal possession and remains even after the body’s demise’ (Weheliye, 2014: 132). This concept theorizes racialization in bioprecarity, and has a focus on the gendered and racialized specificities of biopolitical regimes, which have not

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been thought together in the ideas of Foucault, Agamben and Mbembe’s necropolitics. Habeas viscus serves as a counter-​strategy to Agamben’s habeas corpus, which names the entitlement of human beings to political rights (bios politikos), therefore making the killing of people illegal. And, according to Butler (2004), another characteristic of habeas corpus, is that a person becomes grievable. Therefore people who are stripped of their habeas corpus, meaning their killing is not prosecuted or their death is not grievable, still have viscus, their flesh, even if they have lost their political rights to free life. The flesh remains, being alive or just recently killed (at least for a while). The focus on the flesh means that its relationality –​its subjectivation to racialized, sexualized and gendered norms  –​has to be taken in account. Through the notion of habeas viscus particular processes of biopolitical violence or aggression are brought into relation. Relationality ‘reveals the global and systemic dimension of racialized, sexualized, and gendered subjugation, while not losing sight of the many ways political violence has given rise to ongoing practices of freedom within various traditions of the oppressed’ (Weheliye, 2014:  13). Habeas viscus as a strategic intervention locates the political right to a decent human life, which is grievable, in the flesh. Open normativity The final strategy ‘prioritizes flourishing’ and an ‘openness to the possibility of things being otherwise’. Open normativity ‘keeps futures open’ and states that something or someone ‘deserves to continue’ in order ‘to open freedoms to one another’ (Shotwell, 2016: 155 f.). This is the reverse of what categorizations and norms that cause bioprecarity do, namely restricting and limiting. As an example of such open normativities, Shotwell (2016) cites the Silvia Rivera Law Project (SRLP) founded by Dean Spade. This project seeks ‘to open more possibilities for validation of gender change in state identification documents’ (Shotwell, 2016: 156). States restrict new identifications for trans people who have not fully changed gender, or have not had the required surgeries, hormone and psychological therapy. The SRLP’s policy and advocacy strives for more ‘varied criteria’ for changing documents. SRLP’s effort ‘shifts the effects of norms on people and through those shifts begins to change the norms themselves –​the inhabitation can become corrosive to forms of normativity that harm us’ (Shotwell, 2016: 156, italics in original). More varied criteria change norms and categories so that they are less harmful for precarious people and therefore might decrease bioprecarity that is caused by categorization. A shift towards a more open normativity is a

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move away from antinormativity and introduces more concrete applications than mere oppositionality as antinormativity does. Open normativity opens up more possibilities of (re-​)definition for everyone. CONCLUSION Categorizations create and intensify bioprecarities, even as they are employed to control and help vulnerable social groups. Bioprecarity increases when certain categories of people are constructed as less grievable than others, often as an effect of intersectionalities of categories or because someone fits into more than one category or into no category at all. These categories determine one’s everyday activities and behaviours in their articulation of norms, and their (self-​)disciplining propensities. As Tiffany Page (2017: 22 f.) points out, a certain unspectacular precarity exhausts people as it slowly seeps into everyday and ordinary life (Berlant, 2007: 757; 2011: 122). This kind of bioprecarity is at risk of gradually rising in its intensity without that being registered (Nixon, 2011: 2–​6). The intensified bioprecarity is often barely noticed, partly because of the invisibility of the emotional and physical labour involved (Mahmood, 2012: 15). Such labour is required by precarious people in order to be able to survive in everyday life. Trans people provide a good example of this. It is possible, however, to resist the bioprecarity effected by categorization. The relevant counter-​strategies consist of not applying certain e.g. gender-​ binary categories at all whenever possible, of finding common ground and interdependencies among diverse categories that are focused on the body, of focusing more precisely on the racialized, sexualized and gendered ‘flesh’ (‘habeas viscus’ vs ‘habeas corpus’) or of mobilizing open normativities that allow more possibilities of being otherwise. In a world where binary logics in combination with algorithms are intensifying through the fact that they underlie all technologization and hence have the propensity to pervade our everyday lives, applying these counter-​strategies is essential. NOTES 1 The word ‘cis’ (or cisgendered) designates staying within parameters of normative gendered behaviour (Enke, 2012: 61). It functions in binary opposition to terms such as trans (or transgendered). Cisgendered people ostensibly stay in line rather than crossing the line, ‘as though we agree upon what and where the line may be as well as on what constitutes male and female’ (Enke, 2012: 73). 2 See the Sylvia Rivera Law Project (2007) on the New York State men’s prison.

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3 The debate about trans-​inclusion in the US military has repeatedly been in the media. In July 2017, for example, Donald Trump tweeted that he wanted to ban trans people from the military (presumably because of the high costs of their trans surgery), thus, introducing the ‘don’t ask, don’t tell’ policy again that was reversed under Barrack Obama’s ruling in 2016, which allowed trans people to serve openly. In 2016, a RAND study found that only 29–​129 active duty members would make use of medical treatment, therefore suggesting very limited costs. However, the whole discussion raises other questions such as why do transgender people choose twice as often as cisgender people to join the military service, despite the high rates of sexual abuse and violence in the army and a high suicide rate among veterans? Dean Spade, professor of law in Seattle and trans advocate, points out that it is the higher unemployment rate of trans people (twice as high as for cisgender people) that forces them to join the army in order to have an economically stable situation, health care and a good education (2017). Inclusion in the military is therefore not the primary aim of transgender politics, for example, but a decrease in their poverty and criminalization (Geidner, 2013). Spade (2017) highlights that queer and trans inclusion in the military and the showcasing of LGBT people in the army are not a sign of LGBTQ liberation, but rather a public relations strategy and pinkwashing of the military to divert attention from violence and human rights abuses through and within the army, e.g. Standing Rock (Nassar and Valente, 2017). Spade (2017) warns that the attention paid to the inclusion of trans people in the military is a very disturbing trend. 4 Manning was convicted as E.  B. Manning. Being aware of and to respect the gender-​identification of trans people I do not want to fully spell Manning’s first name, which was given to her at birth. 5 Somerville (1995) explains how scientists in the nineteenth and twentieth centuries looked at the anatomical female body and were keen to establish differences between African and white female bodies. They concluded that African women had a particular (for example ‘bigger’ than the white norm) sexual and reproductive anatomy and therefore suffered from sexual excess. The same argument was employed at times to describe female homosexuals. The discourse of sexual pathology therefore found ‘perversion’ in both the black and the homosexual anatomical body. 6 The Black Lives Matter movement is concerned to redress just that. 7 Althusser’s notion of interpellation describes how he thinks individuals are transformed into subjects. He gives the famous example of a situation, where a policeman in the street calls ‘Hey, you there’ and in most cases the person whom he is actually addressing turns around in response. In turning around the respondent becomes the subject by recognizing that ‘the hail was “really” addressed to him’ (Althusser, 1971: 174 f.). 8 Butler employs the terms ‘subjection’ and ‘subjectivation’, but not ‘subjectivization’, which was used as such by Foucault. In general Butler speaks about subjection, meaning (a)  how power subordinates subjects, (b)  the recognition of the subject and (c)  the iterability of the subject that involves opposing and transforming social terms as well (Butler, 1997: 29). Drawing on the ideas of Hegel, Butler (1997) writes ‘subjection (assujettissement)’. Talking about Althusser she uses both subjection and subjectivation: ‘the law requires subjection for subjectivation’ (Butler, 1997:  112). She uses subjectivation only

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when discussing Foucault:  ‘The term “subjectivation” carries the paradox in itself: assujetissement denotes both the becoming of the subject and the process of subjection –​one inhabits the figure of autonomy only by becoming subjected to a power, a subjection which implies a radical dependency. For Foucault, this process of subjectivation takes place centrally through the body’ (Butler, 1997: 83, italics in original). Butler never makes the differences between the two terms explicit and never uses ‘subjectivization’. 9 Available at www.youtube.com/​watch?v=td9QZQ6zajw (accessed 11 June 2017). 10 Available at www.genderfreeinternet.com/​#home (accessed 11 June 2017).

REFERENCES Althusser, L. (1971) ‘Ideology and ideological state apparatuses (notes towards an investigation)’, in Althusser, L., Lenin and Philosophy and Other Essays. New York: Monthly Review Press, pp. 121–​76. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-​5). Washington, DC: APA. Berlant, L. (2007) ‘Slow death (sovereignty, obesity, lateral agency)’, Critical Inquiry 33(4): 754–​80. Berlant, L. (2011) Cruel Optimism. Durham, NC: Duke University Press. Boris, E. and Parreñas, R. S. (2010) ‘Introduction’, in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 1–​12. Bunch, M. (2013) ‘The unbecoming subject of sex: Performativity, interpellation, and the politics of queer theory’, Feminist Theory 14(1): 39–​55. Butler, J. (1993) Bodies That Matter: On the Discursive Meaning of ‘Sex’. New York: Routledge. Butler, J. (1997) The Psychic Life of Power:  Theories in Subjection. Palo Alto, CA: Stanford University Press. Butler, J. (2004) Precarious Life: The Powers of Mourning and Violence. London: Verso. Butler, J. (2009) Frames of War: When Is Life Grievable? London: Verso. Butler, J. and Athanasiou, A. (2013) Dispossession: The Performative in the Political. Cambridge, UK: Polity Press. Calazza, T. (2016) ‘Release:  Broken criminal justice system disproportionately targets and harms LGBT people’, American Progress, 3 February. Available at www.americanprogress.org/​press/​release/​2016/​02/​23/​131547/​release-​broken-​ criminal- ​justice- ​s ystem-​disproportionately- ​t argets-​and-​harms-​lgbt- ​p eople (accessed 9 June 2017). Cotton, T. T. (2014) ‘Not a caricature of male privilege’, in Keig, Z. and Kellaway, M. (eds) Manning Up:  Transsexual Men on Finding Brotherhood, Family & Themselves. Oakland, CA: Transgress Press, pp. 133–​44. Coughlan, S. (2010) ‘Disabled are socially excluded says Scope survey’, BBC News, 1 September. Available at www.bbc.com/​news/​education-​11139534 (accessed 7 August 2017). Crenshaw, K. (1991) ‘Mapping the margins: Intersectionality, identity politics, and violence against women of color’, Stanford Law Review 43(6): 1241–​99.

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Davis, N. (2012) ‘Subjected subjects? On Judith Butler’s paradox of interpellation’, Hypatia 27(4): 881–​97. Democracy Now! (2017) ‘What role should the military play in the fight for transgender rights?’ 7 July. Available at www.democracynow.org/​2017/​7/​27/​what_​ role_​should_​the_​military_​play (accessed 21 August 2017). Enke, A. F. (2012) ‘The education of little cis: Cisgender and the discipline of opposing bodies’, in Enke A. F. (ed.) Transfeminist Perspectives in and Beyond Transgender and Gender Studies. Philadelphia: Temple University Press, pp. 60–​77. Ennis, D. (2017) ‘13th transgender murder victim of 2017:  Josie Berrios’, LGBTQ Nation, 15 June. Available at www.lgbtqnation.com/​2017/​06/​13th-​transgender-​ murder-​victim-​2017-​josie-​berrios (accessed 6 September 2017). Foucault, M. (1977) Discipline and Punish:  The Birth of the Prison. New  York: Vintage-​Random  House. Foucault, M. (1988a) ‘An aesthetics of existence’, in Kritzman, L. (ed.) Michel Foucault  –​Politics, Philosophy, Culture:  Interviews and Other Writings 1977–​ 1984. London: Routledge, pp. 47–​53. Foucault, M. (1988b) ‘The return of morality’, in Kritzman, L. (ed.) Michel Foucault –​ Politics, Philosophy, Culture:  Interviews and Other Writings 1977–​ 1984. London: Routledge, pp. 242–​54. Foucault, M. (1990a) The History of Sexuality: Volume 1: An Introduction. New York: Vintage Books. Foucault, M. (1990b) The History of Sexuality: Volume 2: Uses of Pleasure. New York: Vintage Books. Foucault, M. (1990c) The History of Sexuality: Volume 3: Care of the Self. New York: Vintage Books. Foucault, M. (2002) The Order of Things:  An Archaeology of Human Sciences. New York: Routledge. Foucault, M. (2008) The Birth of Biopolitics: Lectures at the Collège de France 1978–​ 79, ed. Senellart, M. Basingstoke, UK: Palgrave Macmillan. Geidner, C. (2013) ‘Meet the trans scholar fighting against the campaign for out trans military service’, BuzzFeed News, 9 September. Available at www.buzzfeed. com/​chrisgeidner/​meet-​the-​trans-​scholar-​fighting-​against-​the-​campaign-​for-​ out?utm_​term=.oya53KEp5#.xg5qovB9q (accessed 21 August 2017). Haas, A. P., Rodgers, P. L. and Herman, J. L. (2014) Suicide Attempts Among Transgender and Gender Non-​ Conforming Adults:  Findings of the National Transgender Discrimination Survey. Available at https://​williamsinstitute. law.ucla.edu/​w p-​content/​uploads/​A FSP-​Williams-​Suicide-​Report-​Final.pdf (accessed 12 June 2017). Kelliher, D. (2014) ‘Solidarity and sexuality:  lesbians and gays support the miners 1984–​85’, History Workshop Journal 77(1): 240–​62. Klöppel, U. (2016) ‘Zur Aktualität kosmetischer Operationen “uneindeutiger Genitalien” im Kindesalter’, Bulletin Texte 42:  1–​89. Available at www.gender. hu-​ b erlin.de/​ d e/​ p ublikationen/​ g ender-​ b ulletins/​ b ulletin-​ t exte/​ t exte-​ 4 2/​ kloeppel-​2016_​zur-​aktualitaet-​kosmetischer-​genitaloperationen (accessed 8 October 2017). Lorey, I. (2010) ‘Becoming common:  Precarisation as political constituting’, e-​flux Journal, 17 June. Available at www.e-​flux.com/​journal/​17/​67385/​becoming-​ common-​precarization-​as-​political-​constituting (accessed 4 May 2013).

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Lorey, I. (2012) Die Regierung der Prekären. Vienna: Turia+Kant. Mahmood, S. (2012) Politics of Piety: The Islamic Revival and the Feminist Subject. Princeton, NJ: Princeton University Press. Marksamer, J. and Harper, J. T. (2014) Standing with LGBT Prisoners: An Advocate’s Guide to Ending Abuse and Combating Imprisonment. Washington, DC: National Center for Transgender Equality. Available at www.transequality.org/​issues/​ resources/​ s tanding-​ l gbt-​ p risoners-​ a dvocate- ​ s - ​ g uide- ​ e nding- ​ a buse- ​ a nd-​ combating-​imprisonment (accessed 15 June 2017). McCormack, D. and Salmenniemi, S. (2016) ‘The biopolitics of precarity and the self ’, European Journal of Cultural Studies 19(1): 3–​15. McDonald, C. (2017) ‘The prison letters of CeCe McDonald’, ed. Tinsley, O. N. Transgender Studies Quarterly 4(2): 243–​65. Namaste, V. (2005) Sex Change, Social Change: Reflections on Identity, Institutions, and Imperialism. Toronto: Canadian Scholars Press. Nassar, T. and Valente, J. (2017) ‘Transgender people are not a “burden”: The massive military budget is’, In These Times, 4 August. Available at http://​inthesetimes.com/​ article/​20391/​transgender-​military-​veterans-​queer-​liberation-​war-​occupation (accessed 21 August 2017). Nixon, R. (2011) Slow Violence and the Environmentalism of the Poor. Cambridge, MA: Harvard University Press. Page, T. (2017) ‘Vulnerable writing as a feminist methodological practice’, Feminist Review 115: 13–​29. Pham, L. (2017) ‘Intersex activist and writer Hida Viloria on being “Born Both” ’, Rolling Stone, 20 March. Available at www.rollingstone.com/​culture/​intersex-​ activist-​hida-​viloria-​on-​being-​born-​both-​w472894 (accessed June 13 2017). Rabinow, P. and Rose, N. (2006) ‘Biopower today’, BioSocieties 1: 195–​217. Shotwell, A. (2016) Against Purity:  Living Ethically in Compromised Times. Minneapolis: University of Minnesota Press. Somerville, S. (1995) ‘Scientific racism and the emergence of the homosexual body’, Journal of the History of Sexuality 5(2): 243–​66. Spade, D. (2011) Normal Life: Administrative Violence, Critical Trans Politics, and the Limits of Law. New York: South End Press. Spade, D. and Goodman, A. (2017) ‘What role should the military play in the fight for transgender rights?’ Available https://www.democracynow.org/2017/7/27/ what_role_should_the_military_play (accessed 15 November 2019). Sylvia Rivera Law Project (2007) ‘It’s a war in here’. Available at https://​srlp.org/​files/​ warinhere.pdf (accessed 5 June 2017). Thiem, A. (2008) Unbecoming Subjects: Judith Butler, Moral Philosophy, and Critical Responsibility. New York: Fordham University Press. Thompson Reuters Foundation (2016) ‘2016 deadliest year on record for US transgender people, GLAAD reports’, NBC News, 10 November. Available at www. nbcnews.com/​feature/​nbc-​out/​2 016-​deadliest- ​year-​record- ​u s- ​transgender-​ people-​glaad-​reports-​n682166 (accessed 5 June 2017). Transgender Law Center (2015) ‘Transgender Americans face staggering rates of poverty, violence’, 18 February. Available at https://​transgenderlawcenter.org/​ archives/​11393 (accessed 7 August 2017). Weheliye, A. G. (2014) Habeas Viscus:  Racializing Assemblages, Biopolitics, and Black Feminist Theories of the Human. Durham, NC: Duke University Press.

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Part II

PRECARITY IN  THE MAKING OF KIN

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PRECARIOUS LABOURERS OF LOVE Queer kinship, reproductive labour and biopolitics1 Ul r ik a Dahl

INTRODUCTION We have a 20-​month-​old. We have shared everything equally: parental leave, putting the child to sleep, nights, bottle-​feeding, etc. from day one. My wife has never breastfed. Yet, given a choice, the child always chooses my wife. Is this because my wife is on parental leave? Is this a phase? Or can children ‘feel’ biological ties and have needs for something I can never give? I never thought non-​biological parenthood would feel this complex, I always thought that ‘it doesn’t matter’ and had no idea how sensitive and invisible the role of non-​ gestating parent is. My wife does not get my experiences at all and we don’t talk about it anymore because I just get more sad. (Karin, discussion group on social media)

Taking its cue from this post in an online discussion group for non-​ heterosexual parents, this chapter explores how different forms of reproductive labour create different forms of precarity within queer, as in non-​ heteronormative parenting and kin-​ making. More specifically, it considers the precarization of biological labour in a setting that privileges intimate labour as the foundation for kin-​making. Biological labour, that is the labour of making, gestating and breastfeeding a child, is paradoxically necessary and understood as insignificant, and yet, as Karin suggests, produces strong feelings, even in a kinship structure that departs from the notion of intent and intimate labour as equally shared matters. Framing reproduction as a biopolitical question and a question of gender labour, this chapter thus attends to how gendered and racialized ideas of parenthood and kinship are reproduced and reworked in imaginaries of lesbian, gay, bisexual, transgender and queer (LGBTQ) parenthood.

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Karin’s post is from one of the many social media discussion groups on non-​heterosexual parenthood that I follow in my ethnographic research on contemporary LGBTQ family-​making in Sweden. I am particularly interested in how queer forms of family-​making evoke gendered and racialized forms of biological and intimate labour and in how reproductive desires articulate with ideas about relatedness and parenting. I approach these questions for what they might teach us, not only about LGBTQ people who through the increasingly common practice of assisted non-​heterosexual reproduction create thriving families despite persistent homophobia but also about the broader cultural settings in which contemporary queer dreams and practices of family are formed. Like many of my interviewees, the person I here call Karin is committed to lesbian parenthood as equal in terms of division of labour. For parents like her, the idea that the biological labour of gestation ‘does not matter’ is central to lesbian parenthood as shared and equal. Indeed, downplaying or omitting ‘biology’ is central for the very definition of non-​heterosexual family and kinship. Despite having ‘shared everything’, despite omitting the potential difference that the biological labour of breastfeeding might engender, Karin feels that the child prefers the biological tie and feels left out of kinship. If the failure to conform to gender norms engenders precarity, non-​gestational mothers and parents without legal or biogenetic ties are certainly precarious subjects. Indeed, both family law/​ the state and queers themselves reinscribe biogenetic relatedness in a range of ways. The state does so by managing donor insemination and providing different paths to legal recognition of parenthood depending on mode of conception, and queers by their different strategies for extending biogenetic kin lines through the use of sperm, ova and wombs. Yet, Karin’s feelings about biological ties do not involve the donor and while her sense of rejection by her wife and child might be read as an effect of the heteronormative culture in which queer families are located, here I suggest a different approach, that of considering limits of kinship understood as (intimate) labour. The labour of love that makes a family is complex. The gestating parent does the labour of gestation, which is here understood as both unimportant and elevated, and must do the gender labour of validating the co-​parent’s status, thus frequently giving up the value of her own labour in the spirit of equality. The co-​parent must do the intimate labour of caring for the child in order to achieve the status of parent or mother. The child, finally, must do the labour of reciprocating love equally, for the family to feel ‘complete’ and authentic. Indeed, the majority of the more than twenty commentators insist that parenting is intimate labour, it is what we ‘do’ to take care of the needs of others. Drawing on Jane Ward (2010), I argue that queer parenting

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centrally involves the ‘gender labour’ of performing and attributing gendered parenthood status within and outside of domestic space. As Karin’s story, which is but one of hundreds of similar ones, suggests, in the new millennium in Sweden, queers are fertile and future bound (Dahl, 2018b). They are coming of reproductive age in an era of expanding family rights and a growing array of assisted reproductive technologies (ARTs) available through both state health care and the fertility industry. Information and expertise, consumer choices and interactions with medical professionals are mediated through and entangled with digital technologies that reflect, create and shape queer reproductive desires (Andreassen, 2018). With the privatization of the public sector and the decrease of public meeting spaces, (queer) intimate and family life are also increasingly becoming privatized. For LGBTQ people, online discussion groups are often the only or primary form of queer community available (cf. Andreassen, 2018). There LGBTQ parents like Karin explore and contest ideas and experiences of queer parenting, relatedness and family in relation to the Swedish state. They also mobilize for action and support on various issues ranging from adoption procedures to education. Social media discussions, as semi-​public spaces, reflect the interests of members and are thus instructive for understanding larger (sub)cultural patterns and placing stories from qualitative interviews in a broader context. Karin’s concern with the feeling of biological ties, I argue, reflects a larger concern and a sore point for queer family-​making. As social media constitutes an intensely affective economy, it is a particularly important arena for a kinship theorist interested in affect. Conception and arrival stories and angry accounts of encounters with social workers are interwoven with baby pictures and images of faces with smiles or tears expressing loss and rejection in the feed. Almost all posts revolve around the need to share and for advice on the everyday intimate life of the users. Frequent use of a range of emojis, ‘likes’ and comments animates social media as reproductive technology for the circulation and reproduction of feelings of kinship. Discussion group membership demographics, affective patterns of posting and commenting and the content of comments indicate that some feelings more than others are validated. Thus, discussion groups mediate and circulate affective ‘norms’ around queer parenthood and family-​making, including ideas about gender, race and kinship, the idea of equality of parents and the importance of intent and intimate labour. The cultural analysis I  offer of queer family-​making in this chapter also draws on ethnographic research, survey data and conversations and interviews with about twenty-​five individuals and couples in Stockholm from 2014 to 2018 ranging between the ages of twenty-​five and fifty-​five. Thus far, most research on LGBTQ families in Sweden has centred on white lesbian dual-​parent families and their encounters with heteronormativity

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(cf. Malmqvist, 2015). A  recent survey by RFSL in 2017 indicates that the overwhelming majority of LGBTQ families are white, middle-​class, cisgendered lesbians, and names and profile images in this discussion group suggest that those who engaged with Karin’s concerns with being a non-​gestating parent were all white Swedish lesbians and queers with children under five years of age.2 As such, they have become parents under queer liberalism where marriage and reproduction has become central to queer respectability (Eng, 2010). One aim here is to contribute to critical whiteness studies and show that the (queer) nation is repeatedly recreated as white (Hübinette and Lundström, 2014) even if whiteness remains a norm frequently invisible to those who inhabit it (Ahmed, 2007). My research explicitly includes interviews with hitherto understudied members such as queers of colour, queers who have gone through separation and custody struggles and those who have actively sought to go against the two-​parent model and create different kinds of kinships. In this chapter I aim to contribute to the theoretical discussion of precarity as a concept by pointing to the gendered, racialized and embodied dimensions of reproductive labour. To that end, I am interested in how what gets cast as a labour of love, the making and caring for a child, produces different positions in kinship. In what follows I first outline how the concept of (bio)precarity has been discussed and how this relates to questions of LGBTQ family-​making and queer reproduction as stratified. Next I show how legal changes and ARTs are entangled with the biopolitics of (queer) reproduction in Sweden. From there I home in on the specific understandings of gender and labour that ignite affect in queer understandings of parenting and kinship. I conclude by discussing how the disavowal of biological labour relates to feelings of biological ties. I argue that the (queer) love that is the basis for family and reproduction manifests different forms of potential and situational precarity, not only vis-​à-​vis the state that grants the recognition of their intended and made bonds, but in the intimate sphere of familial reproduction. QUEERING THE (BIO)PRECARITY OF REPRODUCTION As this volume demonstrates, precarity has become a central concept for understanding the uneven distribution of life, health, labour and property under neo-​liberal and global late capitalism. While used in different ways, precarity typically refers to rising and manifold forms of vulnerability of the embodied self in relation to basic needs, to economic survival and to forms of labour in an increasingly unequal world. On the one hand, precarity describes a basic human and ontological condition of vulnerability and interdependence (Butler, 2009; Puar, 2012). It points to how our survival

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is sustained by human and non-​human bodies and their affective labour, and at the same time to how institutionalized forms of recognition and the infrastructures that recognition brings shape our locations and experiences of the world (Shaw and Byler, n.d.). In terms of assisted reproduction, both providers and receivers of particular kinds of biological and intimate labour, such as sperm and ova or gestation, can be understood as precarious (see also Griffin, Chapter 7 this volume). Emphasizing the universality of precarity as a fundamental bodily vulnerability and ontological position, precarity also holds the promise of a different ethic of relationality. Stressing interdependence as fundamental, precarity casts a different light on the figure of the self-​sufficient, rational and autonomous consumer subject and the agential worker who makes choices about their labour. On the other hand, it is clear that under neo-​liberalism and globalization, some groups and bodies more than others are rendered precarious due to heightened and growing inequalities. As Anna L.  Tsing (2015:  2) puts it, precarity captures ‘life without the promise of stability’ and precarious bodies and subjects are also frequently cut off from certain forms of relationality and intimacy. For instance, providing intimate labour for others at the expense of doing that labour for one’s own kin or performing biological labour without inclusion in kinship. Importantly, in the context of queer reproduction, both those who perform the biological labour of gestation and the intimate labour of care can be rendered precarious in terms of lacking rights, recognition and inclusion. As Judith Butler (2009:  ii) notes, precarity is ‘directly linked with gender norms, since we know that those who do not live their genders in intelligible ways are at heightened risk for harassment and violence’. Frequently excluded from certain forms of (gendered and sexual) recognition, including those linked to parenthood, LGBTQ people can be seen as a precarious ‘population’ in need of special (legal) protection. In nations such as Sweden, expanded parental rights and access to reproductive technologies framed as a question of ‘equality’ have been a solution to this ‘precarity’. Yet, as Athena Athanasiou states in a conversation with Judith Butler, precarity also describes the lives of those whose ‘proper place is non-​being’ in the current economic system, where groups and people are ‘differentially exposed to injury, violence, poverty, indebtedness, and death’ (Butler and Athanasiou, 2013: 19). While LGBTQ people’s access to reproductive technologies and parental status is presented as a question of ‘equality’, the growing range of procreative strategies available on global markets of ARTs as well as through welfare states are not equally available to all bodies, nor is all the biological and intimate labour involved in reproduction equally recognized or valued. It is clear that non-​white, non-​gender conforming

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and trans bodies, are particularly precarious and vulnerable, including in their reproductive desires (see Chapters  4 and 12 this volume). My research shows that queers of colour experience racism in every aspect of becoming and being parents and that far from all queer bodies who wish to become parents are seen as fit to reproduce or entitled to assistance from or recognition by the state. Queer reproduction and kinship is a heterogeneous phenomenon that produces many ways of being bodily indebted to others. While privileged white gay men can be read as (bio)precarious in terms of exposure to violence and injury due to sexual orientation or gender presentation, or through the continued challenge to imagining families designed without women or gestational parents, they also have structural privileges that open paths to such co-​parenthood (cf. Nebeling Peterson, 2015). Indeed, in post-​industrial consumerist political economies, white homosexuality is characterized by strong purchasing power and a privileged form of racialized masculinity that engenders structural opportunities for procreation such as transnational surrogacy arrangements that most other LGBTQ subjects do not have (Nast, 2002: 880). This means that under neo-​liberalism, different opportunities for mobilizing ‘biology’ coexist and have different implications for understandings of parenthood and kinship. Whether understood as biogenetic matter or as labour, the biological may or may not ‘matter’ for kinship. The persistent or renewed feelings of biology manifested both in using and purchasing biogenetic materials suggest that understandings of (gay and queer) kinship, while refusing the heterosexual model of relatedness, remain articulated along the lines of ideas of racial alikeness on the one hand and of private property on the other. As such, they are entangled in, rather than separate from, heteronormative, late capitalist and biopolitical logics of reproduction. I argue that there is a paradox at the centre of the double understanding of (bio)precarity and this has particular consequences for analysing new forms of reproduction, kinship and LGBTQ family-​making in particular. When it centres on intimate labour, a term that refers to ‘tending to the intimate needs of individuals inside and outside their home’ (Boris and Parreñas, 2010: 5), the emphasis on interdependence inherent in precarity enables the radical queering of kinship that many advocate. When Butler (2002: 15), for instance, argues for a change in understandings of kinship beyond heterosexually defined biogenetic contributions and relations to ‘kinship practices’ that ‘emerge to address fundamental forms of human dependency, which may include birth, child-​rearing, relations of emotional dependency and support, generational ties, illness, dying, and death (to name a few)’, she not only extends Weston’s (1991) idea of queer kinship as ‘families we choose’, but captures what is fifteen years later arguably a queer subcultural norm,

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namely that intent and intimate labour rather than biological labour or biogenetic ties constitutes family. While empirical research on contemporary queer family life offers ample examples of kinship enacted as a practice or as intimate labour, it not only raises the question of whose ‘intent’ is sanctioned and whose labour is recognized, it also illuminates how sperm and ova have become commodities and donation, gestation and breastfeeding forms of labour. Neither biological nor intimate labour can be separated from the sexed, gendered and racialized positions of those performing and needing it. This leads to a range of potential (bio)precarities within queer reproduction. René Almeling (2010: 64) notes that while ‘the product for sale in this medical market, eggs and sperm, are parallel bodily grooms in that each contributes half the reproductive material needed to create an embryo’, biological sexual differences shape not only the possibility of conception but the process of donating ‘reproductive material’ and how donation as a form of labour is experienced and compensated. In queer reproduction, sperm and ova, along with gestation, engender a range of different feelings. They can be understood as central to conception and to kinship (using one’s ‘own’ eggs, sperm or womb), be seen as ‘donations’ or ‘gifts’, as products and services depending on arrangements and resources. Interestingly, the transformation of procreation into a phenomenon that relies on economic hierarchies, both national and transnational, seems to always be premised on what Heidi Nast (2002: 80) has called a ‘sociospatial side-​lining of motherhood’ as tied to biological labour. Nast (2002:  897) argues that ‘the body of woman, synecdotally collapsed into the womb, is open for rent or temporary purchase’ and furthermore, that ‘in gay white male patriarchal contexts, there is greater potential for the maternal body to be excised from memory altogether’. I argue that when the biological labour of gestation is presented as ‘not mattering’ in queer kinship, it suggests that the very model of queer parenthood as equal and based on equal intimate labour renders what in heteronormative understandings of kinship is taken for granted, namely maternal biological labour, quite precarious. As we shall see, what in the opening quote was called ‘the feeling of a biological tie’ is also entangled with the biopolitics of reproducing race and nation. THE BIOPOLITICS OF QUEER REPRODUCTION IN SWEDEN A nation historically celebrated for gender equality, sexual exceptionalism, colour blindness and state feminism, with its inclusive family policy and access to reproductive technologies and legal recognition via the state, Sweden has been upheld as a paradise for LGBTQ people in general and

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families in particular (cf. Dahl, 2018b). At the same time, Sweden has a long history of heavy regulation of reproduction including decades of enforced sterilization of bodies deemed ‘unfit’ to reproduce, particularly poor, racialized and gender non-​conforming bodies (cf. Broberg and Tydén, 1991). Becoming a queer parent has increasingly come to involve some form of ART and paths to parenthood differ significantly depending on the knowledge, material circumstances, age, health status and citizenship of parents and children. The state plays a perhaps increasingly powerful part in defining kinship and parental status and ultimately which queers are deemed fit to reproduce. A crucial question is whether an intended parent with a womb is involved and the age of this person. Indeed, whether or not accessing these technologies and the biogenetic materials needed involves reproductive travel, it is intrinsically entangled with the biopolitical regulations of a neo-​liberal nation state. As discussed elsewhere in this volume, Foucault’s notion of biopolitics consists of two major dimensions:  one, the anatomo-​politics of various forms of classifications of the human body; and second, the regulatory controls and management of populations related to birth rates, morbidity, mortality, longevity and especially, regulation of access to reproductive technologies. Under neo-​liberalism, the profound transformation of the private and heightened emphasis on parental engagement and responsibility coupled with biopolitical modes of governance create different reproductive strategies for obtaining LGBTQ parenthood. On the one hand, technologies of subjectivity, including social media, encourage citizens to optimize choices, efficiency and competitiveness, to invest in property and futurity and to consider themselves reproductive citizens. On the other, neo-​liberal technologies of subjection centre on strategies to regulate populations for optimal productivity. While ‘same-​ sex marriage and parenthood’ has been recognized in various forms since 1998, it hardly describes all queer family constellations and in fact arguably closes down meanings of kinship (cf. Butler, 2002). Lesbians who had children before the millennium often did so in friendship arrangements with private sperm donation and insemination and thus ‘fathers’ were known and frequently part of parenting arrangements (Hamrud, 2005; Stenholm and Strömberg, 2004; Zetterqvist Nelson, 2006). Around the millennium, growing access to a less regulated international fertility market drastically increased reproductive travel among lesbians who could afford it, especially to neighbouring countries such as Denmark and Finland where sexual orientation or marital status was not an obstacle and thus began having children ‘without men’. Initially, Swedish family law was changed to accommodate the right to adopt a ‘spouse’s’ children (given that no second provider of genetic materials claims parenthood) and as such, it

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secured the precarious position of the non-​gestating parent in the growing number of families where children were conceived ‘without fathers’. In 2004 married and cohabitating women gained access to insemination via welfare state health care and thus to a less complicated administrative procedure for gaining co-​parenthood. At the same time, the state, via its registration of differences in gender and marital status (Leibetseder, Chapter 4 this volume) and its strict regulations of access, also effectively exercises biopolitical control over some groups more than others. Within a decade, a fertile generation of LGBTQ people have become accustomed to certain principled rights and recognitions. At the same time, men who wish to be parents without women or others with the capacity to become pregnant, meet many challenges. Few nations approve of same-​ sex adoptive parents and engaging in commercial surrogacy is culturally controversial, extremely costly and involves transnational arrangements that raise questions about the child’s citizenship. Swedish gender-​equality ideology with its strong roots in radical and socialist feminist theory has tended to cast surrogacy, like sex work, not as a form of labour but as exploitation, and debates frequently highlight the effect and the enactment of unequal global gendered power relations (see Nebeling Peterson 2015).3 In other words, questions of insemination, pregnancy and gestation, their relationship to kinship categories such as mother, father or parent and the legal status thereof are not ‘solved’ and they continue to be debated by queer activists and by the family makers themselves. The different regulations of access to reproductive technologies and to legal recognition of parenthood show the state’s biopolitical regulations of which bodies are deemed fit to reproduce and how. Different laws are tied to different modes and places of conception. They also point to queer reproduction’s complex entanglements in questions of citizenship and to how the value, meaning and implication of different kinds of biological and intimate labour are at work simultaneously. While many contemporary lesbians and queers argue that a sperm donor has no place in kinship, and is certainly not a parent or a ‘father’, the donor and their biological labour conjures up a range of feelings for both the state and individuals. The Swedish state does not accept anonymous donors nor does it allow queers to ‘choose’ donors, and it regulates the number of children born from each donor. In fact, it does not always recognize LGBTQ families formed under other legal frameworks. An Argentinian-​Spanish/​Swedish lesbian couple shared a story of how de-​kinning can occur through migration. Their child was conceived in Spain through anonymous donation and one Swedish parent gestated. Upon migrating to Sweden, they learned that the Swedish authorities did not recognize the co-​parent on the grounds that anonymous

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sperm poses a problem to the Swedish law on a child’s right to origin, thus the Argentinian-​Spanish4 parent is without parental rights. While babies conceived outside the confines of state health care must be adopted, when conception occurs in Denmark to Swedish citizens, the state approves adoption if a receipt for the ‘purchase’ of the substance and the service can be presented and the parents are approved by social workers upon a home visit. The argument for known donors is frequently that children have a right to origin and that no donor can be used for more than six families shows that biogenetic substances are understood to carry important value for identity as well as for the reproduction of the population. Furthermore, while both previous research and several of my interviews suggest that ‘Danish sperm’ (anonymous or not) is laden with positive connotations (cf. Andreassen, 2018) and while both rumours about phenotypical signs of relatedness and active searches for donor siblings is increasing, the non-​Swedish and unknown origin of Danish sperm seems less of a concern. I argue that this suggests that legal regulation of access to reproductive technologies and parental recognition, along with laws that regulate donation of both sperm and egg, can be understood to reflect a desire to protect and promulgate particular sociocultural values (Melhuus, 2012: 13) and that those are tied to the reproduction of whiteness. Stories about the role of donors are especially instructive for how biological and intimate labour articulate with the biopolitics of reproducing race and nation. In 2018 Vårdguiden, an informational magazine distributed to Stockholm households, featured its first article on lesbian insemination (Frojdh, 2018). The double spread entitled ‘The Donor Must Be A Fantastic Person’ told the story of two white women, both police officers, whose son was conceived through insemination and in vitro fertilization (IVF) obtained through state health care. Both legal parents, they stressed that they were ‘so happy to be his parents and often think of the donor. We are incredibly grateful for what he has done and that he has given us this opportunity. He must be a fantastic person’ (Frojdh, 2018:  22). The two blonde feminine women explained that they did not have any wishes regarding the donor. Looking at their child, one said in the interview, ‘but since we are both light the clinic must have chosen someone with similar colours’. For this couple, the biological labour of the donor did not make kin, but rather, it is framed as a gift that conjures up a warm and good feeling. He has done something for them and given them an opportunity. Like many of my own interviewees, they hoped to use the same donor for several children, an idea that, like the search for and engagements with donor siblings (Andreassen, 2018) and the regulation of donor sperm, points to the persistence not of labour but of the feeling of biological ties as entangled with both kinship and biopolitics.

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This story about how the state has ‘matched’ the sperm donor with the parents illuminates a discourse of matching (largely around eye colour, hair colour and texture and skin tone) that is central to discussions of queer reproduction. Even if the matter that comes from the donor is not understood as a kinship matter, it works as a matter of alignment, creating families that look alike. Indeed, as Rikke Andreassen (2018: 133–​4) argues, ‘bodily materiality is central to constructions of race, not because race is biologically founded but because race –​and hence difference and sameness –​has historically (and currently) been constructed via the alignment of bodies through the interpretation of material bodily signs’. For this white couple, the donor is unimportant but they are pleased that matching was done around ‘light colours’. While many interviewees insist that ‘it doesn’t matter’ and white interviewees frequently state that they would welcome raising children of colour as an act of antiracism, many say that non-​white sperm is never given to white couples. In contrast, several interviews with queers of colour account for a very different treatment. Like the policewomen, they are frequently not asked about preferences but unlike white women, they can rarely assume the degree of matching reported in this chapter. Rather, they report being left with a feeling that they should be grateful for ‘any’ sperm and that requests for phenotypical matching leads to being shamed. Ranging from being told they do not get to choose, to being offered ‘any’ non-​white sperm, to being subjected to phenotypical scrutiny, ignorance and guess work with regards to their racial, cultural and national origin, to being told that various groups of men of colour do not donate for ‘cultural’ or ‘religious’ reasons, interviewees often speak of how racism shapes their desires to reproduce and how they are left feeling ‘whitewashed’, as one activist put it (cf. Dahl, 2018a). Tobias Hübinette and Catrin Lundström (2014: 426) have argued that Sweden can be described as characterized by a fantasy of colour-​blindness coupled with a hegemonic whiteness that ‘constantly reinscribes whiteness as the normative, yet unmarked, position that, for example, effectively forecloses, silences and excludes experiences of everyday racism among non-​white Swedes’. Erasing the uneven distribution of biological labour in the form of sperm donation and at the same time casting white sperm as universal, desirable and neutral, the biopolitical management of the population through assisted (queer) reproduction reproduces whiteness through the alignment of some bodies as alike in kinship and not others. PRECARIOUS LABOURERS OF LOVE Let’s return to how intimate and biological labour feature in queer kinship and reproduction. The queer post-​millennial baby boom has led to a new

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wave of research on queer families in Europe and the global North. By comparing queer and heterosexual families, the literature often emphasizes the positive aspects and how same-​sex families persevere, raise well-​adjusted children and experience less intimate violence and inequality. Feminist and queer understandings of gender, and thus of parenthood, as performed and performative tend to stress that parenthood is socially constructed and that LGBTQ people parent differently. This work also tends to stress the precarious position of non-​biological parents as an effect of heteronormative society. The ‘normative’ dimensions of biological labour as constitutive of ‘real motherhood’ is frequently a point of departure for identifying what is ‘queer’ and the potential precarity of biological labour is largely ignored. While LGBTQ families are frequently presented as challenging conventional understandings of mother and fatherhood, Karin’s account at the beginning of the chapter points to the role of affective intimate labour for recognition and validation as a parent. She feels rejected and misunderstood as a parent by both her partner and her child. As Jane Ward (2010: 79) proposes, ‘gender subjectivities are constituted by various labors required of, and provided by, intimate others’. As Ward (2010: 93) rightly points out, queer theorists, including of kinship and reproduction, have attended less to ‘how queerness takes form in and through the micro-​sphere of relationality –​ particularly the feminised realms of caring and witnessing which literally nurture gender subjectivities into possibility, and through the channels of loss and suffering’. Gender labour, writes Ward (2010:  79), describes ‘the affective and bodily efforts invested in giving gender to others, or actively suspending self-​focus in the service of helping others achieve the varied forms of gender recognition they long for’. Karin’s account shows how the relational and gendered dimensions of making family go beyond the impact of ‘heteronormativity’. The idea that ‘it doesn’t matter’ and of parenthood as ‘equal’ masks how queer reproduction and family-​making are gendered forms of labour entangled in ideas of sameness and difference. Several of my interviewees shared similar stories. Gestational parents often say that they did not expect pregnancy to be as ‘intense’ or ‘emotional’ as they then experienced it. Breastfeeding was for many and especially those who see themselves as feminists, seen as unnecessary and as a challenge to equality (see also Malmqvist, 2015). Cristina, a femme of colour in her thirties who carried one of her two children, explained in an interview that she ‘did not expect it to make such a difference to be pregnant’. She began crying as she talked of breastfeeding. She wanted to, she said, but her partner considered it ‘biological nonsense when there are alternatives’ and expressed anger and jealousy so she ‘gave up’. While she felt vulnerable and wanted to be in a ‘baby bubble’ post-​ delivery, her partner did not see her needs at all and expected Cristina to

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care for her partner’s extended family while also excluding Cristina’s kin. She felt caught between wanting to affirm her partner’s co-​parenthood and her own desires and felt ‘unprepared’ for how complex the negotiations of biological and intimate labour became. She said, ‘The fact that I carried our son is not something I can ever talk about’. The desire to ‘share everything equally’ as Karin and many of my interviewees put it, is of course not unique to queers, but it raises a range of themes of interest to how queer kinship is understood. First and foremost, biological labour has to be downplayed, presented as ‘not a big deal’, as Cristina put it, which arguably renders it precarious. Biological labour here clashes with the intimate labour of validating the co-​parent’s position as equal mother or parent. Second, from a feminist perspective, the dedication to intimate and deeply ‘feminized’ labour of parental leave, feeding, comforting and caring that have traditionally defined ‘motherhood’ are not only shared but at times fought over by parents, which raises questions about the circumstances under which ‘equality’ of labour is possible. Third, the (sub)cultural assumption that parenting should reflect equality in intimate labour has interesting effects on ideas of kinship. When the object of love (the child) does not reciprocate love equally, it creates a strain on the love between the parents. While Karin feels that the gestating parent does not understand her feelings of hurt and rejection, she received dozens of replies, all endorsing her value as a parent. Interestingly, while many shared her surprised and sad feelings around the difficulty of not ‘having a biological tie’, the insignificance of biological labour was also stressed. Carina, on the other hand, like several other interviewees, explained that none of her non-​ gestating friends had any sympathy for her desire to breastfeed and she felt that everyone sided with her partner. These negative affects of rejection, sadness and difference are typically explained as unexpected and as a result of heteronormativity and essentialist ideas of motherhood (cf. Park, 2014). It seems to me that they suggest that there is a normative idea of lesbian parenthood as shared and equal. Kinship, here understood as ‘ties’ and manifested in the intimate and biological labour that creates relations between parents and children, is a cultural scenario and an ongoing exchange of gendered labour:  a co-​parent invests gendered parental intimate labour in a child, a gestational parent does gendered labour by validating the intimate labour and feelings of the co-​parent as parental and the child is to reciprocate by expressing equal love for and turning to its two parents. Like all family-​making, non-​heterosexual reproduction involves complex negotiations of gendered forms of biological, intimate and emotional labour. The desire to share motherhood ‘equally’ by stressing intimate over biological labour also points to a desire to conform to a national ideal. Arguably,

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these ideals of sameness and equality also tend to assume white privilege and middle-​class livelihoods. A construction of queer kinship as founded on intimate labour and the social constructed nature of kinship bonds might serve some reproductive projects more than others. Paradoxically, this era is also marked by growing inequality, privatization and rapid dismantling of the very welfare state on which many have come to rely for realizing their family dreams and sharing parental and productive labour equally. CONCLUSION In this chapter, I have approached the question of (bio)precarity in queer reproduction and family-​making by considering LGBTQ parents in contemporary Sweden as differently and sometimes paradoxically situated precarious labourers of love. I  have sought to analyse two interrelated but separate forms of labour, biological and intimate, and discussed how they produce specific and different forms of precarity in families that are premised on reproduction as intent and choice rather than as the effect of a particular and naturalized sexual practice, as is the case when fertile bodies meet in heterosexuality. At the same time, I have sought to challenge the idea that LGBTQ subjects are inherently (bio)precarious, especially in the context of reproduction and kinship by placing the question in the context of biopolitics. Butler (cited in Puar, 2012: 170) contends that precarity invites us to ‘a way of rethinking social relationality’ and at the same time notes that it reflects a differential distribution of power. While queer kinship holds all the vulnerabilities and promises that precarity entails, we must also attend to how queer reproduction and family-​making create (re)newed forms of social relationality structured by difference and inequality. Productively challenging heterosexuality as the origin of kinship, under queer liberalism an explicit challenge to the meaning of (sexual and bodily) difference and its manifestation in biological and intimate labour, runs the risk of overlooking both global and intimate inequalities as well as meaningful ways to engage difference. Queer discussion of kinship typically centres on how it challenges heteronormativity, expands the category of parent and the meaning of motherhood and fatherhood. The anti-​essentialist argument used to dismiss biological labour has been crucial in securing legal bonds to children. Yet, even as (biological) labour, gestation, childbirth and breastfeeding, create ties that pose both ethical and domestic intimate dilemmas. Feminists have interrogated the historical and contemporary connections between kinship and property and how the labour of gestation has long been

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overridden by that of paternal kinship. It seems to me that an idea of ‘equality’ of labour and recognition of parental status does not solve the affective dilemmas posed by Karin in the quote that opened this chapter. While feminist science studies scholars have argued against a simplistic discussion where technologies are either terrifying or liberating, the feminist dilemma of dislodging biological labour from kinship needs to be both historicized and situated. Lauren Berlant (cited in Puar, 2012: 171) observes that ‘the situation of precarity, which is the situation of relationality itself, insofar as our dependencies are vulnerabilities, is also a situation of aggression  –​because of needs whose demands are unmet’. If we are to understand the affective complexities of differentially positioned labourers of love in queer families, and the dilemmas articulated by Karin, it is worth noting that parents and their children depend on one another’s recognition as much as they do on those of society at large. The privileging of intimate labour over biological labour runs the risk of reproducing what Nast (2018:  329) calls ‘masculinist desires to ontologize and organize private property into a schema of value from which human relationality and the biological maternal could be abstracted, commodified, and possessed’. Efforts to transform gestation into a form of labour and a service and to dislodge kinship ties and parental status from biological labour must be historicized and contextualized in a way that complicates the discourse of choice, intent and agency as inevitably progressive and ‘queer’. Indeed, contemporary forms of queer reproduction are entirely entangled with a growing fertility market from which queers now benefit and are even seen as the key consumers of (Mamo, 2013). There is no doubt that the LGBTQ ‘population’ includes many vulnerable embodied selves but there is no universal precarity in queerness. Rather, queer (reproductive) subjects are gendered, sexed and racialized in ways that make them and their labour of love precarious in relation to one another. Here I have argued that queer reproduction is not simply a result of progressive politics. Rather, as privileged queers in a post-​industrial economy create families by accessing care provided by the welfare state, by entering into a commodified fertility market or by drawing on other national schemes of recognition such as adoption or marriage law, they are entangled with rather than outside of neo-​liberal logics and the biopolitics of reproducing race and nation. Discussions about biopolitics cannot occlude the centrality of race (Weheliye, 2014), especially for kinship. A queer theory of biopolitical kinship calls attention to the effects of omitting that difference in the spirit of some reproductive projects and not others. Both the precarisation of biological and maternal intimate labour in LGBTQ kin-​making and the differential distribution of intimate labour as a form of gender labour needs to be studied further. The commodification of reproductive materials (egg and sperm) and gestation and how the

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labour involved in conceiving a child is rendered invisible, both reflect and challenge our understanding not only of kinship but of gender and sexuality. Put differently, the biological labour required and involved in making both babies and kin does matter in particular, though not in predetermined ways to those who perform it. Over-​valued as a point of departure for defining the ‘norm’ against which queer is constituted, under-​valued for its contributions to queer kinship, biological labour, it seems, above all, persists as a feeling. Indeed, Karin’s concern shows the simultaneous affective impact of ideas of relatedness and belonging and of ideas of intimate, affective and biological labour, as central to the reproduction of queer (family) life. NOTES 1 Research for this chapter was conducted within the project ‘Queer(y)ing Kinship in the Baltic Region’, funded by the Baltic Sea Foundation and approved by the Stockholm regional board of ethics. 2 The data from the survey Nationell enkät om hbtq-​personers erfarenheter och behov kopplat till föräldraskap och umgänge med barn conducted in 2017 by RFSL Stockholm is under analysis. The data are owned by RFSL. 3 The numbers of children of gay men born through transnational surrogacy arrangements have nevertheless grown; it is estimated that in 2019 the number of such children will be greater than the number of children conceived through transnational adoption. 4 Personal communication from the parents who shared the statement sent to them by the tax authorities. It read as follows: ‘The tax authorities argue that the child’s right to search for its origin can constitute a reason to limit the right to have foreign parenthood recognized in Sweden. A possibility for the child to search their origin should, therefore … constitute a condition for foreign parenthood being recognized. A  different order would involve a violation of the child’s personal integrity and render it possible to circumvent the internal rules for establishing parenthood.’

REFERENCES Ahmed, S. (2007) ‘A phenomenology of whiteness’, Feminist Theory 8(2): 149–​68. Almeling, R. (2010) ‘Selling genes, selling gender: Egg agencies, sperm banks, and the medical market in genetic material’, in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 63–​77. Andreassen, R. (2017) ‘Social imaginaries, sperm and whiteness: Race and reproduction in British media’, Journal of Intercultural Studies 38(2): 123–​38. Andreassen, R. (2018) Mediated Kinship:  Gender, Race and Sexuality in Donor Families. New York: Routledge.

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Boris, E. and Parreñas, R. S. (eds) (2010) Intimate Labors:  Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press. Broberg, G. and Tydén, M. (1991) Oönskade I folkhemmet: Rashygien och sterilisering i Sverige. Stockholm: Gidlund. Butler, J. (2002) ‘Is kinship always already heterosexual?’, Differences:  A Journal of Feminist Cultural Studies 13(1): 14–​44. Butler, J. (2009) ‘Performativity, precarity, and sexual politics’, AIBR:  Revista de Antropología Iberoamericana 4(3): i–​xiii. Butler, J. and Athanasiou, A. (2013) Dispossession:  The Performative in the Political: Conversations with Athena Athanasiou. Cambridge, UK: Polity Press. Dahl, U. (2018a) ‘(The promise of ) monstrous kinship? Queer reproduction and the somatechnics of sexual and racial difference’, Somatechnics 8(2): 195–​211. Dahl, U. (2018b) ‘Becoming fertile in the land of organic milk:  Lesbian and queer reproductions of femininity and motherhood in Sweden’, Sexualities 21(7): 1021–​38. Eng, D. (2010) The Feeling of Kinship:  Queer Liberalism and the Racialization of Intimacy. Durham, NC: Duke University Press. Frojdh, M. (2018) ‘Donatorn måste vara en fantastisk person’, Vårdguiden 1177(3): 22–​5. Hamrud, A. (2005) Queerkids –​och deras föräldrar. Stockholm: Normal Förlag. Hübinette, T. and Lundström, C. (2014) ‘Three phases of hegemonic whiteness:  Understanding racial temporalities in Sweden’, Social Identities 20(6): 423–​37. Malmqvist, A. (2015) Pride and Prejudice: Lesbian Families in Contemporary Sweden. Linköping: Linköping Studies in Behavioural Science No. 191. Mamo, L. (2013) ‘Queering the fertility clinic’, Journal of Medical Humanities 34: 227–​39. Melhuus, M. (2012) Problems in Conception: Issues of Law, Biotechnology, Individuals and Kinship. Oxford: Berghahn Books. Nast, H. J. (2002) ‘Queer patriarchies, queer racisms, international’, Antipode 34(5): 874–​909. Nast, H. J. (2018) ‘Uterine imaginaries, geopolitical economy, and the maternal/​ unconscious’, Dialogues in Human Geography 8(3): 328–​32. Nebeling Petersen, M. (2015) ‘Between precarity and privilege:  Claiming motherhood as gay fathers through transnational commercial surrogacy’ in Katnsa, V., Papadopoulou, L. and Zanini, G. (eds) (In)fertile Citizens: Anthropological and Legal Challenges of Assisted Reproductive Technologies. Mytilene, Greece:  (In) Fercit, pp. 79–​92. Park, S. (2014) Mothering Queerly, Queering Motherhood:  Resisting Monomaterialism in Adoptive, Lesbian, Blended, and Polygamous Families. New York: SUNY Press. Puar, J. (2012) ‘Precarity talk: A virtual roundtable with Lauren Berlant, Judith Butler, Bojana Cvejić, Isabell Lorey, Jasbir Puar, and Ana Vujanović’, TDR: The Drama Review 56(4): 163–​77. Shaw, J. and Byler, D. (n.d.) ‘Precarity’, curated collection 21, Cultural Anthropology. Available at https://​culanth.org/​curated_​collections/​21-​precarity (accessed 1 July 2019).

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Stenholm, S. and Strömberg, C. (2004) Homofamiljer: guide i praktiska, juridiska och ibland absurda frågor för homosexuella som vill ha barn. Stockholm: Wahlström & Wistrand. Tsing, A. L. (2015) The Mushroom at the End of the World: On the Possibility of Life in Capitalist Ruins. Princeton, NJ: Princeton University Press. Ward, J. (2010) ‘Gender labor: Transmen, femmes, and collective work of transgression’ in Boris, E. and Parreñas, R. S. (eds) Intimate Labors: Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press, pp. 78–​93. Weheliye, A. G. (2014) Habeas Viscus:  Racializing Assemblages, Biopolitics, and Black Feminist Theories of the Human. Durham, NC: Duke University Press. Weston, K. (1991) Families We Choose: Lesbians, Gays, Kinship. New York: Columbia University Press. Zetterqvist Nelson, K. (2006) ‘Att vara pappa i homofamiljer: berättelser om barn, mammor och familjeliv.’ Socialvetenskaplig tidskrift 13(1): 66–​86.

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PRECARIOUS BODILY PERFORMANCES IN QUEER AND TRANSGENDER REPRODUCTION WITH ART D or is Le ibe tse der

INTRODUCTION

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his chapter presents the first outcomes of my Marie Skłodowska-​ Curie Individual Fellowship Program (EU Horizon 2020, Grant Agreement 749218)1 on queer-​and trans-​inclusive assisted reproduction involving studies of six European countries:  Austria, Estonia, Poland, Spain, Sweden and the UK. In this research I  examine the experiences, practices and possible improvements of preserving fertility and achieving reproduction of queer and transgender people in those six European Union (EU) states. This enables the comparison between more liberal countries towards lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) rights and other countries that restrict reproductive possibilities for queer and transgender people. A key aspect of my research is to document the experiences of queer and transgender people using assisted reproductive technology (ART). This is important because there are very different kinds of guidelines and regulations regarding ART in the diverse European countries. My focus in this chapter is on the use of ART by queer and transgender people, how they have to perform particular bodily and intimate selves in the processes of seeking ART (Armuand et al., 2017; Mamo, 2007, 2013) and how this precarizes them. The bioprecarity of queer and transgender people is produced by the enactment of certain kinds of categorical framing (Foucault, 1977, 1990; Somerville, 1995) in the laws regulating ART. Prohibitive laws in some states are often circumvented by going abroad. Thus, I  argue that queer and trans people’s bioprecarity results from the intimate labour they have to undertake to overcome prohibitive laws and

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hetero-​and cisnormative medical institutions as shown e.g. in studies about trans people’s experiences with ART (Armuand et  al., 2017; James-​ Abra et al., 2015). I understand bioprecarity (see also Leibetseder, Chapter 2 this volume) as making some people (their bodies or bodily materials) more vulnerable and precarious than others through either labelling them as a certain category or by them falling outside of pre-​existing categories. I refer to intimate labour when bodily ‘work’ is required in intimate situations (e.g. using intimate body parts or disclosing one’s queer sexuality in a heteronormative environment). I use the term ‘emotional labour’ only for emotional work, where feelings need to be manipulated or hidden in more general settings that are not specific to intimacy. RESEARCH METHODS My research focuses on self-​identified queer and trans people who have used or intend to use ART. To date twenty-​three qualitative interviews (average length approx. one hour) have been conducted in the EU countries involved as well as one focus group (fifty minutes long). An online survey (taking approx. thirty minutes to fill in) was posted on the main LGBTIQ websites and Facebook groups in each participating country. Respondents were asked about their experiences with ART, if they had or intended to have their treatments in local clinics or in another country; what kind of treatments they had chosen or intended to have and why; why they could not use ART, or if they had chosen other options during the treatment; what their experiences were (positive, e.g. interactions with medical staff, support of and familiarity with queer and transgender patients and health concerns; or negative, e.g. problems with clinical documentation, impact of providers’ cisnormative and heterosexual assumptions, refusal of services; and what could be improved to get better access to and treatment of ART). In this chapter I  draw on the empirical material I  have gathered from the online survey, interviews and focus group. At the start of writing this chapter (December 2018)  the English-​language online survey had in total 739 replies, 165 fully complete, 574 incomplete. Of the total number of replies, 84 came from Austria, 19 from Estonia, 15 from Poland, 16 from Spain, 85 from Sweden and 31 from the UK. Additionally, because of language issues, two translated surveys have been used: a Spanish one with a total of 146 replies, 84 of them complete, 62 incomplete; and a Polish one, with 16 replies, 10 complete and 6 incomplete. In demographic terms, the majority of the English-​ language survey participants lived in the country where they were born (229), in a big city (143), were aged between twenty-​six and thirty-​five (123) and felt that they were

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members of a group that is discriminated against (138), 129 on the grounds of their sexuality and 80 of their gender. A total of 27 had had experience of being a trans person; 137 self-​defined as women and 29 as men. Comparing these basic data with the Spanish and Polish surveys, the outcomes look similar except that in the Spanish survey the majority of the participants (62) did not feel discriminated against (versus 56 who did not). Here 63 self-​defined as men, 42 as women. In the Polish survey 13 out of 16 felt discriminated against, 10 of the participants self-​defined as women and 2 as men. Of the twenty-​three interviews, six are from Austria, one from Estonia, one from Poland, ten from Spain, four from Sweden and one from the UK. A Spanish focus group with three participants has also been held. These background details of the online-​survey participants alone speak to the issue of bioprecarity and intimate labour, and how a certain group is categorized and feels more vulnerable. In the English-​language survey the majority felt discriminated against because of their sexuality and a smaller number because of their gender. This indicates that sexual orientation is still a cause of feeling vulnerable in many European states. In Spain, where a small majority did not feel discriminated against, differently from the Polish and English-​language surveys, the largest group of participants in Spain were gay cis men. This could mean that Spanish gay men do not feel vulnerable and discriminated against anymore, and that lesbian cis women, especially in Poland, but also in other European countries, are still more vulnerable and discriminated against than male same-​sex couples in Spain. However, since Spanish gay men rely on surrogacy for reproduction, it could also indicate that Spanish male same-​sex couples and families push for normalization and do not see themselves as different from straight families and couples (Smietana, 2015). Before I jump to early conclusions, I will explore the categorical framing of queer and trans people done through ART legislation and the content of the interviews (the audio-​recorded data of queer and trans experiences with ART). LAWS REGULATING ART: CAUSING REPRODUCTIVE BIOPRECARITY FOR QUEER AND TRANS PEOPLE In the six EU countries investigated here specific laws regulate the access to ART for all people and heterosexuality is, as Paul B. Preciado (2013: n.p.) describes it, a ‘politically assisted reproductive technology’, which is organized and maintained by some states so as not to allow access to ART for same-​sex partners, for certain heterosexual persons (outside of a couple, poor people), transgender, asexual or disabled people. These people constitute a reproductive minority, according to Preciado, referring to the

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phrase ‘sexual minority’, as for them it is forbidden or made difficult to pass on their genetic material. These groups of people are in a sense politically sterilized. Here the political and economic fight to access ART is connected to the de-​pathologization of their lives and to having control over their own reproductive and genetic material (Preciado, 2013: n.p.).2 Thus, where they are debarred from ART access queer and trans people experience reproductive bioprecarity. Their categorization as queer or trans prevents them from using their bodily materials (genetic or reproductive organs) in certain medical and technical procedures for reproduction in their home country. The most common issues for queer and trans people in European countries trying to access ART are, first, to have legal access to ART (sometimes only possible when one is in a legal partnership) in their home country. If this is impossible, ‘fertility travel’ is required. However, this results in the challenge of how to get the legal documentation (birth certificate, citizenship, parenthood recognition) for the home country. This is also a class issue that leads to stratified reproduction, since only queer and trans people with enough money and flexible time can afford to try to escape their reproductive bioprecarity in their home country. Second, even if ART is available to them in their home country, the issue of obtaining legal parenthood as such for same-​sex couples and trans people (often combined with legal partnership recognition or otherwise through adoption or co-​parent recognition) is more complicated than for straight cisgendered couples. A  certain kind of administrative violence (Spade, 2015) can be found in these bureaucratic procedures, as I  will explain later in an example featuring gay fathers. This includes the issue of having the appropriate terminology on birth certificates (e.g. are two mothers/​fathers possible? For trans people: is a birth father possible? For single queer and trans people: is just one parent possible?) is not always straightforward or readily available (Leibetseder and Griffin, 2018:  1 f.). Thus, the reproductive bioprecarity of queer and trans people does not simply have a happy ending with the birth of a child, but continues to sorting out the legal documentation afterwards (possibly for many years, as my Spanish case will show). The survey responses of the Spanish gay men who rely on surrogacy for reproduction and claim that they are not discriminated against and therefore not vulnerable or bioprecarious because of their classification as gay, prompts a closer look at the LGBTIQ rights and ART laws in Spain. In 2005, same-​sex marriage was introduced in Spain (the third country in the world to institute this). In 2006, the current ART law came into force (Pichardo Galán, 2009:  144; 2011:  17 f.; Pichardo Galán et  al., 2015:  189). Spain was also the first state to allow adoption by same-​sex married couples (Imaz, 2017: 6). Gay couples can access adoption (but there are almost no national

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and international adoptees) and surrogacy abroad, as it is banned in Spain. However, many highlight the gender bias in the Spanish ART law (Ley 14/​ 2006, 2006) allowing ART access to all cis women regardless of their civil status or sexual orientation (Smietana et al., 2014: 199). This law leads to the reproductive bioprecarity of gay cis men. Despite prohibitive ART laws, Spanish surrogacy debates are changing because of a sharp increase in surrogacy arrangements by Spanish citizens abroad (mostly in the United States, Canada, India, Georgia and Russia). Many commercial surrogacy agencies have opened in Spain and several associations are advocating gay men’s right to parenthood. Even a political party, Cuidadanos (Blanco et al., 2017), supports legalizing surrogacy (Imaz, 2017: 9; Marre et al., 2018: 166), despite feminist critiques such as the manifesto No somos vasijas (We Are Not Vessels) (No somos vasijas, n.d.) from 2015 and #MiVientreNoSeAlquila (My Tummy Is Not For Rent) in 2017. Babies born through surrogacy or adopted abroad pose legal challenges for parenting rights and the citizenship of the baby (Smietana, 2015:  50). A lengthy legal process is required to transfer parental rights, involving in some cases even Supreme Court appeals (Smietana et al., 2014: 199 f.) and therefore prolonging the reproductive bioprecarity of gay cis men. Thus, in 2010 a directive to facilitate the recognition of transnational surrogacy was issued by the Spanish Ministry of Justice, but was vetoed by the Spanish Supreme Tribunal in 2015 (Leibetseder, 2018: 15 f; Smietana, 2015: 51). Some of the organizations in favour of surrogacy, for example Son Nuestros Hijos (They Are Our Sons/​Daughters), argue that to avoid abuses it would be best to legalize surrogacy (Blanco et al., 2017) and regulate surrogacy to reduce the risk of the exploitation of women. Public opinion seems to be reconciled to surrogacy; according to a Catalan opinion poll in 2017, 73 per cent of citizens are in favour of legalizing surrogacy (El Periódico, 2017a). Since 2017 the Catalan government (Generalitat de Catalunya) has allowed paid paternal leave for public sector employees (including for gay parents) who use surrogacy (El Periódico, 2017b). Thus, there are regional differences concerning ART access in Spain, with autonomous provinces such as Catalonia having their own regulations (Generalitat de Catalunya, 2016; Leibetseder, 2018: 16) and alleviating the reproductive bioprecarity of gay cis men. QUEER AND TRANS EXPERIENCES OF REPRODUCTION WITH ART Queer and trans experiences of reproduction with ART are, of course, at least partly determined by the legislative contexts in which queers and trans people operate. The example of the Spanish gay men who opted for surrogacy

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arrangements abroad, and who claimed not to be discriminated against anymore, can be mapped on to the above mentioned legal provisions that have normalized same-​sex couples since 2005, as well as allowing access to a variety of ART procedures. Although fiscal austerity measures were taken to restrict publicly sponsored access to ART for lesbians, these are now lifted again in some parts of the country, e.g. in Catalonia (Leibetseder, 2018: 15 f.). However, surrogacy is still not legalized, although surrogacy abroad seems to be more or less accepted and made possible through certain legal and bureaucratic processes. The paradox of reproductive bioprecarity for gay cis men As Ulrika Dahl points out in Chapter 3 of this volume, there is a paradox in the understanding of bioprecarity when it comes to LGBTIQ reproduction, family-​and kin-​making. This paradox consists of the interdependence of the family or kin members in their giving and taking of intimate labour instead of (sometimes as well as) their biological labour. Dahl highlights another paradox of reproductive bioprecarity in the example of privileged white gay men, who have structural racial privileges and a strong purchasing power. Thus, they can afford transnational surrogacy as a means of reproduction, whereas for most other queer or trans people it is either not accessible or not within their financial means. However, gay men’s reproduction is still bioprecarious, as they are also exposed to violence because of their sexual orientation and they have to overcome the challenge to form a family without a female partner. In my interviews the bioprecarity of gay cis men’s reproduction and the intimate labour involved in achieving having a baby, the legal documents proving their parenthood and the citizenship of the baby, came up in many different examples. I  shall therefore now discuss one gay Spanish cis man’s reproductive journey with his partner from around the same time as same-​sex marriage was introduced in Spain, in 2005. Guillermo3 (around forty-​six to fifty-​five years old, living in a big city, professional occupation, coped on present income, married) started his interview by highlighting that in his view it is necessary for gay male reproduction and families to be normalized, because just to be proud at Pride is not enough. He said that the most important issue to highlight to everyone now was that gay male families exist. Why this was so crucial for him became evident in his narrative about his husband’s and his own thoughts about reproduction. His partner knew early on that he was gay and therefore thought he was never going to be a father, as for his husband being gay and reproducing did not go together. Guillermo himself found that he was gay much later on in his life and he had always wanted children. Here

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the first way in which reproductive bioprecarity through categorization is produced becomes evident in his partner’s assumption that as a gay person he would not reproduce. A cis male gay family did not appear to exist in his imagination. The restrictive (self-​)disciplinary biopower of his context encouraged him to focus his thoughts about reproduction in particular ways: by disavowing that possibility. The second way in which reproductive bioprecarity is induced is through bureaucratic classifications or ‘administrative violence’ as Dean Spade (2015) calls it. When gay marriage was introduced in Spain in 2005, Guillermo and his partner considered whether to get married or not. His partner was against it because he thought that if they were officially married and their same-​sex status was evident in their documentation, they would never be allowed to adopt a child and Guillermo would never be a father. This is still a valid argument in some EU countries, such as Czechia or Hungary, because adoption is not legal for registered same-​sex partners in both countries. In Hungary, additionally, the access to ART is prohibited. The result is a much lower rate of registered same-​ sex partnerships, especially of lesbian couples who can then access ART in Hungary and adopt each other’s children in both countries (Hašková and Sloboda, 2018: 53–​6; Takács, 2018: 75). However, Guillermo argued that it was equally hard for a single man to adopt a child, and he really wanted to get married since he was not willing to trade in something uncertain (adoption) for something secure (marriage) that he could have at that moment. So they married and started the process of national adoption. At that time Guillermo was working at the same governmental institution where the department for adoptions was based. One day he overheard a conversation in the institution’s cafeteria among civil servants in charge of deciding on adoption applicants’ aptitude to be parents. The officers boasted that they had just refused a parental aptitude certificate for a same-​sex couple; to allow such a certificate for a same-​sex couple would only occur over their dead bodies. The only case of a gay couple’s successful adoption that Guillermo had heard of was one where the couple was closely related to one of the politicians in charge and their child had brain damage because she was born to a drug-​addicted mother. Here administrative violence is quite obvious in how the civil servants categorize potential parents according to their sexual orientation. Guillermo and his partner turned to international adoption, but most agencies told them that there was a scarcity of children. During a business trip to Russia in 2007, Guillermo went to the international adoption office in St Petersburg and asked about the possibilities for same-​sex couples of adopting a child. The English-​speaking Russian officer immediately called two security guys who were about to start beating him up, and only when he told the officer that he had to give a presentation at a scientific conference the next day and the

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officer opened his passport and saw his scientific visa, was he allowed to leave without being beaten by the security staff. In this instance, administrative violence and being more vulnerable than others due to one’s classification nearly came down to a literal level, only being relieved by a privileged (class and educational) position. Finally, Guillermo and his husband became parents of twins through transnational surrogacy in California, although they faced very expensive legal battles up to the European Court in Strasbourg so that they would both be registered as legal parents and to obtain Spanish citizenship for their children. Even more than ten years after the birth of their twins a Spanish court order would have required them to remove one of their names as a parent from the register, but the Spanish authority could not decide which one, so they never forced this. By the time this chapter is published this order will be barred and their registration as parents cannot be revoked anymore. Guillermo emphasized their continuing very good relationship (after ten years) with their surrogate (which came up in most of my interviews with Spanish gay men). This relationship with the gestational woman was also desired by their children who wanted to meet the surrogate’s own children. He saw this as a bond of ‘siblings of one uterus’. According to him, their surrogate earned more money than his husband, and claimed to be a feminist who would have never agreed to this procedure if she had felt pressured or exploited. However, the question remains if surrogacy does not replace one kind of bioprecarity with another (see Nilsson, Chapter 6 this volume), meaning that the reproductive bioprecarity of the two gay cis men is transferred on to the surrogate, leaving her exposed to her own kind of bioprecarity in relation to the intimate labour she provides. It is not obvious how regulations around surrogacy can be done so that no bioprecarity exists for the gestating woman. This might be the next step towards solving the paradox of gay men’s reproductive bioprecarity. Bisexuality: reproductive bioprecarity when categorizations fail Not belonging to an identity category, whether straight or same-​sex category (both these are recognized for ART purposes in EU countries, even if sometimes for the purposes of exclusion), creates other kinds of challenges. These require a certain intimate and emotional labour to overcome reproductive bioprecarity. Ann (around thirty-​six to forty years old, living in a big city in the UK with some health issues and a long-​standing illness/​disability, in paid work, higher education and who found it difficult to live on her present income) self-​identified as bisexual and was single during the ART process. She told me about her struggle to find her way through the

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reproductive jungle. After several miscarriages she went to different medical institutions (her doctor, the national health service, a specialized genetic institution and a women’s health institute) only to discover that for medical reasons she had just about six months left to retrieve eggs and get pregnant (sooner or later, depending on if she wanted to freeze her eggs or embryos). This tight time frame forced her to act quickly. She decided against going abroad as she would have spent too much time trying to find the right institution and to organize the travel, and the costs would have been equal to private treatment at home. So she stayed with the choices in the UK. The first assumption she encountered there was that she was straight, and she was pushed to freeze eggs and not embryos. This was in case she found a man later whose sperm, the medical staff assumed, she might like to use. She felt that in the first institution ‘choices were made for me rather than being based on my sexuality’ and she said, ‘I felt angry and frustrated. I mostly felt blocked in a system constructed around couple and not-​couple, straight and non-​straight’. In the next institution she tried, she therefore said she was lesbian so as not to be confronted with this assumption again. Thus, in the second institution, she developed a different strategy: ‘I used a different sex orientation to access their opinion and to play with the system a bit’. The clinic she finally chose was private. They just asked what she wanted, ‘and they worked with that and never asked for my sexual orientation in the four contact points I had. This felt right for me’. Falling outside of the categories of being straight, lesbian and/​or in a couple forced Ann to work out herself (which meant going to different medical institutions, doing online research) what kind of ART procedures would be available to her. In the public institutions, assumptions about her sexual orientation were made and choices made for her that she did not like. There she felt she was forced to trick the system (i.e. lie that she was a lesbian) to receive the treatment she wanted. Her strategy for coping with being outside of the more common social categories in these institutions was to pretend to belong to a category that was recognized in this system and that allowed for the procedures she wanted to have. Finally, she opted for an institution that never asked about her sexual orientation and just administered the treatment she wanted. In the process she was forced into doing additional emotional labour by using the ‘pretending-​to-​be-​a-​lesbian-​strategy’, since she had to misrepresent herself by ‘lying’ to the medical staff. She started an in vitro fertilization (IVF) process and had two mandatory sessions with a counsellor. Here the focus was on whether or not she was ready to be a parent, and she had conversations around how her family would look different from a heteronormative one. She did not mind this. However, she would have wished for a LGBTIQ counsellor with more experience of how to protect a baby or child from possible homophobia.

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Her counsellor just referred to her insecurity about being bisexual, which Ann regarded as a very heterosexualized response, meaning that her counsellor did not know much about it. She felt like she needed to apologize for what she was and wanted. In the counselling situation, she would have preferred proper LGBTIQ treatment, which is different from public ART procedures, where she felt she had to pretend to be a lesbian to get the treatment she wanted. A  straight counsellor did not fulfil her needs, whereas a queer counsellor might have understood better her anxieties about being bisexual and wanting to have a child. Her counselling experience once again (as with the medical ART procedures) forced her to deal alone with her questions about how to confront homophobia with a child. The process required much emotional labour to overcome these challenges posed by the straight counsellor. The most pressing issue for her was to find and have a network of other bisexual people going through these reproductive procedures. She said it is easier to find a network of families than of people trying to get pregnant. Neither her straight nor her gay friends understood her challenges fully. However, she found Stonewall’s (the biggest UK LGBTIQ organization) web-​based information useful, trusted their advice on legal rights around co-​parenting, and finally decided to become a single parent based on their information. In general it can be said that as a bisexual cis woman Ann would have benefited from LGBTIQ-​trained medical staff in public institutions who might have paid closer attention to her bisexuality and her being/​wanting to be a single parent. A counsellor with LGBTIQ training might have done a better job, as her questions were related to homophobic incidents. When it came to other people in her social environment, different issues arose. When people asked her during her pregnancy who the father was, she told them about the ART procedure. This frequently caused a chain of reactions. As she put it: ‘A desperate grasping of some form of support; such as “very sweet” followed by bafflement –​why anyone would choose that? Followed by a question about my sexual orientation, followed by “oh, this is why” … like a domino effect … “I did not realize that”, “maybe I should not asked you that”, “oh but why”, “wait, are you not straight?” ’ These people did not seem to be aware of her bisexuality at all. Ann also felt that there is still public discomfort around ART, perhaps having to do with sensationalist media programmes on ART in the UK at that time, reporting on ‘super sperm donors’ who are casual unregulated donors on the Internet. She wished for more informed media coverage on medicalized and protected routes of becoming a parent with ART that could be useful for both the public and prospective parents.

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Trans reproduction: certain groups are more vulnerable than others Trans-​male and trans-​female reproduction raise different issues, so I first look at one trans-​male case. Mario, a queer trans boi (young trans man, twenty-​one to twenty-​five years old, living in a big city, in an artistic profession, finding it difficult on his present income), said that he would like to freeze his egg cells, but for that he would need to take female hormones to stimulate his ovaries and he did not want to do that. His potential intimate labour, intervening hormonally in his body that he was already hormonally altering and that would directly contravene his gender trajectory, was already too high a price to pay, as would have been the monetary costs of egg freezing. The second trans-​female case, Karin (bisexual, who had moved across EU countries and was living in Austria at the time of the interview, was around thirty-​six to forty years old and living comfortably on her present income), was about to start her trans hormone treatment and wanted to secure her reproductive possibilities beforehand. She encountered challenges with finding information because storing her sperm was not allowed in Austria. It is only legal if there is a medical condition for doing so, and as gender dysphoria has been removed from the list of mental diseases, being transgender does not count as a medical reason for conserving gametes. Hence her doctors, complying with the legal frameworks, could not give her any information or advice. She had to find it herself through research on the Internet. Private clinics in Spain and Switzerland offered such services. Since Switzerland was closer, and easier for language reasons, she wanted to go there. However, she still had to ask the clinic for the price of the storage, which has to be paid annually. In her view, it was a struggle to achieve the conservation of her sperm, and not everybody is up for such a struggle. When I asked her if she feared encountering transphobia at the clinic she said: ‘I am not full-​time “myself ” at the beginning, it will currently serve my purpose. If I go there, I will not go being “myself ”. I will not explain why, I will not need to. If I was “myself ”, I would be certainly more stressed about it, that is for sure.’ Karin wanted the EU to make storing one’s gametes in one’s own country more accessible rather than encouraging a form of ‘shopping’ in other countries: ‘I do not see any ethical issue why this should not be allowed. Why is it so behind? It is not about a donor or a surrogate –​it is you, you are the donor, you want to keep it and you cannot.’ Here, she questions the reason for her reproductive bioprecarity in some countries. She does not understand why she should not be allowed to keep her fertility options, as there are no ethical challenges to solve.

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At the end of her interview, she talked about it as a positive experience. She felt that with the participation in my project on queer and trans reproduction, ‘it is nice to be recognized as a group … you are not seen as a defect of nature (laughs). I think I did participate in what one could call a normalization of how we are perceived and that this is happening’, and that especially the subject of reproduction was ‘subjected to a lot of resistance’. She hoped for a more ‘objective vision without attachment to religious condemnation and categorization’. This statement might seem contradictory, as she first mentioned that she liked being recognized as part of a group, but then at the end seemed to be against categorization. Reading this with a bioprecarity lens suggests that she wanted to be recognized as being trans with a wish for reproduction, and that being seen as part of a group with reproductive desires might reduce vulnerability as she was not unique and hence was pressing for the normalization of her desires. However, in a sense she also hoped that normalization would reduce or eliminate categorization. CONCLUSIONS Early on in this chapter I discussed the responses of cis gay men in Spain, who did not see themselves as discriminated against anymore, but were still experiencing reproductive bioprecarity. The paradox regarding gay men’s reproduction is that if they can afford it, they can transfer their own reproductive bioprecarity to women who gestate their babies, leaving these women to deal with the effects of their intimate labour and the bioprecarity they experience in being a surrogate. If Guillermo is to be believed, their surrogate would have never done it if she had felt under any kind of pressure. It is therefore possible that there are surrogacy arrangements without any kind of exploitation. Here in this assumed ideal case, the reproductive bioprecarity of the gestating woman would be associated with the intimate and bodily labour of gestating and giving birth with its usual risks, for which expenses she is compensated (in the case of altruistic surrogacy) and an extra amount paid (in commercial surrogacy). Guillermo and his partner were still experiencing administrative violence more than a decade after they had returned with their babies to Spain. Their reproductive bioprecarity continued after birth because of the prohibitive laws in their home country. As Ulrika Dahl mentions in Chapter 3 in this volume, interdependency is needed to overcome precarious situations. In this example, the gay couple was interdependent with their surrogate with whom they and their children still had a very good relationship and with the legal system in their country and in the EU. A  way to overcome the struggles around reproductive

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bioprecarity and intimate labour of all the people involved (intended parents, surrogate (mothers), potential children) would be to pay attention to this interdependence and to clarify and make these forms of interdependence visible, rather than attempt, for example, to adjust or assimilate this reproductive constellation to traditional heteronormative family norms. In her research on ‘troublesome surrogacy’ Ingvill Stuvøy (2018:  40) comes to the conclusion that it is better to ‘find a way to think in the terms of reproductive relations’. She argues for acknowledging those who assisted others in their biological reproduction and that these ‘assisters’ should not just be erased so that the intended parents can fit the traditional family and parenthood norm. For her the goal is to move away from the current surrogate processes and instead move towards a more relational-​being-​together (as already occurs in many gay men’s surrogacy arrangements, as my data show). This would also ‘expand our ideas of family to include more categories of people’ (Lewis, 2018: 222; Stuvøy, 2018: 40) and would have the advantage of reflecting the collaborative effort and treating the ‘assisters’ as ‘full human beings’ (Rudrappa, 2015:  186; Stuvøy, 2018:  40). Stuvøy (2018) recognizes that this will not occur readily, but I think it could be a start to tackle reproductive bioprecarity on both sides. In order to register these collaborative efforts to create new forms of family and reproductive relations, new laws and administrative models have to allow for reproductive constellations involving more people and different family positions than just the hetero-​ or homonormative couple norm, which should be changeable over time according to the wishes, duties and agreements of the involved persons. Perhaps a pragmatic solution to the messiness of these reproductive relations would be, as Gabriele Griffin and I have suggested elsewhere (Leibetseder and Griffin, 2019: 11f ), to create different kinds of registration: one that is a public document and that is adjusted to more traditional family norms and can be used even in more discriminatory environments (for example if the family moves to a more discriminatory country); and another, restricted document only accessible to the people involved in the specific reproductive constellation or with their consent, and that contains details of the names and positions (categories) of all involved people. The above case shows how the concept of bioprecarity may be mobilized to analyse the challenges of reproduction for gay cis men. As Judith Butler (2009: 3, 25–​8) has argued, precarity (in distinction from vulnerability) serves as a political tool towards self-​transformative politics. In the above case we can see how particular forms of reproductive bioprecarity could be solved with transformative family regulations. In the other cases such as having a bisexual identification and being single in institutions used to dealing with hetero-​or homosexual couples, reproductive bioprecarity occurs in so far as certain medical procedures are assumed to be the best choice for the client without

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taking her bisexuality into account and leaving the intending parent alone to find the right information and procedure for themselves, which can also be the case for intended trans parents. More readily available information, and medical and psychological staff training can improve this situation, as would more bisexual networks for intended parents. Trans people’s reproductive bioprecarity is even worse, as being categorized as trans fosters the notion among cisgendered people that trans people have no reproductive wish. Here the first step in order to reduce their reproductive bioprecarity would be just to normalize the idea that trans people too want to have children with their own gametes. Many of them, depending on the couple constellations and on their own bodies, would not even require a donor or surrogate to reproduce; they may simply need to store their own gametes. But we seem some way away from achieving such redress, at least in many European countries. NOTES 1 The full title of the MSCA-​Fellowship is QTReproART:  Towards an Inclusive Common European Framework for Assisted Reproductive Technologies (ART): Queer & Transgender Reproduction in the Age of ART (H2020-​MSCA-​IF-​ 2016, Grant Agreement 749218). More information about the project is available at www.gender.uu.se/​forskning/​qtreproart (accessed 15 July 2018). 2 ‘Jusqu’à maintenant, nous avons payé notre dissidence sexuelle par le silence genetique de nos chromosomes. Nous n’avons pas seulement été privés de la transmission du patrimoine économique: notre patrimoine genetique aussi nous a éte confisqué. Homosexuels, transsexuels, et corps considérés comme “handicaps”, nous avons été politiquement sterilizes ou bien nous avons été forcés de nous reproduire avec des techniques hétérosexuelles’ (Preciado, 2013: n.p.). 3 The name has been changed to preserve anonymity, and the interview paraphrased and translated into English by the author.

REFERENCES Armuand, G., Dhejne, C., Olofsson, J. I. and Rodriguez-​Wallberg, K. A. (2017) ‘Transgender men’s experiences of fertility preservation:  A qualitative study’, Human Reproduction 32(2): 383–​90. Blanco, S., Mateo, J. J., Marcos, J. and de Benito, E. (2017) ‘Will Spain ever legalize surrogacy?’ El País, 3 July. Available at https://​elpais.com/​elpais/​2017/​06/​29/​ inenglish/​1498737625_​194033.html (accessed 30 July 2018). Butler, J. (2009) Frames of War: When Is Life Grievable? London: Verso. El Periódico (2017a) ‘El 73% de los catalanes defienden la legalización de los vientres de alquiler’, 8 August. Available at www.elperiodico.com/​es/​sociedad/​20170806/​ el-​73-​de-​los-​c atalanes-​defiende-​la-​legalizacion-​de-​los-​v ientres-​de-​alquiler-​ 6203064 (accessed 30 July 2018).

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El Periódico (2017b) ‘La Generalitat reconocerá por primera vez a los padres que recurran a vientres de alquiler’, 30 January. Available at www.elperiodico.com/​ es/​sociedad/​20170130/​generalitat-​reconocera-​primera-​vez-​padres-​recurran-​ vientres-​alquiler-​maternidad-​subrogada-​5774460 (accessed 31 July 2018). Foucault, M. (1977) Discipline and Punish:  The Birth of the Prison. New  York: Vintage-​Random  House. Foucault, M. (1990) The History of Sexuality: Volume 1: An Introduction. New York: Vintage Books. Generalitat de Catalunya (2016) ‘Protocol de les tècniques de reproducció humana assistida’, June. Available at http://​canalsalut.gencat.cat/​web/​.content/​_​A-​Z/​R/​ reproduccio_​assistida/​documents/​protocol_​rha_​def.pdf (accessed 29 July 2018). Hašková, H. and Sloboda, Z. (2018) ‘Negotiating access to assisted reproduction technologies in a post-​socialist heteronormative context’, Journal of International Women’s Studies 20(1): 53–​67. Imaz, E. (2017) ‘Same-​ sex parenting, assisted reproduction and gender asymmetry:  Reflecting on the differential effects of legislation on gay and lesbian family formation in Spain’, Reproductive Biomedicine & Society Online 4 (Suppl. C): 5–​12. James-​Abra, S., Tarasoff, L. A., Green, D., Epstein, R., Anderson, S., Marvel, S., Steele, L. S. and Ross, L. E. (2015) ‘Trans people’s experiences with assisted reproduction services: A qualitative study’, Human Reproduction 30(6): 1365–​74. Leibetseder, D. (2018) ‘Queer and trans access to assisted reproductive technologies:  A comparison of three EU-​States, Poland, Spain and Sweden’, Journal of International Women’s Studies 20(1): 10–​26. Leibetseder, D. and Griffin, G. (2018) ‘Introduction:  Queer and trans reproduction with assisted reproductive technologies (ART), in Europe’, Journal of International Women’s Studies 20(1): 1–​9. Leibetseder, D. and G. Griffin (2019) ‘States of reproduction: The co-​production of queer and trans parenthood’, Journal of Gender Studies 08(July): 1–15. Lewis, S. (2018) ‘International solidarity in reproductive justice:  Surrogacy and gender-​inclusive polymaternalism’, Gender, Place & Culture 26(2): 207–​27. Ley 14/​2006 (2006) ‘Ley 14/​2006 de 26 de mayo, sobre técnicas de reproducción humana asistida’, BOE –​Boletín Oficial del Estado, Nr. 126, BOE-​A-​2006–​9292, 26 May. Available at www.boe.es/​buscar/​pdf/​2006/​BOE-​A-​2006-​9292-​consolidado. pdf (accessed 1 August 2018). Mamo, L. (2007) Queering Reproduction:  Achieving Pregnancy in the Age of Technoscience. Durham, NC: Duke University Press. Mamo, L. (2013) ‘Queering the fertility clinic’, Journal for Medical Humanities 34(2): 227–​39. Marre, D., San Román, B. and Guerra, D. (2018) ‘On reproductive work in Spain: Transnational adoption, egg donation, surrogacy’, Medical Anthropology 37(2): 158–​73. #MiVientreNoSeAlquila (n.d.) Available at https://​twitter.com/​hashtag/​mivient renosealquila?lang=en (accessed 27 August 2018). No somos vasijas (n.d.) Available at http://​nosomosvasijas.eu (accessed 30 August 2018). Pichardo Galán, J. I. (2009) ‘(Homo)sexualidad y familia: cambios y continuidades al inicio del tercer milenio’, Política y Sociedad 46(1–​2): 143–​60.

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Pichardo Galán, J. I. (2011) ‘Sex and the familiy: Intersections between family, gender, reproduction and same-​sex sexuality in Spain’, in Takács, J. and Kuhar, R. (eds), Doing Families. Gay and Lesbian Family Practices. Ljubljana:  Peace Institute, Institute for Contemporary Social and Political Studies, pp. 17–​35. Pichardo Galán, J. I., de Stéfano Barbero, M. and Martín-​Chiappe, M. L. (2015) ‘(Des) naturalización y elección:  emergencias en la parentalidad y el parentesco de lesbianas, gays, bisexuales y transexuales’, Revista de Dialectología y Tradiciones Populares 70(1): 187–​203. Preciado, P. B. (2013) ‘Procréation politiquement assistée’, Libération, 27 September. Available at www.liberation.fr/​societe/​2013/​09/​27/​procreation-​politiquement-​ assistee 935256 (accessed 5 June 2014). Rudrappa, S. (2015) Discounted Life:  The Price of Global Surrogacy in India. New York: New York University Press. Smietana, M. (2015) ‘Families like we’d always known’? Spanish gay fathers’ normalization narratives in transnational surrogacy’, in Lie, M. and Lykke, N. (eds) Assisted Reproduction in Movement:  Normalizations, Disruptions and Transmissions. New York: Routledge, pp. 49–​60. Smietana, M., Jennings, S., Herbrand, C. and Golombok, S. (2014) ‘Family relationships in gay father families with young children in Belgium, Spain and the United Kingdom’, in Freeman, T., Graham, S., Ebtehai, F. and Richards, M. (eds) Relatedness in Assisted Reproduction:  Families, Origins and Identities. Cambridge, UK: Cambridge University Press, pp. 192–​211. Somerville, S. (1995) ‘Scientific racism and the emergence of the homosexual body’, Journal of the History of Sexuality 5(2): 243–​66. Spade, D. (2015) Normal Lives: Administrative Violence, Critical Trans Politics, and the Limitations of Law. Durham, NC: Duke University Press. Stuvøy, I. (2018) ‘Troublesome reproduction: Surrogacy under scrutiny’, Reproductive BioMedicine and Society Online 7: 33–​43. Takács, J. (2018) ‘Limiting queer reproduction in Hungary’, Journal of International Women’s Studies 20(1): 68–​80.

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BIOPRECARITY AND PREGNANCY IN LESBIAN KINSHIP Pe tr a N or d qvi st

INTRODUCTION

R

eproduction is perceived to lie at the heart of the making of kin relationships in Euro-​ American cultures. The birth of a child is conceptualized as the beginning of the next generation in a long line of generations, going back through time (Edwards and Strathern, 2000). In the words of Marre and Bestard (2009), a sort of continuity in the body is understood to be traceable across and between generations; a family member is assumed to inhabit ‘the family body’. A kin relationship is professed to follow from this relationship in the body. Such a relationship, Strathern (1992) notes, is culturally speaking understood as simply a social expression of a relationship based in ‘nature’. In terms of how such a relationship is discursively construed, it is thought of as ‘given’ rather than chosen (Mason, 2008; Nordqvist, 2017). Furthermore, a kin relationship is seen to be permanent in the sense that it is thought it cannot be ended or ‘undone’. It is also perceived to be self-​evident in that new kin identities are believed to inevitably ‘arise’ on the birth of a child; a woman who gives birth is transformed into ‘mother’. Her mother, in turn, is transformed into ‘grandmother’. Thus, the making of kin, kin relationships and kin identities such as ‘mother’ or ‘grandmother’ are, it would seem, self-​evident and a straightforward ‘given’ part of human nature. Although a kinship group is constantly evolving and changing, built into the very foundations of the idea of how kin relate are therefore notions of permanence, stability and certainty. ‘Making kin’ might be harder for some than for others, however. Perhaps not everyone can access the stability and certainty that supposedly lie in kin relationships. Indeed, the making of the next generation of kin might,

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for some, be a precarious pursuit both in terms of relationships and kin identities. I came across these suggestions in my recent UK-​based study of people who conceive using donor conception (Nordqvist and Smart, 2014a), and hence the body parts (gametes) of others, to have children of their own. It became particularly evident among the lesbian couples, and their parents, that kinship could be felt to be precarious. Indeed, lesbian couples, on becoming parents, could not presume that kinship would follow. This chapter explores notions of bioprecarity in the relationship between reproduction, parenthood, embodiment and the making of kin. It brings the concept to the realm of the everyday, looking specifically at the making of and ‘living’ kin relationships in the context of lesbian reproduction. Most specifically, it looks at the role of embodied reproduction –​pregnancy and childbirth –​in forging kinship connections as this remains a poorly understood dimension of kinship and lesbian reproduction.1 PRECARITY, BODIES AND EVERYDAY KIN LIVING: THEORETICAL FRAMING Gender and sexuality deeply structure cultural beliefs and understandings about kinship, with heterosexuality being a core organizing principle. In her seminal feminist analysis of a sex/​gender system of kinship, Rubin ([1975] 1997) showed that men and women are constructed in a political economy in which women are ‘trafficked’ between men; she thereby made the point that kinship is constituted through binary constructions of gender. Taking this further, Yanagisako and Collier (1987) suggested that men and women are culturally construed as different, and that this difference is supposedly based in nature: the fact that women bear children is a fundamental part of the supposed ‘biological’ difference between men and women. In terms of the relationship between heterosexuality and kinship, Schneider ([1968] 1980: 51 f.) neatly sums up the ‘logic’ of Euro-​American kinship: ‘the members of the family are defined in terms of sexual intercourse as a reproductive act, stressing the sexual relationship between husband and wife and the biological identity between parent and child, and between siblings’. Lesbian couples who form families through the use of donor sperm contravene this sexual and gender kinship logic on multiple levels. First, and most obviously, lesbian sexuality represents in itself a significant detour. Second, when a lesbian couple goes on to have children, the act of procreation does not produce the culturally expected mother and father, but instead it reproduces two mothers and a donor, a ‘culturally unknown’ family. Third, an integral part of lesbian family-​making is that only one of the women becomes a mother through carrying a child; the other’s claim to

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motherhood upsets deeply held ideas about womanhood and motherhood. A fourth dimension is that lesbians’ parenthood unhinges rules about bodily connections in the making of kinship as their claim to kinship is necessarily in part based on social ties. In short, there is compounding ‘difference’ in families created by lesbians. Following Butler (2004), it could be argued that conventional kinship logic produces grids for liveable lives that render lesbian motherhood quite unintelligible, perhaps even ‘unliveable’. The event of a pregnancy carries particular kinship meanings. Indeed, historically, the event of a woman being pregnant and giving birth is understood as the key determinant of kinship in law. Predating DNA testing, a man’s status as father was always uncertain; his parenthood was assumed rather than known. The only ‘known’ kinship was that of the mother through the event of pregnancy and childbirth, as clearly expressed for example in the Roman legal principle mater semper certa est (the mother is always certain). Pregnancy and childbirth thus may be viewed as the very essence of kinship, indeed as the very marker of kinship as a fixed, stable entity. A biostability if you like. This biostability has however come into question with the emergence of new reproductive technologies. Reproduction through donor conception and surrogacy (including the use of a third-​party’s reproductive tissue or body), or among same-​sex couples (sidestepping the rule of heterosexuality), has introduced questions into law, culture and society about what precisely it is about pregnancy and childbirth that confers kinship (e.g. Konrad, 2005; Nordqvist and Smart, 2014a). Is it being pregnant? Or genetically related? Or might it be the intention to become a parent? This reflects an interesting light back on the presumed biostability of the female reproductive body, because it highlights the need to understand how exactly pregnancy and childbirth operate as vehicles for kinship. The connections that are perceived to ensue from a pregnancy in part refer to kinship tropes of ‘blood’, or more recently ‘biology’ or ‘genes’ (Nordqvist and Smart, 2014a), taken to denote connectedness-​in-​the-​body and so belonging in families. But the way in which a pregnancy ‘makes’ kinship is more complex than this. It also occurs through the biological events of conception and implantation, and the role of gametes and the uterus in these processes. Moreover it is through a woman’s biological process of growing a baby inside her, her experience of doing so, the world witnessing and reacting to this and later her giving birth and lactating. Additionally, it is through the social status of ‘being a mother’, where pregnancy and birth are seen as a rite of passage in a woman’s life, as well as ‘doing’ motherhood and parenthood, which in turn connects with gendered divisions of labour (especially housework and childcare) (e.g. Hook 2006). In other words, the pregnant body carries kinship meaning on multiple levels:  relational,

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symbolic, corporeal, sensory, affective and caring. Thus there are echoes here of Morini and Fumagalli’s (2010) understanding of ‘biolabour’, and the way in which the body operates on a number of levels to produce value (see Griffin, Chapter 1 this volume). What I  want to do here is not to introduce a definitive understanding of what it is about the female reproductive body, pregnancy and childbirth that is understood to confer kinship, nor is it to prioritize and order the dimensions integral to it, but rather to suggest that as a concept it holds within it a whole raft of understandings (about how people connect) and also expectations (on people and their behaviour) that combined are deeply linked to notions of stability, or when in question, as I shall go on to demonstrate, bioprecarity. I use the concept bioprecarity to explore the role of the body in shaping the relationships between reproduction, parenthood and kinship. I define it as vulnerability linked to embodiment (see the Introduction to this volume), and use it because as a concept it lends itself well to thinking about and capturing the vulnerability of people as embodied selves in the context of kinship, and especially the role and significance of embodiment (or lack thereof ) in the production of parental identities and kin recognition. Bioprecarity here functions as a binary concept, relating to the biological processes of either having been pregnant and given birth, or not.2 It is a direct consequence of biological motherhood carrying the meaning of constituting kinship biostability. I  shall use these two concepts throughout. Of course, there is nothing about these biological processes that necessarily makes them a site for the production of stability or vulnerability for women in terms of kinship; importantly, it is because of the ways that these embodied processes are invested with parental and kinship meaning, that they bring into play these issues. Bioprecarity as a term here captures how women and their parents understand and experience the role of their own body in producing a child in relation to becoming and being a parent, looking specifically at how the grandparent generation engage with the role of lesbian mothers’ bodies in order to make sense of motherhood, grandmotherhood/​fatherhood and the child’s kinship. In doing so, this chapter brings bioprecarity into dialogue with the production of relationships, and relationality, thus broadening the debate on bioprecarity from looking at the production of intimate labour, to exploring the production of intimate relationships (or failing to do so). Theorizing intimate relationships and personal life, Smart (2007) notes that individual life needs to be understood, fundamentally, as connected with the lives it runs in parallel to, and also as embedded in networks of relationships (see also Roseneil and Ketokivi, 2016). This embeddedness is likely to become particularly significant in the context of childbirth

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(Bengtson et  al., 2002); reproductive practices trigger questions about relating in networks with kin. For the sake of clarity, it is worth fleshing out the intimate relationships in question here in a little more detail. The relationship between the genetic mother (A), her parents (C) and the child falls close to normative notions of kinship because A carries the child. However, because A is in a lesbian relationship, in the place of the normative father, there is another (non-​birth) mother (B) (and a genetically related donor). The non-​birth mother (B) has to come to terms with being a mother while not having carried the baby that she calls her own. Of course, to her this comes as no surprise: she and the partner decided that this is how they would have a child. B’s parents, the non-​birth grandparents (D) of A and B’s child, on the other hand, might have their own concerns. Had their adult child B been a man, there would have been an established cultural framework (genes) to account for their connection to the child; a pregnancy would not have been a prerequisite to establish kinship links (Yanagisako and Collier 1987). In this situation, B’s parents (D) have become grandparents through their daughter B but she has neither been pregnant nor transmitted any genetic material to the baby (at least not in this study) and her partner is female. They are faced with the task of making sense of what it means for them to be family-​in-​law to the genetic mother, and deciding how to relate to the child, in the absence of there being any established social script for understanding their kinship affinity. In exploring how people find ways of relating in these families in the absence of established social scripts, I  refer to previous work (Nordqvist and Smart, 2014a) and also to Finch and Mason (1993), who emphasize the importance of distinguishing between the cultural dimension of kinship discourse and the actual experience of living family lives. Cultural descriptors of kinship do not fully determine everyday relationships, nor do they translate into practice in any straightforward, predictable way. Rather, Finch and Mason (1993) suggest that life within family networks needs to be understood as shaped by negotiation, rather than obligation or rule. Thus life in kinship networks develops through ways of relating in families –​what they (1993, 2000) call ‘relationalities’. Such relationalities, Finch and Mason note, are imbued with subtle layers of meaning that take shape over time, through the ongoing (explicit and implicit) negotiations between family members. THE STUDY The data discussed in this chapter was collected as part of a broader project in 2010–​13, which explored donor conception and non-​genetic kinship within the context of wider family relationships and investigated the similarities and

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differences between heterosexual and lesbian family experiences.3 In this chapter I  focus only on the interviews conducted with lesbian parents and grandparents with lesbian daughters. Some thirty-​seven interviews (twenty-​ two with parents and fifteen with grandparents; sixty interviewees in total) form the basis of this chapter; recruitment and fieldwork took place in England and Wales in 2011. Parent and grandparent interviewees were recruited from different families to avoid the risk of inadvertently conveying sensitive information during interviews and to ensure anonymity and confidentiality in writing. To further safeguard the research participants, names, places and identifying details have been anonymized in the following accounts. The lesbian parents and grandparents drew on experiences of sperm donation rather than egg or embryo donation (with the exception of one example in which a lesbian couple had one child through sperm donation and were expecting a sibling through embryo donation). The sample was split as follows: twenty interviewees who relied on clinical conception, thirteen who self-​arranged conception, two who had both clinical and self-​arranged conceptions and two who achieved conception through an Internet company provider.4 All clinical conceptions took place in the UK, apart from the one case of embryo donation in which the couple had used a clinic abroad (in Eastern Europe). Aside from that one exception, all the birth mothers used their own eggs to conceive and so they were also the genetic mothers. The majority of the sixty parent and grandparent interviewees were women; only six men (grandfathers) were among them. In this group fifty-​one people (85 per cent) identified as white British and six identified as white European, American or Australian; one identified as of mixed background and two as Chinese British. Over half of the interviewees (52 per cent) in this group identified as atheist or agnostic; 37 per cent identified as Christian (split into different faith groups) and 7 per cent were Jewish. Some 77 per cent of the lesbian parents had gone on to higher education, which compared with the general population of women giving birth in Britain (Dex and Joshi 2004) gives a broad indication that this group of parents was disproportionately middle class. The interviewees lived in both rural and urban locations in England and Wales, with particular concentration in Greater London and Manchester. FAMILY FALLOUTS In order to trace how bioprecarity enters into lesbians’ experiences of kinship at childbirth, it is necessary to understand something about the past relations within the families in which they are embedded. Finch and Mason (1993) remind us of the importance of time in family relationships, arguing that in

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order to understand how family negotiations unfold in the present we need to bring into view family biographies and the way in which relationships have unfolded along particular paths in the past. Predominantly, though not exclusively, the findings explored here emerged in families where the grandparent generation initially reacted badly to a daughter’s ‘coming out’ as lesbian. As discussed elsewhere, ‘coming out’ as gay and lesbian to one’s family of origin remains a difficult and uncertain prospect (Nordqvist and Smart 2014b). Many of our parent participants found that the disclosure of their sexual orientation came as a shock to their own mothers and fathers, leading relationships to strain and sometimes fracture completely: ‘Mum found [my coming out] very, very hard to come to terms with’ (Dawn, with Linda, parent); ‘[My mum] didn’t react well [when I came out]. She said a psychologist would be a good idea’ (Sasha, with Gemma, parent). The relational dynamic surrounding pregnancy and motherhood was often grounded in this kind of reaction, which could range from outright hostility and deep disappointment through to ambivalence, uncertainty and general unsupportiveness. The expectation of a heterosexual life trajectory remains deeply embedded in family culture (e.g. Solebello and Elliot, 2011). In the cases cited above, the grandparent generation reacted as though assimilating a lesbian relationship into the family story was going to be both difficult and disagreeable. In Butler’s (2004) terms, it would appear that heterosexuality provided such a powerful grid for living a liveable life, that a life outside it appeared, at least initially, quite unintelligible to the parents of these adult children. Interestingly, at the heart of the parents’ negative reactions were concerns about kinship and more specifically lineage and grandchildren. Calhoun (2000) notes that gays and lesbians are perceived as ‘family outlaws’, a sort of ‘dead end’ of the kinship line (Nordqvist and Smart, 2014b). In many cases, the issue of grandchildren was the particular sticking point causing a mother, especially, to react unfavourably to a daughter’s lesbianism: ‘I can remember when I came out to my mum. It was one of the things that she really cried about, was, you know, “I won’t have children and she won’t have grandchildren from me”. And I think that was probably more of a loss for her than many other things associated with my coming out and being gay’ (Nina, with Claudia, parent). Although we did not interview two generations from the same family, we did hear the corresponding story of grandparents who found it very difficult to accept a daughter being gay. Veronica, a grandmother in the study, had been devastated by her daughter’s ‘coming out’, in part because she thought it meant her daughter would never have children:  ‘The fact that she was gay in the first place upset me terribly … I  found it terribly hard to accept that she wouldn’t have any children … I kept saying to her “how can you be like this and never have any children”. Because for me it’s such a big part of my life. And I felt very … very sad. And

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heartbroken’ (Veronica, with Howard, grandparent). Culturally, personally and emotionally a new grandchild inhabits a special place in the relational chain of kin, and especially so for those who have longed to one day become grandparents (Bengtson et  al., 2002). A  grandchild can of course change everyday life for grandparents because the transition can result in a new and extensive investment of time, care and emotions (e.g. Fuller-​Thompson and Minkler, 2001; Mason et al., 2007), but he or she might also be perceived as a carrier of hopes, dreams and aspirations for the future. Nina and Veronica’s accounts give an indication about just how much can be invested in the idea of one’s children having their own children. Although grandparents are rarely entitled to influence their children’s reproductive decisions, they are nonetheless likely to be much affected by them. A lesbian sexuality was taken by many to mean no grandchildren. These negative reactions from the older generation were deeply significant because they caused family relations to rupture and strain and set the scene for future events.

PREGNANCY, CHILDBIRTH AND THEIR KINSHIP MEANING These ruptures constitute the relational context in which many of the lesbians that I write about here went on to have children. Interestingly we discovered that the decision to have children could in itself lead to strained relationships being mended, as the announcement of a pregnancy was particularly powerful in helping older family members cope with lesbianism: ‘When my wife first found out that her daughter was gay she took it very, very badly indeed. I  think that really came to an end, the badness, really only came to an end when the baby was born’ (Howard, with Veronica, grandparent). The pregnancy became a vehicle to rekindle fractured family relationships because although the same-​sex relationship was still an issue, the extended family was now able to come together in delight over a daughter being pregnant or, eventually, in a child being born into the family. It is within this context that issues of bioprecarity emerge because the lesbian couple’s decision about who would carry the baby was often pivotal for rekindling kinship connections. Meredith and Priscilla had two children together; Priscilla had carried both boys. Priscilla’s mum disapproved of their lesbian relationship and was initially also against the idea of Priscilla and Meredith having children together. At the time of the interview, however, this grandmother was not only delighted with the children but she lived locally and offered much practical support on a daily basis. However, both Priscilla and Meredith thought that this grandmother might have felt quite differently about her grandchildren had Meredith given birth: ‘If I’d

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phoned my Mum and said you know Meredith’s having a baby –​we’re having a baby and Meredith’s the one that’s pregnant  –​I  don’t think she would have thought of it as hers’ (Priscilla, with Meredith, parent). The biostability and the associated complex affective and symbolic biovalue of a pregnancy carried a crucial significance in terms of women’s lived experience of kinship because this is how kinship bonds were recognized and articulated. Petra:  If it had been [your daughter’s partner] who had actually had the baby, do you think that would have affected the way you feel about [your grandson]? Veronica: Yes. Howard:  Oh yes. There wouldn’t have been any relationship at all. Veronica:  Well there would have been but it wouldn’t have been the same. No. Oh it would have made a hu–​ Howard:  It would have made huge difference … Veronica:  Because it wouldn’t have been [my daughter’s] baby. (grandparents)

It was clear from other accounts in the study too that it could take non-​ genetic grandparents some time to feel akin in this kind of kin relationship. Tony and Anita were non-​genetic grandparents who had different initial reactions from each other: Tony:  I mean I found it harder to accept than you [partner Anita] did I think really because I felt it was, I was sort of grandparent-​in-​law really because it wasn’t my daughter who was pregnant. Yeah but you know, after the first few months I sort of came to terms with that and I was very fond of [the boy], that’s for sure. It certainly took me longer than you I think, didn’t it? Anita:  I adored him. He was my little boy. (Grandparents)

Focusing in particularly on Tony’s account here, by using the term ‘grandparent-​ in-​law’, he appears to suggest that the child’s real grandparents are the genetic grandparents on the side of the genetic mother, whereas he felt himself to be an ‘adopted’ or ‘added’ kin. As noted by Finch and Mason (1993), cultural ‘rules’ do not translate in any straightforward way into modes of conduct, and Anita was more able to sidestep cultural normative blood kinship ideologies in appreciating the little boy as kin. What came through strongly in the parents’ and grandparents’ reflections was that the lack of a pregnancy was associated with more precarious kin relationships. Vanessa and her partner had twins together; Vanessa had been the birth mother. When the twins were two years old the non-​birth mother left, bringing a dramatic change in the relationships with the non-​ birth mother’s side of the family: Members of her family have never so much as sent a postcard since the day [my partner] walked out. Nothing. Having been around a lot, having spent every summer with them from the first two years of their lives, I mean her

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mother was the person who came to stay for the week when they were born … They were all very much part of their life for the first two years but the day [my partner] left I  never heard from anyone again … But they were never very happy about her having children with a woman. They had accepted the children and they had adored the children but I felt … appalled at their part in it. Had I been a man they would have said, ‘They’re your children you stick at it’ … but because I wasn’t, the relationships were so expendable it seemed. (Vanessa, parent)

This account stands in sharp contrast to cultural perceptions of the connection between a grandparent and a grandchild as a fixed relationship in the sense that it cannot be ‘dropped’. We cannot know the grandparents’ reasoning behind this, of course, but to Vanessa it was clear that it was linked to the fact that they never fully accepted the lesbian relationship. It would appear that the combination of a lesbian relationship and non-​genetically connected grandchildren resulted in relationships that did not have the durability usually associated with kinship. This precarity of non-​genetic kinship is echoed in law across Euro-​ American jurisdictions. In the UK legal provisions to recognize the parenthood of non-​birth mothers only became available in the 2000s (Nordqvist, 2012). So even in those cases where the grandparent generation felt themselves to be fully connected despite a daughter not having been pregnant, they had to contend with a legal situation that might not recognize her as a parent. Betty and Richard provide a useful reference point here because unlike the other grandparents discussed in this chapter, they felt fully akin to their non-​genetic grandchild. Betty and Richard had a ten-​year-​old grandson who, in their own words, they felt was ‘theirs’ from the moment he was born. Nevertheless, their daughter being able to secure legal parenthood through adoption came as a great relief. Even so, a genetic relationship between a birth mother and a child is still given much weight in courts dealing with legal disputes between lesbian parents. This renders non-​genetic connections truly fragile in the face of relationship breakdown (e.g. Millbank, 2008). Anita and Tony (quoted above) were facing this very situation because their daughter was in the middle of a difficult legal dispute since the daughter’s partner (the birth mother) had left and taken the child with her. Anita, who loved the boy deeply, was at the time of the interview prevented from having any contact with her grandchild. The contrast was stark between this and a relationship conferred through pregnancy, both as experienced in our study and in law. Louisa’s story is particularly telling because she speaks here of the role of pregnancy in the context of strained family relationships. Louisa, a genetic grandmother in the study, found that her relationship with her granddaughter was only secure because it was the daughter who had given birth:

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Louisa: [My daughter’s] partner made it very difficult for us to see [our granddaughter]. We saw her when she was two weeks old and we didn’t see her again till she was a year and a half. Because [my daughter’s] partner thought that her family was [the child’s] family, not [my daughter’s] family. So she made it very difficult. Petra:  And if it hadn’t been [your daughter] that was the birth mother but the other woman who was the birth mother? Louisa:  We wouldn’t have been allowed to see her at all. (Grandparent)

These accounts indicate that the pregnancy, and all that it represents, continues to structure family relationships as they go into the future. A pregnancy was experienced to protect and ‘fixate’ relationships when put under strain; its absence was associated with vulnerability and non-​permanence. It is important to note, however, that even in cases where women were accessing the biostability associated with pregnancy and childbirth, the parents’ reactions to their sexuality could nevertheless remain an issue. BODIES, PRECARIOUSNESS AND THE LESBIAN ISSUE Although a pregnancy often helped lesbian birth mothers renegotiate the relationship with their parents, this did not necessarily mean that these grandparents fully accepted the lesbian relationship as a ‘proper’ relationship. So genetic grandparents could be quite supportive of their daughter and their genetic grandchild(ren), but fail to recognize the place of the non-​ birth mother in the family or to accept their daughter’s sexuality. Priscilla and her mother, for example, had reached an equilibrium in their relationship and enjoyed a close relationship, and still Priscilla felt her mother did not accept her lesbianism: ‘My Mum doesn’t like the fact that I’m a lesbian but I think I’ve redeemed myself by being a 1950s housewife (laughter) … I  mean she’s happy that I’m happy but I  think she would prefer if I  was straight’ (Priscilla). Being the birth mother, and then fulfilling a number of traditional notions of femininity, including pregnancy and home-​making, this daughter had rendered her lesbian life intelligible to her own mother. In many families, the lesbian sexuality remained an issue that not even the biostability associated with pregnancy could quite undo. It was not uncommon that relationships between parents and grandparents were balanced in a precarious equipoise that could quite easily be unsettled. One example of this emerged in our interview with Sheryl, whose parents had reacted very badly when she ‘came out’. She had a child together with Penny, with Sheryl as birth mother. It was only when Sheryl had the baby that her parents started to warm to her again. Subsequently, the couple’s relationship broke down and Penny later went on to have a second child, on her

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own, by the same donor. This second child was a little sister, both genetically speaking (through the donor) and socially speaking (through the non-​ genetic mother). This complexity of relation reflects the dynamics of lesbian family life and the sorts of relationships that can and do emerge in these families. But whereas Sheryl’s parents were taking a great interest in Sheryl’s birth child, they refused to recognize the connection to Penny as mother, or to the little sister: ‘[My parents] were just like, “Well that’s ridiculous [that they would be sisters] and it’s nothing to do with you.” You know, “You don’t want [your daughter] getting involved cause it’s going to mess her up and it’s going to affect her later on in life” ’ (Sheryl, parent). So not all ruptures were healed by childbirth; in some cases grandparents’ unsupportive views could continue, with parents and grandparents continually negotiating this as part of their relationship. Relationships continued to be precarious and conditional. This left many of the lesbians feeling fearful of change in case something happened that would lead to the loss of these vital kin relationships. Sheryl, who was a single mother at the time of the interview, got by with support from her parents but worried that if she met a new partner they would ‘cut’ her and her daughter out, which is what they had done when she first ‘came out’. They had kept her lesbian relationship a secret from the wider family, and a new partner would risk exposing her sexuality. This fear of change would often come up as couples contemplated the birth of a second child. Laura and Natalie were parents of a daughter that Laura had carried. Laura was close to her own mother, who doted on the child, but the couple were aware that this mother took issue with their sexuality. They were planning another child, but Laura struggled to conceive and so this time they were planning for Laura to get pregnant using Natalie’s eggs and in vitro fertilization (IVF), making Natalie the genetic mother:  ‘Yeah, I  suppose there’s a slight concern, again, would she [my mother] be difficult? You know, would she treat the child differently? Would she behave differently? Probably not, but obviously in my mind there’s the thought of “what if ”, you know, “she did?” ’ (Laura, parent). Laura expresses uncertainty as to what it is that really matters to her mother, and to what extent a donated egg could unsettle the process and prevent her from seeing herself as a grandmother. There is thus an ongoing sense of precarity linked to the event of childbirth experienced in these lesbian families. Whereas the announcement of a pregnancy could often go a long way to healing strained relations between the birth mother and her own family, life outside the heterosexual genetic family remained precarious: the making of kin, and the stability and certainty associated with such relations, could not be taken for granted. Rather, it would appear that relationships continued to hang in the balance; although pregnancy and childbirth could tip that balance in favour

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of a kin relationship being recognized, that recognition might not extend to the lesbian dynamic at the heart of these families. CONCLUDING THOUGHTS Not all families react negatively to a same-​sex relationship of course, but it is sociologically important to recognize that making kin is not an equal playing field and that what we are seeing here is a version of stratified reproduction (Ginsburg and Rapp, 1995): for lesbians, the birth of a child may or may not translate into kin feeling akin with the couple, or their child. To conclude, I want to offer some reflections on how biostability and bioprecarity structures the making of kin in lesbians’ parental projects, as well as some thoughts on the multiple kin meanings embedded in childbirth. My data show that within the context of lesbians suffering a lack of recognition and support from their own parents, the birth of a child may rekindle broken ties. However, the data demonstrate that the process of rekin(dl)ing is different for birth mothers and non-​birth mothers. The fact that it matters who is pregnant and gives birth for the way in which grandparents accept children into the family fold, speaks to how these experiences are structured by biostability (for the mother who was pregnant) and its polar opposite bioprecarity (for the mother who was not). For the birth mother (A)  and her parents (C)  (to go back to the sketch outlined earlier in the chapter), the discourse of biostability aids in making the child into kin: the pregnancy and childbirth help grandparents ‘make sense’ of what may seem to them like confusing family bonds. In other words, these embodied processes forge people’s thinking about relationships, enabling them to be framed as kinship. The non-​birth mother (B) on the other hand, having not become a mother through an embodied process, often senses a vulnerability linked to her embodied self, a bioprecarity, also in turn frustrating her experience of making kin on her side of the family (C). We can see this dynamic playing out in different ways in families: in Sheryl’s case, her ex-​partner (the non-​birth mother) and her subsequent birth child were not perceived as kin by Sheryl’s parents. In the case of Veronica and Howard, it is clear that their recognition and support hinged upon it being their daughter, not her partner, who had carried the child. In terms of the binary opposite of biostability and bioprecarity, it is important to note, however, that there is something particular about the experience of motherhood among lesbian couples, perhaps blurring the relationship between biostability and bioprecarity. It seems that even for women who experience pregnancy and childbirth, activities that lend certainty and stability to kin relationships because of the kinship meaning

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invested in these activities, the shadow of bioprecarity is always present. Even if a woman acts as birth mother, she can sense a potential vulnerability associated with lacking an embodied relationship to the child in terms of making kin, because of the proximity of her partner. Birth mothers such as Priscilla would be aware that their own mothers’ acceptance of the children as kin folk was conditional (on Priscilla giving birth). Birth mothers are engaging in an embodied way in the process of making kin, but it is a deeply circumscribed kinship; kinship that may not have come into being, had decisions about pregnancy been different. For the lesbian couples, their own sense of what it means to be a family, which at its core is built upon recognizing both biogenetic and social bonds as ‘real’ kinship, remain at odds with embodiment being the defining feature of kinship (that is, many grandparents’ idea of ‘real’ kinship). This in turn seems to suggest that bioprecarity is always present, for both birth and non-​birth mothers. Finally, as a second point, it is worth pausing to ask more precisely how the processes of pregnancy and childbirth result in kinship meaning because, although these processes carry conceptual meaning in terms of conferring a perceived relationship in the body between generations, the data indicate that they also carry relational meaning. They are experienced and used as a sign of femininity and womanhood; key components of constructing a conventional female life trajectory. Pregnancy and childbirth are further understood to confer ownership and to be the pathway through which children come to belong in families of birth mothers, whereas this sense of ownership was more in question for non-​birth mothers. Moreover, the example of Priscilla shows that being pregnant was a practice and process that appeared to connect mothers and daughters when the daughters devoted their lives to children and the domestic sphere, as their mothers had before them. A grandmother could feel closer to a daughter because they had both experienced pregnancy and childbirth, and so links were forged in memories, biographies, the everyday and relationships. Drawing on this data, it would appear that pregnancy is important not only as an embodied process, but in how we ‘do’ kinship and how kinship is in fact constituted through everyday actions. What becomes clear are the complex ways in which pregnancy and childbirth confer kinship; showing that they encompass a whole series of social and biological events, meanings, connections and processes. Following Morini and Fumagalli (2010), it would indeed seem that embodiment here produces value on a number of levels, including relational and affective. Understanding lesbian kinship as holding up a mirror to heterosexual (normative) kinship, as it does, it also becomes clear that bioprecarity accompanies the making of kinship as a function of deeply entrenched normative assumptions about kin-​making.

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ACKNOWLEDGEMENT The data used for this chapter came from the ‘Relative Strangers’ study 2010–2013 (PI Carol Smart, Co-I Petra Nordqvist). Many thanks to the UK Economic and Social Research Council for funding this research (RES 062 23 2810)  and to the parents and grandparents who took part. A  special thanks also to Carol Smart and Lindsay Manning for much appreciated feedback and support. NOTES 1 An earlier version of this chapter was published in Nordqvist (2015). 2 As biological and social motherhood are dispersed through egg donation, surrogacy and so on, this may create a less binary and more fluid bodily vulnerability. However, for the purpose of this study I use it as a binary concept. 3 For a full account of the larger study, see Nordqvist and Smart (2014a). 4 Internet company providers of donor sperm were available for a few years in the UK during the 2000s. Since 2007 they can no longer operate because a company needs a licence from the UK Human Fertilisation and Embryology Authority to do so and guidelines only permit companies to use frozen (not fresh) sperm.

REFERENCES Bengtson, V., Biblarz, T. and Roberts, R. (2002) How Families Still Matter. Cambridge, UK: Cambridge University Press. Butler, J. (2004) Undoing Gender. London: Routledge. Calhoun, C. (2000) Feminism, the Family and the Politics of the Closet: Lesbian and Gay Displacement. Oxford: Oxford University Press. Dex, S. and Joshi, H. (2004) Millennium Cohort Study First Survey: The User’s Guide to Initial Findings. London: Centre for Longitudinal Studies, Bedford Group for Lifecourse and Statistical Studies, Institute of Education, University of London. Edwards, J. and Strathern, M. (2000) ‘Including our own’, in Carsten, J. (ed.) Cultures of Relatedness:  New Approaches to the Study of Kinship. Cambridge, UK: Cambridge University Press, pp. 149–​66. Finch, J. and Mason, J. (1993) Negotiating Family Responsibilities. London: Tavistock/​ Routledge. Finch, J. and Mason. J. (2000) Passing On:  Kinship and Inheritance in England. London: Routledge. Fuller-​ Thomson, E. and Minkler, M. (2001) ‘American grandparents providing extensive child care to their grandchildren: Prevalence and profile’, Gerontologist 41: 201–​9. Ginsburg, F. and Rapp, R. (eds) (1995) Conceiving the New World Order: The Global Politics of Reproduction. Berkeley: University of California Press.

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Hook, J. (2006) ‘Care in context: Men’s unpaid labour work in 20 countries, 1965–​ 2003’, American Sociological Review 71(4): 639–​60. Konrad. M. (2005) Nameless Relations: Anonymity, Melanesia and Reproductive Gift Exchange between British Ova Donors and Recipients. Oxford: Berghahn Books. Marre, D. and Bestard, J. (2009) ‘The family body: Persons, bodies and resemblance’, in Edwards, J. and Salazar, C. (eds) European Kinship in the Age of Biotechnology. Oxford: Berghahn Books, pp. 64–​78. Mason, J. (2008) ‘Tangible affinities and the real-​life fascination of kinship’, Sociology 42(1): 29–​45. Mason, J., May, V. and Clarke, L. (2007) ‘Ambivalence and the paradoxes of grandparenting’, Sociological Review 55: 687–​706. Millbank, J. (2008) ‘The limits of functional family:  Lesbian mother litigation in the era of the eternal biological family’, Journal of Law, Policy and the Family 22(2): 149–​77. Morini, C. and Fumagalli, A. (2010) ‘Life put to work: Toward a life theory of value’, Ephemera 10(3–​4): 234–​52. Nordqvist, P. (2012) ‘ “I don’t want us to stand out more than we already do”: Complexities and negotiations in lesbian couples’ accounts of becoming a family through donor conception’, Sexualities 15(5–​6): 644–​61. Nordqvist, P. (2015) ‘ “I’ve redeemed myself by being a 1950s housewife”:  Parent–​ grandparent relationships in the context of lesbian childbirth’, Journal of Family Issues 36(4): 480–​500. Nordqvist, P. (2017) ‘Genetic thinking and everyday living: On family practices and family imaginaries’, Sociological Review 65(4): 865–​81. Nordqvist, P. and Smart, C. (2014a) Relative Strangers: Family Life, Genes and Donor Conception. Basingstoke, UK: Palgrave Macmillan. Nordqvist, P. and Smart, C. (2014b) ‘Troubling the family:  Ongoing problems of coming out as lesbian or gay to families of origin’, Families, Relationships and Societies 3(1): 97–​112. Roseneil, S. and Ketokivi, K. (2016) ‘Relational persons and relational processes: Developing a notion of relationality for the sociology of personal life’, Sociology 50(1): 143–​59. Rubin, G. [1975] (1997) ‘The traffic in women:  Notes on the “political economy” of sex’, in Nicholson, L. (ed.) The Second Wave:  A Reader in Feminist Theory. London: Routledge, pp. 27–​62. Schneider, D. ([1968] 1980) American Kinship:  A Cultural Account (2nd ed.). Chicago: University of Chicago Press. Smart, C. (2007) Personal Life: New Directions in Sociological Thinking. Cambridge, UK: Polity. Solebello, N. and Elliott, S. (2011) ‘ “We want them to be as heterosexual as possible”:  Fathers talking about their teen children’s sexuality’, Gender & Society 25: 293–​315. Strathern, M. (1992) After Nature:  English Kinship in the Late Twentieth Century. Cambridge, UK: Cambridge University Press. Yanagisako, S. and Collier, J. (1987) ‘Toward a unified analysis of gender and kinship’, in Collier, J. and Yanagisako, S. (eds) Gender and Kinship: Essays Toward a Unified Analysis. Palo Alto, CA: Stanford University Press, pp. 14–​50.

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Part III

BIOPRECARITY AND BODIES AS PIECES

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PRECARIOUS PREGNANCIES AND PRECIOUS PRODUCTS Transnational commercial surrogacy in Thailand E l ina N il sson

It’s like having a second child. Like having a second child, that is not my child. (Onwara, surrogate)

In July 2014, I met Onwara, a thirty-​nine-​year-​old Thai woman who had some months earlier signed a contract with an international surrogacy agency in Bangkok to have a baby for a single man from England, and was now six months pregnant. Like many other Thai women, Onwara had left Thailand’s north-​east region Isan for the capital in order to engage in this labour and earn money to support her children and parents back home (Sunanta, 2014). Undergoing hormone treatment, being impregnated with embryos created with other people’s gametes and then gestating and delivering a child, she was engaged in highly embodied and intimate labour (Pande, 2010; Whittaker, 2014). She was expected to be caring and nurturing during pregnancy. But, at the same time, this embodied labour also entailed forms of emotional labour, as the tentative relationship between the surrogate mother and the child she was gestating was going to lead to relinquishment and separation. This requires emotional distance and detachment from the surrogate. As such, the labour provided by surrogates occurs both through bodily and affective processes (Vora, 2012), which can be contradictory. Today, intimate labour in different forms has become an important economic opportunity for women from economically poorer countries, many located in the so-​called global South, whose bodily and emotional services are offered to affluent elites from economically better situated countries in the global North and the Middle East, in the form of reproduction, sex and domestic work (Boris and Parreñas, 2010; Hofmann and Moreno, 2016; Parreñas et  al., 2016). We see Filipina nannies leave their homes to care

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for children in Rome or Los Angeles (Parreñas, 2001), Korean immigrant women working in nail salons in New York City (Kang, 2010) or Ukrainian women donating their egg cells to transnational processes of reproduction (Vlasenko, 2015). On the other side, or one might say direction, people from Sweden, the UK or Australia suffering from infertility, either socially or medically, travel to countries such as Mexico, Kenya or Georgia to hire a surrogate (Majumdar, 2014; Schurr, 2017). In all of these cases we see how ‘Marx’s iconic male, stationary industrial worker has been replaced by a new icon:  the mobile and stationary female service worker’ (Hochschild, 2009:  21), engaged in different forms of intimate labour. These categories of labour often involve working conditions marked by precarity in terms of outsourcing, informal labour, wage squeeze, insecurity, uncertainty, pernicious risk and inequality (Bhadra, 2017). In addition, the intimate dimension of the labour contributes to bodily vulnerability, not least through being dependent upon one’s bodily capacities and/​or bodily services in order to make a living. Following Bula Bhadra’s (2017) research on surrogacy in India, I argue that women acting as surrogates, especially in the global South, experience bodily, intimate and emotional labour, precarized due to the uncertainty and insecurity of the labour. It is bioprecarious not least because it involves certain social categories –​economically disenfranchised women –​and because it is based in bodily labour. In this chapter I will discuss how women acting as surrogates are exposed to vulnerabilities such as social stigmatization, health complications and financial insecurity. These vulnerabilities can be understood as forms of bioprecarity, a form of vulnerability that is corporeal as well as psychosocial and last but not least fiscal (see Griffin, Chapter 1 this volume). The surrogate mother is creating life as a livelihood and using her bodily capacities as a means of survival, a survival that is challenged in several ways. She is financially vulnerable due to her fragile and insecure employment conditions, the temporary contracts and how they are designed, her flexible working hours (Bhadra, 2017: 41), as well as the necessity of limited opportunities for her to actually conduct this work. At the same time she is emotionally, bodily and physiologically precarized as surrogacy entails emotional labour and the bodily risks associated with pregnancy. As such, in the process of transnational surrogacy, bioprecarity operates on multiple levels, capturing the entanglement of bodily and economic interdependency. Drawing on interviews with Thai women enrolled in transnational commercial surrogacy, and the concept of bioprecarity discussed in this volume, I  examine the interrelation between commercial surrogacy, bioprecarity and the globalization of intimate labour through the experiences of Thai surrogates. I begin by providing a brief overview of transnational commercial surrogacy today, as well as an outline of surrogacy in Thailand and the

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context of the material presented. In the pages that follow, I  discuss the surrogates’ experiences in relation to three precarizing conditions: (1) economical/​financial vulnerability, (2)  bodily/​physiological vulnerability and (3) emotional/​psychosocial vulnerability. The chapter concludes by joining the three precarious conditions in order to discuss how bioprecarity can be used to understand women acting as surrogates as subjects of intimate and emotional labour under precarizing conditions. TRANSNATIONAL SURROGACY: A GLOBAL CHAIN OF REPRODUCTION In gestational commercial surrogacy, the sperm from a donor or intended father is injected into the egg of a donor or intended mother and the fertilized embryo is then transplanted into the surrogate’s womb, hired to gestate, deliver and then relinquish the child and any parental rights in exchange for payment. As such, the surrogate is not directly genetically related to the child she carries, but provides the intrauterine environment. Commercial surrogacy is a growing phenomenon as a function of several factors. Changes in biotechnology have resulted in the increasing commercialization of surrogacy, as reproductive body parts (gametes) and services (gestation) have entered the fertility market, as well as moving it beyond state boundaries. For example, it is today possible to use an egg from an (often white) South African donor, fertilize it with sperm from a Swedish intended father and then implant it into a Thai surrogate mother’s uterus for gestation. As such, the process of transnational commercial surrogacy involves the movements of people and gametes across international borders. One contributing factor here is that the laws and regulations on surrogacy (both altruistic and commercial) vary greatly across countries and are constantly changing. The demand for transnational surrogacy also partly derives from the search for cheaper arrangements. This has contributed to surrogacy industries moving to countries such as Mexico, Kenya, Ukraine and Georgia, where the cost of surrogacy is much less than in the United States, for example. As the process of commercial surrogacy encompasses both a contractual monetary agreement as well as care, nurturing and an often-​expressed wish to help others, it involves tensions between ‘money and love’, tensions being characteristic for emotional and intimate labour (Hofmann and Moreno, 2016). The term labour instead of work is particularly apposite regarding surrogacy as it evokes both the economic relations and the process of childbirth involved, as the capacity to produce and reproduce are central in these contexts of income earning (Whittaker, 2014). In their well-​known volume on intimate labour, Boris and Parreñas (2010: 7) use surrogacy as

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an example of intimate labour, but distinguish it from emotional labour as they argue that ‘surrogate mothers do not engage in emotional labour’. In contrast to this, I strongly suggest that surrogates do engage in emotional labour, as nurturing a surrogacy pregnancy ‘requires maintaining a fine balance between attachment and detachment’, something that affects the women in question (Majumdar, 2014: 218). In addition, the surrogates must ‘represent themselves as desirable to intending parents by portraying themselves as humble, compliant, and often religious’ (Riggs and Due, 2018: 20) in order to comply with the image of the ‘good’ surrogate, willing to both nurture and detach from the child she might gestate. SURROGACY IN THAILAND At the time when I  did the interviews for this study (June–​August 2014), several factors made Thailand an international destination for commercial surrogacy. Assisted reproductive technology (ART) was quickly accepted in Thai society, as it was associated with modernity, a patriotic pride in Thai science and medicine, as well as with Buddhist beliefs of merit-​making (tam boon) and a celebration of life and procreation (Whittaker, 2016: 71). Since then, prospective parents from all over the world, typically from Australia, have sought in vitro fertilization (IVF) services in Thailand and the country has become known for its sophisticated medical infrastructure and expertise at comparatively affordable prices. Until 2015, surrogacy arrangements were not clearly regulated by Thai law. However, a need for ART legislation was widely recognized when in February 2010 the police arrested a Taiwanese brokering agency called ‘Baby 101’ located in Bangkok. They had kept fifteen Vietnamese women locked up, trafficked to deliver babies to foreign clients for payment (BBC News, 2011). A draft ART Bill, which included the prohibition of commercial surrogacy, was approved by the Thai Cabinet in May 2010, but was left unratified due to political instability (Stasi, 2017). As such, commercial surrogacy remained legally ambiguous, which made it possible for commercial third-​party reproduction to continue. From 2011, a range of new private clinics and surrogacy agencies emerged in Thailand. There was a rapid increase in foreigners travelling to Thailand to seek surrogacy services, partly due to new surrogacy regulations in India (January 2013), restricting access to married heterosexual couples only. For those who sought surrogacy arrangements in Thailand it was medically difficult or impossible to get pregnant, or physically impossible in the case of single men or gay couples where both were cisgender. As discussed by Damien Riggs and Clemence Due (2018:  58), intending parents may potentially also experience vulnerability ‘due to being positioned as failed (i.e. infertile) reproductive citizens’;

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for them surrogacy may be the only route to becoming (biological) parents. But many adoption and surrogacy agencies refuse gay couples, thus intensifying this vulnerability among homosexual intending parents. In response to this, Thailand was promoted by a number of surrogacy agencies as offering ‘gay-​friendly’ services (Whittaker, 2016). However, in August 2014 the highly publicized case of ‘Baby Gammy’ put Thailand’s surrogacy industry in the global spotlight. Gammy, a baby boy diagnosed with congenital heart disease and Down’s syndrome, was allegedly abandoned by his intended parents, an Australian heterosexual couple. The couple took his ‘healthy’ twin sister with them, while leaving Gammy in Thailand in the care of his surrogate mother Pattharamon Chanbua (Murdoch, 2014).1 Just a couple of weeks later another controversial surrogacy story caused headlines as police found nine surrogate babies, nannies and a pregnant surrogate mother in an upmarket Bangkok apartment connected to a Japanese businessman, Mitsutoki Shigeta. It emerged that Shigeta had fathered at least fifteen surrogate babies via Thai surrogates (Whittaker, 2016). In reaction to these cases and the international pressure and critique of the unregulated surrogacy market in Thailand, the Thai authorities launched a crackdown on commercial surrogacy, closing clinics, publicly arresting doctors involved in surrogacy and effectively banning the surrender of all babies born through surrogacy. Following this, the National Peace and Order Council (the military government formed following the coup d’état in May 2014) revived the ART Bill from 2010 to stop all international surrogacy trade and enforcing a ban on commercial surrogacy. The proposed legislation was enacted on 19 February 2015, with the aim of preventing foreigners from having children through surrogacy and eliminating the emerging phenomenon of procreative tourism in Thailand (Stasi, 2017). The new rules limit surrogacy to non-​commercial arrangements and restrict the entitlement to surrogacy to heterosexual couples (at least one of whom must be Thai), married for at least three years. Following these new regulations, many international surrogacy agencies moved their business to neighbouring countries such as Nepal, Cambodia and Laos where surrogacy was still unregulated. While Thailand no longer allows commercial surrogacy, surrogacy agencies operate in other countries with similar models and thus this chapter provides insight into the bioprecarized positions of women in situations such as Thailand. The fast-​moving surrogacy market adds to the precarious work situation of women acting as surrogates: one day the opportunity is there, and the next day it is illegal and has moved to other countries. In this chapter, I draw upon interviews conducted with eleven Thai surrogates in Bangkok between July and August 2014, when the industry was still unregulated and before the surrogacy scandals became public. I  recruited the women through the surrogacy agency they were

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working for and the semi-​ structured in-​ depth interviews lasted forty-​ five to ninety minutes, focusing on the women’s experiences of acting as surrogates. The interviews were audio recorded and conducted in Thai. I was assisted by a female interpreter, as well as Thai research assistants for their transcription. The women’s names have all been changed to preserve their anonymity. The women all worked for an international surrogacy agency and were at different stages of the surrogacy process. They were all Theravada Buddhists, like most of the Thai population. Their ages ranged from twenty-​ three to thirty-​nine years. They had all previously given birth and had children of their own, with the exception of one woman who had no experience of pregnancy. Most of the surrogates were single; none was married. This was an agency requirement since a registered marriage would automatically have made the husband the legal father of the child. Seven of the eleven surrogates originated from Isan, the poorest region of Thailand. In contrast to surrogacy in India where it is common for surrogates to stay at a surrogacy hostel while pregnant, the Thai surrogates lived in their own homes and travelled to the agency and the clinic for doctor’s appointments or meetings. Their average monthly income prior to entering the surrogacy programme was between 6,000–​9,000 THB (110–​160 GBP).2 This has to be seen in relation to the average monthly wage, which was about 13,000 THB (270 GBP) in 2013 (International Labour Organization, 2014). All of the surrogates in this study had been hired via the agency by intended parents from Australia, England, Switzerland, Malaysia or Indonesia. In four of the cases the clients were a heterosexual couple, in two they were a gay couple and in three cases single men. Notably, one of the surrogates did not know who her clients were or where they came from. BIOPRECARITY 1: FINANCIALLY INDUCED VULNERABILITY I thought, I don’t have a boyfriend, I am a single woman taking care of a child and from where can I  find a large sum of money? So I  decided to do this. (Chantara, surrogate)

Chantara, twenty-​nine years old and a single mother to her four-​year-​old daughter, gave birth to twins for a heterosexual couple from Australia just weeks prior to the interview. In line with her statement above, all the women interviewed reported financial need as their primary motivation for becoming a surrogate mother. In general, the women commented that they needed money to pay for their children’s education, for debts and to be able

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to provide for their parents. A majority of the women I spoke to were single mothers and underlined that the monetary reward was a major factor in their decision to become a surrogate. Siriporn, twenty-​four years old and pregnant with twins for an Australian heterosexual couple, explained: ‘I will spend a part of it on my son. I’m the only one who takes care of him. I will keep it for his education, because I have to raise him by myself. Another part is for my parents.’ Before becoming a surrogate the women earned below the national average; for most the total compensation for the surrogacy process, 390,000 THB (approx. 7,000 GBP), was equivalent to about four years’ wages. Given the unregulated surrogacy market in Thailand at the time, clinics and agencies had the freedom to conduct their practices and structure the contract and payment plans as they wished. For every embryo transfer trial, the surrogate was paid 6,000 THB (110 GBP) and she could do a maximum of three trials. When a pregnancy was confirmed by ultrasound, the surrogate started to receive a monthly stipend of 13,000 THB (230 GBP). Within twenty days after delivery and when the surrogate had signed away her custodian rights, she was to be paid the remaining sum. In the case of miscarriage or an otherwise necessary termination, the surrogate was not entitled to full payment. This minimized the financial risk for the intended parents, while increasing that of the surrogate mother. Besides the monthly wage, the surrogate had no guarantees that the clients would show up at the time of the delivery and many of the surrogates expressed a fear of not being paid. This financial worry was enhanced by inadequate information about the surrogacy process awaiting them; according to the surrogates in this study, contract procedures were often opaque. One surrogate, Maladee, thirty-​nine years old and five months pregnant with a child for a male gay couple from Switzerland, reported receiving no explanations of the content of the contract and recalled only being instructed where to sign: ‘They didn’t explain anything. They just gave me the contract and asked me to sign it.’ According to her, the agency did not go through the contract details or the payment plans, and she only found out about the process through other surrogates. As many of the surrogates came from poor and marginalized communities and were of lower status, the formal language of the contracts may have restricted their understanding of what they signed and any potential information on regulations that could possibly have protected them (Peet, 2016). As such, the women had little bargaining power when it came to their earnings as surrogates, and relied on other surrogates to receive information on the process ahead of them. They also did not receive copies of the contract. In order to receive the full payment, the women acting as surrogates had to carry the pregnancy successfully to term. As such, they depended

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on their bodily capacity and other factors that were out of their control. There was always the risk of failure of the surrogacy to take. Each surrogate was able to go through a maximum of three embryo implantations, but it was not unusual for it to take more than one embryo implantation prior to a successful pregnancy. Given that the intended parents were in a position to decide whether to change the surrogate if an embryo implantation was unsuccessful, it was important for the surrogates to become pregnant easily so that they did not risk being replaced and thus miss their chance of paid employment. Thus, ‘succeeding’ with the embryo transfers preferably early on became all the more important as the promise of money relied on a confirmed pregnancy. This was also implied by Maladee, who told me how ‘the women who find themselves finally pregnant are happy, because they know that they will receive a big sum of money, while those who fail to conceive a baby are upset’. However, even when a pregnancy was confirmed, there was still the risk of something unforeseen happening, such as miscarriage or termination due to medical reasons. According to the surrogacy contract, in case of a pregnancy complication or termination before month five, the surrogate was not entitled to any payment beyond the monthly stipend. Even though this was a relatively large sum of money, the surrogate effectively had only temporary work –​due to bodily limitations –​and could not engage in other forms of work at the same time as well. The surrogacy agency also restricted the process to a maximum of three times due to its attendant physical and health risks. As such, acting as a surrogate is not a long-​term means of income generation and hence highly precarious. Adding to their already stressed financial situation, many pregnant surrogates could not maintain their previous paid work during the pregnancy. This was partly due to restrictions by the agency, such as not being allowed to ride a motorbike during pregnancy (a very common form of transport, especially in the Thai countryside), or not being allowed to lift heavy things. As noted by Jaruwan, twenty-​eight years old and eight months pregnant with a child for an Australian heterosexual couple: After finishing implanting the eggs, I  have to be careful when walking and doing other activities. I  have to take care of myself, as it is easy to lose the embryo. It is different from a normal pregnancy. I used to ride motorcycle, but now I have to refrain from it. I used to work very hard, but now I cannot do it … I was working at a department store … responsible for arranging goods in the store. I had to arrange products and lift heavy stuff. After I became a surrogate mother, I  quit the job, because I  cannot lift heavy stuff anymore, otherwise I will lose the child.

Similarly, Onwara, who had worked at a nursery, had to quit her job when she became a surrogate as she could no longer lift children. Even if the

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monthly stipend Jaruwan and Onwara received was more than their usual monthly wage, the fact that they had to quit their other jobs made their future working conditions uncertain and this had consequences for their livelihood. The interviews with the surrogates showed that they found themselves in a state of financial uncertainty, a hallmark of precarious living. Furthermore, the money the surrogates earned was seen as a compensation or wage for the nine months spent as a surrogate and not for the medical risks they ran (Schurr, 2017). I  will explore this in the next section where I  discuss the bodily precarization that the surrogacy process entails for these women. BIOPRECARITY 2: BODILY VULNERABILITY Often when talking about precarious working conditions we refer to non-​ standard employment, financial insecurity and temporary positions, as described above (Standing, 2011). Bioprecarity as we discuss it here also, and in particular, involves bodily vulnerabilization as an effect of conducting intimate labour. In this context there are bodily and medical risks, which are striking and in many ways unique to surrogacy. This entanglement of economic insecurity and bodily vulnerability places the women acting as surrogates in a state of bioprecarity where financial and bodily precarization both rely on and reinforce one another. For the purposes of gestational surrogacy the body of the surrogate has to be artificially prepared through hormone injections, altering her natural menstrual cycle to synchronize it with the clinic’s schedule for egg donation and embryo implantation. This maximizes the chances of pregnancy. But such hormones can have side effects. One of my informants, Maladee, told me she was worried about this: I am worried. Some people told me about it … The surrogates I met at the clinic said that the hormones we have been consuming could cause a tumour to grow. Some of them went for an ultrasound and found a tumour in their womb, but the doctor said it would disappear soon … I wonder if her tumour would disappear for real, but I don’t know if I also have it in my body.

While a tumour in the uterus may not be a common side effect from these hormones, it is clear that the surrogates had little access to information about the procedure and its possible effects. Thus informal talk and rumours became their main source of information. This added to the surrogates’ worries, a secondary negative effect. It was also not clear who would deal with any side effects, especially if the pregnancy did not take hold.

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Perhaps the most prominent health effect of ART treatment for surrogates is the risk of multiple foetal pregnancies. Researchers link ART to a thirty-​fold increase in multiple pregnancies compared with the rate of spontaneous twin pregnancies (Deomampo, 2016). In recent years, professional organizations concerned with the safety of multiple gestations and births have been recommending that only one, and at most two, healthy embryos be transferred at a time when using IVF as multiple pregnancies bear a number of risks, such as miscarriage, high blood pressure, induced hypertension, pre-​eclampsia, gestational diabetes, placental abnormalities, preterm delivery and prolonged hospitalization (Brody, 2016). Despite these risks, some doctors who want to maximize the chances of a successful pregnancy, transfer more embryos than recommended. The surrogate coordinator at the agency told me how some doctors transferred more than three embryos, which could end up with surrogates being pregnant with triplets or even quadruplets. The surrogates I  talked to were usually implanted with more than one embryo per transfer, and out of the eleven women I interviewed, four were gestating twins. When talking to Maladee, I asked her about the process of embryo transfer. E:  Were you asked how many embryos to implant? M:  They didn’t ask. E:  You found it out later? M:  Yes. When I became pregnant and went for a blood check, the nurse read the information in the record to the doctor, describing how many embryos were injected and how many of them were successful.

In Maladee’s case, two embryos were implanted and one ended in a confirmed pregnancy. Notably, the nurse read the information to the doctor and thus, by chance, Maladee heard it too. Many surrogates were not made aware of the number of embryos implanted in their wombs. Such bypassing of the surrogates meant that they had no power to influence the decision regarding the number of embryos transferred. This was decided in consultations between the doctor and the intended parents. I  asked what would happen if a surrogate mother got pregnant with twins or even triplets. Maladee answered: ‘It depends on the intended parents. There are some women who want to remove them. … A young woman, whom I met recently, is conceiving triplets, and she will not remove them. She wants to remove them, but the intended parents don’t let her do it … It depends on them if they want to remove one or two or three foetuses.’ This highlights surrogates’ loss of right to bodily self-​determination, even if they have a view on the matter. They lose agency in relation to their body. Discussing the expropriation of bodily autonomy, and the objectification and dehumanization of the person concerned, Deomampo (2016:  176) argues that

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given the costs and stress associated with surrogacy many intended parents want twins, as this would be a ‘terrific deal at “two for the price of one” ’. However, even if the surrogate was to be pregnant with twins or triplets, it is still the intended parents who decide about any selective reduction (the practice of reducing the number of foetuses in a multifoetal pregnancy by one or more). Maladee explained: In case of conceiving triplets, some [intended parents] choose to remove one foetus, and some choose to remove two foetuses. I have a friend who used to work for [another surrogacy agency]. She conceived three babies at once. One of the foetuses was in one bag, while the other two were together in another bag. She went for foetus removal in India.

This was also confirmed by the surrogate coordinator who told me about a doctor who had implanted four embryos into at least two surrogates who both got pregnant with quadruplets. Since the intended parents did not want four children, and since it jeopardized both the surrogates’ and the babies’ health, the surrogates were flown to Georgia in order to undergo selective reduction. Even if selective reduction decreases the risks associated with multifoetal pregnancies, the surrogates are not the ones in control of this decision. Moreover, the reason for flying the surrogates to India or Georgia was that abortion is illegal in Thailand and perceived as un-​Buddhist, and therefore un-​Thai. As noted by Andrea Whittaker, who has done studies on the perception of abortion in Thailand, ‘abortion interferes with the karmic cycle of births and deaths by not allowing the rebirth of a being. In so doing, Buddhism teaches that a woman will inevitably suffer karmic retribution for her actions’ (Whittaker, 2004: 74). As ideal womanhood in Thai society is characterized by being a ‘good mother’, a woman who finds herself pregnant is expected to be self-​sacrificing, accepting and to fulfil her ‘nature as a woman’, meaning to gestate, give birth and then nurture the child. In contrast, a woman who decides to terminate a pregnancy is regarded by many as selfish and thus not a ‘real’ woman. She is considered to be destroying life and committing ‘a serious Buddhist sin/​demerit’ (Whittaker, 2004: 112). The fact that an abortion is believed to carry negative karmic consequences makes many women who have undergone abortions engage in ‘merit-​ making’ in order to counterbalance this ‘sinful’ act. Putsaya, thirty-​nine years old, mother of two and ten weeks pregnant for unknown clients, explained that she wanted to become a surrogate to wash away her sins (laang bàap) and make merit (tam boon). Besides the fact that she was a single mother and needed the money to help her children complete their education, counterbalancing the ‘bad deed’ (bàap) of abortion also motivated her. Thus, she wished to earn merit as a sort of compensation for the abortion she

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had had seventeen years previously. However, given that Putsaya had no say in any eventual foetus reduction, she could end up with having yet another ‘abortion’. Thus besides the health effects mentioned above, both the impregnation process and potential foetal reductions also entail cultural or social vulnerabilization (un-​Thai behaviour), bodily precarity and psychological vulnerabilization as they create mental anguish and encourage feelings of guilt. A further health risk involved in the surrogacy process is the delivery of the child, often done by caesarean section (C-​section). This, common in commercial surrogacy, was the mandatory means of delivery for all of the surrogates I  interviewed. While a planned C-​section makes it logistically easier for most parties involved, it carries the common risks associated with major surgery. It can also have a negative impact on future fertility, future pregnancy outcomes and create future pregnancy complications (Kaeg et al., 2018). Moreover, a C-​section can lead to repeat caesareans for subsequent births, with the repeat procedure carrying even higher risks for the mother. As such, this entails bodily vulnerability for their reproductive life after surrogacy. Notably, the agency did not always convey these risks clearly to the surrogates; many of them were worried about this means of delivery as they all had delivered their own children through vaginal childbirth and C-​ section was ‘unfamiliar’ to them. In India, some surrogates receive extra payment for undergoing a C-​section, as it can take a month or more for the surrogate to recover physically, which constitutes a loss of wages for her (Deomampo, 2016). This was not the case for the surrogates I talked to. Putsaya, thirty-​nine years old and two months pregnant without knowing who the intended parents were, expressed concern about this:  ‘At first, I thought if I go through an operation, it is hard for me to continue working. Then I thought that life is short, and by doing this I get to do good deeds and also get money for my children’s education.’ She stopped work during the pregnancy, since she did not want to risk ‘tripping’ over. As such, the labour of surrogacy requires the woman to navigate risks; both for herself and for the child she is gestating. Many women acting as surrogates lack follow-​up physical and mental health care after delivery. This increases their health risks and bodily vulnerability (Khader, 2013). Together with the lack of informed consent, the ignoring of medical rights, the lack of information provided to the surrogates and the requirement to comply with any requests for foetal reduction, this illustrates how the surrogacy process reduced the women to their reproductive capacity and womb, rendering them exchangeable and to a certain degree disposable. In the surrogacy process, the child is the precious ‘final product’. As discussed by Bhadra (2017: 53), ‘the healthcare needs of a

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surrogate are measured only in terms of giving birth to a child’, setting up the surrogates as mere ‘producers’ or ‘devices’ in the reproductive process. Along with these possible physiological harms as potential outcomes of the pregnancy procedure, the mental health dimension also constitutes a risk for the surrogate. Next I discuss how the surrogates are bioprecarized in terms of emotional and psychosocial vulnerability. BIOPRECARITY 3: EMOTIONAL AND PSYCHOSOCIAL VULNERABILITY As described earlier, surrogacy involves bodily intimate labour intertwined with emotional labour. Vulnerability is here corporeal and at the same time emotional and psychosocial. Since the womb is not separate from the rest of the body, the surrogates experience the growth and movement of the child in their womb and the pregnancy leaves traces on their body and affects their everyday life, being constantly present and palpable. When gestating a child the surrogates put material as well as immaterial dimensions of themselves to work, they are ‘putting life to work’ (Morini and Fumagalli, 2010). They conduct ‘biolabour’ in their reproductive capacity and with their emotions. Hence, as Bhadra (2017:  41) argues, ‘it is no longer possible to speak just about precarious labour, but rather [the] precarious life of surrogates’. Talking to the surrogates about the birth, whether it was approaching or already over, many of the women expressed sadness. They said they could ‘accept the truth’ and had to ‘control’ or ‘restrain’ their feelings’, even if they were ‘feeling sad’. Onwara, who was about to give birth to a baby for a single man in England, stated: ‘I already made up my mind. They say that doing this you have to make up your mind, don’t think anything while delivering.’ Maladee, who was five months pregnant, told me: When the time comes I  have to be ready and restrain my feelings … I  am worried when I have to give the baby away. I worry that during the first few days after giving birth I will miss the baby, and might not be able to sleep so I have to be ready for it … As I heard from a friend, she also had experience that she cried. But for me I’ll try to hold myself and prepare for it.

Another surrogate, Isaree, twenty-​three years old and eight months pregnant for a Malaysian heterosexual couple, told me: ‘I take care of the child, but I cannot love the baby fully because when the time comes I will have to give up the child to the parents. But I do my best to take care of this baby.’ These narratives of discipline, restraint and control of feelings are expressions of the invisible but highly emotional labour the women perform in order to

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contain feelings that could interfere with ‘doing their job’, including feelings of attachment to the baby they gestate (Hochschild, 2009: 29). Amrita Pande (2010) calls this process of detachment ‘manufacturing a perfect mother-​ worker’ where the women are asked to cultivate a ‘disposable mothering role’, simultaneously aware that the children they gestate are supposedly not theirs, but that they are precious and should be nurtured during the pregnancy as if they were. Some of the women I talked to felt that the children they gestated were theirs. ‘Yes, it feels like this is my own child’ (Maladee), ‘I carry him, so he is my baby’ (Onwara), ‘I feel like I am carrying my own children. I  want the babies to come out strong and healthy’ (Natee). This emotional labour performed by the women could be understood as ‘emotional surplus value’ (Hochschild, 2000), since the surrogates generate emotional surplus value through their labour, unacknowledged as such and unrewarded by the intended parents and the agency. A couple of weeks after the surrogacy scandals erupted in Thailand, I met Maladee for a follow-​up interview. I  was interested in how she felt about the recent events and the surrogacy issue making headlines in Thailand. Maladee told me that she was very afraid –​afraid of not getting paid, afraid of being investigated by the police and afraid that the intended parents would not come to get the child. She said: I am afraid because the issues have been widely reported, and it’s in the news every day. The intended parents might be afraid of being investigated if they come to Thailand. I am afraid if they don’t come, I will not receive the money, and I  will have to raise the baby for free … I  might take care of the baby, because I don’t know to whom I should give the baby. I don’t want to send it to an orphanage.

In response to this I asked her if she would be able to take care of the baby herself, and she replied: ‘I will have to. I don’t know what to do with it … I love it like my own child.’ The scandals had intensified Maladee’s worries about being abandoned by her clients and left with the child, which would put her in an acutely ambivalent position as she ‘loved the child as her own’, but was not in a financial position to take care of it. While financial needs may have been the primary motivation for the women to act as surrogates, they also mentioned altruistic motivations such as helping others and making merit. This can be understood as a way for the women to represent themselves as intelligible women in a society where gestating a child (with a stranger’s sperm) in exchange for money is seen as un-​Thai/​un-​Buddhist behaviour and potentially stigmatizes the surrogates. As noted by Riggs and Due (2018:  2), ‘for women who act as surrogates, the competing demands to provide for their children but gestate and hand

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over a child to other people potentially produces disoriented relationships to norms of womanhood and motherhood’. As such, the surrogates also become socially vulnerable when engaging in the act of surrogacy. In her work on vulnerability and precarity, Judith Butler (2004: 45) discusses what it means to locate oneself in relation to others, and contends that ‘the desire to persist as a recognisable social being requires submitting oneself to social norms’. By referring to the Buddhist act of merit-​making the women were motivating their act of surrogacy in a way that could be understood as consistent with the Thai view of what constitutes a ‘good’ woman (Whittaker, 2014) and conforming to a morally defensible position. CONCLUSION In this chapter I have outlined how women acting as surrogates in Thailand are bioprecarized in different ways and empirically demonstrated how the opportunities for intimate work available to socio-​ economically disadvantaged subjects often involve high levels of vulnerability and risks such as unsecure payments, temporary contracts and time-​limited means of making a living, health risks and emotional and psychosocial vulnerability. As such the surrogacy pregnancy is ‘precious’ and ‘vulnerabilizing’. However, when discussing the different forms of bioprecarity those women who act as surrogates experience, it might appear as if they are passive objects ‘placed’ or ‘forced’ into these situations. But as noted by Hoffman and Moreno (2016: 9), ‘intimate workers make complex calculations, which include aspects such as financial gain, prospects for advancement and social mobility, stigma of the work among others’. Therefore one cannot ignore the surrogates’ (albeit limited) agency in entering the contract and agreeing to carry a baby. Maladee, Jaruwan and the other women I spoke to all voluntarily contacted the surrogacy agency, signed the contracts and gained a substantial sum of money in the process. They ‘freely’ chose to become surrogates, but in what context? Agency is not the same as freedom of choice and given the women’s economic needs one may ask what their options really were. Many of them were already in precarious working conditions with limited choices; one could argue that insecure employment conditions, temporary contracts and hard physical work –​work often described by the term ‘precarity’ –​is the norm for many in the global South and elsewhere (Bhadra, 2017). However, in recent decades we have seen an expansion of the global market of commercial intimacy, especially in Asia where low-​ waged female workers migrate both within Asia and outside to offer their intimate, embodied and sexualized labour (Parreñas et  al., 2016:  1). Here

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the emerging market of transnational commercial surrogacy and women’s reproductive capacity have become a new ‘arena of investment’ (Bhadra, 2017: 31) and bios –​the body as well as the life of the surrogate mother –​ depends on emotional labour as well as bodily work beyond the surrogates’ control. Their vulnerability is corporeal, emotional and psychosocial where ‘the human body becomes not simply a tool for enacting labour in order to produce goods, but rather the human body becomes a good in and of itself ’ (Riggs and Due, 2018: 8). The intersection of the bodily, intimate and emotional labour performed in surrogacy and the lack of predictability and security with regards to financial and bodily aspects, makes it an utterly precarious means of making a living, producing bioprecarity. Bioprecarity here is conceived both in terms of the commodification of women’s bodies in a context of inequalities in terms of outcomes and choices between the privileged and the disadvantaged, and at the same time accounts for the vulnerability, (inter)dependency and bodily consequences of the workers themselves. NOTES 1 Gammy now stays with Chanbua and her children. It subsequently emerged that Gammy’s intended and biological father had convictions for paedophilia and was under investigation in Australia regarding the well-​being and safety of Gammy’s twin sister. 2 The amounts stated are based on the exchange rates for July 2014, the time of interview.

REFERENCES BBC News (2011) ‘Thailand police investigate baby sales ring’, 25 February. Available at www.bbc.com/​news/​world-​asia-​pacific-​12575566 (accessed 11 April 2018). Bhadra, B. (2017) ‘Precarity and surrogacy: The invisible umbilical cord in the digital age’, in Heidkamp, B. and Kergel, D. (eds) Precarity within the Digital Age: Media Change and Social Insecurity. Wiesbaden: Springer VS, pp. 31–​68. Boris, E. and Parreñas, R. S. (eds) (2010) Intimate Labors:  Cultures, Technologies, and the Politics of Care. Palo Alto, CA: Stanford University Press. Brody, J. E. (2016) ‘Some IVF experts discourage multiple births’, 10 October, New York Times. Available at www.nytimes.com/​2016/​10/​11/​well/​family/​experts-​advise-​ minimizing-​multiple-​births-​through-​ivf.html (accessed 22 October 2018). Butler, J. (2004) Precarious Life:  The Powers of Mourning and Violence. London: Verso. Deomampo, D. (2016) Transnational Reproduction: Race, Kinship, and Commercial Surrogacy in India. New York: New York University Press.

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Hochschild, A. (2000) ‘Global care chains and emotional surplus value’, in Giddens, T. and Hutton, W. (eds) On the Edge:  Globalization and the New Millennium. London: Sage, pp. 130–​46. Hochschild, A. (2009) ‘The back stage of a global free market:  Nannies and surrogates’. Available at www.havenscenter.org/​files/​backstage.global.free. market.pdf (accessed 6 April 2018). Hofmann, S. and Moreno, A. (2016) Intimate Economies:  Bodies, Emotions, and Sexualities on the Global Market. New York: Palgrave Macmillan. International Labour Organization (2014) Global Wage Report 2014/​15:  Asia and the Pacific Supplement. Bangkok: ILO Regional Office for Asia and the Pacific, Regional Economic and Social Analysis Unit (RESA). Kaeg, O. E., Norman J. E. and Stock S. J. (2018) ‘Long-​term risks and benefits associated with caesarean delivery for mother, baby and subsequent pregnancies: Systematic review and meta-​analysis’, PLoS Med 15(1): 1–​22. Kang, M. (2010) The Managed Hand: Race, Gender, and the Body in Beauty Service Work. Berkeley: University of California Press. Khader, S. J. (2013) ‘Intersectionality and the ethics of transnational commercial surrogacy’, International Journal of Feminist Approaches to Bioethics 6(1): 68–​90. Majumdar, A. (2014) ‘Nurturing an alien pregnancy: Surrogate mothers, intended parents and disembodied relationships’, Indian Journal of Gender Studies 21: 199–​224. Morini, C. and Fumagalli, A. (2010) ‘Life put to work: Towards a life theory of value’, ephemera 10(3/​4): 234–​52. Murdoch, L. (2014) ‘Australian couple leaves Down syndrome baby with Thai surrogate’, Sydney Morning Herald, 1 August. Available at www.smh.com.au/​national/​ australian-​couple-​leaves-​down-​syndrome-​baby-​with-​thai-​surrogate-​20140731-​ zz3xp.html (accessed 27 October 2018). Pande, A. (2010) ‘Commercial surrogacy in India: Manufacturing a perfect mother-​ worker’, Signs 35(4): 969–​92. Parreñas, R. S. (2001) Servants of Globalization: Women, Migration, and Domestic Work. Palo Alto, CA: Stanford University Press. Parreñas, R. S., Thai, H. C. and Silvey, R. (2016) ‘Intimate industries: Restructuring (im)material labor in Asia’, positions 24(1): 1–​16. Peet, J. L. (2016) ‘A womb that is (not always) one’s own: Commercial surrogacy in a globalized world’, International Feminist Journal of Politics 18(2): 171–​89. Riggs, W. D. and Due, C. (2018) A Critical Approach to Surrogacy:  Reproductive Desires and Demands. London and New York: Routledge. Schurr, C. (2017) ‘From biopolitics to bioeconomies:  The ART of (re-​)producing white futures in Mexico’s surrogacy market’, Environment and Planning D: Society and Space 35(2): 241–​262. Standing, G. (2011) The Precariat: The New Dangerous Class. London: Bloomsbury Academic. Stasi, A. (2017) ‘Protection for children born through assisted reproductive technologies act, B.E. 2558: The changing profile of surrogacy in Thailand’, Clinical Medicine Insights: Reproductive Health 11: 1–​7. Sunanta, S. (2014) ‘Thailand and the global intimate: Transnational marriages, health tourism and retirement migration’, MMG Working Paper 14–​ 02. Göttingen, Germany: Max Planck Institute for the Study of Religious and Ethnic Diversity.

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Vlasenko, P. (2015) ‘Desirable bodies/​precarious laborers: Ukrainian egg donors in context of transnational fertility’, in Kantsa, V., Zanini, G. and Papadopoulou, L. (eds) (In)Fertile Citizens:  Anthropological and Legal Challenges of Assisted Reproduction Technologies. Mytilene, Greece: (In)Fercit, pp. 197–​216. Vora, K. (2012) ‘Limits of “labor”: Accounting for affect and the biological in transnational surrogacy and service work’, South Atlantic Quarterly 111(4): 681–​700. Whittaker, A. (2004) Abortion, Sin and the State in Thailand. London: Routledge. Whittaker, A. (2014) ‘Merit and money: The situated ethics of transnational commercial surrogacy in Thailand’, International Journal of Feminist Approaches to Bioethics 7(2): 100–​20. Whittaker, A. (2016) ‘From “Mung Ming” to “Baby Gammy”:  A local history of assisted reproduction in Thailand’, Reproductive BioMedicine and Society Online 2: 71–​8.

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‘IT’S JUST SPERM. THAT’S ALL YOU’RE GIVING’ Men’s views of sperm donation G abr ie l e Gr iffi n

INTRODUCTION

M

uch research on in vitro fertilization (IVF), assisted reproduction and gamete donation has centred on their medical, legal and sociocultural processes and meanings. Here, quite frequently, little attention is paid to the donors themselves other than in the context of their selection. The focus tends, instead, to be on the intended parents and the child-​ producing process post-​donation. However, donation is a corporeal process in which body parts are produced and given or sold. This chapter analyses the bioprecarities that derive from the process of sperm donation. It draws on online and social media materials, as well as other texts, in which men who donate sperm for the purposes of assisted reproduction articulate their sense of the meaning of this process, and considers responses to the revelation of sperm donation from people both known and unknown to the donor. These responses show how sperm donation as a form of intimate labour in which a man also parts with somatic material produced by his body, and involving negotiated journeys, is managed and talked about. In this chapter I argue that responses to sperm donation indicate deeply gendered views of reproductive intimate labour in which a sense of bioprecarity masks strongly gendered views of sexuality, intimacy and reproduction. ‘It’s just sperm. That’s all your giving’ was the view of Ben Mays, a donor-​ conceived adult man, seeking to encourage sperm donation in the UK in 2015 at a time when, following changes in UK law regarding donor anonymity, donors were simply not forthcoming (Anon., 2015: n.p.; Dyer, 2009). The same article stated that: ‘At the moment, there are only nine registered donors at Britain’s national sperm bank in Birmingham. It’s thought a law

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change which removed a man’s right to stay anonymous might be stopping people coming forward’ (Anon., 2015: n.p.; emphasis added). Mays sought to downplay the meanings of sperm donation as his use of the words ‘just’ and ‘that’s all’ indicate. But the very low numbers of donors coming forward clearly belied that interpretation, as does other research on sperm donation (e.g. Bossema et al., 2014; Mohr, 2018; Riggs and Russell, 2011; Sydsjö et al., 2012). I  was interested in Mays’ line of argument partly because in doing research on ova and sperm donation I  had read many articles online on donor conception and had been taken aback when coming across a piece on sperm donation (Whitman, 2014) by the –​from my perspective –​clearly gendered responses to that piece and the particularities of those responses. The article titled ‘I Fathered 34 Children Through Sperm Donation’, published on 31 January 2014 (Whitman, 2014), attracted 247 comments between its publication and the closing of the comment section on the evening of 2 February 2014. What struck me in particular was how very different many of the comments to this article were, relative, for example, to the responses to an article about egg donation that had been run in the same comparatively centre-​left UK national newspaper, the Guardian, a couple of years earlier (Saner, 2012). Reading Sebastian Mohr’s (2018) book Being a Sperm Donor served to reinforce this sense of gendered differences regarding the meanings of such donation. It also reinforced the sense that the production of a seemingly endlessly renewable resource, sperm, is entangled with an embodied sense of self or somatic self (Mohr, 2018: 29), which both in the process of sperm production for donation purposes and in its effects creates bioprecarities of particular kinds. As discussed in Chapter 1 in this volume, I understand bioprecarity to entail three dimensions:  following Foucault (1990:  137) I  view it in terms of the institutional regimes designed to ‘administer, optimize and multiply’ life by ‘subjecting it to precise controls and comprehensive regulations’. Sperm donation is one somatic process that is subject to such institutional regimes, as Mohr’s (2018) volume makes only too clear. Second, I take ‘bios’ to refer to life in general but also, in my reading, specifically to the body and the subjectivation of the body or the somatic self to regulatory regimes. The controls and regulations constructed to administer and optimize life in general, and the body in particular, create precarities of different kinds that may be bodily or social, for example. Thus, as discussed further below, the impact of sperm donation on the donor’s life may initially be bodily in terms of regulating his sex life (he may only ejaculate to prescribed time regimes) but also socially in that it structures his sex life outside of the clinic. Hence, third, bioprecarity here refers both to the precarities experienced as a function of being categorized in certain ways and as a function of one’s somatic and thus social vulnerability. This understanding of bioprecarity

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is immediately evident when one considers one of the types of responses Whitman’s (2014) article on fathering thirty-​four children elicited and that is also referenced in Mohr’s (2018) work though he does not comment on this: jokes. I noted this since I have never come across jokes in responses to egg-​donation discussions. It seems to be a response reserved for sperm donation, and possibly mainly produced by men. I  say possibly because online comments, even if they are by named bloggers or commentators, may not reveal the gendered identity of the writer or may have a gender identity that is not congruent with the gender identity of the actual person responding. Nonetheless, it is noteworthy that a man’s biographical account of sperm donation resulted in many jocular responses –​something I have not found in similar texts and comments about egg donation. I shall therefore begin by discussing the meaning of jokes in the context of the intimate labour of sperm donation and its perceptions. I shall then move on to discuss the importance of numbers as a source of bioprecarity in sperm donation. This is linked to questions of somatic in/​adequacy, which is my third concern here, and I shall finally discuss the issue of the relational status of the sperm donor to his offspring relative to his life cycle. These four topics emerged as key areas in the responses to the Whitman piece, and they are also in evidence in other related literature. I  shall suggest that sperm donors experience particular and highly gendered forms of bioprecarity. JOKES: BIOPRECARIOUS REACTIONS TO SPERM DONATION Mohr’s (2018) depiction of sperm donors’ views of sperm donation is peppered with comments about joking about sperm and its donation (e.g. pp. 51, 93, 127). One of these episodes serves to indicate the contradictions this entailed: I was together with friends and some people from university who I did not know that well, and we were joking around, making jokes about sperm, and then a friend of mine shoved his elbow into me from the side and then I said ‘Can we talk about something else?’ I mean, I know that we are just talking among friends, but this [sperm donation] is something that I  want to keep for myself. I don’t want people to judge me and I don’t know how people will react. (Mohr, 2018: 51)

The speaker suggests that sperm donation is a private matter (‘something I want to keep for myself ’) but he has clearly told his friend. Many of Mohr’s interviewees simultaneously asserted the private nature of sperm donation and revealed that they had found out about it from friends or discussed it

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with others. This contradiction speaks both to the repression of sexuality and all matters sexual in many cultures  –​and producing sperm through masturbation is clearly a sexual activity  –​and to the sociality of sexual activity, indicated in the joking with male friends made about sperm. One reason, indeed, why such jokes do not seem to occur in the context of egg donation is that ova are not obviously associated with sexual activity in the way that sperm is. Sigmund Freud (1966) categorizes jokes on sexual matters as tendentious jokes, designed to enable the discharge of penned-​up energy around that which we repress. He regards such jokes as particular to men, not least because they require a third person: the joker, the person or object of the joke and a passive listener (Freud, 1966:  143). According to Freud (1966: 143), ‘The men save up this kind of entertainment, which originally presupposed the presence of a woman who was feeling ashamed, till they are “alone together”. So that gradually, in place of the woman, the onlooker, now the listener, becomes the person to whom the smut is addressed’. Here we have the classic homosocial triangle of which Eve Kosofsky Sedgwick (1985) wrote so eloquently, explaining the highly gendered dimensions of Freud’s account of tendentious jokes. Freud (1966:  263) argues more generally that jokes are ‘a method of degrading the dignity of individuals by directing attention to the frailties which they share with all humanity, but in particular the dependence of their mental function on bodily needs’. Bios in the form of the somatic holds the individual to account, not least because in the Freudian paradigm it is above all the somatic that needs to be repressed. And such repression requires release of psychical energy, as Freud calls it, achieved in this instance, through joking. The degradation of the individual that this involves is of course a form of judging negatively, exactly the experience that Mohr’s speaker is afraid of. The exposure of bodily frailty, the bioprecarity of the individual, is managed here through the joke that both shames and exhilarates at the same time, thereby offering relief from the repression of sexual activity. This has to be understood in a context where sperm donation repurposes intimate sexual activity in the form of masturbation into intimate bodily labour, performed for money and/​or a ‘higher purpose’ (= helping others to achieve families). Its practice is, however, only in limited ways dissimilar from the ordinary sexual activity of masturbation. Furthermore, it is associated with the licensed viewing of pornography, another intimate and somewhat taboo sexual activity that is transformed into intimate labour as part of the sperm donation process. However, the similarity between the two (sexual activity = intimate labour) in this instance also means that sperm donation always gestures towards sexual activity as the intimate private process our cultures decree it to be and therefore lays its practitioner, the donor, open to being the butt of jokes and hence renders him bioprecarious in social

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terms: categorized as donor he becomes suspect. What are his motives? Is he really some form of exhibitionist, seeking to expose himself? The cultural repression of sexual activity renders him vulnerable to social opinions that might ‘unmask’ (to use Freud’s term) him as deserving not respect, but ridicule. Unsurprisingly Ben Mays in ‘Sperm Donation …’ said: But like it or not, it’s very hard to have a serious conversation about sperm donation without someone wanting to make a joke. Ben’s not fussed: ‘If you’re joking about it, just go and do it.’ ‘You’re probably only going to waste it in a tissue later aren’t you?’ ‘I’ve probably cracked jokes about myself. It will always have a bit of stigma but it doesn’t bother me.’ (Anon., 2015: n.p.)

Mays takes it for granted that the exposition of sexual bodily processes to public discussion is managed via jokes. A similar stance is observable in the many jokes with which the commentators on the Guardian’s blog reacted to Whitman’s piece. In one strand where the discussion centred on sperm obtained from ‘Scandinavia’ one response read: ‘Those flat-​pack sperm sent over from Sweden were so hard to assemble. Did you see the size of the Allen key?’ (Fraxby, 31 January 2014, 13:19). This ‘joke’ contains four interesting elements: the conflation of sperm with flat-​packed furniture from IKEA, which gestures towards the notion of commodification; the problematic of achieving effective fertilization via imported sperm; the suggestion that the commentator himself (one presumes it is a male-​identified person) has experience of trying to ‘assemble’ that sperm and found it difficult; and the reference to the ‘size of the Allen key’, a highly conventional displacement from discussions of (the importance of ) the size of the penis to another ‘tool’. Freud (1966) regards displacement as one of the key mechanisms employed in the production of jokes. In its indirect reference to bodily specificity this joke gestures precisely towards the somatic frailty that bioprecarity reflects. It also makes direct reference to the notion of measurement and its importance –​here in the form of size and the well-​established cultural importance attributed to a large penis, but elsewhere also in terms of numbers, the issue I shall now turn to. BIOPRECARITY IN NUMBERS Whitman’s (2014) article is entitled ‘I Fathered 34 Children Through Sperm Donation’, the headline seemingly sensationalized by its key figure: thirty-​ four. In fact, thirty-​four children may not be such a large number in a

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culture that practises polygamy and where children are considered an index of one’s wealth and assured future, but in contemporary Western nuclear-​ family-​structured social contexts, thirty-​four seems large. A not dissimilar headline appeared in 2018 (Knapton, 2018) when a headline in the conservative UK national newspaper The Telegraph read: ‘17 British Sperm Donors Have Fathered More Than 500 Children Between Them, Figures Show’. This immediately startling figure was then qualified in the article itself with: ‘The new figures from the HFEA showed that 17 men had fathered at least 30 babies each between 1991 and 2015. A  further 104 men have fathered between 20 and 29 babies, and 1557 between 10 and 19. More than 6,000 have created nine or fewer’ (Knapton, 2018: n.p.). Size in the form of numbers clearly matters and in the article this is directly related to the transmission of diseases, in other words, the rendering bioprecarious of offspring: ‘The startling numbers have led to fears that men could be unknowingly passing defective DNA to dozens of youngsters, because currently donors are not screened for faulty genes such as BRCA1/​2 which increase the risk of ovarian and breast cancer’ (Knapton, 2018: n.p.). The article suggests that to the extent that sperm by the same men is used repeatedly, these men’s sperm, if not tested for various diseases, may unwittingly transmit serious illnesses to the children conceived with the aid of such sperm. This, of course, cannot be contested. Bioprecarity is partly about risk distribution, a complex matter that includes the weighing up of the relative costs of undertaking certain tests on donor sperm relative to the likelihood of children produced with this sperm carrying particular diseases. The headline constitutes a form of scaremongering, omitting, for instance, the issue of the time span during which multiple children were produced from the same donations. But the headline also points to the importance of numbers in the context of sperm donation. One of the many key differences between sperm and egg donation is that in the latter case it always involves relatively few whereas in the former it involves literally millions. As one comment on the Whitman (2014: n.p.) piece stated: ‘Call me clinical [this a pun on the phrase “call me cynical” –​pointing to the humourous dimension of the comment] … but personally [I]‌don’t see why one would get emotional … about this in anyway … you have between 40 to 600 million sperm in each ejaculation … it’s really not such a big deal.’ This comment led to further numbers-​based ones such as ‘After I turned 43 we did IVF and collected 27 eggs, 19 fertilized. First attempt we got identical twins. So what to do with the other 18 embryos? Donated … ’. At this point two commentators who appear to be women join in and briefly the text seems to indicate different kinds of numbers-​driven boasting  –​boasting about one’s fertility, about one’s implicit altruism, etc. The competitive attitude that this foregrounds suggests the challenge to one’s masculine identity that sperm donation posits, and that Mohr (2018)

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discusses very effectively. Becoming a sperm donor involves the assessment of the viability of one’s sperm and within the Danish system donors need to produce above-​average-​count sperm to qualify. Being admitted to being a sperm donor thus becomes a measure of one’s virility as expressed through sperm count. It is hence intimately tied to numbers. At the same time, rejection by implication questions that form of virility and we know that despite the fact that men account for about half of all fertility problems, in many cultures infertility is attributed exclusively to women and men do not seek either investigations or treatment for their fertility status. Having to engage with the quality of one’s fertility renders men bodily precarious in relation to their identity as fertile males. Adriana Petryna (2004: 264) speaks of ‘new kinds of vulnerability’ that emerge as biotechnology enables the revelation of the possibilities and limits of the somatic self. Mohr discusses this in terms of biosocial subjectivation where biotechnological opportunities create new forms of disciplined subjects, led by somatic regulations that organizations such as donation clinics impose. Sperm donors, for example, are not supposed to have sex for between forty-​eight and seventy-​two hours before a donation. This precarizes their sexual relationships, especially if the donor status is shrouded in secrecy. Whitman (2014: n.p.), for instance, writes that when he mentioned to his girlfriend that he had donated sperm, ‘Her understandable reaction was that it was something she didn’t want to hear about and it was duly never mentioned again’. He actually mentioned it, though it was instantly suppressed, but other donors including Malthe in Mohr’s research (2018: 47) kept it hidden from their partners and family. Inhibitions about revealing one’s donor status appear to be quite common among men; this precarizes their relationships since it forces them to keep their donor status a secret or to negotiate them in accordance with their donation schedule. Mohr (2018) gives a rather unsettling example of a donor, Oscar, whose life was structured around work and donations and who had no private life to speak of. The donations effectively became his sex life. The social vulnerability that somatic regulation through biotechnological subjectivation can foster thus becomes a form of bioprecarity that may facilitate or determine extensive dimensions of one’s day-​to-​day life, structuring one’s biosocial life. THE BIOPRECARITY OF SOMATIC IN/​A DEQUACY Ben Mays (Anon. 2015: n.p.) states that: ‘Becoming a donor isn’t as easy as you might think. Men have to have months of tests and most people are rejected because their sperm isn’t strong enough’. The possibility of being rejected as a potential sperm donor due to an inadequate sperm count or low sperm motility is one of the many ways in which donors lay themselves open

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to the possibility of discovering the boundaries of their somatic prowess and hence becoming vulnerable to the possibility of having their confidence in their bodily selves undermined. Here bios in the form of the body becomes the source of precarity through the discovery of somatic inadequacy or reproductive vulnerability. Mohr’s (2018) research does not make clear to what extent his interviewees had considered this possibility in advance of opting to be donors. But it provides a classic example of masculine prowess competition in relation to somatic in/​adequacy. Donor Alfred said: [Me and my room mate] joked about it [sperm donation] and he said that he had better semen quality than I did and that I should get mine tested to see if I was just as good as he was, stuff like that … I am a bit of a competitive person, and I wanted to be as good as he was … I wouldn’t have gone there if he hadn’t provoked something within me. (Mohr, 2018: 126)

Somatic competitiveness as a motive for becoming a sperm donor may seem somewhat surprising but it chimes interestingly with the fact that many of Mohr’s male interviewees talked about discussing this  –​and always also mentioning joking in this context –​with (close) male friends –​though not necessarily with family. A strong sense of precarity pervaded this sharing among men, with Alfred, for example, describing it in terms of privacy related to his sense of bodily self. Explaining why he would not ‘post on Facebook’ about this, he said: ‘This is more private; also because it involves my body, this is a part of me that I am giving and that’s why only certain people should know about it’ (Mohr, 2018: 128). In relation to this issue, Whitman (2014: n.p.) –​from the position of a successful donor (successful in terms of his sperm not only having been ‘good’ enough to allow him to become a donor but also having resulted in multiple offspring) –​writes merely as follows: ‘Donors needed to be young, healthy and, of course, have good product. Once my sperm had jumped through the necessary hoops, so to speak, I  became a regular visitor to a clinic’. By talking about donors in the abstract and in the plural, sperm as ‘good product’, and by affording his sperm the agency of jumping through hoops, Whitman dissociates himself from the process and its potential implications for an assessment of his virility. He was, of course, successful, hence unchallenged in his virility as far as the quality of his sperm was concerned. But Rene Almeling and Miranda Waggoner (2013: 825) highlight that in the United States, for example, ‘men applying to become sperm donors are subjected to medical, genetic and social assessments. Fewer than 10 percent of applicants make it through the months-​long screening process’. This is a very considerable rejection rate, which tells men that their sperm is not ‘good

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enough’ to be used for donation purposes. One of Whitman’s respondents’ ironic comments reveals the sense of vulnerability this promotes through its very ironic stance:  ‘ “Be warned out of 10 men 7 will fail motility tests and 2 will fail other tests so far from certain.” Makes you wonder how the human race managed all this time’ (nicktecky, 31 January 2014, 19:12). Mohr (2018) also reports how the process of going through the relevant tests and questions in the Danish context produces considerable bodily and psychosocial vulnerability in the potential donors. For one thing, they had to undergo genital and rectal examinations they possibly were not at all used to and that raised questions about their sexual identity, precarizing heterosexual senses of self as their bodies were probed in unfamiliar and potentially shaming ways. They also had to detail their sex lives very precisely; Mohr (2018: 143) suggests that ‘having to verbalize when one last reached an orgasm opens up the masculine self to vulnerability’ as it allows for the possibility of ‘a qualitative judgment about donors’ intimate and sexual life’. Thus both virility and sexual prowess are laid open to inspection in the process of the intimate labour of sperm donation, rendering the donor vulnerable on multiple fronts. Donors also have to negotiate the clinic setting itself with its rooms for donors to masturbate in that were not fully segregated in sound or other terms from other clinic spaces, while performing intimate bodily labour  –​masturbation. As Mohr’s interviewee Emil said:  ‘You can hear them (sperm bank staff ) talk when you’re in there (the donor room) … they are right outside and that is a mood killer to be honest. So, it takes longer because I’m out of my comfort zone’ (Mohr, 2018: 150). Since masturbation is supposed to be a private sexual activity and is furthermore heavily hedged with taboos, donors are inevitably put in an uncomfortable position when donating. Mohr describes this in terms of affective investments, invoking both thrill (doing the forbidden in a semi-​public space) and shame (others such as clinic staff being aware of an activity going on that should be private). For the donor Emil, these contextual factors meant that he might not be able to deliver sperm twice a week as expected, something that challenged his sense of masculinity. In other cases, trying to reach ejaculation as quickly as possible in the donation setting may lead to the donor beginning to suffer from premature ejaculation in his non-​donor sex life (see Mohr, 2018: 147). Potential and actual donors’ (sense of ) somatic self, in so far as it is linked to indexes of virility such as sperm count, ability to produce semen on demand, having or withholding an ejaculation, etc. is thus put under considerable stress. Such stress went far beyond the actual donation situation. Since donors are not supposed to have sex for forty-​eight or more hours before their donation, committing themselves to donating also puts strain on their private sex lives. As Mohr (2018: 50) puts it regarding August, one of his donors: ‘On

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average, he stopped by the sperm bank three times a week, which did not leave much room for a personal sex life’. RELATIONAL BIOPRECARITY Whitman’s article was partly prompted by a change of view he had regarding his relationship to offspring produced from his donations. That change had in the first instance to do with personal circumstance: ‘It was the sudden and unexpected end of my marriage in 2011 that changed everything’ (Whitman, 2014: n.p.). This points to a wholly under-​examined but very important dimension of sperm donation: life cycle and life events. In Mohr’s (2018) research, interestingly, the decision to donate sperm as such was repeatedly linked to life changes: Chris, for example, started donating after his parents had passed away (56) and Thommy began after he had broken up with his girlfriend (70). Changes in personal circumstance as in Whitman’s and these other cases may prompt a rethinking of previous actions, decisions and experiences. This indexes the imbrication of the donor’s life in issues associated with donation, whether these be donating as such or how to engage with the offspring. Bioprecarity is thus not confined to the process of donation but extends into other areas of donors’ and offspring’s lives. Whitman laudably admits that he originally undertook sperm donation for the money, and this is indeed a common reason for becoming a donor –​even if altruism, wanting to help others achieve families, is often co-​produced as an important motivator, since body (part) commodification is a less ‘honourable’ reason than altruism. Whitman’s donations go back to 1991 when donation was still anonymous, and were, according to him, ‘quite disconnected from the rest of my life’. Having his own children led Whitman to think about his relationship with his own father but it was the breakdown of his marriage coupled with a chance hearing of a radio programme about the donor registry that set him off to trace his offspring. He found out that: Between 1992 and 2003, no fewer than 34 children had been born as a result of my donations. This was more than double the number I had imagined. In 1993 alone there were 16 births … my mind swelled with existential musings. Sadly it dredged up an old Viz cartoon … If the Lady wants a Baby, I’m the Cock o’ the North. Twenty girls and 14 boys: more than three football teams worth running around with my genes. (Whitman, 2014: n.p.)

Here again we have the combination of numbers, magnetism and joking that is so common in the context of sperm donation and heralds the sense

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of bioprecarity sperm donation creates. Whitman decides to wave his right to anonymity in case any donor offspring want to contact him. Mohr (2018: 6) makes the point that sperm donation ‘requires a lifetime commitment’. Whitman’s article details the narrative of donation effects from youth to middle age and his changing sense of desire to be available to his offspring. As one commentator on Whitman’s article said: ‘Men do not think about this stuff AT ALL, when they’re 19! What they never seem to take into account is that they will think about it a lot when they get to 40’ (TimJag, 31 January 2014, 12:14). Correspondingly, Whitman’s (2014:  n.p.) piece ends with the statement that ‘a young person has requested information about me. It seems this donor’s tale is not finished’. His piece is also titled ‘I Fathered …’, thus laying claims to biological fatherhood, at the least. But the relation between donors and offspring is highly contested as extensive literature on the subject testifies (e.g. Daniels, 2004; Ehrensaft, 2005; Goldberg and Brushwood Rose, 2009; Nordqvist and Smart, 2014). Here bioprecarity arises out of the biosocial and the ambivalences of its imbrication in the biological and biotechnological. Unsurprisingly, most comments in the blog on Whitman’s piece centred on this, raising four particular points: (1) the impact of donor anonymity on the offspring; (2) the possibility of incestuous relations between people who unbeknown to each other turn out to be siblings; (3) the role of evolution in family building (perhaps a less predictable topic); and (4) the status of the donor as father, ‘sire’, donor or otherwise in the lives of any family and friends he has as well as for the offspring and their families. All four entail particular bioprecarities. Thus donor offspring’s own concern with their donor progenitors is frequently with their genetic inheritance, both in terms of personal traits (often erroneously attributed to genes) and potential inherited diseases (see Griffin, 2017). Not knowing the donor then creates longings for ‘belonging’ in the form of knowing who your biological parent is because of a desire for family connection that is strongly culturally fostered through emphases on similarities among blood relations. Simultaneously absent medical histories are invoked to raise issues regarding cancers and other diseases. One of the commentators on Whitman’s article wrote:  ‘Despite having a great dad, I can’t help but want to know about my donor –​for me, he’s an integral part of who I  am.’ The commentator wanted to ‘find out about [my] heritage’ (Papillonrose, 31 January 2014, 13:50). Many of the comments on Whitman’s article related to the potential for incestuous relationships. Typically, such issues were raised by people who did not suggest they themselves were donor offspring. Incest involves bioprecarity through its potential for the propagation of genetic diseases and, socially, through its defiance of kinship taboos. This was cited as a reason against donor anonymity. In what was for me a somewhat surprising

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manner the issue of potential incestuous relations was also repeatedly linked in the comments to quasi-​evolutionary arguments, e.g. ‘It makes sense, evolutionarily speaking, to mate with someone who shares lots of your genetic traits because the chances are your offspring will be living in the same environment as you and will benefit from having the same advantages that have allowed you to survive and breed’ (Deceptacon, 1 February 2014, 8:38). Often concern for the possibility of incestuous relations was expressed in numerical terms and the statistical likelihood or otherwise of such an occurrence. One of the commentators, for example, posted: ‘A minimum/​ maximum geographic distance would mean that chances of reunion are maximised, while chances of accidental offspring romances are minimized’ (WinnieOfOz, 1 February 2014, 10:14). Veering between the construction of jokey incongruities and quasi-​statistical assessments of the likelihood of such romances, the comments try to create distance from a potentially threatening situation and topic, where bioprecarity manifests itself not only in the act of biotechnologically assisted conception but also in its putative consequences, the inheritance of diseases and the threat of incestuous relationships. Relational bioprecarity is not merely a function of potentially incestuous relations between donor siblings but is also evident in the question of the status of the donor vis-​à-​vis the offspring. Whitman decided to describe his donation as ‘fathering’ –​a term that was extensively contested in the comments made on his text, thus questioning the particular form of biosociality he claimed. One commentator, for example, wrote: ‘Excuse me, masturbating into a jar is NOT the same as fathering … fathering is bringing up a child with love and compassion, through thick and thin’ (julian67, 31 January 2014, 13:13). Another wrote: ‘This man is not the father of all these children, only the ones he cared for and he raised’ (ID3293687, 31 January 2014, 12:38). There were many other statements to this effect; related research (e.g. Goldberg and Brushwood Rose, 2009) abounds with discussions of the problematics of how to name the donor, what status that person might have in the offspring’s life and what the offspring might want or expect from the donor. Since legislations regarding such matters vary enormously across different countries, and sometimes even within them, donor status as a relational category is multifarious and ambiguous, creating insecurity, shame and confusion. Here there is no congruity between bodily labour and social relation, and this creates bioprecarity because of the ambivalence of the connection between the two. This ambivalence, as Chapters  3, 4 and 5 in this volume make clear, extend beyond the status of the donor in relation to the offspring  –​they affect partners, families, grandparents and other kin and non-​kin along generational as well as peer lines. One of the donors Mohr interviewed,

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August, ‘was concerned about large numbers of possible offspring’ and also said:  ‘My mom was especially concerned that she would be grandmother to 100 children’ (Mohr, 2018: 54). Here questions of relation conjoin with issues around numbers. In Nordqvist and Smart’s (2014) work the focus was more on the meaning of donor offspring within given families and how the latter, particularly grandparents, interpreted their sense of their relation to offspring conceived with assisted reproductive technology (ART). The sense of ambivalence was, however, very much the same, calling into question the ‘nature’ of kin and kinship. The questions associated with that are frequently about responsibilities towards such offspring  –​emotional, financial and other such responsibilities. As biotechnological opportunities create new kin formations, the interpretive repertoires that are conventionally applied in deciding who is and who is not kin come under pressure. CONCLUSIONS Bioprecarity in the making of kin takes particular forms in the context of sperm donation. For one thing it raises questions around reproductive masculinity (Daniels, 2006) at all stages of the reproductive process (Almeling and Waggoner, 2013), from the point of donor selection, through the donations and far beyond into the future lives of those who donated, those who were created with the aid of that donation and those whose lives are intertwined with donors and offspring. The bioprecarity produced basically has three different dimensions: one of category, one of body and somatic self, and a biosocial one. In terms of precarization through category, this is immediately evident in the selection processes that sperm donors have to undergo where a huge percentage are rejected. Since masculinity is, inter alia, tied to cultural norms of masculinity that conjoin masculinity with virility, donor rejection as a function of sperm inadequacy is clearly problematic for potential donors. One sees its mirror opposite in the responses one of Mohr’s respondents provided to his experience of being accepted as a donor who ‘was convinced that he was one of the best three donors in his sperm bank’ (Mohr, 2018: 82). This donor thought that it was ‘wonderful to have that quality stamp’ of being accepted as a donor (Mohr, 2018:  83). He not only, and atypically, liked to talk about this but also, and rather worryingly, saw is as a means of access to women who were supposed to find him more irresistible as a function of his virility. He also talked of sizing up men who irritated him by putting them down in his head over their assumed sperm quality and thinking: ‘I can be the father of your children because you are not able to impregnate your wife. And with that you [meaning himself ] feel uplifted’ (Mohr, 2018: 83). Displaying

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certain conventional masculine forms of one-​upmanship this donor directly and strongly related his somatic and social sense of self, his biosocial identity, to his semen quality: ‘It is in some way the physical side of me and what I am in flesh and blood. I have begun to be more proud about this than I was before, sometimes even to the point of being arrogant’ (Mohr, 2018: 83). One wonders how this same man would have coped if his semen had proved inadequate for donation purposes. Category-​induced bioprecarity also resurfaces at the point where the status of the donor relative to the offspring is in question –​from whoever’s side. The many responses to Whitman’s piece that contest any claim he might make to have fathered thirty-​four children testify to this. Here the complexity of this categorization becomes evident since we do not have a ready discourse to describe this relation, and that relation is hedged by a series of regulations and prescriptions that goes well beyond the desires of the individual. The man who donated sperm in the age of donor anonymity has very limited possibilities of tracing the offspring from those donations; likewise it is very difficult for those offspring to trace him. And then there is the biosocial dimension of what any relation between donor and offspring might mean in terms of responsibilities, fiscal, emotional and in any other terms. Here bioprecarity derived from category is compounded by biosocial precarity in that many donors, and possibly their families, still view the potential arrival on their doorstep of large numbers of offspring as a threat. They express a fear of being overwhelmed by numbers. And numbers, as indicated above, play a significant role in the gendered perceptions of sperm donation –​and for obvious reasons. That preoccupation, with being overwhelmed by numbers of offspring, is distinct from the issue of the threat to somatic self that is associated with sperm donation and that affects the donor in his intimate sexual life as much as it potentially affects the offspring. One of Mohr’s informants, Jeppe, raised the issue of the genetic safety of the offspring: ‘I mean, other people’s safety genetically speaking is at stake here and that is very important to consider’ (Mohr, 2018: 109). That stake acted as a justification for donors’ subjectivation to donation regimes but those very same regimes also meant bodily disciplines outside of the sperm clinic, testifying to the ‘new kinds of vulnerabilities’ (Mohr 2018: 29) called into existence through the donation process. The three dimensions of bioprecarity (of category, of body and somatic self and the biosocial) may be distinguished for analytical purposes but they are imbricated in each other and have mutually entangled consequences. Becoming a sperm donor thus has specific meanings, including in terms of bioprecarity. Thus Ben Mays’ line ‘It’s just sperm. That’s all your giving’ is seriously called into question by the responses of sperm donors and the

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commentators on Chris Whitman’s article. Mohr (2018: 6) talks of a ‘lifetime commitment’ to the ontology of sperm donor. This is replicated in Whitman’s change of heart over his engagement with the offspring made with the aid of his sperm. Becoming a sperm donor as a young man in the age of donor anonymity to make some money on the side, Whitman matured through the rescinding of that anonymity and various life changes to a position where he was ready to engage with his offspring. This was clearly something he had not foreseen as a young man. His own sense of bioprecarity was expressed in very limited terms in his article but the reactions that piece generated –​ the jokes, the preoccupation with numbers in a quasi-​competitive manner, the attacks on Whitman regarding his relationship status to his offspring –​ all point to the ways in which reproductive masculinity as a conventional stance of assured virility is unmoored by this narrative of donation, and bioprecarity surfaces in its stead. REFERENCES Almeling, R. and Waggoner, M. R. (2013) ‘More or less equal: How men factor in the reproductive equation’, Gender and Society 27(6): 821–​42. Anon. (2015) ‘ “It’s just sperm. That’s all you’re giving.” That’s the no-​nonsense view on sperm donation according to Ben Mays’, BBC Newsbeat. Available at www. bbc.co.uk/​newsbeat/​article/​34115324/​sperm-​donation-​theres-​nothing- ​to-​fear (accessed 15 December 2018). Bossema, E. R., Janssens, P. M. W., Treucker, R. G. L., Landwehr, F., van Duinen, K., Nap, A. W. and Geenen, R. (2014) ‘An inventory of reasons for sperm donation in formal versus informal settings’, Human Fertility 17(1): 21–​7. Daniels, C. R. (2006) Exposing Men: The Science and Politics of Male Reproduction. Oxford: Oxford University Press. Daniels, K. (2004) Building a Family with the Assistance of Donor Insemination. Palmerston North, NZ: Dunmore Press. Dyer, C. (2009) ‘Experts suggest ways to tackle shortage of sperm donors’, British Medical Journal 339(7711): 11. Ehrensaft, D. (2005) Mommies, Daddies, Donors, Surrogates. New  York:  Guilford Press. Foucault, M. (1990) The History of Sexuality. Vol. 1. New York: Vintage Books. Freud, S. (1966) Jokes and their Relation to the Unconscious. Vol. 6. Harmondsworth, UK: Penguin. Goldberg, S. and Brushwood Rose, C. (eds) (2009) And Baby Makes More: Known Donors, Queer Parents, and Our Unexpected Families. London, ON: Insomniac Press. Griffin, G. (2017) ‘Erasing mother, seeking father:  Biotechnological interventions, anxieties over motherhood and donor offspring’s narratives of self ’, in Rye, G., Browne, V., Giorgio, A., Jeremiah, E. and Six, A. L. (eds) Motherhood in Literature and Culture:  Interdisciplinary Perspectives from Europe. London:  Routledge, pp.  85–​95.

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Knapton, S. (2018) ‘17 British sperm donors have fathered more than 500 children between them, figures show’, Telegraph, 6 May. Available at www.telegraph.co.uk/​ science/​2 018/​05/​06/​17-​ british-​ s perm-​d onors-​have-​f athered- ​500-​children-​ figures-​show (accessed 28 November 2018). Mohr, S. (2018) Being a Sperm Donor:  Masculinity, Sexuality, and Biosociality. Oxford: Berghahn. Nordqvist, P. and Smart, C. (2014) Relative Strangers: Family Life, Genes and Donor Conception. Basingstoke, UK: Palgrave Macmillan. Petryna, A. (2004) ‘Biological citizenship:  The science and politics of Chernobyl-​ exposed populations’, Osiris 19: 250–​65. Riggs, D. W. and Russell, L. (2011) ‘Characteristics of men willing to act as sperm donors in the context of identity-​ release legislation’, Human Reproduction 26(1): 266–​72. Saner, E. (2012) ‘I think of my egg donor every day’, Guardian, 13 December. Available at www.theguardian.com/​soiety/​2012/​dec/​13/​egg-​donation-​donor-​recipient-​ experience (accessed 26 November 2015). Sedgwick, E. K. (1985) Between Men: English Literature and Male Homosocial Desire. New York: Columbia University Press. Sydsjö, G., Lampic, C., Brändström, S., Gudmundsson, J., Karilström, P. O., Solensten, N. G., Thurin-​Kjellberg, A. and Skoog Svanberg, A. (2012) ‘Who becomes a sperm donor:  Personality characteristics in a notional sample of identifiable donors’, BJOG: An International Journal of Obstetrics and Gynaecology 119: 33–​9. Whitman, C. (2014) ‘I fathered 34 children through sperm donation’, Guardian, 31 January. Available at www.theguardian.com/​lifeandstyle/​2014/​jan/​31/​fathered-​ 34-​children-​sperm-​donation (accessed 16 December 2018).

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BODILY DISREPAIR Bioprecarity in the context of humanitarian surgical missions Nanc y Worthin gton

INTRODUCTION

I

n 2000, at a time when there were few opportunities for surgical treatment and care in Honduras, Yesenia1 was born with a life-​threatening congenital heart defect known as tetrology of Fallot. Her mother, Nadia, launched into action, carrying her two-​month-​old daughter to a nearby medical mission for assistance. There she encountered a cardiologist, who contacted a paediatric heart surgeon in the United States named Dr Cooper by short-​wave radio to ask if he could help. Dr Cooper agreed, but only if Yesenia could travel to him. She arrived with her mother within days, all expenses paid by a Honduran charity, and underwent two surgeries within two weeks, the first palliative and the second corrective, otherwise known as a ‘complete repair’. In 2003, Yesenia returned to the United States for another surgery, this time to have a leaky pulmonary valve removed and replaced with a homograft, a valve from a human cadaver. Charities, churches and non-​governmental organizations (NGOs) have long transferred critically ill patients to rich countries for high-​tech medical procedures that are locally unavailable. Increasingly, this trend has been replaced by the movement of specialized surgeons and state-​of-​the-​ art machines in the opposite direction –​from rich to poor countries –​to treat patients in-​country and train locally based personnel to do the same. The US-​based NGO, Operation Pulse, was at the front end of this shift. For nearly twenty years, it has been sending paediatric heart surgery missions to hospitals worldwide, for two weeks at a time, every three months, until locally based teams are operating independently. Honduras became an Operation Pulse destination site in 2008. Although not the first NGO to

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send paediatric heart surgery missions to Honduras, it was the first to send them with regularity. Inspired by his early encounters with Yesenia, Dr Cooper began traveling full-​time with Operation Pulse teams in 2009. Thus, when Yesenia’s homograft needed to be replaced, as tissue implants often do, in 2011, Dr Cooper was in Honduras to operate, and I –​a medical anthropologist interested in the localized effects of such high-​tech humanitarian efforts –​was there to observe. Yesenia’s fourth surgery proceeded without incident, and while she was indeed uncomfortable following the procedure, she nonetheless mustered a smile when asked to pose for a photograph with Dr Cooper in the intensive care unit (ICU). She was discharged from the hospital three days later, the standard during surgical missions. That image later appeared on Operation Pulse’s website, where Yesenia was spotlighted as one of the NGO’s patient success stories. Success, in this context, meant that she had survived surgery, had been discharged from the hospital by the mission’s end and showed no sign of surgical complications. Presumably, she would go on to enjoy a life where her heart condition was no longer physically debilitating and financially and emotionally stressful. POST-​S URGICAL LIFE AND BIOPRECARITY More privately, post-​surgical lives are known to proceed along a more treacherous path, even in countries with a robust health infrastructure (Sharp, 2006). Yesenia’s experience was no exception. From 2011 to 2012, I  regularly visited her and her mother Nadia in their home, a small two-​ bedroom house that they share with four extended family members in a part of Tegucigalpa, the nation’s capital, which few taxis would enter given its reputation for gang activity. From this vantage point, recovery appeared more fragile and incomplete. Complicating Operation Pulse’s official record, Yesenia’s body showed residual signs of illness, whereas Nadia expressed anxieties about Yesenia’s long-​term survival and access to care. The first time that I visited, for example, Yesenia was in bed with a cough. ‘Some days are better than others’, Nadia explained. ‘She exerts herself and then gets tired. She is weak and easily gets a chill. She doesn’t want to eat.’ Even something as seemingly harmless as a tooth infection became not only painful for Yesenia that year, but also life-​threatening because it heightened her risk of infective endocarditis, a potentially fatal condition caused by bacteria from the gums entering the bloodstream and infecting the lining of the heart. While aware of this risk, Nadia, who made less than the minimum wage as a private school teacher, a job that did not provide access to health insurance, could not afford a visit to a private dental clinic. Only after they leveraged

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their contacts at the public hospital, and Nadia actually stepped in as an impromptu dental assistant, could Yesenia bypass the months-​long waiting list and be seen. Further, while grateful for the care already received, Nadia worried about the new implant. Would it work? How long would it last? If it failed, would Dr Cooper be available to operate and if so would Yesenia’s body tolerate another invasive surgery? Her fears, while common after any surgery, were amplified after Yesenia’s 2011 surgery because she received not the same homograft heart valve as in 2003 when they were in the United States, but rather a makeshift version. As I elaborate on below, homograft valves are costly and difficult to transport and thus are not typically used by mobile surgical units. Dr Cooper’s makeshift solution is potentially superior to other types of valves. Not only is the technique portable, the tissue is known to keep its shape, grow with the patient and eliminate the risk of an immunological response. Its long-​term viability, however, is unknown. This chapter examines the biological vulnerability, or ‘bioprecarity’, which, as Yesenia and Nadia’s story attests, both precedes and follows these life-​saving cardiac interventions. Widely recognized as ‘a word of the times’ (Allison, 2013: 6), precarity typically refers to one of two conditions: a labour condition and a generalized ontological condition. Regarding the former, scholars call attention to the ‘uncertain, unpredictable, and risky’ forms of work that, while historically the norm for many workers, are especially characteristic of late capitalism (Kalleberg, 2009). Regarding the latter, they are largely inspired by Judith Butler’s (2004, 2009) observation that, while life is fundamentally precarious –​that is, we are all at risk of dying –​certain populations are more vulnerable than others as a result of their social marginalization, isolation or abandonment. Precarity and precariousness are thus related but distinct concepts; whereas precariousness refers to the first type of vulnerability that we all share, precarity is the ‘politically induced condition in which certain populations suffer from failing social and economic networks of support and become differentially exposed to injury, violence, and death’ (Butler, 2009: 25). Put differently, if precariousness is universal, precarity is patterned along lines of social difference, including race, class, gender, disability and citizenship. Congenital heart disease is a fitting example. Heart defects themselves strike randomly, but the gravity of one’s disease, the timeliness of surgery and the chance of a poor surgical outcome are conditioned by an individual’s social positioning. Other scholars directly relate the two conditions, seeking to capture how precarious labour and precarious existence are linked (Millar, 2017; Neilson and Rossiter, 2008). An especially important observation is that precarious life is not merely sensed but rather physically embodied in the form of nerves, vertigo and nausea (Allison, 2016). I build on these observations. I,

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too, am interested in how insecure labour gets under the skin in the form of illness or disease caused by untreated heart defects. What interests me most, however, is the intervening role of the health care systems –​humanitarian and state-​sponsored –​on which many precariously positioned people must rely if they do not wish to forego care altogether. My main argument is three-​fold. On one hand, humanitarian heart surgery missions are mobilized to respond to bioprecarity. They readily intervene in the lives of children whose parents are denied the means, such as liveable wages, secure employment and medical coverage, to access critically needed surgical treatments. Less commonly recognized, however, is that humanitarian interventions, an arguably ‘politically induced’ necessity, conspire with an already failing public health system to exacerbate existing biological vulnerabilities and even introduce new ones for some individuals. That is, they manufacture bioprecarity, albeit in modified forms, in ways that are coded as ‘life saving’. Added to this, as I  will show, one person’s long-​term bioprecarization as a result of serious and prolonged sickness can propel the bioprecarization of those around her, as the stresses of the sick person’s precarity generate somatic responses in others. Finally, I  suggest that processes of bioprecarization are not always the result of recklessness or self-​interest on the part of surgical volunteers, as some critiques of short-​ term medical and surgical aid would suggest (e.g. Dupuis, 2004). Instead, the vulnerabilities that unfold in the wake of paediatric heart surgery missions are often associated with the humanitarian solutions that mobile surgical units devise to address common problems and criticisms. In other words, while bioprecarity is associated with a failing state, it can also emerge from deliberate, ethically and emotionally motivated responses carried out under less than ideal circumstances. Bioprecarity as it relates to the lives of individuals described herein thus acquires two meanings: one related to the threat to the biological life, indeed the survival, of groups of people who live under materially or otherwise precarious conditions; the other associated with the threat to the biological life of people for whom highly precarious medical settings and associated practices become the standard of care. Regarding the second meaning, there are other, more subtle differences that define the focus of this chapter. I will show, for instance, how humanitarian surgical interventions generate tremendous uncertainty for some, where the medical procedures required to extend life have unknown future implications, and vulnerability for others, where recovery from surgery is prolonged or undermined by unstable, ill-​ equipped health systems. In developing my argument, I also take my cue from a long line of critical anthropologists who write about humanitarianism’s unintended, paradoxical effects. Many anchor their analyses in Giorgio Agamben’s (1998)

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concept of bare life, life that has been reduced to its naked and bare form in places of exclusion. While critical of aspects of Agamben’s work, they use it to show that humanitarian groups often do little more than protect a limited form of human life (Ticktin, 2006) or ‘immediate existence’ (Redfield, 2013:  17). Others, taking a slightly different approach, examine not what life is protected but how it is differentially valued despite the humanitarian promise to value all lives equally (Fassin, 2007). While these approaches have been crucial for understanding some of the uncomfortable truths embedded within efforts to ‘do good’, they are not, as anthropologist Ilana Feldman (2012: 156) attests, ‘all that needs to be understood about humanitarian effects’. Instead, she calls on others to shift attention from the politics of life to the politics of living in humanitarian spaces. I follow her lead, yet focus specifically on the afterlives of humanitarian interventions (Abramowitz, 2015; Malkki, 2015; McKay, 2012), that is, the politics of living in the spaces that humanitarian groups have vacated. My point is not to criticize surgical humanitarianism; this would run counter to the views of most Honduran parents and clinicians I met. Many parents, for example, consented to high-​risk surgeries, knowing full well that the risks were exacerbated by the attenuated time frames of missions or the unavailability of supplies. Honduran clinicians, in turn, saw missions as a necessary source of medical supply donations and access to operating theatres in a context where such resources were difficult to come by. Yet nuanced assessments are still needed, precisely because the existing or potential harms of such interventions are readily silenced by patients, families, visiting clinicians, locally based clinicians and even social scientists (Berry, 2014; Wendland, 2010). Further, the chapter shows how standard measures of success –​short-​term survival and hospital discharge –​fail to encompass the full scope of what it means to actually continue living. My analysis draws on thirteen months of ethnographic fieldwork (2011–​12) that I carried out in Honduras before, during and after visits by six paediatric heart surgery teams, followed by two brief return trips (in 2016 and 2017) to the nation’s capital, after Operation Pulse had concluded its work in Honduras entirely. Missions were two weeks in duration and comprised a wide range of clinicians (critical care nurses, scrub nurses, paediatric nurses, respiratory therapists, medical students, paediatric cardiologists, including paediatric cardiologists who preform diagnostic and therapeutic catheterizations, surgeons and bioengineers) from multiple countries (the United States, Chile, Argentina, Ukraine, Sweden, Canada and the UK). While missions were underway, I  carried out observations and interviews at Regional Hospital, Operation Pulse’s Honduran host, and spent time at the hotel where the visitors stayed. In the three-​month intervals between missions, I balanced my time between visits to public and

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private hospitals, social events and meetings with Honduran clinicians and visits to the homes of children who had undergone surgeries. I conducted ninety in-​depth interviews in total, divided among the visiting clinicians, in-​country medical personnel and the parents of heart patients. Ethics approval was obtained from Columbia University in the United States and Regional Hospital in Honduras. In what follows, I will describe the precarious existence of children living with congenital heart defects in Honduras as a backdrop for understanding the value and appeal of surgical missions. I then turn to how and why post-​surgical living in Honduras is often no less unstable or uncertain than life before surgery. DIAGNOSIS AS DEATH SENTENCE AND THE ARRIVAL OF MISSIONS In most poor countries, a diagnosis of congenital heart disease (CHD) is nearly synonymous with death. The incidence of CHD is believed to be relatively constant worldwide, affecting about nine children per one thousand live births (Hoffman, 2013), half of whom will not survive their first year and in some cases their first month, without early diagnosis and treatment (Thukar et  al., 1997). In most rich countries, patients are diagnosed and treated in a timely fashion with less than 5 per cent mortality. Only 10 per cent of children with CHD live in rich countries, however; the remaining 90 per cent live in areas where cardiovascular services are lacking or nonexistent (Tchervenkov et al., 2008). In 2008, when paediatric heart surgery missions started visiting Honduras regularly, there were six academically trained paediatric cardiologists who diagnosed between two hundred and four hundred new patients each year. Opportunities for treatment and care, however, did not follow suit. There were no academically trained paediatric heart surgeons at the time. The three surgeons who did operate on paediatric hearts were all adult heart surgeons who had learned paediatric techniques through practice. All were located in the same city and typically only operated several times a month on simpler heart lesions. This was not for lack of skill or preparation on their part, but rather resources. It is widely documented that neo-​liberalism devastates government medicine and, by default, the health of the poor (Kim, 2002; Pfeiffer and Chapman, 2010). In Honduras, which has been undergoing intense neo-​liberalization since the 1990s, one of the most visible impacts of neo-​liberalism has been the rapid privatization of the health sector. This has manifested itself in two ways: first, a boom in the construction of private hospitals and clinics, which now outnumber public facilities, but are prohibitively expensive for most

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Honduras; and second, a decrease in the number and capability of public facilities. For example, unlike private clinics, nearly all of which can perform tertiary care, only three public hospitals have paediatric ICUs. Whereas private clinics also have state-​of-​the-​art machines and well-​stocked pharmacies, public hospitals are lacking even basic medical technologies and are often stripped bare of medications and supplies. Finally, whereas the private sector pays its workers on time, in the public sector workers may have to go on strike for months at a time in order to be paid at all. In short, in neo-​ liberal Honduras relatively little government funding is invested in health care, and that which does exist is frequently siphoned off by corrupt hospital administrators. In the early 2000s, finding the time and resources to operate on paediatric hearts thus posed an obvious challenge. Operating rooms were often unavailable, occupied instead by trauma patients, a leading cause of death in Honduras. Further, the Ministry of Health agreed to cover the cost of heart surgery for only a small fraction of patients in need. Some parents of children with CHD were able to pay for heart surgeries out of pocket, which cost, at minimum, US$10,000. Others managed to travel to a neighbouring country on their own or with the help of a charity. For most parents, however, who worked informally and intermittently as field hands, construction workers, tortilla vendors, garment factory workers and housecleaners, earning less than the legal minimum wage of US$280 (5,800L) per month, such options were beyond reach. For others still, for whom caring for a critically ill child became full-​time work, covering the cost of surgery was even less conceivable. Life for these children and their families was bioprecarious at best. It was insecure and unpredictable, punctuated by sudden emergencies and mad dashes to the hospital whenever a child went into crisis. Death was nearly certain; the question was merely whether it would be a matter of months or years. It was, of course, deeply distressing for parents to watch their children become increasingly fatigued, immobilized and subject to cyanosis (blue colouring of the skin) and ‘clubbing’ (thickening and rounding of fingers and toes). Medications, echocardiograms and frequent trips to the hospital were an added burden on household budgets that were already stretched thin at a time when rice and beans and other basic household goods were doubling and tripling in price. Thus, when a hospital in Honduras opened its doors in 2008 to Operation Pulse, many clinicians and parents rejoiced. Working alongside visiting teams, Honduran doctors and nurses were able to treat more patients in two weeks than they otherwise could in a year. In effect, they no longer had to prepare parents for death and surgically treated patients were no longer mainstays in their emergency rooms. For parents, surgical missions were

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viewed as nothing short of a miracle. They were the answer to their prayers, a sign that others, the foreigners and nationals who worked side by side during missions, sought to protect a patient population that seemed of little importance to the Honduran state. SURVIVING SURGERY AND THE SHADOW OF SUCCESS During missions, a visiting and locally based team operates from morning to night, sometimes until after midnight, treating roughly three patients a day. For most patients, the physical benefits of surgery are immediately obvious. Children who entered the operating theatre ‘blue’, or cyanotic, returned a healthy shade of pink. Within anywhere from thirty minutes to several hours they were awake and shortly thereafter playing, colouring, blowing bubbles and even playing soccer with their surgical scars still fresh and their chest tubes, whose purpose is to drain blood, still inserted. When I asked one visiting doctor to explain what it means for a patient to do well during a surgical mission, this was precisely the moment she described: when they stop ‘looking like ICU patients’ and start ‘acting like kids’. Not surprisingly, imagery of the first twenty-​four hours post-​surgery is iconic in humanitarian heart care. When I followed up with patients and families in their homes, I learned about other dramatic changes, such as a child’s weight gain or ability to reach new developmental milestones. Such visible signs of health prompted other developments. An absentee father, for example, suddenly showed up to pay for his daughter to attend private high school. One couple decided to start construction on their home, whereas another decided to move forward with a baptism they had delayed. Yet another couple made the treacherous journey to the United States as undocumented migrants, leaving their child in the care of his grandparents; now that he, aged two, was going to live, they wanted to provide, to quote them directly, ‘the best life possible’. Such life-​altering events were accompanied by new hopes for the future. Children who had been kept out of school or sports due to their illnesses talked about becoming doctors or football stars, and in one case, as far as I know, the former actually happened. One could argue that missions are a thus a stabilizing force, an antidote to other forms of social, economic and even biological precarity. But this is only one side of the story. I turn now to how the ‘ambiguities and ambivalences’ known to outlive humanitarian interventions (Malkki, 2015: 75) resurface in this context. As noted, the bodily uncertainties and vulnerabilities that I describe are not mere embodied outcomes of unemployment, insecure employment or a failing public health sector; rather, they are paradoxically linked to the very solutions that surgical teams devise to save lives under especially trying circumstances.

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‘Necessity is the mother of invention’ A visiting cardiologist invoked this proverb when I  asked what he learns by coming to Honduras on surgical missions. His words speak to one of the many challenges they face  –​resource scarcity  –​and their solution  –​ to improvise and adapt. Although better equipped with material resources than the Regional Hospital, surgical missions operate –​literally –​on shoestring budgets. Global surgery has long been sidelined in global health; no major institution funds it. As many have observed, if global surgery is the ‘neglected stepchild of global health’ (Farmer and Kim, 2008), then global paediatric heart surgery is ‘the child not yet born’ (Sitkin et  al., 2015). At the same time, travelling heart surgery teams are compelled to operate on as many patients as possible, whom others have cast off as unworthy or in some cases, owing to the advanced stage of their illnesses, inoperable. As one visiting nurse explained, justifying their decision to operate on a child who had been rejected by hospitals in the United States on account of risk, ‘every child counts’. For other visitors, operating on as many patients as possible, including more complex cases, was intended to prove a point: that it is indeed possible to do one of the most technologically sophisticated surgical procedures in a resource-​poor setting. Others still, who are socialized in a medical culture that values ‘not letting go’ (Kaufman, 2015), were not able to ‘say no’ to parents who asked them to ‘repair’ their child. To meet these opposing demands  –​minimizing cost and maximizing patient volume –​they have learned to ‘medically MacGyver’,2 which I define as innovating and spontaneously tinkering with machines, devices and standardized practices. I readily observed ‘MacGyvering’ during missions, but I would have never thought to call it that; this was a term the visitors invoked to describe their work. Examples of MacGyvering included creatively reusing or repurposing disposable equipment and materials, such as the improvised heart valve introduced at the beginning of this chapter. It also included employing ‘fast-​ tracking’ techniques  –​such as early extubation (removal of the breathing tube) and pain control without excessive narcotics –​to expedite recovery and shorten hospital stays. Whereas patients spend several days in the ICU in most affluent settings, during missions they spend less than twenty-​ four hours. Further, rather than recover in the paediatric ward for weeks, they are discharged from the hospital within three days. Such measures bring down the cost of each surgery, if patients recover without complications, to under US$5,000 in material resources alone. I should note that paediatric cardiology is already improvised even in the world’s best-​equipped hospitals because congenital heart defects assume innumerable forms and because the vast majority of equipment used in

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paediatric surgery is actually made for adults. Further, it is well known that innovating and spontaneous tinkering are exaggerated in the global South (Livingston, 2012; Wendland, 2010; Zaman, 2004). In the context of paediatric heart surgery missions, however, improvising is often more extreme. The Honduran clinicians I interviewed and observed, for example, also found ways to creatively ‘resource’ (Wendland, 2010) medical devices, but they did not go as far as Dr Cooper did to fashion them out of new materials. I should also note that, while some humanitarian surgical practices are undeniably experimental, showing how experimental and standard treatments indeed overlap in crisis situations (Petryna, 2010), visiting clinicians did not see them as such. As one visiting nurse explained, they were not developing ‘new techniques’ but rather ‘tweaking existing ones’. For children whose heart defects threaten their very survival, a medical MacGyvered solution is often their only chance for surgical treatment and care. Juana was a case in point. She suffered from two heart defects: a ventricular septal defect (VSD; a hole in the wall between the heart’s two upper chambers) and aortic insufficiency (leakage of the aortic valve). By the time she was diagnosed at age eleven, she urgently needed surgery to patch the hole and repair or replace the valve. Juana’s family lived relatively comfortably on her father’s income as a farmer and cattle rancher as well remittances from family members in the United States. Nonetheless, they were unable to afford the procedure at a public hospital, much less in a private clinic. By the time Juana learned that she could be treated by a visiting surgical team in 2011 at age fourteen, she consented without hesitation. There are two types of valves most commonly used in this procedure:  mechanical valves and tissue valves harvested from pigs, cows or human cadavers. None, however, are ideal solutions in the global South. All are costly,3 making them prohibitively expensive for a surgical mission and even a more well-​off, but medically uninsured family such as Juana’s. Mechanical valves also require the use of lifelong blood-​thinning medication and are not recommended for girls who plan to give birth later in life, whereas bovine and porcine valves calcify within ten years and require replacement. Homografts, or human tissue valves, if implanted early in young adults, can last a lifetime, but they must be kept on dry ice, making them difficult to import as donations. As an alternative, visiting surgeons may remove the damaged valve and put nothing in its place or use known techniques and available materials, but in improvised ways. In Juana’s case, Dr Cooper attempted a valve repair using the same new bioengineered tissue that he had used to construct a valve for Yesenia. The tissue acts as a bioscaffold; that is, once implanted, it begins to populate with a patient’s own cells and soon becomes native to the body. In both cases, the style of repair is well known and the tissue is approved by the Food and Drug

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Administration (FDA) for cardiac repair. Few surgeons, however, do these repairs with this tissue. As was true in Yesenia’s case, Juana’s surgery was logged as a surgical success. No complications were reported, nor did she require more than the standard three days in the ICU. As she and her mother left the hospital, they expressed words of gratitude and relief, which I documented for Operation Pulse to include on its web page of ‘patient success stories’. They were thankful that the surgical volunteers had arrived to do what Juana’s mother called ‘God’s work’. They were also relieved that they were no longer racing against the clock in search of a surgical solution before it was too late. As was also true in Yesenia’s case, post-​surgical living for Juana was not problem free. She, too, was fatigued and unable to eat in the weeks and months following surgery. Her heartbeat had intensified to the point where she could see pulsations at her neck. Further, Juana and her mother worried about the need for future hospitalizations and possible surgical re-​ intervention, a worry that was amplified by ongoing signs of Juana’s physical distress. In effect, gaining access to surgery in this case had not mitigated bioprecarity, but rather perpetuated it. Indeed, Juana no longer had to worry about whether she would die in the absence of treatment. She was, however, left with a new concern: the viability of this device, which, in time, proved itself to be less reliable than anticipated. Juana returned to the operating theatre at the next mission’s visit. It was clear, by that point, that the valve repair had not completely resolved Juana’s issue. Dr Cooper reopened her chest to replace the valve, again using the same bioscaffolding tissue. The need to tinker did not end there. During Juana’s second surgery, she started to hemorrhage excessively from her chest cavity. She was transfused with all the blood products that were immediately available: the four pints on hand for her surgery plus two additional pints leftover from the previous surgery. But she needed more, and the blood bank needed time to prepare and send more blood products. Dr Cooper’s solution –​yet another MacGyverism –​was to directly and immediately transfuse blood donated by three visiting clinicians who had verbally confirmed a matching blood type. This was not the first time the visitors had transfused blood products without cross-​matching them first during a mission, nor is Operation Pulse the only humanitarian heart NGO I have encountered that does it. Juana received more than ten pints of fresh whole blood that day, even after blood products had arrived from the blood bank. As I later learned, fresh whole blood is seen by some as preferable in the event of massive, potentially fatal bleeding complications because of its clotting abilities. Direct blood transfusions, however, are rare events anywhere in the world. They are unheard of in Honduras and otherwise reserved for combat

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situations and catastrophic disasters. This is because their effects are highly unpredictable. Some risks include possible infection with HIV, Hepatitis B and C or other viruses; possible cross-​matching misfires; and possible alloimmunization, which can put a patient at risk for future hemolytic disease or make future transfusions risker and more difficult to cross-​match. This is not to suggest that patients treated in private clinics or at the world’s most prestigious medical centres do not also face clinical and biological uncertainties. Any type of medical device can fail. Any patient can experience considerable blood loss or adversely react to foreign blood products. Any surgeon may tweak an existing procedure if it has the potential to save a patient from certain death. My point, rather, is that Juana’s care was more unorthodox than most, that her bioprecarity was, as a result, intensified and that her experience as a surgical patient was a direct reflection of her positioning as a humanitarian subject. Juana was not a victim. She and her parents went to considerable lengths to make contact with this visiting surgical team. Nonetheless, she was left with few, if any, alternatives for survival because of her family’s limited mobility and economic security and the state’s failing health infrastructure and inability, or unwillingness, to ensure access to a liveable wage and basic clinical resources, such as a well-​stocked blood bank. Once again, the problem is only complicated by the fact that clinicians are trying to complete a nearly impossible task:  operate on as many patients as possible despite having minimal funding support. As mentioned, bioprecariatization is not limited to those who are directly afflicted with illness. Many caretakers of children with congenital heart defects felt that their own health had been compromised as a result of their children’s condition. Juana’s grandmother, for example, had a crisis the night before Juana’s surgery, what Juana called ‘un ataque de nervios’ (an attack of nerves), because she feared she would never see her again. Nadia, too, suffered as a result of Yesenia’s illness trajectory. She reported considerable emotional and somatic distress after each of Yesenia’s surgeries. Despite being told by doctors that Yesenia had physically recovered, she would get depressed, crying for months at a time. Her depression made it difficult for her to get up and go to work, nearly costing her her job. After Yesenia’s 2003 surgery, Nadia became paralysed on one side of her face and had to undergo physical therapy to regain feeling. On my return trip to Honduras in 2017, I learned that she had been diagnosed with a thyroid problem and hypertension as well. She attributed both conditions to the stress of Yesenia’s many surgeries, hospitalizations and crises over the course of her lifetime. Whether Nadia would have presented with depression, a thyroid problem, or hypertension had her daughter been born with a healthy heart is beside the point. Nadia’s belief that her afflictions are linked to her daughter’s is suggestive of bioprecarity’s reach.

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Packing up, shipping out Medical missions, surgical missions in particular, are pejoratively called ‘duffle bag medicine’ (Roberts, 2006), ‘fly-​by medical care’ (Snyder et  al., 2011), ‘blitz surgeries’ (Nthumba, 2010) and ‘band-​aid missions’ (a term I  often heard during fieldwork), reflecting the concern that they provide little more than fleeting, superficial responses to otherwise enduring, deeply entrenched social, political and economic problems. Sensitive to this critique, Operation Pulse, as mentioned, seeks to partner with a single hospital in the countries it visits, train a specialized in-​country team, build a paediatric cardiac centre and ultimately ‘become obsolete’. It does not, in other words, ‘[shun] commitment to place’, as does the higher-​profile medical humanitarian NGO, Médecins Sans Frontières (Doctors Without Borders) (Redfield, 2012:  359). In fact, many clinicians choose Operation Pulse as a place to work or volunteer precisely because of its emphasis on sustainability. Nonetheless, the duffle bag metaphor still rings true for parents and clinicians stationed in Honduras permanently. According to one Honduran doctor, despite its rhetoric of partnering and team building, Operation Pulse still ‘comes, operates and leaves’. For emphasis, she added, when the teams leave, ‘they really leave’. By really leaving, she means that they inventory their supplies, store them away in the hospital’s basement, vacate the hospital premises and delegate responsibility for ongoing care to in-​country personnel, who provide follow-​up examinations, operate if necessary and attend to patients still in a critical condition. Some visitors are never seen or heard from again; a small minority, mostly those who receive a partial or full salary from Operation Pulse, return in three months with a new crop of visitors. For Operation Pulse, this style of intervention is not incompatible with programme building. The rationale for such a radical departure is to allow Hondurans, to quote Dr Cooper directly, to ‘step up to the plate’, which is a reference to the moment when a player is poised to score points in American baseball. In other words, the mission’s departure is intended to let Honduran clinicians step forward as key players in post-​surgical recovery. But his word choice, alone, is telling. Having to ‘step up to the plate’ signals that the task at hand is both an opportunity and a challenge, wherein the player may succeed or fail. The problem, of course, is that cardiac care is not a game; actual lives are at stake. Departure, thus, alongside the imperative to improvise, becomes yet another engine of bioprecarity for those patients left behind. The problem of departure was especially apparent during one of the last missions I observed. I arrived on the final day of one mission to find two ambulances with lights flashing parked outside Regional’s ICU. Because two

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patients were still on mechanical ventilation, they had to be, as one visitor put it, ‘shipped out’. Regional, the mission’s host and anticipated site of the self-​sustaining surgical centre, had yet to permanently hire the specialized in-​country team that Operation Pulse was training. These personnel, instead, either came voluntarily to assist and learn from the visitors or were hired as contract workers for its two-​week duration, after which they returned to their normal places of work or to not working at all. Further, Regional had yet to establish an actual place that could accommodate paediatric heart patients on an ongoing basis; during missions, teams occupied what was otherwise an adult ICU that would revert back to its original function when a mission ended. I stood with Ed, a North American who lives in Honduras and serves as Operation Pulse’s local liaison. As we watched Honduran Red Cross workers carry two unconscious patients out on stretchers, Ed was critical of what he described as a ‘mass evacuation’. It made him question the Regional’s commitment to building a sustainable programme; that he did not question Operation Pulse’s role shows where his allegiance lies. To me, it highlighted a cruel irony: rather than visiting experts ‘saving’ children from state neglect, roles had reversed and in-​country providers were ‘saving’ children from an unfinished humanitarian effort. To make matters worse, most had to be transferred to the National Hospital, which housed, at the time, the only paediatric ICU in the nation’s capital available to patients not covered by the country’s social security system, which covered the health care costs of state employees. This posed additional barriers to recovery, once again, not because personnel were less capable, but because the hospital was perpetually overcrowded, understaffed and destocked, even more so than Regional. As one nurse described it, ‘It’s the kind of place where you die for lack of a syringe’, in other words, where the state fails to make available even the most basic supplies. Others referred to the National as a ‘war hospital’, which makes the phrase ‘shipping out’ especially troubling, as if patients are indeed entering a combat zone. Moreover, the National Hospital is a place where recovery is difficult because the water system shuts down for weeks at a time, clinicians work without crucial machinery such as paediatric ventilators, portable infusion pumps and working monitors and where hospital-​born infections can kill more than a dozen patients at a time, as happened in 2011. In the case of post-​surgical heart patients, the interruption of care and transfer to National Hospital threatened their lives in several ways, complicating readily accepted notions of surgical survival. The National’s paediatric ICU is home to the most skilled critical care doctors in the country, but it can only accommodate five beds. On the day of the ‘mass evacuation’ mentioned above, four beds were already occupied. As a result, a sixth bed was brought in so that the unit could admit both patients. In effect, this

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further stretched material resources and overburdened personnel, making it more difficult for the doctors and nurses to deliver quality care. It also meant that any paediatric patients not from the surgical mission, who had been admitted to the emergency room until an ICU bed became available, would have to wait even longer, thus exacerbating their own bioprecarity. There were times, too, when post-​surgical heart patients, still in critical condition, were barred entirely from the ICU at the end of a mission. Consider the case of Mari. She suffered from a defect known as Epstein’s Barr, but, unlike most patients treated by surgical teams was not diagnosed until her late teens, which made her surgery especially high risk. Mari tolerated the surgery well, and by the time the visiting surgical volunteers were preparing to leave, she was awake in her ICU bed, smiling and waving goodbye. It was expected that she would be transferred to the paediatric ward later that night and discharged the next morning. Mari’s health deteriorated that evening, however. An X-​ray showed fluid in her lungs. She was having difficulty breathing. Her Honduran ICU doctor, a longtime collaborator with surgical missions, had to place her back on mechanical ventilation and transfer her to the National, where she was scheduled for an overnight shift. By then, the two other post-​surgical patients had already been admitted to the ICU, which left this doctor with no option but to put Mari in the National’s emergency room, where there was more space but less individualized attention. Shortly after the transfer from the Regional to the National Hospital, Mari went into a coma. She never recovered. Isai was the only post-​surgical patient I  knew who survived after being transferred to the National Hospital after a mission’s departure. His recovery was nothing short of a miracle. When Isai arrived at the National, he was in such terrible shape that one Honduran nurse told me that there was little hope for recovery. He remained in the ICU for a month, breathing through a tracheostomy tube, until he gained enough strength to be transferred to the paediatric ward. Few patients need a tracheostomy following open-​heart surgery; in the case of Isai, he had not tolerated extubation and when the clinicians tried to reinsert his breathing tube, he resisted. The tracheostomy was the only way to access his airway. When I visited Isai in the National’s paediatric unit, his father, Saul, reported that he was doing better. Isai, however, was noticeably uncomfortable. He smiled when he made eye contact with his father, but cried every time his father turned away to address me directly. Saul was feeding Isai baby food at the time; it was already noon and the hospital had yet to deliver breakfast, let alone any liquids. If, in the case of Juana and Yesenia, bioprecarity took the form of bodily uncertainty, in these case examples, it presents as bodily vulnerability. Post-​surgical patients are put at heightened risk of decompensating or not recovering at all in the midst of a well-​intentioned effort to engage and empower in-​country personnel.

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Bioprecarity and bodies as pieces SURGERY, BIOPRECARITY AND INTIMACY: CONCLUDING THOUGHTS

As mentioned, heart defects and even some post-​surgical complications strike randomly, affecting the most as well as the least socially and economically disenfranchised patients. As such, they exemplify the precariousness of life per se: the fact that we are all at risk of death, disease and violence. Others, however, are exacerbated by conditions of poverty, underlying illness, malnourishment, hunger, failing health sectors, lack of medical insurance, social isolation and insecure employment. They, in turn, signal precarity, the socially and politically engineered condition that does not affect all populations equally (Butler, 2009). Yet, as I  have argued in this chapter, it is not social marginalization alone that threatens post-​surgical living. The precarious nature of humanitarian and state-​sponsored care heighten existing bodily insecurities and vulnerabilities and even introduce new ones. In effect, they become engines of bioprecarity. One of the central objectives of this volume is to examine the relationship between bioprecarity and intimate labour. With that in mind, I  will conclude by making some preliminary observations. While not explicitly identified as ‘intimate labour’ as conceptualized by Boris and Parreñas (2010), humanitarian heart surgery shares two of its defining features: first, it is a form of ‘bodily upkeep’, especially in the case of patients like Yesenia, whose survival rests on repeat surgical interventions; and second, it involves ‘emotional closeness’ (Boris and Parreñas, 2010:  2). Drawing an association between surgery and emotion may seem counterintuitive, since the most skilled surgeons are often thought to be the most unemotional and detached. But, as Prentice (2012:  38) argues, this is more of a Euro-​ American cultural assumption than reality, as demonstrated by the surgical residents in her US-​based ethnography who strategically ‘objectify the body’ and ‘activate the person as needed’ in the anatomy lab. By ‘activate the person’, she means that they call ‘forth the cadaver’s personhood, linking it with family members, loved ones and other people with whom a dissector might have a connection’ (Prentice, 2012: 50). Further, humanitarianism is already known to be largely affective. In the words of Wilson and Brown (2008: 2), it as an ‘ethical response [that] arises from emotion: compassion, sympathy (in the nineteenth century), and, more recently, empathy’. Fassin (2010:  269) reinforces this point in his definition of humanitarianism as both ‘reason’ and ‘emotion’, emotion here defined as ‘the virtue by which human beings feel personally concerned by the situation of others’. The visiting clinicians I met similarly described emotion, specifically empathy and concern for others, as a primarily motivation for traveling overseas on missions.

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How might intimacy perpetuate bioprecarious living in the aftermath of visiting paediatric heart surgery teams? It may further limit critique of an already morally unquestionable activity. On the part of surgical visitors, knowing that they were key to a child’s ‘bodily upkeep’ or ongoing survival was often enough to rationalize any doubts they had about the efficacy of their work. Further, knowing that they had more wins than losses, evidenced by the number of children whose lives were ‘saved’, helped them feel that they were, in fact, helping more than harming. As I have shown, however, such narrow definitions of success gloss over a broad spectrum of experiences that make up post-​surgical survival. Even in ideal scenarios, where hearts are repaired and patients successfully discharged, new bodily uncertainties and vulnerabilities surface, whereas others fail to disappear. Bioprecarity is not limited to paediatric heart patients either. High-​tech humanitarian interventions have far-​reaching effects on parents, in-​country personnel and state-​sponsored medicine. As mentioned, it would be easy to point fingers at visiting surgeons who might operate carelessly. It would also be easy to fault the simple reason that missions are transitory, another common critique. Both readings, however, are overly simplistic explanations of what makes post-​surgical lives especially fragile and uncertain. As I  have shown, the visitors are highly skilled improvisers, especially when navigating scarcity. They are also highly sensitive to the impacts of their departure, which they seek to mitigate by empowering a locally based team. Nonetheless, their actions, however ethically and emotionally driven, fuel bioprecarity. Their actions are telling examples of why technical fixes, however innovative, and time-​ bound interventions are poorly suited as global health solutions. NOTES 1 All names of people, institutions and organizations are pseudonyms. 2 MacGyver is a popular North American TV series from the 1980s that chronicles the adventures of secret agent Angus MacGyver, who can manage a crisis with little more than a pocketknife, paperclip and duct tape. As a cultural icon, MacGyver epitomizes heroism and humanitarianism, evidenced by the tasks he is assigned by the non-​profit ‘think tank’ for which he works. For example, he’s called up to disarm a bomb threatening innocent victims or rescue Nobel Peace Prize nominees trapped in a collapsed underground laboratory. He also never carries a gun –​further testament to his ‘good’ nature –​instead relying on his knowledge of science and the outdoors, which he draws upon to make clever use of ordinary items to avert disaster. 3 Mechanical valves cost 35,000L (US$1,700). Biological valves cost 55,000L (US$2,600).

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Neilson, B. and Rossiter, N. (2008). ‘Precarity as a political concept, or, fordism as exception’, Theory, Culture & Society 25(7–​8): 51–​72. Nthumba, P. M. (2010) ‘ “Blitz surgery”:  Redefining surgical needs, training, and practice in sub-​Saharan Africa’, World Journal of Surgery 34(3): 433–​7. Petryna, A. (2010) ‘The politics of experimentality’, in Feldman, I. and Ticktin, M. I. (eds) In the Name of Humanity: The Government of Threat and Care. Durham, NC: Duke University Press, pp. 256–​89. Pfeiffer, J. and Chapman, R. (2010) ‘Anthropological perspectives on structural adjustment and public health’, Annual Review of Anthropology 39: 149–​65. Prentice, R. (2012) Bodies in Formation: An Ethnography of Anatomy and Surgery Education. Durham, NC: Duke University Press Redfield, P. (2012) ‘The unbearable lightness of expats: Double binds of humanitarian mobility’, Cultural Anthropology 27: 358–​82. Redfield, P. (2013) Life in Crisis:  The Ethical Journey of Doctors Without Borders. Berkeley: University of California Press. Roberts, M. (2006) ‘A piece of my mind: Duffle bag medicine’, JAMA 295(13): 1491–​2. Sharp, L. A. (2006) Strange Harvest: Organ Transplants, Denatured Bodies, and the Transformed Self. Berkeley: University of California Press. Sitkin, N. A., Doruk, O., Donkor, P. and Farmer, D. L. (2015) ‘Congenital anomalies in low-​and middle-​income countries: The unborn child of global surgery’, World Journal of Surgery 39: 36–​40. Snyder, J., Dharamsi, S. and Crooks, V. A. (2011) ‘Fly-​By medical care: Conceptualizing the global and local social responsibilities of medical tourists and physician voluntourists’, Global Health 7: 6. Tchervenkov, C. I., Jacobs, J. P., Bernier, P.-​L., Stellin, G., Kurosawa, H., Mavroudis, C., Jonas, R. A. et al. (2008) ‘The improvement of care for paediatric and congenital cardiac disease across the world:  A challenge for the world society for pediatric and congenital heart surgery’, Cardiology in the Young 18(S2): 63–​9. Thakur, J. S., Negi, P. C., Ahluwalia, S. K. and Sharm, R. (1997) ‘Integrated community-​ based screening for cardiovascular diseases of childhood’, World Forum 18: 24–​7. Ticktin, M. (2006) ‘Where ethics and politics meet:  The violence of humanitarianism in France’, American Ethnologist 33(1): 33–​49. Wendland, C. L. (2010) A Heart for the Work: Journeys Through an African Medical School. Chicago: University of Chicago Press. Wilson, R. and Brown, R. D. (2008) Humanitarianism and Suffering: The Mobilization of Empathy. Cambridge, UK: Cambridge University Press. Zaman, S. (2004) ‘Poverty and violence, frustration and inventiveness:  Hospital ward life in Bangladesh’, Social Science & Medicine 59(10): 2025–​36.

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Part IV

BIOPRECARITY IN THE TRANSGRESSION OF BOUNDARIES OF INTIMACY

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TRANSGRESSING BOUNDARIES Seeking help against intimate partner violence in lesbian and queer relationships N ic ol e  Ove sen

INTRODUCTION You have known violence. You have known violence. You are queer and you are brown and you have known violence. You have known a masculinity, a machismo, stupid with its own fragility. You learned basic queer safety, you have learned to scan, casually, quickly, before any public display of affection. Outside, the world can be murderous to you and your kind. Lord knows. But inside, it is loud and sexy and on. If you’re lucky, it’s a mixed crowd, muscle Marys and bois and femme fags and butch dykes and genderqueers. If you’re lucky, no one is wearing much clothing, and the dance floor is full. If you’re lucky, they’re playing reggaeton, salsa, and you can move. People talk about liberation as if it’s some kind of permanent state, as if you get liberated and that’s it, you get some rights and that’s it, you get some acknowledgment and that’s it, happy now? But you’re going back down into the muck of it every day; this world constricts. You know what the opposite of Latin Night at the Queer Club is? Another Day in Straight White America. So when you walk into the club, if you’re lucky, it feels expansive. ‘Safe space’ is a cliché, overused and exhausted in our discourse, but the fact remains that a sense of safety transforms the body, transforms the spirit. So many of us walk through the world without it. (Torres, 2016: n.p.)

Justin Torres’ essay ʻIn Praise of Latin Night at the Queer Clubʼ, published in the Washington Post just a few days after the mass shooting at the Pulse nightclub in Orlando, Florida, draws attention to the violence that lesbian, gay, bisexual, transgender and queer (LGBTQ) people and especially those of colour are subjected to in everyday life. Here we see the manifestations of bioprecarity in several ways, which I  will discuss throughout this chapter. First through the classification of social groups that renders people

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vulnerable depending on whether they are considered ʻmainstreamʼ or not. Second in terms of how these classifications, such as being queer and brown in cultures that devalue these attributes, threaten people in their physical and psychological lives thus making their lives (= bios) precarious. People who are rendered precarious in their context easily become the victims of violence, all sorts of violence, committed by the state, in the public spheres and even within intimate relationships. Violence shapes and constructs precarious lives. By emphasizing the intersecting structures of homophobia and racism, Torres (2016) conceptualizes violence as a fundamental and daily condition, which shapes the LGBTQ community and its members. LGBTQ communities are here constructed as vulnerable as they are marked as objects of violence in the public sphere. This vulnerability is displayed through the images of safe and unsafe spaces, drawing the line between the outside and the inside of queer space. Finally, the notion of safety inside community space is produced in close relation to bodily intimacy and sustained by the recognition of social identities. Torres describes this as entering a place of intimacy, where the constraints of the public sphere are loosened and feelings of safety transform the body. However, what happens when you are not safe within those intimate boundaries of the community? LGBTQ people are not only the object of violence in the public sphere but even within their intimate relationships. However, this type of violence is often not so visible or addressed within or outside the boundaries of the community. In this case, the very presumption of safety might even enhance your level of vulnerability. In this chapter, I discuss how bioprecarity operates in relation to recognition and visibility in the case of intimate partner violence (IPV) in lesbian and queer relationships. I  start by discussing how bioprecarity produced by violence shapes LGBTQ communities. I  then move on to explore how victimization in relation to visibility and recognition contributes to an imaginary of intimacy as a contrast to danger, thus making it difficult to raise the issue of intra-​community violence. I  then reflect on how constructions of the imaginary of safety in relation to recognition of social identities operates simultaneously on interpersonal, community and institutional levels and affects how IPV can be conceptualized and how one can seek help against such violence. Through these perspectives, help-​seeking is constituted as a transgressing encounter, as the lesbian and queer victim-​ survivor transgresses community boundaries, as well as cultural perceptions of victimhood when meeting help providers in an institutional context. I end with a reflection on the importance of institutional and community recognition in order to become an intelligible victim worthy of protection to reduce the bioprecarious state of LGBTQ victim-​survivors.

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INTIMATE PARTNER VIOLENCE IN LESBIAN AND QUEER RELATIONSHIPS In this chapter, I  draw, among other sources, on interviews with twenty-​ five people who have experienced violence in an intimate lesbian and/​or queer relationship.1 The interviewees identify within different categories such as lesbian, homosexual, bisexual, pansexual and queer or as women who engage or have engaged in relationships with women. All interviews were semi-​structured, lasting from around forty minutes to one hour and fifty minutes, and were conducted in different places around Sweden from March to June 2018. The interviews focused particularly on the participants’ experiences of violence and help-​seeking. Throughout this chapter, the names of the interviewees have been changed and I have translated quotes from Swedish into English. Before I turn to this material, I will first discuss how violence contributes to the construction of LGBTQ lives as precarious. BIOPRECARITY AND LGBTQ LIVES I consider bioprecarity to be the articulation of vulnerability that affects the lives and bodies of social groups and individuals. In Precarious Life: The Powers of Mourning and Violence, Judith Butler (2004:  44) addresses the body as a site of human vulnerability, emphasizing that ʻthis vulnerability is always articulated differently, that it cannot be properly thought of outside a differentiated field of power and, specifically, the differential operation of norms of recognitionʼ. By describing the social conditions of embodiment, Butler (2004: 26) emphasizes the contradictory position we engage in when struggling for the rights to our own bodies, which through exposure and interdependence to others are never truly our own in the first place. According to Butler (2004:  27), violence is an exploitation of the ways in which we are in a position of interdependence, ʻthe way in which we are, as bodies, outside ourselves and for one anotherʼ. This perspective on vulnerability and violence as relational informs my reading of bioprecarity as a process of precarization in which certain bodies are rendered vulnerable through exposure or negligence, affecting the way one perceives and reacts to violence. Gail Mason (2002: 97) suggests that homophobic violence hurts those it targets in discursive as well as corporal ways, suggesting similarly to Torres that discursive injuries are not confined to a single incident or attack but exists as a daily condition. The shooting at the Pulse nightclub and the bombing of the Admiral Duncan Pub2 in London are just two examples of violence against LGBTQ communities. However, these examples do not

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stand alone, but live alongside other instances of violence that have shaped and continue to shape the lives of LGBTQ communities. Here I also refer to our collective memory, which contains everyday experiences of violence, such as the threat of hate crimes on the street, bullying at school or in the workplace, the exposure to social exclusion from families, to name just a few. All of these result in enhanced vulnerability and construct a knowledge of violence that is reflected in, for example, the high rates of suicide and other health-​related issues among LGBTQ individuals (Ard and Makadon, 2011: 630). Leslie Moran and Beverly Skeggs (2004: 14) argue that how we live with violence and what kinds of strategies and resources we have are so deeply embedded in our culture that they reshape ʻwhat and how we can be in this worldʼ. According to Mason, homophobia-​related violence marks the bodies of those it targets with signs of victimhood and vulnerability, and makes a contribution to the process of subject formation. Violence is thus a type of knowledge that constructs some groups as appropriate targets of certain types of victimization (Mason, 2002: 97, 108, 99). To elaborate further on the consequences of being seen (or not seen) as a potential victim, I  shall now explore the relationship between visibility and recognition of social identities in relation to violence and safety. (IN)VISIBILITY AS A PREREQUISITE FOR SAFETY AND VIOLENCE ʻAre lesbian and gay men invisible? Are you “out” or “open” about your homosexuality? Are you in the closet? Should homosexuals “flaunt” their sexuality?ʼ (Mason, 2002:  4). These are some of the commonly asked questions that, according to Mason, support the strong yet ambiguous relation between visuality and sexuality. Cheshire Calhoun similarly argues for the significant role of visibility, as sexual identities unlike many (though not all) social identities have the potential to be closeted. Lesbian and gay subjection is, according to Calhoun, upheld by discriminatory policies that require everyone to present themselves as heterosexual in order to gain full access to the public sphere (Calhoun, 2000: 16). Mason uses the metaphor of visuality throughout her analysis of homophobia-​related violence, as the metaphor resonates strongly both with the discourse of homosexuality and that of violence (Mason, 2002: 4). One has to become visible to be the object of violence but also when claiming recognition and protection. Following this line of thought, Moran and Skeggs (2004: 5) suggest that visibility and its opposite are central to politics of recognition and impact on the construction of new visibilities and claims for protection against violence. The demand for protection through the law

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has been central to lesbian and gay politics in various ways, for example through the adoption of legislation making hate crimes a meaningful legal term applied to provide protection to LGBTQ people (Moran and Skeggs, 2004: 15). However, while one needs to be visible in order to be recognized and to claim rights to protection, visibility on its own may not result in or equal recognition. Recognition is thus in itself precarious. As a concept, it invokes who is seen and recognized as legitimate in relation to a certain claim or status. When demanding the protection of the law, groups are forced to be visible, this can have negative consequences such as misrecognition, new forms of pathologies and exclusions (Moran and Skeggs, 2004: 5). The criminalization of primarily gay men’s sexual activities for example has meant that this group has been made more visible, not least by the state (Moran and Skeggs, 2004:  50). Whereas visibility can render you vulnerable to harassment or unwanted intervention, invisibility, such as failing to acknowledge your relationship or the specificity of your experiences, works as symbolic violence through practices of estrangement (Moran and Skeggs, 2004:  151). Thorgerdur Thorvaldsdóttir (2010:  136) proposes for instance that whereas prejudice and homophobia have characterized society’s view of gay men, lesbian existence has been surrounded by invisibility and silence. These two seemingly opposite dynamics have very different consequences, by either erasing or targeting social groups and individuals. However, they are both the result of what one might call a politics of estrangement. As Doris Leibetseder discusses in Chapter 2 in this volume, vulnerability can be enhanced when groups and individuals fall outside categories or when they are misrepresented within a given category. Thus, bioprecarity derives from categorizations as it renders groups and individuals visible and per se vulnerable to attack or when failed representation results in a disavowal of existence. When examining sexual assaults among women, Lori Girshick (2002) describes lesbian and bisexual women’s lives as a struggle for recognition. Emphasizing the importance of visibility, Girshick (2002:  45) argues that ʻ[l]‌esbians and bisexual women are absent from history (largely written by men), contemporary lesbian and bisexual role models are few (as a result of homophobia and biphobia), and coming out or being visible is always at the risk of physical or psychological harm (or both)ʼ. Lack of awareness around IPV in woman-​to-​woman/​lesbian relationships has been a recurring theme in much research on the subject (Balsam, 2001; Barnes, 2011; Girshick, 2002; Giorgio, 2002). This affects both the acknowledgement of and responses to violence at individual, community and institutional levels. One possible explanation of the lack of awareness of IPV within LGBTQ communities might be that the latter have primarily been interested in advocacy with a focus on gaining rights for community members. This

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has rendered other issues invisible or incomprehensible. Girshick (2002), for instance, explores the reasons for denial of violence within lesbian and bisexual communities. A reoccurring theme is the fear that admitting violence would hurt the general community and ʻprovide more homophobic and biphobic ammunition to generate even more negative views of lesbians and bisexual womenʼ (Girshick, 2002:  51). This notion of advocacy was also a recurring theme during my interviews, for instance in the interview with Saga, a woman in her mid-​thirties who identified as a lesbian and had been in a violent relationship for around ten years. When asked about help-​ seeking she answered: One of the reasons that I didn’t want to tell people how bad we were doing was that on some level I felt that I wasn’t just representing myself and our family, I was also representing lesbian family constellations and somehow I was like … well we have to! I wanted to show that we are actually good parents, that they were right to allow us to have children so it was also a thing like that.

This statement illustrates the defining and obligatory role positive representation plays for Saga, which is unavoidably bound up with the struggle for recognition and rights, such as the right to have your relationship acknowledged by social institutions and the right to have children. It also shows how social identities and interpersonal relationships are performed in the everyday and how this affects how individuals define and react to violence. Intra-​community IPV enhances precarity simultaneously on several levels, both directly within the intimate relationship by being exposed to violence and indirectly through community silence or denial due to fear of further marginalization. Grace Giorgio (2002) argues similarly that lesbian victims of IPV struggle to define their experiences of abuse due to the institutional and cultural marginalization of lesbians and a heteronormative perspective on violence that does not match their experiences of victimization. The combination of these factors makes it hard to define and navigate within and across community boundaries in the case of IPV, as Giorgio (2002: 1235) emphasizes: ʻWe witness this in how abused lesbians mediate a complicated nexus of power relations –​protective services, the legal system, and their own loyalty to the relationship as well as their lesbian communitiesʼ. Thus, when it comes to the subject of violence in lesbian relationships, we are dealing with two intersecting phenomena, which are both to some extent shaped by their connection to invisibility:  invisibility of sexuality, especially that of lesbians, bisexuals and femmes within the queer communities and the general public and that of interpersonal violence within these communities. As I have shown in this section, visibility and invisibility are essential factors in the construction of precarious social positions, whether

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these social identities are targeted or denied existence and this impacts on how one perceives and reacts to violence. The following section explores the contradictory position of the community as both a place of escape from violence but also a contributing factor to the denial of violence within the community. THE IDEA OF THE SAFE SPACE ‘Safe space’ is a cliché, overused and exhausted in our discourse, but the fact remains that a sense of safety transforms the body, transforms the spirit. So many of us walk through the world without it. (Torres, 2016: n.p.)

Torres positions the queer space as a place of escape. Entering the queer space invokes a bodily transformation. This suggests a form of safety that relies on recognition within a given context, the possibility of constructing but also crossing boundaries, by obscuring the lines between public and private realms and constructing community as a resource for safety. A similar perspective on queer space as transformative can be found in Laurent Berlant and Michael Warner’s article ʻSex in Publicʼ (1998), where queer culture is described as a radical place of resistance, a place where intimate boundaries can be negotiated, challenged and expanded: We have developed relations and narratives that are only recognized as intimate in queer culture: girlfriends, gal pals, fuckbuddies, tricks. Queer culture has learned not only how to sexualize these other relations, but also to use them as a context for witnessing intense and personal affect while elaborating a public world of belonging and transformation. (Berlant and Warner, 1998: 558)

Thus, queer culture has constituted new forms of intimacies, negotiating the privatized norms associated with sexuality in our culture (Berlant and Warner, 1998: 558). When proposing that there is ʻnothing more public than privacyʼ, Berlant and Warner (1998: 547, 553), emphasize how intimacy is publicly mediated and constructed through heterosexual culture and ideologies that set up intelligible and unintelligible subjects. Queer intimacies can be seen as disruptive and transgressive, as they reconceptualize what we consider private and public, recognizable and unrecognizable subjects and relationships. Queer culture has thus developed relation and narratives that, to return to Torres (2016), resist the constrictions of the outside world. The queer culture’s awareness of its subordinate position to heteronormativity makes it resourceful but also precarious. The anticipation of violence shapes the construction of queer culture and thus the very formation of LGBTQ

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subject positions as precarious. Girshick (2002: 46) argues that bisexual and lesbian communities, however loosely defined, serve as social, psychological and political support against the dominant culture: ʻConnection to community becomes all the more imperative when this negativity and the lack of acceptability create a need for the self to be part of a larger group to help sustain that sense of belonging.ʼ The sense of belonging, which constructs a community as safe, is therefore sustained by the threat of an outside violence, allowing for a narration of hate crimes but not IPV. Cindy Holmes (2009) argues against the dichotomist notion of a public–​ private divide that has dominated much theoretical work and activism on domestic violence. Holmes suggests that specifically marginalized social groups’ experiences of violence crosses the public–​private divide since the state continues to regulate non-​normative forms of sexuality and families. Holmes (2009: 83–​4) emphasizes that as a consequence, ʻmuch of the private lives of people of colour, indigenous people, poor people, lesbian, gay, bisexual and transgender people is “neither affirmed nor protected by institutions in our society” ’. Returning to Saga, who explained how her ideas about representation were upheld by constantly having to represent the community especially regarding her identity as a lesbian mother: ‘I am rather used to having to be a representative with all the questions that come [with it, ] “Oh how did you get children? How did you decide and how did you do it and where then? How many tries then?” Like that … which a heterosexual couple would never get.’ The expression of obligatory representation can be read through the lens of transgressing intimacies. LGBTQ intimate relations are not only not protected but also forced to be visible and negotiated in the public sphere when claiming, for example legal recognition, whether it concerns the right to family and kinship or protection against violence and discrimination. Thus, it is something of a paradox that the transgressive nature of LGBTQ communities can make it harder to acknowledge IPV, which is in itself a transgressive phenomenon. However, this paradox might be explained through the construction of the ʻcommunityʼ,3 which in line with Torres’ essay is the place where you are known and recognized, where your social identities are accepted. When constructed as a counter-​public or in relation to a violence targeted at the community from ʻthe outsideʼ, certain narratives and social positions are made imaginable such as the intimate relationships Berlant and Warner (1998) refer to. However, as emphasized by Butler (2004: 146), ʻdisidentification is part of the common practice of identification itselfʼ. This suggests how this image of the community in opposition to a violence inflicted upon it from outside becomes a strong constructing narrative for the community itself. This perspective was raised by many of the interviewees who were critical towards the LGBTQ communities’ lack of awareness of IPV. For example, when I asked Elin, a

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woman in her early-​twenties, how she thought the LGBTQ communities were handling the issue of IPV, she reflected as follows: Oh, that’s tricky. Spontaneously, I  would say that LGBTQ people have healthier and sounder attitudes towards a relationship since there in general are less preconceived notions around how a relationship is and how it should be, which could enable violence. However, at the same time it is very rare to hear anyone talk about that violence could occur in intimate relationships at all or at least I have rarely discussed this with other LGBTQ people. I think we have a tendency to focus on what is good in our relationships. It’s this kind of entitlement … it’s good to be a lesbian. It’s okay to be a lesbian. In general, you want to be proud kind of. I think that I also want to be proud of myself and my relationships and myself as an individual. And it’s hard to accept the thought that there could be something bad like that. Cause you want things to be good for once. You just want to exist.

Elin’s reflection contributes to the narrative of LGBTQ communities as progressive and freer from conventional restraints on relationships, thus making IPV unrecognizable. It also shows how this narrative is upheld by an affirmative politics of the self, where the lesbian identity is not only recognized but also valorized. Paradoxically this also enhances the precarious position of victim-​survivors within these communities, as their victimization disrupts their intimate relationship and the very founding narrative of the communities’ imaginary of safety and creates specific conditions for seeking help against IPV. TRANSGRESSING ENCOUNTERS IN HELP-​S EEKING Moran and Skeggs (2004) argue that victimization should be understood through the interplay between visibility, space and recognition. Thus, the exposure to violence as well as safety depends on whether you are read as in or out of place, a given context, a community or an institutional setting (Moran and Skeggs, 2004: 6–​9). Being in the right place should thus protect while being in the wrong place (and at the wrong time, as the saying goes) enhances precarity. This very stance makes the recognition and acknowledgment of IPV inside the queer community –​the supposedly safe space –​ difficult and, in turn, challenges help-​seeking. Social networks play an important role when it comes to seeking help in the case of IPV (Calton et al., 2015; Guadalupe-​Diaz and Jasinski, 2016; Kaukinen, 2002; Turell and Cornell-​Swanson, 2008; Turell and Herrmann, 2008). Studies have shown that lesbian, bisexual and gay victims are more likely to disclose violence to their informal networks such as friends, for

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example, than to seek formal support. This is not unique to these specific groups but has also been found to be a tendency among heterosexuals (Edwards et al., 2015: 116). What may be specific to the help-​seeking behaviour of lesbian and queer victim-​survivors is the way in which informal networks are used as a resource and how this unfolds within socially marginalized communities. Social networks played an important role for most of the people I interviewed, though their helpfulness depended very much on timing and often the combination of additional formal support such as psychological therapy or other types of counselling. Consequently, the lack of a social network or the lack of understanding from social networks played a significant role in the help-​seeking process. This was the case for Ewa, a pansexual woman in her mid-​thirties, who had moved to Sweden with her partner as same-​sex relationships were not accepted in the country where they grew up. Ewa explained that the violence had started escalating after they moved to Sweden. When I asked if she had talked to any friends or family members about the violence, Ewa explained that, as they were new to the country, they did not have many friends and that she specifically did not consider her parents a potential source for help: I really did not feel like telling my parents. I was so ashamed by this up here, it felt like, god then I’m a super failure, moving to become … to live freely and then I move straight into shit like that … it just feels like … No, it would feel like I would be working against myself because I was working on getting them to accept me and us, which they didn’t do for a long time. So then, it would be like, okay, if I say this, then they will never accept me.

Ewa’s concerns about telling her parents show the enhanced risk LGBTQ victim-​survivors run when seeking help through their social networks, especially when the perceptions of the partner and the relationship are tied up with issues around acceptance. Janice Ristock (2005: 10) also argues that it can be difficult for LGBTQ people to use their social networks to seek help from IPV out of fear that the violence may be seen as sign that their sexual or gender identity is unhealthy. Joan C. McClennen (2005: 150) suggests that the silence sexual minorities are met with in the case of IPV causes individuals to be ʻdouble closeted  –​entombed in their same-​gender identity and in their personal pain of abuseʼ. In order to understand the different and changing conditions that inform the help-​seeking of lesbian and queer victim-​survivors, it is useful to turn to Kimberly Crenshaw’s influential work ʻMapping the Margins: Intersectionality, Identity Politics, and Violence Against Women of Colorʼ (1991). Crenshaw emphasizes the importance of applying an intersectional perspective in order to understand how social categories intersect and create specific conditions for

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violence and help-​seeking. In Saga’s case, her position as a lesbian mother conditioned how she could seek help from violence. Ewa’s position as pansexual and as a migrant in Sweden and the lack of social support due to her sexuality also conditioned how and where she could seek support. Thus, what sources of support are available for one to deal with violence are highly dependent on how one’s social identities are perceived by one’s social context. These different conditions call for different sorts of support. Susan Turell and Molly Herrmann’s (2008) qualitative study of support systems for lesbian and bisexual women who have experienced abuse discusses the perceived benefits and risks associated with community and general sources for support. The study showed for instance how misrecognition had an important impact on help-​seeking behaviour. A  fear of having to educate their help provider about sexual orientation, for example, made some informants critical of seeking help outside LGBTQ communities (Turell and Herrmann, 2008: 219). This aligns with other studies on help-​seeking by LGBTQ community members. Worries about having one’s relationship, gender identity, sexuality or experiences of abuse questioned were a determining factor when deciding where to seek help (or not) for transgender victim-​survivors of IPV in the study by Xavier Guadalupe-​Diaz and Jana Jasinski (2016), for example. My interviews show a pattern of help-​ seeking that often consisted of several and different attempts, which could easily be disrupted, for example when Ewa called a helpline for women who have experienced violence: Well it was like this, I think I said she and this person said he anyway. You know so you just go ‘I mean my wife!’ ‘Ah okay’. Such things you know and in that moment you are just … well I am just really tired of this quite simply. You just want them to pick it up when you tell them. It is also bigger problems than just that but … But it feels like this heteronormativity was even more annoying in that moment somehow. That in some way it was … or maybe it was my own ideas about this. Okay so what, another girl hits you, how does that work? Maybe it was also myself who had thought it was extra shameful that … will they wonder about … yes, men are much stronger and of course you would be scared and of course that could break her down. But it wasn’t about that really. Who was strongest physically … I lived with this thought myself that it was kind of extra … well that I could have … should have protected myself in some way and that it wasn’t a person who was bigger or stronger than me.

Ewa’s reflection touches upon a number of factors that help to explain potential barriers for help-​seeking when the perpetrator is a woman. This concerns cultural frameworks of IPV as men’s violence against women and explains why Ewa expressed fears of not fitting in within the help-​provision context, and why the heteronormative assumption about her partner’s

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gender had an alienating effect as it related to her own struggles to define and conceptualize her experiences of violence as legitimate. This indicates very well how social and cultural assumptions around IPV construct lesbian and queer IPV as unintelligible and thus unrecognizable for those it affects as well as for the help providers. Turell and Herrmann (2008) describe help-​seeking as an ongoing process that involves multiple actors at different stages. Many of their participants expressed a need for functioning peer support within the LGBTQ community as a first response, as well as in the later stages of dealing with the aftermath of IPV. The general support systems outside the community were considered vital after the first responses, as they could offer services that were not available through the LGBTQ communities, such as psychological, legal and medical assistance or shelter services (Turell and Herrmann, 2008:  212). However, some feared homophobic responses and generally expected less understanding from help services that were not targeted at LGBTQ groups. This uncertainty meant that the general services were often thought of as the last resort (Turell and Herrmann, 2008:  219–​20). This study therefore showed a picture of help-​seeking as a process, moving in and out of community and informal contexts to formalized, professional help provision. Unlike Turell and Herrmann’s finding (2008), very few of my interviewees used the LGBTQ community as their first port of call when seeking help. The reasons for this are various, but it is worth noting that practical implications were important:  to date, for example, there is only one organization in Sweden that offers specialized help for LGBTQ people who have experienced violence.4 Apart from such practical issues, a reason to seek help from ‘outside’ could be that communities’ close-​knit structures have their restrictions such as the lack of anonymity, making it harder to reach out for help (Turell and Herrmann, 2008: 215, 218). In my project I  use help-​seeking broadly defined as even formal help support will most often be supported by social network support such as family, friends or colleagues. This view of help-​seeking as dependent on several different types of actors can also be found in Belle Liang et  al.’s (2005) theoretical framework for understanding help-​seeking processes among survivors of IPV. Their theoretical framework entails three stages or processes of help-​seeking, including defining the problem, deciding to seek help and selecting a source of support. These three procedural stages inform one another in a dialectical process and are shaped by individual, interpersonal and sociocultural factors (Liang et al., 2005: 71, 74). Different realms provide different kinds of support at different times. Seeking help against violence thus means crossing different realms of intimacies and in the case of lesbian, bisexual, transgender and queer (LBTQ) victim-​survivors, help-​ seeking transgresses not only the public/​private realms, but also community

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boundaries. Especially if one is involved in smaller communities, there is a higher chance of social exclusion in the case of IPV, which can make it harder to talk about violence within the community, as the break-​up of a couple can turn into a break from the community. According to Ristock this is especially the case in small, close-​knit communities, when people align themselves with one person in the relationship (Ristock, 2005: 9). The precariousness that community connectivity constructs thus creates a need to ‘move outside’ these communities when seeking help against violence. The transgressing character of help-​seeking makes it even more relevant to raise the issue of IPV outside communities’ spheres as well. However, claiming protection against violence has political implications, which will be the focus of the discussion in the last two sections of this chapter. RECOGNIZED VULNERABILITY Vulnerability takes on another meaning at the moment it is recognized, and recognition wields the power to reconstitute vulnerability. (Butler, 2004: 43)

I started this chapter by discussing how violence constructs LGBTQ lives as precarious in several ways, both directly as the object of violence, but also indirectly when experiences of victimization are silenced within the community, leaving victim-​survivors to deal with the violence on their own. Throughout this chapter, I  have argued that visibility and recognition are important factors in shaping social identities and the dynamic between the two can help us to understand the conditions that render LBTQ victim-​ survivors’ lives unrecognizable and thus bioprecarious as their bodily needs are not supported either within the community or beyond. I have argued that the LGBTQ communities bear a responsibility to recognize victimization and to address the obstacles that silence victim-​survivors, as communities’ recognition of violence has a strong impact on the individual’s ability to define the violence as well as to seek help. However, community recognition also needs to be followed by an increasing awareness of the issues within the general support services. The vast majority of my interviewees had sought formal help through services that were not specialized in IPV or violence for that matter. Tina, a woman in her mid-​thirties who had experienced IPV in a lesbian relationship, described her encounter with the help providers at the hospital as a missed opportunity: N:  But you said you were often at the emergency room too? T: Yes.

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N:  What did you tell them when you went there? T:  Well, things like, that you had fallen there or you had … you know such classic intimate violence stuff. Only, when you come in with another woman then no one reacts. N: Mm. T:  Which is a shame because if they had reacted then maybe I would have gotten out faster. Cause I didn’t dare to say anything. Especially not with her in the room and she was just sitting in the room like that. It wasn’t like anyone took me aside or told her to go out or something … asked anything.

Lesbian, queer and bisexual victims of IPV run an enhanced risk of not being recognized as such either by not having their sexual identity acknowledged or having this acknowledged but still or maybe even precisely therefore not qualifying as a legitimate victim of IPV. Tina’s story also emphasizes the potential specificity of lesbian IPV when it comes to institutional recognition, as she enters the emergency rooms on various occasions with bruises and marks from previous injuries to her body. Yet despite this, she is never addressed as a potential victim. Here bioprecarity derives from the very social structures that decide who is seen as worthy of protection. As emphasized by Butler: ʻIn this sense, precarity is indissociable from that dimension of politics that addresses the organization and protection of bodily needs. Precarity exposes our sociality, the fragile and necessary dimensions of our interdependencyʼ (cited in Puar et al., 2012: 170). However, recognition is not just about being seen and counted as a victim, it also concerns a sense of belonging within a certain context. Recognition can take different forms at different stages of the help-​seeking processes depending on time and place. Here I  want to return to Saga, who had primarily sought help through a women’s organization. Although she stated that she was pleased with the help she had received, on several occasions during the interview she also expressed concerns about not fitting in: It might sound stupid because I don’t wish there to be other people with the same experiences as I  but at times I  sort of miss talking to someone who has also lived in a same-​sex relationship where there was physical and psychological abuse. Just because there are so many other aspects apart from that and because in my experience when the question comes up at different occasions and people share their experiences about violence in heterosexual relationship then … well then it doesn’t fit, I don’t fit in or it feels like I am disturbing a bit.

Saga’s expressions of herself as a disturbance can be seen as the result of Fraser’s (2000:  114) concept of misrecognition that ʻis perpetrated, as we have seen, through institutionalized patterns  –​in other words, through the workings of social institutions that regulate interaction according to

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parity-​impeding cultural normsʼ. These patterns represent what Mason (2002: 108, 99) describes as particular discourses that ʻscriptʼ the imaginable options for those who may occupy positions of victims or violator and determine how these positions may be occupied. This can help to explain why Tina, for example, was not recognized as a victim in the emergency room or why Saga describes her experience as a victim as disturbing; they both result in making LBTQ victim-​ survivors unintelligible victims of IPV. Thus, recognition is not just about having your social identity seen. It is about addressing misrecognition, which for Fraser (2000, p.  115) is a question of ʻchanging the interaction-​regulated values that impede parity of participation at all relevant institutional sitesʼ. According to Ristock (2005: 9, 14), universal approaches that assume sameness in experience of violence enhance the precarious position of LGBTQ people who experience violence, when failing to account for the oppressive structures such as racism, sexism, trans-​, bi.-​and homophobia, which render LGBTQ people’s lives precarious in a number of ways beyond the violence in the intimate relationship(s). Thus, the dilemma then concerns how to acknowledge differences in conditions for violence while still addressing IPV as a social and structural issue. According to Ristock (2005) this involves spreading knowledge and awareness around the ways that LGBTQ people’s needs might differ and are therefore not met in the general support services’ approaches. However, Ristock also argues for the need to recognize violence within the LGBTQ communities as a political issue that has the potential risk of being used against LGBTQ people, therefore running the risk of rendering already marginalized groups more vulnerable. This paradoxical relationship between visibility and recognition means that claiming rights for protection is in itself precarious. PRECARIOUS CLAIMS FOR PROTECTION People talk about liberation as if it’s some kind of permanent state, as if you get liberated and that’s it, you get some rights and that’s it, you get some acknowledgment and that’s it, happy now? (Torres, 2016: n.p.)

Torres criticizes the idea that LGBTQ liberation can be permanently resolved through affirmative recognition of identities in terms of legal rights. Claiming protection against IPV for instance also calls for a different kind of mobilization. However, claiming protection against IPV still relies on recognition of social identities and relationships in order to be able to even formulate such claim, which makes it difficult to address IPV as it can

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be seen as potentially harming for the community or for the individuals who raise the issue. As I have discussed throughout this chapter, help-​seeking is transgressing and thus depends on both community and institutional recognition. However, recognition is entangled with distribution of resources as well.5 IPV requires different kinds of measures from psychological and legal counselling addressing both general issues and those specific to LGBTQ individuals. This might concern legal counselling to help individuals whose kinship is not legally recognized, accessible and inclusive accommodation when seeking help against violence or preventative measures such as specific outreach programmes to communities to name just a few (Ristock, 2005: 11). However, according to Ristock (2005: 11) these objectives can only be achieved if the social service institutions critically examine the underlying assumptions, barriers and gaps that exist in current policies and practices that exclude LGBTQ people from accessing their services. Calton et al. (2015) also propose more collaboration between community services and IPV service providers, to make sure that help providers will be aware of the specificity of LGBTQ IPV so that they are able to address potential obstacles for help-​seeking. This could include measures such as adapting a more inclusive language but also to ensure that social services are explicitly LGBTQ friendly (Calton et  al., 2015:  594). Thus, in conclusion, the social organizations and institutions working for protection against violence need to recognize the precarious position of LGBTQ victim-​survivors, in order to become sensitive and aware of the intersecting structures that enable silencing, but they also need to display this recognition to the communities. This applies to all relevant institutional and social sites such as educational institutions, for example, who bear a responsibility to provide resources and support for LGBTQ people as well. Catherine Donovan and Marianne Hester (2008: 277), for instance, propose the inclusion of different sexualities and same-​sex relationships in sex and relationship education, in order to strengthen knowledge about safer sex and non-​abusive relationships for young people in a school setting. To conclude, the overcoming of misrecognition is, according to Fraser, not altered solely by affirming group identities but through overcoming status subordination. In the case of IPV it becomes all the more apparent how such subordinating positions can be both formally and informally institutionalized, sustained in long-​standing customs or through associational patterns or social practices. How can we overcome such misrecognition? I have argued that recognition needs to be accompanied by measures of redistribution in order to change patterns and exclusionary practices that prevent LBTQ victim-​survivors from seeking help against violence. I have discussed throughout this chapter, how the LGBTQ communities’ struggle for recognition through an affirmative approach to justice has made it

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harder to define and narrate violence occurring within the community and in consequence to seek help. Without a collective narrative around IPV, we run the risk of individualizing the issue. The lack of mobilization around certain types of violence within the communities leaves victim-​survivors of IPV unintelligible and burdened by the obligation of positive representation. On top of that, as stressed by Torres (2016) and Crenshaw (1991), the violence embedded in racism, classism, sexism +interacting with homo-​ , bi-​and transphobia shapes the lives of LGBTQ people and impacts not just on what strategies are available to deal with such violence but also how one becomes a recognizable victim within one’s surroundings (Moran and Skeggs, 2004:  14). Here bioprecarity becomes a meaningful concept as it emphasizes the procedural aspects of precariousness that are inscribed in certain bodies in certain spaces and impact on who is seen as legitimate and appropriate to have their needs met or not. This emphasizes the need move away from homogenizing understandings of violence in order to discuss how violence occurs in various spaces and is entangled with social hierarchies of inequality (Ristock, 2005:  9) creating different conditions for violence and help-​seeking. We therefore need to work simultaneously both within and beyond communities and on multiple institutional sites, to reduce the bioprecarious status of LGBTQ victim-​survivors by making IPV a collective and public concern rather than a silenced and individualized matter. NOTES 1 I use the abbreviation LBTQ when referring to my interviewees as a group, as gay men are not part of my study. However, I also use the abbreviation LGBTQ, or terms such as the queer community, when I discuss the community in general terms or when referring to studies that use such terms. 2 The attack on Admiral Duncan refers to a nail bomb attack in London on 30 April 1999, where a right-​wing extremist planted a nail bomb in the gay pub Admiral Duncan in Soho, killing three people and injuring seventy-​nine, just days after targeting the Black and Asian communities in Brixton and Brick Lane. More than a hundred people were injured during the three attacks (MacLeod, 2005). 3 I use the term community similarly to Berlant and Warner’s (1998) concept of queer culture, as I  consider community as more than a physical location or confined social groups but also as ideological identifications, which constructs an imaginary of belonging on several levels. 4 RFSL Stödmottagning (RFSL Support Service) is located in Stockholm and has since 1998 offered support service to LGBTQ people who have experienced hate crimes, domestic abuse, honour-​based violence or sexual violence. They also provide services for relatives and friends of LGBTQ people who have experienced violence and for professionals working with LGBTQ people (RFSL, n.d.).

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5 Fraser makes an analytical distinction between recognition and redistribution but emphasizes the ways in which the two are imbricated and interacting, for instance in the status model (Fraser 2000:  118), which is the concept I  have used when referring to Fraser’s concept of (mis)recognition.

REFERENCES Ard, K. L. and Makadon, H. J. (2011) ʻAddressing intimate partner violence in lesbian, gay, bisexual, and transgender patientsʼ, Journal of General Internal Medicine 26(8): 930–​3. Balsam, K. F. (2001) ʻNowhere to hide: Lesbian battering, homophobia, and minority stressʼ, Women & Therapy 23(3): 25–​37. Barnes, R. (2011) ‘ “Suffering in a silent vacuum”: Woman-​to-​woman partner abuse as a challenge to the lesbian feminist visionʼ, Feminism & Psychology 21(2): 233–​9. Berlant, L. and Warner, M. (1998) ʻSex in publicʼ, Critical Inquiry 24(2): 547–​66. Butler, J. (2004) Precarious Life: The Powers of Mourning and Violence. London: Verso. Calhoun, C. (2000) Feminism, the Family, and the Politics of the Closet: Lesbian and Gay Displacement. Oxford: Oxford University Press. Calton, J. M., Cattaneo, L. B. and Gebhard, K. T. (2015) ʻBarriers to help-​seeking for lesbian, gay, bisexual, transgender, and queer survivors of intimate partner violenceʼ, Trauma, Violence, & Abuse 17(5): 585–​600. Crenshaw, K. (1991) ‘Mapping the margins: Intersectionality, identity politics, and violence against women of color’, Stanford Law Review 43(6): 1241–​99. Donovan, C. and Hester, M. (2008) ‘ “Because she was my first girlfriend, I  didn’t know any different”: Making the case for mainstreaming same-​sex sex/​relationship educationʼ, Sex Education 8(3): 27–​87. Edwards, K. M., Sylaska, K. M. and Neal, A. M. (2015) ʻIntimate partner violence among sexual minority populations: A critical review of the literature and agenda for future researchʼ, Psychology of Violence 5(2): 112–​21. Fraser, N. (2000) ʻRethinking recognitionʼ, New Left Review 3: 107–​18. Giorgio, G. (2002) ʻSpeaking silence:  Definitional dialogues in abusive lesbian relationshipsʼ, Violence Against Women 8(10): 1233–​59. Girshick, L. B. (2002) Woman-​to-​Woman Sexual Violence: Does She Call It Rape? Boston: Northeastern University Press. Guadalupe-​ Diaz, X. L. and Jasinski, J. (2016) ‘ “I wasn’t a priority, I  wasn’t a victim”: Challenges in help seeking for transgender survivors of intimate partner violenceʼ, Violence Against Women 3(2): 160–​71. Holmes, C. (2009) ʻDestabilizing homonormativity and the public/​ private dichotomy in North American lesbian domestic violence discoursesʼ, Gender, Place & Culture 16(1): 77–​95. Kaukinen, C. (2002) ʻThe helpseeking of women violent crime victims:  Findings from the Canadian Violence Against Women Surveyʼ, International Journal of Sociology and Social Policy 22(7/​8): 5–​44. Liang, B., Goodman, L., Tummala-​Narra, P. and Weintraub, S. (2005) ʻA theoretical framework for understanding help-​seeking processes among survivors of intimate partner violenceʼ, American Journal of Community Psychology 36(1–​2): 71–​84.

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MacLeod, D. (2005) ʻLondon: past terror attacksʼ, Guardian, 7 July. Available at www. theguardian.com/​uk/​2005/​jul/​07/​terrorism.july73 (accessed 26 September 2018). Mason, G. (2002) The Spectacle of Violence: Homophobia, Gender, and Knowledge London: Routledge. McClennen, J. C. (2005) ʻDomestic violence between same-​gender partners: Recent findings and future researchʼ, Journal of Interpersonal Violence 20(2): 149–​54. Moran, L. J. and Skeggs, B. (2004) Sexuality and the Politics of Violence and Safety. London: Routledge. Puar, J., Berlant, L., Butler, J., Cvejic, B., Lorey, I. and Vujanovic, A. (2012) ʻPrecarity talk: A virtual roundtable with Lauren Berlant, Judith Butler, Bojana Cvejić, Isabell Lorey, Jasbir Puar, and Ana Vujanovićʼ, TDR: The Drama Review 56(4): 163–​77. RFSL (n.d.) RFSL Support Service. Available at www.rfsl.se/​en/​rfsl-​support-​service/​ crime-​victim-​support (accessed 9 November 2018). Ristock, J. L. (2005) ‘Relationship violence in lesbian/​gay/​bisexual/​transgender/​ queer [LGBTQ] communities:  Moving beyond a gender-​ based framework’, Violence Against Women Online Resources. Available at http://​citeseerx.ist.psu. edu/​viewdoc/​download?doi=10.1.1.208.7282&rep=rep1&type=pdf (accessed 10 February 2017). Thorvaldsdóttir, T. (2010) ʻIceland 1869–​1992: From silence to rainbow revolutionʼ, in Rydström, J. and Mustola, K. (eds) Criminally Queer:  Homosexuality and Criminal Law in Scandinavia 1842–​ 1999. Amsterdam:  Aksant Academic, pp. 117–​44. Torres, J. (2016) ‘In praise of Latin night at the queer club’, Washington Post, 13 June. Available at www.washingtonpost.com/​opinions/​in-​praise-​of-​latin-​night-​at-​ the-​queer-​club/​2016/​06/​13/​e841867e-​317b-​11e6-​95c0-​2a6873031302_​story.html (accessed 23 November 2017). Turell, S. C. and Cornell-​ Swanson, L. V. (2008) ‘Not all alike:  Within-​ group differences in seeking help for same-​sex relationship abuses’, Journal of Gay & Lesbian Social Services 18(1): 71–​88. Turell, S. C. and Herrmann, M. M. (2008) ‘ “Family” support for family violence: Exploring community support systems for lesbian and bisexual women who have experienced abuse’, Journal of Lesbian Studies 12(2–​3): 211–​24.

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PRECARIOUS SUBJECTIVITIES Understanding the intimate labour involved in seeking clitoral reconstruction after female genital cutting M al in J or dal

INTRODUCTION

U

tilizing three case studies of women with female genital cutting (FGC) in Sweden, this chapter discusses how precarious subjectivities are created and manifested through female genital cutting and its aftermath. First, undergoing FGC involves bodily vulnerability of physical, sexual and psychological kinds. Second, for women belonging to an immigrant (and often African) minority, bioprecarity can manifest itself through corporeal, cultural and structural racism (Gondouin, 2012; Pred, 2002), which places them at the lower end of the social hierarchy. A third cause for their particular bioprecarity relates to finding themselves ‘cut’ in surroundings where FGC is considered ‘barbaric’ and ‘uneducated’ and thus produces them as ‘victims’ of FGC. These factors are likely to be amplified by the fact that they are ‘women’ with ‘women’s problems’, thus are less likely to be prioritized by the state and the health care sector. Worldwide, around two hundred million women and girls have undergone some form of FGC (UNICEF, 2016a). Around half a million of these are estimated to live in Europe due to immigration from FGC-​practising countries (van Baelen et al., 2016). In recent years Sweden too has seen extensive immigration from countries practising FGC, particularly Somalia, Eritrea and Ethiopia (Statistical Central Bureau, 2015). Recent estimates suggest that more than thirty-​eight-thousand girls and women living in Sweden have undergone FGC (Socialstyrelsen, 2015), resulting in one the highest FGC prevalence rates in Europe. Rising public awareness about FGC has led to its increased visibilization in public media and discourse (Johnsdotter, 2002).

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FGC is often carried out on young girls without consent (UNICEF, 2016b). Its rationale varies, but includes being part of a ritual necessary for proper womanhood, marriage and/​or full membership of the community (Ahlberg, 2002); safeguarding women’s sexual morality (Johansen, 2017); and religious justifications (Johnsdotter, 2002). There are different types of cutting, including the cutting of the clitoris (clitorectomy), labia minora/​majora (excision) and/​or closing of the vaginal orifice (infibulation) (WHO, 2014). Negative health consequences of FGC are widely described in the literature, where immediate health risks include infections, excessive bleeding, shock and even death (Berg and Denison, 2012; Berg et al., 2014). Long-​ term consequences can involve cysts, scar tissue, sexual problems and difficulties in passing menstrual blood or urine, particularly if infibulated (WHO, 2014). Yet, the occurrence of sexual problems is sometimes contested due to a lack of comparative evidence or research showing little or no difference in sexual health between cut and non-​cut women (Catania et  al., 2007; Obermeyer, 2005). Nonetheless, due to its perceived harmful consequences and non-​consent, FGC is today widely recognized as a violation of girls’ bodily integrity and women’s sexual and reproductive health (WHO, 2008). Transcultural migration and societal changes create new perceptions of the body, self and identity. More specifically, migration of FGC-​affected women and girls to Sweden may result in unsettling the norms around the gendered body, new notions of bodily rights and what is perceived as legitimate health care needs and claims. Advances in biotechnology have resulted in new possibilities for cut women to have their clitoris reconstructed. Developed by the French urologist Pierre Foldès in the 1990s, clitoral reconstruction (CR) is now available in an increasing number of European countries, including Sweden (Jordal and Griffin, 2017). The surgery promises a functionally and aesthetically restored clitoris for women with FGC, which thus implies an enhancement of sexual capacity (Foldès et al., 2012). Conceptualizing bioprecarity Utilizing the concept of bioprecarity, I  investigate women’s experience of FGC and CR in the context of Sweden. My understanding of bioprecarity is an elaboration of the notion of Judith Butler’s (2004) work on precarity and Michel Foucault’s theorization of bios (Rabinow and Rose, 2006). I take an intersectional approach (Crenshaw, 1991) in considering how categories such as ethnicity, gender, sexuality, class and economic status interact to produce a specific kind of bioprecarity.

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In part, bioprecarity builds on Foucault’s understanding of biopolitics and biopower as reformulated by Rabinow and Rose (2006). Foucault’s understanding of ‘bio’ refers to human life. This intersects with Foucault’s notion of categories as a ‘hierarchizing structure of differences’, where some populations (groups, individuals) are classified differently from others (Foucault, 2002; see also Leibetseder, Chapter 2 this volume). Such categorizations produce social in-​and/​or exclusions (Foucault, 2002). In order to control such in-​or exclusion, individuals discipline their bodies (Foucault, 1977). Individuals constantly manage their selves in relation to their social environment, but also in relation to the biotechnological possibilities in a given society. This means that people make choices about their lives and are constrained by the existing possibilities (or lack of these). Foucault acknowledges this process as coercive due to people’s constraint by the prevailing discourse, but also as agentic and liberating. In Precarious Life (2004), Butler explains the notion of precariousness in terms of vulnerability. The latter serves as a basic human condition that allows us to have a common ground in a possible political community. Precariousness is, according to Butler, an ontological dimension of lives and bodies. Yet, while all humans are precarious, some are more precarious than others, depending on their social, political and economic conditions. Thus, there is an inequality and hierarchization in relation to precariousness. Governments and institutions play a significant role in this hierarchization of people and their value through the orders and structures they establish. Foucault’s and Butler’s notion of categories is thus of a hierarchizing structure of differences. According to some feminist and post-​ colonial scholars, categories of race, class and sexuality are important markers in the hierarchization of bodies and of people’s lived experiences (Crenshaw, 1991; hooks, 1992, 2015; Skeggs, 1997). Categorization creates and intensifies bioprecarities, since it serves to identify and control vulnerable groups (see Leibetseder, Chapter 2 this volume). Mostly belonging to marginalized and racialized African minorities (Pred, 2002), women with FGC living in Sweden navigate multiple systems of cultural expectations and prescriptions. While FGC in African countries is often carried out to signify bodily and cultural belonging and create the ‘mature, desirable and marriageable woman’, in a European context it instead symbolizes ‘the deviant other’ (Pedwell, 2010). I suggest that living with FGC in Sweden makes these women bioprecarious in specific and multiple ways and will now analyse three case studies of FGC-​affected women who asked for CR in Sweden, in order to demonstrate how a certain kind of vulnerability is played out on these women’s bodies.

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ANNA, FATOU AND LEILA: THREE WOMEN SEEKING CR The three histories discussed below are extracted from a larger data set of twenty-​one interviews with women requesting, and most of them undergoing, CR surgery. All the interviewed women were recruited in a hospital setting by the operating surgeon. The women were interviewed twice; prior to surgery and six to twelve months post-​operatively. The pre-​operative interviews focused on how they perceived living with FGC, including their memory and perception of undergoing FGC; their pre-​ operative genital, mental or sexual situation and how this affected their social and intimate relations; and their motives and expectations of surgery. The post-​ operative interviews focused on their reflections and experiences of having undergone CR. Anna I met Anna, a thirty-​eight-​year-​old woman from Eritrea, for the pre-​op interview outside a Stockholm tube station. It was early spring and we discussed where it would be most comfortable to do the interview and decided on a bench in a park nearby. Anna had lived in Sweden for twenty-​ five years. She told me she was married on paper, but single in practice. She had undergone FGC Type III (with partial infibulation) at a young age but could not remember it. Anna recounted a history of psychological difficulties. Even though she could not remember the actual cutting, she ascribed much of her psychological ill health to it. This in her view had resulted in a lifelong bodily unease. She described this unease as both mental and physical. In particular, it had made her unable to be comfortable in intimacy with a partner. Thus, she felt that FGC had affected her ability to form healthy relationships, as ‘it hinders emotional development and affects one’s personality’. For Anna, it had been difficult to be open about her FGC –​it was rather something that she wanted to hide: Malin:  Did you feel that it was mental or also a physical sense of uneasiness? Anna:  Both and. Physically, I couldn’t be comfortable if I was with my partner and we were to have an intimate relation. ‘It doesn’t work’ I felt in general. I couldn’t undress and feel comfortable, that I cannot do even today. Malin:  No … Do you see this as having to do with the FGC? Anna: Absolutely. Malin:  You think so? Anna:  It is almost like one is hiding something, something that one doesn’t talk openly about. But the older I got, the more I could open up, and it became better … But still, I have always felt uneasiness.

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Due to her psychological problems, Anna had been having therapy regularly for the last eight to nine years. Yet, she was unsure how much this had actually helped her. She believed that of all her difficulties, the FGC had affected her the most; she recounted becoming psychotic when pressured to talk about it. Furthermore, Anna had seen a sexologist as part of the requirement before CR surgery, which she recalled as positive, at least to understand the whole concept of CR surgery. But at the same time she thought it might have affected her negatively, as she felt very uncomfortable talking about FGC. Anna was also reluctant to be open about her FGC because she feared ‘that people would start talking’. She recalled a friend who had talked openly about her FGC, which had resulted in people talking negatively about her behind her back. This made Anna choose not to talk openly about her FGC or her plans for undergoing CR. Not remembering the actual cutting, Anna had sought confirmation and information of her FGC with several doctors and gynaecologists; she wanted to know whether and how much she had been cut. The message she got was that she was ‘normal’, i.e. not cut. Although this made her happy, she simultaneously did not believe it as she somehow ‘knew’ she was cut. This was also confirmed by other doctors later. Thus, the initial assurance by health personnel of not being cut had only confused her. Anna told me that she had previously undergone defibulation (opening) surgery. Recounting the defibulation, she said that this had made her feel a bit better, but at the same time it was not what she had hoped for. Encouraged by her gynaecologist, she had now opted for CR, which she hoped would make her feel differently. Yet, Anna found it difficult to explain exactly what she thought CR might do, apart from ‘restoring something missing’ and resulting in her feeling more at ease with herself. Perhaps this could enable her to start building a ‘normal life’. She also hoped that her genitals would look better after the surgery. This did not mean that she was unaware of the risks of surgery. However, she was willing to take them, largely because she trusted in the surgeon’s competence. Six months post-​operatively, I met Anna for the follow-​up interview. We had decided to meet in a café in town, and seated ourselves in a quiet corner. I wanted to know if the surgery had met her expectations. She started by saying that she was happy that she had had the surgery and that it felt ‘much more comfortable now than before’. Having gone through surgery had improved her self-​confidence and she now felt more at ease in her body. But at the same time there were some disappointments. These were mainly related to feeling that her clitoral sensation had not improved as expected. However, since the interview was conducted only six months after the surgery (prematurely as Anna had plans of moving abroad), she hoped that her

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clitoral sensation would improve still further; the surgeon has said that it might take up to a year. Malin:  Is there less sensation [in the clitoris] now than before the surgery? Anna:  Well, it is a little bit difficult to say, but I would say yes and no. Both and. Malin:  Both and, and in which sense would you say? Anna:  Well, it is that … It is not as sense … It is hard to say, yes. Because I would be able to say no too, because it feels very good. So that, but if I should say no, I would also say that it … that it may not feel as natural in a way. Malin:  Less natural now than before? Anna:  I think so. It is perhaps a strong word to use, but …

Despite the less than optimal clitoral sensation, she explained that having undergone CR had cheered her up, made her feel relieved and happier with herself. Also, it had made her more relaxed and less anxious, particularly in relation to being naked with a partner. At one point during the interview, she asked me if I  could recognize any difference in her confidence compared to when I  had interviewed her the first time. She said that she felt us to be more equal now than at the first interview; her restored clitoris created a sense of communion with others in society: ‘So it feels like, I  don’t know if you can notice, since we met last time and now? Now it feels like we are more equal in some sense … One is getting the feeling that, some kind of communion with others. So that I think is cool.’ Still, except for one friend and her sister, Anna had not talked with anybody about her CR surgery. This was mainly related to her fear that people would start talking about her, which had happened to her friend. On the other hand, she felt a desire to tell others about having undergone CR, especially if they also suffered due to their FGC. Fatou Fatou was a thirty-​year-​old woman from the Gambia who had lived in Sweden for five years. She was currently married to a Swedish man and had a five-​year-​old child. I interviewed her at the hospital premises in a private room on the same day she was scheduled for her CR operation. Fatou had undergone FGC II (excision) at the age of two months, which meant that she, too, could not remember the actual cutting. For Fatou, FGC had first become an issue when she started to have sex. She was then around eighteen years old. She recalled beginning to realize ‘the importance of the clitoris’ when she did not feel much pleasure during sex. Her then boyfriend had also told her she was ‘missing something’. This had intensified the feeling that there was something wrong. While it had been emotionally disturbing

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to hear this, she also felt that he was right. She said that like most men in Gambia he knew the difference between cut and uncut women. Because men from Gambia, they know the difference, even my boyfriend before, he told me he can tell the difference between the ones they cut and the ones they didn’t, because you know, the way you are active in bed. You know it so it is very bad (laughing) so, they actually say it and maybe it is like, they mock you, they tell you ‘you are not good in bed’ or ‘you cannot do this or that’ (embarrassed laughing).

Fatou said that she had never experienced an orgasm and related this to being cut, even though she was aware that some cut women were able to have an orgasm. She recounted telling her friend that if she ever got the possibility to restore her clitoris, she would, even if it cost money. Yet she had at that point not really believed that this might happen. Thus, learning about the possibility for CR in Sweden was like a dream come true for her. I did many searches in Google and saw what it [FGC] did to women regarding the sexual part and delivery, and something like that. So I told my friend, ‘If I see they are doing this operation, even if it cost money I will do it’. She was just laughing and I just took it as a joke. Then just a month ago, I was looking at TV, and I saw this and I said ‘Oh my god!’ I just took my telephone and called her, and she said, ‘So, your dreams come true!’

Fatou told me that she had never really enjoyed sex. While having sex regularly with her husband, this was more for his sake than for hers, always using lubricating creams to avoid dryness and pain. She hoped that the CR would result in improved sexual desire and pleasure and the ability to orgasm. Yet the sexual dimension was not the only important rationale for the CR, it also had to do with her sense of womanhood. She wanted to have her clitoris back in order to ‘become a full woman’ again:  ‘Yeah, not only at the sexual part, but I think I will have, I will be a full woman again (laughing). That’s what I think, but I don’t know. Because I can see, like this [the clitoris] missing from you, you can be a woman, but not a full one. But when I get it back I think I can be a full woman (laughing).’ In contrast to Anna, talking about her FGC had not been that difficult for Fatou; she had talked to her friends and sisters about it many times. She had even asked her mother why she had made her undergo FGC, who had replied that it was important for her sexual respectability. Fatou had also talked openly about her plans for CR surgery to her mother, her sisters and friends, but they had either not believed her or indicated that she was ‘crazy’: ‘But my people [people from Gambia] they think you are crazy, if you open your mouth and tell them you are going to have that operation and have that thing [the clitoris] back, they

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will think that they should take you to a psychiatrist because you are not well.’ Her sister had discouraged Fatou from undergoing surgery, worrying about the risks, something that made Fatou less enthusiastic to talk to her about it. So, even if on the phone with her sister the whole night before the surgery, she had refrained from mentioning the operation the upcoming day, which felt strange. Fatou had talked to her husband about her FGC, but thought in general that this was not something he could relate to. While he had never told her that there was something wrong with her, as her first boyfriend had, she believed that he too recognized the difference between cut and uncut women. Her husband supported her in having CR, but he had never pushed her. However, she recalled with unease the first time he had learned about her FGC: ‘I am the first cut one he saw, he never saw it before. So the first time he told me “you people are animals” (laughing embarrassingly).’ I met Fatou at the hospital premises for the post-​operative interview around a year after her operation. She started by saying that it had taken time to heal and that the pain had been more intense than expected. Yet, eventually the wound had healed and Fatou was very happy now with having gone through the surgery. Her ability to enjoy sex, and even reach orgasm, had improved drastically following CR; she no longer used lubricants as she lubricated naturally. She also felt like a whole woman again. She explained: Fatou:  Not even the sexual part, I am happy that I have … I have a, I’m like, I am a woman I can see, I am. So (laughing a little) that makes me happy. Malin:  The visual part makes you happy. But the sexual part? Fatou:  The sexual part too. Malin:  Yeah? How, can you describe, has it changed anything on the sexual part? Fatou:  Yeah, it changed. Malin:  Mmm, how? Fatou:  Like, I can say I, I do have sex, like orgasm (Yes?) which I never expected I was going to have usually, I have that during having sex.

Even her sexual desire had improved; while before she had seldom enjoyed sex she now both desired and enjoyed sex:  ‘Now I  know that I  am having sex’, she said laughingly. Yet interestingly, Fatou told me that for a period after the operation, the little sensation that she had had in the clitoral area had vanished, which had been worrying. She had first tried to massage the clitoris and apply creams, but then given up. After some time she had tried again and experienced that the sensation had returned and was stronger than before. This was the beginning of her new sex life. She was also very happy with the aesthetic results of the surgery. However, the most important aspect of the CR for her was to have taken back what had been taken from her.

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Leila was a thirty-​three-​year-​old woman from Somalia, who had lived in Sweden since her childhood. She was divorced and currently single. Leila underwent FGC Type III (infibulation) at the age of six when still in Somalia. She said she was fortunate; since her family were better off financially, so she had undergone FGC under local anaesthetic in a hospital setting. But due to an infection afterwards, she still remembered her FGC as very painful. As she had been infibulated with a very small opening, she had also experienced problems urinating and menstruating. A  few months after arriving in Sweden, her mother had taken her to a doctor for defibulation. This had reduced her menstrual cramps and eased the urine flow, but it had also made her urinate in all directions and left her genital area exposed and oversensitive. Leila worried what a future husband or fellow Somali would think and if it had been unwise to undergo defibulation. This made her reluctant to talk about it. I felt it [defibulation] was positive when I  associated with my classmates who were not infibulated or didn’t know anything about it. At the same time I had a bad conscience like, ‘What will my future husband say? How do my countrymen see this? Are others defibulated, is it ok to be defibulated among others? What will the women say about me?’ So in that sense I felt outside that group … That I didn’t live up to the norm.

Leila partly blamed herself for having undergone infibulation, saying that if it had been up to her mother, she would have undergone a milder form. But because she wanted to be part of the group, she had asked for infibulation, which her grandmother had pressured her mother to agree. Thinking that her mother already felt bad for what Leila had had to go through, she did not want to tell her mother about the planned CR. She had not told anybody else either. Leila had had only one sexual partner in her life, and that was her ex-​ husband. She described sex with him as pleasurable and did not think, as Fatou and Anna, that the FGC had affected her sex life negatively. The only negative aspect was that she felt embarrassed exposing herself to him. Her discomfort in doing so was, however, not related to something he had said or indicated, but to her own perception of her genitals as ‘ugly’. Thus, Leila’s motivation for undergoing CR was not related to sex. Instead, she wanted surgery to change the aesthetics of her genitals, which she thought looked ‘too open’ and exposed after the defibulation. She hoped the surgery would make her vulva look natural or at least ‘as natural as possible’. Leila had considered reconstructive surgery for a long time, but thought that it would cost money. She was grateful for CR being available freely in

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Sweden, which saved women like her from paying large amounts of money and travelling abroad for CR. Leila thought there were many other women who, like her, ‘wanted to fix themselves’. It also felt reassuring to receive help from someone knowledgeable about the issue, which she considered the surgeon to be. The post-​operative interview was carried out around a year after the operation, over the telephone. When I asked how satisfied Leila was with the CR she hesitated. On the one hand, the problem with oversensitivity had improved, but on the other, she felt that the aesthetic aspects had not improved much. On further probing, she said that she might not have been clear enough with the surgeon when describing what she wanted and expected from the surgery: Malin:  But do you feel that there was like a communication problem between you and the surgeon, that he didn’t understand what you wanted? Or? Leila:  I think I might not have been clear enough.

At the time of the interview, Leila had already met the surgeon for the one-​year, post-​surgery follow-​up. She had then told him about her dissatisfaction. He had examined her, and said he thought she looked fine and that there was not much more he could do anyway. In any case, Leila says, she was not prepared to go through another surgery, mainly because her experience of FGC had been traumatizing due to the infection, but also because she had promised herself that this would be her last operation. In fact, she told me, she had been nervous prior to the CR, fearing flashbacks to the actual cutting. She had also worried that the CR would be unnecessary and not as she expected, which turned out to be partly true. All this she had kept to herself, except for two sisters, the only ones to know about her CR. Despite her fears of post-​surgery complications and pain, the healing process had gone well; she could walk and pass urine without problems directly afterwards. And even if it felt a little bit uncomfortable, she now understood why, something that had not been the case after the actual cutting or defibulation. When I asked Leila whether she would have gone through the surgery at all if she had known the outcome, she said yes; after all her problem with oversensitivity and discomfort in the genital area had disappeared following surgery. Furthermore, on Leila’s post-​operative visit to the surgeon he had shown her pre-​and post-​operative pictures of her genitals. She explained that these pictures had ‘calmed her down’, as she realized that the surgery had after all improved the appearance of her genitals. She just wished this post-​operative visit had come earlier, as it had  been important for how she felt about her body and the effects of the surgery.

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Bioprecarity and boundaries of intimacy DISCUSSION

Utilizing these three case studies, I  will now discuss how bioprecarity is manifested here. I  understand bioprecarity, alongside with others in this volume (e.g. Ovesen, Chapter  9), to be the articulation of vulnerability affecting individuals’ or groups’ bodies and lives, indicating a certain kind of precariousness inscribed in certain bodies in certain spaces. How this vulnerability comes into play varies depending on how individuals and groups are categorized in particular contexts. The bioprecarity involved in living with FGC As mentioned in the introduction to this chapter, Anna, Fatou and Leila had migrated from a context where FGC was considered ‘normal’, even if increasingly challenged by global and local anti-​FGC discourses. Anti-​FGC campaigns inevitably produce categories. Anna, Fatou and Leila, along with most of the interviewed women in this study, had at a certain point in time come to share the view of FGC as violence and harmful to their sexuality. This involved associating their selves with the category ‘cut’ and was demonstrated by articulations of feeling violated and deprived of something important for their capacity for sexual enjoyment. Butler notes that historical and discursive meanings attend human sexual organs (Butler and Athanasiou, 2013). Unsurprisingly, the interviewed women largely considered themselves to have ‘damaged’ genitals due to FGC. Consequently, they experienced shame related to their ‘mutilated’ genitals. This troubled their sense of self. This self and other categorization of ‘women as victims of FGC’ manifested corporally, producing a certain kind of bioprecarity. One aspect of this was the sense of being violated and mutilated (Jirovsky, 2014; Jordal and Griffin, 2019; Pedwell, 2010). Living with FGC was a bodily and psychological experience, such that Anna described having lived her whole life with a feeling of ‘bodily unease’. Her difficulty in describing this unease can be related precisely to her experience being ‘bodily’ and sensed, thus difficult to convey with words. Even when medical personnel declared her ‘uncut’, she did not fully believe this as her bodily experience told her otherwise. The desire for confirmation of being cut not being met was not particular to Anna (Sveriges Radio, 2018) and can be read as a mismatch between body and mind. The reason why medical doctors may not confirm such cutting may be inexperience in recognizing FGC or a benevolent attempt to make the woman feel ‘normal’ (Levin, 2018). Yet, for Anna, this only intensified her feeling of precariousness. Anna’s experience also indicated another layer of her precariousness.

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The combination of her bodily discomfort and perception as cut resulted in physical, mental and emotional unease, which, according to Anna, hindered her from developing emotionally mature, intimate relationships and created a sense of inferiority relative to other (non-​cut) women. While also a bodily experience for Fatou, FGC seemed for her more a concern in relation to sex in particular. Growing up in Gambia where FGC is common but not universally practised, she had not thought much about it until she started having sex. In the Gambian context where ‘cut women’ are seen as sexually incapable (Lien, 2017), she felt unable to have satisfying sexual experiences. This affected her sense of womanhood; without her clitoris, a symbol of female sexuality, she felt she was not ‘a whole woman’. As with Anna, this made her feel inferior compared to non-​cut women whose sexual capacity she valued and envied. This resulted in bodily and social precarity. Furthermore, because the female body is often ‘object and prey’ for the male gaze and judgment (Weitz and Kwan, 2010), exemplified in Fatou’s account of being judged and mocked by her first boyfriend, her bioprecarity intensified in terms of being vulnerable to discursive violence or injury (Ovesen, Chapter 9 this volume). Leila’s story conveys yet a different perspective. Leila did not feel that having undergone FGC had affected her sexual capability nor her sense of womanhood. Instead, she was concerned with aesthetic aspects of her genitals, which made her ashamed and reluctant to undress in front of a partner. Furthermore, her defibulation had put her in an ambiguous position where she neither fitted the ideal ‘Somali woman’ (which implies infibulation), nor the ideal ‘Swedish woman’ (which implies non-​cut). This illustrates what Leibetseder calls ‘falling outside categories’ (Leibetseder, Chapter  2 this volume):  outside two categories of ideal womanhood. There is an evident hierarchy among these categories; Leila, Anna and Fatou all did not want to belong to the category of ‘cut woman’ any longer. This may be because ‘cut genitals’ can denote ‘barbarism’ and ‘backwardness’ (Pedwell, 2010; Pred, 2002) in Western contexts such as Sweden, while ‘non-​cut’ denotes sexual liberation, modernity and freedom from patriarchy, ideals prevailing in contemporary Sweden. Thus, the women’s desire to change their category from ‘cut’ to ‘non-​cut’ related both to space (‘barbaric Africa’ versus ‘enlightened’ Sweden’) and time (‘traditional/​backward’ versus ‘modern’). A  failure to fit into categories, or desire to switch categories, produces a particular kind of bioprecarity as a function of falling outside, of not fitting in. All three women were affected in their sense of self. They dissociated from their cut genitals, a process that Butler (2004) recognizes as part of identification itself. Ambjörnsson (2016: 96) writes that one way of deviating from the heterosexual matrix (Butler, 2006), which has a strong normative

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effect, is, even if performing the ‘right’ gender and heterosexual desire, to display the ‘wrong’ bodily characteristics, features or functions. This would lead to what Signe Bremer (2011) refers to as ‘cultural awkwardness’.1 This phrase denotes a contrast to persons who do not have to think much about their bodies, gender identity and gender expression and who do not experience their situation as more or less comfortable (Ambjörnsson, 2016: 96). This is how I understood Anna’s, Fatou’s and Leila’s experiences: living with FGC implied an intensified awareness of their genitals. This resulted in what I understand as bioprecarity: a sense of bodily discomfort that implied shame and a feeling of inferiority, and interfered with these women’s life opportunities and experiences. This intertwining of capacity, aesthetics and identity is recognized by Weitz (2010), who suggests that it has implications for women’s sense of self. In the case of these women living with FGC, bioprecarity manifested itself in three ways: an inability to enjoy sex, regretting how their genitals looked, and a troubled self-​identity. Consequently, the women disciplined their bodies (Foucault, 2002) by avoiding intimate relations, forcing themselves to have sex despite a lack of desire, not talking about their experience of FGC or containing difficult emotions for fear of being ‘talked about’ and by opting for CR surgery. Bioprecarious surgery Women’s request for CR surgery raises questions of victimhood and agency. Tired of being ‘victims of FGC’ and the sexual, emotional and mental suffering this entailed, the women wanted to switch category to ‘a non-​cut, sexually able, and “normal” ’ woman. This can be seen as a form of self-​surveillance and of disciplining their bodies to ‘fit’ into contemporary ideals of modernity and sexually emancipated womanhood, thus as obedience to patriarchy (Foucault, 1977). But on the other hand it may also be viewed as a form of agency. Perceiving FGC as a form of patriarchal violence and misogynist oppression, opting for CR was by many of the interviewees, including Fatou, Anna and Leila, voiced as a way to ‘take back’ power over their own bodies. This indicates that the body is an important site where power can be played out (Weitz, 2010). Weitz (2010) writes that investing in the body and its attractiveness is an indirect form of power. Thus, when Leila opted for surgery to look ‘normal’, this was a way of disciplining her body into fitting the normative ideal, and of exercising individual disciplining power, thus a practice of liberation, according to Foucault. As individual choices are laden with political meaning (Weitz and Kwan, 2010), this is also the case with women opting for CR. Yet, most of the women found it difficult to talk openly about their FGC, their desire for CR surgery and their potential fears about it. As indicated

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by Anna and Leila, this was largely related to considering FGC a taboo; talking about it could render the women vulnerable to ‘gossip’. However, it was also related to an unwillingness to voice discontent with one’s already stigmatized and racialized culture and community. Knowing that Somali immigrants were already subject to the ‘gaze’ and receiving media attention as ‘barbaric and uneducated’ people who ‘cut their daughters’, many of the interviewed women felt that they could not afford to reinforce this image. Further, talking about their desire to undergo CR involved risks of being classified as ‘crazy’, as in the case of Fatou, or making parents feel bad for having let one’s daughter undergo FGC, as in the case of Leila, or being seen as at risk of being considered ‘sexually loose’, as implicitly conveyed by Anna. The resultant need to deal with their thoughts and concerns regarding surgery on their own intensified bioprecarious feelings. In their quest for CR, women are required to reveal their assaulted status and display their intimate and stigmatized body parts to health care professionals. Women wanting CR are thus precarious in that they have to expose themselves to the gaze and the judgement of health care teams providing surgery to decide whether or not they can have it. For example, previous studies have shown that women wanting CR surgery are required to talk about the FGC in terms of ‘violation of bodily integrity, harmful for health and of rejecting the culture perpetuating FGC’ in order to be considered eligible for surgery (Villani, 2009). Consequently, women opting for CR are required to articulate private emotions about their cutting, its effects on intimate relationships and sexuality, intimate accounts of their psychological state and display their genitals in order to claim the right to CR surgery. Anna described this as particularly difficult, when saying she had become psychotic when forced to talk about her FGC. Such expectations by health personnel of expressing and translating private emotions into a public setting may maintain and amplify bioprecarity. The women were also required to control the display of their hopes and desires for the surgery, as when Fatou refrained from mentioning her surgery to her sister on the phone. The women thus felt compelled to control any potential emotional and psychological upheaval associated with CR, its management in case of surgical complications and in handling potential disappointment with the surgery. This was exemplified by Leila, who experienced disappointment regarding the surgery, and to a certain degree by Anna, who still lived in the state of ‘not knowing’ the final outcome at the time of the interview and who had ‘hoped for more’. Yet, there was little room to discuss their concerns with others or to voice their disappointment with the surgeon, although Leila had done so at the one-​year post-​operative check-​up. While seeing the surgeon had changed Leila’s level of disappointment, it also meant that she had lived in a state of unease for a year.

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Fatou also voiced uncertainty related to the outcome of the surgery, having experienced diminished sensitivity in the clitoral area for some months. Despite their concerns and heightened bioprecarity, all three women articulated a sense of ‘relief ’, thus indicating that they felt less precarious after the surgery. Anna felt more relaxed in her body, and able to undress in front of a partner. And perhaps more importantly, she no longer felt inferior to uncut women. Fatou, too, was happy about the surgical outcomes; she no longer had to use lubricants, enjoyed sex and was able to orgasm. Furthermore, CR had affected her sense of self; she now felt like ‘a whole woman’. And while Leila had initially been disappointed with the aesthetic outcome of the surgery, and to a certain degree still was, she was relieved to be rid of the oversensitivity of her clitoris and thought that her genitals did look okay, which made her feel more relaxed. An important aspect brought up by most of the interviewees was gratitude for being offered CR within the Swedish public health care system. Ovesen (Chapter 9 this volume) discusses the importance of recognition and who is seen as legitimate for certain claims. She notes that bioprecarity derives from existing social structures categorizing those worthy of protection and care and those not. When adapting her argument to the situation for women with FGC, the provision of CR can be seen as an institutional recognition of these women’s needs. Yet, one concern might be whether such provision creates new categories of pathology and exclusion, in making FGC into a ‘disease’, even if years of anti-​FGC campaigns already have categorized FGC as pathological. Another concern is a certain regional exclusion since CR is only available in one hospital in Stockholm and not well known about by many health care providers who meet cut women in their daily practice (Levin, 2018). Yet, it is worth considering CR’s potential to affect cut women’s bioprecarity in a larger sense. The classification of social groups, creating categories of ‘brown’, ‘African’ or ‘immigrant’ in a culture that devalues such attributes makes these lives particularly precarious. While racism was not explicitly discussed in the interviews, the example of Fatou’s husband referring to her kin group as ‘animals’, combined with the general image of people performing FGC as ‘barbaric’ indicates racism. Although investing in their bodies suggests a certain exercise of power and agency for these women, some bioprecarity remained at stake. CONCLUDING REMARKS This chapter has demonstrated how women living with FGC in the Swedish context, and who ask for CR surgery, are precarious in specific and multiple ways. For these women, opting for CR was a way of diminishing their

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bioprecarity, by quitting the category of ‘cut’ woman and becoming equal to other women in their social context. CR was a means of assuming power over their bodies and sexual selves. But opting for surgery also heightened their bioprecarity as they had to handle their private emotions regarding fears about the surgery and the risk of disappointment. Undergoing CR was thus not without worry and pain. Yet, even if not necessarily 100 per cent satisfied, the women felt that undergoing surgery had diminished their sense of precarity; they felt more at ease, had less pain, felt more like a woman and had a more satisfying sex life. Thus they may have become less precarious by quitting the category of ‘cut’, but prevailing racism and the devaluation and marginalization of immigrant women still rendered their lives somewhat bioprecarious. NOTE 1 My translation of Signe Bremer’s term ‘kulturellt illamående’ in relation to transsexual persons’ encounters with the Swedish health care, which Ambjörnsson refers to in Vad är Queer? (2016).

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BIOPRECARITY AND EUGENICIST HISTORIES

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‘MY BODY, MY SELF’ Indigeneity, bioprecarity and the construction of the embodied self –​an artist’s view K ata r i na Pir ak Sik k u and G abr i ele Gr i ffi n

INTRODUCTION

B

ioprecarity, understood as the vulnerabilization of individuals and specific groups of people based on their assumed psychosomatic traits, as an effect of state categorization (see Chapters 1, 2 and 12 this volume), has a long history in Western countries, which became particularly virulent from the late nineteenth century onwards. Indigenous peoples in many countries were affected by such bioprecarity as an effect of colonization and eugenicist policies by the governments of the day (Bashford and Levine, 2010) but also of scientific preoccupations with classifications and the emerging possibilities that statistics afforded. Chambers 20th Century Dictionary rather coyly, or neutrally, defines eugenics as ‘the science of race improvement’ and Chapter  12 in this volume indicates that institutes for such ‘science’ were widespread in the early twentieth century across European countries. One such institute was the State Institute for Racial Biology in Uppsala, Sweden.1 This institute, in modified form part of the university at which the co-​authors of this chapter currently work, features indirectly in the recent film, Sameblod (Sámi blood) (2016). This coming-​of-​age film set in 1930s Sweden (Ehrlich, 2017) centres on a young Sámi girl who ‘[e]‌xposed to the racism of the 1930s and race biology examinations at her boarding school … starts dreaming of another life. To achieve this other life, she has to become someone else and break all ties with her family and culture’ (IMDb, n.d.). But this break with her Sámi family history does not happen before the film has detailed the many humiliations to which the central character and her younger sister are exposed because they are Sámi. One of these humiliations involves ‘a couple of scientists from the State Institute for Racial Biology in

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Uppsala [coming] to the school to measure and photograph [the Sámi children being taught there] naked’.2 Elle-​Marja, the central character, is made to undergo this examination, the purpose of which is unclear to her, but its effects on her in terms of making her feel othered, humiliated and exposed are very obvious. Discussions about the bioprecarity of indigenous and minoritized groups of people remain very much alive in contemporary culture (e.g. Broberg and Roll-​Hansen, 2005; Spektorowski and Mizrachi, 2004; TallBear, 2003; 2013). This may be a function of contemporary biotechnological developments that allow increasingly sophisticated and complex interventions in procreation, but also of the long-​standing battles for recognition of their human, land and other rights that indigenous peoples have fought. Sameblod is just one example of this. In this film, it is made very clear that the Sámi are regarded as an inferior race, akin to animals, by the dominant Swedish population. At one particularly harrowing and violent point in the film, Elle-​Marja has her ear cut by a group of Swedish boys who harass her. She is thus ‘marked’ in the same way that Sámi mark their reindeer, thereby (re)inforcing her animal status in the eyes of those Swedish boys. Both the eugenicist measuring incident and the ear-​cutting involve Elle-​ Marja’s body as the site of intervention, distinction (here understood as differentiation from others whose bodies are not abused in this way) and identity ascription. More than that, they effect an expropriation of that body. As the eugenicists’ measurements are transferred into numerical accounts of the Sámi children’s bodies, their corporeality becomes disembodied in the interests of classifications and categorizations that serve to establish population groups that are then discriminated against. Disembodied, marked corporeality structures eugenicist thinking and creates classifications on the basis of which judgements are made that in turn structure individual and population lives. In this the Sámi population is no different from any abused, subjugated minority (or, indeed, majority) population such as black people in the United States or in South Africa, American Indians, the Maori in New Zealand or Aborigines in Australia, for example. One response to such subjugation and subjectivation to discriminatory classifications is dissociation. In Sameblod this takes the form of Elle-​Marja running away from the segregated Sámi school to Uppsala to attend school there, intent upon acquiring a majority Swedish identity. She renames herself Christina, a very Swedish name, and seeks to pass as Swedish rather than be identified as Sámi. As Michael O’Sullivan (2017: n.p.) argues, ‘How long that self-​deception can persist, and what the psychic costs may be, are the central questions of the film’. The expropriation of her body that Elle-​ Marja experiences in her objectification by men (the scientists, the boys) leads to her rejection of that self she experiences as abjected in favour

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of an identity that protects her from such expropriation. This is not self-​ deception as O’Sullivan (2017) describes it, but  –​in more contemporary terms –​‘care of the self ’ and for the self, the recognition that self-​protection, self-​preservation and the possibility of leading a life distinct from the one of constant humiliation that has dominated Elle-​Marja’s childhood, can, from her perspective, best be attempted through a reinvention of the self as being part of the Swedish majority. This is a perfectly understandable strategy in a country such as Sweden, which places high significance on belonging and the expression of that belonging, not least through the suppression of differences through a strong public equality discourse within the majority population (Pred, 2000). But this strategy also entails a denial of self and self-​alienation, the abjection of the self by the self, which goes unassuaged until quite close to the end of the film. One issue with Elle-​Marja’s denial of self is that even as it constitutes a rational response and care of self in the context of persistent bodily threat, it also affirms the abjection of the Sámi body and of Sámi people. Elle-​Marja denies her Sámi identity but is continuously haunted by it. Though she has no pride in her Sámi identity, it is present as the unacknowledged other of her majority-​identity performing self. Certain –​even if possibly only temporary3  –​shifts in race politics across Europe over the past fifty years or so, such as globalization, social movements, ethnic minority rights claims, anti-​discrimination legislation, etc. make it possible for Elle-​Marja as an old woman to (re)acknowledge her Sámi heritage. But this is after a lifetime of denial. There are, as Katarina Pirak Sikku’s work shows, other ways of dealing with the bioprecarity inflicted by eugenicist practices and histories. O’Sullivan (2017: n.p.) suggests that the film offers ‘the feeling of a distant memory  –​one that is neither entirely pleasant nor painful, but persistent’. That notion of ‘distant memory’ creates a space between the contemporary viewer and the film’s narrative, reinforced by its being set in the 1930s. Somewhat like the film Distant Voices, Still Lives (1988), which through the very word ‘distant’ in the title conjures up a seemingly long-​gone era (in this instance around working-​class Liverpool life), so O’Sullivan’s description produces a gap between the now and the then that, however, the very production of Sameblod in 2016 puts into question. That notion is also put into question by the work of contemporary Sámi artist Katarina Pirak Sikku who, inter alia, deals with the effects of eugenicism on Sámi identity and her own sense of self. In a series of colour photographs taken between and variously exhibited at the Umea Bildmuseet in 2014 and at the Moderna Museet, Stockholm in 2018,4 for example, Pirak Sikku explores the legacies of eugenicism, its imbrication of ‘science’ and technology, indeed its expression of itself as ‘science’ through technology in the form of specific instrumentation and tools, its focus on

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the body as material expression of racialized identities, its staging of scientific processes and results, and its objectifying gaze. That gaze produces bioprecarity through not only refusing the bodily integrity, autonomy and agency of those who are thus objectified, but also through gesturing towards the notion that some bodies occupy different orders from others. The main questions for Pirak Sikku in this work concern:  Who has the power to create an image of my self? Who has the right to define my embodied self? Pirak Sikku engages with these issues, putting her own body into different positions to take back her history and/​or to make her own history. To be a subject instead of an object (Tuhiwai Smith, 1999). The process of making art figures as a way of making subject. And the subject she makes goes well beyond being a response to eugenicist practices only, for she simultaneously engages not only with that history but also with Sámi history, which enjoys and enforces its own normativities. Thus, as will be discussed below, she uses, for example, photos of herself in embroidered underwear that references certain Sámi craft traditions. That underwear was meant as a provocation to Sámi traditional handicrafters. But its meaning also changed in the process of its making. It ended up being an act of independence both from histories of Sámi-​ness as articulated by Sámis themselves, and from the eugenicist biopolitics that have shaped much of Sámi life in Sweden. She embroidered the underwear with seed beads in wool material referencing traditional patterns from Sámi handicraft. A pattern by her grandmother. She then went into the forest, a space conventionally associated with Sámi people, wearing her traditional Sámi boots and hat. And wearing that underwear. Standing in front of the camera, a woman, living in 2004, a Sámi woman. This chapter explores the meaning of the reappropriated body of those rendered precarious by eugenicist biopolitics. A WORD ON THIS CHAPTER This chapter constitutes a collaboration and a dialogue between the co-​ authors in which their two voices are intertextually conjoined, that of the artist Katarina Pirak Sikku discussing the making of her work and that of the academic Gabriele Griffin commenting on Pirak Sikku’s work and practices. The two voices, which reflect different ways of engaging with bioprecarity, with categorizing and constructing object and subject worlds, utilize different pronoun styles to signal their particularity. Pirak Sikku writes in the first person, taking on the I that has been in question in the history of Sámi subjugation while Griffin uses the third person both because it is common in academic writing and to avoid appropriation. The

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chapter as a whole has come about following intense discussions, repeated readings and continuous reflection. At its core is a tripartite structure that follows Pirak Sikku’s process of engaging with the bioprecarization of her people. The first section, ‘Racing biology’, deals with Pirak Sikku’s discovery of eugenicist instrumentation used to measure Sámi people as part of the race-​classification system exercised in the early twentieth century. The second section, ‘Refusing/​exploring bioprecarity, appropriating the tools of race biology’, details Pirak Sikku’s initial attempts to work with race biological instruments as a way of countering the history of subjection and precarization that these tools bespeak. The third section, ‘Will the master’s tools ever dismantle the master’s house?’, a quote of Audre Lorde’s famous eponymous essay title, centres on the uneasy question of whether and how bioprecarization can be countered by the artist’s reappropriation and transformation of the master’s tools, in this instance, race biological instrumentation, to construct a different self, to become subject. Each section begins with Pirak Sikku’s reflections and is followed by a commentary from Griffin. KATARINA PIRAK SIKKU: RACING BIOLOGY In the early 2000s in Sweden, race biology was much discussed. In the daily Swedish newspapers there were many articles about tvångssteriliseringar (forced sterilization). And the Swedish Institute for Race Biology was mentioned. At the time I  did not really understand what it was about. Looking back, I blush when I think of my first encounter with race biology. Shame accompanies ignorance, even if that ignorance is not of one’s own making. I was twenty-​one years old then. I had given blood for a scientific study, a study designed to map Sámi genes (Beckman, 1996). This occurred during my first month as a student at Umeå University. And we had not even started learning how to critique science. On Nordnytt5 that evening, Per Mikael Utsi, a Sámi politician, stood outside the Swedish Reindeer Herders Association office at Brogatan in Umeå, and talked about race biology. This was my first introduction to race biology. I had never heard of it before. But I was paying attention now. In the autumn of 2004 I started my degree at the Art Institute of Umeå University. And race biology became part of my work for my art exam. I did a piece in which I tried to deal with the question, ‘Can Sorrow Be Inherited?’ My first physical contact with race biology was the instruments used in eugenicist investigations. I had looked at different books, read a little. These instruments were kept in a green cardboard box, the kind that you use for parcels in Sweden, at the Research Archive (forskningsarkivet) of Umeå

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University. The same boxes contained a manuscript, photos, a case made of fabric and some small cardboard boxes. The photos were of human teeth. The teeth of both living and dead people, photos of the teeth in a skeleton’s head and from living models. The manuscript smelt unkind and old. The manuscript had been typed, the paper was yellow and dog-​eared. The paper was so old that it was falling apart. The case of fabric was rolled up and bound with a white linen ribbon. In the roll there were compartments that had been sown into the fabric. They contained pieces of metal. A friend of mine, Maria, and I picked up the curious metal pieces that we understood were some kind of instrument. We were curious and turned the things we had in our hands over and over. These were instruments. What were they used for? We tested ourselves. I  held the instruments against myself. Did one use them in this way or in that? What looked likely? I  had a picture of someone stuck in a place. I thought the instruments might hurt. That there would be physical pain. This was linked to the fact that many people seemed to experience discomfort when race biology was mentioned. I thought that the physical pain was part of the problem. So I was almost disappointed about the non-​physical pain I experienced. It would have been so easy to explain this feeling as a physical pain. The physical is easier to grasp than diffuse, non-​somatic feelings. How would I  explain them? Something happened that December 2004 when I  saw those instruments. A curiosity was awakened. All I read about was Sweden’s approach to race biology and its race institute. Some believed that it was like a parenthesis in Swedish research history. It was no big deal. Others said it was important to engage with that history to understand what had actually happened. I could not find anything that could answer my questions. Where did the eugenicist investigations take place? Who was investigated? Who were the race biologists? Was participation voluntary? How were you made to take part? In December 2004, I thought such participation must have hurt. The image of a person sitting in a chair was my idea of race biology. I also thought that the Sámi had to visit an institution to be investigated. I imagined that there might have been a great resistance to race biology on the Sámi side. I realized that there was a lot I did not know about race biology. There was no manual for the instruments.6 What were they called? To find out more, I began to read Herman Lundborg’s, Racebiology and Racial Hygiene ([1914] 1922), his Swedish Folk Types (1919), along with his work, written jointly with John Runnström, The Swedish Nation in Word and Picture (1921). I  also read The Race Biology of the Swedish Lapps (1932), co-​edited by Lundborg and Sten Wahlund. I did not find anything specific about the eugenicist measuring instruments that were used. But I did find

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out how they calculated the values ​​they published in The Race Biology of the Swedish Lapps. They were presented as lengthy mathematical formulae that I did not really understand. So I set out to measure. Myself. My self. I measured, counted, probably counted wrongly and guessed. I compared my own skin tone with the skin stick that was in the box. Like my hair. I studied my eyes, what colour did they really have? Close-​set eyes or not? What metrics did they use? When I measured, I wondered how they could be consistent. Measuring depends on where you place the point from which you measure. Every seamstress who creates a pattern knows this. So how could they be accurate? Pronounce on ‘types’? In trying out the instruments on my self I  realized that the measuring process itself, which I had somehow imagined to be physically painful –​the pinching of body parts, the application of instruments to human bodies –​ was not that. It was not physically painful. But there was something else in this process that was painful. And it was with this insight that I understood that I needed to investigate what had happened –​and what it meant –​with my own body. I wanted to know. The visit to the research archive where I found the instruments was very important for my approach. The lack of physical pain in the measuring process made me understand that the whole issue was much larger than I had imagined. I began to feel that this was a history I should have been brought up with from an early age, not learn about it only when I was in my early twenties. At school we read about World War II, we read about Anne Frank. But not about the eugenicist histories related to us, to Sámi people. But the ideas that informed Anne Frank’s experiences were in fact the same ideas that informed the measurement of Sámi people for eugenicist purposes (see Kjellman and Eld, 2015). This haunts me. My parents did not talk about race biology but I have an instinctive, bodily reaction to this. Can sorrow be inherited? Shame, nudity, vulnerability. There is also the fact that in 2004 when I first encountered race biology, Sámi people as human beings remained invisible in what was written about race biology. Something was going on, abstractly, above our heads. We had been affected, but we were not part of the debate. The box in the archive is exciting. Who owned it? And when I investigate the matter more closely, I find that Gustav Bergfors owned it. He was a dentist in Örnsköldsvik. He was the vicar of the church in Vittangi, in the north of Sweden. I find that Gustav Bergfors7 participated in a race biology expedition to northernmost Lapland in 1923.8 In The Race Biology of the Swedish Lapps, vol. 2, I find my father-​in-​law Johan Sikku.9 He was measured in 1923, most probably in Upper Soppero. Discovering this makes the instruments that until then were only in a box

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even more loaded. Are these the same instruments used on my father-​in-​ law that I am now measuring my body with? On being confronted with bioprecarity Pirak Sikku recounts three moments of encountering race biology that function as an awakening for her to Sámi history and the history of her immediate family:  being the unwitting participant in an ongoing race-​ biological study, hearing it talked about on television and coming across the instruments used in the early twentieth century to measure Sámis. Each moment is marked by a recognition of (at least partial) incomprehension –​ not quite knowing what one is attending to –​and an affective response, most strongly described by blushing, the mark of shame. The three moments connect the present, the ongoing study, with the past, race-​biological categorization practices and to a sense of a problematic not (yet) fully grasped. One of the effects of race biological categorizations was the production of hierarchies of beings, the ontologization of difference into lesser and greater beings. Such hierarchies produce shame in those inferiorized and contempt in those superiorized. Unsurprisingly, Eve Kosofsky Sedgwick and Adam Frank (1995) link shame–​ humiliation and contempt–​ disgust. Shame, as they indicate, is associated with humiliation, here the humiliation of being objectified, of being made an unwitting participant, of seeing the otherwise suppressed past of bioprecarization re-​enacted in the present and creating a pain that is not physical but psychological. As Cathy Caruth (1996: 100) puts it, in discussing ‘unclaimed experience’:  ‘To awaken is thus precisely to awaken only to one’s repetition of a previous failure to see in time’. Pirak Sikku describes working through that dawning realization of the problematic of what she encounters, a problematic made especially poignant through the fact that she is just one generation away from the humiliating categorizations that her parental generation underwent and that is so powerfully described in the film Sameblod. Confronted with the ‘complex relation between knowing and not knowing’ (Caruth, 1996: 3), Pirak Sikku chooses to know. The bioprecarization of her parental generation results in an unwillingness to renounce or turn away from the object, a refusal not to see while recognizing the shame involved in this, shame in not having seen, shame in seeing. But the importance of seeing is also immediately made clear. In referencing Anne Frank, Pirak Sikku makes a direct connection to the wider race-​biological politics of her parents’ lifetime that resulted in the Shoah. By engaging with the eugenicist instruments, she works through the past (LaCapra, 2001:  90) and through this asks, what constitutes an adequate response to the encounter with that past but also her own present that involves racializing technologies?

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KATARINA PIRAK SIKKU: REFUSING/​E XPLORING BIOPRECARITY, APPROPRIATING THE TOOLS OF RACE BIOLOGY During our first visit to the research archive in Umeå,10 I decided to work with the material there. I had taken a small camera with me. Maria set me up. With the instruments. The skin samples were laid against her skin and we tested her skin colour. I took the photographs. Not that many photos. The camera was analogue; as an impecunious student I  had to do things cheaply. The photos were quick and spontaneous, sort of tourist images. Then I got up, and my friend Maria directed the camera towards me. And took a picture. With no regard to light, background or anything else. No make-​up, no red lips, no gábdde (traditional Sámi costume). No set-​up. It was a first engagement with this material. Afterwards Maria and I had lunch. We talked about race biology. What had it meant for our history? We often talked about the power to define ourselves. Maria has been a long-​term conversation partner for me and my desire to tell my own story. I wanted to make an artwork with the measuring instruments. So I talked to the research archive about borrowing the measuring instruments and doing the pictures outdoors. I wanted to use natural light. The suggestion to take the instruments outside of the archive did not go down well. I borrowed their meeting room. And I tried to build a photo studio in the archive. I brought with me a backdrop cloth, tape, black paper and clamps. But I  am really short, 150  cm. So to cover the fluorescent lamps in the archive room I had to stand on a chair set on a table. I probably created a good studio for taking photographs. But the photos did not come out well. I  did not own any additional lighting that I  could bring, so the fluorescent light did not create a good effect. At this time, I only had an analogue camera. I also did not use Photoshop. And I had never used studio lighting. I  had mostly used daylight. Daylight was in short supply in the research archive’s meeting room. A  windowless room. There ended my second engagement with the archive. Reconnecting to the archive. This time I  borrowed the photo studio beneath the research archive. The photographer who normally used this studio was not around but he had set up all the lights. So I  just had to operate it all. Nils-​Henrik, my husband, and I went down into the university cellar. With the eugenicist instruments in our hands. I wore the traditional Sámi costume (gábdde), we brought the camera and film. I  mounted the camera on the camera stand. Measured the light, set the aperture and was ready. Unfortunately, I had left the auto-​timer at home. The pictures became somewhat blurred. The image became blurred, motion blurred.

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I was so pissed off about this. Because it is a strain to model. I do not know why it is so demanding. There is something about using one’s own body. I have never used other photographers. I cannot handle it. Often I have someone who takes a photo, once I have set it up. When these pictures have been taken, I  sometimes get really annoyed. Feel pissed off and irritated. I would go to pieces if someone tried to reason with me. I realize I would have completely different photos if I had asked another person, indeed any other photographer, to take them. At the same time, there is also something about having someone close to me as support. The photographs taken of me have been taken by people I trust. Who wish me well. So here I  am in the archive, trying to create images that involve the eugenicist instruments. I realize that I will never be able to recreate the historical moment when their use was documented by the race biologists and their helpers. What I do is to stage an investigation. I am setting a scene. Well, not exactly that. I am trying to ‘figure out’ –​literally and metaphorically –​race biology. To show that these scientific instruments were used on actual people. What happens here, however, is not part of the truth that I find later. I will return to this. I am choosing to do this. I recreate a scene. Later I read about how the collected data were processed and dealt with in the same way. I do not really know how the instruments were used but I guess. There is no manual. What are the instruments called? We live in a different time. When I started to work on race biology, I made a piece that was my own version of my country, Sápmi (see Figure  11.1). I made a map with defined borders against other countries. A country with its own board of directors, president, official language and its own laws. On the map I drew a view of the Sápmi republic. Where Sweden ended and Sápmi began. I  also made some images (see Figure  11.1) of the boundary between the two different countries that I had created. If Sápmi had been Sápmi, what would our household utensils have looked like? How would we have looked at other non-​ethnic Sámi? For example Swedes living in my imaginary Sápmi country? As part of this project, I  made some underwear in the Sámi tradition. That means that I employed traditional embroidery patterns and materials. A project that began in anger. I had been provoked during a conversation about Sámi handicraft traditions, in this case shoes sewn from leather. A Sámi friend and I had talked about the peek at the front of the shoe, which she could not get right as far as she was concerned. She wanted it to look like the shoe her grandmother had made. I reasoned that this did not matter; rather, the question was about the peek’s relation to the appearance, width, length and particular animal skin used to make the shoe. For her, it was all about following tradition. But for me it was about creative transformation.

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Figure 11.1  Här börjar Sápmi –​ häar slutar Sverige, 2004 (Here begins Sámiland, here ends Sweden).

I was refusing the inheritance of sorrow. I went back to Umeå and my studio, wanting to create something that would challenge Sámi traditionalism, the slavish adherence to old patterns. I wanted to provoke, to cross boundaries. I wanted to create a debate. This was in 2004. But instead of becoming a provocative project, my work became an act of definition. At the art institute in Umeå, many students worked with videos. I was one of the few who sat and did crafts, making the Sámi underwear. So for quite a while I stopped going to the institute and worked at home. That was what I liked best. I was in a bad way and I needed to be at home. Not to see what others were doing, not to have to compare myself. When I  had finished making my Sámi underwear, I  went out into the woods and set up a photograph of myself. My studio partner, Anna Westin, was at the camera. We were in the forest around Umedalen in Umeå. And something happened. I stood there. In my Lule Sámi hat, Sámi boots and underwear. Underwear sewn from klade (red wool cloth) embroidered with seed beads in a pattern magnified from my grandmother’s embroidery. Two

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different Sámi histories were meeting. My mother’s Syd Sámi tradition and my father’s Lule Sámi one. A  mixing of two Sámi traditions that is completely prohibited within the Sámi costume tradition today. In these images, which pre-​dated my work in the Umeå research archive, I assumed, that is I gave, myself the power to define myself. I made my own self-​image, as a woman, in the twenty-​first century. I considered myself a separate entity. An attempt to free me from images imposed on me by others. Since I had been a child, I had been given a self-​image. Classic images of Sámis in traditional costumes backlit by the midnight sun. Beautiful natural scenery with Sámi people in the foreground. A  national chromatic image that was only an image. Had it ever been a reality? So when I began to engage with race biology, it was with that position as the context. I had my own Sápmi republic, I had made my own self-​image. I engaged with a different perspective on myself and my own worth. This certainly affected my race research. Return to the first photographs where I was wearing my gábddet. In my first photos I was at the university on their terms. I could not borrow the eugenicist instruments. It was good to borrow their rooms. At this institution where I did not own the situation altogether. Taking the images gave me control. I  could decide when, where, how. I  decided on aperture, time and ISO. I  went out as a free woman to take my position. And let someone else press the shutter button. I used myself because I am responsible for myself. It would seem strange to ask someone else to stand in my place. Who would I  ask? Would I  have to pay? How would it feel to pay another person for the purpose I  have? What if that person changes their mind, say in about ten years? That it did not feel good to ‘borrow’ my body. It is still about control. I have control of myself, my process. Although the action of taking the photos is staged by myself, it feels horrible. Using the instruments that Gustav Bergfors used before. The measuring stick that has been part of a real survey. An object is an object and we assume it has no memory. It is me who charges it with my memory. With my knowledge, with my story. I am not sure if my father-​in-​law was examined with these instruments but already the suspicion makes me feel some discomfort. It is all so close to history. Then I decide to put on a gábdde (traditional Sámi costume). Most of the photos in the eugenicist albums feature fully dressed Sámi. So I decide to dress fully too. I stand before the camera. This is the image I need to take next. It’s an anxiety-​provoking situation. The first two images are the most difficult because I use analogue technology. Unable to check if the images work. It is a complex tension that is difficult to explain. That’s just the way it is. Is that good?

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Many images taken by race biologists show people in the nude. I tried for a long time to get hold of such photos of Sámi people. But it was impossible to get them. I  have only seen such photographs twice. Perhaps twice too often from my perspective. Most naked eugenicist photos in Uppsala’s Kart-​ och Bildenheten (map and image archive) are located in separate albums. The first time I looked, I just wanted to know how it felt to see them. And study the images. I tried to order some of these images from the Uppsala archive. And was refused. However, one of the archivists told me that under the Swedish ‘common interest’ legislation (offentlighetsprincipen) they were wrong to deny me access to the pictures and I  could put in a new request. I’m so glad I was refused. What would I have done with a lot of such photographs cluttering up my space? I  decided not to request the photographs again. For bodies a hundred years ago were different from our present-​day bodies. We use the body in a different way today. But I  had come across some images in the Uppsala archive. A  young woman photographed in nine positions: front, rear, side view, hands up and hands down, hands in front of and behind the back. In nine positions, why nine? Why not eight or ten? Aesthetically, nine images may well be presented in a structurally more pleasing way in a photo album than a different number of pictures. But surely the albums were not based on aesthetic merit?! So why nine? I have not seen nine positions for any male figure. Maybe I need to investigate this further. Does it have anything to do with classic Greek statues? Something that one might genuinely detect if one stood in different positions? I  do not know. It may just have been that the photographer was voyeuristic and wanted to expose as much as possible of this woman. In any case, I decide to use my own body. I hire the photo studio at Ájtte (the museum in Jokkmukk, my home town, on Sámi territory). My niece Cecilia is my helper. I set up the camera. I want to do this fast. There is no sign on the door to ask that nobody enter. I instruct Cecilia to check that the head and feet are in the picture. We look at the woman in the Uppsala archive photograph and I take up the same positions. It is both cold and unpleasant. Nonetheless, I do this in an environment with someone I know and am closely related to. Still, it feels uncomfortable. When I stand there with hands above my head, I cannot cover my chest or my sex with my hands. We take the photos very quickly. I set up the camera and lights to make the shutter speed short. With a big-​format camera, it would have taken longer. And maybe the woman in the Uppsala archive photo moved and the photo had to be taken again. When we’re done, Cecilia says, ‘Auntie, this did not feel good’. Inheriting sorrow?

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I uploaded the pictures on to my computer and looked through them. Cecilia had missed out my feet in all the photographs. What was I to do? My feet had been cut off. If I wanted to use the photos, I needed my feet. So I would have to take the photographs again. Did I want to do that? And how would my teenage children react when I exhibited my body in these nine positions? I decided to make drawings based on the photos. This would expose my body less obviously. I also chose not to draw in great detail. The images will become a refused body. Refusing the inherited sorrow. A weird choice. The pictures are silhouettes of my body and have little to do with me. I was asked if the images could be published and I said yes. They do not represent my body in particular. They have become something else. A tool for focusing on something else. Namely the nine positions. My body is a work tool. And I am thinking about prostitution as soon as I write ‘work tools’. Because that is what I have downgraded my body to. Or is it? I am alone in the act. I have control. I decide. No one else touches me. But I display my body and when I do, it has ceased to be my body. Using one’s body in art transforms that body. The artwork leaves one when it is finished. It is the process of making art that is painful. And when it is done, you let go of the work. The photographs from the race-​biological expeditions are set against a neutral background. When there are group photos, a floor, cork mat or wooden floor can be seen. More information about the actual photo-​taking is not available. At Ájtte there is an album. It was donated by a Folke Isaksson and is a family heirloom. Folke’s aunt was married to Martin Nilsson, a man who took part in eugenicist expeditions to Sámi territory and was given an album as a thank-​you gift. This album contains pictures from the expedition. Examples of how a photo studio would look on a mountain. On one of the pictures a woman is sitting against the wall of a kåta (traditional Sámi house). And that’s the background in her photo. This was a wake up call for me. The photos I  had taken had all been done in institutions. And I  had had the bizarre idea that the Sámi got a call in the form of letters and were asked to participate in a study. But this was not the case. Instead, the racial biologists conducted expeditions to places where they knew Sámi gathered. Schools, retirement homes, church gatherings. A kind of outreach activity. I need to redo the eugenicist measurement images. This will be the third or fourth time in as many years, but it is necessary. To show what was really done. I  took my gábdde, borrowed a copy of one of the eugenicist measuring instruments, took my camera to Parka, a place 2.5 miles south-​west of Kvikkjokk. The race biologists never went to Parka. But they did go to the mountains in the north of Sweden where they met people who went to Parka for the

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spring, summer and autumn. It rained every day while I was in Parka. And I was a little tired so I did not drive the process forward very strongly. On our last day in Parka, I had to get the images done. And it was raining. So we went out after five in the afternoon. I had a plan of how I wanted the images to look. I tried to communicate this to my daughter Máridja who was to take the photos. She and I did not understand each other. I felt I was hovering above myself. I was trying to see how the images would look, but could not. So we walk around, looking for an appropriate place. I am in my kolt and hat among the mountain birches. The sun does not really come through the dark clouds. There is a beautiful light. The lake Parkajaure shines between the birch leaves. It is fresh outside. The green leaves on the birch trees accentuate the whiteness of the bark in the afternoon light. To the west, the clouds are heavy and dark grey. Rain is on its way again. There I am, carrying a pallet to sit on and a bed sheet. Of course I have forgotten the linen fabric that would look more authentic, I have forgotten. I have tried to iron the sheet. In Parka there is no iron or electricity. And I do not have an iron for a woodstove. I want Máridjá to use the camera stand because I realize it’s pretty dark. And of course, she does not want to. So we try things out. I  want her to shoot me with our cabin in the background. I’m sitting on the hill below the cottage. The image does not come out right. The house’s dark-​brown background is too solid. No highlights in the colours. And the intimate dance of the birches becomes unspectacular against that background. So we continue. We walk around. Nils-​Henrik sits on the roof of the goahte and butts in. I want it to be quick. I want to get ready. I feel uncomfortable. Finally, my daughter finds a position that may work. And finally, calm descends. And we can start. My daughter has at last found the area where she thinks the photo may work. I  feel she’s happy. And it is contagious. She works with her whole body. Changes angles, moves. I’m directed both by the photographer and the man on the roof. I give up and let it be. I focus on my self. I’m really happy afterwards, feeling an incredible satisfaction. I  have taken back the place. Not the Parka site. I have followed the race biologists in their tracks. To take the picture in the mountains is an act of recalling the memory that this ground is wearing. I have also regained knowledge of what happened. I can tell. Or is it something else? Empathetic unsettlement: making objects to resist the bioprecarity of objectification LaCapra (2001: 103) argues that ‘performative engagement with unsettling phenomena is important in an exchange with the past’. Pirak Sikku seeks such engagement through her attempts to get at ‘what was really done’ when the

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race biologists rendered her people an abjected group through their eugenicist representation of them. She experiences that engagement as multiply unsettling: because she gets it wrong (her ancestors were not recorded in institutions but on their home territory; the recording process of her performance fails to work out), because she is bodily, somatically unsettled by what she undertakes, and her sense of shame unsettles her. The classic of bodily shame, the desire to cover one’s breasts and sex when naked, has to be endured by her just as Elle-​Marja endured it in Sameblod, and as Pirak Sikku’s ancestors endured it for the nude photos Pirak Sikku was refused access to. Bodily enactment, creating a sense of precarity through the very reliving, albeit under different circumstances, of the poses into which Sámis were encouraged by the race biologists, produces bodily discomfort, a sense of alienation from the self that threatens that self. Putting oneself in the other’s place, quite literally here, expresses the empathy that LaCapra (2001) argues is necessary to become attentive to the other and their bioprecaritized state. Pirak Sikku asks many questions including one about the knowledge she has gained from the process of (re)enacting eugenicist bodily measuring. What does it signify to engage in this work? In Pirak Sikku’s text, the issue of control and of agency is critical; her agency in undertaking the photographic (re)enactment defies the objectification of her ancestors, her unwitting participation in the ongoing eugenicist Sámi study –​it disrupts that chain of subjugation. Her uncomfortableness recalls the ‘moving and sorrowful voice that cries out’ from the wound inflicted ‘through the unknowing acts of the survivor and against his very will’ (Caruth, 1996: 2). This is a wound inflicted ‘not upon the body but upon the mind’ (Caruth, 1996:  3). The original wounding, the bioprecarization of a people shamed through somatically constructed classifications, is recovered by Pirak Sikku’s work. As Caruth (1996: 8) puts it:  ‘one’s own trauma is tied up with the trauma of another … through the vey possibility and surprise of listening to another’s wound’. This is about resituating history in our understanding, rather than eliminating it (Caruth, 1996: 11) –​the necessary point of departure and antidote to the silencing and shutting off of that history in certain Swedish museums and archives. KATARINA PIRAK SIKKU: WILL THE MASTER’S TOOLS EVER DISMANTLE THE MASTER’S HOUSE? What effect/​s did making these images and working with a materialized history of eugenicist interventions among Sámi people, my people, have? I  do not remember why I  photographed myself with the instruments. In

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Figure 11.2  First encounters with eugenicist instruments in the archive.

the archive, the first time I  went there, it was a spontaneous act. When I  looked at the photo together with Julia Peirone,11 we decided to photograph me in my gábdde. It was going to be a completely different photograph, highlighting my Sámi heritage through the clothes I was wearing. So I worked on this. I made three works using the eugenicist measuring instruments during my first visit to the archive. The second set of photos, also done in the archive, were planned and carried out with some difficulty, as described above, and the third set of photos were taken by me in the mountains. The spontaneous photograph (Figure  11.2) speaks to the environment where the instruments are housed today –​an institutionalized environment. During the second photo session in the archive, I ‘staged’ race biology (Figure  11.3). I  showed how these scientific instruments were used on Sámi people. During that second photo session I, in a sense, repeated or reproduced the actions of the race biologists. I tried to set up a photo studio within the archive. The equipment I brought with me to the archive was the same as the race biologists had used. Muslin, needle, thread, tape, booklet, etc. All in order to change the actual background into a neutral one. To erase the physical evidence of where they were. Although of course it is possible that the race biologists did not intend to erase that background but simply took photos in the manner of a certain quasi-​anthropological/​medical/​scientific convention that demanded neutrality of background to foreground the ‘object’ of scientific enquiry. I tried to do the same thing in the windowless meeting room at the archive. I did the same when I borrowed the photo studio. From the viewpoint of the resultant photos, I could be anywhere. This is an insight I gained in recent years –​in 2017. That’s almost eleven years later. But when I took the first photos I had no idea how the race biologists had worked, that they had undertaken expeditions as part

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Figure 11.3  Dollet, 2006.

of the infrastructural inquiries done by energy companies in the early twentieth century. In the photos I took, I used my own body. Yes, I reproduced the photos the race biologists had staged. At the time I felt uncomfortable in my own body in taking these photographs. Did I have these feelings because somewhere –​ somatically –​I understood that I was repeating the abuse of my ancestors by the race biologists? With my own body? Yes, maybe. But simultaneously, somewhere within me, this was also not exactly it. It was in some way important that I  give voice to what had happened in these eugenicist investigations. That I show how it was. It’s something different to describe and write about

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a situation than to figure it out. I access something else, something subtler, a sense of my ancestors’ powerlessness or maybe not even that. I do not know. I have wondered for a while why I want to show this? I think it’s like this. I’m curious. I do not understand the mechanisms behind the process. I want to know how it was. Many of those surveyed did not understand what was being done to them. They could not speak the language of race biology and some did not know Swedish. There came tall men and women in different clothes from theirs, speaking a strange language, with a big black box, a lot of cans and other unknown things. This must have generated curiosity, scepticism, caution, but many may also have thought that this might be a good thing, something positive. We also know that the Sámis’ level of education was low. The education offered at the nomad schools set up for them was of a lower level than that of ‘ordinary’ schools. As the government officials used to say,12 nomads do not need to know that much. There is something I want to develop. I want to feel the pain again. The pain I felt when I created the photos. I want to touch it. My research has not produced physical pain. It’s about a psychological pain. In the early twentieth century in Sweden the land disappears. Mines, hydropower, roads, railways and cities are built. In all this, the Sámi do not even own their own bodies. The Sámi are visited and their bodies become research objects. Objects in a science to be rejected and discarded after World War II. I also want a deal. A settlement regarding what happened. I want knowledge. For now, I have not read very much about how it was for those who were investigated, the objects of eugenicist observations. How did it feel when some stranger speaking a language you did not fully master stepped into your kitchen, took possession of your house, draped it in white muslin and then wanted you to pose naked? Some thirty to forty years later, I realize that these eugenicist surveys were one of the reasons for the Holocaust during World War II. It is painful to know that I have used my body to stage the same images as the race biologists. And I cannot answer the question why I did this. It is one way to shine a light on the issue. I could have chosen not to use my own body. I have not really been aware of how or why I’ve done it. I have not been source-​critical enough. But maybe if you are going to analyse everything in advance, things never get done. Reflecting on the process has raised many questions. Can sorrow be inherited? How much did I  think about all this in advance? It’s painful. It is also almost a bit annoying. Am I better than the race biologists? Am I exposing my people to abuse again? How can my work not be a repetition of the past? Why is it different because I do it? Does it hurt? Is it problematic?

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Figure 11.4  Suojehis ruokto –​Värnlöst hem, 2015 (Suojehi’s Ruokto –​homeless home).

I feel that I  need to redo the images I  took. So I  reworked the picture I  took in the summer of 2015 (Figure  11.4). Because I  need to correct the truth. In the previous photographs I went to an institution and I created a seemingly neutral background just like the race biologists did. But having learnt so much more about how the race biologists operated, I now want to make different statements with my photographs. To show how it really was. I have been involved in maintaining the image of the sterile examination room we are used to from eugenicist images. But these photographs were actually taken in people’s kitchens, their houses, the church, in the mountains, in their goahte, their outermost skin. They were not taken in an institution. Can sorrow be inherited? The German playwright Bertolt Brecht, who lived through the Nazi period, talked of ‘laying bare the devices’ to discuss how art should treat its self in order to achieve some kind of transformative power. Pirak Sikku’s work is partly concerned with this, with revealing truth by producing accuracy and by showing how it  –​race biological classification  –​was materially enacted. But as LaCapra (2001) has discussed, history is not purely factual. The epistemic injustices inflicted upon the Sámi people through their racist

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categorizations, which led to what one might describe in Hilde Lindemann Nelson’s (2001) words as damaged identities, damaged to order by a scientific establishment content in its sense of its own rightness, are not simply counteracted by the presentation of a factual truth. Pirak Sikku’s own discomfort testifies to this. What her enactment importantly achieves, however, is the raising of questions about the construction of oppressed identities, the kinds of moral agency that can be mobilized to countermand this process and the possibilities of refusing bioprecarity, even as the artist uses her own body and hence in certain ways bioprecaritizes her self. This is the empathetic unsettlement that signals both the inheritance of sorrow and its refusal, the art-​based repair that Pirak Sikku sets against the bioprecarity visited upon her people and her self, the states of injury that need to be confronted. NOTES 1 The Statens institut för rasbiologi (SIFR; State Institute for Racial Biology) was a Swedish governmental research institute founded in 1922 with the stated purpose of studying eugenics and human genetics. It was located in Uppsala, Sweden. In 1958, it was renamed by the state as the Institute for Human Genetics (Institutionen för medicinisk genetik) and is today incorporated as a department of Uppsala University. Its first head was Herman Lundborg. 2 This description is from https://​en.wikipedia.org/​wiki/​Sami_​Blood (accessed 21 March 2018). 3 The rise of the Right and of popular nationalisms across Europe since the 2000s suggests that xenophobia and racism as well as the abjection of ethnic minority groups may well (re-​ )intensify after what has been a period of its gradual abatement. 4 See www.bildmuseet.umu.se/​en/​exhibition/​katarina-​pirak-​sikku/​12046; www. youtube.com/​watch?v=-​cu_​6BOn-​uk&vl=en; and www.modernamuseet.se/​ stockholm/​en/​exhibitions/​manipulate-​the-​world/​works-​artists (all accessed 27 November 2018). 5 A local TV news programme. 6 Recently, I  came across Rudolf Martin’s Lehrbuch der Anthropologie in systematischer Darstellung (1914), which, as its title indicates, contains 460 images that show graphically how race biological measuring was done. 7 Gustaf Abdon Gregorius Bergfors (1891–​1975) was a Swedish dentist, artist and anthropologist. He undertook anthropological investigations (a rather more neutral term here for eugenicist) of the Sámi during 1924–​26, went to Polynesia on an anthropological trip in 1927–​28 and was an anthropologist at the State Institute for Race Biology, Uppsala in 1930. He was one of the founders of the Nordic Association for Anthropologists (1925) and corresponded with the American Anthropological Association. He wrote about the meaning of odontological research for anthropological research.

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8 It is worth noting that some of the early twentieth-​century volumes on race biology reference research travel in their very title. 9 Johan Anders Larsson Sikku, born 9 November 1914, died 15 July 1997. He was a reindeer herder. In his childhood his family moved from Torneälv, north Sweden, to the Atlantic coast in Norway. After the border between Sweden and Norway closed, they continued to move with their reindeers but not to the Norwegian coast. He married Elle Márjá Baer, born 11 April 1922, died 21 September 1984. They had five children. 10 See www.foark.umu.se (accessed 3 July 2018). 11 Julia Peirone is an artist working mainly with photography. She is best known for her portraits of young girls that are deprived of the disguise of gestures and facial expressions and positioned in a kind of nakedness of uncontrollability–​ and celebrated for the strength of their vulnerability. 12 See Utbildning för samiska barn, available at www.samer.se/​utbildning (accessed 24 September 2019).

REFERENCES Bashford, A. and Levine, P. (eds) (2010) The Oxford Handbook of the History of Eugenics. New York: Oxford University Press. Beckman, L. (1996) Samerna  –​en genetiskt unik urbefolkning:  fyra decenniers genetiska studier av svenska samer  –​från blodgrupper till mitokondriellt DNA [The Sámis, a unique Ur-​people:  four decades of genetic studies of Swedish Sámis, from blood types to mitochondrial DNA]. Umeå, Sweden: Umeå Medical Institute. Broberg, G. and Roll-​Hansen, N. (2005) Eugenics and the Welfare State:  Norway, Sweden, Denmark, and Finland. Ann Arbor: Michigan State University Press. Caruth, C. (1996) Unclaimed Experience: Trauma, Narrative, and History. Baltimore, MD: Johns Hopkins Press. Distant Voices, Still Lives (1988) Dir. Terence Davies. Distr. Film Four International. Ehrlich, D. (2017) ‘Review: “Sami Blood” is a coming-​of-​age story unlike any you’ve seen before’, IndieWire, 1 June. Available at www.indiewire.com/​2017/​06/​ sami-​blood-​review-​amanda-​kernell-​coming-​of-​age-​story-​sweden-​1201835404 (accessed 21 March 2018). IMDb (n.d.) Sami Blood. Available at www.imdb.com/​title/​tt5287168/​plotsummary? ref_​=tt_​ov_​pl (accessed 21 March 2018). Kjellman, U. and Eld, C. (2015) ‘The construction of whiteness in the work of the Swedish state institute for race biology’, conference paper. Available at www. diva-​portal.org/​smash/​record.jsf?pid=diva2%3A812911&dswid=8486 (accessed 25 March 2018). LaCapra, D. (2001) Writing History, Writing Trauma. Baltimore, MD: Johns Hopkins Press. Lundborg, H. B. ([1914] 1922) Racebiology and Racial Hygiene. Stockholm: Swedish State Institute for Race Biology. Lundborg, H. B. (1919) Svenska folktyper:  Bildgalleri, ordnat efter rasbiologiska principer och försett med en orienterande översikt. Stockholm:  A B.  Hasse W. Tullbergs förlag.

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Lundborg, H. B. and Runnström, J. (1921) The Swedish Nation in Word and Picture, Together with Short Summaries of the Contributions Mades [sic] by Swedes Within the Fields of Anthropology, Race-​Biology, Genetics and Eugenics: A Jubilee Book Given Out, with the Cooperation of Experts Commissioned by the Swedish Society for Race-​Hygiene. Stockholm: Hasse W. Tullberg Co. Lundborg, H. and Wahlund, S. (eds) (1932) The Race Biology of the Swedish Lapps. Stockholm: Swedish State Institute for Race Biology. Martin, R. (1914) Lehrbuch der Anthropologie in systematischer Darstellung:  mit besonderer Berücksichtigung der anthropologischen Methoden; für Studierende, Ärzte und Forschungsreisende; mit 460 Abbildungen im Text, 3 Tafeln und 2 Beobachtungsblättern. Jenna: Gustav Fischer Verlag. Lindemann Nelson, H. (2001) Damaged Identities, Narrative Repair. Ithaca, NY: Cornell University Press. O’Sullivan, M. (2017) ‘ “Sami Blood”: A haunting tale of ethnic assimilation and its psychic toll’, Washington Post, 29 June. Available at www.washingtonpost.com/​ goingoutguide/​movies/​sami-​blood-​a-​haunting-​t ale-​of-​e thnic-​a ssimilation-​ and-​its-​psychic-​toll/​2017/​06/​28/​39698d5a-​5924-​11e7-​b38e-​35fd8e0c288f_​story. html?utm_​term=.83d7570fb80c (accessed 22 March 2018). Pred, A. (2000) Even in Sweden:  Racisms, Racialized Spaces, and the Popular Geographical Imagination. Berkeley: University of California Press. Sameblod (2016). Dir. A. Kernell. Distr. Nordisk Film. Sedgwick, E. K. and Frank, A. (eds) (1995) Shame and Its Sisters: A Silvan Tomkins Reader. Durham, NC: Duke University Press. Tuhiwai Smith, L. (1999) Decolonizing Methodologies:  Research and Indigenous Peoples. London: Zed Books. Spektorowski, A. and Mizrachi, E. (2004) ‘Eugenics and the welfare state in Sweden:  The politics of social margins and the idea of a productive society’, Journal of Contemporary History 39(3): 333–​52. TallBear, K. (2003) ‘DNA, blood and racializing the tribe’, Wicazo Sá Review 18(1): 81–​107. TallBear, K. (2013) ‘Genomic articulations of indigeneity’, Social Studies of Science 43(4): 509–​34.

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THE INTIMATE LABOUR OF NON-​NORMATIVE  BODIES Transgender patients in early Swedish medical research Jul i an Honk a sal o

INTRODUCTION

T

his chapter examines the paradoxical interplay of humanist and eugenic ideology underlying early Swedish clinical studies on ‘transvestite’ and ‘transsexual’ patients.1 In this context I theorize bioprecarity2 as being generated through a double-​bind of inclusion and exclusion. Rather than examining scientific testing of gender as a past practice that belongs to the history of psychiatry, this chapter conceptualizes gender-​determination tests of transgender patients as a biopolitical apparatus of power.3 Although the invention of both the modern prison and asylum were based on disciplinary power through detainment in physical spaces, such as cellular units, these institutions also operated through an intervention into life at the level of the temporality of the subject. In the context of trans-​specific medical and psychological diagnostics, indefinite waiting and being caught in a temporal standstill are constitutive of disciplinary power over ‘trans temporality’ (Pearce, 2018). The 1960s Swedish clinical studies on transsexual patients that I examine in this chapter formed the scientific background for the 1972  ‘sex determination’ legislation, which was the first ‘trans law’ in the word. It was also the first sterilization law to target trans persons specifically. Sterilization as a form of biopower over the population operates through an intervention into reproductive future, that is, temporality at the level of the population. Hence, in the context of my inquiry, power over trans temporality operates both at the level of the subject and the population, rendering trans persons vulnerable to bioprecarity. In the introduction to Intimate Labors: Cultures, Technologies, and the Politics of Care, Eileen Boris and Rhacel Salazar Parreñas define ‘intimate

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labour’ as ‘work that involves embodied and affective interactions in the service of social reproduction’ (Boris and Parreñas, 2010:  6). Drawing on a vast literature of feminist sociology and Foucault’s theorization of ‘technologies of the self ’, the authors describe ‘intimate labour’ as the ‘tending to the intimate needs’ of others, such as their ‘bodily keep up’ and the ‘creating and sustaining [of ] social and emotional ties’ (Boris and Parreñas, 2010: 5–​6). Although intimate labour is usually theorized in the context of the neo-​liberal globalization of the labour market and the commodification of women’s care work, theorists inspired by Boris and Parreñas have also theorized the domestic work of men (Näre, 2010) as well as processes of ‘self-​making’ in transgender online communities (Psihopaidas, 2017). In this chapter, I expand the umbrella term ‘intimate labour’ to include narrative accounts, such as personal histories, collected in case files of Swedish trans patients undergoing diagnostic and psychiatric evaluation for ‘transsexuality’ during the 1960s and 1970s. As the adjective ‘intimate’ originates in the Latin verb intimare (to make known) and the noun intimus (inmost, innermost, deepest), I argue that the term is beneficial for historical research on trans agency, patient agency and the ways in which trans patients undergoing psychiatric evaluation produce value and knowledge about themselves and their communities in the midst of normalizing biopower. By intimate labour in this specific context, I mean activities such as providing self-​narrative accounts that stem from lived realities, participating in scientific experiments and diagnostic tests, as well as the public self-​disclosure of one’s gendered self as non-​normative, despite the risk of being rendered unintelligible, undeserving or subjected to discursive and physical violence. I argue that historically, the intimate labour of transgender patients has functioned as the condition for the possibility of trans lives to be recognized as liveable and intelligible to begin with. As Judith Butler contends: ‘When we ask what makes a life livable, we are asking about certain normative conditions that must be fulfilled for life to become life’ (Butler, 2004: 39). For stigmatized persons, agency and resistance thus emerge through bodily labour processes through which the person experiences, inhabits, reframes, transforms and resists social norms. Historically, this type of ‘labour’  –​ although not part of the labour market –​has produced value, such as statistical and empirical data collected in case files. The data has then been commodified as the intellectual property of medical ‘experts’, both in the advancement of their own careers and to secure research funding for new research paradigms, but also in their attempts to justify hormonal and surgical health care options for their patients. Hence, the trans body/​mind constitutes the biopolitical boundary territory on which claims to intelligibility and citizenship rights are shaped and determined.

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In the specific context of this chapter, I  problematize hierarchical understandings of institutionalized care, in which the care provider, such as a clinic or hospital and its personnel, engage in care work, whereas the psychiatric patient is merely a passive receiver of care. Also, working through Foucault’s notion of normalizing power, subjectivation and strategies of resistance, I  argue that trans patients are not merely passive subjects produced by matrices of medical ‘power/​knowledge’. Rather, in order to transform a society that has historically rendered gender transgressive behaviour and manners as either criminal or psychotic, trans people throughout history have actively engaged in emotional and intimate labour, both in the form of techniques of the self, as well as through community building and care for others. The history of gender reassignment surgery has been widely documented in the tradition of medical and cultural history (e.g. Hausman, 1995; Gilman, 1999; Kennedy, 2007; Meyerowitz, 2002), and still informs popular understandings of persons whose gender identity and presentation do not fit the binary category of male and female. Albeit producing new knowledge on the clinical history of the hormonal and surgical reconstruction of bodily characteristics, medical historical accounts on so-​called ‘sex change’, often reduce gender non-​conforming identity to the mere object and product of medical knowledge. Transgender thus becomes a diagnostic category for a specific type of a personal and behavioural disorder. The simplistic notion of the ‘transsexual subject’ as a product of medical discourse has also given ground for arguments according to which persons who undergo medical gender reassignment processes simply normalize and stabilize Western, normative conceptions of the gender binary (e.g. Hausman, 1995; Jeffreys, 2014; Kulick, 1998; Raymond, 1979). As a critical response to the individualizing and often pathologizing, medical histories of ‘transsexuality’ as an identity category, transgender and queer studies scholars have inquired into the ways in which trans identity is articulated, self-​defined, shaped and contested within marginalized communities themselves (e.g. Bailey and Arnold, 2009; Clare, 2015; Devor, 1999; Green, 2004; Halberstam, 2005; Namaste, 2000). Members of various trans communities throughout history have shared stories, experiences and recommendations with each other either in person or in letters (Stryker, 2017; Talmey, 1914; Thompson, 1951; Wickman, 2001). Furthermore, American community-​ based transgender historians and activists, such as Feinberg (1992), Stryker (2008); Gossett et  al. (2017), Clare (2017) and Snorton (2017) have turned to historical archives, community history and oral history, presenting documentation of transgender persons in history as agents and members of numerous political, activist communities and social justice movements. Community activists and scholars in the

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interdisciplinary fields of critical race theory, disability studies and transgender studies moreover, have provided insight not only into the question of how transgender persons negotiate gender identity in relation to the gender norms of dominant society, but how multiple forms of marginalization, such as poverty, chronic illness, homelessness, disability –​or simply being a trans woman of colour –​shape lived experiences and articulations of the transgression of binary gender norms (Bailey, 2013; Boelstorff et al., 2014; Cárdenas, 2016; Spade, 2015). This chapter aims to offer an account of bioprecarity that focuses on the patient’s agency; lived reality and possibility of resistance, however minimal, in the midst of normalizing biopower. I argue that such a perspective is crucial, as it has significant contemporary implications for understanding political processes through which some lives are rendered intelligible and worthy of autonomy and self-​determination, whereas others are subjected to bioprecarity. Here, I follow Mitchell and Snyder (2015), who in the introduction to The Biopolitics of Disability write: ‘the emphasis is upon a critique of strategies of inclusion that discount, universalize, and normalize disabled people on behalf of claims to social integration’ (15–​16, my emphasis). I begin by giving my interpretation of Foucault’s notion of ‘state racism’ as a biopolitical account of eugenics. I  then move to examine the history of the Swedish, state-​controlled diagnostic process of ‘transsexuality’ in the context of bioprecarity and intimate labour. I  will also analyse how American sexology shaped the Swedish discourse. Finally, I  will locate points of tension, disruption, intervention and resistance in the midst of bioprecarization. ‘RACISM AGAINST THE ABNORMAL’: BIOPOLITICS AS STATE RACISM Biopolitics as a philosophical concept denotes a network of strategies and power-​ mechanisms through which the state regulates and administers human life. Although the concept has a number of different meanings depending on the academic discipline and context of analysis, Foucault’s idea of modernity as the political regulation of biological life has had the most significant impact on contemporary theorizations of biopolitics. For Foucault, biopolitics means political power over life itself and operates through ‘normalization’ (Foucault, 1990, 2003b). In the first volume of The History of Sexuality (La Volonté de Savoir, 1976), Foucault discovers a new form of power that he calls ‘biopolitics’ (bio-​politique). Instead of the institutional practices and techniques over the individual body that Foucault had analysed in Discipline and Punish

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(Surveiller et Punir:  Naissance de la prison, 1975), biopower operates at the level of life, intervening and regulating every vital aspect of a population, including sexuality, health, nutrition, reproduction, immigration and death (Foucault, 1990:  139–​43; 1995). New forms of normalizing power/​ knowledge, such as standardized ‘population analysis’ and ‘statistics’ now help to dominate large groups of people. Yet, disciplinary power over individual bodies does not disappear with the birth of biopolitics. Instead, the two become coexistent, operating on different registers of society. A concrete example of this coexistence is European eugenics and the invention of the biological notion of the human race. According to Foucault, eugenic discourse on race, sexuality and reproduction connects disciplinary power over the body (anatomo-​politics) and regulatory power over populations (biopolitics) (Foucault, 2003b: 243). Foucault argues that the invention of the ‘human race’ divides and ranks life hierarchically into the superior, healthy, good and fit versus those that are inferior, degenerate, abnormal and pathological. Through this type of categorizing, ‘state racism’ defines certain groups of people as internal threats from which a society must be defended (Foucault, 2003a:  317–​18; 2003b: 254–​5,  258). As Snyder and Mitchell (2006: 100–​4) argue, the early eugenic movement was a Euro-​American project. As criminality and poverty became ‘hereditary problems’, advocates of eugenic sterilization saw sterilization as a more humane form of population control than compulsory institutionalization (Honkasalo, 2016). According to Foucault, the matrix of criminology, psychiatry and sexology functioned as the condition for the birth of eugenics. Supporters included heredity biologists, penologists, social workers, educators and even first-​wave feminists. By the early twentieth century, eugenic societies and research institutes had been established all over the world. Modernity hence generated a specific type of ‘state racism’: The racism that psychiatry gave rise to in this period is racism against the abnormal … It is a racism, therefore, whose function is not so much the prejudice or defense of one group against another as the detection of all those within a group who may be carriers of a danger to it [degeneracy]. It is an internal racism that permits the screening of every individual within a given society. (Foucault, 2003a: 316–​17, my emphasis)

Foucault’s characterization of ‘internal racism’ is thus synonymous with the standard understanding of eugenics as state-​enforced racial hygiene. He even argues that Nazi ideology simply had to craft and mould the already existing techniques of disciplinary power, the sovereign right to kill and the discourse of biopolitical state racism, in order to legitimate the construction

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of a totalitarian, genocidal state (Foucault 2003b:  259). Contemporary historians of genetics, such as Mukherjee (2017), agree. The compulsory euthanasia programme, ‘Aktion T4’, for instance, was an extension of the already standardized eugenic sterilization programme (Mukherjee, 2017: 64–​85, 119–​32). I have here deliberately emphasized Foucault’s theorization of the intimate link between biopolitics and eugenic ideology in order to strengthen my argument for the need to theorize intimate labour in the context of resistance to bioprecarization. I will next analyse how biopolitics operates in the Swedish eugenic state and its discourse on ‘transsexuality’. THE AMBIVALENCE BET WEEN HUMANISM AND EUGENICS: PSYCHIATRIC POWER IN THE SWEDISH CONTEXT In April 1963, Jan Wålinder (1931–​2014), a doctoral student in psychiatry at Gothenburg University, began a clinical study on ‘forty-​three cases of transsexualism’. The study was the first of its kind to be conducted in Sweden and functioned as the scientific background for the 1972 Swedish law that for the first time in the world regulated specific and detailed psychological, medical and legal measures for ratifying the ‘sex’ of what was then termed somatic intersexuals (somatiskt intersexuella) and non-​somatic intersexuals (icke-​somatiskt intersexuella) or transsexuals (transsexuella) (Alm, 2006; Garland, 2015). From 1966 to 1972, Wålinder was a member of the Justice Department’s expert committee, set up to investigate issues regarding change of official gender. During the course of 1963–​65 Wålinder conducted his doctoral research under the supervision of professor Hans Forssman (1912–​ 94) at Saint Jörgen’s Psychiatric Hospital in Gothenburg. Forssman, who at the time had just become a professor of psychiatry at Gothenburg University, had conducted his own dissertation on hereditary factors contributing to diabetes. He saw the Swedish eugenic sterilization programme as a humanist form of population politics and advocated the release of ‘feeble-​minded’ persons from psychiatric institutions upon the condition of sterilization. Forssman also advocated the sterilization of disabled persons (Forssman, 1958; Forssman and Olow, 1964).4 Forssman was best known for his investigation, together with the social worker Inga Thuwe, into the living conditions in Swedish mental hospitals, described in a number of articles and in his 1986 autobiography Törst efter Vatten och Vetande (Thirst For Water and Knowledge). The task of the three-​ year-​long, state-​organized investigation was to evaluate if the patients who

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were placed in hospitals, asylums and care homes for the ‘mentally retarded’ (psykiskt efterblivna) were placed in the correct institution and whether there were persons held against their will. The investigation was a response to complaints about violations in care. In her academic dissertation on the care for the ‘feeble minded’ in 1950s Sweden, Sara Hansson describes in detail how the lack of supervision gave Forssman a free hand to shape the investigation and also gave him access to hospital populations and data to advance his own scientific career (Hansson, 2007: 104–​15, 117–​45). Altogether, only one doctor (Forssman) investigated thirteen thousand inmates during the course of merely three years. This was possible due to simple, standardized questionnaires and quick IQ tests (Hansson, 2007: 104–​15). In his report, Forssman concluded that only thirty-​ nine patients were not ‘feeble minded’ and that a much larger problem were the patients who were ‘difficult’ to care for, due to behaviour problems and lack of adjustment to institutionalization. According to Hansson, the results reflect the social norms that guided psychiatric care at the time. During the 1950s, there were over two hundred different public and private care homes, mental hospitals and asylums for the ‘feeble minded’ and ‘mentally retarded’ throughout Sweden. Patient populations ranged from small to several hundred. Yet, the warehousing of patients in state custody was no longer seen as a functioning model for psychiatric care. Saint Jörgen’s hospital, where Wålinder conducted his doctoral dissertation on ‘transsexuality’, was a mental hospital built in 1872. In the 1950s and 1960s it specialized in anti-​psychotic treatment with new psychotropic medicines as an alternative to permanent state custody. A 1969 article by Forssman and Wålinder gives a picture of mental health care at St Jörgen’s hospital. The authors write about ‘the astonishingly good results’ with lithium experiments in comparison to electroshock treatment, insulin-​induced coma or lobotomy. One patient, a forty-​three-​ year-​old woman who was institutionalized at the age of sixteen for ‘attacks of uneasiness, violence and stupor’, had since then received altogether ‘79 insulin comate, 139 electric shock séances, lobotomy operation twice and massive pharmacotherapy’ (Forssman and Wålinder, 1969: 34–​5). Forssman and Wålinder write that in 1966 they tried lithium: ‘[W]‌ith an observation period of a good two years she has been kept on lithium and the change is striking. She has a friendly smile and can be employed with sewing’ (Forssman and Wålinder, 1969: 35). Another patient in the study was a ‘28-​ year-​old student, working with archives. Markedly asthenic and with certain schizoidia. Hospitalized on repeated occasions from the age of 24 years for paranoid notions that people consider him to be a homosexual’ (Forssman and Wålinder, 1969: 36). The patient was treated with lithium and showed the following signs of improvement: ‘He feels a new harmony and security

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and does not want to be without lithium, after earlier being unwilling to take his medicine. Observation period 13 months’ (Forssman and Wålinder, 1969: 36). Wålinder and Forssman also thought that epilepsy and ‘transsexuality’ might be related. One of Wålinder’s cases had been admitted to the mental hospital earlier, diagnosed with an abnormal EEG and then treated with phenantoin, an early-​generation anti-​epileptic drug. Wålinder writes that ‘as an experiment, he was given phenantoin, without any suggestion being used; three weeks later his transsexualism vanished. The drug had to be stopped because of its side effects, and with this the transsexualism reappeared’ (case 15 in Wålinder, 1967). It is against this historical context of a transforming psychiatric care system that the early Swedish psychiatric experiments on ‘transsexuality’ must be understood.5 Like the German-​born, American endocrinologist and sexologist Harry Benjamin (1885–​1986) before him, Wålinder was part of shaping a standardized diagnostic system, treatment method and legal process for patients for whom there existed no standardized diagnostic and no systematized and state-​supervised health care. Who were the ‘cases’ in Wålinder’s study? How did they find out about the possibility of endocrinological and surgical health care? The only published material on these Swedish ‘transsexual’ patients are the case reports summarized in an appendix to Wålinder’s doctoral dissertation, his article publications, as well as a follow-​up study that he conducted together with Forssman’s colleague, Inga Thuwe, in 1975 (Wålinder and Thuwe, 1975). Individual patient case files are strictly classified by the Swedish National Archives and often inaccessible because they contain personal information of persons who are still alive. According to librarians and archivists, there are no records of Wålinder’s papers or correspondence in Swedish regional archives, university archives or the National Archives.6 Hence, in the following, I proceed through an examination of published case report material in Wålinder’s dissertation and follow-​up study. Such an inquiry is bound to move from the margins to the centre, from that which is left unnoticed, unsaid or unwritten, to a reimagining of established truths and knowledge. In the introduction to the first volume of The Transgender Studies Reader (2006), historian Susan Stryker writes that a central element of academic transgender studies is a Foucauldian questioning of knowledge and power, and a scholarly and rigorous inquiry into what Foucault in Society Must be Defended calls ‘subjugated knowledges’ (Foucault, 2003b; Stryker, 2006). Subjugated knowledges are historical contents that have been erased, and knowledges that have been disqualified, but that nevertheless form the prerequisite for critique. I build on Stryker’s Foucauldian theoretical premise according to which transgender studies both critiques and re-​narrates past truths and norms about gender. I  am interested in

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examining bioprecarizing processes through which the multiplicity and diversity of trans lives become data, a statistical, deviant population to be administrated by the state, or simply ‘lives reduced to case files’, to quote Eli Clare (2017). These involve processes of erasure, but also points of rupture, intervention and resistance to bioprecarization. MEASURING AND TESTING THE ‘SEX’ OF ‘TRANSSEXUALS’ Has a transvestite ever consulted you or been referred to you? If so, please let me know their names and addresses, birth dates and birthplaces, and whether they are still alive? By transvestites I mean persons who feel as if they belong to the opposite sex, and who want others to look upon them as members of the opposite sex, whether they are content with only wearing the clothes of the opposite sex, or whether they also want their body changed to look like that of the opposite sex. (Wålinder, 1967: 30)

Wålinder obtained his cases by sending a letter to all practising psychiatrists in Sweden. He received a response from 361 doctors via letters or phone calls. Only a few refused to disclose the requested personal information about their patients. The majority of the patients were referred to Wålinder and Forssman by their colleagues such as psychiatrists, child psychiatrists and specialists in plastic surgery, endoctrinology and internal medicine. Only eight patients consulted Wålinder directly (Wålinder, 1967: 31–​2). During the course of the study, the patients were subjected to numerous tests. As the medical examination took place, the patients’ physical characteristics were examined and carefully measured. The outer appearance, size and consistency of testes and breasts were studied. Pubic hair was evaluated according to whether it had a ‘feminine appearance’ or was of a ‘male type’ (Wålinder, 1967: 35–​6). Patients assigned as female at birth, had their chest width and shoulder breath measured. The size of hands and feet were measured. Wålinder then compared his anatomic measurements with a 1956 anatomical-​anthropological study on 320 Swedish, physically healthy men enrolled in the military, conducted by Bengt Lindegård from the Laboratory of Differentiated Somatology, University of Lund. Lindegård, who had studied and measured human facial skeletons, had, according to Wålinder, created a reliable method for evaluating the arithmetic means for different body measurements of the ‘two sexes’. He thus repeated Lindegård’s measurements on his ‘transsexual’ patients and drew up tables to represent the ‘body dimensions in transsexuals’ (Wålinder, 1967: 35–​8). From physical measurements, Wålinder (1967: 38) proceeded to report on ‘mental and behavioral characteristics associated with transsexualism’. In order to receive empirically verifiable results, Wålinder administered

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numerous questionnaires to his cases, which attempted to receive a mean value in percentages of the total frequency of gender atypical behaviour.7 The subjects were also given other psychometric tests as well as open-​ ended and behaviour-​based interviews for testing sexuality. These included questions about their personal history with regard to sexual activity, amount of partners and preferred position during sex as well as fantasies during masturbation. In Wålinder’s study, disciplinary power operates through attempts to both make the patient detect and confess their innermost fantasies, as well as to make the patient’s unconscious transparent. Masculinity and femininity were measured with both verbal and non-​verbal tests, such as the ‘M–​F scale’ and ‘draw-​a-​person test’ in order to receive accurate measures of the person’s unconscious and conscious gender-​identification and self-​ image (Wålinder, 1967:  52).8 In five cases Wålinder (1967:  57) excluded drawings because ‘it was not clear what sex was intended (1 male and 4 female patients)’ . Hence the tests sought for and favoured certain types of gender experience and representation over others. In the context of IQ tests, the patients’ socio-​economic background and level of education was not taken into consideration, despite the fact that many of the patients in Wålinder’s study had been brought up in one or multiple foster care homes and had taken up manual work at an early age instead of having the chance of pursuing advanced education. Remnants of eugenic discourse surface particularly when Wålinder tracks the patients’ family history. He frequently uses terms such as ‘retarded’, ‘backward’ and ‘neurotic’ when describing relatives that he has either never met or has only met once. Intelligence, personality, social adjustment and possible family history of psychiatric disorders were evaluated with both open-​ended interviews and standardized, psychometric tests. In addition to the massive data obtained through physical and psychological tests and interviews, Wålinder tested the truth of the patients’ stories by obtaining information from relatives, parents, siblings, husbands or wives when possible. He also gathered information about the patient from state-​run registries, such as welfare agencies, child welfare bureaus, insurance offices, hospitals and psychiatric departments (Wålinder, 1967: 33). One reason for testing the parents and siblings was to check for possible genetic hereditary conditions. Another reason for the extensive research into patient records and family history was to see whether the patient was telling the truth about their psychological condition and gender identity and to differentiate possible delusion, memory loss or psychosis (Wålinder, 1967: 6–​9). The demand that the patient proves under medical and psychiatric observation that their condition is authentic and permanent, was carried over to

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the 1972 legislation on ‘transsexualism’ and to the process whereby the juridical confirmation of the ‘sex’ of ‘transsexuals’ was established. In addition, legal identity documents were conditional upon at least one to three years of psychiatric evaluation, a certificate showing that the person was at least eighteen years old, a Swedish citizen, unmarried and had undergone sterilization or was for other reasons incapable of reproduction. In the view of the state, the applicant who sought to change the gender marker on their birth certificate under the 1972 legislation was not simply an individual patient undergoing a psychiatric diagnostics and treatment process, but also a member of a population, whose reproductive future needed to be suspended. As eugenic discourse had shifted from ‘negative eugenics’ (forced sterilization) to ‘positive eugenics’ after the discovery of genocides conducted by the Nazi regime, eugenics now operated by supporting the family building of healthy, white, heterosexual couples (Stern, 2016). Citizenship was tightly connected to sexual reproduction and heteronormative family building. In such a context, particularly trans men became a threat to the Swedish binary family registry system. They were juridical men who could potentially give birth, whereas the registry only recognized women as birth givers and mothers. Hence, the sterilization requirement was not legislated as a voluntary or optional reproductive choice, but instead it was made mandatory for everyone who wanted to change the gender marker in their ID documents. The meeting protocols of the Justice department’s expert committee stated administrative clarity (administrativ klarhet) as a justification for sterilizing trans persons (Alm, 2006; Riksarkivet, n.d.: YK 2185, I). A SUBJECT PRODUCED BY MEDICALIZATION? Scholars such as Jay Prosser (1998), Sander Gilman (1999) and Jennifer Germon (2009) have shown how historically, ‘transsexual patients’ shaped the entire medical discourse on gender. On the other hand, as Sanna Karhu (2017) argues, some Foucauldian feminist theorists, such as Hausman (1995; 2020), go as far as to claim that ‘the pathologizing discourse on gender actually produced the transsexual subject position, which therefore necessarily became dependent on the medicalized “gender discourse” ’ (Karhu, 2017:  45–​6). Hausman’s argument is that the ‘transsexual subject’ is a creation of medical technology and that trans persons merely reinforce existing, sexist, binary gender norms. Critical of Hausman, Vivian Namaste (2000: 34) argues that ‘transsexuals in this type of scholarship can only exist as medical practice, so individuals who live and identify as transsexuals are best understood as victims of sexist and capitalist ideology’ . Marie-​Louise Holm (2017) too argues that the static, passive and pathologizing notion

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of trans is ethically problematic. In contrast to Hausman, Holm (2017: 113) asks how individuals have negotiated strict ‘gendersexed norms in different situations’. In a similar way, Karhu (2017: 60) develops the concept of trans liveability to denote the ethics and politics of trans embodiment as resistance to ‘unliveable gender norms’. Jane Ward (2010) makes a similar argument as Hausman regarding trans as a subject position that is produced through anti-​feminist discursive practices. Whereas Hausman focuses on medical technology as producing trans as a subject position, Ward (2010) theorizes the making of trans in the context of feminist theorizing of intimate labour. In Ward’s theorization, ‘gender labor’ denotes multiple ways in which cis-​lesbian, ‘femme’ women (who have sexual relationships with trans men), ‘give gender’ through validation, ‘bolstering their authenticity’ and ‘treating them like “real” men’ (Ward, 2010:  80–​1). Treating trans men as ‘real men’ involves according to Ward both the ‘labor of forgetting’, and learning a new ‘script’, that is, that a cis woman forgets her partner’s past as well as the sex assigned at birth (Ward, 2010: 87–​8). As a consequence, Ward contends that the ‘relational, intimate and sexual labor’ of the cis-​female partners of trans men has ‘produced transgender subjectivity’ (Ward, 2010: 79–​81). In her analysis of intimate labour, Ward postulates an essentialist distinction between authenticity (the sexed body) and appearance (gender presentation). This type of a distinction between appearance and reality is a common stereotype. Feminist trans philosophers, such as Talia Mae Bettcher (2007) have termed the distinction as ‘transphobia’ in the context of her analysis of the murder of Gwen Araujo, a trans teen who was murdered by four men after they discovered that she was transgender. ‘Fundamental to transphobic representations of transpeople as deceivers is an appearance-​reality contrast between gender-​representation and sexed body … Such a position is connected to this distinction between gender appearance and sex reality, where genitalia play the role of “concealed truth” about a person’s sex’ (Bettcher, 2007: 48). In Ward’s framework, trans as a subject position is rendered intelligible mainly as a result of cisnormative practices of intimate labour and care work that resemble a conservative heterosexual relationship. As a result, Ward goes as far as claiming that these ‘sexualized forms of gender labor’ resemble a form of non-​paid sex work (Ward, 2010: 87). Like Hausman, Ward too theorizes trans subjectivity as a passive end product of someone else’s knowledge and work. The fact that many trans men desire to give birth, have given birth, chest feed their babies and are in intimate relationships with other cis and trans men, is dismissed in Ward’s research. Furthermore, she does not refer to scholarly work on the identity-​and community-​building care work conducted by trans persons themselves (e.g. Claire, 2015; Devor, 1999; Namaste, 2000). This exclusion

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matters, because citational practices are not only ethically, but politically relevant for feminist theory (Hemmings, 2011). By leaving out alternative ways of understanding intimate labour, Ward distorts the multiple ways in which trans men engage in intimate labour and care. I will return to care as constitutive of the preservation of trans communities further below. First, however, I  want to problematize the simplistic conception according to which trans as a subject category and identity position is merely a product of the Western medical industry or the work of non-​trans experts. This does not mean that trans persons are not in many ways dependent on trans-​specific health care. Neither am I  denying the importance of medical science in making trans lives more liveable and intelligible. Rather, my argument concerns claims about the medical production of transgender subjectivity as such. I follow Pearce (2018) in my epistemological and methodological commitment to a genealogical critique of medical authority. In doing so, I follow a tradition of similar critiques in feminist theory, queer theory and AIDS activism. SELF-​N ARRATING AND INTIMATE LABOUR AS AN ANTI-​N ORMALIZING PRAXIS In the context of Foucault’s discussion on biopower, he states that: ‘[w]‌here there is power, there is resistance, and yet, or rather consequently, this resistance is never in a position of exteriority in relation to power’ (Foucault, 1990: 95). Against the classical liberalist notion of the autonomous and individual subject, whose agency and will exists independently of social norms and power, Foucault theorizes the subject as relational. Hence, various techniques of the self and economies of pleasure take place in the midst of matrixes of power. Foucault thus theorizes resistance in the plural, that is, as multiple practices that are context dependent, local and challenge predominant discourses of power/​knowledge in numerous, divergent ways. ‘They are struggles that question the status of an individual by promoting new forms of subjectivity and by questioning the ways in which knowledge circulates and functions in relation to power’ (Oksala, 2012: 49, my emphasis). These types of resistances in the midst of disciplinary techniques can be detected in historical, clinical case files of trans patients. In Wålinder’s study, for instance, four patients refused to finish the Frank Drawing Completion Test ‘because it was too silly, they said’ (Wålinder, 1967:  55). One patient refused to take the IQ test (Wålinder, 1967: 57) and another patient refused to complete the personality test that Wålinder used for diagnosing ‘psychoinfantilism’ among other personality traits (Wålinder, 1967: 48).

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Trans patients in clinical studies from the 1950s to the 1970s show repeated attempts at self-​narrating a coherent life story and promoting new forms of subjectivities within the context of social norms that did not recognize trans lives and bodies as intelligible and liveable in the first place. Katariina Parhi’s study of unpublished patient case files of persons diagnosed with ‘transvestitismus’ in the Helsinki Psychiatric Clinic 1954–​68, for instance, sheds light on how trans persons narrated their personal gendered experience to psychiatrists and doctors before the medical terminology of ‘transsexuality’ was even introduced to Finnish diagnostics. They thus actively engaged in the production of psychiatric knowledge (Parhi, 2018: 52). However, just as in Wålinder’s dissertation and follow-​up study, it was the ‘experts’ who wrote the patient case reports in clinical settings, that is, at a mental hospital, and thus the narrative accounts of the patients did not take place in a vacuum, neutral to power structures and social norms. As Pearce (2018: 116) argues, ‘the expert, professional opinion of practitioners is prioritized over the lived identities, desires and experiences of trans patients in terms of recognizing gendered possibilities’. Autobiographical and autoethnographic accounts by trans persons throughout history indicate repeated and complex stories of challenges, struggle and creativity (Holm, 2017). I  would add that these stories also entail a heavy engagement in intimate and emotional labour. On the one hand, trans persons engage in emotional labour by negotiating, compromising and convincing medical ‘experts’ that they can ‘pass’ in the ‘new’ role of ‘the opposite sex’ (Leibetseder, Chapter 4 this volume). At the same time, they must not intimidate the clinician who is the gatekeeper of access to health care. Hence, control and management of emotions, body language and voice are crucial for survival (Linander et al., 2017; Psihopaidas, 2017). As both the trans activist-​theorist Sandy Stone as well as the American psychologist and sexologist Leslie M. Lothstein has recalled, distrust in the patient was a recurring theme discussed in publications by psychologists, clinicians and endocrinologists working with trans patients in the 1960s and 1970s. The problem, from the perspective of the ‘expert’, was that some of the patients seemed to have prepared rehearsed stories that clearly fit the diagnostic criteria (Ekins, 2005:  329; Lothstein, 1984). However, from the perspective of the patient, anything regarded by the clinician as a failure to meet the strict diagnostic criteria or a failure to present oneself as permanently belonging to the ‘opposite sex’, could lead, often did lead and still leads to a rejection of the application, thus rendering the patient into an even more precarious situation (Stone, 1991). Intimate labour as ‘work that involves embodied and affective interactions in the service of social reproduction’ (Boris and Pareñas, 2010) is evident also in the ways in which many members of various trans

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and cross-​dressing communities throughout history have shared stories, experiences and recommendations with each other either in person or in written form. In Germany and in the United States, for instance, psychologists and sexologists used letters from around the world as source material in their attempts to understand and create diagnostics and treatment methods for ‘transvestism’ and ‘transsexuality’. The life stories obtained from letters thus became part of data, case files, knowledge and intellectual property of the medical ‘experts’. In addition to Hirschfeld’s research, some early collected letters include those collected by Bernard S.  Talmey in 1913 (Schaefer and Wheeler, 1995; Stryker, 2017; Talmey, 1914). Also Nordic trans persons established letter clubs. The most known of these are transvestite and trans clubs that followed Virginia Prince’s Transvestia club from the 1960s, such as the Swedish chapter of the Full Personality Expression (FPE) established in 1962 and Transvestia in 1964. FPE-​Northern Europe (FPE-​NE) was established in 1966, with members from Sweden, Denmark and Finland. Swedish trans pioneer community organizers, such as Eva-​Lisa Bengtsson (1932–​2018) had been active already in the 1950s (Westerlund, 2018). Another example is the intellectual collaboration between endocrinologist and trans health care pioneer Harry Benjamin and his patients. ‘Doris’, who was one of Benjamin’s first patients, cooperated with Benjamin to the extent that she can be characterized as having been his research assistant. She published an auto-​ethnographic article on ‘transvestisms’ under the pseudonym ‘Janet Thompson’ in 1951, provided Benjamin with new patients to study and helped him shape the diagnostic through constant correspondence. The two even discussed the diagnosis of other patients and whether they were ‘authentic transsexuals’ or not. Benjamin scholars Schaefer and Wheeler (1995: 81) write: ‘The uniqueness of their correspondence was that Doris, as a patient and as an inner analytic inspiration to Benjamin, taught him much about the condition; and Benjamin, in turn, could use Doris as a sounding board for the development of many of his ideas.’ Although Schaefer and Wheeler write empathetically about the intellectual collaboration between Benjamin and ‘Doris’, the focus is exclusively on Benjamin’s achievements in sexology, how he became ‘the father of transsexualism’ and hence they ignore the power dynamic between the ‘expert’ and the patient whose life is dependent on continuing hormonal prescriptions, for instance. In ‘The Three Kings’, his memorial piece on working with Benjamin and his followers John Money (1921–​ 2006) and Robert Stoller (1924–​ 91), sexologist Richard Green (1936–​) recalls how Benjamin invited patients to his home and took them out for dinner in Manhattan (Green, 2008: 603). This was possible

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because Benjamin had a private practice, free of institutional concerns (Ekins, 2005: 309). He writes: Harry seduced me deeper into transsexualism. At our first clinical day, he introduced me to a beautiful post-​operative patient. She had been operated on by George Burou in Casablanca. She allowed me to conduct a pelvic examination. I  was astounded at the excellence of the surgery. The three of us went to an elegant Manhattan restaurant. I have never had a companion who caught the eye of so many admiring, lustful men. This was not because she appeared as a sex-​change. She was a genuine woman stunner. I still receive her Christmas greetings. She is still beautiful. (Green, 2008: 610)

Green’s objectifying and sexist attitude towards Benjamin’s patient sheds light on the power dynamics between the ‘kings’ and the patients in 1960s American society. The trans woman is depicted by Green as both a researchable and sexually approachable object of curiosity. The intimate and emotional labour carried out by the numerous patients, and the value they produced, was transformed through a process of commodification and fetishizing into the intellectual property of Benjamin and his followers, and after their death, archived in their name. Yet, these stories and letters are also part of the cultural and oral history of the rich and internally diverse trans community. As the patients’ life stories became transformed into scientific, sexological knowledge, their intimate labour underwent a process of alienation. According to Ekins (2005), Benjamin’s early studies, for instance, were more open towards gender diversity, whereas in his later work leading up to the Transsexual Phenomenon (Benjamin, 1966) that established him as ‘the father of transsexualism’, he began to ‘normalize’ the descriptions of his patients to better match a heteronormative framework of diagnostics and treatment (Ekins, 2005:  320). In this way, claims Ekins, Benjamin compromised good scientific practice for politics. The patients who best represented or who best fit Benjamin’s clinical criteria and aesthetic ideals for ‘transsexualism’ were most likely to receive medical care, such as hormonal treatment and gender affirming surgical procedures (Ekins, 2005: 320). As Sandy Stone recalls, patients who signed up for clinical studies and an evaluation for treatment were familiar with Benjamin’s work. When the first clinics were constituted, Benjamin’s book was the researchers’ standard reference. And when the first transsexuals were evaluated for their suitability for surgery, their behavior matched up gratifyingly with Benjamin’s criteria. The researchers produced papers which reported on this, and which were used as bases for funding. It took a surprisingly long time  –​several years –​for the researchers to realize that the reason the candidates’ behavioral

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profiles matched Benjamin’s so well was that the candidates, too, had read Benjamin’s book, which was passed from hand to hand within the transsexual community, and they were only too happy to provide the behavior that led to acceptance for surgery. (Stone, 1991, my emphasis)

Historians and sexologists such as Schaefer and Wheeler (1995) and Green (2008) write from an angle that separates and individualizes the collaboration between the experts and the patients in the shaping of the diagnosis and treatment. On the contrary, trans theorists such as Stone (1991), Namaste (2000) and Stryker (2017) among others, offer a perspective from the point of view of the lived realities of the patients:  how they shared experiences, recommendations and knowledge and, most importantly, how they survived and kept the trans communities alive. The transnational exchange of knowledge is evident in the fact that Wålinder’s conceptualization of ‘transsexuality’ was heavily influenced by the Cold War American sexology of Money, Stoller, Green and most importantly Benjamin, with whom Wålinder communicated in 1966. Parts of Wålinder’s study even read like an attempt to empirically verify Benjamin’s characterization of ‘transsexualism’ in the Swedish context.9 Similarly, in 1971 Kalle Achté, professor of psychiatry at the University of Helsinki, repeated Wålinder’s methods of data collection and analysis. He thus attempted to confirm Benjamin’s and Wålinder’s results in the first study on Finnish ‘transsexuals’, published in 1971. Unlike Benjamin and Wålinder, Achté was a strong proponent of psychoanalysis and opposed surgery as a treatment for what he considered to be a mental disorder. According to Achté, gender reassignment surgery was ethically comparable to lobotomy. As he thought that ‘transsexualism’ was simply an extreme form of homosexuality, he suggested therapy as treatment, despite Benjamin’s and Stoller’s studies on the ineffectiveness of conversion therapy (Alanko and Achté, 1971). Characteristic of ‘transsexualism’ as a ‘separate disease entity’ became ‘(a) a conviction of belonging to the other sex, (b) abhorrence of sex attributes given by nature and (c) and an overwhelming longing for a “change in sex” ’ (Wålinder, 1967:  88; cf. Alanko and Achté, 1971; Benjamin, 1966). Like Benjamin, also Wålinder sought to find a biological etiology to the ‘anomaly’ in order to secure legally the option of hormonal and surgical treatment for suitable patients. Benjamin had suggested the possibility of brain damage or genetic factors as a cause of ‘transsexualism’ (Benjamin, 1966; Ekins, 2005) and Wålinder called for more research to confirm this hypothesis. What distinguishes the American sexological studies on ‘transsexuality’ dramatically from Wålinder’s study, the Swedish Justice Department’s committee report and the Swedish legislation on ‘transsexualism’ is that the American sexologists did not promote evidence of infertility or sterilization

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as a condition for federal, legal recognition. As I have argued in Honkasalo (2019), the Swedish diagnostic was shaped under strict state control, during a time when the eugenic sterilization programme was still in effect, whereas the American diagnostic was crafted in private practices or privatized university hospitals with trans persons themselves participating in the formulation of diagnosis and care. The Swedish Gender Recognition Act was quickly taken up by other European nations. Norway established a service for the treatment of ‘transsexuals’ in 1979, Germany ratified a Trans Act in 1980, Italy in 1982, Austria in 1983 and the Netherlands in 1985. In addition to the requirement of infertility all five countries also required partial or complete genital surgery. Until 2004, all European countries that juridically recognized trans persons, required infertility as a condition for new ID documents (Dunne, 2017; Rappole, 2015). Between the years 1935 and 1975 Sweden sterilized some sixty thousand citizens (Broberg and Roll-​Hansen, 2005: 96–​169). In 1997 the government ordered an official investigation into the 1935–​75 eugenic sterilization programme (Steriliseringsutredning). Trans persons were not included in the investigation (Riksarkivet, n.d.: YK 5302, II). Instead the report considered ‘sex change’ as a voluntary process that inevitably led to infertility (Tydén, 2003). In the memos of the massive investigation is a section reflecting on future perspectives (framtidsaspekter) and the question of what contemporary practices might be conceived as unethical or problematic fifty years ahead. Cloning is taken up as an example, whereas the ongoing sterilization of trans persons is not (Riksarkivet, n.d.: YK 5302, II). It was not until sixteen years after the Steriliseringsutredning, following decades of activist work, that the law mandating the sterilization of persons requesting a change in their legal gender marker was ruled as unconstitutional by the Stockholm Administrative Court of Appeal, in 2013. Four years later, the Swedish government published a nearly one-​thousand-​page official report on trans people’s living conditions, entitled Stronger Status and Improved Living Conditions for Trans People (SOU, 2017: 92). The report shows that up until 2017, similar tests and questionnaires to the ones used by Wålinder in the 1960s had been used in the diagnostic evaluation of ‘gender identity disorder’. CONCLUSION: TRANS COMMUNITY BUILDING AS RESISTANCE TO BIOPRECARIZATION The implication of my use of the concepts of ‘bioprecarity’ and ‘intimate labour’ in the context of transgender patient agency in the shaping of diagnostics and care is that simplifying understandings of ‘medicalization’,

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‘gender labour’ and care work risks concealing the genealogies of power that render various minorities and marginalized communities differently and disproportionately oppressed. Consequently, the historical, geographical and cultural differences between diverse strategies of resistance to exploitation and normalization risk becoming obscured. As an example of this, I have discussed a number of ways in which transgender intimate labour has been exploited in the biopolitical, administrative project of documenting, quantifying and standardizing normative notions of gender and sexuality, as well as how trans patients have endured, survived and resisted bioprecarization, while at the same time seeking hormonal and surgical health care. In order to understand and further theorize the complex power dynamics between medical experts and patients, and in order to locate points of tension, disruption and intervention of disciplinary power and biopower, more references to trans community building are necessary. Trans identity as articulated and shaped through historical time, in relation to marginalized communities and subcultures, has received only marginal, if any, scholarly attention in the tradition of medical and clinical history on transsexuality. Although sociological and empirical literature on trans community building and identity formation is growing, this research largely theorizes community as spatially and geographically bound, but does not inquire into experiences of the relationship between community and notions of future (Ekins and King, 2006; Hines, 2007; Hines and Sanger, 2010; Lev, 2007; Valentine, 2007). And yet, the depiction of the present time as one that hinges between a history that has been erased and a future not yet here, is a prevalent theme in transgender liberation and trans-​feminist scholarly writing (e.g. Claire, 2010; Feinberg, 1992; Green, 2004). A characteristic of texts on trans liberation is the vision of trans as establishing community care and preserving community memory in order to survive and resist state-​legitimated and socially sanctioned forms of oppression and violence. For instance, trans communities have produced rich community-​based knowledge on gender transition related to health care, as well as HIV health care (Bailey, 2013; Bailey and Arnold, 2009; Gossett et al., 2017; Namaste, 2000). The passing on of community-​based knowledge can be seen as a form of resistance and counter-​power (counter-​dispositif) to biopolitics. Whereas disciplinary power over the temporality of the subject and biopower over the future of marginalized populations administers and regulates which lives are allowed to foster and which lives must be neglected to the point of death, community resistance to biopolitics intervenes with the control and regulation of futurity.

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NOTES 1 I use the term ‘transsexual’ in the context of historical, medical texts where the authors themselves have used the term. Otherwise, I  follow Stryker (2017) and Pearce (2018) and use the umbrella term ‘trans’ very broadly, to denote trans, gender non-​conforming and non-​binary persons. 2 Bioprecarity means ‘the vulnerabilization of people as embodied selves’ (see Griffin and Leibetseder, Introduction this volume). 3 The apparatus (dispositif) is a term that Foucault developed in the mid 1970s, while working on his theorization of security governmentality. For Foucault, the term signifies a set or network of strategic mechanisms –​such as institutions, norms and knowledge structures –​through which power is exercised, either at state level as a response to an urgency or an emergency, such as an epidemic, or then at the level of the subject, as power/​knowledge (Bussolini 2010: 87). Foucault (1980: 195) characterizes an apparatus of power as a set of multiple ‘discourses, institutions, architectural forms, regulatory decisions, laws, administrative measures [and] scientific statements’. 4 Forssman was an influential member of the Swedish eugenic movement, but like many scientists of his time, he was also a humanist and distanced himself strongly from the German Nazi movement. At the end of World War II, Forssman joined the Swedish Red Cross ‘white buses’ as a medical emergency respondent to the Belsen-​Bergen concentration camp (Riksarkivet, n.d.: RA721068). In a rare interview for the Swedish Radio in 1990, the then nearly eighty-​year-​old Forssman claimed that back in the day, everyone was a eugenicist (Lindqvist, 2014). 5 In 1922 Sweden became the first nation in the world to establish a state-​run eugenics institute, named the State Institute for Race Biology (Statens Institut För Rasbiologi). The Institute was effective until 1958, when its name was changed into the Institute for Medical Genetics, and it integrated into Uppsala University. Hence, when Wålinder took his BA in medicine at Uppsala in 1952, the Institute for Race Biology was still operating with the eugenicist (and friend of Hans Forssman) Gunnar Dahlberg (1893–​1956) as its head. 6 Honkasalo, personal correspondence in 2017 with Lindköping University archives, Lindköping regional archives and Gothenburgh University biomedical archives. 7 Wålinder follows here 1950s and 1960s American sexological and behaviourist experiments on reversing ‘sissyism’ in ‘effeminate boys’ (see Honkasalo, 2016). Hence, he studied how often ‘boys’ played with dolls or played house, sewed or helped the mother, and how often ‘girls’ played with ‘Indians and cowboys’, spent time with ‘things of a mechanical nature’ or ‘climbed trees’. 8 The male–​female scale (M–​F scale) was originally invented and developed by the eugenicist sexologists Lewis M. Terman and Catharine Cox Miles in a study on masculine and feminine behaviour in male, Alcatraz prison inmates. Terman and Miles also developed eugenic theories on IQ (Honkasalo, 2016). The ‘draw-​ a-​person test’ was originally called the ‘draw-​a-​man test’ and developed in 1926 by Florence Goodenough to evaluate children’s IQ based on their drawings. Goodenough was an assistant of Terman.

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9 In the bibliography to his dissertation, Wålinder refers to personal correspondence with Benjamin in 1966. However, there is no archived correspondence between the two in the Harry Benjamin Collection at the Kinsey Institute Archive, University of Indiana. In 1969, two years after his PhD, Wålinder published a chapter on ‘Transsexuals: Physical Characteristics, Parental Age and Birth Order’ in Transsexualism and Sex Reassignment, edited by two of the most famous American sexologists, John Money and Richard Green. They were both students and close friends of Benjamin. The anthology was dedicated to Benjamin. Wålinder’s name is listed as a member of the scientific programme committee of the Harry Benjamin Gender Dysphoria Association’s XVI symposium in London, hosted by the association’s president, Richard Green. Green was also the president of the scientific programme committee. Thus, the impact of Benjamin on Wålinder’s work was not short-​lived, but systematic.

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Wålinder, J. (1969) ‘Transsexuals, physical characteristics, parental age and birth order’, in Green, R. and Money, J. (eds) Transsexualism and Sex Reassignment. Baltimore, MD: Johns Hopkins University Press, pp. 221–​33. Wålinder, J. and Thuwe, I. (1975) A Social-​Psychiatric Follow-​Up Study of 24 Sex-​ Reassigned Transsexuals. Stockholm: Akademiförlaget. Ward, J. (2010) ‘Gender labor: Tansmen, femmes, and the collective work of transgression’, Sexualities 13(2): 236–​54. Westerlund, U. (2018) ‘RFLS minns en transpionär’. Available at www.rfsl.se/​aktuellt/​ rfsl-​minns-​en-​transpionjar (accessed 1 October 2019). Wickman, J. (2001) Transgender Politics:  The Construction and Deconstruction of Binary Gender in the Finnish Transgender Community. Turku, Finland:  Åbo Akademis förlag.

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CONCLUSIONS G a br i e l e Gr iffin and D or i s L ei betseder

I

n this volume we have considered how bodily interventions, and their seeking and their doing through intimate labour, produce bioprecarity. Using a range of very different examples we argue that to understand bioprecarity as we develop it in this volume means thinking through the ways in which the body, life, the production, maintenance and application of categories and intimate labour are entangled. This entanglement creates a complex biosociality (Mohr, 2018) far beyond those immediately involved. One reason for this entanglement relates to the threat to or actual collapse of the boundaries that often serve to establish distinctions, differences in and of category. Hence in the first chapter of this volume the idea of bioprecarity is developed out of Foucault’s thinking about biopower, the disciplinization and regulation of life, Butler’s concept of precarity and the unequal distribution of vulnerability or precariousness among diverse groups of people and individuals. This is linked to the ways in which intimate labour as body work and as embodied work challenges boundaries between the personal and the public and between paid labour and personal care/​caring. It is also linked to the articulated relations between structures of governance, such as the government and public institutions and individuals or groups of individuals, and how these are perceived in the codifications employed by governments and institutions. In a somewhat perverse inversion of the second-​wave feminist assertion that the personal is the political, here the personal has become the public and those conducting intimate labour struggle to retain a self that is not subjectivated by the biosociality of their labour. In this people who provide intimate labour are rendered more vulnerable than other people not undertaking this kind of biolabour, not least because the agency they have in undertaking this work is very limited indeed.

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Intimate labour in its many different forms is embedded in structures of inequality or ‘inequality regimes’ (Acker, 2006), and bioprecarity is thus endemic to those regimes. These inequality regimes come out of sustained formal and informal histories of categorization involving categories such as gender, race, ethnicity and sexuality. They work in tandem with geospatial locations, biotechnological developments, globalized economic forces and changing political landscapes to render groups of people and individuals, frequently on the basis of their embodied selves, particularly vulnerable as embodied beings. Both being fitted into categories and failing to fit them can lead to enhanced bioprecarity when, for instance, one’s health comes under threat because one is denied access to certain treatments. One question raised by this is how to counter such bioprecarities. This is a difficult question in an age when we see two phenomena that directly intersect with these issues:  the first is the rise of conservatism and new forms of nationalism that sanction, for instance, old forms of bioprecarization through the resurgence of racism, anti-​Semitism and anti-​ immigration policies. All of these are about resistance to the other. And questions about resistance to the other have continued to be at the forefront of both politics and of theoretical thinking. Theorists of community such as Georgio Agamben (2006), for example, have talked eloquently of the role of fear in this phenomenon. In Precarious Rhapsody Franco Berardi (2009a) discusses the ways in which contemporary labour conditions are structured to produce not just fear, but panic, partly as a result of the information overload that the infosphere produces and that is no longer processable by humans. However, bodily interventions through intimate labour are not entirely regulated through the infosphere or the technosphere. In many instances such interventions occur at the interface between individuals who interrelate in the process of those interventions, and larger formations such as migration, human capital and economic resource flows that circumscribe those interventions and interactions. We need only to think of people wishing to form a family through surrogacy, going on the Internet to find out about the various possibilities they have and opting to go to another country than the one they live in to pursue their dream of a family because the related procedures are cheaper or less legally regulated there. When Dr John Zhang wanted to help a couple have children using DNA from three parents in 2016, for instance, he could not do so in the United States where he is based because this procedure had not been approved there, ‘so Zhang went to Mexico instead, where he says “there are no rules”. He is adamant that he made the right choice. “To save lives is the ethical thing to do,” he says’ (Hamzelou, 2016: n.p.). Here it is less the issue of information overload and more that of complex and contradictory entanglements and regulations that shape the experience

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of that process, both for those seeking that intervention and for those providing it. Indeed, complexity has become one of the core descriptors of contemporary cultures and it is one that can produce a certain paralysis around making judgments and decisions about what is or is not ethically, legally, politically, socially acceptable. The way out of this conundrum is frequently described in terms of ‘resilience’ (e.g. Butler et al., 2016), a ‘rolling with the punches’ that bespeaks adaptation rather than confrontation or indeed resistance to the practices and politics that produce bioprecarity. Sarah Bracke (2016: 67) has eloquently shown how the incitement to resilience becomes a tool for appropriating the ‘gendered damage’ that ensues, turning it into opportunity, resource or capital. ‘Putting up with’ the chemical fumes breathed in while working long hours in a nail bar may thus seem like a form of resilience on the part of the worker, and the immediate material gain, even in the form of a very low wage, may appear to outstrip the disadvantage of this somatic exposure to bodily stress. But it also simply continues to reinforce the exploitary mechanisms inscribed in this whole process:  the use of migrant labour made cheap and expendable, the disregard for worker safety at a specific personal somatic level, the reduction of workers to individualized labourers who lack a collectivity to lobby on their behalf and the ready consumption for superficial personal gain of the gendered damage that goes with deciding to have one’s nails done in a nail bar. In all this time emerges as an important factor, and not only in terms of the way in which cheap labour results in precarious short-​termism by those providing that labour as a consequence of low wages that do not allow for long-​term planning. Here we need to attend to the second phenomenon that makes difficult the issue of what to do about the bioprecarities that arise from bodily interventions through intimate labour –​time. This is readily apparent in the speed of development of biotechnologization. Opportunities, possibilities and techniques for bodily intervention utilizing technology have changed, and continue to change, at rapid rates. These rates do not map readily on to either political or legislative cycles, and hence there is a disjuncture between those developments and their regulation, for good and for ill. Recent debates in the UK and elsewhere about the use of cannabis to alleviate certain forms of epilepsy, or about the use of cryo-​stored sperm by people whose sperm-​providing partner has either left them or died are just two examples of the disjuncture between biotechnologically driven opportunities for undertaking bodily interventions and their entanglement in legislative frameworks that are overtaken by the speed of these developments. Here it could be argued that advances in technologization also suggest that some of the more demanding and bioprecarizing forms of intimate labour such as carework (medical, social, child, elder, etc.), for example, may

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in time be done by robots or mediated to such an extent that the bioprecarity of the workers in these fields is safeguarded or becomes irrelevant as humans are no longer required to fulfil these tasks. However, as Jennifer Robertson’s (2018: 6) work also makes clear, creating humanoids –​robots that resemble humans and ‘can perform in a human-​like manner in environments designed for the capabilities of the human body’ –​is a difficult process that may not come to fruition in the medium or indeed the long term. Although carebots, sexbots, nannybots (robots with functions that enable them to do care work, sex work or childcare) are much discussed and seem ready or only around the corner, they are neither remotely fit for purpose at this point in time, nor readily available. Then there are the questions: Do you want a robot to discipline your child for misbehaving? How do nannybots cope with tantrums? The implications of bot use, from their resource impact on the environment to their impact on social relations and corporeal realities, are unknown. Technology revolutions or developments that obviate intimate labour, especially in care terms, are thus largely a matter for the long term rather than the short-​or medium-​term future and, in any event, they may only be readily available even then to a relatively small number of the world population (see Tegmark, 2017). Technology-​driven bodily interventions in kinship-​making, in contrast, are on the rise as biotechnologies diversify and migrate to new forms and content. Recent discussions about trans parenthood, for example, make this very obvious. These produce not only new types of somatic relation but also new forms of social relation, the impact of which is not (yet) fully understood, not least because human lives develop relatively slowly compared to technological change. Here there are possibilities for all kinds of bioprecarities, for those who provide the bio materials, for those who receive them and for those created from them. The mitigation of the accompanying bioprecarities is complex since it involves the negotiation of multiple differential positions, and potentially over the life times of all those involved. An indicator of this is the sperm donor who in his twenties when he donates does so anonymously but in his forties experiences the desire to meet his offspring. Or the surrogate who spends her life wondering what became of the child she gave birth to. Biotechnologization is here to stay  –​its benefits, dilemmas and developments need addressing and monitoring, not least for the unintended ethical or biopolitical concerns these may generate (e.g. Williams et al., 2018). In the biotechnologized world we inhabit inequalities are rife, inequalities of power to control and influence these situations, material inequalities, inequalities of opportunity. Indeed, Bruno Latour (2018: 1, 2), among many others, has noted the ‘explosion of inequalities’, as he puts it, which has occurred in recent years and that he links to ‘the absence of a common world we can share’. This absence relates to new exclusions and inclusions

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that have been fostered by their co-​creation between those who are in a position to promote them and those who have to consent to them in order to prosper, or rather, quite simply to survive. Power (Foucault, 1983:  193) is here not evenly distributed but becomes an effect of inequality regimes that enable biosubjectivation. And such subjectivation goes beyond the bioprecarious scenarios in intimate labour we have discussed in this volume. It links also to much broader issues, not least climate change and its impact on natural resources. Biopower in the Foucauldian sense may have shifted from the ‘right to kill’, to the ‘right to let live’, to, finally, ‘the right to maim’, as Jasbir Puar (2017) explains. But this biopolitics of debilitation is significantly augmented by climate change, what people do to other people via how they inhabit this earth. Bruno Latour argues that we need to understand ‘ “climate” in the broad sense of the relations between human beings and the material conditions of their lives’ and that it is at the centre of contemporary politics since ‘the ground is giving way beneath everyone’s feet at once’ on account of this change (Latour, 2018:  1, 8). Hurricane Katrina, tsunamis, year-​long droughts  –​all of which force population migration  –​indicate this pervasive phenomenon that certain conservative elites choose to deal with by denying it. This, Latour suggests, is because they are engaging in the abandonment of any notion of solidarity (evidenced in the US withdrawal from the Kyoto Agreement) in the new anti-​globalization movement that they spearhead; the one world we inhabit is not enough space or resource to deal with the effects of climate change. Large-​scale bioprecarity looms –​a sustained attack on the ‘bare life’ that many of those least able to defend themselves against this scenario inhabit, supported by ‘the creation of semiocapitalism, the new regime characterized by the fusion of media and capital’ (Berardi, 2009a: 18) that makes the proclamation of ‘fake news’ possible. In these contexts of competing versions of realities, there is no longer a shared horizon, and the atomization of labour forces, including the individualized intimate labour that is the work-​life norm for many women, poor people, those excluded on account of their ethnicity, sexuality, race or class, reinforces this absence of a shared horizon. And even though ‘the individual actor is the last locus’ (Appadurai, [1996] 2009:  33), not just individuals but whole communities are constructed as not salvageable, as bioprecarious and bioexpendable, through the ways in which their lives are framed. They are condemned to death, the destruction of ‘bare life’, at a remove from the elites that seek to withdraw from spaces that are threatened by climate change. This is the new thanatopolitics or necropolitics where the body is threatened with extinction. Bioprecarity as an effect of climate change’s consequences is, as Latour (2018: 25) puts it, ‘a deficit of shared practice’. How does one regain such a practice, the notion of a shared horizon and of solidarity? Already in The

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Soul at Work (2009b) Berardi asks how we can move from community to collectivity, from an aggregate of people who share certain traits, experiences, practices, etc. to a group who conjoin for political action and intervention. The past few years have seen attempts to create coalitions between diverse groups of people for the purposes of thwarting the bioprecarizing thanatopolitics of our times. Mass demonstrations by bioprecarized people, often resulting in the deaths of many of the protesters, in places such as Turkey, Yemen, Sudan, France, the UK and the United States, have drawn attention to the possibilities of such collectivities to come together for the purposes of intervention. They have had very limited success, but they are indicators of a groundswell of reaction against the forces that conjoin to ensure that bioprecarity is the fate of those selected as expendable. Countering these bioprecarious positions is not straightforward. It might hinge on thinking through more carefully what biocitizenship (Rose, 2009) might mean, whether this be at local or global level. The codification of human beings should not be the reason for unequal treatment or unequal biocitizenship, since ‘anatomy cannot be the foundation for political agendas and moral judgements, given that anatomy (a historically fabricated system of representation) is in and of itself the result of changing political and social conventions’ (Preciado, 2016: 408). The recognition of the interdependencies that exist between humans as a function of their bioprecarity might be the source of collective action in the political realm to change the impact of exclusionary forms of governance and categorization. And the impetus for such action might come not from the conditions of intimate labour that promote bioprecarity but from the impact of climate change on our relation to the earth and to each other. REFERENCES Acker, J. (2006) ‘Inequality regimes: Gender, class, and race in organizations’, Gender and Society 20(4): 441–​64. Agamben, G. (2006) Fear of Small Numbers. Durham, NC: Duke University Press. Appadurai, A. [1996] (2009) Modernity at Large:  Cultural Dimensions of Globalization. Minneapolis: University of Minnesota Press. Berardi, F. (2009a) Precarious Rhapsody. London: Minor Compositions. Berardi, F. (2009b) The Soul at Work: From Alienation to Autonomy. Los Angeles, CA: Semiotext(e). Bracke, S. (2016) ‘Bouncing back:  Vulnerability and resistance in times of resilience’, in Butler, J., Gambetti, Z. and Sabsay, L. (eds) Vulnerability in Resistance. Durham, NC: Duke University Press, pp. 52–​75. Butler, J., Gambetti, Z. and Sabsay, L. (2016) (eds) Vulnerability in Resistance. Durham, NC: Duke University Press.

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Foucault, M. (1983) ‘The subject and power’, in Dreyfus, H. and Rabinow, P. (eds) Beyond Structuralism and Hermeneutics. Chicago:  University of Chicago Press, pp. 208–​26. Hamzelou, J. (2016) ‘World’s first baby born with new “3 parent” technique’, New Scientist, 27 September. Available at www.newscientist.com/​article/​2107219-​ exclusive-​worlds-​first-​baby-​born-​with-​new-​3-​parent-​technique (accessed 3 June 2019). Latour, B. (2018) Down to Earth:  Politics in the New Climate Regime. Cambridge, UK: Polity Press. Mohr, S. (2018) Being a Sperm Donor:  Masculinity, Sexuality and Biosociality in Denmark. New York: Berghahn Books. Preciado, P. B. (2016) ‘Politically assisted procreation and state heterosexualism’, South Atlantic Quarterly 115(2): 405–​10. Puar, J. K. (2017) The Right to Maim:  Debility, Capacity, Disability. Durham, NC: Duke University Press. Robertson, J. (2018) Robo Sapiens Japanicus. Berkeley: University of California Press. Rose, N. (2009) The Politics of Life Itself: Biomedicine, Power and Subjectivity in the Twenty-​First Century. Princeton, NJ: Princeton University Press. Tegmark, M. (2017) Life 3.0. London: Penguin Books. Williams, N. J., Scott, R. and Wilkinson, S. (2018) ‘The ethics of uterus transplantation’, Bioethics 32: 478–​80.

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Note: Page numbers followed by ‘n’ refer to notes. abortion 123–4 Achté, K. 248 administrative violence 82, 85–6 Admiral Duncan pub attack 185n.2 adoption 85–6 advocacy 173–4 Agamben, G. 150–1 agency bodily ownership and 4–5 and clitoral reconstruction 200 in feminist writing 2–3 and intimate labour 5, 25 and Pirak Sikku’s work 224 of surrogates 122–3, 127 of trans patients 233, 234, 244 see also resistance alliances see collective action Almeling, R. 67, 138 Andreassen, R. 71 assisted reproductive technologies (ART) and concepts of kinship 97, 102–5, 107–8 LGBTQ use of 79–80 biopolitics in Sweden 67–71 experiences 83–90 laws regulating 67–70, 81–3 overcoming bioprecarity 90–2 research methods 80–1 Thai law relating to 116, 117 see also donor conception; sperm donation; surrogacy Athanasiou, A. 45, 65 Benjamin, H. 246–8, 252n.9 Berardi, F. 258

Bergfors, G. 215, 229n.7 Berlant, L. 175 Bernstein, E. 23 Bettcher, T. 243 biocosts 16, 31 biological labour and kinship 97, 102–5, 107–8 and LGBTQ parenthood 61, 62, 67, 71–6, 97, 102–5, 107–8 see also surrogacy biomedicine 31 biopolitics 7 Foucault on 28–9, 45, 68, 190, 235–7 of queer reproduction 67–71, 75, 81–3 as state racism 235–7 biopower 2, 21–2, 28–9, 42–3, 45, 50, 190, 236 bioprecariat 9 bioprecarity and bodies as pieces see humanitarian surgical missions; sperm donation; transnational commercial surrogacy and boundaries of intimacy see clitoral reconstruction; intimate partner violence in LGBTQ community challenging 9–10, 50–3, 90–2, 224–9, 249–50, 258–62 conceptualizing 1, 5–8, 21–2, 37–8, 98, 132, 189–90, 257 bios 21–2, 28–31 intimate labour 22–8 precarity 32–5 see also categorization

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INDEX diverse forms of 36–7 histories of see Sámi people; ‘transsexual’ patients of 1960s and kin-making see LGBTQ parenthood rise of 9 bios 21–2, 28–31 biostability 97, 98, 103, 107–8 biotechnologization 3, 259–60 see also assisted reproductive technologies biovalue 16, 31, 97–8, 103 bisexual people 86–8, 91–2, 173 blood transfusions 157–8 bodily ownership 4–5 see also agency bodily vulnerability of surrogates 121–5 body, understandings of 2–3 Boris, E. 22–3, 24, 26, 35, 115–16, 232–3 Bourdieu, P. 32 Bracke, S. 259 breastfeeding 72–3 Brown, R. D. 162 Butler, J. on gender norms 44, 65 on grievability 45 on kinship 66 on subjectivization 48–9, 54n.8 on vulnerability and precarity 5, 6, 32, 44, 65, 127, 171, 190 Calhoun, C. 172 Calton, J. M. 184 capitalism 45 cardiac interventions see paediatric heart surgery missions care work/workers 23, 33–5, 36 Caruth, C. 216, 224 categorization 4, 9, 41, 190 counter strategies 50–3 failure of 43–6, 86–8, 199 and FGC 198, 199 Foucault on 42–3, 190 and inequality 258 and LGBTQ reproduction 85–90 and measurement see race biology; ‘transsexual’ patients of 1960s and sperm donation 143–4 and subjectivation 46–50

265

and visibility 173 CHD see congenital heart disease childbirth and pregnancy and kinship 97, 102–5, 107–8 and LGBTQ parenthood 61, 62, 67, 71–6, 97, 102–5, 107–8 see also surrogacy children, of sperm donors 135–6, 140–3 cisgendered people 53n.1 climate change 261 clitoral reconstruction (CR) 189 Anna’s case 191–3 bioprecarity and 200–2 Fatou’s case 193–5 Leila’s case 196–7 research methods 191 collective action 6–7, 51, 262 Collier, J. 96 ‘coming out’ 101–2, 173 commercial surrogacy see transnational commercial surrogacy commissioning 26 commodification of bodies 3, 4 common experiences 51 see also interdependencies congenital heart disease (CHD) 152 conservatism 258 contracts (surrogacy) 119 control see agency; disciplinary power; regulation Cotton, T. T. 46–7 counselling 87–8 CR see clitoral reconstruction Crenshaw, K. 44, 178 Crooks, V. 36 cross-border medical help-seeking 36–7 see also reproductive travel Dahl, U. 61 Deomampo, D. 122–3 desires 48–9 digital communication 3 see also social media disability 42–3 disciplinary power Foucault on 22, 28–9, 46–7, 236 and sperm donation 137, 144 in study of ‘transsexuality’ 241 see also regulation; self-discipline

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dissociation 210–11 domestic work 23, 25 donor anonymity 69–70, 140, 141–2, 144 donor conception and biopolitics 67–71 gendered responses to 132, 133, 134, 136 and kinship 69–70, 96, 97, 142–3, 144 see also lesbian parenthood; sperm donation Donovan, C. 184 Due, C. 116–17, 126–7 economic vulnerability 114, 118–21 egg donation 132, 133, 134, 136 egg freezing 89 Ekins, R. 247 emotion 34, 35, 162–3 emotional labour of bisexual people 87, 88 of surrogates 26–7, 116, 125–6 of trans patients 49, 245 emotional vulnerability, of surrogates 125–7 empathy 224, 229 Esposito, R. 1, 7 eugenics 209 Foucault on 236–7 and sex determination law 242, 249 sterilization in Sweden 68, 236, 237, 242, 249 see also race biology families of origin and IPV help-seeking 178 and parenthood see lesbian parenthood family-making see kinship-making Fassin, D. 162 fatherhood, and sperm donors 142, 144 fear 258 female genital cutting (FGC) 188–9 Anna’s case 191–3 bioprecarity and CR 200–2 and cultural meaning 190, 198, 199 Fatou’s case 193–5

Leila’s case 196–7 living with 198–200 research methods 191 feminist writing 2–3 fertility status, and sperm donation 137–40 fertility travel see reproductive travel FGC see female genital cutting financial insecurity 114, 118–21 Finch, J. 99, 100–1 Forssman, H. 237–9, 251n.4 Foucault, M. on biopolitics 38–9, 45, 68, 190, 235–7 on biopower 2, 28–9, 42, 45, 50, 190, 236 on bios 21–2, 28–9 on categorization 42–3, 190 on resistance 50, 244 on subjectivation 47–8 Frank, A. 216 Fraser, N. 182–3 Frears, S. 31 Freud, S. 134, 135 Fumagalli, A. 30 gay cis men 84–6, 90 gender, and kinship 96 gender labour 62, 63, 72, 73, 75 Giddens, A. 24 Giorgio, G. 174 Girshick, L. 173, 174, 176 global context 3, 113–14 see also humanitarian surgical missions; transnational commercial surrogacy global surgery 155 grandparents see lesbian parenthood Green, R. 246–7 grievability 45–6 Griffin, G. 1, 21, 131, 209, 212, 257 habeas viscus 51–2 Hansson, S. 238 Hausman, B. 242 health risks 27–8, 121–5 heart surgery see paediatric heart surgery missions

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INDEX help-seeking for IPV 174, 177–83 Herrmann, M. 179, 180 Hester, M. 184 heterosexuality, and kinship 96 Hochschild, A. 30 Holm, M.-L. 242–3 Holmes, C. 176 Honduras health care system in 151, 152–4, 160–1 see also humanitarian surgical missions Honkasalo, J. 232 hormone injections 121 humanitarian surgical missions 147–8 benefits 154 departure and local sustainability 159–61 Honduran context 152–4 innovation 155–8 and intimate labour 162–3 Juana’s case 156–8 post-surgical life 148–51, 157, 158, 159–61 research methods 151–2 surgical success 148, 157 Yesenia’s case 147, 148–9, 158 Ibarra, M. de la Luz 33–5 identity see Sámi people; self in vitro fertilization (IVF) 87, 116 see also donor conception incestuous relations 141–2 indigenous peoples see Sámi people inequality 2, 3–4, 8, 25–6, 65–6, 258, 260–1 see also transnational commercial surrogacy infertility, and trans recognition 249 innovation 155–8 instruments of race biology appropriation of 217–24 and countering bioprecarity 224–9 encountering 213–16 interdependencies 7–8, 51, 65, 90–1, 262 Internet 3, 61, 63

267

interpellation 48, 54n.7 intersectionality 44, 178–9, 189 intersex people 43, 44 intimacy 24, 25–6 boundaries of see clitoral reconstruction; intimate partner violence in LGBTQ community intimate labour concept of 4–5, 22–8, 232–3, 257 examples of see clitoral reconstruction; LGBTQ parenthood; sperm donation; surrogacy; ‘transsexual’ patients of 1960s in global context 113–14, 127–8 and humanitarian surgical missions 162–3 and trans subjectivity 49–50, 243–4 intimate partner violence (IPV) in LGBTQ community claims for protection 183–5 denial of 175–7 help-seeking 174, 177–81 lack of awareness 173–4 recognized vulnerability 181–3 research methods 171 intimate relationships, and lesbian parenthood 98–9 invisibility 172–5 IPV see intimate partner violence IVF see in vitro fertilization jokes, about sperm donation 133–5, 140 Jordal, M. 188 Kang, M. 27 Karhu, S. 243 kinship-making 95–8, 260 and sperm donation 69, 96, 141, 142–3, 144 see also lesbian parenthood; LGBTQ parenthood Knapton, S. 136 labour politics 6, 22, 32 LaCapra, D. 223, 224 Latour, B. 260–1

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law and biopolitics of queer reproduction 67–70, 81–3 and biotechnologization 259 and non-genetic kinship 68–70, 82, 86, 104 and sex determination 232, 237, 242, 248–9 and sperm donation 131–2 and surrogacy 83, 86, 116, 117 visibility, protection and 172–3 Leibetseder, D. 1, 41, 79, 257 lesbian parenthood bioprecarity/biostability in 95–6, 98, 104–8 and IPV help-seeking 174 and kinship concepts 96–7, 99 kinship meaning of pregnancy 102–5, 107–8 ongoing kinship relations 105–7 past family relations 100–2 research on kinship and 99–100 see also LGBTQ parenthood lesbian women, and recognition 173 letters, of trans people 246 LGBTQ parenthood and biopolitics 67–71, 75, 81–3 and bioprecarity 64–7 gender, labour and 61–3, 71–5 and kinship see lesbian parenthood researching 63–4 use of ART 79–80 experiences 83–90 overcoming bioprecarity 90–2 regulation 81–3 research methods 80–1 LGBTQ people community as safe space 175–7 LGBT–miners alliance 51 violence against 169–70, 171–2 violence between see intimate partner violence see also transgender people; ‘transsexual’ patients of 1960s Liang, B. 180 Lindegård, B. 240 lithium 238–9 Lorey, I. 32–3, 51

Lothstein, L. M. 245 Lundborg, H. 214 McClennen, J. C. 178 McDonald, C. 45–6 masculinity 143–4 Mason, G. 171, 172 Mason, J. 99, 100–1 Mays, B. 131–2, 135, 137, 144 measurement of indigenous bodies see race biology of ‘transsexual’ bodies 240 medical discourse and trans subjectivity 49, 242–3 see also psychiatric study of ‘transsexuality’ medical humanitarianism see humanitarian surgical missions medical tourism 36–7 see also reproductive travel medication 238–9 merit-making 123–4, 126, 127 migration 30, 188, 189 military, trans people in 54n.3 Millar, K. 32, 33 miners, LGBT alliance with 51 Mitchell, D. T. 236 Mohr, S. 132, 133, 136–7, 138, 139–40, 141, 143–4, 145 Moran, L. 172, 177 Morini, C. 30 Mukherjee, S. 237 multifoetal pregnancies 122–3 nail salons 27–8, 259 Namaste, V. 242 Nast, H. 67, 75 nationalism 258 neo-liberalism 152–3 Nilsson, E. 113 non-governmental organizations see humanitarian surgical missions Nordqvist, P. 95, 143 norms/normalization 2, 47–50, 52 online discussion groups 61, 63 open normativity 52

 269

INDEX Operation Pulse see humanitarian surgical missions other, resistance to 258 Ovesen, N. 169 paediatric heart surgery missions 147–8 benefits 154 departure and local sustainability 159–61 Honduran context 152–4 innovation 155–8 and intimate labour 162–3 Juana’s case 156–8 post-surgical life 148–51, 157, 158, 159–61 research methods 151–2 surgical success 148, 157 Yesenia’s case 147, 148–9, 158 Pande, A. 126 parenthood see assisted reproductive technologies; LGBTQ parenthood Parhi, K. 245 Parreñas, R. S. 22–3, 24, 25, 26, 35, 115–16, 232–3 Peirone, J. 230n.11 Petryna, A. 137 photographs in race biology 210, 221, 222 reappropriation of 217–28 Pirak Sikku, K. 209, 211–12 appropriating race biology tools 217–24 countering bioprecarity 224–9 encountering race biology 213–16 population regulation 4, 22, 28, 42–3, 67–71, 81–3 see also law power see agency; biopower; disciplinary power; regulation Precarias a la deriva (Precarious Women Adrift) 6–7 precariat 6, 7, 32 precariousness 149, 162, 190 precarity 5–7, 22, 32–5, 64–5, 149, 162 see also bioprecarity Preciado, P. B. 81–2 pregnancy/gestation lesbian kinship 97–8, 102–5, 107–8

269

LGBTQ parenthood 61, 62, 67, 71–6 see also surrogacy Prentice, R. 162 prison 41 procreative tourism see reproductive travel psychiatric care, historical context 237–9 psychiatric study of ‘transsexuality’ 239, 240–2 ‘expert’–patient collaboration 246–7 patient resistance 244 patients’ self-narration 245–8 psychosocial vulnerability, of surrogates 125–7 Qayum, S. 25 queer space, as safe 175 race and racism 2, 44, 45–7, 64, 66, 70–1, 202 race biology appropriating tools of 217–24 countering bioprecarity and 224–9 encountering 213–16 historical study of Sámi 209–10, 211–12 Ray, R. 25 recognition 173, 179–80, 181–3, 202 registration documents 82, 86, 91 regulation and biotechnologization 259 Foucault on 4, 21–2, 28–9, 42–3 and queer reproduction 67–71, 81–3 see also disciplinary power; law relational bioprecarity 140–3, 144 see also kinship-making relationality 52 reproductive travel 68, 82 see also transnational commercial surrogacy resilience 259 resistance 49, 50, 244, 258 see also bioprecarity, challenging Riggs, D. 116–17, 126–7 Ristock, J. 178, 183, 184 Robertson, J. 260 Rose, N. 30–1

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INDEX

Rubin, G. 96 Runnström, J. 214 safety 172–7 Sameblod (film) 209–11 Sámi people eugenic study of 209–10 identity in Sameblod 209–11 Pirak Sikku’s work 211–12 appropriating race biology tools 217–24 countering bioprecarity 224–9 encountering race biology 213–16 Schaefer, L. C. 246 Schneider, D. 96 Sedgwick, E. K. 216 self impact of FGC on 199–200, 202 maintenance of 23 reinvention of 210–11 self-discipline 47–50, 190, 200 self-narration 245–6 service sector 3–4, 25–6 see also transnational commercial surrogacy sex work 22–3, 37 sexual pathology discourse 44, 54n.5 see also ‘transsexual’ patients of 1960s shame 216, 224 Shotwell, A. 52 Silvia Rivera Law Project (SRLP) 52 Skeggs, B. 172, 177 Smart, C. 143 Snyder, L. 236 social class 82 social media 3, 61, 63 social networks, and IPV 177–9, 180–1 somatic in/adequacy 137–40, 143–4 Spade, D. 47, 52 Spain, ART laws in 82–3, 86 sperm donation 131 and biopolitics in Sweden 69–71 bioprecarity relating to 132–3, 143–5 jokes 133–5, 140 numbers 135–7, 140, 144 relational 140–3, 144 somatic in/adequacy 137–40, 143–4

and kinship 68–9, 96, 141, 142–3, 144 laws relating to 69–70, 131–2 media coverage 88 sperm storage 89 SRLP see Silvia Rivera Law Project Standing, G. 32 state, biopolitics of queer reproduction 67–71, 81–3 State Institute for Racial Biology (Uppsala) 209–10, 229n.1 state racism, biopolitics as 235–7 sterilization 68, 232, 236, 237, 242, 249 stigma, of surrogacy 27 Stone, S. 245, 247–8 Stryker, S. 239 Stuvøy, I. 91 subjectivation/subjectivization 46–50, 54n.8 surgical interventions 36–7 see also clitoral reconstruction; humanitarian surgical missions surrogacy agencies 26, 118, 119 and bioprecarity 36, 86, 90, 114 as controversial 69 and emotional labour 26–7, 116, 125–6 experience of gay cis men 86 law relating to 83, 86, 116, 117 overview of transnational 113–14, 115–16, 127–8 relational approach 90–1 Thai context 116–18 and vulnerabilities 27, 114, 118–27 surveillance 47 Sweden, biopolitical context 67–71, 75 temporality/time 232, 259 Thailand, surrogacy in 116–18 Thorvaldsdóttir, T. 173 Thuwe, I. 237–8, 239 Torres, J. 169–70, 175, 183 transgender community building 249–50 transgender people categorical framing 41, 45–7 historical analysis see ‘transsexual’ patients of 1960s

 271

INDEX self-discipline and normalization 47 use of ART 79–83, 89–90, 92 transgender subjectivity 49–50, 242–4 transnational commercial surrogacy 113–14, 115–16, 127–8 bioprecarity of 86, 90, 114 bodily vulnerability 121–5 economic vulnerability 118–21 law relating to 83, 86, 116, 117 psychosocial vulnerability 125–7 relational approach 90–1 Thai context 116–18 ‘transsexual’ patients of 1960s agency of 233, 234, 244 ‘expert’–patient collaboration 246–7 intimate labour of 233, 245–8 measuring and testing 240–2 psychiatric care context 237–9 self-narration of 245–8 and temporality 232 ‘transsexualism’ legislation 232, 237, 242, 248–9 travel see medical tourism; reproductive travel Turrell, S. 179, 180

LGBTQ community as safe space 175–7 see also intimate partner violence virility 137–9, 143–4 visibility 172–5 vulnerability 5–6, 7–8 Butler on 5, 6, 32, 44, 127, 171, 190 recognized in IPV 181–3 of sex workers 23 of surrogates 27, 114, 118–27

violence against LGBTQ people 169–70, 171–2 (in)visibility in relation to 172–5

Yanagisako, S. 96

271

Waggoner, M. 138 Wahlund, S. 214 Wålinder, J. 237, 238–9, 240–2, 244, 245, 248, 252n.9 Ward, J. 72, 243–4 Warner, M. 175 Weheliye, A. G. 51 Weitz, R. 200 Wheeler, C. C. 246 Whitman, C. 132, 135, 137, 138, 140–1, 144, 145 Whittaker, A. 123 Wilson, R. 162 Worthington, N. 147

Zelizer, V. 25 Zhang, J. 258