The idea that biological reproduction is a social activity, distinct from the activity of childrearing and determined by changing material conditions and social relations, is essentially Marxist. In The German Ideology,
Marx defines ‘Three aspects of social activity": along with "the production of material life" and "the production of new needs," human procreation— reproduction within the family—is also a "social relationship." That is, it involves not only "natural," or biological, relations but social, cooperative relations among men and women through sexual and procreative practices. That activity is social insofar as it is cooperative, purposive, and above all conscious.22 We can extend this view to human sexuality in general, which, whether heterosexual, homosexual, or bisexual, is fundamentally social, involving reciprocity, the conscious articulation and re-creation of desire; not merely satisfying a need but doing so in an interactive context that people create together. Moreover, sexual meanings and practices, like the meanings and practices of motherhood, vary enormously through history, across cultures, and within the same culture— indicating that these "natural" realms of human experience are incessantly mediated by social praxis and design.23
If this variability characterizes sexual and maternal experience, how much more is it true of contraception, abortion, and childrearing practices—all domains that, throughout civilization, have been transformed by conscious human interventions.24 A woman does not simply "get pregnant" and "give birth" like the flowing of tides and seasons. She does so under the constraint of material conditions that set limits on "natural" reproductive processes—for example, existing birth control methods and technology and access to them; class divisions and the distribution/financ — ing of health care; nutrition; employment, particularly of women; and the state of the economy generally. And she does so within a specific network of social relations and social arrangements involving herself, her sexual partner(s), her children and kin, neighbors, doctors, family planners, birth control providers and manufacturers, employers, the church, and the state.
Georg Lukacs takes up the idea of a "metabolism," or necessary interaction, between the natural and social aspects of human life. He suggests that the progressive socialization of "natural being" through "social practice" is the essence of history.25 To dichotomize "nature" and "society" is false; and, by inference, it is also false to assume a split between women’s "biological" functions and her "social" ones. Hilda Scott similarly reflects this view in paraphrasing the Czech demographer Helena Svarcova: "Marx’s observation. . . suggests looking for the dialectical relationship between the natural and social sides of reproduction, instead of regarding them as two parallel but independent processes. In this view, human population is seen as the unity of biological and social aspects which condition each other, the social aspects being the chief but not the only factor."26
The attempt to develop a social conception of reproduction is, of course, not limited to Marxists. Demographers, for example, conventionally acknowledge the importance of social conditions in determining population, but within a set of completely mechanistic assumptions. A social phenomenon such as changing birthrates is thus viewed solely in terms of statistically measurable demographic events (numbers of women in a given childbearing cohort, numbers entering the labor force, availability and use of contraceptives, and so on) as though it were a natural, unintended occurrence.27 Population-oriented anthropologists emphasize not only the tremendous variability but the rational, deliberate character of methods for controlling population and fertility among all societies, including the most primitive.28 However, they view such activity from a functionalist perspective, as "adaptive mechanisms" adopted by the culture as a whole, undifferentiated by sexual divisions or divisions of power. Utterly lacking is any sense that the methods and goals of reproduction, and control over them, may themselves be a contested area within the culture—particularly between women and men.
In contrast, an analysis of reproductive activity in terms of the "social relations of reproduction" would emphasize the historical dynamism of consciousness and social conflict and the historical agency of social groups. Social divisions, based on differing relationships to power and resources, mediate the institutional and cultural arrangements through which biology, sexuality, and reproduction among human beings are expressed, and such relations are essentially antagonistic and complex. At the most basic level they involve gender divisions, or the sexual division of labor (itself a predominantly cultural product); but in class-divided societies, they are also entangled with divisions based on class. Gordon’s book is laced with examples of the ways in which, in nineteenth — and twentieth-century America, women’s birth control possibilities were directly affected by their class position, which determined their relationship to medical and family planning distribution systems. Thus the diaphragm—"the most effective available contraceptive in the 1930s"—was virtually inaccessible to working-class and poor women, due to material conditions such as the lack of privacy, running water, and access to private clinics and medical instruction through which diaphragms were dispensed.29 Today, class and race divisions in reproductive health care determine not only women’s access to decent gynecological services, counseling, and the like, but their risk of exposure to involuntary sterilization, dangerous contraceptive drugs, or unnecessary hysterectomy.
The social relations of reproduction are also complicated by the forms of consciousness and struggle through which they are expressed in different historical periods. Sometimes antagonisms remain implicit or repressed; sometimes, under conditions that need to be understood more precisely, birth control and abortion become areas of open sexual and class conflict. Anthropological and historical studies, while scant, record the particularity of reproductive relations to class and culture and the ways those relations are recurrently ones of social division. Devereux, for example, describes societies in which abortion, or retaliation against involuntarily-induced abortion, represented a clear act of female defiance.30 Flandrin, in his analysis of late medieval church views toward contraception and sexual relations, points out that the evidence of widespread contraceptive practice indicates that conscious, even unrepentant resistance to the dominant ecclesiastical morality must have been common in Europe from the fifteenth to the eighteenth centuries.31
These examples suggest that the critical issue for feminists is not so much the content of women’s choices, or even the "right to choose," as it is the social and material conditions under which choices are made. The "right to choose" means little when women are powerless. In cultures where "illegitimacy" is stigmatized or where female infants are devalued, women may resort to abortion or infanticide with impunity; but that option clearly grows out of female subordination. Similarly, women may have autonomy over reproduction and childbirth, as in New Guinea, while being totally excluded from everything else.32 Or, like the women employees at the American Cyanamid plant in West Virginia, they may "choose" sterilization as the alternative to losing their jobs. To paraphrase Marx, women make their own reproductive choices, but they do not make them just as they please; they do not make them under conditions they create but under conditions and constraints they, as mere individuals, are powerless to change.33 That individuals do not determine the social framework in which they act does not nullify their choices nor their moral capacity to make them. It only suggests that we have to focus less on "choice" and more on how to transform the social conditions of choosing, working, and reproducing.
At present, the organized forces that shape the class-specific socially constructed character of women’s reproductive experience in the United States are powerful and diverse. The intervention of doctors, particularly obstetrician-gynecologists, in women’s control over their reproductive lives has been pervasive; yet medical control over reproduction is far from monolithic. Private and public population control agencies have cooperated with the medical profession, as "medical indications" and "medical effectiveness" became euphemisms for technical efficiency in population control. But these agencies maintain a financial and institutional power base independent of doctors. Further, the large-scale commercialization of birth control products and services has meant that other interests, such as pharmaceutical and insurance companies, have become important influences on the methods available to women, their safety or risk, and whether they will be reimbursed.
This conjuncture of medical, corporate, and state interests in the "management" of reproduction has defined the choices of all women, but in a way that is crucially different depending on one’s class and race. Still the major providers of birth control and abortion information and services to women, physicians are widely known to vary the information and the quality of services they provide based on the class and race of their patients. For example, private doctors in Maryland were found to provide abortions with much greater regularity to their middle — class than to their lower-class patients.34 Similarly, cases of sterilization abuse by physicians in the public health services have occurred almost entirely among black, Native American, and Mexican-American welfare recipients, as well as women who are prisoners or mentally retarded.35 Low-income and non-English-speaking women are regularly denied information about safer, "nonmedical" methods of birth control because of racist and class-biased assumptions that they are not "competent" to "manage" such methods. Moreover, it is poor and Third World women who are likely to be used as experimental subjects in international population control programs for testing or "dumping" contraceptive chemicals or implants whose safety has been questioned by the FDA.36 Finally, in a capitalist society, class is the mightiest determinant of the material resources that help make having and raising children joyful rather than burdensome.
It would be wrong, however, to picture women of any class as the passive victims of medical, commercial, and state policies of reproductive control. In hearings before the House Select Committee on Population and in lawsuits, women of all classes have successfully challenged drug companies and doctors regarding the severe health hazards of the pill, Depo-Provera, and other synthetic hormones.37 Groups of Mexican American, Native American, black, and other women have joined with women’s health and reproductive rights groups to fight against involuntary sterilization in the courts and through extensive federal and state regulations. An active, vocal movement to defend women’s reproductive freedom and "abortion rights" is growing in the United States and Western Europe and is currently a major force in the feminist movement.
What is "reproductive freedom" from the standpoint of historical materialism? On what principle is women’s struggle to secure control over the terms and conditions of reproduction based? A materialist view of reproductive freedom would justify this struggle in terms of the principle of socially determined need. The moral imperative grows out of the historically and culturally defined position that women find themselves in through motherhood. Because it is primarily women who bear the consequences of pregnancy and the responsibility for children, the conditions of reproduction and contraception affect them directly and in every aspect of their lives. Therefore, it is women primarily who should have control over whether, when, and under what conditions to have children. Moreover, an emphasis on the social rather than biological basis of reproductive activity implies that such activity is once and for all removed from any "privatized" or "personal sphere" and may legitimately be claimed for political and social intervention. That intervention may take the form of measures to protect or regulate reproductive health—for example, to assure the safety and voluntariness of contraceptive methods— or to transform the material conditions that currently divide women’s reproductive options according to class and race.
On the other hand, a materialist view of reproductive freedom recognizes the historical contingency of the conditions in which women seek reproductive control. For most of history, women’s "choices" over reproduction have been exercised in a framework in which reproduction and motherhood have determined their relationship to society. A materialist (and feminist) view looks forward to an eventual transcendence of the existing social relations of reproduction so that gender is not ultimately the determinant of responsibility. This implies that society be transformed so that men, or society itself, bear an equal responsibility for nurturance and child care. Then the basis of the need would have changed and control over reproduction might not belong primarily to women.38
It is here, however, that a contrary feminist sensibility begins to rankle and the limitations of a historical materialist, or traditional Marxist, framework for defining reproductive freedom become apparent. These limitations are disturbingly suggested in Alison Jaggar’s "Marxist feminist" defense of abortion, which argues that the "right" of women to an abortion is "contingent" upon "women’s situation in our society": ". . .if the whole community assumes the responsibility for the welfare of mothers and children, [then] the community as a whole should now have a share in judging whether or not a particular abortion should be performed. . . ."39
Can we really imagine the social conditions in which we would be ready to renounce control over our bodies and reproductive lives—to give over the decision as to whether, when, and with whom we will bear children to the "community as a whole"? The reality behind this nagging question is that control over reproductive decisions, particularly abortion, has to do not only with "the welfare of mothers and children" but very fundamentally with sexuality and with women’s bodies as such. The analysis emphasizing the social relations of reproduction tends to ignore, or deny, the level of reality most immediate for individual women: that it is their bodies in which pregnancies occur. Indeed, that analysis becomes false insofar as it disregards the immediate, sensual reality of individuals altogether. In order to make this connection, a theory of reproductive freedom has to have recourse to other conceptual frameworks, particularly one that is more commonly associated with a feminist tradition and asserts women’s right to and need for bodily self-determination.