Women and Birth in Transition: The Politics of Childbirth Medicalization in Reform era China 

In the last one hundred years, childbirth practices in China were increasingly subject to biomedical interventions and technologies. This process of medicalization was accelerated in the second half of the 20th century due to the expansion of the country's hospital infrastructure and its family planning bureaucracy. Starting from the 1990s, under the influence of the United Nations' Millennium Goals, the government stepped up its efforts to increase the number of hospital births in rural areas, but this transition to universal hospital births was accompanied by a dramatic increase in C-sections. Between 2008 and 2014, the average cesarean rate was as high as 32.9%, more than double the rate recommended by the World Health Organization. This project is one of the first qualitative research projects in the social sciences to approach this cesarean epidemic from the perspective of pregnant women. Most existing studies of childbirth in post-1990s China attribute the rise in cesarean rates to increasing demand from women. This project argues that this demand should not be conceptualized as a matter of individual choice but should be analyzed in the context of a larger political economy of childbirth medicalization, population governance, and health care marketization. Drawing on ethnographic research in rural and urban areas in Guangdong province, this project approaches the dynamics of decision-making leading to birth as a collective process of negotiation that is shaped not just by state actors and medical authorities, but also by women's own families and networks of support. The project will address two major questions. First, the project will situate the recent rise in cesarean rates in a larger historical and cultural context, highlighting the emergence in the late 20th century of a set of technocratic political rationalities aimed at regulating birth, controlling female reproductive life, and governing the life of the population. Second, the project will focus on the moral dimensions of such technocratic rationalities. Drawing on both rural and urban materials, we will show how these technocratic rationalities enable the construction of new female moral subjectivities, while giving rise to new tensions within families, between generations, and in society writ large. This project will generate high quality historical and ethnographic data with policy implications. Theoretically, the project joins recent anthropological debates on reproductive technologies and social change, while making a contribution to social science studies of childbirth medicalization and population governance.