Vol. 13, No. 2, February 2011, 201–215
Contraceptive medicalisation, fear of infertility and teenage pregnancy in Brazil
Helen Goncalvesa, Ana D. Souzaa, Patrıcia A. Tavaresa, Suelen H. Cruza and Dominique
P. Behagueb,c* a ´
Programa de Pos-graduacao em Epidemiologia, Departamento de Medicina Social, Universidade
Federal de Pelotas, Pelotas, Brazil; bDepartment of Epidemiology and Population Health, London
School of Hygiene and Tropical Medicine, London, UK; cDepartment of Anthropology, Brunel
University, Uxbridge, UK
(Received 27 April 2010; ﬁnal version received 2 September 2010)
In Brazil, as in many other countries, teenage pregnancy is widely recognised as a public health problem. Buttressed by a public health science of the economics of teenage pregnancy that emphasises the postponement of parenthood as key to poverty reduction, young people’s lack of appreciation for medical knowledge of contraceptives is most often credited for failed attempts to reduce teenage pregnancy.
Based on a longitudinal ethnographic study conducted in Pelotas, Brazil, with young people over the course of 10 years, our study found that young women who became teenage parents did not lack medical knowledge but were, rather, highly medicalised.
Not only were they intensely concerned with the ill-effects of oral contraceptives on possible future fertility, they also engaged in intricate routines of contraceptive-use as a way of testing and safeguarding their fecundity. Our analysis attends to the way these practices are shaped by the problematisation of the economics of teenage pregnancy, as well as by the gendering of cultural norms relating to the transition to adulthood. We theorise the results by considering how contraceptive medicalisation enabled some women to engage with the authority of normative society, while developing a potent off-stage critique of this authority and of what they considered to be discriminatory messages imbedded in scientiﬁc discourses on teenage pregnancy.
Keywords: infertility; adolescent pregnancy; medicalisation; Brazil
In Brazil, as in many other countries, teenage pregnancy has come to be widely recognised as a public health problem of ‘epidemic’ proportions (Heilborn et al. 2006). Although historians and sociologists have shown how the problematisation of teenage pregnancy has developed over the course of the twentieth century in the psycho-medical, legal and pedagogic spheres (e.g. Wilson and Huntington 2006), only recently has a public health science of the economics of teenage pregnancy gained global recognition (Heilborn,
Brandao, and Cabral 2007; Sax 2010). New to this science of teenage pregnancy is the reversal of the relationship between fertility and poverty; whereas earlier studies focused on socio-economic disadvantage as a core determinant of teenage pregnancy, research has begun to chart teenage pregnancy as a key cause of poverty itself (Hobcraft and Kiernam
1999; Luker 1996).
*Corresponding author. Email: email@example.com, firstname.lastname@example.org
ISSN 1369-1058 print/ISSN 1464-5351 online q 2010 Taylor & Francis
DOI: 10.1080/13691058.2010.521576 http://www.informaworld.com 202
H. Goncalves et al.
The view of teenage pregnancy as a key vehicle in the multigenerational cycle of poverty has given renewed impetus to the wide-spread medicalisation of contraceptives and fertility
control, now being actively promoted as key to poverty-reduction (Brandao 2006). Although oral contraceptives and condoms are readily available in the Brazilian public healthcare system, efforts have focused, by and large, on tackling issues related to assumed low levels of medicalisation,1 including, for example, lack of knowledge about availability of contraceptives and lack of effective sexual education (e.g. Espejo et al. 2003). Such constraints are said to be