In Plastic Bodies Emilia Sanabria examines how sex hormones are enrolled to create, mold, and discipline social relations and subjectivities. She shows how hormones have become central to contemporary understandings of the body, class, gender, sex, personhood, modernity, and Brazilian national identity. Through interviews with women and doctors; observations in clinics, research centers and pharmacies; and analyses of contraceptive marketing, Sanabria traces the genealogy of menstrual suppression, from its use in population control strategies in the global South to its remarketing as a practice of pharmaceutical self-enhancement couched in neoliberal notions of choice. She links the widespread practice of menstrual suppression and other related elective medical interventions to Bahian views of the body as a malleable object that requires constant work. Given this bodily plasticity, and its potentially limitless character, the book considers ways to assess the values attributed to bodily interventions. Plastic Bodies will be of interest to all those working in medical anthropology, gender studies, and sexual and reproductive health.
The excerpt below is from the beginning of the book’s Introduction, which can be accessed in total at this link.
In June 1975, the San Francisco Chronicle and the San Antonio Express ran articles on a young Brazilian scientist’s research on hormonal contraceptives. “I have declared a war on menstruation,” Elsimar Coutinho, the Brazilian scientist, told the Chronicle “his dark eyes flashing.” The press coverage appeared in the wake of a meeting of the WHO taskforce on fertility regulation held in Texas. Coutinho told the Chronicle: “Before, we thought that lack of menstruation was a bad side effect of the long-term contraceptive pill. Now I consider it the main good effect (sic.).” The Express reported that “he has patients in Brazil who have not had a menstrual cycle in 10 years.” Coutinho is a polemical and highly mediatized doctor. Professor of human reproduction at the Federal University of Bahia’s medical school in Salvador da Bahia (in northeastern Brazil) and Director of a private research center and clinic called CEPARH (the Centre for Research and Assistance in Human Reproduction) Coutinho derived much prestige from the international networks he partook in throughout the 1970s and 1980s. Manica (2009) shows how he gained considerable local legitimacy through his international connections with institutions such as Ford Foundation, Rockefeller, Population Council and WHO, while opening up research hospitals (and their attend populations) in a strategic region for these institutions interested in the “population problem.” For years, he appeared weekly on women’s television programs from where he professed advice about sexuality and family planning and found a unique platform to air his provocative statements such as “Menstruation is a useless waste of blood,” or “Eve did not menstruate.”
In 2005, I began fieldwork in Salvador with the intent of studying the role that sex hormones play in contemporary social life. I gained access to CEPARH where a wide array of different hormonal regimens and treatments continue to be administered to prevent unwanted pregnancies, suppress menstruation, regulate moods, maintain youth or assist reproduction. CEPARH is an atypical institution in the Bahian medical landscape, catering simultaneously – although in clearly differentiated spaces – to a clientele with private health insurance while offering a free, charitable family planning service to the “poor.” On one of my first days at CEPARH, Dr Paulo, one of the clinic’s directors took me on a tour. We began downstairs in the ambulatório (out-patient clinic), where a bustling crowd of women was waiting. “They come here from the periferia (slums),” Dr Paulo tells me. “We give them high quality atendimento (care), entirely for free.” In the infirmary, we met the two nurses who weigh patients, apply the contraceptive injections and “release” the drugs that the doctors have prescribed. An old-fashioned glass cabinet full of jumbled pill and hormonal injection boxes occupies one wall, next to an imposing manually counterbalanced weighing-scale. Faded advertisements for different hormonal contraceptives representing white, fair-haired couples tenderly embracing hang on the wall. A framed photograph of a caesarean-section birth sits on the desk next to a little figurine of a nurse holding a bottle labeled carinho em gotas (care in drops). One of the nurses is drawing the air out of a syringe while joking with a young high-heel clad doctor. Dr Paulo introduces me and they nod knowingly. We engage in small talk: Larissa, the nurse, tells us that menstruation is uma coisa muito moderna (a very modern thing). Her grandmother only menstruated three times she explains, her first period came when she was eighteen, then she had seven children and by the time she was done, she was menopaused. “Just like as indias (indigenous women),” Dra Beatriz added, “they never menstruate either.”
Upstairs, CEPARH functions as a state-of-the-art gynecological center, where women who subscribe to private health insurance are offered a host of diagnostic exams, gynecological surgeries and where doctors prescribe the newest contraceptive technologies, including tailor-made hormonal implants. The paint is fresher, there is air-conditioning and no crowds. A few days earlier, I met with Elsimar Coutinho in his office on the 3rd floor. It is spacious and I count nine statues of naked women, some neoclassical in varying shades of gold, several celebrating the pregnant form. I was invited to sit in a predictably low-laying sofa at the other side of his desk, behind a barricade of papers and journals. An enormous three-dimensional model of the female reproductive organs and a few glossy pharmaceutical monographs on new hormonal regimens sit on the coffee table beside me. After reviewing my research proposal, Coutinho noted that they needed more research on the “social” side of things. Crendices (beliefs) about menstruation still inhibited the uptake of the new hormonal contraceptive methods they have been developing at CEPARH. “You see, women don’t understand yet that they have a fake menstruation when they use the pill. Pill makers used to instruct women to take a pause every 21 days to produce an artificial withdraw bleeding episode that women think is menstruation. But it is not menstruation, it is not natural and not necessary,” he told me in impeccable English.
Emilia Sanabria has a PhD in Social Anthropology from the University of Cambridge and is Lecturer in Anthropology at ENS-Lyon (France). She conducted long-term ethnographic fieldwork in Bahia, Brazil on menstruation, experiences of the body, sex hormones and pharmaceuticals which gave rise to her monograph Plastic Bodies: Sex Hormones and Menstrual Suppression in Brazil.