Abortion Pills, Test Tube Babies, and Sex Toys: Emerging Sexual and Reproductive Technologies in the Middle East and North Africa

By L. L. Wynn

From Viagra to in vitro fertilization, new technologies are rapidly changing the global face of reproductive health. They are far from neutral: religious, cultural, social, and legal contexts condition their global transfer. The way a society interprets and adopts (or rejects) a new technology reveals a great deal about the relationship between bodies and the body politic. Reproductive health technologies are often particularly controversial because of their potential to reconfigure kinship relationships, sexual mores, gender roles, and the way life is conceptualized. This collection of original ethnographic research spans the region from Morocco and Tunisia to Israel and Iran and covers a wide range of technologies, including emergency contraception, medication abortion, gamete donation, hymenoplasty, erectile dysfunction, and gender transformation.


Table of Contents

Acknowledgments

Introduction | Setting the Context: Sexuality, Reproductive Health, and Medical Technologies in the Middle East and North Africa
Angel M. Foster and L. L. Wynn

Part I | Preventing and Terminating Pregnancy

Is There an Islamic IUD? Exploring the Acceptability of a Hormone-Releasing Intrauterine Device in Egypt
Ahmed Ragaa A. Ragab

Introducing Emergency Contraception in Morocco: A Slow Start after a Long Journey
Elena Chopyak

Mifepristone in Tunisia: A Model for Expanding Access to Medication Abortion
Angel M. Foster

Navigating Barriers to Abortion Access: Misoprostol in the West Bank
Francoise Daoud and Angel M. Foster

Part II | Achieving Pregnancy and Parenthood

"Worse comes to worst, I have a safety net": Fertility Preservation among Young, Single, Jewish Breast Cancer Patients in Israel
Daphna Birenbaum-Carmeli, Efrat Dagan, and Suzi Modiano Gattegno

The "ART" of Making Babies Using In Vitro Fertilization: Assisted Reproduction Technologies in the United Arab Emirates
Shirin Karsan

Wanted Babies, Excess Fetuses: The Middle East's In Vitro Fertilization, High-Order Multiple Pregnancy, Fetal Reduction Nexus
Marcia C. Inhorn

Birthing Bodies, Pregnant Selves: Gestational Surrogates, Intended Mothers, and Distributed Maternity in Israel
Elly Teman

C-Sections as a Nefarious Plot: The Politics of Pronatalism in Turkey
Katrina MacFarlane

Part III | Engaging Sex and Sexuality

HPV Vaccine Uptake in Lebanon: A Vicious Cycle of Misinformation, Stigma, and Prohibitive Costs
Faysal El-Kak

Hymenoplasty in Contemporary Iran: Liminality and the Embodiment of Contested Discourses
Azal Ahmadi

"Viagra Soup": Consumer Fantasies and Masculinity in Portrayals of Erectile Dysfunction Drugs in Cairo, Egypt
L. L. Wynn

Sex Toys and the Politics of Pleasure in Morocco
Jessica Marie Newman

Narratives of Gender Transformation Practices for Transgender Women in Diyarbakir, Turkey
M. A. Sanders

Conclusion | Individual, Community, Religion, State: Technology at the Intersection
Donna Lee Bowen

Acronyms and Abbreviations

Glossary of Foreign Terms

Bibliography

Contributors

Index

• Language: English
• Publisher: Vanderbilt University Press
• Release date: Jul 25, 2017
• ISBN: 9780826521293

Book preview

Abortion Pills, Test Tube Babies, and Sex Toys

ABORTION PILLS, TEST TUBE BABIES, AND SEX TOYS

Emerging Sexual and Reproductive Technologies in the Middle East and North Africa

Edited by L. L. Wynn and Angel M. Foster

VANDERBILT UNIVERSITY PRESS

NASHVILLE

© 2016 by Vanderbilt University Press

Nashville, Tennessee 37235

All rights reserved

First printing 2016

This book is printed on acid-free paper.

Manufactured in the United States of America

Library of Congress Cataloging-in-Publication Data on file

LC control number 2016007085

LC classification number RG133.5 .A26 2016

Dewey class number 618.1/8

ISBN 978-0-8265-2127-9 (hardcover)

ISBN 978-0-8265-2128-6 (paperback)

ISBN 978-0-8265-2129-3 (ebook)

To Dave, Eddy, and fruit bats.

Contents

Acknowledgments

INTRODUCTION: Setting the Context: Sexuality, Reproductive Health, and Medical Technologies in the Middle East and North Africa

Angel M. Foster and L. L. Wynn

Part I: Preventing and Terminating Pregnancy

1. Is There an Islamic IUD?: Exploring the Acceptability of a Hormone-Releasing Intrauterine Device in Egypt

Ahmed Ragaa A. Ragab

2. Introducing Emergency Contraception in Morocco: A Slow Start after a Long Journey

Elena Chopyak

3. Mifepristone in Tunisia: A Model for Expanding Access to Medication Abortion

Angel M. Foster

4. Navigating Barriers to Abortion Access: Misoprostol in the West Bank

Francoise Daoud and Angel M. Foster

Part II: Achieving Pregnancy and Parenthood

5. Worse comes to worst, I have a safety net: Fertility Preservation among Young, Single, Jewish Breast Cancer Patients in Israel

Daphna Birenbaum-Carmeli, Efrat Dagan, and Suzi Modiano Gattegno

6. The ART of Making Babies Using In Vitro Fertilization: Assisted Reproduction Technologies in the United Arab Emirates

Shirin Karsan

7. Wanted Babies, Excess Fetuses: The Middle East’s In Vitro Fertilization, High-Order Multiple Pregnancy, Fetal Reduction Nexus

Marcia C. Inhorn

8. Birthing Bodies, Pregnant Selves: Gestational Surrogates, Intended Mothers, and Distributed Maternity in Israel

Elly Teman

9. C-Sections as a Nefarious Plot: The Politics of Pronatalism in Turkey

Katrina MacFarlane

Part III: Engaging Sex and Sexuality

10. HPV Vaccine Uptake in Lebanon: A Vicious Cycle of Misinformation, Stigma, and Prohibitive Costs

Faysal El-Kak

11. Hymenoplasty in Contemporary Iran: Liminality and the Embodiment of Contested Discourses

Azal Ahmadi

12. Viagra Soup: Consumer Fantasies and Masculinity in Portrayals of Erectile Dysfunction Drugs in Cairo, Egypt

L. L. Wynn

13. Sex Toys and the Politics of Pleasure in Morocco

Jessica Marie Newman

14. Narratives of Gender Transformation Practices for Transgender Women in Diyarbakir, Turkey

M. A. Sanders

CONCLUSION: Individual, Community, Religion, State: Technology at the Intersection

Donna Lee Bowen

Acronyms and Abbreviations

Glossary of Foreign Terms

Bibliography

Contributors

Index

Acknowledgments

This book has been a work in progress for a long, long time. As editors, we are especially grateful to the contributing authors for engaging with these topics—it has been a privilege working with all of you. We are also thankful to the many colleagues and friends who have supported this work, contributing their intellectual insights, humor, and critiques. We would like to give a special shout out to Wayne Chambliss, Laryssa Chomiak, Raywat Deonandan, Greg Downey, Marcia Inhorn, Matteo Legrenzi, Bobby Parks, Chris Patil, Gordon Peake, Eugene Rogan, Cari Sietstra, James Trussell, Tracy Weitz, and the Sydney Writers Anthropology Group (SWAG).

We gratefully acknowledge the organizations and funders who supported the editors’ work on this book at various phases, including the Australian Research Council, the Richard and Rhoda Goldman Fund, the Society of Family Planning, the William and Flora Hewlett Foundation, Cambridge Reproductive Health Consultants, Ibis Reproductive Health, Macquarie University, Yale University Department of Anthropology, and the University of Ottawa. Angel’s Endowed Chair in Women’s Health Research is funded by the Ontario Ministry of Health and Long-Term Care, and we appreciate the general support for her time that made this book possible.

Michael Ames at Vanderbilt University Press has been an incredible champion of this project, and we thank him and his team for seeing it to the finish line. We also thank the fabulous interns and research assistants who helped with various phases of this project: Mona El-Mowafi, Ilgin Irmak, and Mackenzie Taylor Shaheen-Akins.

Lisa wants to thank David, Saiph, Rigel, Alex, Elijah, Jeff, and Louise.

Angel wants to thank Nancy Mancy (yes, you read that right), Emad Mancy, and Pruney Lemmens for their love and encouragement and Eddy Niesten for . . . everything.

INTRODUCTION

Setting the Context

Sexuality, Reproductive Health, and Medical Technologies in the Middle East and North Africa

Angel M. Foster and L. L. Wynn

To paraphrase Claude Lévi-Strauss (as anthropologists are wont to do), technologies are good to think with (Lévi-Strauss 1969, 162). That is because technologies are society made durable (Latour 1990). This is nowhere more true than with sexual and reproductive health technologies. Emerging reproductive health technologies are particularly important to study because they are life and death, both literally and figuratively.

In a world where unsafe sex is the second most important risk factor for disability and death in the world’s poorest communities and the ninth most important in developed countries (Glasier et al. 2006, 1595), sexual and reproductive health technologies make the difference between life and death. Medical technologies such as contraception, abortion, interventions in childbirth, and treatment for sexually transmitted infections have a tremendous impact on the well-being of women, men, and families. Assisted reproductive technologies offer the possibility of new life—a child—to infertile individuals seeking to become parents.

Emerging sexual and reproductive health technologies are important for social scientists to study also because they are metaphorically about life and death, touching as they do on sex and the beginning of life, two of the most moralized areas of society (Wynn and Trussell 2006). Assisted reproductive technologies, pregnancy termination technologies, and new forms of contraception all intervene in or prevent early human life, placing new technologies of reproduction within an interpretative space where different ontologies of fetal existence and human coming-into-being compete (Gammeltoft and Wahlberg 2014, 209).

When new reproductive health technologies emerge or are taken up in society, these technologies crystallize social debates, reminding us that culture is not static or uniformly distributed within society; rather, culture is the organization of diversity (Wallace 2009). This organization of diversity is vividly illustrated in the robust debates the contributors to this volume document over the uses of new technologies across the Middle East and North Africa. Studying these debates about emerging reproductive health technologies reveals social attitudes toward ideal and proscribed sexuality, assumptions about and challenges to normative gender roles, beliefs about families, cosmologies about when life begins and how an individual relates to God, and expectations about the role of government and medical experts in individuals’ sexual and reproductive lives.

As products of scientific knowledge, technologies sometimes appear to be culturally neutral, but both technologies and the science that produce them are always products of social networks and cultural discourses (Roberts 2007, 3). Therefore, Bruno Latour urges us to not ask ‘is this social,’ ‘is this technical or scientific’ when we study technologies, but rather to see how technologies are never one or the other, but are always a chain of the connected social and technological (1990, 110).

Another way of thinking about the sociality of technologies is in terms of Star and Griesemer’s account of boundary objects, which they define as "scientific objects which both inhabit several intersecting social worlds . . . and satisfy the informational requirements of each of them" (Star and Griesemer 1989, 393). This insight explains why technologies sometimes appear to be socially and culturally neutral. Technologies are easily reconfigured and adapted for use in different social and cultural settings, and yet at the same time they retain a common identity that allows them to circulate transnationally in forms that are mutually intelligible. It is that shared identity that allows technologies to appear universal, and it is their plasticity, their translatability across diverse social worlds, that makes them ubiquitous. That technologies are simultaneously concrete and abstract has implications for the chapters in this volume, where contributors both present the biographies of material things and invoke imaginations of social worlds.

Some technologies are materia medica—that is, medical materials, including but not limited to pharmaceutical products, that have social lives (Appadurai 1988) and vigorous commodity careers (Whyte, van der Geest, and Hardon 2002, 3). Others are less material and more ephemeral, yet nevertheless are technologies: surgical or laboratory techniques, taught in medical school or improvised by innovative physicians, deployed on or through women’s and men’s bodies, and debated by ethicists, religious authorities, and laypeople. Both concrete and abstract, physical and metaphorical, medical technologies thus have deep and abiding presences in our bodies, our persons, our selves (Downey and Dumit 1997, 5).

Although the term technology often connotes innovations at the cutting edge of science, it does not necessarily refer to something new, and the title of this volume deliberately draws our attention to technologies that may or may not be globally new, but that are emerging to have new significance in local societies. As Michelle Murphy points out,

While high-tech reproductive technologies, such as genetics and cloning, have garnered more attention from scholars as a route to understanding the tangle of life, politics, and capitalism, the less glamorous and simpler technologies . . . have vitally touched a vastly greater number of people and have provided crucial sites for the emergence of neoliberal governmentalities, for the industrialization of medicine and for the entanglement of sexed and raced living-being with capitalism (Murphy 2012, 3).

The term emerging technologies in this volume’s title captures a range of technologies, from high-tech assisted reproduction to contraception and abortion technologies that have recently been introduced to countries in the region. This perspective draws our attention not only to global flows and terrains of access to technology, but also to continuities and disjunctures between old and new technologies, between simple tools and sophisticated commodities.

Technology, Religion, Culture, and Non-Normative Sexualities

Over the past two decades, anthropologists have studied the ways that new medical technologies, including in vitro fertilization (IVF), gamete donation, surrogacy, and organ transplantation, have been locally adopted and interpreted in the Middle East and North Africa (Clarke 2007; Clarke 2006; Inhorn 2006b; Inhorn 2006c; Tremayne 2006b; Inhorn 2003b; Inhorn 1994; Hamdy 2012). They have studied the effects of new technologies on kinship, marriage, and gender norms, and they have documented the coexistence of global technologies with indigenous belief systems and the medicalization of illness states that were previously dealt with outside of the realm of biomedicine.

These studies have demonstrated the powerful influence of Islamic authorities who rule on the religious appropriateness of new technologies (Inhorn 2003b; Zuhur 1992), or what Anderson calls entextualization strategies, by which people attempt to recast knowledge and science in Islamic vocabularies with modern arguments (Anderson 2003). They have also shown the complex relationship between religious leaders and medical authorities in the interpretation and application of technologies, as well as the dynamic interaction between national policies and theological positioning (Inhorn 2003b; Ali 2002; Kahn 2001).

Yet the study of new reproductive health technologies in Muslim majority countries in the Middle East and North Africa has largely focused on the circumstances of married heterosexual couples who use reproductive health technologies to ensure their fertility. The result has been a scholarly focus on normative sexual and social relationships. Islam mandates that sexual relationships occur within the framework of marriage, and powerful religious and cultural norms enjoin the married couple to procreate. But what about the experiences of unmarried people who have sex?

Consider the circumstances of an unmarried woman who has sex without contraception. The religious penalties imposed by shari’a (Islamic law) are severe (Zuhur 2006) but rarely applied, as the required burden of proof is nearly impossible to achieve. Yet if evidence of her sexual activity comes to light—through pregnancy or if the hymen is found to be torn—the social consequences can be severe. She may be socially ostracized and at risk of violence by family members; her child would be legally considered illegitimate and face lifetime stigmatization, and she might find it difficult to ever marry. Emergency contraception (EC), which can prevent pregnancy after sex, is one way that a woman can control her reproduction and hide the fact that she has had premarital sex, while hymenoplasty can disguise a torn hymen to present the illusion of virginity. These technologies can thus be of critical importance to women seeking to reconcile private sexual lives with public social identities.

This volume thus asks some key questions: What are the attitudes toward reproductive health technologies of those whose sexual and reproductive lives defy religious codes and sociocultural norms? How do they use these technologies? Do they care about formal religious opinions about the technologies? Studies of new medical technologies in the Middle East and North Africa have the lingering tendency to focus on official and expert Islamic opinions and to neglect the quietly dissenting opinions and practices of nonexpert, nonauthoritative users. Yet focusing solely on official religious discourse risks obscuring the everyday lives, beliefs, and practices of individuals and groups in the society who have personal, cultural, political, or socioeconomic reasons to think and act in opposition to dominant moral codes (Tober, Taghdisi, and Jalali 2006). These people and groups include sexual, religious, and ethnic minorities; nonheterosexual women and men; individuals whose bodies and lives reject binary gender categories; and men and women who have premarital and extramarital relationships.

Researchers have documented a range of ways that people comply with and circumvent local religious interpretations in seeking reproductive health treatment (Clarke 2007; Tremayne 2006b; Inhorn 2003b; Ali 2002). Yet when it comes to reproductive and sexual health technologies that may be used to disguise evidence of non-normative sexuality, the stakes are particularly high for women, as it is primarily women who bear the consequences of extramarital sex in the Muslim world (Foster 2002). Informed by studies in other regions (Zhang 2007; Farquhar 1999), this volume is thus particularly concerned with the social stakes and the gendered moral codes revealed in religious debates over, and biomedical applications of, new reproductive health technologies.

Technologies and Gender

Technologies are gendered, beyond simply the matter of the gender that predominantly uses them. Consider one phenomenon of gendered pharmaceutical technologies in Cairo. More than a dozen brands of sildenafil (Viagra®) are available without a prescription in Cairo pharmacies, yet only one brand of progestin-only EC is sold. While EC is stigmatized in Egypt as an enabler of immoral sexuality (Wynn, Moustafa, Ragab 2013), erectile dysfunction drugs are thought to be a beneficial pharmaceutical treatment that enables exuberant, pleasurable sexuality but is not associated with immorality (Wynn, this volume). If both erectile dysfunction drugs and emergency contraceptive pills (ECPs) are pharmaceutical products that can equally be used by both married and unmarried men and women, why is only the female product thought to be a cover-up for immoral sexuality? This paradox points to some of the important ways that studying new and emerging reproductive and sexual health technologies in a society can index social constructions of desire, morality, and appropriate gender roles and sexuality.

One of Judith Butler’s key contributions to feminist debate over the relationship between sex and gender was her observation that not only does sex (biological and physiological difference) shape gender (the social construction of sexual difference and roles), but also the reverse is true: gender shapes sex (Butler 1993). Or, to put it another way, sex and sexed bodies . . . materialise through the operation of gender (Roberts 2007, 8). Technology is a key arena where we can see gender materializing sex and sexed bodies, whether it is a reconstructed hymen necessitated by social norms that demand that women be virgins when they marry (Ahmadi, this volume), the regulation of Cesarean sections in Turkey (MacFarlane, this volume) hormone injections and cosmetic interventions that transform men to women in Kurdish Turkey (Sanders, this volume), or gamete preservation that solves the social problem of bodies that cannot sexually reproduce (Birenbaum-Carmeli, Dagan, and Gattegno, this volume).

Until recently, gender studies was almost exclusively equated with women’s studies, but recent anthropology of the region has focused on the construction of "men as men" (Guttman 1997, 385), particularly the work of Marcia Inhorn (2012, 2004) and Farha Ghannam (2012). The examinations of reproductive and sexual technologies in this volume include studies of how technologies inflect and are inflected by cultural constructions of both femininity and masculinity (especially, for the latter, the contributions by El-Kak, Karsan, Sanders, and Wynn).

The essays gathered here examine the ways in which technologies shape gender, sex, and sexualities, creating emergent masculinities (Inhorn and Wentzell 2011) and femininities, as well as other nondichotomous, nondualistic ways of inhabiting social worlds. Studying emerging reproductive health technologies helps to focus our attention on the the ‘microphysics’ of power negotiations in . . . gender relations in the Middle East and North Africa (Inhorn 1996, 18) and the ways that new and emerging technologies make room for new maneuvers, new relations, new hierarchies, and new imaginations of bodies, physiological processes, and morality. The contributors to this book also challenge the pervasive view that technologies inevitably entrench dominant norms and ideas regarding parenting and family formation. New technologies always slot into existing social norms and ideals, and yet they offer possibilities in many different directions—opportunities for people to seize those technologies and harness them to multiple projects, some of which may entrench existing norms and some of which may not (Inhorn and Birenbaum-Carmeli 2008).

For this reason, this volume focuses equally on technologies that advance normative sexual and reproductive roles and those that advance non-normative roles, including forms of contraception and abortion that allow women to divorce their sexuality from reproduction (Chopyak, Foster, and Daoud and Foster), and surgical and pharmaceutical interventions that allow them to disguise their sexual activity and thus open up new possibilities for quietly subverting the power of social norms around women’s sexuality, even as they publicly appear to uphold them (Ahmadi, Newman, and Sanders). Even assisted reproductive technologies that enable normative reproduction may have secondary effects that subvert dominant norms about reproduction, as Elly Teman (this volume) describes for gestational carriers in Israel, which is changing the way Israeli Jewish women think about the relationship between motherhood and pregnancy.

Religion, Medicine, and Regulatory Authority

Sexual and reproductive health technologies offer a unique vantage point for studying not only cultural attitudes toward religion and the body (Wynn and Trussell 2006), but also the structures by which religion and science compete for authority over individuals’ sexual and reproductive lives, as well as the relationship between medical authorities and laypeople. Both Marcia Inhorn and Shirin Karsan (this volume) have demonstrated how the close relationship between religious and medical authorities has determined the availability of assisted reproductive technologies in Lebanon and the United Arab Emirates, and Angel M. Foster (this volume) similarly documents a strategic alliance between religious and medical authorities that made medication abortion part of the normative reproductive health landscape in Tunisia. Ahmed Ragab (this volume) posits that the intrauterine device (IUD), long available and deemed religiously permissible in Egypt, often conflicts with religious praxis, and thus the new-generation hormone-releasing IUD may be highly desirable from both religious and medical standpoints.

Yet religious and medical authorities are not always in sync. Consider, for example, one paradox of reproductive health technologies in Egypt. Several 2007 fatwas from Al-Azhar University pronounced hymenoplasty religiously permissible. Despite an intensive spate of media coverage of these authoritative religious pronouncements, L. L. Wynn’s research demonstrates that Egyptian doctors are reluctant to admit that they perform the procedure under any circumstances. Many believe that the procedure is criminalized, though there is no law against it, and it is not taught in Egyptian medical schools (2013).

Why do Egyptian medical authorities refuse to teach or openly perform a procedure that has been approved by one of the highest Islamic authorities in the country, and why do many doctors erroneously believe it is illegal? This apparent paradox demonstrates the importance of looking at the complex intersection between religious leaders, medical authorities, and laypeople. Religious authorities help to determine what medical technologies are available, not only by influencing legislation about the legality and regulation of a technology, but also by influencing what technologies are taught or not taught in medical schools. Conversely, medical authorities shape religious experts’ understandings, which influence their decisions about the religious permissibility of a technology. Standards, Adriana Petryna and Arthur Kleinman tell us, encompass monopolies over strategic knowledge (2007, 13) and are primarily set through the interactions of religious, medical, and regulatory authorities in each country. Yet as men and women in the Middle East and North Africa harness sexual and reproductive health technologies to their own individual projects of self-fashioning, they find opportunities to subvert authoritative knowledge and regulatory control, as many of the contributors to this volume demonstrate, forging new social norms and cultural understandings of technologies that, in turn, offer new possibilities for inhabiting sex and gender roles in society.

A new frontier in the intersection of religious authority, reproductive health, and individual practice involves the cyberfatwa. Websites that are sometimes dubbed fatwa banks are a popular resource for Muslims that emerged in the late 1990s. Some offer searchable online databases of preexisting fatwas; many additionally allow readers to submit questions and then provide rulings by religious jurisprudence experts online. The public question-and-answer format of what are essentially religious advice columns allow users to not only submit their own questions, but also read about other people’s problems and personal lives. The combination of anonymity and the lack of a personal relationship between religious counselors and the people submitting questions means that cyberfatwas engender new kinds of relationships between individual Muslims seeking answers to their personal dilemmas and the authorities pronouncing rulings.

Questions related to sexual and reproductive health and the permissibility of old and new technologies feature prominently on these online religious resources. These allow for individuals to both challenge and defer to traditional structures of authority in interesting ways and offer important insight into a key anthropological question: Under what previously existing technologies and social realities are new technological possibilities subsumed? The transnational circulation of technologies, information, and authority offer new opportunities for publicly working out underlying visions of sexuality, gender roles and family relations, personhood, and life in the global umma.

From Structures to Affect, Materiality to Symbol

Health and well-being form a key site where moral economy meets political economy (Petryna and Kleinman 2007, 3). In studying reproductive health technologies, we see how market economies intersect with global authorities such as the World Health Organization; United Nations declarations and conventions; private foundations that fund research, educational campaigns, and family planning programs; state regulators that determine local availability and distribution of technologies; and national and transnational religious authorities that influence public attitudes about how a technology fits into moral worlds. New technologies bring new opportunities for profit (Gammeltoft and Wahlberg 2014), which can lead to new opportunities for reinforcing, shifting, or subverting inequality of access to resources. Because new medical technologies are often highly regulated, they also offer opportunities for social interventions into market processes.

We might then borrow Petryna and Kleinman’s term the pharmaceutical nexus and speak of a health-technology nexus: the confluence of local moral worlds and for-profit actors, religious leaders and medical authorities, government regulators, nongovernmental organizations (NGOs), and global authorities, all of which interact to determine the interpretation, adoption, acceptability, and availability of new technologies. These multiple intersecting layers of national and global authority and public and private interests trouble the simplistic notion that culture is what inflects the local adoption of medical technologies.

While the term technology is often paired with phrases and words like cutting-edge, innovative, and high, denoting novelty and the triumphant progress of science, technologies can also be very simple and can include folk innovations and do-it-yourself techniques that bypass the market. In this volume, M. A. Sanders’s chapter reminds us of the importance of informal economies through which technologies are used and exchanged (Petryna and Kleinman 2007), looking at how people appropriate pharmaceuticals, including hormones and erectile dysfunction drugs, to shape transgendering bodies. But Sanders doesn’t privilege estrogen shots or Viagra over more mundane technologies, such as wigs and makeup, in her analysis of techniques of gender transformation. Similarly, Jessica Marie Newman (this volume) shows us that a carrot is in important respects equivalent to a vibrator when it comes to technologies of pleasure and religious authorities’ debates about the relationship between women’s kinship roles, sexual desire, and the morphology of women’s bodies (especially hymens). Francoise Daoud and Angel M. Foster (this volume) document how women faced with legal restrictions affecting access to safe abortion care are increasingly turning to inexpensive and widely available medications, in addition to traditional abortifacients, to self-induce early pregnancy termination. Tracking continuities between folk medicine and biomedical technologies offers useful insights into how private sexual lives are shaped by or defy technological innovation and authoritative biomedical and religious interpretations of reproductive health technologies.

The newness of a technology matters in both a regulatory sense and a much more ephemeral one: because new and emerging technologies often have an unsettled position in society, they are in the process of being defined, fixed, regulated, and contained. In these maneuvers, we see the workings of society revealed. As the introduction of new technologies triggers the intervention of moral gatekeepers, we can see which groups have the power to exert control over gender roles and sexuality, and which groups contest those dominant ideologies—and whether they do so in ways that are overt or subtle.

Technologies offer far more than insights into social and economic structures of power, however. They also have profound affective meaning, as Sanders shows when she documents the powerful emotions her informants associate with gender reassignment surgery. The hope of being a mother, described by Daphna Birenbaum-Carmeli and colleagues, Karsan, Inhorn, and Teman in this volume, and the hope of being able to marry without stigma and to save face in front of family, as Azal Ahmadi recounts, are all powerfully documented by the contributors. The technologies documented in this volume that enable non-normative sexualities provide hope for shelter from the social repercussions that women and men face when they go against local social norms and moral codes. But we also see fear and anxiety triggered by reproductive health technologies, as Daphna Birenbaum-Carmeli, Efrat Dagan, and Suzi Modiano Gattegno show of Israeli cancer patients seeking gamete cryopreservation, and as Ragab demonstrates with regard to the rumors that circulate in Egypt about the monstrous properties of IUDs.

Technologies are simultaneously material things and symbols. Whyte, van der Geest, and Hardon argue that the substance of medicines, their thinginess, is what makes them so important for anthropologists to analyze because in their circulation they link and transgress social worlds, revealing political and economic structures and enabling key social transformations to occur (2002, 5). They circulate, they are sold and taught and practiced and consumed, but they are also debated and imagined. In the process, they become thought devices or figurative repositories through which people understand and act on social rules, gender norms, and other structures of authority.

Technologies also offer new ways of imaging and imagining the female body and its internal processes (Treichler, Cartwright, and Penley 1998), and this in turn can give impetus to new religious interpretations of bodies and technologies, as Ahmadi describes in her chapter on hymenoplasty. Similarly, in a chapter on hormone-releasing IUDs in Egypt, Ragab describes how this new technology may be prompting new conceptualizations of when life begins, what constitutes abortion, what kind of IUD is more or less Islamically appropriate, and what ancillary technologies are necessary in order to see what is happening inside a woman’s uterus. Such findings illustrate Treichler, Cartwright, and Penley’s observation that new imaging narratives are also arguments about professional authority (1998, 5), as well as Inhorn’s argument that new reproductive technologies in the Middle East are leading to new improvisation in religious practice and reinterpretation of the meaning of those [religious] rules (1996, 20).

Transnational Movements of Technologies

Technologies circulate globally through products, people, and ideas. The institutions that shape social engagement with sexual and reproductive health technologies are often both national and transnational. Attending to the circulation of new technologies requires attending to the intersection of national frameworks—not only local laws and regulations, but also physician training, nationally controlled religious institutions, and distribution networks through which technologies circulate—and transnational ones, including transnational pharmaceutical and other technology corporations, transnational religious leaders and ideologies, global regulatory bodies and health agencies, and technology consumers who move internationally to gain access to treatment and technologies.

For example, pharmaceutical products and medical devices cross borders, both formally and informally, as Elena Chopyak shows for Morocco and Wynn documents in the Egyptian context (this volume). As