Issue 5 2021 Long Essays 

Speculative Design for a Better Pregnancy

Katrina Orsini

When I proposed my thesis Designing Pregnancy: Speculations on Labor, Autonomy, and Biopower in December 2019, Ohio legislators had just introduced the “abortion murder felony” bill, or Ohio House Bill 413, which threatened anyone who received or performed an abortion with 15 years in prison.¹  Falsely named “heartbeat bills” were passed in six states, banning abortions after six weeks.² A Kentucky law went into effect requiring abortion providers to display and describe ultrasounds to women seeking an abortion before proceeding with the procedure.³ The same month, the New York Times ran an article proclaiming the Left is “Losing the Battle on Abortion.”⁴ When I finished writing my thesis in September 2020, Arkansas had just passed a set of bills that put a blanket ban on dilate and evacuate abortions.⁵ Nurse Dawn Wooten heroically spoke out as a whistleblower, exposing an immoral hysterectomy sterilization program in an ICE detention center in Georgia. Then Supreme Court Justice Ruth Bader Ginsburg passed away, leaving a Supreme Court vacancy which President Donald Trump and GOP Senators rushed to fill, potentially endangering abortion and in-vitro fertilization rights for the next generation. Some of these bills were defeated in court, but with numerous federal judges appointed by Trump (including three Supreme Court justices), any remaining sense of judicial security is quickly disintegrating.⁶ It is easy to agree with the New York Times article that the Left is losing the battle. But sometimes, there are glimmers of hope that reproductive services, needs, and the overall fight for justice around them are being taken seriously. My thesis investigates how speculative design might fuel that hope.

The discourse dedicated specifically to reproductive care can be seen on many channels. For example, the New York Times has a dedicated Parenting section and newsletter,  and design projects dedicated to reproduction are popping up everywhere. A case in point is the Designing Motherhood project, which will culminate with an exhibition at the Mütter Museum in Philadelphia in 2021. These projects, although predominantly positive in their intentions and ambitions, have fallen into a rhetorical trap that has motivated negative attacks and caused a loss of reproductive rights. They have mistakenly included issues of pregnancy, reproduction, and gynecological care under the identification and misnomer of motherhood. The New York Times Parenting section has subsections for both pregnancy and fertility, both issues that may be related to parenting for some, but are certainly not parenthood. The Designing Motherhood project’s Instagram page includes an evaluation of different kinds of contraceptive designs over time, something many use explicitly to not become a mother. Being pregnant does not make one a mother or parent, nor does one necessarily have to go through pregnancy to become a mother. A similarly presumptive pattern can be seen through reproductive health offering. One can expect the OB-GYN’s waiting room to be trafficked by both pregnant and nonpregnant people; however, the selection of magazines available in the waiting room would suggest those who are pregnant were somehow already new parents—full of baby care tricks and childrearing topics. The presence of this ephemera may also act as a signifier for those who aren’t pregnant, as if everyone in the waiting room is ultimately on the same path to one eventual outcome and that is to become pregnant—not simply interested in taking care of their gynecological health. These outlets and projects could more beneficially represent the full spectrum of reproductive health by choosing names or signifiers that do not imply the outcome of reproductive matters or that reproductive design is only about reproducing when for many people it is the opposite.⁷

The many aspects of reproductive justice, which include motherhood, pregnancy, fertility, contraception, and sex education, are given so little dedicated space in design, the arts, history, education, or cultural discourse at large that they are often forced to be discussed all at once, under one umbrella. That umbrella is mislabeled “motherhood” without examining the ways in which these subcategories intersect or oppose. More importantly, this conflation leaves no room to discuss the ways in which the term “motherhood,” when prematurely applied to discussions of sex, reproductive health, or pregnancy, is not only incorrect and misleading but downright dangerous.

The presumption that pregnancy and motherhood are one timeline, although unintentional in many spaces or projects, allows for a premature separation of the pregnant body and fetus that is often aided by the design and visual culture of pregnancy. By including pregnancy in a maternal timeline starting with a sonogram, a baby’s life begins earlier and earlier, changing the narrative of a growing fetus into that of an individual with a subjecthood. This shifting timeline has created a call for “fetal rights,” a still undeclared set of rights that rival or surpass that of the pregnant person within whom the fetus still exists. Of course, the most important right here, according to the anti-choice movement, would be the “right to life,” a call unanimously made by the anti-choice movement that has led to the scrutiny, prosecution, and loss of autonomy for pregnant people across the country. The “right to life” would force people through a pregnancy and parturition despite court rulings that under no circumstances can one person be forced to have a medical procedure to benefit another.

As is evidenced by the twenty-three states that have passed targeted regulation of abortion provider (TRAP) laws, the ramifications of something as seemingly innocuous as using the word “maternal” to describe the pregnant body need to be brought to light.⁸ My thesis, therefore, investigates how the designed world of pregnancy conflates pregnancy and motherhood and how speculative design projects can expose the consequences of that. By contrasting the reality of the designed world we live in with speculative spaces, ideas regarding the pregnant body can be explored. The pitfalls, performance, and perceived public existence of pregnancy, and its myriad possible outcomes at times exist outside the language we have structured around the “maternal” body. The beauty of speculative design is that it allows us a lens to evaluate current structures by eradicating restrictive notions such as sales or scientific or ethical possibilities. Eradicating these restrictions and being able to name what we actually want, regardless of possibilities, can help us shape the future.   

In her essay, “Privilege and Oppression: Towards a Feminist Speculative Design,” designer Luiza Prado de O. Martins discusses the unintentional roles of design and the boundaries of its possibilities “as a product of a patriarchal, classist and racist society…a discipline where the contribution of women has seldom been recognized throughout its history.”⁹ She describes design as contained by and created within the same social structures, both because society can limit possibilities and because the ambition of designers is to make objects that flourish, i.e., sell, within the capital market of this society. Therefore, she concludes, very little design is feminist because it cannot advocate for a feminist model through its participation in patriarchal capitalism where it remains marginalized. 

Prado then posits that speculative design may play the role of the exception that proves the rule. Because speculative design’s inclination is to imagine use in a different time, landscape, society, political system, etc., it is able to avoid being constrained by our current societal structures. And because it has no intention to be mass-manufactured and sold within the capitalist market, speculative design objects do not need to succumb to the pressures of customer or corporate comforts to appease the public. When these barriers are erased, Prado argues for speculation as a subset of design that not only advocates for intersectional feminism, but may actually help inform the practice and theory of intersectional feminism by contemplating our relationship to the material world:

Being disciplines rooted mainly in the humanities, with strong ties to sociology, philosophy and political sciences, feminist and women’s studies have a long tradition of textual research outcomes. This confines most of the production of knowledge in the field within the academic realm of books, papers and journals. The issues at hand are, however, much more tangible than this would suggest; oppression is a real, daily experience, capable of provoking serious consequences on the lives of those it affects.¹⁰

Prado’s argument rests on the claim that developing a speculative design practice that advocates for intersectional feminism would advance its goals twofold. First, by expanding the avenues through which the subject is communicated, it would allow for a growing dialogue that informs, pushes, and advances theory across disciplines, instead of only pushing critical, text-based work. This includes the way in which design is intimately related to our physical being, a relationship that, for many, is much more profound than a collection of words on a page. Perhaps more importantly, speculative design would allow more people to engage in the dialogue that ultimately shapes the intersectional movement as it progresses. Critical theory texts are notoriously dense, usually academic, and often rest upon a knowledge of preceding texts. This excludes many—if not most—people from a perspective on the world around them that they could potentially feel deeply connected to, one that may help them understand or digest many of the ways they feel, frustrations they have, and barriers they encounter, as well as how to name them, process them, grapple with them, and ultimately, hopefully, push back against them.

Prado’s argument here can be witnessed through the reaction to Ani Liu’s project Grab Them by the *: Mind-Controlled Spermatozoa (2017) (Fig. 1), in which participants don an EEG running through a computer interface that changes directional thoughts into electric impulses. The electric impulses are then sent out over a petri dish of sperm. Through the process known as “galvanotaxis,” the wearer formulates directional thoughts such as “left,” and the EEG can communicate the direction through a computer into electric impulses that direct the sperm—indeed, moving them left. Women who use Liu’s design can then effectively control sperm with their minds. The overwhelming relief women expressed to Liu when controlling sperm, followed by an immediate resentment for standard methods of birth control, confirmed what Liu always thought to be true: women are forced to spend far too much time, energy, and money searching for the approval of different people in order to gain any semblance of control over their own reproductive bodies. Whether it be driving to doctors’ appointments, filling prescriptions at the pharmacy, or dealing with waves of emotional, physical, or hormonal changes from contraceptives or fertility drugs, the toll reproductive services take on women is a harmful construct designed by an overly puritanical culture—especially when many arbiters of said medical appointments or pharmaceutical drugs are defenders of patriarchy. On more than one occasion, pharmacists have denied birth control pills to women, claiming the dispersal goes against their religious beliefs.¹¹  

Following Prado’s argument, any number of these participants certainly could have read about biopower or be familiar with Michel Foucault, but they may feel a much deeper relationship to his arguments when the effects were actually evoked emotionally from their lived experiences rather than read from a page. On the other hand, Liu’s work could have been, for others, their first introduction to the web of biopower wielded by the patriarchy. The voices and perspective Liu has brought into the conversation—voices which need to be heard and included to ultimately shape and bring forth an equitable society—are arguably more important than the voices accessed through academic literature. The inaccessibility of academic texts lead to a very small portion of the population reading and responding to them: an educated, wealthy, predominantly white population. The demographics who participated in Liu’s exhibition piece, although (admittedly) exclusive to groups who attend gallery and museum exhibitions, may have been more diverse than those reading Foucault. 

The road to reproductive justice can take different avenues, including speculative design, which can open the discourse around pregnancy to include more diverse voices as to what is wanted and needed for the future. By incorporating more voices, speculative design projects can help shape the future by molding our notions of the future before it arrives. That is why it is crucial to start doing this work now. Interrogating the limitations and human rights violations around the issue of pregnancy as we experience it now can help us realize a more equitable future.

Changing our understanding of pregnancy will include changing and disrupting our expectations of the structures, both personal and social, that make up pregnancy. This shift is already beginning. Take for example Stiliyana Minkovska’s project Erotic Kit for Internal Selfies (2016) (Fig. 2), which allows users to take interior images during pregnancy without prescribing what one should search for in the body. Compare this to sonograms, which search for a fetus and erase any other visual material of pregnancy. The Kit is user-friendly and does not require a visit to a doctor or sonographer to access imagery or information. The name Selfies designates the user as the one taking the picture. The notion that an individual should have the power and autonomy to see within their own body is proliferating throughout the gynecological field. In what has come as a welcome surprise to many, OB-GYNs have begun offering patients the option to insert speculums and transvaginal ultrasound wands into themselves at their appointments.¹² This simple act has diminished the pain many associate with their gynecologist appointments, both physical and emotional. Folks with chronic diagnoses like endometriosis are much more in tune with the navigation of pain they experience regularly. They are better equipped than their doctor to insert a speculum in a way that causes themselves as little pain as possible. This option also gives a sense of security back to survivors of sexual trauma who experience PTSD or similar symptoms during gynecology appointments when they are not in control over what is happening to their body. Equally important is the conversation that has spiraled from this practice regarding who has power and control in the exam room.

The article cited above, “Why Some Doctors Allow Patients to Take a Hands-On Approach During a Pap Smear,” was published in Teen Vogue—not exactly the leading publisher of medical practices or feminist progresses, though arguably farther to the left than its Condé Nast parents and siblings. The magazine describes itself as a “young person’s guide to conquering (and saving) the world” that “covers the latest in celebrity news, politics, fashion, beauty, wellness, lifestyle, and entertainment.”¹³  Although this is obviously a self-inflated view of the publication, the magazine has already begun shaping the minds of young people to consider the ways in which they should view their own bodies: namely as their own. Because of this small shift towards claiming autonomy, many people now engage in dialogue about power dynamics within gynecological visits, and the conversation has entered into many facets of these appointments.

Other discomforts that have faced backlash, such as the product design of the speculum, are rapidly facing redesign as their primary user shifts from the medical examiner to the patient. It is important to note that physicians are not willfully giving up the comforts of their profession, and the demand for change has come to such a crescendo that designers and corners of the market have been forced to react. Take for example the Yona, a redesigned medical device meant to remedy the speculum’s cold, hard, uncomfortable aspects. For their design process, the developers interviewed men in a practice they call “radical empathy,” in which they handed the men a speculum and asked for their reactions to the design object they knew nothing about. Their immediate reactions to the traditional speculum included descriptions such as “something from a horror movie,” definitely not “anything I would want near my body,” and “primitive and scary.” The developers then explained to the men what the tool is and how it is used, asking them to read women’s firsthand accounts of their experiences with speculums that recount it as “a torture device” used in a moment of utter “isolation.”¹⁴ The men’s voices audibly break (presumably in empathy) as they make their way through the statements. Finally, the participants were asked how they feel having read these statements, at which point they articulate their noticeable discomfort.

The designers and engineers at Yona were essentially asking their research contributors to participate in an act akin to speculation. By asking them to engage emotionally with the accounts of experience with the speculum, they were imagining a world in which the gendering of medicine didn’t exist and the medical tool was used on patients regardless of gender or sex. Their reactions, although unsurprising and doubtlessly tiresome to people who have experienced speculum visits, display how the potency of imaginative thinking can drive a more empathetic and equitable world, as long as the process does not stall out at imagining and pushes forth into material change. In support of Prado’s argument, then, visualizing the world free from patriarchal and gender-divided medicine removed constraints enough to devise a more humane, and even feminist-designed speculum. This is not because it is designed by a woman, nor because it is branded in a way to appeal to women (like coloring something pink), but because it makes the lived experiences of obstetric appointments less intrusive or painful and returns a sense of control and autonomy to the patient—even perhaps introducing a new relationship to one’s body through self-education.

Although the Yona speculum is not yet available for purchase and awaits FDA approval, it is just one example of many victories that can have a tangible effect on the experiences of pregnant people and others. These victories, although small, feel increasingly important as they are clouded by bad news of invasive legislation. It is reasonable to believe that many rights of autonomy can and will be taken away from myself and many others like me in the very near future. That future looks drastically worse for Black women, undocumented women, those who identify as non-binary conforming genders, and trans men seeking gynecological care. This is all the more reason to take the possibilities of future-oriented thinking seriously. 

We have seen the rise, conquest, and potential fall of what happens when rights are fought for within the structures of the status quo. The incorrect assumptions that the privacy granted from Roe v. Wade is the heroine of reproductive freedom has backed the feminist fight into the corners of court rooms, doctors’ offices, and voting booths. Roe does not open its arms to reproductive justice in the slightest. It does not address the egregious and brutal history of racist sterilization programs that are still happening in this country. It does not allow poor or low-income people the freedom to choose how and when to have a family free from poverty. It does not allow people autonomy to choose their reproductive future for themselves, free of doctors and courts. No one striving for reproductive justice should desire the precedent set by Roe, but many have been pushed to the brink of defending it, grasping at the last straws of reproductive choice. 

 Thinking outside current frameworks may hold the power to bring about real change. Instead of defending the minimal reproductive rights we do have, things that are so far from what would make pregnancy remotely enjoyable, we should be spending time improving pregnancy to make it an open-ended, non-threatening life experience for all. Recently, a woman’s search history sent her to prison for second-degree murder for seeking information on misoprostol pills (an abortifacient). Instead of battling for her right to privacy, we should be demanding the right to a safe, comfortable, at-home abortion.¹⁵ Another women was forced to relive her miscarriage trauma because an algorythm continued to send her ads for baby paraphenalia. It is worth questioning why presumptive pregnancy timelines are being used as a boon for capital.¹⁶ A new technology known as “geofencing,” is currently weaponized to harass people approaching Planned Parenthood or other abortion clinics.¹⁷ So few full-service reproductive healthcare centers are left that anyone visiting is easily targeted. If we could harness the powers given to us through speculative design we could build the future we actually want: one that values and appreciates the labors of pregnancy, one that empowers women by trusting them to know what is best for their own bodies, one that allows pregnancy to be an active and conscious choice, and one that makes no assumptions that pregnancy should always lead to motherhood. 

Notes

1. Anna North, “The new bill that would create a crime called ‘abortion murder’ explained,” Vox, accessed August 23, 2020.
2. Anne Ryman and Matt Wynn, “Copy, Paste, Legislate: For anti-abortion activists, success of ‘heartbeat’ bill was ten years in the making,” AZ Central, accessed August 23, 2020.
3. Adam Liptak, “Supreme Court Lets Kentucky Abortion Ultrasound Law Take Effect,” New York Times, accessed August 23, 2020.
4. Elizabeth Dias and Lisa Lerer, “How a Divided Left is Losing the Battle on Abortion,” New York Times, accessed August 23, 2020.
5. Doug Criss, “Does new Arkansas Law force women to get rapists’ OK before getting abortion? ACLU thinks so,” CNN, accessed August 23, 2020.
6. John Gramlich, “How Trump compares with other recent presidents in appointing federal judges,” Pew Research Center, accessed August 23, 2020.
7. The word reproductive here is used as a catch-all to express matters regarding or related to obstetric, gynecological, midwifery, vaginal, ovarian, etc., health and care. The word reproductive is in itself presumptive and is an example of rhetorical shortcomings. 
8. “Targeted Regulation of Abortion Providers,” Guttmacher Institute, accessed August 23, 2020.
9. Luiza Prado de O. Martins, “Privilege and Oppression: Toward a Feminist Speculative Design” (PhD diss., Universität der Künste Berlin, 2017), 5.
10. Ibid, 6.
11. Jenny Brown, Without Apology: The Abortion Struggle Now (Brooklyn, NY: Verso, 2019), 157.
12. Cass Belzer, “Why Some Doctors Allow Patients to Take a Hands-On Approach During a Pap Smear,” Teen Vogue, November 14, 2019.
13. “Teen Vogue,” Teen Vogue, accessed September 21, 2020.
14. “Process – The Work,” Yona, accessed September 21, 2020.
15. Laura Rankin, “How an online search for abortion pills landed this woman in jail,” Fast Company, accessed March 30, 2020.
16. Rachel Moss, “This is What It’s Like to Be Targeted by Baby Ads After Miscarriage Or IVF Struggles,” Huffington Post, accessed April 6, 2020.
17. Ibid.