The re-colonization of South Asian women’s bodies: Normalizing off-label experiments in the pharmaceuticalization of homebirths

In the guise of global health humanitarianism, the off-label medical uses of the uterine-contracting misoprostol pill has effectively turned homebirths in “resource-poor” nations into unmarked and un-enunciated zones of experimentation, whereas the same drug is regarded too risky for similar uses, even in hospitals, in “resource-rich” nations. Informed by ethnographic research in Balochistan, Pakistan, this chapter delineates the relationship between homebirths and routine artificial labor induction to examine the consequences on Pakistani women’s health of normalizing the “un-enunciated experimental” off-label uses of misoprostol in nearly every case of childbirth, in homes and clinics, in the hopes of averting postpartum hemorrhage (PPH), whether or not the woman is at risk for it. The author argues that the rationale underlying the advocacy of misoprostol to presumably secure ‘global South’ women’s lives, even those not at risk of PPH, is an example of colonial governmentality. Moreover, normalizing misoprostol use in contexts of socio-structural inequalities, particularly where excessive artificial labor induction prevails, constitutes the enactment of a kind of “medical relativism.“In the guise of humanitarianism, the uterine-contracting misoprostol pill is increasingly viewed to be the best low-tech obstetric first-aid against maternal mortality, despite the evident risks of its use for women and the fetus. As such, the transnational off-label medical uses of this drug has effectively turned homebirths in “resource-poor” nations into unmarked and un-enunciated zones of experimentation, whereas the same drug is regarded too risky for similar uses, even in hospitals, in “resource-rich” nations. Misoprostol has become the public health solution in response to medico-humanitarian development discourses that construct homebirths as responsible for high maternal mortality. In the absence of proper safety tests, advocating its routine administration against postpartum hemorrhage (PPH) in Pakistani homes serves to erase the distinction between service-delivery projects and experimentation. Drawing from ethnographic research in Balochistan, including Panjgur district and Quetta city, as well as Karachi and Islamabad in Pakistan, this chapter addresses the relationship between homebirths and routine labor induction in Pakistan to examine the implications on Pakistani women’s health of normalizing what I call the “un-enunciated experimental” off-label uses of misoprostol in nearly every case of childbirth, in homes and clinics, in the hopes of averting PPH, whether or not the woman is at risk for it. I suggest that the rationale underlying the advocacy of misoprostol to presumably secure ‘global South’ women’s lives, which may or may not be at risk of PPH, is an example of colonial governmentality. I argue that normalizing misoprostol use in contexts of socio-structural inequalities, particularly where excessive artificial labor induction prevails, constitutes the enactment of a kind of “medical relativism."