Unsettling care: Troubling transnational itineraries of care in feminist health practices

What concerns me is how much this affirmative turn actually depends on the very distinction between good and bad feelings that presumes that bad feelings are backward and conservative and good feelings are forward and progressive. Bad feelings are seen as oriented toward the past, as a kind of stubbornness that ‘stops’ the subject from embracing the future. Good feelings are associated here with moving up and getting out. I would argue that it is the very assumption that good feelings are open and bad feelings are closed that allows historical forms of injustice to disappear.

Sit in a circle. Assemble a kit composed of mirror, light, and plastic speculum for each participant. Lubricate your speculum with the duckbill closed and the handle in the upward position. Insert with care. Squeeze the handle and press down. You will hear a click to let you know it is locked open. To see yourself, hold the mirror between your legs and direct the light toward it. The light will reflect off the mirror into your vagina so that your cervix will pop into view. Appreciate the lush color, texture, odor, and shape of the cervix and vaginal walls. Take turns sharing your observations within the group and connect with others through your exchanges. Admire the subtle variations and the fine differences in form. Track changes. Attend to the variations within yourself, but also notice what is not uncommon with others. Listen, feel, and look carefully.

These are some of the ingredients that made up the affectively charged protocol of vaginal self-exam developed by the Los Angeles feminist self-help movement in the 1970s, a protocol that traveled and was tweaked across the United States, into Canada, to Europe, down to Brazil, over to India, and into the Caribbean (Murphy, 2012). This subversive research assemblage of simple technologies, embodied subjects, and emotional scripts became an iconic feminist practice. At stake was how to see, feel, care for, and create knowledge about bodies and to attend to the power dynamics in clinical encounters. It offered a route toward depathologizing and destigmatizing sexuality and reproduction. Influentially, it crafted a vision of the scientist-subject as deeply responsible and implicated in her object of study, her own body. Moreover, feminist science studies scholars’ insistence on embodiment, situatedness, and reflexive responsibility (e.g. Haraway, 1991, 1999; Harding 1991; Harstock, 1983; Jaggar, 1989; Rose, 1983; Tuana, 2004) was in part inspired by the affect-laden rearrangements of this feminist practice that demonstrated how it might be possible to craft ‘speculums for a new world order’ (Haraway, 1999). ¹ Starting with yourself in what you were studying and highlighting your subjectivity and perspective were core epistemic values of many late 20th-century feminist projects that aspired to produce better, more accurate, more attentive, more responsible knowledge. In the 1980s, early feminist historians and philosophers of science in particular celebrated the place of emotion, embodiment, and care within scientific production, integrating the ‘hand, brain, and heart’, in Hilary Rose’s (1983) words. Later, embodied ways of knowing were extended and transformed into the more complexly geopolitical versions of theorizing situated knowing in feminist science studies today. Feminist self-help, with all its complex baggage, is a strand of feminist science studies’ recent past. Its subversive practices of care crafted welcoming clinical spaces for women to rearrange reproductive health. How far do those good feelings go, and what work did they do?

This article asks science studies scholars to take a more critical stance toward the politics of care in technoscience, by attending to the complexities and complicities in recent histories of care within feminist and postcolonial circuits. This critical stance is not a blanket rejection of the politics of care, for the exercise of power operates through care in many divergent ways. Instead, the article enacts a commitment to grappling with the multiply fraught histories and structures that animate the ongoing crafting of a critical feminist science studies. In adopting this stance, I want to resuscitate critique as contributing to, and not simply working against, a better politics of care. More specifically, I caution against the conflation of care with affection, happiness, attachment, and positive feeling as political goods. In contrast, this article emphasizes the continued salience of critique by troubling some of the ways that care has been performed in the history of North American feminist health activism and its entanglements in histories of persistent racisms, class privilege, colonialism, and American imperial ambitions of the late 20th century. This vexation of care is important because there is an ongoing temptation within feminist scholarship to view positive affect and care as a route to emancipated science and alternative knowledge-making without critically examining the ways positive feelings, sympathy, and other forms of attachment can work with and through the grain of hegemonic structures, rather than against them.

The first section of this article seeks to disturb assumptions about the political work of positive affect within feminist science studies. The second half of the article critically follows two histories of the transnational politics of care within feminist interventions into cervical cancer that differently acknowledged and addressed colonial legacies, capitalism, and emerging forms of postcolonial empire at the end of the 20th century. ² This work of disturbing feminisms’ recent pasts is not toward the nihilism of critique and a doing away of feminism but instead toward the continuous work of making a more critical feminist science studies accountable to the economic, racialized, and colonial entanglements of both science and feminism.

As one ancestor of feminist science studies, feminist self-help was a subversive way of hitching together care and science that both deserves attention and need troubling. It was protocol feminism inventive of practices, manuals, and guidelines that could move translocally and that explicitly sought to take note of how power, emotion, and bonding circulated within clinical settings so as to create less oppressive medical experiences and less pathologizing research. It was a kind of lay science, shaped by an aspiration of individualized control over reproductive health focused on the scale of the technical act of examination itself. Practitioners hoped to build in microcosm a liberated form of health care, one that could provide an alternative to the rising violence of population control, the legacy of eugenics, the criminalization of abortion, the sexism of everyday medical practice, and the controlling patriarchal moralism around fertility, sex, and sexuality more broadly. They sought to positively appreciate genitalia, sexual and reproductive processes, and bodily variation as a way to combat feelings of shame, squeamishness, stigma, or shyness. Their practices of knowledge-sharing among lay people challenged the patriarchal and increasingly profit-driven medical profession.

In the context of the United States, Canada, and Europe, feminist self-help tended to confine its critical interventions to the choreography of clinical techniques and research within women’s health centers or small collectives, believing that their emphasis on flexible, individualized control over clinical encounters could circumvent, by virtue of implicitly accommodating, explicit questions of race, colonialism, and class. By focusing on individualized control, they thought they could leave race at the clinic door. Like much early feminist science studies, US feminist self-help was predominantly, though not only, practiced by white educated women, whose focus on gender, sex, and bodies often effaced interlocking structures of colonialism, racism, or nationalism. Yet, the same historical period saw many radical health projects by women and people of color in North America that directly tackled racism, citizenship, poverty, and colonialism (Asian Communities for Reproductive Justice, 2005; Avery, 1990; Di Chiro, 2004; Nelson A, 2013; Nelson J 2003, 2005; Orleck, 2005; Silliman et al., 2004; Sister Song Women of Color Reproductive Health Collective, 2007). The US feminist self-help movement’s aspirations toward an unraced woman-focused politics within the scope of the clinical encounter imagined itself as welcoming all women, with visions of multiracial participation in its materials but without taking on the critical analytics of women of color, immigrant, anti-colonial, and indigenous politics. Typically, detailed observations about bodies emphasized the intimate and lush scale of color, taste, smell, texture, and sensation but not generally questions of employment, citizenship, war, racialization, or poverty. The feminist self-help movement did not, for example, explicitly challenge the coercive, racist sterilization of Latina women that was then rampant within Los Angeles hospitals (Espino, 2000; Gutierrez, 2003; Tajima-Peña, 2013). In the effort to celebrate embodied variation, privilege shaped who easily saw and felt themselves as already ‘healthy’ and hence available to the aspiration of happily caring and responsibilizing themselves for their own health. This happy healthiness was scripted into the 1970s Los Angeles ‘self-help in a suitcase’ road show, which ended with a public demonstration of vaginal self-exam, prepping its audience with a slideshow photograph taken from the view of a woman staring over her belly, through her legs, and into the smiling faces of a multiracial group of women looking back. The script for this slide declares ‘Happiness is knowing your own cervix … Happiness is knowing your sisters’ cervix’. ³ In moments like these, feminist self-help aligned participants in a collective project of bonding and pleasure, through the epistemic value of embodied knowledge-making, but skipped over the structural histories that brought different arrangements of power to this practice. Rearranging technoscience was in this instance a romantic project that tended to emphasize the liberating potential of a politics of positive feeling. It tended to avoid addressing the ongoing, painful, and extensive forces of racism or colonialism that do not disappear with good intentions or by constructing spaces where such forces are not keenly felt by privileged subjects.

Since questions of care remain crucial to the ongoing project of feminist science studies, how might we trouble – without nihilistically foreclosing – the multiple and fraught histories of feminist mobilizations of care? Since feminist science studies scholarship still holds on to some tendencies to focus on gender and sex distinct from the interlocked legacies of racism, capitalism, colonialism, and other forms of violence, there remains a contemporary urgency to trouble feminist mobilizations of care. In the recent pages of this journal, Maria Puig de la Bellacasa (2011) has eloquently elaborated a turn from ‘matters of concern’ to ‘matters of care’ as urgent work for our engagements with technoscience as a world-making practice. Puig de la Bellacasa takes critical inspiration from Bruno Latour’s (2004) call for a reorientation away from a critique of ‘matters of fact’, thereby diminishing facts, to a strategy that emphasizes enriching objects so that they are studied as extensive, contestable and dynamic social, technical, and political assemblages, renamed ‘matters of concern’. ‘Matters of care’, in turn, amplifies the affective entanglements through which things come to matter and injects commitments to attending to marginalized, invisibilized and neglected elements, experiences, and relations. In the example of 1970s feminist self-help, then, we might say that fostering reproductive health as a ‘matter of care’ was performed in ways that sought to validate non-expert knowers, value bonding with research objects and between researchers, as well as foster ‘happiness’ and ‘health’ in hegemonically pathologized bodies. At the same time, we must also grapple with how the elevation of a politics of care by 1970s feminists was simultaneously conditioned by white privilege, capitalism, and postcolonial humanitarianism (which the second half of this article attempts to show). Assembling matters of care provokes some questions. Where does care begin and end? How does the politics of care already weave in and extend out from technoscientific practices? Or, in and out of situated feminist commitments? If care is non-innocent, if care is entangled, what work does the politics of care do for critical technoscience studies?

In trying to think through technoscience as a matter of care, Sara Ahmed’s (2010) critique of the political work of happiness is a guide to unsettling, easy validations of happiness, affection, or attachment as the equivalent to a critical feminist politics of care. Ahmed argues that the ways in which we are enjoined to be happy are often normalizing strictures. To be content is to be aligned with and comfortably oriented within dominant ways of belonging, from heteronormativity to nationalism. Thus, she asks us to pay attention to those moments of alienation from belonging, to the ‘unhappiness archives’, to moments of unease that might prompt the possibility of feminist, queer, anti-colonial, non-nationalist politics (Ahmed, 2010). Something similar might be emphasized for matters of care in technoscience. ‘Productive doings that support livable relationalities’ (Puig de la Bellacasa, 2011: 93) are not just complexly valued and devalued but are enabled through non-innocent historically and spatially layered distributions of belonging and alienation, comfort and unease. As Puig de la Bellacasa (2011) reminds us, ‘the politics of caring have been at the heart of concerns with exclusions and critiques of power dynamics in stratified worlds’ (p. 86). Conflating care with affection and attachment, and positing positive feeling as a political good, are temptations with which feminist science studies have long wrestled. What, then, is the work of discomfort, unease, and trouble in matters of care?

Care carries (at least) four different interlaced meanings: first, it refers to the state of being emotionally attached to or fond of something; second, it means to provide for, look after, protect, sustain, and be responsible for something; third, it indicates attention and concern, to be careful, watchful, meticulous, and cautious; while its fourth meaning (and the first in the Oxford English Dictionary entry) is to be troubled, worried, sorrowed, uneasy, and unsettled. It is this final facet of care that I want to dwell on. What is the caring work of criticism, of historicizing and situating, of tracking non-innocent genealogies, of making uneasy, of troubling, of unsettling? By picking out unsettling as a generative task within the politics of matters of care in technoscience, I hope to introduce into the conversation the following: (1) the urgencies of transnational, postcolonial, and anti-racist analytics, for which to unsettle is a disruption to non-innocent narratives of belonging and a challenge to gestures of rescue, sympathy, and occupation that too often recapitulate colonial legacies, and (2) the work of disturbing and setting into motion sedimented arrangements of valuation and devaluation. Unsettling, in this second sense, is the purposeful undoing and troubling of particular arrangements so that they might be acknowledged and remade in better, less violent, more livable ways. The ambit of ‘matters of care’ is already transnationally extensive with self-identified feminists implicated at every turn in the rescue missions of non-governmental organizations (NGOs) as World Bank consultants teaching empowerment, as health and other frontline workers who perform care labor, as scholars and as ‘sufferers’. Care and feminism are already entangled within and against development projects, public health practices, labor stratigraphies, family planning practices, humanitarian interventions, pedagogy, family formations, and so on. If matters of care are already distributed into racialized, postcolonial, economic, and transnational stratigraphies, if empire and capital can operate through acts of affection and care, what about these distributions might be productively unsettled through the ongoing project of a critical feminist science studies? Or put differently, what about the scope and habits of an extant, already circulating, feminist politics of care in science studies is troubling and needs to be unsettled?

This call to attend to the constitutive vexations and violences within matters of care is not intended as a critique in search of a properly corrected feminist science studies. Critical, political, partial, affectively reorienting, situated technoscience is skillful hard work, as Donna Haraway has taught us. It is ongoing. It is troubled. But more than troubling, I want to argue that it can also be generatively unsettling. In thinking ‘unsettling’, I turn to lessons from scholars and activists theorizing the project of decolonization in Canada and the United States as a kind of unsettling project not confined to indigenous people, but a project that also responsibilizes settlers to histories, entanglements, and complications that come from the historical and current structural violence of colonialism that unevenly distributes pain, trauma, and vulnerability as much as rewards, pleasure, and privilege (Unsettling Minnesota, 2009). Reaching for a world accountable to the knotted histories of raced and sexed violence, dispossession, and privilege is a project of unsettling. No one is innocent, and all entwined. Scholars of decolonization show how a politics of unsettling challenges conventional feminist and queer affective formulations of belonging, inclusion, healing, confession, ownership, and solidarity as caught up in the logics of settler colonialism (Arvin et al., 2013; Million, 2013; Morgensen, 2011; Tuck and Yang, 2012). Unsettling the politics of care, then, requires further thinking about the political and affective dimensions of Donna Haraway’s (2010) call to ‘stay with the trouble’.

Unsettling care in technoscience and feminism invites ways to situate affection, attention, attachment, intimacy, feelings, healing, and responsibility as non-innocent orientations circulating within larger formations, instead of as attributes of individual scientists or feminists. Integral to Lorraine Daston’s (1995) notion of ‘moral economies of science’ is an insistence on studying morals not as residing in individuals, but as affectively charged historical formations that individuals come to inhabit. Relatedly, the feminist theorist Sara Ahmed (2004) argues that we should think of emotions as constituted in ‘affective economies’, in which emotion is not a primal force in the individual or the psyche but rather is incited through historically specific arrangements of circulations between subjects. For Ahmed, the notion of ‘affective economies’ has a distinct affiliation with how commodities are analyzed by Marx. Just as Marx shows that the commodity, which seems a thing in itself, conceals the social relations and labor that make it possible, for Ahmed, ‘affects’ as emotions, which seem to originate prior to social relations in bodies and minds, are better understood as generated in historically specific circulations that align and differentiate bodies in particular ways. Just as the commodity’s value is the effect of circulations of labor, money, and capital, the value of certain affects such as happiness, attraction, disgust, or hate are the accumulated effects of patterns of circulation between subjects in uneven worlds and thus perform particular kinds of work arranging social relations. In other words, value (moral, economic, and otherwise) is conjured, assigned, and circulated in affective economies, and hegemonically oriented by racial privilege, colonialism, nationalism, capitalism, religion, patriarchy, and so on.

Thus, the embrace of questions of care by feminist science studies scholars and feminist self-help practitioners is also partially animated by larger circulations and valuations of affect in the late 20th century. It is significant then that in the moment of the emergence of feminist self-help in California and its celebration of positively charged caring, feminists in many sites around the world had begun to critically investigate the function of ‘affective labor’ (variously encompassed by terms such as ‘emotional labor’, ‘care work’, and ‘social reproduction’) as the unwaged work of caring that women commonly did in families. Such care work was not explicitly valued with a monetary wage and thus was a form of exploited labor on which capitalism depends but, that it does not remunerate (Dalla Costa and James, 1975; Edwards, 1971; Federici, 1975). Instead of understanding this unwaged care work as outside of production, Marxist feminists argued that care was crucial to both life and capitalism because it was necessary for sustaining supplies of labor, that is, the raising of the next generation of workers. Capitalism, so Marxist feminists of this period argued, was dependent on patriarchy for keeping the care work of social reproduction as unwaged labor so that capital could freely accrue the benefits of the labor power (as well as consumption) created by the caring practices that nurtured new workers and new consumers. In this strand of feminism, matters of care were subsumed as matters of labor.

At the same moment that Marxist feminists assembled this analysis of devalued, unwaged care labor, other feminists began looking at another aspect of care politics: the gendering of waged emotional labor in the expanding service industries, where women as stewardesses, nurses, waitresses, receptionists, clerks, teachers, child care workers, nurses, or customer services representatives had to perform the affective labor of smiling, friendliness, warmth, and caring as part of their paid work (Hochschild, 1983). It is no irony then that the very first radical feminist speech on consciousness raising was given to an audience of stewardesses (Sarachild, 1975). Feminist scholarship on care labor challenged the racialized and transitionally stratified circuits of care work in the 20th century that saw poor, immigrant, and racialized women undertaking low-waged care work (as nannies, domestic workers, nurses, and so on) for privileged others in ways that undermined the spatial and temporal possibility of contributing to the unwaged care work of their own families or communities. In the cleavages of transnational political economy, care became ‘stratified reproduction’ cut by capitalism, race, migration, and citizenship (Colen, 1995). Many scholars have shown how the stratigraphies of care, intimate relations, and labor have long legacies that thread through the very operation of European colonialism and American slavery, segregation, and empire (Hartman, 1997; McClintock, 1995; Morgan, 2004; Stoler, 2002). Scholars such as Rhacel Parreñas, Ara Wilson, and Evelyn Nakano Glenn have continued to expand this critical work, tracing the contemporary racialized and transnational itineraries of ‘intimacy’ and ‘care’ as constituted through immigration, citizenship, family law, sex work, tourism, and postcolonial rescue (Boris and Parreñas, 2010; Glenn, 2012; Parreñas, 2001; Wilson, 2004).

Already in the 1970s, care was simultaneously legible as a kind of devalued work and as a generative, value-producing capacity to feel and connect that feminists mobilized and that capitalism could harness and attract. Feminist calls to value affective labor resonated with other late 20th-century valuations of affective labor such as the celebration of American entrepreneurial passions, or the role of creativity in programming, or the social network of friendships in entrepreneurial ventures (Lazzarato, 1996; Negri, 1999; Terranova, 2000; Weeks, 2007). A telling example of the contemporary embrace of positive affect as a privileged form of labor is the aphorism ‘Do what you love, love what you do’ as a work mantra. This mantra extends its ethical reach only to the proximate relations around the self, making positive affect the measure of meaningful work (Tokumitsu, 2014). It forecloses questions about the uneven political economic conditions that provide the tools, shelter, and support labor that afford some the privilege of working toward their pleasure.

Moreover, in the 1970s, when STS and feminist self-help were emerging, the stratified labor of biomedicine was gathered together as the ubiquitous term ‘health care’ (Greco, 2004). In the second half of the 20th century, care has become a normative biomedical deliverable, involving its own history of commodification and labor, of bedside manners and gendered emotional expression, of managed care and insurance, of the pharmaceutical management of affect, and, most crucially, of deeply unequal access. Charis Thompson (2013) identifies a politics of biomedical ‘triage’, in which the always uneven distribution of care involves complex moral, practical, and political decisions about how to value life and who is available for rescue and treatment when not everyone is being cared for. The transnational circulation of the politics of care likewise animated late-20th-century humanitarianism, where the desire to be responsible for suffering both locally and from far away was harnessed toward what Mariam Ticktin (2006, 2011) calls an ‘anti-politics of care’ defined by emergency interventions that shed explicit political engagement. Through the example of Doctors without Borders, Ticktin shows how emergency care, as a reaction to violence that eschews political engagement, became the core logic of late-20th-century humanitarianism.

What I am suggesting here through these multiple manifestations of the politics of care is that present day feminist and queer scholarship is already entangled in the complex devaluing and valuing of care, even as care is repeatedly promised as a source of potential emancipation and alternative technoscience. This is not to dismiss the importance of affect and responsibility as crucial dimensions of politics, labor, knowledge-making, and living, or to reduce affect to a mere evocation of capitalism and colonialism. Instead, I want to suggest that feminist projects of care are within a skein of appropriation and re-appropriation, of antagonistic and yet enabling relations, of uneasy animations that are not merely political, economic, and complicit, and yet also not merely reparative or oppositional or better. Projects of care, feminist and otherwise, are full of romantic temptations that disconnect acts that feel good from their geopolitical implications.

The broad lesson to be learned from historicizing feminist self-help’s turn to care is that the ‘how’ of technoscience is as much a question of the promise and limits of affectively charged knowing, as much a question of imperfectly drawing the scale of your responsibilities and relations, and as much a question of subjects in non-innocent economies, as much a question of erasure and disinvestment, as much a question of entangled reassemblies and appropriations, and as much a question of marked and unmarked labor as it is an effort to make knowledge and the world otherwise. How, then, should we critically take up the charged work of engaging matters of care in technoscience, cognizant of the fraught genealogies of care that are so unsettling? How should we learn from the past and unsettle care? I try to think this through in two examples of feminist projects around cervical cancers and pap smears from the last decades of the 20th century. I look at these examples as means of exploring the recent history of how different feminist projects articulated their entanglements with postcolonial expressions of empire and its politics of care and also as departure points for circling toward unsettling care as an alternative orientation.