Book review: Narratives of Consent and Reproductive Subjects: Tales of Invisibility

Introduction

Narratives of Consent and Reproductive Subjects: Tales of Invisibility, edited by Samantha Halliday, Rebecca Brione, and Jacqueline Nicholls, offers a timely and multidisciplinary interrogation of the forms of invisibility experienced by those receiving reproductive healthcare. The collection explores how consent often operates in ways diverging from its idealised presentation in law and policy, with a focus on those marginalised in reproductive healthcare. By exploring the experiences of those with complex social and health circumstances, those who have a mental illness, those who speak another language than English, Black and Brown pregnant people, and non-gestational parents or those who do not conform to maternal roles, the book illuminates the gap between the law and lived experiences, and calls for sustained, practical efforts to reorient reproductive healthcare around the experiences of those receiving such care.

The book aims to reach those working in law, nursing, medicine, midwifery, sociology, ethics, and anthropology. ¹ I would argue that it speaks powerfully to anyone who has navigated consent processes in a reproductive or maternity-care setting, as it not only successfully amplifies the voices of those who have reported feeling unseen or unheard in their encounters with reproductive healthcare but also exposes how easy it is to accept substandard care, prompting a necessary reckoning for readers who may recognise their own experiences in its pages.

Summary of chapters

The book starts with a chapter written jointly by the three editors (Chapter 1), followed by a chapter written solely by each of the editors (Chapters 2, 3, and 4). The subsequent chapters (Chapters 5, 6, 7, and 8) and afterword (Chapter 9) are written by contributors spanning across multiple disciplines, from professional backgrounds in law, philosophy, ethics, linguistics, and policy work.

In Chapter 1, ‘Diminishing Consent and Promoting Invisibility’, the editors establish the collection’s conceptual foundation, examining why consent is uniquely strained within the reproductive context. They argue that features such as the ‘two-patient scenario’, ² in which the foetus is treated as separate from the pregnant person, create persistent tensions complicating the realisation of autonomy. These early insights foreshadow themes developed throughout, particularly the gap between consent in doctrine and consent in practice. The chapter demonstrates how pregnant people, especially those who diverge from medical advice, are marginalised and positioned as passive recipients of care rather than active agents. The editors emphasise the importance of lived experience in shaping more responsive, person-centred practice, a recurring thread across subsequent chapters. As an anchoring introduction, the chapter prepares readers for the nuanced analyses that follow, framing the collection’s overarching concern with visibility, autonomy, and the structural conditions that undermine both.

Chapter 2, ‘I Just Want To Be Me’ by Jacqueline Nicholls, provides a foundational exploration of whether pregnant people’s lived experiences genuinely align with the legal commitment to bodily autonomy. By focusing on pregnant people’s experiences in a broad sense, Nicholls effectively sets the tone for the following chapters, foregrounding the central question of what individuals actually want when navigating reproductive decision-making. Positioning her analysis in the post-Montgomery ³ legal landscape, she examines how the landmark case reshaped the doctrine of consent by placing renewed responsibility on clinicians to engage with contextual factors shaping women’s choices. Nicholls highlights empirical evidence suggesting a narrow interpretation of Montgomery. Clinicians prioritising communication of material risk, rather than fostering genuine dialogue, contributes to the broader theme of invisibility. Ambiguity around what constitutes Montgomery-compliant practice undermines autonomy and obscures voices. Ultimately, the chapter raises a critical question that reverberates throughout the book: whether the legal ideal of consent is compatible with the realities of contemporary healthcare systems.

The chapters move from broad legal discussions to increasingly fine-grained analyses, with each successive contribution honing its focus on more specific issues and subgroups. Chapter 3, ‘It Wasn’t About What I Wanted’ by Rebecca Brione, is a particularly illuminating example, examining the consent experiences of pregnant people living with complex social and health circumstances. Drawing on two Birthrights research projects, ⁴ Brione highlights how pregnant people with disabilities and those facing disadvantages encounter constrained or illusory choice, making the centring of autonomy and control in birth experiences especially vital. Brione identifies three interconnected themes: invisible choice, failing to be recognised as a person, and bodily integrity and boundaries, each revealing layered forms of invisibility. ⁵ Pregnant people’s narratives show how clinical risk framing narrows available options, how they are reduced to labels rather than treated as experts in their own lives, and how invasive procedures disregard or disrespect their boundaries. Brione’s analysis powerfully demonstrates how these experiences intersect, exposing the structural conditions undermining meaningful consent.

Chapter 4, ‘What Are the Odds? Invisible Women and the Construction of Risk in the Court of Protection’, written by Samantha Halliday stands out personally as one of the most interesting contributions in the collection. The chapter offers an incisive analysis of how risk is constructed around pregnant people with mental illness. Halliday demonstrates that it is not pregnancy or mental illness that is framed as risky, but the pregnant person themselves, whose decisions, refusals, or perceived non-compliance are cast as threats to the foetus. Through two Court of Protection cases involving women with agoraphobia who wished to give birth at home, ⁶ Halliday illustrates how judicial reasoning renders pregnant people invisible, subsuming their autonomy beneath an overriding concern for foetal protection. This chapter resonates with contemporary debates on the spatial and temporal dimensions of mental capacity law ⁷ and offers a nuanced critique of how legal processes can marginalise those they purport to protect. Halliday’s call for a more holistic approach to risk assessment, ⁸ attentive to clinical considerations and the pregnant person’s well-being and expressed wishes, highlights the persistent gap between policy rhetoric and practice. This sophisticated case law analysis renders the chapter particularly compelling.

Chapter 5, ‘Choice and Consent’, by Emma Brooks turns to communicative challenges arising in multilingual antenatal settings, reminding us that informed decision-making must, at its core, be genuinely informed. For women who face linguistic barriers, comprehension cannot be assumed, and Brooks foregrounds this point through her analysis of interlingual antenatal consultations in a multicultural London hospital. Distinctively within this collection, she uses transcripts from three clinical interactions ⁹ to illustrate how difficulties in multilingual communication subtly yet significantly shape decision-making processes. Although these exchanges were not exclusively centred on consent, Brooks demonstrates how misunderstandings, hesitations, and asymmetries in communication can undermine the conditions necessary for meaningful choice. The chapter concludes by advocating for longer consultation times where language differences exist and for enhanced interpreter training, particularly in maternal healthcare terminology, to ensure that linguistic diversity does not become a barrier to autonomy or equitable care. ¹⁰

In Chapter 6, ‘You Speak and Nobody Hears’ by Eli Ansari and Katherine Maslowski, the contributors examine the racialisation of pregnancy and birth and the associated profound inequalities. The chapter begins with a statistic: Black pregnant people face more than triple the risk of perinatal mortality compared to white pregnant people, and Asian pregnant people nearly double, ¹¹ and the authors argue that these outcomes do not stem from individual pathology but from entrenched systemic racism. The authors trace how racist assumptions shape medical systems and professional attitudes, creating a self-reinforcing cycle rendering Black and Brown pregnant people invisible within maternity care. Drawing on recent reports and lived accounts, the chapter organises these experiences into three Birthrights-identified themes: dehumanisation, being ignored or disbelieved, and consent and coercion. ¹² Each theme explores how epistemic violence and structural bias undermine autonomy and safety. While emphasising the need for systemic reform, the authors highlight the role of individual clinicians, noting that emerging practitioners may be particularly receptive to anti-racist training. Ultimately, the chapter argues that meaningful change begins with listening to Black and Brown pregnant people and centring their experiences in maternity policy and practice.

Chapter 7, ‘COVID-19 and Beyond’ written by Anna Nelson, offers a careful examination of how pandemic-era maternity policies exposed long-standing weaknesses in consent and choice. Despite the law’s emphasis on autonomy, Nelson argues that COVID-19 policies frequently sidelined pregnant and birthing people, as NHS Trusts developed their own restrictions and national bodies issued only partial guidance. This fragmented approach prioritised operational pressures over individual rights, reflecting what Nelson identifies as a false assumption of policy neutrality: measures appearing reasonable on paper that produced harmful consequences in practice, particularly for those already facing limited options, such as people seeking home births. ¹³ The chapter highlights how restrictions marginalised nongestational parents and reinforced idealised, patriarchal expectations of motherhood. Nelson argues that the pandemic magnified preexisting systemic failures and calls for reforms centring women and birthing people in policymaking and embedding mechanisms for ongoing feedback. ¹⁴ The chapter makes clear that meaningful change requires shifting focus from legal doctrine to the policies shaping everyday maternity care.

Chapter 8, ‘Mandatory (M)othering’ by Zaina Mahmoud, examines British surrogates’ healthcare experiences, revealing how law and policy systematically erase surrogates’ identities. Drawing on empirical work, Mahmoud argues that UK surrogacy regulation rests on assumptions that surrogates act from vulnerability rather than autonomy, leading to their mislabelling as ‘mothers’ and pregnancy deemed a barrier to valid consent. This misrecognition shapes their interactions across a fragmented system: in private fertility clinics, surrogates often become peripheral to intended parents; within NHS settings, they are treated as default mothers and expected to conform to dominant maternal ideals. The precautionary logic of assisted reproduction, framing the foetus as ‘precious cargo’, ¹⁵ positions surrogates as risky. Mahmoud ultimately shows how legal invisibility and inconsistent healthcare provision reinforce an idealised ideology of motherhood, underscoring the need for reforms recognising surrogates’ autonomy and reflecting the realities of contemporary surrogacy in the United Kingdom.

The volume concludes with Emma Cave’s Afterword (Chapter 9), drawing together the collection’s central insights and offering a reflective synthesis thereof. Cave revisits the development of informed consent and considers its implications for those navigating pregnancy and birth, tracing the reproductive journey from conception through antenatal care to illustrate how consent is often framed as a straightforward matter of choice when, in practice, it is far more complex. She highlights how idealised constructions of motherhood and entrenched structural inequalities continue to undermine genuinely patient-centred care, arguing that a uniform approach to information and communication is insufficient for the diverse realities of reproductive subjects. ¹⁶ By weaving together the book’s interdisciplinary narratives, Cave demonstrates how lived experiences can illuminate the limitations of current legal and policy frameworks and guide more responsive reform. Her concluding reflections reinforce the overarching call for personalised, supported decision-making centred on the voices and needs of pregnant and birthing people.

Analysis and conclusion

Narratives of Consent and Reproductive Subjects: Tales of Invisibility offers a sophisticated and genuinely multidisciplinary exploration of consent. The structure of the collection is intuitive: the conceptual groundwork laid in the early chapters enables the reader to engage more deeply with the later, experience-rich contributions, which sharpen the book’s central themes. The methodological diversity is a further strength. Some authors draw on interviews, others on case law or theoretical literature, creating a textured and expansive account of the problems surrounding consent in reproductive healthcare. Although the chapters range widely in context, the volume maintains two clear and coherent threads: that law, policy, and practice frequently fail to align, and that meaningful reform requires listening to the voices of pregnant people.

Other assets to this collection include the interweaving chapters, with authors engaging in each other’s arguments, the sense of a collaborative scholarly project rather than a fragmented anthology is reinforced. The book’s practical relevance is also striking, illuminating issues such as multilingual communication barriers, pregnant people with agoraphobia and the complexities of surrogacy, issues frequently overlooked in mainstream discussions. Moreover, its timeliness, particularly in the wake of COVID-19’s ongoing disruption of healthcare systems and the various maternity scandals discussed in Cave’s Afterword, ¹⁷ underscores the urgency of these debates. As Cave points out: ‘[c]hange is not occurring quickly enough’, ¹⁸ signalling the importance of sustaining these debates if the persistent gap between law, policy, and practice in the reproductive context is to be meaningfully addressed.