The "rightness" of a technology for completing a particular task is negotiated by medical professionals, patients, state institutions, manufacturing companies, and non-governmental organizations. This paper shows how certain technologies may challenge the meaning of the "job" they are designed to accomplish. Manual vacuum aspiration (MVA) is a syringe device for uterine evacuation that can be used to treat complications of incomplete abortion, known as post-abortion care (PAC), or to terminate pregnancy. I explore how negotiations over the rightness of MVA as well as PAC unfold at the intersection of national and global reproductive politics during the daily treatment of abortion complications at three hospitals in Senegal, where PAC is permitted but induced abortion is legally prohibited. Although state health authorities have championed MVA as the "preferred" PAC technology, the primary donor for PAC, the United States Agency for International Development, does not support the purchase of abortifacient technologies. I conducted an ethnography of Senegal's PAC program between 2010 and 2011. Data collection methods included interviews with 49 health professionals, observation of PAC treatment and review of abortion records at three hospitals, and a review of transnational literature on MVA and PAC. While MVA was the most frequently employed form of uterine evacuation in hospitals, concerns about off-label MVA practices contributed to the persistence of less effective methods such as dilation and curettage (D&C) and digital curettage. Anxieties about MVA's capacity to induce abortion have constrained its integration into routine obstetric care. This capacity also raises questions about what the "job," PAC, represents in Senegalese hospitals. The prioritization of MVA's security over women's access to the preferred technology reinforces gendered inequalities in health care.
Bibliographical noteFunding Information:
This study was funded by fellowships from the National Institute of Child Health and Human Development (NICHD) ( HD059397 ), the Social Science Research Council (SSRC), the American Council of Learned Societies (ACLS), and the Institute of African Studies at Columbia University . I owe enormous gratitude to the Senegalese medical and public health professionals who participated this study, as well as to the West African Research Center (WARC) for support during the fieldwork period. I am also grateful to the three anonymous reviewers for their excellent feedback. Special thanks to Alondra Nelson, Constance Nathanson, Monica Casper, Heather Talley, Wendy Chavkin, Abby DiCarlo, Kirk Grisham and Sanyukta Mathur for their helpful suggestions on earlier versions of this paper.
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- Manual vacuum aspiration
- Population politics
- Reproductive health