Rwanda experienced genocide from April to July 1994 during which over 800,000 people were murdered. Among the far-reaching changes that followed this event among individuals and in society overall, the Rwandan Demographic and Health Surveys (DHS) showed that contraceptive prevalence declined from 13% in 1992 to 4% in 2000 among married women of reproductive age. This dissertation has two hypotheses concerning Rwandan women's fertility preferences and behavior following the genocide. It is hypothesized that, first, high levels of conflict reduced women's desire for a child or for additional children and second, that women who experienced relatively high levels of conflict were more likely to act on their wish to not have a child or another child by using modern contraceptives than were women who experienced relatively low levels of conflict. The study's logistic regression dependent (outcome) variables were desire for a or another child and the use of modern contraceptives; the source for these data was the 2000 DHS. Three groups of independent variables were included: socio-demographic variables, also from the 2000 DHS, included age, number of living children, education level, urban/rural residence and socio-economic status; availability of family planning services, assessed using women's perception of distance as a barrier to obtaining health care for themselves, from the 2000 DHS, and quality of health services, assessed with data from the 2001 Service Provision Assessment; and experience of conflict, measured as the percentage of the 1994 commune populations that resided in refugee camps in 1995. Communes were considered `high migration' if 10 percent or more of their populations migrated to camps and `low migration' if less than 10 percent of their populations migrated to camps. Women who lived in high migration communes were considered to have relatively high experience of conflict and those who lived in low migration communes were consider dot have relatively low experience of conflict. Analysis showed that residents of high migration communes were significantly less likely to want a or another child as compared to residents of low migration communes (OR = .74); it appeared that the social environment of high migration had a dampening effect on desire for children. The analysis also showed that residents of high migration communes were significantly less likely to use a modern contraceptive method than were those of low migration communes (OR = .57), even though they were less likely to want a or another child and even when family planning services were reasonably available. The reasons for these results are unclear, and many factors may contribute. The generalized trauma experienced by the population may have had a numbing effect, in which taking action in any domain was difficult. Women may have felt pressured by society to have children as the society emerged from war, despite their own preferences. The population may also have distrusted government health facilities - the only source of services for most - in light of the interactions with officials during and after the genocide. However, another set of reasons specific to women and women's health may also have influenced the findings. There is a pervasive social stigma around reproductive health; these services have generally lagged behind other primary health care components. Moreover, rape was used as a weapon of war in the genocide; these experiences may have reduced women's willingness to seek reproductive health services specifically. Finally, the Rwandan genocide and its preparation were decidedly misogynistic; this pervasive dehumanization may have made it particularly difficult for women to seek care for their sexual and reproductive health needs and desires. This complex personal, social, physical and political context may explain why Rwandan women who may not have wanted a child or additional children nonetheless did not consistently act on their desires in the years following the 1994 genocide. The dissertation includes a series of essays providing the author's personal perspective on working in Rwanda in the 1980s and 1990s and being present in the country at the start of the genocide in April 1994.

This dissertation aims to contextualize the normative and structural constraints on women's bodies, health, and wellbeing in rural Tamil Nadu, India. Using theoretical frameworks by R.W. Connell and Michel Foucault, this qualitative study explores the intersection of gender and power at interpersonal-, institutional-, and community-levels. Findings from this research highlight specific manifestations of the local gender regime that women may need to overcome to better care for their bodies and selves.

Over the 20th century, Malians relied on local reproductive specialists: excisers (who oversaw initiation and circumcision ceremonies), nuptial counselors (who provided sexual education at marriage), and midwives. These older women’s work remained vital to social conceptions of proper reproduction, even as the biomedical maternal health system expanded, and Malians adjusted to new forms of religiosity and new ideas of status. Reproductive Labors: Women’s Expertise and Biomedical Authority in Mali 1935-1999 traces how, as biomedical care expanded over the 20th century, women and their families, feminist activists, medical professionals, and non-profit workers began to debate the importance of local reproductive practices. Part 1 explores the role of specialist labor in socializing sexuality and gender norms. In Chapter 1, I argue that following the end of slavery in the early 20th century, Malian families used nuptial counseling to instill concepts of honorable sexuality and demonstrate status at marriage (1935-1958). After independence, public outcry over unwed mothers revealed different visions of extra/marital sexuality and adolescence for nuptial counselors and state-affiliated women activists (1959-1986). In Part 2, I turn to reproductive health interventions. Chapter 3 reveals how the colonial maternal health system relied on external actors, from benevolent associations to Malian midwives, all of whom defined women’s bodies as childbearing bodies (1935-1958). Successive post-colonial governments sought to develop policies to ensure rural health access, toggling between training medical professionals to work in rural places and training local specialists, such as midwives, in biomedical techniques (1957-1976). The integration of midwives into biomedical clinics created substantial overlap between various therapeutic interventions, as I show in Chapter 5. Finally, Chapter 6 demonstrates how Malian participation in anti-excision activism owed as much to previous debates over marriage, unwed mothers, and rural maternity care as to transnational feminist movements and developmentalist interventions (1984-1999). Reproductive Labors is based on interdisciplinary research in Mali, Senegal, France and the US, including archival research, oral histories, and ethnographic work. In addition to working in national archives, the project engages with the floatsam of project reports now safe-guarded in people’s homes, bureaucratic documents from institutional archives like Mali’s National Health Directorate, and student theses. However, women’s specialist labor is less visible in archival material. In response to this elision of gendered knowledge, the project integrates ethnographic observation and French and Bamanakan oral history interviews with women specialists, as well as medical personnel and gender-rights activists. Reproductive Labors demonstrates how Malians were socialized into heterosexuality not simply through family or media, but through specific specialist interventions which linked heterosexuality to biological reproduction and gendered identities, deepening key themes in gender and sexuality studies. Reproductive specialists’ expertise was defined by their gender, skill, age, and social status, as most were older women of endogamous social group descent. Conversely, the activists who campaigned against them were usually highly-educated young women with close ties to international feminist institutions, although these linkages were structured by the colonial afterlives of educational and financial networks. Over the 20th century, questions about which group should have authority over young women’s reproductive experiences led to numerous debates for women and their families. Secondly, this project demonstrates that the continued value of local specialists for Malians, alongside the medical system’s reliance on external actors and instability in rural areas, created a specific form of Malian biomedicine driven as much by local therapeutic practices and social hierarchies as by international norms, enriching recent scholarship on the local specificities of biomedicine. Finally, this dissertation deepens scholarship on state-making in Africa. It demonstrates that reproductive health was not simply a subfield of the post-colonial Malian health system but that it became a key site for innovation in governance. As the first academic history of reproductive health in Mali, which has one of the world’s highest rates of maternal and child mortality, this dissertation seeks to understand the history of reproductive practices as a step towards reproductive justice.