The tension between universality and locality
As I have indicated, the transformation of scientific body concepts into natural phenomena requires a second activity: the concealment of contexts. Beyond the Natural Body shows that the decontextualized status of scientific knowledge is the result of specific scientific activities. I have described how knowledge claims about sex hormones acquired the status of context – independent facts and artefacts because they became materialized in chemical compounds that could exist independently of the laboratory conditions that shaped them. The history of sex hormones exemplifies how scientists turn observations into materials in which contexts gradually disappear, materials which are subsequently claimed to enjoy an a priori natural existence.
Female sex hormones, for example, have taken on a variety of different forms, showing an increasing degree of context-independency:
1 observations of specific disorders in patients following surgical removal of the ovaries in a gynecological clinic in Vienna
2 preparations of gonads extracted and purified in Laqueur’s laboratory in Amsterdam
3 crystals in a bottle on laboratory shelves, carrying an Organon label with a chemical formula
4 pills in a plastic strip provided by health care professionals.
Laboratory experiments have played a major role in this decontextualization of knowledge claims. Scientists used experiments to transform the concept of sex hormones into standardized substances with precisely denned qualities that then became accepted as such by the international scientific community and the industrial world. Subsequently, clinical testing procedures have made these standardized substances available as specific drugs and eventually the pill. Local laboratory practices thus became decontextualized by developing instruments, techniques and standards robust enough to survive outside the laboratory.
However, scientists are not always successful in decontextualizing knowledge claims. There exists a basic tension between scientists’ striving for universal, decontextualized knowledge and the notion that science is shaped in its local contexts,2 a tension with severe practical consequences particularly with respect to the development of (contraceptive) technologies. The decontextualization strategy suggests that technologies can be made to work everywhere, but this is not always so. Scientific artefacts require a specific context in which they can work, one similar to the context from which they arise. If this context is not available, scientists have to create it. Or to use Latour’s metaphor of railroads again: scientists first have to construct railroads before the locomotives can move in the envisioned direction. The problem is that for contraceptive technologies such as the pill, the railroads are chiefly constructed in the western industrialized world. Most contraceptive technologies are made in industrialized countries and therefore bear the fingerprints of western producers, including locally and culturally specific ideas of how ideal contraceptives should look like. Every technology contains, so to say, a configured user.3 Consequently, technologies cannot simply be transported elsewhere.
The case of the contraceptive pill illustrates the complications that emerge if western technologies are introduced into developing countries. Although pill researchers claimed that the pill was a universal, context-independent contraceptive, it nevertheless contained a specific user: a woman, disciplined enough to take medication regularly, who is used to gynecological examinations and regular visits to the physician, and who does not have to hide contraception from her partner. It goes without saying that this portrait of the ideal pill user is highly culturally specific (with varieties even within one culture). This user is more likely to be found in western industrialized countries with well-developed health care systems. From this perspective it can be understood that the pill has not found a universal acceptance. Actually, the user-specificity of the envisioned universal contraceptive pill was already manifest during the clinical testing in Puerto Rico. The early trials witnessed a high percentage of drop-outs. I have described how disciplining women to the conditions of the tests was not always successful. Many women did not participate in the gynecological examinations or simply quit the program because they preferred other contraceptive methods, particularly sterilization. The Puerto Rican trials provided the pill researchers with information indicating that the pill did not meet with universal acceptance. These test conditions were, of course, a much heavier burden than the conditions of using the pill after it had been approved by the FDA. Two conditions remained, however, the same: frequent visits to a physician (the pill was available only on prescription) and regular gynecological examinations (women using the pill had to take regular gynecological examinations, including blood-pressure tests and vaginal smears to check for adverse health effects).4
The making of the pill into a successful contraceptive technology thus required a specific context, a context in which
1 there exists an easily accessible, well-developed health care infrastructure
2 people are accustomed to taking prescribed drugs (many developing countries mainly use “over the counter” drugs, which people can buy in shops)
3 women are used to regular medical controls
4 women and men are free to negotiate the use of contraceptives.
The pill could be made into a universal contraceptive only if its producers put great effort into mobilizing and disciplining people and institutions to meet the specific requirements of the new technology. Needless to say, many of the required transformations were beyond the power of the inventors of the pill. The sad conclusion therefore is that, although new contraceptive technologies such as the pill are often tested in Third World countries, the local needs of its potential users are rarely taken into account. During the tests the technologies are more or less successful because scientists make the contexts fit the demands of the testing, for example by enrolling trained medical staff and by selecting trial participants who may be made into ideal test subjects but who are not necessarily representative of the whole population. It is by creating such controlled settings that scientists are able to make the technology work. These controlled settings, however, no longer exist when the trials are over and the technologies are put on the market.
This situation often leads to health risks among the users of the new technologies. Since the 1980s, feminist health organizations seeking safe and reliable contraceptives have reported women’s complaints about serious side – effects while using contraceptives such as implants and injectables, particularly in developing countries (Anonymous 1985; Mintzes 1992: Ward 1986). Many of these adverse health effects seem to be related to insufficient medical follow-up. These contraceptive technologies all require a health care infrastructure that can provide medical controls for their administration and removal.5 In many Third World countries, such an infrastructure simply does not exist, particularly in rural areas. To avoid potential health risks, women’s health advocates campaign for the development of contraceptives that require less dependency and interaction with health care providers. They prefer the so-called user-controlled technologies and stress that users’ views should be taken into account in assessing acceptability (Bruce 1987; Pollock 1984).6 Scientists in the field of reproductive technology acknowledge the problems with the diffusion of new contraceptive technologies and introduced so – called “introductory trials” in the 1980s. These trials were conducted to assess the acceptability of new contraceptives in different social and cultural settings (Hardon and Claudio-Estrada 1991:12).7
These developments exemplify my point that scientific artefacts are not in themselves universal and context-independent. They have to be made into universal technologies by a whole variety of different activities. The introduction of contraceptive technologies shows that science is not always successful in its striving for universal, context-independent knowledge.