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Law in Contemporary Society
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Capitalizing the Womb: Exploitation of Reproductive Labor through Healthcare-- By VelenWu - 19 Feb 2025 I. Reproductive Labor as Capital A woman’s reproductive system is perhaps the single most valuable thing for society’s productivity, for it enables the continuation of the labor force. In its pursuit of profit maximization and cost minimization, capitalism has staked a legitimate interest in controlling the womb as territory for accumulation (Romanis, 2020). As a result, throughout history, women’s reproductive labor has defined our purpose—and duty—in a capitalistic society: to bear and raise children. Curiously, however, as Marx observed in Capital, the sexual division of labor—a characteristic of patriarchal societies—existed prior to capitalism and did not emerge for the first time during primitive accumulation (Murillo, 2021). This then begs the question: how did capitalism reconstitute this pre-existing patriarchal structure to facilitate its exploitation of reproductive labor and how is such a system sustained? I argue that capitalism adapted pre-existing patriarchial home relationships to alienate reproductive labor, thus setting it up for capitalist exploitation, which is perpetuated by a healthcare system that simultaneously ensures the viability of women’s reproductive systems while exerting oppressive pressures that thwart empowerment. II. Capitalism’s Reconfiguration of Patriarchal Structures Capitalism’s adaptation of the pre-existing patriarchal familial relationships and structures revolved around the disposition of the “family unit.” Vogel asserts that the role of the working class family shifted “from an overriding preoccupation with the internal structure and dynamics of this family form to its structural relation to the reproduction of capital” (Ferguson, 2013). It follows that the family unit is then no longer an isolated social unit; rather, it is connected to larger economic structures—embedded within and in service of the capitalist system. By placing the internal family structure in the context of capitalism, the pre-existing sexual division of labor is transformed into a distinction between productive and unproductive labor. Marx’s analysis of capitalism frames “productive” labor narrowly as work that generates exchange value (Murillo, 2021). By definition, this excludes reproductive labor such as child care, child-rearing, and housework. The alienation of household chores and family responsibilities from professional engagements relegated women's reproductive labor to a secondary position in the labor market (Lin, 2023). As reproductive labor became seen as “naturally” occurring rather than deserving of compensation, it sustained the workforce and thereby drove capitalistic production at no expense to the capitalist. During the slave trade, Partus Sequitur Ventrum provided that a child would follow the status of their mother. In 1662, the Black woman’s body was legally codified as the site where more slaves were produced (Tuner, 2017). Enslaved women’s children were “counted… in slaveholding ledgers as property and future workers” (Turner, 2017). This, in turn, facilitated the reproduction of the slave labor force to maintain the institution of slavery, allowing slaveowners to capitalize on both the enslaved woman’s physical and reproductive labor. In the modern-day context, the coerced sterilization of immigrant women and the overturn of Roe are stark reminders that women remain procreators first and autonomous beings last. III. The Medicalization and Neglect of Women’s Bodies Given that “the maintenance … of the working class [is] a necessary condition for the reproduction of capital” (Humphries, 1977), the health of women’s bodies became a necessity for perpetuating oppression. The healthcare system enforces the exploitation of reproductive labor through two complementary mechanisms. On one hand, investing in the health of women’s reproductive system is necessary to ensure the viability and continuation of reproductive labor; on the other hand, the neglect of holistic care acts as an oppressive pressure to hinder female empowerment—a force that threatens the exploitation of reproductive labor. Historically, medical knowledge about female biology has been centered on safeguarding women’s capacity to reproduce. Her illnesses and diseases are consistently related to the “secrets” and “curiosities” of her reproductive organs (Cleghorn, 2021). For example, in his 1895 obstetrics textbook, Dr. A.F.A. King, an Obstetrics Professor. assured his male medical students that “it is not necessary to obtain verbal consent… before instituting the [pelvic] examination,” analogizing it to taking a pulse (King, 1889). On its face, the medical focus on women’s reproductive systems ensures that women’s bodies are healthy sites for capital extraction. More systematically, viewing women’s bodies as grounds for economic production, “the state… has had to resort to regulation and coercion to expand or reduce the workforce” (Pope, 2024); and healthcare, as the most proximate tool for regulating women’s bodies, became a means for exerting such control. Simultaneously, the neglect of other aspects of women’s health consolidates capitalism’s grip over women’s reproductive labor by distancing them from empowerment. For example, women with chest pain had a 29% longer wait time for heart attack evaluation than men (eClinicalMedicine, 2024). Similarly, women are less likely than men to be prescribed pain-relief medications for the same complaints (Guzikevits, 2024). Such gender disparity is present not only in diagnosis but throughout the healthcare system—from research (70% of patients with chronic pain are women, but 80% of pain studies are conducted on male mice or human men) (Epker, 2023) to cultural bias (women’s pain is more likely to be seen as having a psychological cause instead of a biological one) (Bever, 2022). To this end, the healthcare system has been programmed to hamper women’s access to proper care. Since healthcare plays a critical role in the empowerment theory’s core goal of “gain[ing] mastery over their lives,” stripping women of care confines them to exploitation. IV. Path Forward Healthcare in a capitalist system is seen not as a right, but as a commodity. Thus, solely imposing demands or forcing change on the healthcare system itself may be feeble in uprooting its role in the exploitation of reproductive labor. Instead, by revealing and influencing the values and epistemic dispositions that underlie the healthcare system, we can dismantle, bit by bit, the specific mechanisms through which it supports the man-made capitalist system. This requires women’s voices and testimonies to be heard and believed—not just on its face, but within the history of how the world around her came to be and how the systems and mechanisms that confined her came to exist. Works Cited Bever, Lindsey. “From Heart Disease to IUDs: How Doctors Dismiss Women’s Pain.” The Washington Post, 13 Dec. 2022, www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/. Cleghorn, Elinor. “The Long History of Gender Bias in Medicine.” Time, Time, 17 June 2021, time.com/6074224/gender-medicine-history/. eClinicalMedicine. “Gendered pain: A call for recognition and health equity.” eClinicalMedicine, vol. 69, Mar. 2024, p. 102558, https://doi.org/10.1016/j.eclinm.2024.102558. Epker, Eva. “Being a Woman Doesn’t Have to Be a (Chronic) Pain.” Forbes, Forbes Magazine, 7 Apr. 2023, www.forbes.com/sites/evaepker/2023/04/05/why-is-being-a-woman-a-chronic-pain/. Ferguson, Susan, and David McNally? . “Capital, Labour-Power, and Gender-Relations: Introduction to the Historical Materialism Edition of Marxism and the Oppression of Women.”Marxism and the Oppression of Women, by Lise Vogel, Brill, 2013, pp. xxiv. Guzikevits, Mika, et al. “Sex bias in pain management decisions.” Proceedings of the National Academy of Sciences, vol. 121, no. 33, 5 Aug. 2024, https://doi.org/10.1073/pnas.2401331121. Humphries, Jane. “Class struggle and the persistence of the working-class family.” Cambridge Journal of Economics, vol. 1, no. 3, Sept. 1977, pp. 241–258. King, A. F. A. A Manual of Obstetrics, Lea Brothers, 1889, pp. 167–167. Lin, Jinlong, and Yang Wang. “Back to marx: Reflections on the feminist crisis at the crossroads of neoliberalism and neoconservatism.” Humanities and Social Sciences Communications, vol. 10, no. 1, 14 Dec. 2023, https://doi.org/10.1057/s41599-023-02341-2. Murillo, Celeste D’Atri, and Andrea D’Atri. “Producing and Reproducing: Capitalism’s Dual Oppression of Women.” Left Voice, 25 May 2021, www.leftvoice.org/on-reproductive-labor-wage-slavery-and-the-new-working-class/. Pope, Audrey, et al. “SisterSong v. State of Georgia: A Feminist History and Tradition? |.” Harvard Law Review, 16 Dec. 2024, harvardlawreview.org/blog/2024/12/sistersong-v-state-of-georgia-a-feminist-history-and-tradition/. Romanis, Elizabeth Chloe, et al. “Reviewing the womb.” Journal of Medical Ethics, vol. 47, no. 12, 29 July 2020, pp. 820–829, https://doi.org/10.1136/medethics-2020-106160. Turner, Sasha. “The Invisible Threads of Gender, Race, and Slavery.” AAIHS, 22 June 2017, www.aaihs.org/the-invisible-threads-of-gender-race-and-slavery/.It seems to me that you did a good job adapting your prior writing to the context. In getting shorter it got blunter, naturally, and risks ideological self-parody to an extent it takes subtlety to avoid. (I am a little surprised at the reliance on low-quality journalistic sources: why not actual scholarship rather than news-service websites?) But in the course of reworking your rereading no doubt made you aware that at the very moment you wrote Trump and Musk, Kennedy and Rubio, were (not from Marxist or feminist motives, to be sure) implementing your program thoroughly. They have destroyed faster than anyone could have thought possible the infrastructure of health care relied upon by millions of women, here and around the world, that you have so trenchantly criticized. (It turned out to be not capitalism but American social democracy that had achieved these compromised goals, which is what made it possible for them to be so easily devastated, but that's just one among the ironies.) This state of affairs turns the focus even more urgently to the question your original work did not address: how to replace what you do not want with what you do. With every passing day serious, sometimes irreparable, harm is done to vulnerable people. Marx is quite right that philosophers can criticize the world, but the point is to change it. Now we most desperately need your second draft,. the one that takes this criticism for given, and shows us what has to be put in place instead, Decommodifying Reproductive Health: Building Resilience Through A Rights-based ApproachA woman’s reproductive system is perhaps the single most valuable thing for society’s productivity, for it enables the continuation of the labor force. Throughout history, reproductive health has followed the needs of labor capital as opposed to a steady progression towards reproductive autonomy. Indian famine conditions energized the neo-Malthusian birth control movement across the British Empire (Sreenivas, 2015); in the 1960s, the “population bomb” thesis led to various aggressive birth control policies (Felitti, 2022). Most recently, against the backdrop of demographic decline, Hungary introduced a tax exemption scheme for mothers — temporary for one child, and lifelong for two or more — to “encourage family growth” and foster a "family-centered economy.” (Anadolu Ajansı, 2025) Hungary’s literal equation of reproductive labor with monetary value demonstrates that the goal of reproductive policies is often not to advance autonomy, but to keep capitalism on its feet. Given that “the maintenance … of the working class [is] a necessary condition for the reproduction of capital” (Humphries, 1977), the health of women’s bodies became a necessity for perpetuating oppression. On one hand, investing in the health of women’s reproductive system is necessary to ensure the continuation of reproductive labor; on the other hand, there must be sufficient oppressive pressure to hinder female empowerment. In turn, far from being an enshrined right, reproductive healthcare, from the beginning, has largely been designed to be a tool towards socio-political ends. Yet, as long as it is considered a commodity rather than a fundamental right, it will be susceptible to market forces and to efforts to maximize profits.” (Pavlakis, 2021) Such structural instabilities heighten its vulnerability to systematic destruction, as starkly demonstrated by the swiftness and ease of the Trump administration’s onslaught on the reproductive care system. Undoubtedly, progressive social values and feminist advocacy have made considerable strides toward reproductive autonomy. However, historically, advocacy sprang from a variety of motivations — Malthusian, eugenics, sexual radicalism, anti-patriarchical thought, and socialism (Hodgson, 1997; Gordon, 1975). In turn, while these discrete strands of advocacy have advanced reproductive care in critical areas, their often conflicting priorities have resulted in fragmented, often stand-alone, gains. The absence of a cohesive and comprehensive framework to safeguard the right to reproductive care, as a result, has left it vulnerable to recurrent political retrenchment. Path Forward A unified, rights-based approach to reproductive health is critical in building resilience against political and ideological shifts. Using international law’s Availability, Accessibility, Acceptability, and Quality (AAAQ) framework as a blueprint for tackling barriers to services, implementing a rights-based approach requires restructuring along three axes: bottom-up solutions tailored to local realities, participatory governance, and renewed public-private partnership. First, bottom-up solutions tailored to local realities are critical in ensuring the equitable access and acceptability of reproductive care. While policies apply with equal force to all women in theory, their impact is by no means uniform. Instead, structural inequalities shape how, whether, and under what conditions individuals have access to reproductive care. For example, modern policies such as the Hyde Amendment, which prohibit federal Medicaid funding for abortion services, reveal a continuing pattern wherein reproductive choices are stratified by race and class, treating access to care as a privilege rather than a right (Harris, 2014). Community-driven initiatives essentially created a microcosm of a decommodified medical system for populations that are often neglected by the formal system. For example, in the 1960s, against a cascade of medical discrimination and disparities, the Black Panthers established community clinics in over a dozen major cities, providing free reproductive health care to Black and low-income communities otherwise denied adequate treatment within mainstream healthcare (Nelson, 2011 p.51). These clinics not only filled critical service gaps left by the healthcare system’s racialized exclusion, but their understanding of local history and context enabled them to respond to the specific social, cultural, and material needs of diverse populations (Olaniran, 2017). This is critical in addressing distrust of the medical system and increasing the acceptability of care. Second, shifting from a top-down decision-making body to one rooted in participatory governance is crucial for reducing inequities and increasing accessibility. Historically, marginalized women (who are often the most disproportionately affected) have largely been excluded from formal healthcare decision-making. (Soriano, 2024) Yet, engagement of those most affected is crucial in ensuring that the service of care remains accountable, responsive, and resistant to top-down political rollbacks. (Snow, 2018) For example, in Brazil, the Sistema Único de Saúde (SUS) engages over 5,500 local health councils, involving more than 100,000 citizen participants. Decision-making is, in turn, democratized through community health boards, patient advisory councils, and participatory budgeting processes. (Barnes, 2009) While the expansion of the system has revealed funding and oversight challenges, Brazil has seen a reduction in inequalities in the inter‐regional distribution of public health resources, as well as a reduction in disparity. (Barnes, 2009) Lastly, public-private partnerships provide essential top-down institutional support and regulatory frameworks to sustain bottom-up solutions. While current partnerships under neoliberal paradigms largely prioritize market efficiency (Singh, 2022), a rights-based approach calls for a transition to a framework grounded in universality and public ownership. In 2010, Vermont’s legislature adopted Act 48, which enshrined healthcare as a “public good” and established a framework for a public-private, single-payer system of healthcare based on five human rights principles (universality, equity, accountability, transparency, and participation), which mirror the AAAQ framework. The adoption of these principles into Vermont law allowed them to be “internalized by legislatures.” (MacNaughton? , 2015) While Vermont’s efforts to adopt a single-payer system ultimately failed, it reflects a core paradox of America’s healthcare system: the failure to control costs fortifies the status quo, as private profiteers extinguish efforts to reallocate financing in the current system. (Kliff, 2014) To this end, the problem wasn't the single-payer itself, but the starting point — Vermont was building a public system on top of an extremely expensive private one. As such, for a rights center public-private partnership to take root, innovation incentives should be realigned to address unmet needs (Hoffman, 2011), and financing mechanisms must shift toward more publicly accountable structures. (Esping-Anderson, 1990 p.95) Anadolu Ajansı. (2025, March 17). Hungary announces sweeping reform exempting mothers from income tax. Anadolu Agency. https://www.aa.com.tr/en/europe/hungary-announces-sweeping-reform-exempting-mothers-from-income-tax/3512119 Barnes, M., & Coelho, V. S. (2009). Social participation in health in Brazil and England: Inclusion, representation and Authority. Health Expectations, 12(3), 226–236. https://doi.org/10.1111/j.1369-7625.2009.00563.x Esping-Andersen, G. (1990). The three worlds of welfare capitalism (p. 95). Princeton University Press. Felitti, K. (2022). The birth control pill and family planning. Oxford Research Encyclopedia of Latin American History. https://doi.org/10.1093/acrefore/9780199366439.013.1043 Gordon, L. (1975). The politics of birth control, 1920–1940: The impact of professionals. International Journal of Health Services, 5(2), 253–277. https://doi.org/10.2190/bfw2-c705-25te-f99w Harris, L. H., & Wolfe, T. (2014). Stratified reproduction, family planning care and the double edge of history. Current Opinion in Obstetrics & Gynecology, 26(6), 539–544. https://doi.org/10.1097/gco.0000000000000121 Hodgson, D., & Watkins, S. C. (1997). Feminists and Neo-Malthusians: Past and present alliances. Population and Development Review, 23(3), 469. https://doi.org/10.2307/2137570 Hoffman, S. J., & Pogge, T. (2011). Revitalizing Pharmaceutical Innovation for Global Health. Health Affairs, 30(2), 367–367. https://doi.org/10.1377/hlthaff.2011.0103 Kliff, S. (2014, December 22). How Vermont’s single-payer health care dream fell apart. Vox. https://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin MacNaughton? , G., Haigh, F., McGill? , M., Koutsioumpas, K., & Sprague, C. (2015). The Impact of Human Rights on Universalizing Health Care in Vermont, USA. Health and human rights, 17(2), 83–95. Nelson, A. (2013). Body and soul: The black panther party and the fight against medical discrimination (p. 51). University of Minnesota Press. Olaniran, A., Smith, H., Unkels, R., Bar-Zeev, S., & van den Broek, N. (2017). Who is a community health worker? – A systematic review of definitions. Global Health Action, 10(1). https://doi.org/10.1080/16549716.2017.1272223 Pavlakis, S., & Roach, E. S. (2021). Follow the money: Childhood health care disparities magnified by covid-19. Pediatric Neurology, 118, 32–34. https://doi.org/10.1016/j.pediatrneurol.2021.02.005 Singh, N. (2022). Decoding the changing role of the neo-liberal state in a Globalising World: Convergence of public–private partnership in Innovative Governance. Indian Journal of Public Administration, 68(3), 367–380. https://doi.org/10.1177/00195561221103559 Snow, M. E., Tweedie, K., & Pederson, A. (2018). Heard and valued: The development of a model to meaningfully engage marginalized populations in health services planning. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2969-1 Sreenivas. (2015). Birth control in the shadow of empire: The trials of Annie Besant, 1877–1878. Feminist Studies, 41(3), 509. https://doi.org/10.15767/feministstudies.41.3.509 Sánchez-Soriano, M., Arango-Ramírez, P. M., Pérez-López, E. I., & García-Montalvo, I. A. (2024). Inclusive governance: Empowering communities and promoting social justice. Frontiers in Political Science, 6. https://doi.org/10.3389/fpos.2024.1478126You are entitled to restrict access to your paper if you want to. But we all derive immense benefit from reading one another's work, and I hope you won't feel the need unless the subject matter is personal and its disclosure would be harmful or undesirable. To restrict access to your paper simply delete the "#" character on the next two lines:
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