The Thin Pink Line: Regulating Reproduction


Carol Lynn Curchoe Burton¹, PhD
¹ Newport Beach, CA, USA

Series: Obstetrics and Gynecology Advances
BISAC: MED033000

The Thin Pink Line: Regulating Reproduction is a critical exploration of historical perspectives to modern controversial topics in gynecology; from birth control to sterilization, to episiotomies and the “husband stitch,” to “educational” pelvic exams, shackling laboring convicts, gender affirming surgery, human embryo research, assisted reproduction and much more. This book poses questions for us to consider about the current and future reproductive ethical decisions. Does reproductive health need more or less regulation? Who should be deciding? The Thin Pink Line: Regulating Reproduction is a brave and honest look at where we have been, so we can figure out where we want to go. The Thin Pink Line: Regulating Reproduction is intended to educate a wide audience of womynx, men, femmes, gender non-conforming folks, uterus owners, and everyone in between. It has a specific intersectional focus on the impact that the current reproductive regulatory framework has on disenfranchised groups, such as people of color, LQBTQ individuals, and the lower socioeconomic strata.




Chapter 1. Medical Bondage
The History of the Speculum and Fistula Surgery
“Educational” Pelvic Exams
HeLa Cells: The Immortal Legacy of Henrietta Lacks
Skeletons in the Closet: Human Zoos and Imperial Collections

Chapter 2. Menstruation and Birth Control
Eugenics and Ethical Lapses in the Quest for Hormonal Birth Control
Griswold v. Connecticut (1965)
Eugenic Sterilization
The Colorado Experiment
Medication Abortions and Access on the Internet
Period Poverty

Chapter 3. Coitus
Contagious Diseases Act
Premarital Blood Tests
Marriage Annulment and Impotence

Chapter 4. Sterilization
Eugenic Sterilization
Chemical and Surgical Castration
Access to Endometrial Ablation and Tubal Ligations

Chapter 5. Parturition
The Royal Roots of “Back Labor”
Episiotomy and Interventions
The “Husband Stitch”
Shackled and Separated: Parturition in Prison
Pregnancy Crisis Centers
Racial Disparities in the USA

Chapter 6. Gender
The Origin of Female and Male Reproductive Tract
Development of the Reproductive Tracts
Genetics, Sex, and Gender
Official Documents
Intersex Timeline
Conversion Therapy
Gender Selection

Chapter 7. Genital Alteration
Genital Cutting
Sex Reassignment Surgery
Barriers to Sex Reassignment Surgery
Denial of Gender-Affirming Care to Armed Services Veterans

Chapter 8. Assisted Reproductive Technology
Assisted Reproductive Technologies (ART)
Reproductive Tissue Donation
Artificial Insemination
Illegal Embryos
Personhood Bills

Chapter 9. Research
Human Reproductive Experimentation
Chimeras—How much human DNA is too much?
14 Days: The Limit of Human Life in the Lab
Procuring Fetal Tissue



“Women’s health has been regulated and politicized for much longer than we like to admit. When we look back through our own history, the truth is both alarming and eye opening. The use of women’s health and reproduction as a political tool has simplified the issue down to abortion access and care. And despite the importance of this topic, and the relevance to modern life, the history of women’s care is so much more than one single political issue. Many of us don’t know the roots of racism and misogyny in medicine and reproductive care. Many of us don’t want to acknowledge the past. As a fertility physician, I see first-hand how the history of women’s health plays a role in our everyday life. This is because reproduction is not talked about. From menstrual cycles, to infertility and miscarriage. The culture of silence and ignorance, which was a part of society long before women started leading conversations, is so ingrained in human behavior that an active movement is needed to discuss the past and change the future. As technology advances faster than research, we must understand the ethical principles that guide us as a field. Honestly, there are parts of this book that are hard for me to read as a gynecologist. Things I know are true, and things I know that I wish were in the past, but sadly are not completely. I have seen women die from lack of medical care, I have taken care of patients who have been victims of female genital mutilation, I have seen the discrimination and hate laid at the feet of a trans person, I’ve watched how we treat our incarcerated, and I’ve had patients sterilized by the government who had no idea the procedure was done. I am a woman who believes in education and empowerment. But this is not just our history, it is also our present. Dr. Curchoe Burton, a reproductive physiologist and senior clinical embryologist, has watched the first stages of life unfold in a dish in the lab. She has seen the ethical debate that exists in the reproductive world when it comes to research, legality of embryos, personhood, and the advancement of technology. If you ever sit in a lab and watch the first cells of human life divide, then you know – there is art in this science. But the responsibility to protect this beauty becomes your burden. We must not let ignorance be the guiding light regulating female reproduction by politicians and those with other motives. In The Thin Pink Line, Dr. Curchoe Burton has given life to something more – a telling of the past, present, and future with precision and an absolute attention to detail, as I know reflects her role overseeing life in the embryology lab. The reproductive world is undergoing an evolution. There is high interest from tech companies and money being funneled into an industry of patient care. The largest network of fertility clinics in the US is led not by physicians, scientists, or embryologists, but by businessmen, and the people who are behind the industry advancing the science in our own IVF labs are all coming from outside medicine. At face value, advancement is always good. More money will be put into development and acquisition and new technology. But respecting research and upholding ethical principles is essential for our own society’s growth. In order to do this, we must collectively understand the history of how we came to be as a field, the origins of women’s health, and how reproduction has been, and continues to be, regulated.” -Dr. Natalie M. Crawford, MD, MSCR, FACOG

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