Good Quality. Ayo Wahlberg
comprised of an ensemble of interconnected parts that, when configured in specific ways, allow for the deployment, circulation, movement, and organization of specific forms of goods, people, capital, and/or ideas in specific ways. As such, these concepts allow us to think about and analyze historically and ethnographically situated governmental configurations (cf. Foucault 1991). A complex, then, as I define it, is a domain—systems of relations—within which we can discern heavy accumulations of patterned knowledges and practices around a distinct “aggregate problem” such as infertility, overpopulation, or low fertility. What I am calling a reproductive complex is thus in no way transient. Rather, reproductive complexes are very often nationally circumscribed (albeit with regional, if not global, overlaps), emerging over decades and involving scientists, doctors, nurses, hospitals, policy makers, laws, media, laboratories, techniques, secretaries, janitors, drivers, and more. Consequently they are rarely reconfigured overnight. Moreover, as Barbara Prainsack and I argued in “Situated Bio-Regulation,” “certain regulatory configurations [are] tied to what [i]s thinkable and sayable” (Prainsack & Wahlberg, 2013, p. 341) in a given place, at a given time. In China, over the course of the last three or four decades, a reproductive complex has coalesced around the dual objectives of controlling population growth and improving population quality. It comprises a total set of laws, regulations, family planning institutions, quotas, information campaigns, experts, hospitals, clinics, pharmaceutical companies, premarital counseling sessions, prenatal screening services, and more. Medical procedures and techniques related to birth control (population quantity) include contraception, sterilization, and abortion as well as ARTs, while those related to the health of newborns (population quality) include genetic counseling, fetal education, prenatal screening, and abortion as well as SRTs. It is within such reproductive complexes that what anthropologists Lynn Morgan and Elizabeth Roberts have called reproductive governance takes place as “legislative controls, economic inducements, moral injunctions, direct coercion, and ethical incitements . . . produce, monitor, and control reproductive behaviours and practices” (Morgan & Roberts, 2012, p. 241).
Empirically attending to how sperm banking came to fit within China’s reproductive complex has required what I have called a site-multiplied assemblage ethnography,6 which is to say a site-specific, in-depth ethnographic study of the Hunan Sperm Bank in Changsha from where I nonetheless followed and participated in national and global flows and exchanges of knowledge, people, equipment, and regulations related to sperm banking. The siting of this assemblage ethnography was essential, as it is in particular sites that we see how the knowledge-practice configurations that characterize China’s reproductive complex are manifest in the daily routines and practices that make up sperm banking. While by no means mutually exclusive, it can be helpful to contrast assemblage ethnographies with ethnographies of lived experience on the one hand and laboratory ethnographies on the other. If ethnographies of lived experience generate insight into the ways in which individuals and communities experience, navigate, negotiate, or relate (for example, to infertility and insemination with donor sperm) and laboratory ethnographies examine how specific forms of knowledge, truth, or fact are produced through practice, assemblage ethnographies generate insight into the ways in which certain problems, or better yet problematizations, take form.7 This is not to say that I have been uninterested in the experiences of sperm donors and couples undergoing AID or in the laboratory practices that generate knowledge about sperm, but rather it is to point out that the task of my ethnography has been to provide an account of the making of sperm banking in China through a heavy accumulation of patterned knowledges and practices, enmeshed within a very particular reproductive complex.8 As a result, readers will note that I have not set myself the task of explaining what is particularly Chinese about sperm banking or male infertility in Hunan;9 instead, I have been concerned with how sperm banking is practiced on a daily, routine basis in China. Mine is an assemblage ethnography of sperm banking in China rather than an ethnography of Chinese sperm donors or infertile couples. As such, throughout the book I will attend to the central questions of: How has routinized sperm banking become possible in China? What forms of problematization have allowed sperm banks a legitimate place within China’s restrictive reproductive complex? What style of sperm banking has emerged in China as a result? How has AID become an acceptable reproductive technology in China?
Figure 2. Site-multiplied, Hunan Sperm Bank provides donor sperm to fertility clinics around China.
When it comes to medical technologies I define “routinization” as a socio-historical process through which habituated regimes of daily micro-practices coalesce, thereby shaping a medical technology and its uses. Routinization indexes the transformation of a technology from frontier to mundane, as “new technologies must traverse this continuum, changing from a status of pure experiment to the standard of care” (Koenig, 1988, p. 466). Barbara Katz Rothman (1993), Marcia Inhorn (1994; 2003), Lisa Handwerker (1995a; 2002), Sarah Franklin (1997), Rayna Rapp (2000), and Gay Becker (2000) have been pioneers in the social and ethnographic study of new reproductive technologies, showing us how the development and routinization of technologies such as in vitro fertilization (IVF), amniocentesis, or prenatal genetic diagnosis (PGD), on the one hand, resulted from complex intersections within and between biomedical research, healthcare services, social policy, social movements, popular media, and more in a particular country; and on the other, turned them into an important part of the daily lives of providers, donors, patients, and family members alike. Hence, building on their work, with the term routinization I point firstly to socio-historical processes whereby certain forms of medical technology come to be (re-)produced and entrenched within particular juridical, medical, social, economic, cultural, and institutional configurations. Not only were there technical, cultural, and logistical obstacles to sperm banking in a post–Cultural Revolution China, but sperm banking also had to mold into a suitable form to fit within a reproductive complex that was otherwise configured to strictly restrict fertility. Following initial resistance, sperm banking (together with other forms of reproductive technology) has gone on to be championed by scientists, doctors, and administrators as a national project that can help not only infertile couples, but also the nation itself. Also at stake have been the multiple ways of knowing infertility that continue to circulate in China today, often leading to pluralist medical practices and therapeutic itineraries.
Secondly, I refer to all those daily practices through which certain medical technologies become an established and habituated part of health delivery, which is to say a standard of care for a given condition provided in a fixed setting. As Barbara Koenig has argued, “perhaps the most important change during routinization is the change in who actually performs the [. . .] procedure” (1988, p. 476) once its novelty has worn off and standardized protocols have enabled a hierarchized division of laborious and repetitive tasks in hospitals and clinics. There is what I would call a “daily grind” to the emergence of any medical technology, and in the case of sperm banking in China this has involved donors, doctors, andrologists, laboratories, egg yolks, chemicals, cryotanks, regulations, paperwork, computers, medical files, money, recruiters, leaflets, patients, university campus dormitories, social media, and more. Buildings have to be maintained, cryotanks need to be procured, liquid nitrogen stocks have to be replenished, staff must commute to work, rosters have to be planned and monitored, workflows developed and managed, students recruited and screened, telephone calls made, accreditations maintained, straws of sperm shipped to clinics, activities assessed, and so forth. While this is true of any sperm bank, the particular ways in which these daily practices play out in different sperm banks are never the same, not least because of the reproductive complexes within which they operate. In China, a five-woman’s-pregnancies limit coupled with family planning policies have resulted in a unique style of sperm banking, which requires mass recruitment and appropriate logistics to achieve that. The largest sperm banks in China assess the sperm quality of up to 100 men per day, which profoundly shapes workflows, socialities, and donation processes.
Thirdly, and finally, for a medical technology to become routine it must also be a normalized part of daily life, in the sense that it is available to and used by its (un)intended users in a routine manner. As Gay Becker observed, “When a specific medical technology is no longer viewed by medicine as experimental, that technological