TINE M. GAMMELTOFT

PrenatalDiagnosisin Postwar Vietnam: Power Subjectivity,and Citizenship careis expandingto incude ultrasoundimagingand other prenataldiagnostic ABSTRACT Acrossthe world, routlnepregnancy researchhas examlnedhow suchtechnologies are hardlyany anthropoLogical Yet, despitetheir globalproliferation, =:.rnologies. capita, Hanoi,handlethe hardchoices how pregnantwomenin Vietnam's In this art cle,I investigate : c oyedoutsldeEuro-America. '"i u trasonographles confrontthem with when a fetal anomalyis detectedand a decrsionmust be madeto eithermaintalnor in advanced with the emphasis on indivldualism Whereasresearch conductedin NorthAmerica,in consonance :-T natethe pregnancy. "moral pioneering," prenatal lshow how Vietnamese women turn the choices in terms of individual frames diagnosis :ral societles, The generalargumentadvancedis kinship,socialbelonging,and sharedresponsibilty. :/ haveto make into issuesof collectlvity, ':i a comprehensive involves of local reproductlve actions intentions necessarily closeconsideration of ind vidual and understandlng ^figurations Vietnam] abortion,citizenship, subjectivity, and cit zenship.IKeywords: ultrasound, of power,subjectivity, I

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the onSoing Slobal AN|HRO|OLOGY,

p r o l i l e r a t i o no I t e c h n o l o g i e sf o r p r e n a t a ld i a g n o . compels exploration of a range of issues such as the .-lowing: how individuals and collectivities define and rintain limits for human normality; how medicine and -.:hnology are implicated in shaping our perceptions of :orma1" bodies and lives; how policies aiming to enhance e quality of lives, people, or populations are instituted : d diffused; how medical expertise and resources ate cially controlled; and how new forms of sociality are -::sing along with new knowledge of our biological consti-dons. In this article, I shall limit the discussionto issues :lcerning human agency and intentionalitt exploring : t1\' agency is enabled, represented,and coniested when :egnant women in Hanoi, Vietnam, find themselves :rfronted with a medical categorization of their fetus as .rnormal." New reproductive technologies are often con:rtualized as "globalizable"-in other words, potentially ::nsferable from one part of the globe to another (Inhom - 02; Whyte and Ingstad in press). Unfortunately, how,'.er, nearly all existing anthropological research within ':is fleld has been conducted in liberal countdes of the -:iluent West (e.g., Browner and Press1995; Edkson 2003; : tpp 1999). The breadth of vadation in the social actions r:rd responsesthat new technologies of pregnancy may :oduce has therefore not yet been sufficiently explored. :'. paying closer attention to cross-cultural vadations in te ways in which new prenatal diaSnostic technologies I

are employed the world oveq ethnographic analysis may, I contend, not only enhance insights into the implications of globalization for human reproduction but also contdbute to a more multifaceted understanding of human social action. To illustrate this, let me start out by presenting luttt s case.' TUYET ' ' G r d n d m o t h eT r .h e c h i l d c r i e d .N o w i t i s y o u r t u r n l o c r y f o r t h e c h i l d , ' ' t h e w o m a n i n t h e n e \ t b e d s a i dt o T u l e t ' s mother. Tu'€t was pale, her eyes blank. Her mother and husband were sitting at her bedside. A while before, they had heard the sound of an infant's voice crying from the delivery room next door. Tulet's mother had left, then came back with the body of the newborn in her arms, tightly wrapped in blankets. Later she told me: "My arms trembled so much that I could hardly hold it. But I did as she said. I cried for it for severalhours. Here in Vietnam you must cry when someone in your family dies, to show your love for that person. This child cried. This means it was a human being." O n t h i s m o fn i n go f F e b r u a r2y 1 ,2 0 0 4 ,T u y € th a da p o r l diagnostic abortion at 29 weeksgestation.The abortion was performed through induction of labor, and asfeticide is not practiced at this hospital, the fetus lived for a few minutes after the delivery. Three days earlier, I had met Tu)€t for the fi$t time, on a gray lebruary moming when Lan, the nurse working

- .1.ANANrHRapoLaG'r, onlinelSSNI 548-1433.O 2007bythe American AnthropoLogical Assoclation. Vol.109,lssue1,pp.153 163,ISSN0002-7294 , .ightsreserved.PJease Rights for permisson to photocopyor reproduceartlclecontentthrouqhthe Universltyof CaliforniaPress's direcral reqLrests .- I Perrnssonswebsite,http://www.ucpresslournals.corn/reprintlnfo.asp. DOI:I0.1525/AA.2007.109.1.153.

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in the 3D ultrasound scarning room, urged me to try to find her outside in the hospital's courtyard. Tu)€t had iust left, and Lan said with a sigh, "The doctor pedoming the scanning found water in the brain of the fetus, but she does notbelieve the resuli. Could you find her and give her some counselling?"2The hospital's courtyard was full ofpregnant women,.but Tu)€t did not seem to be among them. Lan pointed to a young man sitting in the small makeshift caf6 outside: "There. Her husband is sitting dght there. Why don't you go and talk to him?" I introduced myself and explained our researchproject to Huy. He gestured to the blue plastic chair next to his own and ordered us tvvo cups of coffee. "This is so distressing," he said, "I keep thinking about why it has happened. Can you explain this to me?" At this point, my colleagueHing joined us, and soon after also TuJ€t arrived. She looked very pregnant. From ihe size of her belly, I estimated her to be about seven months into her pregnancy. Tu)€t was clutching the pdntout of the 3D scanning result in her hand. HAng asked the couple what they intended to do now. Huy said, "There are only two options. Yesor no. It is very difficult. So we ha\/e to comply with the doctors' decision." TuyCtappealedto HAng: "Could you go with me and ask the doctors for me? I don't know how to talk to them." The tuo left, and returnedhalf an hour later.Hdng told us I hat the doctor simply advisedTuyel lo haveanother JD scan at the National Obstetrics Hospital and to also ha\.e the abortion there if she opted to terminate the pregnancy. While Huy and three women working at the cafe discussed whether to go for another scanor not, Tu;.€twas sitting by herself. "I am scared," she said in a low voice, "I am scared of having to have an abortion. I don't understand this. Evhas arms and legs, everlthing erything seemsnomal-it looks so fine. There is only this problem with the brain. But having an abortion now would be wrong (f6t). But if it is not well, keeping it means misery for the child and misery for me. We iust have to trust the doctors." Later the sameday Huy called me to saythatthewomen at the cafe had helped them contact a senior doctor at the hospital. His advice was very simple and straightforward: They should terminate the pregnancy. Therc is no point, he had said, in giving birth to a child that they will not be able to raise.Huy and Tuyet then went home to their village and told Huy's father this. A few days later, Huy's father told us about the family meeting he convened on the same day: Wlen Lhechildrenn Lryel andHu)] camehomeaherlhe scanningin Hanoi,they discussed it with us. Fi6t of all we hadto find out whatthe childrenthemselves thought. Second,afterhearingtheir opinion,I askedfor the opinion of my elderson both sides-that is, the childrcn's gmndparentson both sides.Eventhough I am Huy's father,I cannotdecideaboutthis on my own, nobodycan makethis decisionalone.This hasto be a collectivedecision.In caseproblemsor regretsariselater, it is important that no one cansayit is anybody'sfault. Our elde$ said: 'We are simplepeople,we cannotimaginewhat this fetus is like. Sofllst of all, we haveto trust the experts.If the expertshavegiventheir opinion, we shouldbelieve

them.' Both sides of our family then made the decision together to long pause] . . . give it up. In short, this is the story. lconversation with author, February 25, 2004]

The grim situation that Tu)€t and her family themselves in that early moming at the obstetdcal pital was the outcome of a sedes of decisions made Tu'€t herself, her family membe$, and the involved in managing her pregnancy. In this article, I amine these decisions, focusing padicularly on the relations within which they were embedded and the of agencythey involyed.3 In her poignant study on

centesisin New York City, RaynaRappshowshow diaSno\LicLechnologies confront their userswiLh new of choices,tuming prcgnant women into "moral Rapp &'rites, "This new biomedical technology proyide3 context in which every pregnant woman is into the role of moral philosopher: one cannot the issueof the'qualiw control' of fetuseswithout ing whose standardsfor entry into the human will prevail and what the limits of voluntary might be" (1998:46).Tuft's case,howevet and others bring into question the universality of this particular of conftonting new technologies of pregnancy. Over the couTse of two years,my Viefnamese and I talked to 55 women who found themselvesin a ation similar to Tu)€t's. When conftonted with an sound examination result that characterized their to-be as somehow anofialous-too short legs, a hand, water in the brain, a heart defect-these women suddenly, asone of them put it, "thrown into a world of tion" (conve$ation with author, February 10, 2004). ing to determine how to act on the basis of biomedical formation that contradicted thet own embodied sense being halfway through a healthy pregnanc, these werc facing a culturally unprecedented situation: they trust this information or not? Should they keep

pregnancyor not? What would happenif they did? If did not? Whose advice should they seek?Whose could they trust? Facing a mass of bewildering and ing questions, most of the women went through a of sounding out opinions within thet immediate social roundinSs before making their decisions.While certainly a morally excruciating situation-having to decide if child-to-be should live or not-these women rarelv to handle this prcdicament by looking inward toward own" moral sentiments and standards.The trying tasl! most of them prcsented it, was not to determine what "themselves," deep in their heats, found best to do in situation. Rather, it was to find out what would be

Woper" (dfungddn) in the eyesof others. Unlike most the women in New York describedby Rapp(1999), generallythesenorthem Vietnamese women did not to perceive their expedence and their relations with ers mainly in terms of fieedom and individual volitiGRather, it seemedthey sought to make senseof disruptiE and harrowing life expedencesin terms of social duty ad necessrty.

Gammeltoft . This observation brings to mind earlier anthropological discusslons of culturally varying notions of personhood and self that posited Asian selvesas sociocentric and context dependent, in contrast to the egocentdc and autonomous Western self (e.9., Dumont 1986; Schwederand Bourne 1984). This literature, however, often tended to essentializeand reify cultural difference,while paying limited attention to the complex everyday strugglesover meaning, identity, and value that constitute people'sperceptions and practicesof self (cf. Kleinman and Kleinman 1991). Rather than searchingfor culturally fixed conceptsof"self" or "person," I find it more fruitful to cdtically examine specificsocial encounters in which individuals, through othe$, tum themselvesinto particular klnds of pe$ons. In this article, I explore how women in northem Vietnam act to compose their selvesand lives when finding themselvesconftonted with existentially shattedng medical information.

HUMAN AGENCY SPECIFICATIONSOF SUBJECTIVIry Vuch recent anthropological scholarship seeksto take human agency sedously by placing people's own actions and deliberationsat the forefront of analysis.Within the field of human reproduction, this odentation toward subjectivity hasbeen criticized for "romanticizing" reproductive agency, particularly when the analysis concems Third World societies in which a range of economic, social, and political constraints limlt the "ftee choices" that individuals are able to make. Writing about new technologies for assistedconception, Marcia Inhom points to the need for interrogation of the concept of "reproductive choice" itself, arguing that ''the time has come to sedously ponder the profound con5traints facing many infertile people, particularly in Third \Vorld settings wherc these technologies are being rapidly The analysis I present in this article deployed" (.2OO3:17). starts ftom this observation but takes it one step further. Rather than assuming that individuals would be free to act lvere it not for the external constraints placed on them, I proposea critical examination of the forms and modalities of power that generatehuman subjectivity itself. By distinguishing too sharply befi,veenthe individual and the external world facing her, one risks supporting an understanding of pe$ons as ontologically pdor to the social worlds. In rhis context, Maudce Merleau-Ponty's vision of the inherently social characterof all individuality is helpful in bdnging into analysis the intlmate engagementsbetween indiriduals and their social environments: "Our relationship io the social is, like our relationship to the world, deeper ihan any expressperception or any judgement. . . . We must return to the social with which we are in contact by the mere fact of existing, and which we carry about inseparably rvith us before any obiectification. . . The social is aheady there when we come to know 01 judge it" (1,995:362).In other words, as human beings we are not related to our rocial surroundings as subjects to objects; rather, we are imme$ed within and parts of our worlds. The present ar:icle is informed by this phenomenological vision of our

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socially grounded presence in the world and by Michel Ioucault's analytics of power. Although the phenomenology ofMerleau-Ponty and the poststructuralism of Foucault may be seen as antithetical, I argue that they have much in common-€specially shadng, as they do, the intention to show how human subjectivity is socially shaped. As Nick Crossleypoints out, "There is a common ground between these two writers which allows theh work-and particularly their work on embodiment, power and subjectivity-to be brought into a mutually informing and endching dialogue,, (1996:99\. Ioucault's central insight is that subiectivity cannot be unde$tood apart from questions regarding the nature of power in society.ln the 18th century, he argues,a new "capillary form" of power emerged, a form of power that was exercisedwithin the social body rather than from above it: "Power reachesinto the very grain of individuals, touches their bodies and inserts itself into their actions and attitudes, their discounes, Iearning processesand everyday lives" (Foucault 1980:39).This form of power, Foucault argues, is not confined to the modeln West or to capitalist societiesbut, rather, has spread all over the world. However,starting in the 1960sin industrial societies,this "cumbersome" form of power turned out to be no longer necessary, as human beings werc coming to govem themselves. Hence arose the modern "deep" individual of choice, autonomy, responsibility, and ftee will. This kind of individual is, as Zygmunt Baumrin (1988) has pointed out, a local phenomenon, a hlstodcal creation that is closely tied to a Western, modern, and capitalist form of society in which it is assumedthat people are the true sourcesof their own actions and the ones to bear the full responsibility for them. Even though the values of personal autonomy and self-directednessmay be evadedand contested aspeople go about their everyday lives (e.9.,Ong 2003), these are values that do tend to form an overall horizon of social existence in advancedliberal democracies.Nikolas Rose(1999,2001) pu$ues a similar argument, maintaining that the contemporary West has now entered the field of "ethopolitics," such that people are obliged to think ethically and to organize concern for othe$ in terms of attempts to "set them free." Power now works through the very notion of freedom, asthe self-govemment of the autonomous individual blends with practices of good government. Through processesof "responsibilization," indiyiduals are equipped with moral agency,made responsiblefor their own lives, and expected to freely seek out the ways of living most likely to promote their own welfare: "Modern individuals are not merely 'free to choose,'but obligedto be /?ee,to unde$tand and enact their lives in terms ofchoice. They must interpret their past and dream their future as outcomes of choices made or choices still to make" (Rose1999:87). Rapp's ethnography of amniocentesis in New York City, notes Rose (2001), provides an excellent example of this novel kind of enactment of responsibility. Rapp shows how pregnant women feel confronted with a painful personal choice when an amniocentesis finds a genetic

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aberation in thet fetus, a choice that often haunts them for years after the pregnancy has been terminated: "The intertwined technologies of sonography and amniocentesis underline the liminality of pregnanct ebhing the burdens 'choice' into the heart of the as well as the bene1ts of expertence"(Rapp 1997:45,emphasisadded). Rapp'sanalysisthus exemplifies the "politics of life itself" (Rose2001) that charactedzes advanced liberal societiesin which autonomous actors are made responsiblefor making their own vital decisions. But if the tendency to conceptualize the individual in terms of freedom is tied to a particular form of society, then other kinds of society may generateother ideas about human intentionality and action.

THE COUNTRYSETTING:PRENATALSCREENING IN VIETNAM Over the last few decades,the government of socialist Vietnam has given the issueofpopulation growth a central position in its national political agenda,making massiveefforts to curb and control population size (cf. Gammeltoft 1999). Today,govemment messagescontinue to frame population and development as closely intenelated and mutually constitlrtive issues,considedng a stable and well-proportioned population as a basic precondition for national growth and development. Yet attention seemsto be cunently shifting from a more nanow focus on family planning and fertility control toward broader and more qualitative concerns with "reproductive health," "child welfare," and "population qualiry" A central objective of the most recently issued national Poprlqtion Strqtegy(ZO0l) is to enhance "population quality" by improving "the physical, intellectual and spidtual aspectsof the population" (NCPFP2001:13). Such imprcvement is represented as a cdtical precondition for the planned industdalization and modernization of the country As a tool to operationalize the elusive notion of "population qualiry" the government usesthe Human Development Index (HDI) developed by the United Nations. The indicators of population quality used in Vietnam arc, however, not entircly congment with the HDI. Among other differences,one of the principal indicators of the goals to be achieved by 2010 is a reduction in the number of children bom with congenital malformations. As a government document states:"The life situation of people with congenital malformations is very painful, the lives of their family members are nretched and difficult, and they are a burden for society....The aim is to reduce the rate of people with congenital malfomations" (Ut Ban Dan S0, Gia Dinh va Tre Em 2003:140).In order to reduce the number of disabled children bom while also respecting reproductive rights, the Population Strategystressesthe need for premadtal health check-ups,especiallygenetic testsfor people considered to be at dsk of genetic diseasesor for those who have been exposedto toxic chemicals. Although Vietnam is not the only country in EastAsia that links national development with the quality of population (cf. Anagnost 1997; Lock 1998), the situation of

Vietnam differs ftom that of other countdes in one signiF icant respect: its history of chemical wafare. During tlc Second lndochina War, U.S. aircraft sprayed millions liters of the highly toxic herbicide dioxin known as "Agent Orange" over Vietnam. Reproductive health problems reported among veterans exposed to Agent Orange high incidences of premature births, spontaneous tions, stillbirths, birth defects, and childhood cancem and Johansson 2001). As justification of the need for madtal Senetictesting for people "at dsk," the implicitly comments on the repeated and often ful attempls of "Agent Orangeviclims' to have a child: "Many families with disabled children are still ing that their second,third child will not be suffering aftermaths (of war). This leads to many families three or four disabled children, causing misery and cultiesfor family and society"(Ut Ban Diin Sd,Cia Dinl.

Trd Em 2003:140).The political suppot in Vietnam for prenatal diagnostic technologies seems, to be noudshed by a combination of compassion for tims of the long-tenn consequencesof wadare and ing fears that the dioxin sprayed over Vietnam has a lasting contamination of the social body that will it difficult for the country to attain its development At present, genetic tests such as amniocentesis and

fetoprotein(AFP)blood testsare usedonly on an mental basis in northern Vietnam and are not easily sible. But obstetdcal ultraSound scans,the most low-cost all technologies for prenatal screening,are now

ing in urban and periurban areas,offered by public as asprivatehealth careproviders.In addition, o\/erthe five years,3D scans-popularlyknown as scans"(siCudm di tAr-have becomeintegral parts of urban women'spregnancyexperiences.a THESITEAND THESAMPLE:PREGNANTWOMEN AT HANOTSOBSTETRICS HOSPITAL Hanoi's Obstetdcsand G1'necologyHospital wasfounded

1979,with funding providedby an international organization as a gesture of solidarity toward the of Vietnam "who have suffered so much hardship" Nguy6n Huy BAo, personal communication, January 2006).The history o[ lhis hospital,like that of other public hospitals in northern Vietnam, is inseparable

the country'shistoryofrevolutionarynationalism.After dependencein 1954,the socialistgovernment ofthe cmtic Republic ofVietnam made massiveefforts to a health care system that was accessibleand affordable all. The French had left medical facilities stripped bare, in an effort to establish a new national health care the government allocated one-third of national to health (Craig 2002). In govemment propaganda, building and health mobilization were closely linkedone slogan went: "Hygiene is the love of one's

(VQsinh ld yAun*dc; seeCraig2002:56).In Vietnam government messagesstill maintain close links

Gammeltoft . :jalist nation-building, science,and medicine, represent: the pursuit of health as a collective, national effort in\ ing the entire population. For instance, on the occasion : rhe 30th anniversary of national reunification on April . 2005, an article on the front page of lleqlth qnd Life, the :rnal of the Ministry of Health, connects "our people" rjely with "the health care sector": "The road that the -:lth care sector has traveled dudng the passageof these r earsftom 1975 to 2005 is the very same road that our . pie have passedthrough. This has not been a straight .1, full of 'red roses and sweet-smelling grass.' We have ' :: to overcomemany exhausting difficulties. We have had ,ted sweat,tea$, and evenbloodin orderto reachtoday's 'ievements"(Tram2005:1). Hanoi's Obstetrics and Gynecology Hospital has pro:.d 2D ultrasound scans since the mid-1980s, and, in - , 3, a 3D scanning machine was purchased.Our sample of ' ;\'omen includes 30 women recruited through the hospi. : 3D scanning room between December 2003 and April - , -1,and 25 women recruited between June and October , , j. During the initial months of research,we were present :le 3D scanning room on a daily basis, obserying and . , rng to women and health staff. When a scanning found -:al anomalt we introduced the project to the pregnant .:lan and invited her to participate. Approximately four r\-e women acceptedto take part in the research.We had :nsive contacts with the fiI5t 30 women, conducting re::ed interviews, visiting them at home before and after lion or birth, and following them through the health -:: servicesthey obtained. At the time of wdting, more .: two years after our first meeting with them, we still :.rtain contact with most of these families. Our inter:: rns with the 25 women recruited in 2005 were less in!:\-e,usually consisting of a single home-basedinteNiew - tr few telephone conversations.At this stageofresearch, , >ought mainly to substantiatethe insights generatedin ' . irst year of fieldwork. The women involved in the researchranged in agefrom -+4.They were all marded. The majodty were preg:J . . : \\'ith their first or second child: 26 women were ex.:rg their first child, 23 women had one child aheadt ,r l\romen had two children, and two women had three rq children. Half of the womer' (n - 27) lived in a nu:: iamily, half (n : 28) In an extended family. Most of ' : '.!omen : 41) were residents of urban Hanoi, while 01 :y came ftom Red River delta proyinces around Hanoi: - a\i Vinh Phric, or Brc Ninh (, : 14). Interms of occu. ln, the women were a heterogeneousgroup, compds- ,rtudents,accountants, tailors, factory worke$, farmers, , -jers, street sweepers,Iournalists, and housewives.With -. few exceptions, they all lived in households with sta, rncomes-rarely high but enough to maintain a stan.:: of living in which the family owned a house, at least . .notorbike, a television, and a refrigeratot and had no rlems affording schooling for their children. At the time :n we met them, the women wele pregnant in weeks -18 with fetusessuffedng ftom a range of different con-

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ditions: Some that health professionalsconsidered minor, such as a cleft lip, and others, such as anencephaly (absenceof a major portion of the brain, skull, and scalp), incompatible with life.s Two-thirds of the women had the pregnancy terminated (n : 37), while one-third gave birth to the child (r?: 18). Of the 18 children born, sevendied dudng or shortly after birth. In the following sections, I first examine how women in our study decided how to act based on a prenatal diagnosis. Becauseall the women we talked to consulted health careproviders and family members before deciding what to do, I focus the discussionparticularly on the forms of medical and familial authority that shaped women,s responses and reactions.6Next, basedon this discussionof the ethnographic data, I explore how knowledges, subjectivities, and governmentalities tend to be differently configured in an EastAsian and socialist country such as Vietnam.

ACCEPTINGABORTION:TRUSTIN MEDICAL AUTHORITYA5 AN ACT OF BELONGING "Look, isn't this a pretty little one!" exclaimed the sonographer. Nodding in appreciation, he froze a 3D picture showing a clear picture of the fetal face. I noticed that Tam, the woman undergoing the scanning, did not seem to share the sonographer'senthusiasm. She looked anxious, glancing from the screen to the sonographer and back again. A few minutes later, I realizedwhy. When he scannedthe fetal abdomen, the sonographer'sattitude suddenly changed. He stopped the small talk and concentrated fully on the scanning. "There is something wrong here," he said.The picture on the screen showed a large black bulk frlling nearly the entire fetal abdomen. Later, Tam told us how a scanning at h e r l o c a lh o s p i t a hl a d r e v e a l e ldh a t t h e f e t u sh a df l u i d i n i t s stomach. "Your fetus is malformed," the doctor had simply told her. Her husband refused to believe this and took her to Hanoi for another scanning. Only after obtaining a second scan at Hanoi's Obstetdcs Hospital and a third at the National ObstetricsHospital did Tam and her husband trust that there was indeed a problem. Like this young couple, most women and thel relatives expresseddisbelief when fi$t informed that their fetus was "abnormal." Nearly all had planned and wanted the child they were expecting; most had felt wetl during pregnancy and assumedthat everything was all right. The detectlon of the anomaly was usually unexpected, and believing in the medical messagethey received seemedto requirc a gigantic leap of faith for most women. The 3D scanning pictureclearly showing a fully formed little human being, heart beatlng and limbs moving-was in stark contrast to the medical messagethey received: that this child might not be viable after all. Thirty-year-old Bich underwent a second trimester abortion when the ventricles in the fetal brain were found to be dilated, an indication that the fetus is developing hydrocephalus. She had a number of scanningsfive in all-before she and her husband felt confident that the scanning result was correct. When we talked with her a

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few days after hei fourth scanning, Bich said: "Honestly, if I have to give up this child I think it will haunt me for the rest of my days. I will never be able to forget it. [. . . ] When I heard this, I was shocked. I asked,why does this happen to me? Can I ask you, why does this happen to me?" Her husband Hing continued, "To tell you the truth, when we had the first scanning and the doctor told us this, I did not believe it at all. We had to seekfurther examinations to find out ifit was really correct.I took my wife for additional scans at thrce more places" (conversation with author, February 4,2OO4). Unlike the women in Rapp'sresearchftom North America, the decision that women in our study found themselvesconftonted with concerned not primarily what kind of child they were able to accept.It was an ethical question of another nature, concerning how to conduct themselves within complex relationships to others, including medical professjonals. ln mosl cases,as'IuleCs5lory illustrales,the women were provided with very rudimentary information about the condition of their child-to-be. Generally, they were told simplythat the fetus was "abnormal," and in most casesthey would be advisedby the doctor to either keep or terminate the pregnancy. Knowing only that the fetus was anomalous, but lacking more specificinformation about its condition, the women were rarely able to make concrete decisions about this particular child-to-be. Hence, the first decision they were confronted with was, rather, whether or not they should trust medical authority. Five women in our sample opted to maintain their pregnancy against medical advice to terminate it, while one woman had an abortion in spite of medical advice to keep the pregnancy. The vast majority, however, choseto comply with medical authority, feeling, like Tu)€t and her relatives, that they were best off trusting expert opinion. Our talks with women and thet families revealed that trust in medical authority was far from automatic or given; instead, it often required conscious effort and intentional investment of faith on the part of women and their relatives.TEven though very fewwomenwould openly display-and even lessact on-feelings of skepticism vis-a\/is medical authoriry doubts about the correctnessof medical judgments llngered in most of the abortion accounts we heard. ln some cases,women and their relatives declaredwithout prompting ftom us-that they certainly did trust "the experts" and were in no doubt whatsoever about the reliability ofthe scanning result and the justification for the abortion. Yet the very emphasisthey placed on this seemed to suggestan underlying unceltainry a fear that, after all, the entire painful yenture and the loss they had suffered might be grounded in a faulty medical assessment.For instance,when we talked to her two years after the abortion, TuyCt'smother kept insisting that even though the child c ed at birth and looked completely normal, its head did seemslightly longer than normal. Sheseemedto be still trying to convince henelf that the medical verdict on the fetus was collect. A few women voiced their doubts more explicitl, such as zg-year-old My, who underwent an abortion in

her fifth month of pregnancy becauseher fetus was ing from hydrops fetalis (abnormal accumulation of When we met her again more than a year after the tion, My still felt pained: "I keep thinking, my thoughts twisting and spinning. How can I be surc that this result wascorrect?Perhapsthey misinterpteted it? I feel I the wrong thing, I made a terible mistake. I keep o f m y c h i l d , I d r e a mo f h i m a t n i g h l . H e w o u l d h a v e ten months old now" (conversation with author, 19,2006). A lingering question, then, in many of the we heard concerned whether medical authodw, in this tressing situation, could be trusted or not. As and the party-state are closely connected in Vietnam, decision facing women ramifies far beyond the doctor-patientencounter.ln the politicalconte.\,tof ist Vietnam, noncompliance with medical advice seems

most traitorous-indexing distrustnot only regarding skills ofindividual docto$ and the new medical they are operating but also regarding the socialist state has invested so much effort and so manv resourcesin ing up the health carc system after years of colonialism . war. This was clearly expressedby Mai,s 76-year-old mother, whose perceptions of prenatal diagnosis mixtwe of faith in scienceand humility regarding her educationallevel, a responsethat we often This elderly woman, a dce farmer living on the Hanoi, placed her granddaughte/s postdiagnostic within the context ofnational and family history when said: Everyone in our family agreed on terminating the pregnancy. To tell you the truth, we do not have long educations. But scienceis skillful, we have to recognizethat. Al lhe ho(pital lhey are 50 clever.They hare-medicine, everything. You know one of my daughte$ came home in '72, and she gave birth to a son, and something was wrcngwith his testicles.But he was operatedand now he is ine. We found that so skillful. [As for Mait abortion] . . . if we did not believe in the state (nhd nwba:), in t\e doctors, we would not have consented. But now we feel at ease.We are famers, what do we know We do hai,e ideas,but we will never be like people like you, people of science. [...] There is nothing to wolly about. We have the state. The state is so clevet it has helped our child lthe fetus] escape suffering. If we did not have the state. we would have been worded to hear the doctor tell us lthat something was \a'rong].But now we do not woifqIn lhe teudaltimes [if a dicabledchild wa5born], we were scaredto death. How would we take care of it? Would ii die soon so we would be teleased,ot would it iust keep h,ing lhere?ll wasvery (cary.In the pd5t.disabililiesc;uid notbe cured.We had no science.That,swhynowwe have to put our trust in science.To be honest, if we do not trust people of science,who can we trust? lconversation with author, December22, 20031

As Mai's grandmother suggests,complying with the provided by medical doctors can be seen as an act of longing, an acknowledgment of membership of a community that is histodcally rooted in collective

Gammeltoft o PrenatalDiagnosisin PostwarVietnam :rr freedom and independence. By accepting a prenatal :iagnosis, one also turns oneself into a proper citizen:lmeone who recognizes and appreciates the efforts in:sted in building the Vietnam oftoday. The abortion deci,-on, then, concerns not only the ability of a mother-to-be : l accepta disabled or lessthan pefect child but also what .rnd of citizen she aspiresto be.8 Yet the decision regarding whether or not to trust med:al authodty was rarely made by the individual woman or ::re couple alone. Nearly all women discussedthe scannlng ::sult with family and kin before making thet decision. .lost often, as in Tu)€t's case,the woman and her family ron opted to comply with the medical advice they had re,:ived, But a few women found themselvescaught between rmpeting forms of authodty: between family and kin, on -re one hand, and state-supportedmedicine, on the other.

DISABILITYAS A MATTEROF KINSHIP \fy family forced me to keep it. The entire kin-group :rrced me to keep it" (conversation with author, October 2005). Xu6n's voice was deeperthan most women's, and 1e sounded sad.For three days in a row I receiveda phone .:11from her every evening, Du ng her first call she told re that a 3D scanning had found that her seven-month-d fetus lacked its left hand. Another 3D scan had come I the same result. However, as the fetus was estimated I weigh 1.4 kilos, the doctors had advised against abor: Jn. Terminating the pregnancy now may result in a pre:--aturely bom child, not an abortion, they had warned. --rart ftom the missing hand, no other defects had been -rund. Yet Xuan feared there might be other problems that ::re scan had failed to detect. What if there were hidden :romalies that would only become visible at bilth? What : the child was severely disabled? Couldn't she still have ,r abortion, although she was seven months pregnant? I ruld hear from the way she posed her questions that she :aned toward abortion. "I feel sorry for my child," she said, ':r voice dropping, "I am afraid it will have a miserablelife. .nd what about my daughter? When we are not here any,ore, she will have to take care of him. She wil1be the one I suffer most." When she called me on the third evening, .uan said she would keep the pregnancy. This was not her ::cision, she claimed, but her family's, a decision made by ::r husband, his mothet and her own and her husband's blings. Her health was not strong, and they all feared she ould not be able to cope with the physical and emotional : luma of a late abortion. Also, though having been preg' lnt nve times, Xuan had only one live child, so her rel,:ives believed she should keep this child. After all, they ,id, a missing hand is a minor defect, and the scanshave -rrundthe two most important organs-heart and brain-to r: normal. Two months latet Xuan gave birth to a healthy r)/ weighing 3.4 kilos. He had both hands, but the devel:rment of the flngers on his left hand was rudimentary. In the majority of cases,the woman, her husband, and :leir families all soon agreed on what to do based on the

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scanning result, without need for extensive discussion and only rarely challenging the doctor's advice. Yet in a few cases,especially when the anomaly was identified late in pregnancy, agonized family discussionsunfolded before a decision was made. [n Lan's case, for instance, the fetal problem-hydrocephalus (excessiveaccumulation of fluid in the brain)-was detected only two weeks before the due date, and the doctors did notprovide Lanwith anyguidance regarding what to do with this information. When we visited the family, we found a situation that seemedto reflect the male-centerednature ofVietnamese kinship that ethnographic studies have often asserted (e.9., Hy Vdn Lu,o,ng 1989): Lan's iathet father-in-law elder brother, brother-inlaw and husband were sitting together in a circle on the floor. Lan and her mother-inlaw sat in silenceoutside their circle, listening to the men, while Lan's father-inlaw was leading the discussion. He pondered aloud about their options in this situation, stating that if this child was going to be "uselessfor society" fthdng c6 ich cho xA hAr, he would rather opt for termination of the pregnancy.When the men decided that she should undergo an abortion, Lan consented without a word.v Not all women, however, left the decision to their family to such a dramatic extent as Lan. We encountered wide vadation in the ways that women's responseswere configured through famil)' and kinship relations. While some left the decision nearly entirely io their relatives,othen-especially urban women, women in their thirtles and forties, and womedwho had a child already and had establisheda household separatelyftom their parentsinlaw-tended to make up their own minds first, in consultation with their husbands, and afterward merely ensured that senior family members agreedwith ihis decision.ro A few women, such asXudn, claimed that their families "forced them" to give birth while they themselves would have preferred an abortion. Yet when we talked in more depth to thesewomen, we leamt that this statement may to some extent have been rhetodcal-made within a cultural context in which mothers are commonly blamed when reproduction goes awry. What these women were saying to their relativeswas: "Ifthis child turns out to be severelydisabled and a burden on oul familt don't blame me. It was you who told me to keep it." Witnessing decision-making processeswithin families made itclear tous that the birth ofa disabledchildhas social and moral consequencesfor the entire family-and, especiall, for the parents and siblings of the pregnant woman and her husband. In a social setting where karmic explanations are often mobilized when misfortune strikes, local moral opinion tends to link congenital malformations directly with the morclity (phrtcdirc) of the family: The physical anomaly is taken asan indicator of moral transgressions made by the child's parcnts or grandparents.At issue,then, tor parents-to-be is not only the possible defectivenessof their child's body but also the risk of blemishing the entire kinbody. Moreover, even though everyone knows that the mother will be the one to provide daily care for a disabled child, it ls also common knowledge that this is a taskthat no

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mothercan manageon her own without socialand financial support from family and kin. The birth of a disabled child therefore has implications for the connected body-selves of the wider family to which it belongs, both socially and morally. Most women explained that they could act only after consultation with-at the least-their own and their husband's parents and siblings. In sum, also within the family setting, the women we met representedthemselves as acting out of responsibility toward others rather than as simply making their "own" individual and consciencebaseddecisions.They describedtheir possibilities for action mainly in terms of social relations of dependenceand obligation, seeing themselves as responding to the needs and expectations of a larger collectivity. At issue, again, is be, longing: the woman's senseof belonging to her family, the child's belonging to the kingroup.

ANTENATAL SCREENINGAND HUMAN AGENCY: THE PRAGMATICS OF SOCIAL CONNECTEDNESS Subjectivities emerge situationally. The women we met in the course of this researchwere responding to medical information that placed them in a situation where they felt conftonted with one of the most painful decisions of their lives. As Bich said: "This lthe ultrasound scanning] gives us the opportunity to choose,either to keep it or to give it up. If the diagnosis is conect, this is an advantage for us. But it also pushes us into a situation where we must do something evil, evil to our own child" (conversationwith author, Februaly 10, 2004). In this situation, as we have seen,most women reacted by tuming thet predicament into a question of how to conduct themselves within social relations to others-medical professionalsand relatives-rather than a question of personal moral beliefs. Although there was nearly universal agreement between docto$, relatives, and women that the final decision regarding whether to keep the pregnancy or not must rest with the pregnant woman, as she is the one who cardes both the pregnancy and the ultimate responsibility for the child, most women in our study-regardless of age, occupation, residence, and fanily form-seemed to make huge efforts to explain to themselyesand to others that this decision was not thets alone, but one they had made with and through socially signifi. cant others. In doing this, they were enacting and drawing on certain values and rationalities made available by the soc! ety they live in. While opening up to market forces, Vietnam still maintains a one-party political system with the Communist Party of Vietnam firmly in power. This is a political community in which the party's visions of society and those expressedin the media have a strong tendency to converge and overlap (Drummond 2004; pettus Z0O3). In government discoulse, values of social obligation, loyalty, and collectivism are held supreme. Individuals are enioined to seethemselves,above all, as socially responsible beings: as members of families toward which they have duties, and as citizens of a nation-state to which they owe

respect and commitment. Particularlv for women. suchasselflessness, duty, piety,and faithfutnessare sized (Gammeltoft 1999; Pettus 2003). As raDid transformation generatesanxiety that /,Vietnamese values" will be lost in the face of global capitalist tion, academic and popular journals consistently family and nation as timeless and endurins of loyalty and shared responsibility, as in a recent witten by the chairwoman of the Vietnam for Population, Family and Children: In the consciousnessof the Vietnamesenation, the fam_ ily is always a sweet home, a pdmary envitonment in which virfues are botn and nurtured and the Vietnamese personality created.The ptecious traditional values of the Vietnamesenation such as love fot the country, solidar_ iq, industriousner!and cfeativeness dt work, ;esilienceundaLrntedne\\in overcoming diifi(ulties, lridis, have been kept up and developed by the Vietnamese famil!' lhroughoul the hi5toryof nationalconstructionand defense. [Le 2004:41

The cultural integrity and survival of the nation is envisioned as depending on the ability of uals to fuIfil1 their social responsibilities within family community; the individual who fails to do so lets not only her kin but also her nation. In government

course,then, rather than being positionedvis.e_vis o t h e r i n f r e e d o ma n d i n d e p e n d e n c ei n. d i \ i d u a l sa r e visioned as organically felated social beings, tied through mutual and blood-basedobligations. Within day lives, a range of citizen-forming technologies aimed the "conduct of conduct,, are employed to instill in this senseof social duty and responsibility. In socialist bilization campaigns, state bureaucracies-schools, care institutions, population control cadres-instruct monitor people in the maintenance of health and persooal hygiene and direct them asto how to spaceand limit birtb (Drummond 2004; cammeltoft 1999; pettus 2003). Educe. tional messagesare transmitted to citizens through publt loudspeakers,mass medla, wall paintings, biUboards, ad street banners, or through home visits performed by locC cadreswho, for instance, remind mothers to take their chil dren for their annual dose of vitamin A, to begin using r modern contraceptive method soon after birth, or to €nsure that their children are attending school. This is a forn of society, then, in which key forms of power work by instilling social responsibility and a senseof duty rather than through the $anting offreedom and rlghts. Citizens are expected to relate to themselvesas subjectsof obligation and to respect and comply with standards and norms defined by authorities-whether school teachers,medical docto6, orpopulation cadres.Within this political community, corF cern for othersis expressed by overseeingand taking careof them, rather than by setting them ftee (cf. Milwertz 1997)People, however, are multifaceted, and human being may transcendand transformsocialconditions:,,Tobe bom is both to be born of the world and to be bom into the world. The world is aheady constituted, but also never

Gammeltoft . ;ompletely constituted; in the fiISt place we are acted upon, n the second we are open to an infinite number of pos)ibilities" (Merleau-Ponty 1995:453). Although domlnant >ocial discoursesmat as in the case of Vietnam, provide ::latively unitary and constant definitions of Proper per.lnhood, individual expedence tends to surpasssuch defi:.itions. As Aihwa Ong notes (2003:9), no "single totalizing :trm of citizenship" is ever produced by the diverse tech:quesofpower that are employed in goveming individuais ,rd populations. Recentanthropological researchconducted in Vietnam :ovides rich illustrations of how national ideals are con-.sted and subverted as people 80 about their daily llves Taylot 2004). In the 2002; Pettus 2OO3; ..g., cammeltoft we encountered innumerable examples rurseof freldwork, authorities in may evade or counter social women : how purposes An, for inthis suits their best. where :uations ::nce, insisted on bringlnghome her severelydisabledtwo.ar-old daughter from hospital, defying her mother-inlaw :ro had told her to abandon the child. Hoping to have a :r, Qui got pregnantwith herfourth child, well awarethat . wasbdnging herself and her husband a paty member . -J state official-into the disfavor of local authorities. To :ep the pregnancy secret,shewould hide on their top lloor :en colleaguesof her husband visited. Thus, when preg'.nt women in our study framed the profoundly painful .:isions they had to make in terms of respect for medical fertise or social obligations to relatives, this should not = jeen simply as a passiveand blind submission to author-. or the spirit of collectivity but, rather, as a pragmatic -::ronse to a painful personal predicament. Women were . .ere, as Bich said, that they were making a decision that r{ht haunt them forever-and they therefore prefened .ast it in terms that turned it into a collective rather -.,n an individual endeavour. In this situation, they were . r.i to draw on a wide repertoire of cultural concepts and . ues that accentuated communiry shared responsibilit, .,lprocity, familial solidadty, and collectivism. When con-rrted with a decision that was almost unbearable for a ::son to make, in other words, women opted to embrace -. cultural values that allowed them not to have to bear it , :te. :ONCLUSION .',! technologies of pregnancy are cu[ently placing peo' : acrossthe globe in new kinds of dilemmas. Whereas -: vast majority of anthropological studies on prena. Jiagnosis have been conducted in Euro-Amedcan set:s, this article has explored how women in Hanoi, =tnam, handle the troublesome decisions that an ultra-nd scanning result forces them to make when a fetal ,,formation is detected.The analysisshows how womenrs .-.l1cy in this situation consists not only of sorting out ;r to act based on distressing medical information but - :,r of representing their predicament in a way that alr';t them to share responsibility for their decision with ':ers.

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In contrast to citizens of societiesthat emphasize personal autonomy and individualisrn, women in northern Vietnam live in a social world that enables them to turn prenatal diagnosis into an issue of social belonging rather than individual moral pioneering and to ftame the issuesat stake in terms of social connectednessrather than penonal moral conviction. Living in a society that provides them with powedul cultural means for seeing themselvesas tied to others through mutual obligations and commitments, women are enabled to share with others the burdens of excruciating existential decisions. This casefrom Vietnam, then, does not simply illustrate culturally "Other" notions of self and person-it also shows how people may draw on the specific social and cultural resourcesthat theil society offers when responding to information provided through new biomedical technologies, forying subjectivities by iuggling dominant cultural representations. This Vietnamese case thus points to the importance for the anthropology of reproduction of explicitly considering how notions of "citizenship" and structures of kinship may operate as social resourcesfor the fashioning of individual thought and action. The casealso adds to the anthropological ploject of understanding how human subiectivity and intentionality maybe shapedin diverseways in different settingsofpower, aspeople go through thetu lives finding ways of coping with suffering and affirming the social relationships that sustain their existence.

T|NE M. GArvnuEToFTInstitute of Anthropology, University of Copenhagen, @ster Farimagsgade 5 E, 1353 Copenhagen K, DENMARK

NOTES Acknowledgmets. A draft of this article was presented at the international conference "Reproductive Disruptions: Childlessness, Adoption, and Other ReproductiveComplexities," held at the Uni versity of Michigan in May of 2005. The researchwas supported bv the Council of DeveloDment Researchof the Danlsh International De\ elopmenrA\\i.ldncelDanida).Tl\ i\h lo acl,nowlcdgethe contributlons of my Vietnamese colleaguesto data collectlon and in particular NguyAn Thl Thui Hanh, Nguy€n Huy Bao, an_alysis, D6 Thi Thanh Toan, Brii Kim Chi, Tran Minh Hang, Hoeng Hii Van, and Nguyon Thi Hiep. I also thank staff at Hanoi's Obstetrics and Gynecology Hospital, and the pregnant women and their families who participated in the research.Finallt I am gratetulto Benjamin Blount, four A.4 reviewe$, and, as always,to Susan RemoldsWhvte. fol their constrlctive comments on the first drafts of ihis aiticle. 1. A11names of informants have been given as pseudonyms. 2. This researchproject was conducted by a group of 11 rcsearchers, one Danish and ten Vietnamese. C)ualnformants were most often shocked and deeply distressed,stluggling with a wealth of questions, thoughts, and feelings. Working ethnographically with women in this situation therefore constituted an enormous challenge, making constant ethical reflection an integral part of this freldwork. While finding it neither appropriate nor possible to provide women with the advice that thet their relatives, and health care providers often asked us to give, we did seek to support them emotionallt while alsc facilitating contact with doctors at the maternity hospital where the researchwas conducted or at more specializedhealth care facilities, such as the National

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PaediatdcsHospital, the National Obstetrics and Gynecology Hospital, or Hanoi Medical Universiry 3. In subsequent articles, I will discuss how and why keeping or terminating an "anomalous" ptegnancymade sensetowomen and their relatives.All the women we talked to pondered at length the moral, ethical, social, and existential dilemmas that the scannins rerull (onfronted lhem wilh. A djscussionof theseconsiderationa would, however, take us beyond the scope of this article. 4. This development must also be seenin the conteit ofanincreasingly pdvatized, liberalized, and competitive health care economy in which ultasound scansare sourcesof revenue for public aswell asprivate health careproviders (Gammeltoft and Nguyan inpress). 5. The fetal conditions included the following: dilatation of ventricles/hydrocephalus {15); anencephaly/holoprosencephaly f7); hydrop5 fetali\ (b)i abdominal/umbilicalhernia (6.);hean deIects (5); prune belly syn&ome (5); abdominal/kidney anomalies (4); cleft lip (3); anomalies of atms, legs, or hands (3); and twins with a shared spine (1). 6. Some of the women in our sample interpreted their expe ence in religious terms, prayingfortheif child during pregnancy or ftaming their loss as "the will of Heaven." Yet none of them consulted religious authodties in order to flnd out how to odent themselves in this situation. 7. Although induced abortion is legal and officially sanctioned in Vietnam, and even though the country has one of the world,s highest abortion rates,pregnancy tetminations remain morally and culturally contested (e.g., Gammeltoft 2002). Late-term aboitions in particular are often experiencedasintenselypainful by the women undergoing them (Gammeltoft 2006). 8. It is important to emphasize that this does not mean that out infomants condoned state practices in all contexts, or all aspec,ts of medical practice within the public health care system. For instance,many expressedconsiderablefrustration and angerover the cofiuption thal plaguespubli( health careat present. 9. However, the hospital's board of diiectors tefused to permit an abortional lh is advanced5tag(of pregnancy.Two weektlater,Lan gave birth through caesarean section to a boy suffering from severe hydrocephalus. He died at the age of two. 10- These varied rcsponsesinde{ the complexities of Vietnamese kinship: Whereas kinship structures in Vietnam are often rcpiesentedashierarchical age-and sex-basedstrucfuresthat place males and elderi in position\ o[ powef and authority. competing cLrltural models frame kinship as much lessage-and sex hieratchized (Gammeltoft 1999; Hy Vin Luo,ng 1989). REFERENCES CITED Anagnost, Ann 1997 National Past-Times:Narrative, Representation,and Power in Modefn China. Durham, NC: Dule UniversityPress. B a u m a nZ. ) B m u n t 1988 Freedom.Minneapolis: University of Minnesota press. Browner, Carole H., and Nancy Press 1995 Normalization of PrenatalDiagnostic Testing.L Conceiving the New World Order: The clobal Politics of Reproduction. FayeD. Ginsburg and Rayna Rapp, eds.Pp. 307,322. Berkeley: Universiw of Califolnia Press. Craig, David 2002 Familiar Medicine: EverydayHealth Knowledge and pmctice in Today'sVietnam. Honolulu: University of Hawai,i Press. Crossley, Nick 1996 Body-Subject/Body-PoweriAgency, Inscdption and Control in Foucault and Merleau-Ponty.Body and Society 2(2):99116. Drummond, Lisa 2004 The Modem "Vietnamese Woman": Socialization and Womenk Magazines. Ir Gender Practicesin Contemporary Vietnam.Lisa Drummond and Helle Rydstrom,eds.Pp. 158178.Singapore:SingaporeUniversii) Pres\. Dumont, Louis 1986 Essayson Individualism. Modem Ideology in Anthropo, logical Perspective.Chicago: Univeisity of Chicago Press.

Edkson, SusanL.

2003 Post-DiagnosticAbortion in Germany: R( GoneAwry.Again?SocialScience and Medicine(s6): 2007. Foucault,Michel 1980 Prison Talk. L Power/Knowledge: Selected InteNievrs Other Wdtings 1972-1977. Colin Gordon, ed. pp. 37 54-. Yorki Pantheon. Gammeltoft, Tine 1999 Women's Bodies, Women,s Woties: Health and

Planningin a Vietnamese RuralCommuniry Richmond: zon rtess.

2002 Between "Science" and "Supe$tition,,: Moral pel oflnduced Abortion among Young Adults in Vietnam. Medicine and Psychiatry (26):313-338. 2006 "Beyond Being": Emergent Naratives of Suffering in nam. Journal of lhe Royal AnthropologjcalInstitu-te (12):589605. Gammeltoft, Tine, and Nguyen Thi Thui Hanh ln prcss The Commodiication of Antenatal Care: Ultrasound Scanning in Urban Vietnam. Reproductive Matte$ 15(29). Hy V;n Lu o,ng 1989 Vietnamese Kinship: Structural Pdnciples and the I Transformation in Northern Vietnam. Joumal ofAsian

48(4):741-7s6. Inhorn, MarciaC. 2OO2The "Local"Conhontsthe ,,Global,,: Infeitile Bodi6 New ReproducliveTechnologies New in Eglpt. /r lnfertility the Clobe:\ew fhin|jng on Lfritolesiir'ess, Gender,and ductive Technologies. Marcia C. Inhoin and Frank van pre eds. Pp. 263-282. Berkeley:University of Califomia presi 2003 Local Babies, Global Science: Gender, Religion, ad

--- Vitro lertilization in Egypt.New York Routledge. Kleinman, Arthur, and loan Kleinmarr

lqql Sufferingand lts tuofessional Transformation:Toward Ethnograph) ot Intefpirsonal fxperience.Culture,Medki and Psvchiatrv 15:275-301.

LC,Thu Thi 2004 The VietnameseFamilyin the Causeof National

t alization and Modernization. population, Family and dren. September-O( tober:4-5. LC,Tuy€t Nham Thi and AnnikaJohansson 2001 Impact of Chemical Wafare with Agent Orange Women's Reproductive Lives in Vietnam: A Pilot Studyprcductive Health Matters 9(18):156-164. Lock, Margaiet

1998 ?edecting Society: Reproductive Technologies, Testing,andthe PlannedFamilyinJapan.ll?pragmatic and Body Politics. Margarct lock and ?atdcia Kaufert, !p. 206-239. Cambridge: Camb dge Univenity press. Merleau-Ponty, Maurice

19ie5#621 ThePhenomenology ofperception.Newyork Milwertz,CeciliaNathansen 1997 Accepting Population Control: Urban Chinese and the One-Child Family Policy. Richmond: CuEon

NationalCommitteefor Populationand Familyplanning 2001 VietnamPopulationStntegy2001,2010.Hanoia planning. - Committeefor Populationand Family

Ong. Aihvra 2003 Buddha Is Hiding: Retugees,Citizenship, the New Berkeley:University of California Press. Pettus, Ashley 2003 Between Sacrifice and Desire: National Identity and coverning of femininity in Vietnam.New york: Ro;tled* Rapp, Rayna 1997 Real-TimeFetusi The Role of the Sonoqtam in the Monitored Reproduction./l?Cyborgsand Citadels:An1 logical Interventions in Emerging Sciencesand Technr

GaryLeeDowneyandJosephDumit, eds.pp. 31 48. NM: S(hoolof American Resear(h fress

1998 Refusing Prenatal Diagnosis:The Meanings of Bj in a Mullicultural World. Science,TechnoLogyand Values23(1):45-70.

Gammeltoft

1999 Testing women, Testing the Fetus: The Social Amedca. New York: ImDact of Amniocentesis in Routledge. Rose,Nikolas 1999 Powers of Freedom: Reframing Political Thought. Cambridge: Cambf idge University Press. 2001 The Politics of Life ltself. Theory Culture and Society 18(6):1-30. schweder,Richard A., and Edmund J. Bourne 1984 Does the Concept of the Person Vary CrossCulturally? h Culture Theory: Essays on Mind, Self and Emotion. Richard A. Schweder and Robert A. Levine, eds. Pp. 158-199. Cambddge: Cambddge University Press.

.

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Taylor,Philip 2004 Goddess on the Rise: Pilg mage and Popular Religion in Vietnam. Honolului University of Hawai'i Prcss. Tram, Quyen 2005 30 N5m Thanh Tuu Nganh Y (30 years oJ achievements for the health carecectofl.Sit Khde va Dbi Song,April 30:1. U('2003 Ban Dan 56. Gia Dinh vA Tre Em NhDog Nqi Dung Chu Yeu Cua Phrip lenh DAn Sd (Th_e main contents ofthe population ordinance). Hanoi: Nhd Xuat Ban Lao Dong-Xa HOi. Whyte, Susan, and Benedicte Ingstad, eds. In pr€ss Disability Connections. L Disability in Local and Global Worlds. BenedicteIngstad and SusanWhyte, eds.Pp. 129. Berkeley:Unive$ity of California Press.