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Fetal Positions: Fetal Visualization, Public Art, and Abortion Politics.

Fourteen enormous bronze sculptures loom over the pedestrian mall outside the Sidra Medical and Research Center in Doha, Qatar. Tipping your head back, staring into the bright sky, visitors report that you can just about grasp the shape of them. At a distance, or in photographs, their subject matter resolves: the sculptures, ranging in height up to 36 feet (11 meters), depict the development of a human fetus from four-celled zygote to birth. (1) Damien Hirst titled the series, his most recent major installation, The Miraculous Journey (TMJ).

When the sculptures were unveiled in October 2013, U.S. media outlets speculated that the work might transgress local cultural norms around the representation of human bodies. Writing for the New York Times, for example, Carol Vogel (2013) argued that "this installation takes official acceptance of Western art to a new level," characterizing the sculptures as "audacious" within a society where "local women still adhere to centuriesold Islamic traditions, wearing the abaya, a long cloak, and niqab, or face covering; images of women are routinely censored in books and magazines. Even the representation of the human form," she said, "is unusual" (paras. 3-4). The sculptures were commissioned as part of a modernization effort by Sheikha al Mayassa Hamad bin Khalifa al-Thani, intended to refigure Qatar as a center for art and culture (Vogel, 2013, para. 4), and so Vogel's response is, in some sense, the desired one--indeed, the Qatar Museum Authority's page about the sculptures characterizes the commission as "audacious" and suggests the sculptures "will stimulate debate at home and abroad for years to come" (Qatar Museums, n.d., para. 5). This suggestion proved partly true: coverage in U.S media saw the sculptures incorporated into debates over abortion access in the United States, but it appears the sculptures have not been received that way in Qatar. (2)

Situating TMJ only in the domain of figurative art, as Vogel does, occludes the sculptures' medical genealogy, immediate physical context, and persuasive potential. The scientific discourse embedded in Hirst's work goes almost unmentioned these days, 25 years after he burst onto the international scene with his vitrines. In the case of TMJ, the sculptures' position outside a hospital and visual-intertextual citation of texts from across the history of anatomy serve as appeals to authority that legitimize the work as simultaneously artistic and scientific. The sculptures' position in a public square situates the works as everyday objects for consumption--safe, admirable, beautiful, desirable. But this occludes the sculptures' articulation with historic practices of anatomic visualization, and longstanding debates about the representation of women's bodies in the history of medicine. In this article, I trace this double movement through Hirst's large-scale anatomy sculptures with particular attention to TMJ. The installation, I argue, dances a line between art and science, citation and invention, and familial and political concerns. Fetal imaging has long been criticized for its erasure of women's bodies; in TMJ, this practice is solidified and writ large--36 feet tall, to be precise. I examine the relationships between these sculptures, practices of medical visualization, and the space of the hospital, then move on to consider the sculptures' interarticulation with discourses of women's bodily autonomy and their co-option by anti-abortion rhetors as evidence in U.S. abortion debates, which link medical and social visualization of women's bodies to cultural and legislative control over them.


This article offers a rhetorical-cultural analysis of TMJ and its articulation with and use in U.S. debates over access to abortion care--but it's an analysis of a culturally specific bent. In "Extending Rhetorical-Cultural Analysis: Transformations of Home HIV Testing," J. Blake Scott (2003) notes that "cultural studies is a heterogeneous, contested, and changing enterprise" (p. 353), which makes it difficult to make solid claims about cultural studies' methods. I agree with this characterization, if referencing U.S.-based cultural studies, which has been adopted largely as a methodology in literature, gender studies, sociology, and other disciplines. Yet cultural studies has a wide reach and has taken a variety of culturally specific formations, responsive to local conditions, preoccupations, and disciplinary traditions. My approach is shaped by my background in Australian cultural studies, which Graeme Turner (2015) has described "as the most distinctive of these local formations" (p. 609). Here, the difficulty of pinning down methods is a feature, not a bug: the field is defined not by its methods, its modes and tools of analysis, but by a shared topical focus and political commitment. (3)

I bring that sensibility to this analysis, pairing a rhetorical analysis of TMJ with an examination of the sculpture's interarticulation with medical visualization and U.S. debates over abortion care. Rebecca Dingo (2012) offers interarticulation "as a rhetorical tool that can help us account for both the shifting meanings and unevenness of rhetorics as they travel" across cultures, arguing that as "arguments circulate transnationally, they become composed of elements derived from different things that are distinctly joined or marked" (p. 110). In this essay, I trace the interarticulations of TMJs visual-material rhetoric with Hirst's body of anatomic art and the history of medical visualization and abortion care, attending to the hyperlocal context of the hospital as well as the transnational circulation of the sculptures into U.S. abortion debates. A study that closely attends to the sculptures' function within Qatar and their relationship with discourses of gender, class, and national identity would contribute to a more rounded picture of TMJs work; however, such an examination is beyond the scope of this article.

In the first half of the paper, my rhetorical analysis of the sculptures' relationship to the gendered history of scientific visualizations is informed by my training as a rhetorician in the United States and a cultural studies practitioner in Australia; in the second half, I turn my attention to the way that these sculptures have been read by U.S. anti-abortion activists in debates over desire for and access to abortion care. This latter section likewise employs rhetorical analysis, examining the visual tropes and signifiers that are deployed by rhetors in those debates. It also reflects my commitment to an activist mode of cultural studies which might intervene in such debates; by better understanding how texts are forcibly transcoded between the medical and public spheres, we may become better equipped to argue for, among other things, improved access to healthcare. As such, this analysis may be especially helpful as a model for feminist rhetoricians of health and medicine, and others interested in the political dimensions of medical rhetoric.

Hirst's Reproductive Bodies

Damien Hirst first gained fame as part of the Young British artists (YBa) movement in which he was a key early player, organizing Freeze, the first show featuring work from 16 artists who would go on to become prominent in the movement. He is perhaps most famous for his 2007 sculpture for the Love of God--a platinum skull studded with nearly 9,000 diamonds. The piece is described on Hirst's website as a memento mori "with inspiration drawn from Aztec skulls and the Mexican love of decoration and attitude towards death" (Hirst, 2012). Slipped into the description--eclipsed by extended descriptions of the size, color, cut, and provenance of the diamonds--is the note that the skull at the heart of the sculpture was cast from an 18th-century anatomic specimen. Hirst's work has shown similar influences of biological sciences and the material body throughout his career. His most controversial early works were a series of installations displaying animal bodies or body parts, often in decay or preserved; the installation In and Out of Love, for example, combined living butterflies (hatched in the gallery) with dead ones, their wings painted over on monochrome canvases. Richard Shone describes this as "menacingly beautiful in its combination of artifice and nature" (in Adams et al., 1997, p. 22), phrasing that could equally be applied to later work. Hirst's vitrines--glass enclosures containing sectioned animal cadavers suspended in formaldehyde--employed techniques of dissection and preservation borrowed from medicine, and Hirst added to his repertoire over the years, displaying bodies of animals that had been sectioned or taxidermied in fantastic ways, such as The Child's Dream--a simulated unicorn made from the body of a foal and a gold-plated steel horn.

While Hirst's fantastic vitrines are clearly imaginative in nature, they draw on texts from the scientific tradition in a way that makes them seem familiar and legible to lay viewers as in some way scientific. He identifies himself as participating in scientific endeavors, operating under the company name of Science Ltd. and referring to his Science Gallery, an exhibition space and associated studio completed in 2012 and advertised at the time as the largest art creation space in the world (Phaidon, 2013), as a site for "science production" (Arbuthnott, 2012, para. 18). All this comes together to give much of his work a sense of "truthiness," a term employed by comic Steven Colbert (2005) to call out pathetic appeals that promote a feeling of rightness where logical appeals are expected. Truthiness is an invitation to feel--the ethos of Colbert's satirical persona is established when he tells his audience that "the truthiness is anyone can read the news to you; I promise to feel the news at you". Hirst's anatomic sculptures in particular have that sense of truthiness: they look right to inexpert eyes, but more importantly, they feel right, participating in a recognizable genealogy and appealing to the widely recognized authority of medical science.

The influence of science's visual culture is quite obvious in Hirst's 21st-century anatomy sculptures, precursors to TMJ, which are modeled on contemporary anatomic visualizations; scaled down, they would be at home in a classroom--and indeed, Hymn (1999-2005) was inspired by a children's educational model owned by Hirst's son (Hirst, 2005a). Hirst (2002) has stated that the model was "just so accurate, it was like a chemistry set, and I loved that it was a toy... similar to a medical thing, but much happier, friendlier, more colorful and bright" (in Hirst & Burn, p. 147). This phrasing establishes the piece as at once scientific--"like a chemistry set"--and not; he insists on the source being a toy and "more colorful" than educational models, although such models are in fact typically brightly colored to aid visualization and more clearly distinguish the anatomic structures they depict (as when vivid stains are applied to slides to better highlight demarcations and structures). TMJ was inspired by Hirst's own childhood memories of seeing fetal development illustrations in "family health guides" (Blundell, 2013, para. 3); this situates his early exposure to fetal imagery within a domestic sphere, not an institutional or educational space. These citational practices and visual references serve as an appeal to scientific authority. It's worth noting that even in this artistic context, citations, which, as Judy Segal observes, serve as the primary argument from authority of medical texts (Segal, 1993, p. 524), remain in Aristotelian terms inartistic proofs--applied, not invented. Hirst explicitly names scientific texts in his artist statements, website blurbs, and other framing discourses, identifying books and models as the inspiration for his art--but those citations are no less explicit in the artistic works themselves, which owe clear debts to the visuals of those scientific texts. The citation--application--would be clear if one never read a word of framing discourse.

These citation practices are visible in TMJ, too, and cemented by the installation's location outside Sidra Medical and Research Hospital, Qatar. The sculptures' positioning and subject matter, an (extremely) large child and (metonymic) woman, clearly associate them with the hospital, a women's and children's facility. But the location again highlights the sculptures' liminality; their location, outside the hospital, also points to their spectacular nature. They are with but not of the hospital, consciously placed in an open space, as objects for public consumption, and as consciously placed within the artistic tradition. Indeed, the sculptures were unveiled in October 2013 to coincide with Relics, a major Hirst retrospective held at the Qatar Museum Authority's Al Riwaq Doha gallery as part of the Qatar UK 2013 Year of Culture (Hirst, 2013a; Hirst, 2013c). The hospital itself did not begin operations until three years later and is still not in full operation. (4)

The Miraculous Journey is a set of public art pieces that tower over the pedestrian mall and street in front of the hospital; their immense scale, even in photographs, makes them monumental--even the smallest is twice the size of the average adult human. That monumental effect is furthered by the fact that they have been cast as simple bronzes, an aesthetic choice that aligns them with an artistic sculptural tradition. Many of Hirst's other anatomic sculptures are parti-colored, and so more closely resemble the plastic models used in classrooms; bronzing conceals that genealogy--as well as the bloody interior of the uterus and the compulsory (now literally invisible) whiteness of the medical model. Instead, the statues assume the stature of other bronze statues on plinths in town squares--heroic public figures--and in so doing embody the sacrification of the fetus that Barbara Duden (1993) traces in German abortion debates. At the same time, the bronze recalls something a little closer to home for the Americans who encounter the sculptures via global media--the tradition of bronzing baby shoes or casting baby's feet, domestic art forms designed to capture and freeze a personal and familial memory, preserving forever a newborn's tininess (and here, realizing its imaginary enormity). This association is a deliberate one: in the Qatar Museum Authority's Public Art Fact Sheet, Hirst is quoted saying that "the project came from a desire to create 'something monumental, whilst essentially human'" (Qatar Museums, 2014, p. 4).

The doubling at the heart of TMJ--the creation of something that is familiar, yet strange or novel--is at the heart of both monument design and scientific discourse. In the case of monuments, designers must invent something that is disruptive but at the same time consistent with enduring social values, since such texts are intended to have an audience that spans generations and so need to have an enduring rhetorical effect. They must also identifiably reference a person or event, while working to establish new public memories (Balzotti & Crosby, 2014). Monuments and memory places, Jonathan Balzotti and Richard Crosby (2014) argue, "eras[e] and replac[e] memories and implicitly call for assent on a particular, active, publicly shared identity that spans time" (p. 329). This process is apparent here, too: in foregrounding fetal development and birth, The Miraculous Journey works to establish the pediatric hospital behind it as associated primarily with healthy reproduction. It's likely that births will constitute a large number of admissions at the Sidra Medical and Research Center--in the United States, for example, births account for two-thirds of pediatric hospital admissions (Merrill & Owens, 2007)--but much of the work of the hospital will be tending to sick, disabled, or injured children, nowhere present in the hospital's visual identity at the time the sculptures were unveiled, or in the years leading up to the hospital's phased opening. (5) The sculptures' effect is unavoidable: the scale of the sculptures and their presence in open space is such that, as Carole Blair (1999) put it, they "remain in our perceptual fields... they do not fall into silence, nor [get] 'put away'" (p. 17); this is especially true of those admitted to the hospital, for whom the sculptures are not a chosen destination like the memorials Blair examined. Sidra currently operates on a referral-only basis with a limited network, accepting patients who are referred by either the Hamad Medical Corporation or Primary Health Care Corporation for specialist care.

Likewise, rhetoricians of science have long accepted the notion that successful scientific discourse must be at once novel and familiar. In their study, David Kaufer and Cheryl Geisler (1989) argue that authors looking to contribute to the field "search for ideas that flow from existing knowledge and promise to extend it... they manage to be new when the imprint they make fits the community standard and when they can make it before their competitors make theirs" (p. 289). Further, they suggest, the balance between familiarity and novelty is a delicate one: "Contributions that respect the past with too little change become tired and predictable... contributions that push change with too little rootedness are likely to remain unclassified rather than revolutionary" (p. 289).

Feminist scholars of science have been particularly critical of medicine's visuality, especially as it produces women's bodies as deficient models (6)--and the criticisms leveled at scientific representations of the body can also be leveled at Hirst's artworks. Of his giant anatomy models, for example, most show female bodies, although one, Hymn, is said to be a "neutral" figure. It has a smooth, rounded crotch reminiscent of a flayed Ken Doll, and as the dissection extends into the chest cavity to show the lungs, there is no sign of breast tissue (external genitalia and breast tissue would be key indicators of sex for a lay viewer and their absence allows the sculpture to read as neutral). I consulted anatomic pathologist Helen Doyle (personal communication, May 8, 2014) to determine whether subtler sex markers were visible to a medical professional: "It looks like a male, based on the hip size, the lack of lumbar lordosis, and also the laryngeal cartilage shape--it is pointed at the front rather than flattened (a female characteristic)," she explained, adding, "Also, apparently it is ripped 100% from a children's model, which were all male as standard--you had to specify female". Doyle went on to note that female anatomy models are "nearly always pregnant," an attribute that Hirst's three female anatomy-model sculptures share: all of them depict a female-bodied person carrying a near-term fetus and all three are shown dissected in such a way that the fetus is the visual focus of the piece, as in TMJ. Indeed, the dissection is deliberately designed to show the fetus; all three sculptures are flayed on the right torso, upper arm, thigh and head, and are sectioned to show the intact skull and the organs of the abdominal cavity. They're named, too, for purity--Verity, The Virgin Mother, Virgin (Exposed). By way of contrast, Temple (male) and Hymn ("neutral"/neutered?) show bodies dissected to highlight not their reproductive but their cognitive ability; the two male figures are shown with their skulls cut away to reveal their brains, and they're named for markers of civilization. Women here, then, are all body--and bodies in the service of reproduction--while men represent the cognitive, a divide consistent with early feminist science studies' criticisms of binary thinking associating women with, among other things, nature and the material, and men with the mind and intellect (Jordanova, 1999, 1993).

This dichotomy is taken to extremes in TMJ, in which women exist only as allusion. The fetuses in the sculptures are hyperrealistic yet diagrammatic; they show the clear lines of the illustrations Hirst drew on rather than the softer contours of a real fetus. In Decoding Abortion Rhetoric, Celeste Condit (1990) compares a diagram of an early fetus to abortus material from a fetus at the same stage of development. The diagram fetus is alien yet recognizable, apparently clenching its tiny fists, whereas the fetal tissue looks like a puddle of slightly lumpy goo (p. 90). She credits U.S. readers' ability to decode such images to training in a cultural context in which their "code for what is visually human is very broad" (85), while noting that rhetors using these images nonetheless must offer commentary and use other rhetorical devices to facilitate the reading of fetuses as babies. These commentaries function to promote a cultural medico-visual literacy that parallels the institutional literacy T. Kenny Fountain (2014) outlines in Rhetoric in the Flesh; in medical school, students viewing diagrams must learn to "identify this pictorial image as a body, a recognition gained through formal training and informal socialization" (p. 59), analogizing between idealized diagrams and the messy cadavers they will later dissect. If this analogy seems like work, it's in fact easier than decoding the "expert prosections" that Fountain identifies as offering "authentic value" even as they "make visual identification challenging" (p. 59); these are provided with labels and commentary as students are stepped through visual representations of the body that are ever-more authentic and confusing on the way to being able to locate and identify structures in a cadaver. Diagrammatic representations like TMJ are inexpert audiences' primary, and often only, exposure to anatomic imagery; as such, even as they are visually inauthentic, they are the realest--indeed hyperreal--representation of the interior of the body that's legible to this audience. They feel true and look true; they are truthy, but not true.

These detailed figures are contained within a stylized uterus with visible vagina, fallopian tubes and ovaries. Two of the sculptures, depicting the zygote and the earliest stages of embryonic development, show the figure in isolation--likely a result of the relative scale of fetus and uterus at that point--and the final sculpture shows a newborn baby with a clipped umbilicus. The sculptures are not a continuous representation of a single fetus, however, since one represents a twin pregnancy; the twin fetuses are shown approximately halfway through their development, with the sculptures that chronologically bracket them showing single pregnancies.

Sex characteristics are not visible in all of the sculptures, but most of the fetuses represented in TMJ have penises and would be assigned male at birth--including the final statue, the endpoint of the titular "journey," which shows a newborn with a clipped umbilicus. It's interesting to note, too, that when the sculptures were unveiled, Hirst chose to ally himself with that final statue; in publicity photos of the event, Hirst appears only in front of the newborn boy--and the photograph, unlike many other news images documenting the series, is taken from such an angle that the infant's genitalia are visible. (Most images of the sculpture, both photographs and promotional CGI mockups, show the baby from a perspective such that its leg obscures its penis.) Similarly, Carol Vogel (2013) reports that Hirst's initial pitch for the series highlighted masculinity, presenting gestation as beginning with sperm rather than an egg: "Mr. Hirst showed [Sheikha al Mayassa Hamad bin Khalifa al-Thani, who commissioned the work] some drawings of prenatal and natal development he had made in 2005, from sperm to fetus to newborn" (para. 13).

Throughout the series, the only sign of the mother's body is the reproductive organs, precisely enacting the erasure of women and privileging of the fetus that Carole Stabile (1992) and others have demonstrated to be a practice of domination and control. The synecdochic use of the fertile, fertilized uterus reduces women to not only their material reproductive potential, but also to a specific social role. The woman is worthy of representation (7) only insofar as she is capable of reproducing a man--an act that also testifies to her previous, and presumably future, sexual availability to a man. What's depicted here is not just the physical reproduction of the species, but also the social reproduction of fertile heterosexuality and patriarchy, norms that are naturalized and legitimized by their links, here as elsewhere, to scientific authority.

But the (mis)representation of the parent goes further. The uterus is included, and thus the woman's body represented, partly to provide context for the developing fetus--most necessary, perhaps, in its more alien early stages--but it also serves as a kind of decorative flourish. The zygote, embryo, and fetuses are represented in painstaking detail, but the woman's reproductive organs are heavily stylized. The fallopian tubes are shown completely enveloping the ovaries, with both structures wrapping down and around the uterus; the cervix is missing entirely and the vaginal canal, when present, serves as a base for the statue (a transition point between the plinth and the sculpture proper). The smooth muscles of the uterine wall are depicted with an almost wood-like texture with large swirls around central eyes--similar structures appear at the microscopic level in real smooth uterine tissue, but here they are scaled up and arranged linearly, appearing like a gilt frame or jewelry. (8) The reproductive structure is legible as such only because readers recognize its contents. It exists not just as a framing or contextualizing device, then, but as a literal frame--an aesthetic addition designed to highlight and show to best advantage the developing fetus that will ultimately become a bouncing baby boy.

The simultaneous presence and absence of the woman points to another rhetorical device: catachresis, which Jacques Derrida (1992) defines as the "violent and forced abusive inscription of a sign" (p. 255, emphasis in original). The reversal of scale--exemplified when the adult Hirst stands in front of the final baby sculpture--upends the primacy of the parent. The fetus is ripped from its literal context, shown freestanding rather than contained within another body, in the public square rather than within the family, and is also ripped its historical context of visual representation. The invisible fetus becomes a visible monument. Everything is wrong--and, as Paul de Man (1978) has it, "already turning into prosopopeia" (p. 21), throwing into relief the mother's presence as a readily dismissed figment of the viewer's imagination. (9)

Beyond Shock and Gore: Fetal Visualization and Abortion Care

These practices of visualization--and strategic erasure--are characteristic of fetal visualization beyond figural art. TMJ is clearly indebted to modern fetal visualization techniques, and the sculptures' explicit citation of Western medical visualizations facilitates their ready transcoding as evidence by anti-abortion activists in U.S. debates over access to abortion care.

The sculptures have much in common with fetal ultrasound, a practice that has been examined at length by feminist scholars, who criticize its construction of women's bodies as voids to be filled and its privileging of the fetus, and that has also been co-opted into abortion debates. Anneke Smelik (2008) tells us that endoscopic imagery feminizes the body by demonstrating that when "the interior of the body [is] made visible, its interior consists mostly of cavities" (p. 140). In TMJ, women's bodies are not mostly but only cavity, unvisualizable, missing, present only insofar as they can serve as a container for a developing fetus. Like ultrasound, Anne Balsamo (1996) explains, this "technological isolation of the womb from the rest of the female body" (p. 91) promotes objectification of women and "encourages the 'personification' of the fetus" (p. 93). In the years since Balsamo's landmark discussion of the politics of fetal visualization, little has changed. The development of technologies like amniocentesis, genetic profiling and fetal heart monitoring have offered new routes to creating the fetus as both person and patient, but ultrasound visualization--which, in its most basic form, is cheap, accessible, and a routine part of prenatal medical care--remains the dominant mode by which fetuses are comprehended and (de)contextualized medically, domestically, and socio-politically.

This process is codified in the legal requirement in many U.S. jurisdictions that abortion seekers see a sonogram of their fetus before a termination can be scheduled. (This is typically just one of a suite of laws aimed at restricting access to abortion care; other laws include waiting periods, heartbeat laws, physician scripts, and facility regulations.) The tactic is lifted directly from anti-abortion activists who, as Rosalind Petchesky (1987) put it close to 30 years ago, "have long applied the principle that a picture of a dead fetus is worth a thousand words" (p. 263). The principle still holds and now, alongside the graphic pictures of abortus material Petchesky discusses, anti-abortion activists carry ultrasounds of late-term fetuses.

The governmental control sought through these measures functions, in Carol Stabile's (1992) phrasing, not through ideology, but through the repression of material female bodies. The maternal space has, in effect, disappeared and what has emerged in its place is an environment that the fetus alone occupies. In order for the embryo/fetus to emerge as autonomous--as a person, patient or individual in its own right--all traces of a female body (as well as the embryo's presence as parasite within that body) must disappear (p. 180). Where the pregnant woman is permitted to appear, "in both popular culture and medical-legal discourses," she is set in a combative relation with the fetus she carries; her body is "an erstwhile benevolent, nurturing and ideal environment [which] has been transformed into a hostile, infanticidal toxic waste dump" from which the fetus must be protected, either by the government or by others setting themselves in a paternalistic position of authority (pp. 182-183). This ideology is most visible in debates over abortion access, but is also at work when miscarriages are framed as murder (Martin, 2014; Sheppard, 2013), when women are denied medical treatment that may harm the fetus (Stabile [1992] offers a compelling example in her article) and, in effectively the same terms Stabile uses, when billboards are posted asserting that "The most dangerous place for an African American is in the womb."

Visualization of the developing fetus has also become an aesthetic practice. Jose van Dijck (2005) describes ultrasound examination of a pregnant woman as "concurrently a medical diagnostic checkup, a psychosocial event, and a photographic ritual" (p. 101). This ritual and aesthetic dimension dates to the earliest days of fetal visualization. Janelle Taylor (2002) argues that early sonographers served as "image makers" whose role was not just to produce a diagnostic image but also to show the baby to the expectant mother and to her various guests. Dave, a sonographer working in the late 1960s, explained to Taylor that "it turned into a real show, and I'm a ham, I'd try to make people laugh and comfortable with the situation... you wanted good PR for the procedure anyway, because it was a fledgling... It was just natural with the obstetrical process... ito] give everybody a picture" (p. 372). Elsewhere in the article these printouts of the fetal image are referred to as "snapshots," moving them out of the medical domain and into the exclusively aesthetic--a memento for the family album, something to be displayed (Taylor, 2002, p. 369). These aesthetic practices created a market for routine diagnostic ultrasound and extend to the emerging market for "keepsake ultrasounds" provided by commercial businesses taking advantage of "the advent of new 3D and 4D ultrasound devices capable of generating more visually appealing and 'realistic' images" (Taylor, 2008, p. 144, emphasis added).

Taylor's phrasing highlights the dual demands placed on the representational practice of ultrasound, both within and outside its diagnostic context. The images produced must be as detailed as possible to be medically useful, but they must also be aesthetically pleasing in order to maintain their commercial appeal and perhaps remain an appealing part of the medicalization of pregnancy, as when early sonographers spoke of hamming up the procedure to ensure women's continued participation in prenatal scans. This double movement is also true of TMJ: it is designed to be accessible to and enjoyable by a broad audience while still maintaining an aura of scientific authenticity or truthiness due to its physical and narrated contexts and its hyperreal detail.

The sculptures are a monument not just to the fetus, but to visualization. There is a longstanding drive toward better visualization of the body's interior structures--clearer, more accessible, less invasive--and in the medical realm, ultrasound wins on the latter two counts. Ultrasound equipment is both cheap and portable, and it does not rely on harmful ionizing radiation. In addition, unlike many other technologies, ultrasound produces a real-time image, so that scanning procedures can be adjusted on the fly for better results. But it has historically lost out on the clarity front, producing murky images that require interpretation from a trained technician, and failing to visualize structures occluded by bone (such as the adult brain; infant skulls are more penetrable) or especially gas (for example, gastrointestinal gas makes it difficult to image the pancreas using ultrasound, and the lungs are entirely off-limits). Further, because sound is attenuated as it passes through

the body, ultrasound is limited in its ability to visualize the deep structures of the body. This problem is accentuated when imaging people of size, an increasing concern as obesity rates worldwide continue to rise. (10) Ultrasound is used for a variety of medical imaging purposes but is most commonly--i ndeed almost iconically--a ssociated with prenatal sonography. Fetal ultrasound is used for a variety of medical purposes (for example, diagnosing fetal abnormalities, monitoring placenta placement, etc.) as well as non-medical applications, although the U.S. Food and Drug Administration (2015) has for the last 20 years counseled against what they term "fetal keepsake videos," videos of ultrasound images lasting up to an hour, performed outside a medical context, and intended as entertainment to be watched and re-watched.

These videos are one side of an argument about identification and recognition in which fetal ultrasound is used to imaginatively establish the fetus as a baby--an independent person--whether in "baby's first home video" or in the pre-termination ultrasounds women are forced to look at in many U.S. states. Anti-abortion activists have in common with commercial sonographers the claim that viewing images of the fetus promotes maternal bonding--identification with the fetus as a result of its (re)identification as a baby. Indeed, some commercial sonographers pitch this as the entire reason for their services--for example, one Australian provider operates under the business name "3D Baby Bonding," offering home visits as well as baby shower and gender reveal party packages (3D Baby, n.d.). This bonding opportunity is pitched as a parent's right, and the accessibility of ultrasound imagery is an increasing concern. Diaper company Huggies scored a major public relations coup with a 2015 advertisement in which they 3D-printed a sculpture of an ultrasound for a visually impaired pregnant woman (Nudd, 2015). The advertisement was produced for the Brazilian market but garnered attention around the world. This "right-to-see" discourse is also implicated in the increasing prevalence of elective fetal ultrasound around the world, where routine ultrasound is less frequent than in the United States (Gammeltoft, 2007).

Like fetal photography, ultrasound images construct the fetus as an independent identity within what Nathan Stormer calls "a biological matrix" (Stormer, 2003) indicating the extent to which the fetus' environment is almost incidentally a(nother) person's body. These images are a critical component of the anti-abortion toolkit (Joyce, 2011), with 25 US states regulating ultrasound use and display as part of abortion care as of March 2016--ten require an ultrasound be performed and that the person seeking termination be invited to see the image, and a further three require the abortion provider to show and describe the image (Guttmacher Institute, 2016). Such laws have their basis in claims by anti-abortion activists that the overwhelming majority of people who see images of the fetus they are carrying choose not to terminate their pregnancy--the figures cited range as high as 90% (Kertscher, 2013).

But large-scale ethnographic studies demonstrate the opposite: viewing ultrasound images of the fetus they are carrying has little effect on people's decisions to terminate or continue their pregnancy (Graham, Ankrett, & Killick, 2010; Kimport, Weitz, & Foster, 2014). In the largest such study, a team led by sociologist Katrina Kimport examined the medical records of 15,575 people seeking abortion at a Planned Parenthood facility in Los Angeles, CA (California does not legislate ultrasound use during abortion care); all patients in the study underwent ultrasound examination, and 42.5% chose to view the images (Gatter et al., 2014). Ultimately, 98.4% of people who opted to see the ultrasound continued to abortion, compared to 99% of people who did not see the image, with a total termination rate of 98.8%. They found that viewing images of a fetus had a suasive effect only in the small proportion (7.4%) of study participants who reported major uncertainty about the choice to terminate: "women with medium or low decision certainty who viewed had a slightly lower rate of proceeding to abortion than did those with high decision certainty who viewed (95.2% compared with 97.5%)" (p. 83). While they caution against a too-easy generalization to include states that require ultrasound viewing as part of abortion care, the authors suggest that "it is unlikely that mandatory viewing would substantially affect the number of abortions performed" (86), but that it is likely such requirements will have a negative effect on patient care and outcomes by removing people's sense of agency.

Some anti-abortion activists have argued that artistic images of the fetus, divorced from the explicitly medical context of the ultrasound, facilitate a greater affective response and thus persuasive effect--and Hirst's TMJ has featured as an exemplar in many such arguments since its unveiling. In fact, the Colorado-based anti-abortion organization Personhood USA (2013) put the sculptures at the top of their (un-reviewed) BuzzFeed list, "7 Spectacular Pieces of Pro-Life Art." Their selection is telling, though: of the seven pieces, two are explicitly medical--Leonardo da Vinci's sketches and an engraving from Percival Willughby's case history Observations in Midwifery. Another set of images commonly circulated in the same way--as both art, divorced from science, and anti-abortion artifacts--are Lars Nilsson's early photographs of the human fetus. These photographs were first published in 1965 in Life magazine and have become icons of 20th-century scientific imagery; they have also come to be used frequently by antiabortion activists who find them priceless. Because the images are framed as documentary photographs, these activists argue, relying on a naturalistic enthymeme (Finnegan, 2001), that they "give intimate detail and clarity to the humanity of unborn children in the womb" (Smith, 2009, para. 1). But many of these images, said to show the living fetus, are in fact photographs of abortus material "obtained from women who terminated their pregnancies under the liberal Swedish law" (Buklijas & Hopwood, 2008, para. 3). Nilsson "experiment[ed] with lighting, background and positions, such as placing the thumb into the fetus' mouth" (Buklijas & Hopwood, 2008, para. 3) to create the appearance of life--experiments only possible because he was working with dead tissue. This perfect representation of the independent fetus, as in TMJ, is available only as a fiction in which death is marshaled in the service of life.

If the Nilsson photos are the best-known exemplar of this phenomenon, TMJ takes it to its extreme, and the sculptures have been received warmly by anti-abortion activists who saw the sanctity of fetal life articulated in the sculptures' title and Hirst's defining statement. (11) Some identified the pieces as uniquely powerful, surpassing medicalized images, precisely because of their artistic nature. For example, Eric Metaxas (2013) wrote that "The Miraculous Journey is yet another reminder of the power of art to communicate truth" (referencing, it appears, the "truth" that life begins at conception) (para. 12), while Joseph Granda (2013) speculated on the relative merits of beautiful--s anitized, metallic--s culptures over carnographic images: "If changing the culture of death in regards to the unborn is an artist's goal, then thoughtful works of art such as this is the best way of doing that. Not by shoving giant HD photos of the horror of abortion in the face of the public, that makes it too easy to look the other way" (para. 6).

Granda (2013) further argued that these sculptures "celebrate life," contextualizing them with reference to Qatar's laws around abortion, which he indicates is "punishable by jail and deportation"; these are set against more liberal laws in, presumably (given Breitbart's location) the United States with the comparison "casual abortion as birth control is an absolute no" (para. 5). It is of course the case that abortion occurs illegally around the world, and restrictive laws do more to ensure unsafe abortion than to curb termination rates; the World Health Organization estimated in 2017 that 45% of abortions between 2010 and 2014 were performed in violation of local law (Ganatra et al., 2017, p. 2372). Qatar's abortion laws are less strict than others in the region and comparable to laws in parts of Australia (Children by Choice, n.d.) and in the United Kingdom (Williams, 2017), both countries where abortion is still listed in local criminal codes but where grounds for a legal defense are codified in law. Many countries in the Middle East and North Africa bar termination on any grounds. In Qatar, abortion is permitted to preserve the physical or mental health of the mother, or in cases of fetal impairment (Center for Reproductive, n.d.). For example, the United Arab Emirates (like Qatar, a wealthy country whose population is dominated by non-citizens) permits abortion only to save the mother's life (Center for Reproductive, n.d). Given the relatively ready availability of abortion in Qatar, the similarity of Qatar's laws with those of Hirst's homeland, and the apparent lack of Qatari discussion about abortion in relation to the sculptures (see footnote i), it's hard without local evidence to take seriously Granda's implication that TMJ reflects or promotes an exceptionally pro-life culture.

Hirst has not commented publicly on such receptions of the work. But it's worth noting that these arguments rely on the premise that the beauty of this kind of fetal art renders them more effective as persuasive texts; the sculptures' positive affective potential offers a more compelling argument than the horror tactics of abortus photographs or the grainy charm of "Baby's First (Ultrasound) Picture." Above all, though, it's clear that these antiabortion activists recognized in TMJ a double movement which parallels their own visual rhetoric: as the fetus is rendered visible, the woman is erased.

The Present Politics of Visualization

This deployment of medical art as evidence in public debates points to the political urgency of this mode of analysis. Patriarchal cultures have long been intent upon controlling women's bodies, with the medical establishment an active participant in that effort. The last ten years, though, have seen a marked escalation in the intensity of visual surveillance applied to women's bodies in particular--and if the body is the battleground, the front line is its interior. Since 2011, record numbers of laws acting on women's bodies have been proposed in the United States, and these laws have often depended on visualization of the body's interior. This is best exemplified in recent debates over mandatory ultrasound laws in which women seeking abortion are required to view images of the fetus they carry; such representations reduce women to their reproductive capacity and have long been used to exclude and silence women (as well as used by women to resist such oversimplifications).

Such laws rely on appeals to scientific authority--the unstated premise that medical imaging reveals the objective truth of the body--for legitimation. But artwork like TMJ takes another route to naturalizing this mode of visual control. Medical discourse is set up to legitimize and naturalize certain ways of being and thinking, delineating certain kinds of bodies as a universal norm; artwork like TMJ is able to access medicine's authority, and thus its legitimizing power in the eyes of inexpert audiences. This affords such pieces a larger stage--quite literally, in the case of Hirst's outsized anatomic sculptures--as they are able to address broader audiences and operate in both logical and affective persuasive registers. TMJs liminal scientificartistic location works to legitimize and naturalize reproductive heteropatriarchy, while at the same time glorifying and monumentalizing it, making this social order not just inevitable but desirable. This double move further cements the "desired normality of reproduction" Stormer (2008) identifies at the core of "a politics that submerges bodily rights in the imperative of conceiving more human beings" (p. 54).

The Miraculous Journey is not unique in operating in a liminal space between the technical and public spheres. The sculptures and similar popular medical texts recall what Mary Louise Pratt (1991) terms "the arts of the contact zone"; while the term originally referred to linguistic and cultural encounters in the aftermath of colonialism and slavery, it resonates with popular medical images. Popular texts are far-reaching and engaging, and thus influential, and medical epistemologies are deeply enmeshed in society and carry enormous weight; people negotiate the relationships of themselves and their bodies within these cultures through textual production, circulation and mediation, "describ[ing] themselves in ways that engage with representations others have made of them" (Pratt, 1991, p. 35). My analysis in this paper extends studies in medical rhetoric of how people use cultural forms to mediate their experiences with and of medicine, and analyses in cultural studies examining the ways that power is articulated through and with medico-cultural forms. Pairing rhetorical criticism with cultural studies, as I have done here, offers a model for rhetorical analysis of texts that transgress generic boundaries by examining production, circulation, and effects in relation to their multiple genres and epistemologies, as well as engaging their implications for social justice. Attention to these articulations of medical, personal, and public discourses in popular texts could inform rhetoricians of health and medicine studying other discourses that are prominent in public debate, such as those of genomics, obesity, disability, and indigeneity, as well as reproductive health care beyond abortion access--all timely examples of sites where medical imagery is used to warrant social and political claims.

This mode of analysis may also facilitate action towards social justice. In "Bridging Analysis and Action," January Peterson and Rebecca Walton (2018) argue that scholars of technical and professional communication can enhance social justice scholarship by "examin[ing] how technologies might be used in settings other than those intended" (p. 23). Extending this call, medical rhetoricians can attend to the way patterns of representation and argumentation interarticulate with other power structures across cultures and disciplines in order to better understand and engage with their political effects. TMJ is one such site; by "trac[ing] its contexts and interarticulations" (Dingo, 2012, p. 111), we are able to see the artwork differently and better understand how, even as the sculptures might disrupt the epistemic norms of art and science in some contexts, they nonetheless function in other contexts to reinscribe cultures of expertise and domination that disproportionately impact women and people of color, such as anti-abortion ideologies in the United States. This richer understanding of The Miraculous Journeys diverse effects can allow a more nuanced engagement with and response to other such transcoded medico-cultural rhetorical texts.

BECK WISE lectures in writing at the University of New England, Australia. She studies medical rhetoric in public culture, with a specific focus on gender, race, disability and equity.


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doi: 10.5744/rhm.2018.1015

(1) Hirst uses the word "baby" in referring to the figures represented in these sculptures, in both interviews and contextualizing documentation. I will use the word "fetus" throughout this article, as the term--which describes the developing human organism between its tenth week of development and its birth--captures the majority of the 14 sculptures. In all, the series comprises one sculpture of a zygote, three sculptures of an embryo, nine sculptures of a fetus, and one sculpture of a baby.

(2) A Google search for "Hirst miraculous journey," limited to sites from Qatar, returns seven pages of results, mostly marketing or tourism sites, and mostly in English; adding "abortion" to the search string returns no results. Such a search can of course only give a limited indication of local debate; a full examination of the sculptures' reception in Qatar would require different methods.

(3) U.S.-based cultural studies is also politically committed, of course. The disjunction I'm drawing between U.S. and Australian notions of cultural studies is paralleled by the differing understandings of rhetoric in the two cultures: rhetoric is in Australia understood as a methodology in the named discipline of media and communication studies, in the form of rhetorical analysis.

(4) The hospital is currently undergoing a phased opening and opened an outpatient clinic on May 1, 2016; the main hospital's operations are at time of writing still being phased in.

(5) As of this writing, the Sidra hospital website does include images of medical practitioners and children undergoing examination on their "Clinics + Services" page ("Sidra Medicine," n.d.); online image searches suggest that some are unique to the Sidra site (including photographs of hijabi medical practitioners treating children of color), while others are stock photographs (including photographs of happy white families, or white children undergoing dental procedures).

(6) See, among others, Lisa Cartwright (1995); Donna J. Haraway (2013); Anneke Smelik (2008); Paula A. Treichler, Lisa Cartwright, and Constance Penley (1998); Catherine Waldby (1998, 2000).

(7) The representation here is literal but might also be read as Burkean: as the sculpture of the fertilized uterus stands in for the woman, the (absent, idealized, universalized) woman stands in for all women (Burke, 1941, p. 427).

(8) I presented an earlier version of this paper at the 2016 Gender, Bodies, Technology conference; one audience member suggested that the teardrop-shaped details in the uterine lining looked like sperm. They also look a bit like paisley. The teardrop shapes in that pattern are thought to reference the bent cedar, a figure signifying life in some Middle Eastern traditions.

(9) Allison Rowland (2016) recently argued that prosopopeic en/facing of fetuses--"any rhetorical event in which the unborn have faces, bodies or are generally considered social actors"--works to establish them zoetropically as "human-ized social actors toward whom we have an ethical obligation" (p. 42).

(10) This is most commonly discussed in relation to fetal ultrasound. Results vary, but medical research suggests that sonographers carrying out abdominal ultrasounds are unable to obtain satisfactory images of fetuses carried by people of size in around 70% of cases (Hendler et al., 2004a); this is ameliorated with advanced imaging technologies (higher-resolution or 3D imagers), with one study suggesting the rate of unsatisfactory images falls to around 40% when such technologies are employed (Hendler et al., 2004b)--although other studies have not found so pronounced an effect. Transvaginal ultrasounds are often used later in pregnancy for people of size for this reason: accuracy with abdominal ultrasounds increases with the gestational age--and thus size--of the fetus (Khoury, Ehrenberg, & Mercer, 2009). Researchers have also experimented with placing transvaginal transducers inside the belly button of people with a large volume of abdominal fat and found it to offer better visualization (Rosenberg, Guzman, Vintzileos, & Knuppel, 1995). Mommy blogs run by women of size, such as Pamela Vireday's (2010) Well Rounded Mama, offer strategies pregnant people can use to improve visualization, including the transvaginal transducer tip--but also things the screenee can do themselves, like manipulate their abdominal tissue to allow the sonographer a better angle.

(11) For select examples, see Joseph Granda (2013); Eric Metaxas (2013); Personhood International (2013); Carol Vogel and Natalia Osipova (2013).
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Date:Jun 22, 2018
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