Making Healthy Families: The Biomedicalization of Kin Marriage in Contemporary Turkey

这一奖学金旨在通过不同的参与途径将我的博士研究成果提供给更广泛的受众。这项研究通过探索亲属婚姻是如何被概念化、管理和谈判为遗传风险因素和在当代土耳其交叉的生物医学和遗传空间内的生殖健康问题，来关注生殖遗传健康服务对土耳其“健康”家庭的影响。它询问“健康”生殖和“健康”家庭的概念如何影响围绕亲属婚姻的生物医学管理的卫生政策、论述和做法，以及实行亲属婚姻的夫妇如何在他们的遗传服务经验中回应和谈判“有风险的生殖”和“遗传风险”的概念。虽然近亲婚姻在土耳其是合法的，而且相对频繁，但这些婚姻模式在土耳其社会中一直占据着一个有争议的地位。现代主义民族主义话语将亲属婚姻描绘为奥斯曼帝国历史的残余，象征着内在的“非现代性”、“传统主义”和“东方”他者的挥之不去的存在。自1980年代以来，随着土耳其生殖遗传健康服务的普及和常规化，随着亲属婚姻作为生殖健康问题重新概念化的出现，这些对亲属婚姻的他者化和污名化的现有遗产获得了新的生物医学性质。这种血缘婚姻的生物医学化(阿黛尔·克拉克)将未来公民应该如何在社会和政治上令人满意的家庭环境中抚养长大的问题转移到了未来公民应该如何孕育和出生的问题上。基于对政府发布的关于生殖健康、家庭和亲属婚姻的相关文献的批判性阅读，对医学遗传学专业人员以及实行亲属婚姻的夫妇的37次定性采访，以及在伊斯坦布尔一家公共遗传学诊所停留的两个半月的观察，本研究探索了这一“生物医学化”过程的(生物)政治含义。它揭示了将以前被社会污名化的做法(如亲属婚姻)重新定义为医疗问题并不一定会结束，但可能会加剧污名化。它还阐明了生殖遗传健康服务的扩展如何为在分子/基因组层面上(自我)监测和(自我)管理家庭制造和生殖开辟了新的场所，同时使国家干预家庭生活和生殖亲密关系的现有遗产永久化。因此，这项研究强调，不仅需要调查医疗保健领域技术科学创新的变革潜力，还需要调查其将医学、民族主义和国家治理之间持久的、令人不安的联系延伸到21世纪的能力，同时通过强调个性化基因组医学和自愿选择使这些联系更加崇高。最后，本研究告诫不要将遗传健康服务视为改善生殖健康的灵丹妙药，因为它突出了这些服务的不平等目标的潜力以及它们被使用的分层和分层的背景。

This fellowship aims at following up on my PhD research by making it available to wider audiences through different pathways of engagement. This research focuses on the impact of reproductive genetic health services on the making of "healthy" families in Turkey by exploring how kin marriage is being conceptualized, managed, and negotiated as a genetic risk factor and reproductive health concern within intersecting biomedical and genetic spaces in contemporary Turkey. It asks how notions of "healthy" reproduction and "healthy" familyhood inform the health policies, discourses and practices surrounding the biomedical management of kin marriage, and how couples practicing kin marriage respond to and negotiate concepts of "risky reproduction" and "genetic risk" in their experiences with genetic services. Although kin marriages as close as first cousin marriage are legally accepted and comparatively frequent in Turkey, these marriage patterns have long occupied a contested position within Turkey's society. Modernist nationalist discourse depicted kin marriages as a remnant of the Ottoman past signifying the lingering presence of internal "non-modernity", "traditionalism" and "Oriental" otherness. These existing legacies of otherization and stigmatization of kin marriage have gained a new biomedical quality with the emerging re-conceptualization of kin marriage as a reproductive health problem following the spread and routinization of reproductive genetic health services in Turkey from the 1980s onwards. This "biomedicalization" (Adele Clarke) of kin marriage has shifted the question of how future citizens should be brought up in a socially and politically desirable familial environment to the question of how these future citizens should be conceived and born in the first place. Based on a critical reading of relevant government issued texts on reproductive health, family making and kin marriage, 37 qualitative interviews with medico-genetic professionals as well as couples practicing kin marriage, and observations during a two-and-a-half months stay at a public genetics clinic in Istanbul, this research explores the (bio)political implications of this "biomedicalization" process. It reveals how the redefinition of a formerly socially stigmatized practice (such as kin marriage) as a medical concern does not necessarily end but may intensify stigmatization. It also sheds light on how the expansion of reproductive genetic health services opens up new sites for the (self)surveillance and (self)management of family making and reproduction at the molecular/genomic level while perpetuating existing legacies of state intervention into the intimacies of family life and reproduction. This research thus emphasizes the need to investigate not only the transformative potential of technoscientific innovation in healthcare but also its capacity for extending enduring, unsettling affinities between medicine, nationalisms and state governance into the 21st century while rendering these more sublime through an emphasis on individualized genomic medicine and voluntary choice. Finally, this research cautions against notions of genetic health services as a panacea for improving reproductive health by foregrounding these services' potential for unequal targeting as well as the stratified and stratifying context within which they become employed.