“When I had my abortion, I was told not to have any food or drink for the day. The medical staff did not let me bring an accompanier either. They did not give me painkillers or anything. The process just happened, and it was ‘a successful abortion.’ They did not yell at me, but I knew they thought I was not a good woman.” (Elvira, 27. Mexico City)
Elvira’s abortion took place in 2019. Although first-trimester abortions have been legal in Mexico City since 2007 and abortion bans were declared unconstitutional by the Supreme Court in 2023, gyneco-obstetric violence in Mexico continues to raise alarms. According to the last National Survey on the Dynamics of Household Relationships in 2021, nearly a third of women in Mexico have experienced some form of violence during childbirth-related procedures. However, this figure could be even higher, reaching four out of ten women in Mexico City, when considering other sexual and reproductive care procedures like routine check-ups, abortions, and contraception consults. Gyneco-obstetric violence in Mexico is not the result of “a few bad apples” but rather reflects a systemic problem rooted in the exploitation women endured in the name of modern gynecology and obstetrics development.
In Surgery & Salvation: The Roots of Reproductive Justice in Mexico 1770-1940, Elizabeth O’Brien traces how the development of reproductive surgery shaped reproductive governance in Mexico. She offers a historicized account of technical developments in surgery as products of both religious and scientific praxis, as well as crucial instruments in the disciplining of women into “useful” commodities for political projects. In the 18th Century, for example, the Spanish Crown, through Catholic authorities, mandated priests to perform cesarean operations on dead and dying women, in order to baptize infants whose souls would be saved from purgatory by becoming subjects of the Catholic Church and, no less importantly, of the Viceroyalty of New Spain.
She offers a historicized account of technical developments in surgery as products of both religious and scientific praxis, as well as crucial instruments in the disciplining of women into ‘useful’ commodities for political projects.
Later, in the 19th and 20th centuries, O’Brien illustrates how women served a “corporeal service” to the nation-making project of Mexican science and medical advancement. Ovariotomies, tubal ligations, vaginal bifurcations, and hysterectomies were performed on women as a means to advance surgical techniques, but also were often conducted to treat “hysteria” and other “moral crises.” For example, therapeutic abortions were performed on young women to prevent them from being perceived as “fallen women.”
O’Brien covers nearly three centuries of Mexican medical history, tying the evolution of reproductive surgery as a professionalized scientific endeavor to the concept of salvation. She focuses on four historical periods: religious (1745-1840), post-colonial (1840-1876), positivist (1876-1911), and revolutionary (1911-1940). The primary sources O’Brien employs include clerical, medical, and state archives; mission records; medical student theses; journalistic coverage; women’s formal complaints against hospitals and clinicians; and correspondence from physicians, public health officials, and the Sanitary Police—a state-designed authority in charge of hygiene policy enforcement. These documents demonstrate how the surgical salvation rhetoric evolved from a metaphysical endeavor aimed at saving souls during the religious period to a secular moral directive serving the positivist project of the Porfiriato by protecting the nation from unfit women and their progeny. She describes this period as defined by a Darwinistic focus that emphasized the need for “useful citizens” that could “advance the race.” Thus, the pathologization of gender and race emerges as a significant theme throughout the book’s diverse range of primary sources.
The first of five sections in the book, “Surgery and Religious Salvation,” focuses on cesarean surgery by analyzing Sacred Embryology by Francesco Cangiamilia and its notions of “ensoulment,” a concept that still informs present debates over the prioritization of fetal personhood over the health and well-being of pregnant individuals. The second, “Surgery and Postcolonial Salvation,” deals with the construction of women as irrational subjects in two ways: as hysterical and immodest patients in need of medicalized intervention, and as unfit healthcare providers in need of supervision from male doctor-scientists.
The third, “Racial Science and Surgical Salvation,” shows how the Porfiriato secularized medical knowledge for population control within the framework of a nation-making project. O’Brien documents how pelvimetry was used as a tool for racial discrimination against Indigenous women, since doctors believed that pelvic structure was indicative of fertility and moral character. The fourth, “Surgery and Revolutionary Salvation,” follows the Malthusian logic on eugenic sterilization through tubal ligations, vaginal bifurcations, and hysterectomies. During this period, doctors framed the sterilization of Black and Indigenous women as a “professional sacrament” required to achieve the “racial regeneration [of Mexico]”.
Surgery and Salvation’s main contribution is the historicization of reproductive injustice in the clinical space.
Finally, in “Resistance,” O’Brien highlights women’s organizing efforts to advocate for their dignity, autonomy, and even survival by protesting mistreatment and violence in hospitals during the Mexican Revolution. This historical analysis reveals how surgical practice and innovation became a site of reproductive injustice, highlighting the power dynamics intersected by gender, race, and class that enable gyneco-obstetric violence, as Elvira experienced, to persist in Mexico’s healthcare system today.
Surgery and Salvation’s main contribution is the historicization of reproductive injustice in the clinical space. A particular strength of this book is the triangulation of diverse sources, including the unpublished writings and theses of medical students. These provide the reader with a somewhat unfiltered view of how medical training evolved in Mexico and the influence theological ideas had on scientific and clinical developments. Further research in this field might examine women’s notions of consent and agency in the clinic during these periods, or deepen the inquiry regarding midwives, parteras, and nurses’ engagement in surgical practice and salvation discourse. O’Brien’s archival research reveals that cases like Elvira’s are not isolated incidents, but expressions of structural violence. Addressing reproductive injustice today requires reckoning with this history.
Génesis Luigi Bravo is a doctoral student at the Departments of Sociology and Women, Gender, and Sexuality Studies at Yale University.