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Two parallel forms of citizenship are revealed through an analysis of Brazilian health care. Within reproductive health, the first—available to those who can afford private health—is founded on notions of individual choice and self-enhancement, whilst the second frames reproductive decisions in terms of the individual’s moral responsibility to the nation. These structural differentiations can be traced down to differences in the way sex hormones are administered to distinct segments of the population. Sex hormones are mobilized as modes of regulatory control on the one hand and to discipline individuals on the other. As contraceptives they are central to interventions on the population and through the unfurling of new forms of administration which produce innumerable consumer-subject(ivitie)s, they are also involved in individualizing modes of biopolitics, concerned with the performance of the body at the molecular level. Drawing on ethnographic descriptions of the negotiation of access to differentiated standards of care, the chapter initiates a broader discussion on health inequalities in Brazil through a critical discussion of the literature on biopolitics. Here, biochemical and biopolitical concerns intermingle. The chapter critically engage with approaches to bio-citizenships developed in contexts where biological inclusion is predicated on patient activism, and details how, in a context marked by deep inequalities, complying with medical regimes is an integral part of constituting oneself as a citizen.

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