 Critiques of the concept of procreative autonomy as misleading or empty rhetoric reflect a larger feminist project critical of autonomy construed as individual choice: within an inegalitarian social and economic system, some feminists argue, pressures on choice will ensure that supposedly free choices disadvantage women (e.g. Dodds and Jones, 1989a). This is particularly problematic when the medical establishment presents burdensome technologies as the expected norm. Choices are shaped by the salient alternatives, so that the widespread adoption of new medical technologies will affect women’s choices (as the normalization of testing for Downs’ syndrome shapes women’s choice to undergo such testing). The point is not that adopting new technology is always problematic, but that the repro-libertarian framework for evaluating it is naïve and misleading (Sherwin 1992; see also  3.5  below, State Policies). These concerns extend to the way in which reproductive policy and technologies shape, and are shaped by, race as well as gender (Roberts 1997; Russell 2018).