News this week has been filled with coverage of the Supreme Court's announcement that it will hear two challenges to the HHS contraception mandate. Consider the possible outcomes in the context of this smattering of stories also from this week's news:
Sorry, guys, no articles about SPERM and fetal harm.
Long before we get the to point where we are talking about men, sperm mutation, fetal harm and reproduction we will be grappling with the consequences of women's bodies no longer being involved in gestation at all. And, every time we make a decision about contraception and abortion, we create dangerous and powerful precedents for who gets to have a say in gestation.
J.B.S. Haldane, a British scientist who predicted that by 2074 live human births would make up less than 30 percent of all births, first coined the term ectogenesis in 1924. His prediction about ectogenesis, a technology in which a human fetus gestates completely out of a mother's body, was ambitious, but not unrealistic. It is already a partially realized, life-saving technology. In the past 30 years our reproductive technologies have achieved what would have previously been considered miraculous. Artificial wombs, a form of life support, are the logical conclusion of those efforts and their reality will end the abortion debate as we know it. But it more than that, it will challenge gender roles and ideas about "mothering" and "parenting." It will also show the degree to which we are willing to ignore misogyny.
There are two commonly cited endeavors in progress. Focusing on finding ways to save premature babies, Japanese professor Dr. Yoshinori Kuwabara of Juntendo University, successfully gestated goat embryos in a machine that holds amniotic fluid in tanks. That was in 1996. On the other end of the process focusing on helping women unable to conceive and gestate babies, is Dr. Helen Hung-Ching Liu, Director of the Reproductive Endocrine Laboratory at the Center for Reproductive Medicine and Infertility at Cornell University. Quietly, in 2003, she and her team succeeded in growing a mouse embryo, almost to full term, by adding engineered endometrium tissue to a bio-engineered, extra-uterine "scaffold." More recently, she grew a human embryo, for 10 days in an artificial womb. Her work is limited by legislation that imposes a 14-day limit on research project of this nature. As complicated as it is, her goal is a functioning external womb and the result will be sexless (in both meanings of the word) reproduction.
Even if it takes scientists several decades, medical advancements are steadily narrowing the gap between in vitro conception and neo-natal scenarios of fetal viability outside of the womb. Predictions for the full realization of what scholars Scott Gelfand and John Shook call "immaculate gestation"* range from 10 to 60 years. When the gap closes then babies, navel-less, will no longer have to be "born."
Gee, this will make the monitoring and regulation of women as production units so much easier. Problematic women, from poor white ones in Alabama and poor black, unwed mothers in Mississippi, immigrants who might drop anchor babies or needy suicidal ones don't have to cause society so much angst because they muck up gestation environments. Same with those who trip or are worried, or get into car accidents. South American cardinals can set up cozy homes with extraction facilities for girl children who "find themselves" pregnant with twins. I know how harsh that last one sounds, but there it is -- from Magdalene Laundries to excommunicated, raped 9-year olds to Catholic bioethical arguments for "embryo transfer" -- it would be irresponsible to ignore.
Current issues pale in comparison to the potential impact that ectogenesis will have. It has astounding power to alter, in unprecedented ways, the interests, roles, rights and responsibilities of women, men and the state. What happens when women, like men, can be parents without bearing children? What happens when both men and women contribute equally -- by providing only gametes -- to reproduction? Does one form of gestation, in womb or out, become a status symbol like breastfeeding versus wet-nurses used to? Will using a biological womb become a stigma, something only the underprivileged do?
Here's my favorite today because it is already so relevant: Who decides which gestation environment is healthier or more economical? You? Your gamete-partner? Your priest? Your hobbyist-heaven evangelical Christian employer? Your insurance company? Your Catholic hospital? Your state house! There are a whole lot of people already massively invested in women's pregnancy outcomes and clearly, deleteriously affecting risk assessment and care. I'm not being snide when I say consider Darrell Issa and another all-male panel of "experts" making "ethical" decisions about "gestation environments." While there are many male feminists and no shortage of female misogynists, actually being a person who can get pregnant appears to affect how you think about female bodily integrity. I mean, really, only 23 percent of Republicans in this country think electing more women to office is important -- which is how we end up with patriarchy patrolls. Do women have to carry human babies? What if they don't want to? What if "transferring" is coerced? It bears repeating out loud: As long as these considerations are the result of men's only clubs speaking for all of humanity, they are incomplete and insufficient and can make no claim to morality or ethics. That's why organizations with traditional, all-male power structures, like religious institutions, have zero business being making gender-unilateral decisions about women's lives and health. EVER.
Feminists in many disciplines have extensively considered what ectogenesis could mean for women's rights, the structure of the family, class, race and society.
At first, the medical benefits seem clear -- the technology will help infertile couples, enable premature babies to survive, create an alternative to surrogacy when needed, and help people unable to carry their own babies. Ectogenesis can provide safe, healthy gestational environments -- free from drugs and alcohol. Other benefits posited by advocates of the technology range from better-adjusted children, freed from mothers who are overly invested in them, to, although morally repugnant, the steady supply of "spare parts" that could be harvested from "bottled" embryos.
As far as considerations of what it means to give "birth," be a "mother" or a "father" -- right wing anti-choice activists, although perhaps initially delighted to have an alternative to abortion, will have to contend with radical redefinitions of "motherhood" and the hierarchical and gendered societal relationships to which it's a necessary prerequisite. Ectogenesis opens up real possibilities for men becoming primary care takers.***
But, what does it mean to sever human "birth" from the human body? In the U.S., ectogenesis renders viability and issues surrounding privacy and a woman's right not to be pregnant moot. This connection, between women and human birth, is one of the sole sources of security that women have in some societies. The terms, practices and applications of the technology have troubling antecedents. Once a fetus can be safely and entirely gestated outside of a biological womb, it can be removed from its mother, right?
Arrests and Forced Interventions on Pregnant Women in the United States, 1995-2005: Implications for Women's Legal Status and Public Health, a study released earlier this year by the Journal of Health Politics, Policy and Law, described more than 400 examples of women seized and in which pregnancy was a necessary part of the deprivation of their civil rights. No state has any law holding women liable for the outcomes of their pregnancies or laws that overtly target women. However, many states engage in the deliberate misapplication and misinterpretation of existing laws to target women who are "bad." We now have precedents in the law that make it entirely feasible that states could require women to have their fetuses extracted as an alternative to abortion, with serious long-term negative impacts.
In her seminal work, The Dialectic of Sex, written in 1970, Shulamith Firestone argued that inequality between genders, and women's virtual imprisonment in the home, was the direct result of biological reproductive differences and women's correlating investments in mothering. To date we aren't comfortable talking about pregnancy as a violation of women's right to freedom. Maybe ectogenesis will surface that fact. For her, ectogenesis, accompanied by revolutionary social changes, was the way to free women from the tyranny of their own biology put in the employ of patriarchal structures, including the traditional family. She noted that, so far, these technical and social changes have been impeded by medicine's domination by men, who have no vested interest in upsetting the traditional status quo.
This same status quo has demonstrated the extent to which it is willing to view mothers as flesh and blood mother machines**. News stories like the ones above do little to inspire confidence. Ann Oakley's book The Captured Womb: A History of the Medical Care of Pregnant Women illustrates how ectogenesis would be part of a long-standing habit in which male and often misogynistic medical cultures have taken control of birth and women's wombs in the name of science. In this framework, ectogenesis will exaggerate preexisting inequities and biases. This is the Handmaiden's Tale scenario. In this envisioning, not only will women be further marginalized and oppressed, but also they will become obsolete. Writing in the National Catholic Bioethics Journal in 2005 Christopher Kazor focused on the difference between extraction/evacuation and termination in considering the impact of ectogenesis on abortion decisions, citing a Guardian article titled, "Men Redundant: Now We Don't Need Women Either." No mention of power, false equivalencies or similar "tricky issues."
Sounds like hyperbole until you take a good long look at the 160 million women are missing from the planet because of existing boy preferences. Misogyny has always resulting in the killing of girls and women because they are girls and women, using the technology at hand: rocks, fists, sperm spinners, abortions. There is very little reason to think that in parts of the world this technology will not similarly amplify the same sentiments. Although women have "value" other than growing babies in a patriarchal society -- most specifically child rearing and free labor -- gestation remains, worldwide, the most important. Even in the most female-denigrating cultures a woman is prized, if only, for her childbearing, at least as long as there remains a chance that she'll give birth to a son. Ectogenesis means women stand a real chance of losing the fragile, temporary primacy currently conferred on them as a result of gestation.
Feminist analyses include intersectional implications of ectogenesis, the predictable patterns of which can be found in the current distribution of assisted reproductive technologies and reproductive injustice along racial and class lines. This technology becomes another form of violence in what Patricia Hill Collins long ago called a global matrix of domination. Dorothy Roberts, Killing the Black Body, Michelle Goldberg's The Means of Reproduction and Rebecca Kulka's Mass Hysteria: Mass Hysteria: Medicine, Culture, and Mothers' Bodies are all excellent discussions of these ideas.
Who controls ectogenesis technology, and how it is utilized, is the key to whether or not it is a tool of liberation or oppression for women. Globally, compared to other developed countries, the United States has very little regulation regarding assisted reproductive and related technology. And, although lots of people in state capitals are eager to wax on about the status of embryos and throw around the word "personhood" there are currently virtually no federal or state regulations regarding the impact of how we use gametes, embryos, artificial wombs and engineered birth.
As with all new technologies, particularly biotechnological ones, bioethicists are thinking about the social, legal and ethical implications. Fore example, Kulka, the author cited above, headed up a 2012 committee of feminist bioethicists explore, among other things, equipoise, the balance and counter-balancing of interests during pregnancy. I, for one, am very happy they are because the moral, ethical, legal and societal consequences are so profound and we are so blithely unprepared for them.
Portions of this post were originally published in RH Reality Check.
Additional Sources and Reading
** Gena Corea, The Mother Machine: Reproductive Technologies From Artificial Insemination To Artificial Wombs, Harper Collins, 1985
***Maureen Sander-Staudt, Of Machine Born?, Ectogeneis: Artificial Womb Technology and The Future of Human Reproduction, Editions Rodopi, B.V., 2006
Richard T. Hull, Ethical Issues in the New Reproductive Technologies, Prometheus Books, 2007
Christopher Kaczor, The Ethics of Abortion: Women's Rights, Human Life, and the Question of Justice, Routledge, 2011
Jessica Pierce and Georgle Randels, Contemporary Bioethics: A Reader with Cases, Oxford University Press, 2010
J.B.S. Haldane, Daedalus Revisited, Oxford University Press, 1995
Shulamith Firestone, The Dialectic of Sex, 1970
Ann Oakley, The Captured Womb: A History of the Medical Care of Pregnant Women,Blackwell Publishers, 1985