Essays: Gender Studies : New Reproductive Technologies

Essays and papers

An examination of the assumptions about motherhood and feminine agency which are embodied in debates about the new reproductive technologies.

All papers in this section ©2002 Franni Vincent : they are here for your information, and I'm happy to discuss the ideas & content - contact me at franni@cantab.net .However, please do remember that some have been available on my websites since my time at Cambridge University: before you're tempted to use whole paragraphs from them, remember your tutor's probably already read them...

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'I don't remember Mr Steptoe saying his method of producing babies had ever worked, and I certainly didn't ask. I just imagined that hundreds of children had already been born through being conceived outside their mothers' wombs. Having a baby was all that mattered. it didn't seem strange that I had never read about anyone who had had a child in that way before. I could understand their mothers wanting to keep it quiet afterwards about how their children had been started off. It just didn't occur to me that it would be almost a miracle if it worked with me'

The words of the first mother of a test-tube baby illustrate several of the issues of both motherhood and feminine agency which have been highlighted in debates in the West about the new reproductive technologies. Women's supposed desire for children, whether real or socially manufactured, the all-powerful male hierarchy, the experimentation disguised on women disguised as therapy, the social stigma of infertility, the complete absence of agency conveyed in the lack of informed consent to what was taking place are all demonstrated in her words. Overlaid on this, the language of benevolence, the 'miracle' produced by the kind doctors whose only interest was to help infertile women... This one piece illustrates many complex issues.

Leaving aside for the moment an examination of aspects of new reproductive technologies other than infertility treatment, examining assumptions about motherhood in the light of the issues of infertility itself shows just how little choice women actually have. The assumption throughout is that infertile women are somehow not fulfilling their 'natural' goal of motherhood. Despite changing patterns of women's work, where girls now expect to work and possibly delay childbirth until far later than the immediate post-war generation, there is still an assumption that marriage equates with motherhood. Women's participation in Motherhood can be said to be still the main goal: however, technology has allowed women, in the West at least, not just to produce a baby, but to ensure it is a physically perfect one, which includes one of the 'right' sex. This becomes an end which excuses the methods by which infertility is (mis) treated. Infertility treatment has increased as the number of children produced has declined. It is no longer acceptable in the West for women to accept their lack of children without trying all available options. As contraception became more successful, particularly among the unmarried, and at the same time the social stigma of illegitimacy declined, and social workers insisted on 'same race' placements and barriers placed on third world adoption, fewer babies came up for adoption, and the main alternative to producing a baby of her own disappeared.

Development of this aspect of new reproductive technology in itself is sometimes the converse of the 'success' in other aspects of the same technology - that of prevention of fertility. More women are presenting as 'infertile' who have children but have become sterile through previous long term attempts to control fertility through IUD, or less often through the Pill. Thus the pressure to enter motherhood again, to present a new partner with 'a child of his own', or the desire to delay motherhood which has inadvertently turned to sterility is adding to the ranks of the infertile. The increased pressure for infertility treatment comes in part from the unwillingness on the part of women themselves to continue to 'try' and 'fail' to achieve pregnancy for the length of time which might once have been recommended, and also from the general awareness that infertility is no longer necessarily untreatable. Awareness of the technologies through the media has built up the expectations of society as a whole which has maintained the illusion that medicine is science. By treating IVF as an established, successful therapy, rather than a still experimental and largely 'research and development' oriented business, the medical profession has obliterated some women's real choices, including the right to be given safe treatment. Only the rare successes received publicity, not the statistics of the many whose traetment failed, or the deaths of women and miscarried babies.

The first move on what becomes an assembly line of treatment may seem to have been made voluntarily. But the 'natural' desire for parenthood is soon overwhelmed by the technology involved. Being defined as infertile ensures an immediate transformation from a woman healthy in all respects, who happens not to have produced a child, into a 'patient'. Any sense that an infertile woman continues to retain 'choice' or agency is illusory. Even before arriving at the IVF clinic, a woman has at the very least had her sexual life reduced to a series of encounters marked by circles on a temperature chart in attempts to predict ovulation, and a set of extremely painful treatments behind her usually carried out without anaesthetic, as air and/or dye is forced through her fallopian tubes. With little indication that such procedures rarely work, she may have had fallopian tubes reconstructed more than once, her navel reduced to an area of zero nerve sensation through laparoscopies, and major surgery to remove consequent adhesions. Students may even have practised steering the laparoscope or vaginal examinations on her during her operations, about which she will know nothing. At the lowest end of the technology, any woman given a temperature chart , a set of instructions about when to have sex, and faced with the 'evidence' of her failure as a woman by allowing herself to be labelled 'subfertile' would be brave to ask her gynaecologist for a speculum, mirror and instructions on what a 'ripe' cervix and cervical mucous looked and felt like as this might be of more use.

IVF and other forms of embryo transfer technology have displaced investigation into causes of infertility. This is not necessarily the choice of the infertile women themselves, but the result of the research priorities being driven by those 'pharmocrats' for whom there seem to present more publicity, more job opportunities, and certainly more financial reward than in, for example, investigating sperm/ cervical mucus hostility , a major cause of intra-couple infertility, even when each individual concerned is not otherwise infertile. The desire for the male embryologist to succeed in creating human life, womb envy carried to an extreme might be involved. Infertile couples have not 'driven' the technological developments in research: gynaecologists, together with embryologists originally working in the veterinary field have. Success on a research project may be measured only in terms of 'viable embryos', life artificially manufactured, not babies in cots: the prohibition on experiments after the embryo is 14 days old may actually encourage this.

Risks of treatment are rarely explained. Ever increasing doses of Clomiphene, with its inherent risk of multiple birth at 'best' and over stimulation of her ovaries leading to cysts, or ovarian cancer at worst, will be prescribed with no encouragement from her consultant to question possible side-effects. Painful injections of Perganol will be given, and even if the egg capture is successful, and the embryo implants, it will still be bombarded with more and more drugs. No one will be able to answer truthfully whether the resultant baby might, (like the sons and daughters of women who took DES), be a walking time bomb, who will later develop cancer, or have fertility problems of its own. Issues surrounding the necessity for egg collection for embryo research is an active discouragement to the medical practitioners to modify the dosage to produce only the eggs necessary.The opportunity to have IVF treatment on the NHS is available to so few women, that any questioning of the treatment given will carry the unacknowledged fear that it will result in a more acquiescent 'patient' being given priority. Socially, once the woman has admitted receiving treatment, "giving up" before financial resources are exhausted becomes almost impossible: to the stigma of infertility which already existed, an additional one is thereby added, that of 'not trying hard enough'

Yet the 'infertile' population is in itself not a unified whole. Writing as if all infertile women have the same access to this technology is misleading: it ignore the unequal access across class and race boundaries. The greatest level of infertility is likely to be in those who have had the worst deal on contraceptive treatment, or their gynaecological problems ignored or misdiagnosed. These are, not surprisingly, in Britain likely to be poor, of Asian or Afro-Caribbean origin, probably living in inner city areas, possibly given IUD or even in some cases Depo-Provera. Athough they might live which within reach of teaching hospitals where the few IVF research projects operating in NHS hospitals take place, they are less likely to be referred for IVF and are less likely to be able to afford the costs . The selection procedure for those who may have access is dependent now on two factors: ability to pay, and 'suitability' for parenthood. As NHS resources shrink, infertility treatment is regarded as suitable for cuts: infertile women can be relied upon after all to be patient, or if not to find ways of financing private treatment.

The new reproductive technologies have brought about not just economic, but moral judgements are made about suitable candidates for motherhood. The recommendations made firstly in the Warnock Report in 1984, and later reinforced in the Human Fertilization and Embryology Act of 1990, restricted 'suitable' candidates for motherhood to those in stable (implying heterosexual, married) relationships. Single women and lesbian couples were specifically mentioned in the debates as less than ideal candidates for motherhood, and their experience within NHS infertility clinics bear this out . Women's 'natural' desire for children, upon which the arguments for developing the techniques are based, is thus only legitimated if the desire is accompanied by the social desire of a father to complete the unit. Yet those selected have passed no tests for their potential suitability other than approval by the gynaecologist: for example, the 'subjects' for the research carried out on the MRC programme at Cambridge were selected in part from one consultant's list of patients he was treating at a local private hospital , by definition 'suitability' for this group in part came from their proven ability to pay for their desire for a child. Inability to pay even the 'nominal' drugs charges on some MRC programmes excludes many, and in countries with no equivalent to the NHS, and all medical fees to be found, motherhood in these circumstances is economically restricted to the middle class able to pay.

The ownership of embryos themselves have become an issue: pressure on research clinics for eggs leads to couples being encouraged to sign over 'spare' embryos. The 'problem' of the several thousand frozen unclaimed embryos is currently being discussed on television chat shows, as to whether these can be 'donated' to infertile couples, or whether they remain legally the property of their parents who should be able to vet potential recipients. New degrees of motherhood have been created by the concept not only of egg donation, but of surrogacy and donor insemination, sometimes all three combined in the production of a child. Surrogacy cases which have come to the courts test further the concept of 'fitness' for parenthood:cases such as that of "Baby M" have involved consideration of the ethical and legal issues which had lagged behind reproductive reality. The host mother who decides she is unable to part with the baby can no longer rely upon the courts defining the mother as the person who gives birth. Regardless of whether the egg was from her own ovaries, or whether she was acting as merely a 'host' to an embryo from gametes giving birth is not enough when the concept of motherhood itself becomes so fragmented; bio-motherhood, uterine-motherhood and social motherhood no longer encapsulated in one person.

Dworkin has expressed the fear that the end result may be breeding brothels as middleclass ovaries are superovulated to produce eggs which will be hatched in wombs of the lower classes, creating a caste of 'reproductive prostitutes'. This fear seems encapsulated in the attempts to prevent payments for more than 'expenses' in surrogacy. Any attempt to prevent the commodification of reproductive services by making payments illegal has ensured these are being driven underground: egg donors presenting as 'best friends' of the infertile woman may be being paid for their services. Sperm donors continue to be allowed to receive payment for services, but in continuing to treat motherhood carried out on behalf of a third party as 'natural', and therefore not suitable for payment, the dangers and hardship involved in donating eggs, or in GIFT or IVF treatment continue to be unacknowledged. The woman is supposed to act out of altruism alone, 'sacrificing comfort and ease in order to enable others to have children'. A woman who has little opportunity of legitimately earning the money surrogacy could provide her may be being denied a choice..

The technology's entry into areas of reproduction other than infertility treatment predated IVF. Ultrasound scanning which twenty years ago was barely able to detect twins, a placenta too close to the cervix, or an anencephalic baby can now be used to ascertain whether foetal development is 'normal' at earlier and earlier stages of pregnancy, and even used to pinpoint eggs in their follicles. The effect of this may apparently be a positive enhancement of the experience of motherhood, but the effect of both ultrasound techniques and foetal-heart monitoring has been described by feminists as attempts to 'monitor, control and possibly intervene' as well as to overmedicalise the 'natural' process of reproduction. Corea, Oakley and others class foetal monitoring techniques as another example of the male attempt to exert control, in line with most medicalisation of childbirth, but Petchesky points out that being able to see the foetus is for many women a sense of their own control in the situation, as well as a reassurance. The elements of control seem to increase as women's own resistence to the medicalisation of childbirth gathers momentum: 'birth plans', rejection of epidural anathesia and stirrups in favour of active birth, returning to breastfeeding has been for Western middleclass women an attempt to regain their agency.

There is through these techniques pressure to produce a child which is not handicapped, and in some areas ultrasound scanning has become routine for all pregnant women, just as amniocentesis is becoming routine for all 'older' mothers. The apparent choice offered is whether to carry to term a child for whom the quality of life will be less than perfect, although detection of abnormalities is not necessarily accurate. As resources to care for such children diminish, the woman is left with little choice. A family which would be unable economically to finance the medical care has little real choice: counselling is designed to help come to terms with inevitable termination, not explore support available. Valuing a child for itself is now no longer an option: eugenic selection in this area has been a reality for many years, driven by the producers of the technology. At the same time, this choice is withheld from many women: detection of handicap, and early abortion, is less likely to be available to poor women in western countries, and most women in the rest of the world. Access to either contraception or abortion can be removed at any time by laws enacted by governments made up of mainly men, with no reference to the wishes of women themselves.

Not only perfection , but selection of sex can now take placein utero. Whereas pre-conception selection by separation of male sperm or detection of sex in embryos is still being perfected, in countries where female babies are a regarded as undesireable, amniocentisis has been regarded as a viable means to deselect a child of the 'wrong sex' for those who could afford it for many years. As the 'wrong sex' is almost inevitably female, to condemn not only the use of amniocentis but any of the newly developing preconception selection procedures as sexist and femicide seems to ignore what already happens. Forbidding the techniques will not increase the value put on the resultant daughters, nor ensure they are given equal care whether in food or medicine to their brothers. Women forced to kill their female children, or to commit suicide at the birth of one daughter too many could be seen to be better served by a safe method of selection. Even in the West, the desire for a son first is so often expressed, that the opportunity to select would probably result in a similar imbalance. Women themselves are not, however, likely to be valued more highly as their numbers decrease: less job opportunities, enforced early marriage, and a more violent society as men attemt to take women by force is the likely dystopia.

Motherhood is either the 'natural' goal of all women or a curse which prevents women from achieving greater goals? These two assumptions can divide the debates about the new reproductive technologies into the constitutive parts: either the purpose should be to enable infertile women to fulfil their maternal goal of producing perfect babies, or all fertile women to have the choice of delaying, postponing or avoiding motherhood. The technologies themselves could be seen as potentially increasing feminine agency: the radical feminist view started by believing that by freeing women from the burden of motherhood, women would be free to participate in society on the same level as men. At the same time, their negative effects are often to reduce women's agency in the amount of access they are forced to give men to their bodies;fear of pregnancy once removed gives women less legitimate reason to participate in sex against their inclinations. Firestone's wish for

The freeing of women from the tyranny of reproduction by every means possible...childbearing could be taken over by technology {or} reward women for their special social contribution of pregnancy and childbirth

might be seen as tacit permission on behalf of women for the experiments, but with no hope of the second part ever happening.

As contraception, the new reproductive technologies are not 'new' in themselves, but are only an extension of practices which have been available for thousands of years. Elements of control have been the greatest issue in this area: this is particularly noticeable in the controversy surrounding the use of Deep Provera: defined as unsuitable because of its dangers for the majority of Western women, it continues to be supplied to women within the West deemed less fit for parenthood, whether these are black and Asian minority populations in Britain, or Polynesian women in New Zealand , and widely distributed in the Third World. The advantages which an injectable, unremovable contraceptive has in forcible control of women's fertility, for example in refugee camps, outweighs for the distributors in this situation the possible longterm effects. However, women for whom pregnancy and childbirth present great hazards, and whose life expectancy is likely to be considerably shortened through these might still themselves choose the potential dangers of the contraception; the main issue is that they are unlikely to be given the information which enables them to make an informed decision. Similarly, the Dalkon Shield and Copper 7 IUD's were an early example of experimental techniques used on women whose consent was not informed :both caused infertility and in some cases death. Both IUD and injectable contraception are likely to be seen by the medical profession as instruments of control.

Over all, the implication of the new reproductive technology for women seems to be one of further loss of agency, rather than greater choice for women. Improving the technology could have more detrimental effects for women: for example development of foetal technology to enable premature babies to survive with articicial placentas will eventually lead to a reduction in access to abortion, or in aborted foetuses becoming commodities. Men as it stands control the development of the technology, run the companies who produce the drugs, legislate for the benefit of the embryos with little consideration of the risks to the mothers. Any beneficial extensions of agency are questionable: the right of choice to space children by contraception may come with the choice of cancer. Improved implantation techniques need donors willing to risk their future health to produce dozens of eggs. Participating in miracles of IVF and surrogacy is restricted, being denied to women of the Third World, most single women, lesbians, women over whatever age limit is set by government or individual gynacologist.

Although the fear that new reproductive technologies will bring about the end of motherhood, that Aldous Huxley's vision of babies decanted from bottles will come seems farfetched and impossible, it seems to have been a blueprint for the male technologists in their effort to create life. They have at times seemed to have lost sight of the need to remember that their initial reason for undertaking this project was to benefit infertile couples, or to enable women greater freedom of choice, and have become caught up in the technology itself.

Essays and papers

An examination of the assumptions about motherhood and feminine agency which are embodied in debates about the new reproductive technologies.

Footnotes