08 November 2010
Ruth is a BioNews volunteer. Zeynep is at the Centre for Family Research, University of CambridgeAppeared in BioNews 583
Making Babies in the 21st Century: The Rise of Reproductive Technologies
Hall 2, Kings Place, 90 York Way, London N1 9AG, UK
Tuesday 2 November 2010
Review by Zeynep Gürtin-Broadbent
Academics, clinicians, representatives from patient groups and other interested people came together last week to discuss the rise of reproductive technologies. The event was the first of three 'public dialogues', organised by the Cambridge University Centre for Gender Studies in association with the Guardian newspaper. The aim of this series, supported by Cambridge University Press, is to aid conversation between experts and the general public on issues of gender and 21st century biomedical advances.
The evening began with four experts answering questions posed to them by Dr Jude Browne, Director of the University of Cambridge Centre for Gender Studies. First to speak was Professor Carl Djerassi, inventor of the modern day contraceptive pill and a prolific author of what he calls 'science-in-fiction'. He painted a picture of a future in which fertile women would freeze their eggs in youth and undergo voluntary sterilisation to avoid unintended pregnancy.
Such a future would, he argued, enable women to extend their fertility and guarantee each child would be 'wanted'. Simultaneously, this would allow couples to enjoy sex without concerns about unintended pregnancy. Professor Djerassi also screened an excerpt from his play 'Taboos' to illustrate the complex impact of reproductive technologies on society, particularly when morals clash among family members.
Professor Susan Golombok from the Centre for Family Research in Cambridge said Assisted Reproductive Technologies (ARTs) have generated new family forms, including same-sex, donor-conceived and surrogacy families. They have, she said, also made it possible for a child to have up to five parents: the genetic mother and father, the gestational mother, and two social parents.
Professor Golombok argued these new family forms have challenged and changed beliefs about what matters most in parenting and child development. She concluded the quality of family relationships is most important in determining children's wellbeing, not any element of family structure like number of parents, their gender and sexual orientation or genetic relatedness.
Professor Marcia Inhorn, a medical anthropologist from Yale University, highlighted some of the bioethical and moral dilemmas raised by the globalisation of reproductive technologies. She focused on how assisted reproduction has been received in the Middle East, particularly the differences between what Sunni and Shi'ite Muslim clerics believe should be permissible.
Professor Inhorn turned her attention to the growth of 'reproductive tourism' and the challenges posed by global inequalities in access to reproductive health services. She concluded her talk by drawing links between the availability of safe and effective conception and access to abortion and infertility services. Her presentation ended with the question 'Is having a baby a global reproductive right?' and she challenged us to think what can be done to reduce inequalities.
Baroness Onora O'Neill, a philosopher and cross-bench peer, argued there was no 'human right' to reproduce, although there may be a 'positive right' to access reproductive services. 'Negative rights', such as the right not to be forced to marry or reproduce, should also have a place in discussions since they are the most seriously violated worldwide.
She said reproduction is not just about individuals, but has population-level and social consequences. A grown-up debate should see the global consequences of reproductive choices enabled by new technological advances, such as PGD for sex selection.
Once the panel had spoken, the discussion was opened to the floor by Dr Browne and the experts received an impressive selection of comments. While some questioned the extent to which reproductive technologies would gather mass appeal in the manner predicted by Professor Djerassi, others questioned the balance of positives and negatives as we enter an age of technological procreation.
Audience-member Wendy Savage, distinguished gynaecologist and champion of women's rights in childbirth and fertility, spoke of the misery caused by reproductive technologies to those who remained unsuccessful and childless. She asked whether society may regret opening this Pandora's box.
The evening was a thoroughly thought-provoking: a tour-de-force of empirical evidence, ethical debate, and most importantly enthusiastic engagement, on an emotive topic with serious and complex implications for how we think about families, relatedness and gender.
Review by Ruth Saunders
The event began with an introduction to ARTs before the panel discussion began. Carl Djerassi, Emeritus Professor at the University of Stanford, was the first panel member to speak. Professor Djerassi said ICSI (intracytoplasmic sperm injection) and his invention, the contraceptive pill, were among the foremost developments in ART.
Professor Djerassi demonstrated the relational and ethical dilemmas that can arise from the use of ARTs through a short clip of his science-in-fiction play 'Taboos'. Taboos tells the story of a lesbian woman who donates her embryos to her sister in exchange for her brother-in-law's sperm. Professor Djerassi also discussed freezing eggs as a potentially popular choice for young, career women in the future.
Next to speak was Susan Golombok, Professor of Family Research and Director of the Centre for Family Research at the University of Cambridge. Professor Golombok discussed her research, which focuses on the social, emotional and identity development of children born into gay and lesbian families, to single mothers or to families assisted by ARTs like surrogacy.
Professor Golombok discussed the risk that parents who undergo IVF and ICSI are more likely to be overprotective of their resulting children and project unrealistic expectations onto them. She also mentioned concerns about the effects of secrecy on the relationship between the parent and the child, and the child's feelings on discovering they were donor conceived.
Professor Golombok concluded from her research that children genetically unrelated to one parent or conceived with ARTs were well-adjusted and had a good relationship with parents. Although only a small minority of parents choose to tell the child they were donor conceived, Professor Golombok found children told at a younger age dealt with the news better.
Marcia Inhorn, Professor of Anthropology and International Affairs at Yale University, talked about her research in the Middle East on the social impact of infertility and ARTs, including the increased use of ARTs in countries such as Egypt, Iran, India and Lebanon.
Professor Inhorn discussed the bioethical and moral issues raised by the globalisation of ARTs, including the implications of fertility tourism and global inequalities. She found there were significant levels of cross-border reproductive care within the European Union, mostly due to the evasion of a country's laws.
There are also significant global inequalities in ART provision, Professor Inhorn said. Only 48 of the 191 member states of the World Health Organisation offer ART. Less than one percent of the projected need for ART is being met in larger countries such as China, India, Pakistan and Indonesia, and less than 15 percent in the United States. Perhaps more shocking are the reported cost inequalities, ranging from $12,400 for IVF in the United States to $1,360 in Iran.
Finally Baroness Onora O'Neill, Professor of Philosophy at the University of Cambridge, criticised the notion of the right to have a child, saying there is no convincing legal and ethical evidence of this. She argued a rights discourse does not take the resulting child's needs seriously as a person with their own needs, wishes and desires. Instead of viewing a child as a right, it should be regarded as a gift.
Although a thought-provoking and insightful evening, I was slightly disappointed that the event was advertised as covering more issues than it did. The speakers engaged little with the gender-specific issues surrounding the rapid development of ARTs or the ethical issues that could be raised by future ARTs, such as uterine transplant.