by GULAR BARN
Infertility treatments aim to improve women’s lives. But they risk tying womanhood to the toxic expectation of motherhood
Feminist critics first met in vitro fertilisation (IVF) developments with suspicion. Gena Corea argued that assisted reproductive technologies (ARTs) would reduce women to ‘Matter’ and represented a troubling medicalisation of the reproductive process that was poised to harm women. Corea made prescient predictions that markets in wombs and eggs would develop along classed and racialised lines. Writing in her book The Mother Machine (1985), she estimated that there would be a demand for the wombs of women of colour but not for their donor eggs, in a manner continuous with racism. Corea also observed that a woman’s economic situation was central to her ‘will’ to engage in commercial surrogacy.
A generation or more later, Corea’s claims have been borne out by the development of surrogacy industries in the Global South, which are hotspots for ‘reproductive tourism’, attracting wealthy international consumers. Ethnographic research reveals that surrogates typically exhibit socioeconomic vulnerabilities and palpable financial motivations. They are poor and want to make money. Meanwhile, countries in Europe including Spain, the Czech Republic and Greece, have emerged as popular centres for compensated egg donation.
In her book Women As Wombs (1993), the feminist theorist Janice Raymond pointed to the marketised development of ARTs and the cultural expectation that all women should mother. She saw these as constructing women’s choice to engage in fertility procedures. Corea and Raymond shared a scepticism about ARTs. They called attention to their experimental nature, citing the harm previously inflicted upon women by the medical profession (through practices such as forced sterilisation, medically unnecessary hysterectomies, and harmful birth control) and advised caution toward further reproductive interventions in the name of fertility.
While extremely rare, IVF can still lead to serious adverse outcomes. Pregnancies through IVF are considered higher risk, and may lead to gestational diabetes, premature delivery, low birth weight, and miscarriage. The use of fertility drugs in IVF to induce egg production can cause ovarian hyperstimulation syndrome: last year in India, a seemingly healthy egg-donor died while doctors were retrieving her eggs.
ARTs such as IVF are often viewed as a ‘treatment’ for infertility. Infertility, however, turns out to be difficult to define. A prima facie attempt might see it as the inability to conceive and reproduce through natural means. Yet, from the outset, Raymond and other feminist theorists questioned the claim that infertility is a disease, and instead noted how infertility diagnoses rose in tandem with the proliferation of commercially motivated infertility specialists. Raymond also drew an analogy with the classification of disability, pointing to the way in which disability rights activists maintain that physical handicaps should not be treated as diseases. Philosophers of medicine continue to debate the nature and definition of ‘disease’.
The naturalist position in this debate holds that we can maintain purely descriptive definitions of disease and health. In the 1970s, Christopher Boorse’s biostatistical theory of health set out the terms of naturalism, and it remains influential. The naturalist view focuses on the idea of typical, or species-normal, biological functioning. A fundamental grounding claim is that the human body comprises organ systems that have teleological natural functions. These organ systems might depart from their natural functions in various ways. Some of these departures are harmful, and these are classified as diseases. Disease is thus defined as a harmful deviation from species-normal biological functioning. On the naturalist view, the determining of bodily malfunction is an objective matter.
Normativists argue that health and disease are essentially value-laden phenomena. It is impossible, normativists maintain, to assess health, disease or disability without making value judgments, which are often concealed (even from those making them), and so health, disease and proper bodily functioning are anything but objective. In support of their position, normativists point to the historical and cultural nature of disease classification. For example, some conditions that human societies have considered and treated as diseases have been discredited as unscientific or discriminatory, such as ‘hysteria’. Masturbation was until very recently considered a disorder that could be treated by surgical intervention through circumcision. Homosexuality remained classified as a disease by the World Health Organization until the publication of the ICD-10 in 1992. The evolving ways of thinking about mental health illustrates the expansion and development of human understanding of health and changing social norms.
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