'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.
© 1996 Franni Vincent
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