Analysis Maternity and Birthing

What Do Artificial Wombs Mean for Women?

Soraya Chemaly

Would you chose external gestation if you could? What do artificial wombs mean for reproductive rights - including abortion, equality and the role of women in society? The moral, ethical, legal and societal consequences are profound and we are unprepared for them.

What happens when women, like men, can be parents without bearing children?  Does one form of gestation become a status symbol? Another a stigma? Who decides which gestation environment is healthier or more economical? You? Your gamete-partner? Your priest? Your employer? Your insurance company? If we think we have a complicated debate now, just wait. The current War on Women pales in comparison to the potential impact that ectogenesis, a technology in which a human fetus gestates completely out of a mother’s body, will have. It is, in its ultimate manifestation, qualitatively different from birth control or other assisted reproductive technologies. This change has the power to alter, in unprecedented ways, the interests, rights and responsibilities of women, men and the state.

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 was ambitious, but not unrealistic.  Despite the sci-fi horrors evoked by “artificial wombs,” this isn’t the stuff of dark dystopias. It is a partially realized, life-saving technology. Since the 1920s, researchers have seen the development of artificial wombs as a final goal of assisted reproductive technologies. Research focuses variously on helping premature babies to survive to finding substitutes for women’s bodies as baby machines. 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.

Current Research

There are two commonly cited endeavors in progess. Focusing on finding ways to save premature babies, Japanese professor Dr. Yoshinori Kuwabara of Juntendo University, has successfully gestated goat embryos in a machine that holds amniotic fluid in tanks.  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 ten 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.

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Predictions for the full realization of what scholars Scott Gelfand and John Shook call “immaculate gestation”* range from 10 to 60 years.  However, it is already partially possible and entirely within the spectrum of acceptable practices.  Even if it takes scientists several decades, medical advancements are steadily narrowing the gap between in vitro conception and fetal viability outside of the womb.  When the gap closes then babies, navel-less, will no longer have to be “born” through women.

Is that an advantageous human adaptation?

Medical Benefits

The medical benefits seem clearest – the technology will help infertile couples, enable premature babies to survive, create an alternative to surrogacy when needed, and help women unable to carry their own babies. Ectogenesis can provide safe, healthy gestational environments – free from drugs and alcohol. It will give gay couples new fertility options.  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.

Societal Consequences

The moral, ethical, legal and societal consequences are profound and we are unprepared for them.  Definitions and distinctions, the meanings of words like “life,” “human,” “embryo,” “natural,” and even “mother,” that we’ve historically relied on to make ethical decisions, are dissolving faster than we are adapting. What happens when both men and women contribute equally – by providing only gametes – to reproduction? Do women have to carry human babies? What if they don’t want to? Who decides? What does it mean to sever human “birth” from the human body? This connection, between women and babies, is one of the sole sources of power that women have in some societies.

Abortion, Reproductive Rights and Equality

In immediate terms, the foundations on which a woman’s rights to choose are predicated in Roe v. Wade, namely the issue of fetal viability and the right to privacy (the right not to be pregnant), will be rendered virtually meaningless.  First, once a fetus can be safely and entirely gestated outside of a biological womb, it can be removed from its mother.  Second, ectogenesis means that viability starts with conception.  Both consequences radically alter the terms of the pro-choice debate as it is currently framed and understood.  The tension inherent in the current debate, between the rights of the woman and the state’s interest in the fetus, disappears when the woman and the fetus can be safely and immediately made independent of one another.  The reproductive choices of men and women become equal and women lose the primacy now conferred on them as a result of gestation. States could require women to have their fetuses extracted as an alternative to abortion, with serious long-term negative impacts.  Reproductive rights and social justice issues will take on an even more surreal dimension.

Feminists, not surprisingly, have extensively considered what ectogenesis could mean for women’s rights, the structure of the family, class, and society.  Right wing anti-choice activists, although perhaps initially delighted to have an alternative to abortion, will have to contend with a radical redefinition of “motherhood” and the hierarchical and gendered societal relationships for which it is an antecedent.  There is no guarantee that these changes will be good for women who currently already struggle to defend reproductive freedoms. Feminist critique ranges from one extreme to the other in terms of whether ectogenesis will liberate or further oppress women.

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.  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**.  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 process by which virtually all 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 potentially exaggerate preexisting inequities and biases.  In this equation women aren’t liberated, they are further subjugated and alienated from their own bodies and abilities.  This Handmaiden’s Tale scenario is fairly believable if you pay any attention to, for example, Rick Santorum’s antediluvian reproductive rights agenda and the number of people willing to vote for him.  

Prominent feminists and activists, including Andrea Dworkin and Janice Raymond, have concluded that not only will women be further marginalized and oppressed by this eventuality, but they will become obsolete.

Fertility, and the ability to be the species’ reproductive engine, are virtually the only resources that women collectively control, they argue. And, although women do have other “value” in a patriarchal society–child rearing, for example–gestation remains, worldwide, the most important.  Even in the most female-denigrating cultures women are prized, if only, for their childbearing. If you take that away, then what? This technology becomes another form of violence. 

Other feminist analyses takes into account the class and race implications of the enthusiastic adoption of assisted reproductive technologies by the wealthy. Some, eco-feminists, relate the eventuality to correlating a general campaign against nature. Ectogenesis also opens up the real possibility of men becoming mothers and primary care takers.***

Who controls ectogenesis and how it is utilized is the key to whether or not it is a tool of liberation or oppression for women. Men rule, literally, and until we have more gender balanced representative leadership in all sectors of society, that has predictable consequences. Women are outnumbered as researchers and scientists in the field of reproductive technology, as opinion-shaping media commentators and pundits, as clerical and religious leaders, and as governmental policy makers and regulators.  In this context, as with the current contraception/Catholic church debacle, is highly unlikely that woman-centered reproductive agendas, especially those that take into account the needs and health of poor women and women of color, will result.  

Bioethics and Regulation

Scientists are the first to admit the complexity of gestation.  They don’t understand the subtle interactions – everything from the nature of the mother-child bond to the necessary and ideal balance of temperature, sounds, fluids and hormones – between women’s bodies and the bodies and development of fetuses.  As with all new technologies, particularly biotechnological ones like in vitro and cloning, bioethicists are thinking about the social, legal and ethical implications. But, compared to other developed countries, the United States  has very little regulation regarding assisted reproductive technology.   And, although lots of people in Congress are eager to wax on about the moral status of embryos and the definition of personhood there are currently virtually no federal or state regulations regarding the impact of how we use gametes, embryos, artificial wombs and engineered birth to define those terms. A quick search of the Presidential Council on Bioethics’ website for “artificial womb,” “ectogenesis,” “gestation,” yielded only one result on the not-specific-to-reproduction moral science of limiting human subject research.  A 2004 Presidential Commission on Regulation of New Biotechnologies was concerned with commercialization of ova and sperm donations, insurance coverage, truth in advertising and patent issues.  The NIH is primarily in the business of monitoring stem cell research. The FDA with regulating substances used in IVF.

Any integrated, comprehensive pragmatic and/or philosophical approaches are political nightmares in this country. However, not any longer in others. Britain, for example, established a Human Fertilization and Embryology Authority (HFEA) in 1990. HFEA has authority, independent from the health and research facilities and the government, to regulate assisted reproductions services and products. 

Decisions about reproductive technologies are more often then not made by doctors and individuals in the absence of a social justice framework. Progressive people, interested in equality and social justice, need to prepare for how rapidly evolving technology will shift reproductive rights and responsibilities. The real dystopian future is one where we look back with nostalgia at the brief period during which Roe vs. Wade had its fragile relevance and impact as a high point in women’s reproductive freedom. It may sound alarmist, but really, we have time to consider the ethical, moral, societal ramifications of this technology and frame the arguments of the future before others do it for us. We have some time, but, not much.

 

Sources and Additional Reading

* Scott Gelfand and Shook, John R., eds., Ectogeneis: Artificial Womb Technology and The Future of Human Reproduction, Editions Rodopi, B.V., 2006

** 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 

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

 

Tell us your story. Have religious restrictions affected your ability to access health care? Email stories@rewire.news

News Human Rights

What’s Driving Women’s Skyrocketing Incarceration Rates?

Michelle D. Anderson

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Local court and law enforcement systems in small counties throughout the United States are increasingly using jails to warehouse underserved Black and Latina women.

The Vera Institute of Justice, a national policy and research organization, and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge initiative, released a study last week showing that the number of women in jails based in communities with 250,000 residents or fewer in 2014 had grown 31-fold since 1970, when most county jails lacked a single woman resident.

By comparison, the number of women in jails nationwide had jumped 14-fold since 1970. Historically, jails were designed to hold people not yet convicted of a crime or people serving terms of one year or less, but they are increasingly housing poor women who can’t afford bail.

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

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Overlooked: Women and Jails in an Era of Reform,” calls attention to jail incarceration rates for women in small counties, where rates increased from 79 per 100,000 women to 140 per 100,000 women, compared to large counties, where rates dropped from 76 to 71 per 100,000 women.

The near 50-page report further highlights that families of color, who are already disproportionately affected by economic injustice, poor access to health care, and lack of access to affordable housing, were most negatively affected by the epidemic.

An overwhelming percentage of women in jail, the study showed, were more likely to be survivors of violence and trauma, and have alarming rates of mental illness and substance use problems.

“Overlooked” concluded that jails should be used a last resort to manage women deemed dangerous to others or considered a flight risk.

Elizabeth Swavola, a co-author of “Overlooked” and a senior program associate at the Vera Institute, told Rewire that smaller regions tend to lack resources to address underlying societal factors that often lead women into the jail system.

County officials often draft budgets mainly dedicated to running local jails and law enforcement and can’t or don’t allocate funds for behavioral, employment, and educational programs that could strengthen underserved women and their families.

“Smaller counties become dependent on the jail to deal with the issues,” Swavola said, adding that current trends among women deserves far more inquiry than it has received.

Fred Patrick, director of the Center on Sentencing and Corrections at the Vera Institute, said in “Overlooked” that the study underscored the need for more data that could contribute to “evidence-based analysis and policymaking.”

“Overlooked” relies on several studies and reports, including a previous Vera Institute study on jail misuse, FBI statistics, and Rewire’s investigation on incarcerated women, which examined addiction, parental rights, and reproductive issues.

“Overlooked” authors highlight the “unique” challenges and disadvantages women face in jails.

Women-specific issues include strained access to menstrual hygiene products, abortion care, and contraceptive care, postpartum separation, and shackling, which can harm the pregnant person and fetus by applying “dangerous levels of pressure, and restriction of circulation and fetal movement.”

And while women are more likely to fare better in pre-trail proceedings and receive low bail amounts, the study authors said they are more likely to leave the jail system in worse condition because they are more economically disadvantaged.

The report noted that 60 percent of women housed in jails lacked full-time employment prior to their arrest compared to 40 percent of men. Nearly half of all single Black and Latina women have zero or negative net wealth, “Overlooked” authors said.

This means that costs associated with their arrest and release—such as nonrefundable fees charged by bail bond companies and electronic monitoring fees incurred by women released on pretrial supervision—coupled with cash bail, can devastate women and their families, trapping them in jail or even leading them back to correctional institutions following their release.

For example, the authors noted that 36 percent of women detained in a pretrial unit in Massachusetts in 2012 were there because they could not afford bail amounts of less than $500.

The “Overlooked” report highlighted that women in jails are more likely to be mothers, usually leading single-parent households and ultimately facing serious threats to their parental rights.

“That stress affects the entire family and community,” Swavola said.

Citing a Corrections Today study focused on Cook County, Illinois, the authors said incarcerated women with children in foster care were less likely to be reunited with their children than non-incarcerated women with children in foster care.

The sexual abuse and mental health issues faced by women in jails often contribute to further trauma, the authors noted, because women are subjected to body searches and supervision from male prison employees.

“Their experience hurts their prospects of recovering from that,” Swavola said.

And the way survivors might respond to perceived sexual threats—by fighting or attempting to escape—can lead to punishment, especially when jail leaders cannot detect or properly respond to trauma, Swavola and her peers said.

The authors recommend jurisdictions develop gender-responsive policies and other solutions that can help keep women out of jails.

In New York City, police take people arrested for certain non-felony offenses to a precinct, where they receive a desk appearance ticket, or DAT, along with instructions “to appear in court at a later date rather than remaining in custody.”

Andrea James, founder of Families for Justice As Healing and a leader within the National Council For Incarcerated and Formerly Incarcerated Women and Girls, said in an interview with Rewire that solutions must go beyond allowing women to escape police custody and return home to communities that are often fragmented, unhealthy, and dangerous.

Underserved women, James said, need access to healing, transformative environments. She cited as an example the Brookview House, which helps women overcome addiction, untreated trauma, and homelessness.

James, who has advocated against the criminalization of drug use and prostitution, as well as the injustices faced by those in poverty, said the problem of jail misuse could benefit from the insight of real experts on the issue: women and girls who have been incarcerated.

These women and youth, she said, could help researchers better understand the “experiences that brought them to the bunk.”

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