Reconceiving the womb in medicine, law and society

By Elizabeth Chloe Romanis, Dunja Begović, Alex Mullock and Margot Brazier.

Our new JME article, Re-Viewing the Womb is a collaborative endeavour from the Centre for Social Ethics and Policy at Manchester, which was established over 30 years ago by Professors Margot Brazier and John Harris. Our centre has always had an active interest in repro-ethics and the current cohort includes a group of PhD candidates all working on womb-related legal and ethical questions. Continuing the ‘Manchester’ theme of bringing people together to explore exciting research connections, we hosted an event (very kindly supported by the Institute of Medical Ethics) to explore diverse womb-related developments from the past, present and future. The object of the event was to highlight and interrogate ethical and socio-legal questions emerging from new and future womb technologies; to showcase the work going on at Manchester and to build on our network of researchers.

The speakers (and participants) at our event should be credited with helping us to shape our article. Historical and medical perspectives enriched the discussions which we have developed into an exploration of the historical and contemporary forces which drive maternal-foetal conflict, and which must be resisted as we embrace emerging womb technologies.

Re-conceiving the Womb

Our symposium consisted of three panels tracing issues from the past and present of thinking about wombs and tying these together to speculate about the future. The first panel focused on how wombs have been conceptualised, even mythologised, throughout history, and the legacy of such attitudes on the treatment of female people today. Margot Brazier considered how the ‘wandering womb’ was seen as a source of both mystery and danger, and thus a matter of public attention, leading to female bodies being seen as imperfect compared to those of men. Sarah Fox considered humoral theory and its continuing influence on how we understand the womb as an organ in need of careful regulation as the site of female traits and of reproduction. Finally, Caroline Henaghan considered contemporary medical management of Premenstrual Dysphoric Disorder through the lens of pervasive ideas of female hysteria, drawing attention to the need to listen and learn from the stories of women affected by premenstrual disorders. These talks illustrated how the supposed dangerous nature of wombs has been used to justify legal disabilities imposed upon women. As put by Brazier: “the ghosts of those ancestral theories on wombs and women still haunt us today.”

The second panel moved from reproductive ‘hystories’ to the contemporary rights and responsibilities linked to possessing or wishing to possess a womb. Dunja Begović examined the ethical implications of technologies allowing us to ’look into the womb,’ using maternal-foetal surgery to demonstrate how technology that could expand the scope of reproductive choices might also threaten pregnant people’s autonomy. Nicola Williams and Stephen Wilkinson spoke on ‘transferring the womb:’ thinking about the key rights and stakeholders in uterus transplantation. Williams explored the potential harms of uterine transfer for recipients, donors and potential future children, concluding that the potential for recipient harm is not sufficient to outweigh reproductive autonomy. Wilkinson focused on the public provision of uterus transplantation and a potential positive right to access it, looking at the nature of infertility, the harms stemming from it, and who should be expected to bear the costs of this. These talks all highlighted the need to be mindful of the potential for autonomy to be compromised.

The final panel considered the possibilities associated with ectogestation as a reproductive choice. Emily Jackson discussed the potential for artificial womb technology to bolster the construction of the female body as a place of danger for the foetus and to embolden anti-abortion politics. Chloe Romanis then considered some of the hurdles pregnant people might face in accessing ectogestation as a reproductive choice and the potential harms in some of the argumentation that is often used to bolster the importance of ectogestation as a reproductive choice, for example, language that pathologises gestation. Both talks reinforced the importance of the female body. Theorising about the ’artificial womb’ as a potential ’alternative to abortion’ and ’alternative to pregnancy’ overemphasises the capacity of technologies in development and fails to appropriately account for the role of the female person.

Maternal-Foetal Conflict

In reflecting on the themes that emerged, we found ourselves focusing on a point that was at the root of all of the talks – as we see expanding reproductive choices enabled by technologies allowing a view into the womb (or potentially a womb with a view) such technologies equally foreshadow limitations in access to choice as a result of the exacerbation of ‘maternal-foetal conflict.’ This conflict is generally characterised as instances in which the interests of a pregnant person and a foetus are in competition with each other, or where a pregnant person behaves in a way that is harmful to a foetus. Such notions are closely tied to the visibility of the foetus and how it is and interacted with. Conflict, fear and the othering of pregnant people and women, and the need to medicalise and control was recurring in discourses of the past, present and how we think about the future. To look forward we must look back, and so to speculate about reproductive futures, we can only look at our reproductive consciousness in the present and in the past.

Our article focuses on maternal-foetal conflict and the womb as a site of dangerousness and argues that this notion, perpetuated in the law and ethical frameworks, must be abandoned as it is conceptually and factually inaccurate and has dangerous political connotations, particularly in light of future technologies. Technologies like ‘artificial wombs’ have the potential to change how we reproduce and share the labour in reproduction, but these potential benefits can only be realised if notions of maternal-foetal conflict are abandoned.

 

Paper Title: Re-Viewing the Womb [OPEN ACCESS]

Authors: Elizabeth Chloe Romanis, Dunja Begović, Margot Brazier and Alexandra Mullock

Affiliations: Centre for Social Ethics and Policy, University of Manchester

Competing Interests: None declared.

Social media accounts: @ECRomanis @begovic_dunja @alex_mullock

 

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