By Giulia Cavaliere.

It is once again November and I am once again—three years since writing this piece—thinking about extra-corporeal gestation, the futuristic prospect of supporting foetuses in an artificial uterine environment. Considering that it cannot be the approaching winter months that sparked a wave of fresh thoughts on this technological possibility, what is?

A couple of weeks ago, I was invited to speak at the first workshop of the Wellcome Trust project The Future of Human Reproduction: Where will tomorrow’s babies come from? by Laura, Nicola and Stephen. I was asked to offer my perspective on extra-corporeal gestation, what I think is missing from these discussions and what future work I would like to see being done.

Part of my contribution to these discussions appeared in the JME. In my article, I engaged with and responded to liberal defences of extra-corporeal gestation that celebrate its potential to promote women’s equality and freedom. My main contention was that it might certainly deliver on these desirable ends, but it would do so primarily for a small group of women who are arguably less in need of measures to redress inequalities than others who would not have access to the technology. I also argued, there and elsewhere, that levelling the playing field requires more than technical tinkering in the form of outsourcing gestation to machines. That is, gender-based oppression, and the freedom- and equality-restricting effects it produces, cannot be fixed by solely or even simply largely falling back on extra-corporeal gestation. We need more. Extra-corporeal gestation is thus better understood as a political perspective and a provocation: something that can advance truly liberating political programmes because it forces us to rethink the role of women in biological and social reproduction, and the disadvantages that, in gender unjust societies, come with it.

I stand by these ideas. Liberal defences of extra-corporeal gestation too quickly dismiss important and, crucially, structural constraints associated with gender-based oppression. Despite this, and thanks to conversations with colleagues (thanks, Andrea, among others!), I now believe that while extra-corporeal gestation might not be (nearly) enough to achieve gender justice, there are important advantages associated with it. What I would like to canvass here however, is what I think might be missing from current discussions.

Let me start with some broader social and political questions: Why are we doing research on extra-corporeal gestation? Why do we think we need it or it might be worth developing as an alternative to slightly boring, kind-of-functioning, sort-of-miraculous, potentially enjoyable (so-called) “natural” gestation?

Those who defend “partial” extra-corporeal gestation have a straightforward answer to this: the premies. Mortality and morbidity rates are still high for premature infants. More sophisticated technologies for the neonatal intensive care unit could increase the chances of survival for these infants and reduce the incidence of severe impairments. But for those, like me, that are primarily interested in questions of gender justice, these questions are important. They compel us to think of what goes wrong and of desirable strategies to improve it, and to raise further questions to guide future research on extra-corporeal gestation. These are, for instance:

• Why are pregnancy and childbirth still so risky and traumatic?
• Why is it still impossible to safely take drugs that could improve the health and well-being of pregnant and lactating women?
• Why do we regard the biological inevitability of gestation and birth as a prescribed social role that women ought to fulfil?
• Why are we still accepting the so-called “double shift”?
• Why are we still so far from achieving gender equality in the labour market?

I could go on, but you get the idea: It is worth pausing and reflecting on why we think we need extra-corporeal gestation and why we think it should be defended as an alternative to “natural” gestation and childbirth. It is additionally important to engage with the biological and political reasons why gestation and childbirth are still something that disadvantages women and generates different kinds of negative externalities for them. Lastly, it is necessary to theorise on, and work towards, a world where the decision to gestate and birth children is not especially costly for women. This is crucial: gestation, childbirth and breastfeeding could be beautiful and enriching experiences, but they should not come at significant costs in terms of health, well-being and flourishing for women.

In my previous blog post and article, I was especially concerned with the groups of women that are more likely to experience severe complications during gestation and childbirth and die as a result of giving birth: women of colour, poor and disabled women. I argued that their equality and freedom is much more curtailed than that of the women that will probably use this technological possibility and for whom it seems to be designed for. A sort of prioritarian feminism informed my analysis and my conclusions. Such an approach is, in my view, worth adopting in discussions on moral and political questions raised by reproductive technologies, gestation and childbirth. This is due to the enormous disparities in IVF success rates, morbidity and mortality during gestation and childbirth, and on how they are located along class and race lines. As Elizabeth Spelman convincingly argued, too often feminist theory and practice has isolated gender from other identities and categories, such as race, class, sexuality and age, to name a few, to engage with shared experiences of oppression. Iris Marion Young explains that assuming that women’s experience of oppression is stable, fixed and universal, “has exhibited privileged points of view by unwittingly taking the experience of white middle-class heterosexual women as representative for all women”.

As a white, middle-class, heterosexual woman, I am trying to remember this when I defend the development or use of a certain reproductive technology or when I expose the negative externalities that might be associated with it. However, I thought that I was immune from experiencing many of these externalities and that my privilege protected me. Turns out that it does so only partially.

Last September, I had to stop taking the first drug that actually worked to reduce the (very high) incidence of the migraines I have experienced since I was a child. I had to “choose” between a reduction in the pain that I suffer from daily and the possibility of having children because there is no evidence available on whether this drug could be harmful to foetuses. This is a relatively new drug, but historically and to date pregnant women have been excluded from clinical research. As a result, they cannot safely access medications that might be needed to treat both pre-existing conditions and conditions that arise as a result of becoming pregnant.

Women can and do make many choices with respect to gestation, childbirth and childrearing. But so many of these choices are constrained by biological, structural and other constraints that are portrayed as inevitable. Some of them are not. So, to go back to my questions: Why are we thinking about extra-corporeal gestation? Why do we think we need it, or it might be worth developing as an alternative to “natural” gestation?

Because things still stink when it comes to women, gestation and childbirth. They do not stink for everyone in the same way and to the same extent, but they do stink. And we need alternatives, yes, but we also need to think why we need these alternatives in the first place.

Author: Giulia Cavaliere

Affiliations: Dickson Poon School of Law, King’s College London

Competing interests:  None declared

Social media accounts of post author: @giuli_cavaliere