Laura Johnson Dahlke, Outer Origin: A Discourse on Ectogenesis and the Value of Human Experience (Pickwick Publications, 2024. ISBN-13: 978-1666772104).
Book Review by Erika Warbinton

Laura Johnson Dahlke’s Outer Origin: A Discourse on Ectogenesis and the Value of Human Experience is an essential read for anyone interested in artificial womb technology and its implications for humanity. She grapples with one of the most pertinent and important questions of our age: how will technology alter something as fundamental and valuable as how humans come into being? Once only the topic of science fiction, complete ectogenesis—growing offspring outside of a woman’s body from conception to full gestation—may soon become possible. Johnson Dahlke implores readers to imagine this reality mindfully.

Researchers at the Children’s Hospital of Philadelphia are currently seeking approval from the Food and Drug Administration for their EXTra-uterine Environment for Neonatal Development (EXTEND) device. EXTEND’s senior investigator, Alan W. Flake, explains that the “whole idea” is for the wombs to “support normal development; to re-create everything that the mother does in every way that we can to support normal fetal development and maturation” (46). As Johnson Dahlke details in her book, many other researchers are also hoping to create similar systems.

Though the current goal of these synthetic wombs would be to help extremely premature infants survive and thrive, and not to replace women, Johnson Dahlke believes their application will extend beyond neonatal medicine. In this belief, she takes a futurist’s view: “the next logical extension of this technology . . . is that it expands to improve infertility and decrease maternal complications of pregnancy. Eventually, it may be viewed as a more optimal and ethical choice for both mother and baby by avoiding the complications of organic pregnancy and childbirth” (xvii). But she also asks readers to seriously consider all the possibilities such a future holds. Will women’s bodies be removed from the reproductive process all together? Will they be expected or forced to use ectogenesis?

The opening chapter, “Into Existence” establishes why Johnson Dahlke believes humanity has been on a path toward ectogenesis for centuries, if not longer. She offers readers a history of human intervention in reproduction, showing how creation myths, casting the female body as deficient and fragile, and the human desire to overcome biological constraints contribute to the inevitability of ectogenesis. Later, Johnson Dahlke coins the term extra-uterine destining, defining it as our desire to completely control reproduction (and nature at large). She writes that synthetic womb usage is inevitable “because of humanity’s long and varied manipulation of reproduction” (52). She contends, however, that this “destiny” or dominant path is something we can influence and alter rather than merely succumb to (63). Her book is an attempt to offer just such an influence.

The middle chapters of Outer Origin further establish how current obstetrical tools and techniques, as well as modernity’s drive toward efficiency and control more broadly, contribute to the development of artificial wombs. To help illustrate the inevitability of ectogenesis, Johnson Dahlke employs Martin Heidegger’s rule of enframing, the dominant belief in Western culture that people understand themselves and the world through science, mathematics, and technology, and that these modes of inquiry and knowledge offer humanity truth (59). Though she recognizes the potential benefits of artificial womb technology, Johnson Dahlke remains skeptical of accepting its widespread use without interrogation. She believes that instead of being an equalizer for the sexes, it could further devalue women’s lives and experiences. It may even place further constraints on access to abortion by potentially forcing women to undergo a “fetal transfer” instead of termination (131). She wonders, like some feminists before her, who will control this new technology?

The author also speculates that synthetic wombs may one day be paired with gene editing technologies such as CRISPR, potentially inspiring the “horrors of eugenic ideologies” if not regulated (136). Guarding against this is critical, she insists, not only to avoid creating haves and have nots but to regulate the use of these combined biotechnologies in countries with declining birth rates, like China (138). She writes, “ectogenesis and CRISPR-edited embryos may come to be the dei ex machina of the twenty-first or twenty-second centuries—ensuring there are enough citizens for economic growth and sustainability” (138). Setting worldwide ethical and moral parameters around these biotechnologies is critical, or a genetic arms race may ensue.

Perhaps equally important to ectogenesis, however, is Johnson Dahlke’s conversation about the value of childbirth as a human experience. The last chapter, “Awe in Childbirth,” offers readers insightful observations about the transformative power of birth. She argues that “apart from the arrival of the child and counter to cultural understanding, childbirth itself is proven to be valuable” (153). On this subject, she holds a humanistic view, a perspective that often contrasts with technology-driven obstetrical care, which largely focuses on physical outcomes rather than holistic measures. People caring for women during the birth process should endeavor to recognize that the act of giving birth is “an end in itself” and not just “a means to an end” (144). Ectogenesis would interfere with or eliminate birth as a principal conveyer of awe, one that can add insight and meaning to life.

For all these reasons and many more, Outer Origin is an essential book about the future of human reproduction. It will be a text often referenced and should stand up over time for its insights and clarity. Johnson Dahlke has established herself as an important voice in the conversation about ectogenesis and this book should not be missed.

Erika Warbinton, PhD, is a clinical psychologist in Kansas. She specializes in rural mental health, women’s issues, and treating personality disorders in psychotherapy.