Reproductive Technology and Ethics
Until the development of reliable contraception methods in the 20th century, control of the means of reproduction belonged to those who exercised brute force or financial coercion. Sex led to pregnancy, abortions were difficult to obtain and unsafe, families and relations between the sexes were structured to protect the property rights connected to paternity, and these were accepted as givens, based on the natural or God-given order of the universe.
The ability of women to control whether and when they will reproduce has brought tremendous change. In much of the world, we now take it for granted that sex can occur without fear of unwanted pregnancy, and when such pregnancies do occur, safe methods of terminating them exist.
The Cairo Programme of Action, 1994
Reproductive rights have been identified as basic human rights, as in the 1994 Cairo Programme of Action : “These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes the right of all to make decisions concerning reproduction free of discrimination, coercion and violence as expressed in human rights documents. In the exercise of this right, they should take into account the needs of their living and future children and their responsibilities towards the community.” (International Conference on Population and Development)
Dazzling Options and Gendercide
In recent decades, technological advances in reproductive technology have made possible a dazzling array of options, at least for those who can afford to pay. These advances open up the concept of “choice” beyond the most publicized issues of access to contraception and safe, affordable abortions.
If extensive and expensive fertility treatments don’t work, babies can be purchased in a variety of ways. Sperm and egg “donors” are paid for their “donations,” with white, college-educated egg donors commanding top rates. Would-be parents who are too old to conceive, don’t have partners, or are gay, can purchase eggs or sperm from donors with specific ethnic, vocational or psychological traits, can have their own eggs or sperm extracted to be used for in-vitro fertilization, or hire a surrogate mother who will carry and deliver “their” child.
Intercountry adoptions, facilitated by the internet and easier travel, have led to poor countries taking turns as the baby source of choice (origin nation) for adoptive parents in the West. Korea, Romania, Russia, Ethiopia, Guatemala and now China have all played this role.
Advances in pregnancy termination have also led to more “choice.” Through pre-natal testing, a woman can learn the gender, potential or actual disabilities of the fetus she is carrying, and decide whether to terminate the pregnancy. This has contributed to gender imbalance, most notably in China and India, but noted as a growing trend in other countries, where pregnancies of females are terminated at a much higher rate than those of males, sometimes labeled “gendercide.” With the increase in multiple embryos resulting from fertility treatments, parents can choose their desired number of children through selective fetal reduction.
These changes can lead to increased autonomy for women, expanded opportunities for men and women to become parents, and more economically secure families. However, the ability to make choices about reproduction is dramatically different from millennia of following the will of God or the dictates of Nature (depending on one’s perspective). Have we developed an ethical consensus about these expanded choices? The backlash in many countries, sometimes rhetorical and sometimes violent, says that we have not.
In the United States, despite serious economic issues that need to be discussed, the current campaign for the Republican Presidential nomination seems to be focused on issues of reproductive rights—access to abortion, contraception, and pre-natal testing. New York Times columnist Nicholas Kristof refers to “the war over women’s health being fought around the country—and in much of the country, women are losing.” Recent state laws require women seeking abortions to undergo ultrasound examinations (including vaginal probes), lectures and waiting periods. The U.S. Senate narrowly defeated an amendment (to a transportation bill!) that would have allowed employers to deny health insurance coverage to their employees for anything to which the employer had religious or moral objections, with a focus on abortion and contraception.
However, ethical questions are not limited to those whose politics or religion lead them to yearn for the certainties of earlier centuries, when choices based on reproductive technology were not available. There are also significant concerns, often voiced by progressives, about the role of the market in determining reproductive choices. Should access to abortion, contraception and/or technological means of conception be determined by one’s ability to pay? Are limits on the number of children a sperm donor can father desirable and enforceable? Should a woman who carries another’s child to term have any parental rights? Is terminating a pregnancy because of the child’s gender ever justified? How do the inequities between parents in different parts of the world influence adoption? Origin nations have shut off intercountry adoptions due to concerns about trafficking and fraud, as well as fears that economic disparities may lead to “adoption colonialism.”
And who has the right to decide these ethical issues? Pro-choice advocates argue that these are decisions between individuals—the mother or parents and the health care provider. Others, on both the right and left, feel that there are community and societal interests that should be weighed. Advocates for children have their own priorities. The 1994 Cairo statement quoted above attempts to straddle all of these perspectives. Although it is the steering document for the United Nations Population Fund, the document has faced serious opposition in primarily Catholic and Muslim countries, and among conservatives in secular nations. It seems clear that the issues raised by technological advances in reproduction have raced ahead of our ability to find an ethical consensus. Without such a consensus, the power of patriarchy around the world will lead to a continuation of the war against women.