The Politics of Women's Health

Emerging Issues: Assisted Reproductive Technologies and Fertility Tourism

New developments in assisted reproductive technologies (ART) have enabled many people to have biologically related children who previously could not. At the same time, these technologies continue to raise complicated ethical questions that are often difficult for individuals and society to resolve.

Drawing the line with ARTs is both an individual and a social concern. In countries such as Canada, the United Kingdom, South Korea, and Australia, public policies have already been established to ensure greater safety for everyone involved with fertility procedures—parents, children, women who donate eggs, and gestational, or surrogate, mothers. These countries have prioritized the need for public discourse to ensure that these technologies—powerful enough to create human life outside a woman’s body and to alter the species—are used in ways that society deems ethically acceptable.

Procedures that enable women to have a gestational—but not genetic—tie to a child, or that result in children with several sets of parents, pose new social and logistical dilemmas. Other procedures that test the genes of fetuses or embryos for genetic conditions open the way to further stigmatize people with disabilities; every day, more conditions are classified as diseases requiring intervention. A small but vocal group of scientists and others envision a future in which parents routinely choose their offspring’s sex, physical traits, and even intelligence, prospects that would alter family and social relationships in disturbing ways.

As assisted reproduction technologies have mushroomed into a multibillion-dollar fertility industry, ethical and social challenges multiply. And as people seek to avoid policies in one country by traveling to another country to seek the services of a gestational mother, or to obtain embryos or donated eggs not available in their own countries, a rapidly growing phenomenon of cross-border reproductive tourism—also called fertility tourism—has magnified these problems.

For example, because the services of gestational mothers are less expensive in India than in the United States, India has become the leading go‑to source of such services. Women with few other economic options are becoming gestational mothers with little assurance that contracts specifying particular payments will be honored, and with little protection for their own well-being and autonomy. These women are sometimes required to leave their own children for part or all of the duration of the pregnancy, live in dormitories attached to fertility clinics, and deliver by C‑section even when that is not medically indicated.

The remarkable and exponential growth of infertility services across the globe, as well as the increasing use of ARTs that have not been adequately assessed for safety, requires new and more effective alliances among feminists, public health advocates, ethicists, and others who recognize the serious threats to women’s health and human rights—especially for more vulnerable women enticed by misleading advertising and prospects of income.

One group that has taken the lead in such movement building is SAMA: Resource Group for Women and Health, located in New Delhi. In 2010, SAMA brought together scholars, activists, and researchers from around the world to develop strategies that will address these issues and also call for more efforts to identify and remove the environmental causes of infertility. “Unraveling the Fertility Industry,” a report from the conference, is available at samawomens health.org.

Recommended Viewing: Made In India and Eggsploitation Reproductive tourism, a booming trade valued at more than $450 million in India, is the subject of the excellent documentary Made in India. The film features a thoughtful portrayal of the ethical dilemmas involved in hiring women from other countries to serve as gestational mothers. Another film, Eggsploitation, explores the health risks facing younger women who provide eggs for other people’s fertility treatments.