You can’t blame me for assuming Anna must be a diehard feminist; she’s quoting radical feminist Shulamith Firestone when she calls pregnancy ‘barbaric’. But when I ask how important feminism is to her work, she baulks. ‘My interest is not rooted in feminism per se. I’m interested in questions of justice and the way that human bodies are expected to produce things, or are acted upon in various ways by the state and medicine.’ Ectogenesis doesn’t fit into neat categories of thought, and neither does Anna.
‘This is my pet subject,’ she says with a playful smile. ‘I’ve always been fascinated with reproduction, and especially pregnancy and childbirth. I think they are really strange. And when you look at the way in which different creatures reproduce, it’s not at all a given that it has to be the way it is. I remember my mother saying to me when I didn’t want to go to the doctor, “Oh, wait till you have a baby – your body belongs to everyone then.” There’s such an unquestioned assumption that women will have babies, and a real failure to notice how bizarre it is that we have to produce new human beings out of our own bodies. And also how risky and dangerous a process that is, even with Western medicine.’
To demonstrate her point, she tells me about the time when a colleague was having her wisdom tooth out. Anna suggested they should film it, as a beautiful experience to share and savour: ‘Here it comes! And look, here’s the stitching! Wow – you did that without any painkillers!’ This makes me laugh out loud, both because the crude comparison to childbirth is completely perverse and also because I can kind of see her point. Our attitude to birth is very strange. There is blood, pain and stitching even if it all goes well, and we are meant to ignore it all. We fetishize the pregnancy and birth part of motherhood.
‘We’ve become much more dependent on surgical interventions in pregnancy and childbirth because in the past women and babies died – that was sad, but that was how it was. These days, people survive and go on to have narrow-hipped, large-headed babies. We are actually making ourselves more dependent on medical intervention in childbirth. Modern childbirth is as safe as it is, very largely, because of antibiotics.’ In the face of a looming antibiotic-resistant catastrophe, the future for mothers looks apocalyptic.
Rates of maternal mortality and stillbirth are going down globally, but Anna says that isn’t necessarily all good news. ‘It doesn’t mean that you or you baby have come out unscathed. The more medicine advances, the more women do get scathed,’ Anna says. ‘The ways we can regulate and monitor the foetus while it’s in the uterus has an impact on women’s lives, what they are allowed to do, the kinds of medical interventions that they have to undergo. I don’t see any great breakthroughs on the horizon in terms of maternal–foetal medicine, but I do see a trajectory towards knowing so much about the foetus and what’s good or bad for it in the uterus that women’s lives become almost as though they were ectogenetic gestators themselves. Their whole function becomes about maximizing what’s good for the baby.’
I wouldn’t have described it that way at the time, but I have definitely felt like an ectogenetic gestator. I have had to lie back and stare at hospital ceiling tiles, trying not to panic while a twenty-centimetre needle was plunged into my belly so that doctors could extract my son’s DNA because something came up on a routine scan that made them think he might have a chance of perhaps having Down’s syndrome. (He did not have Down’s syndrome, or anything else wrong with him, but then I got appendicitis.) I have had to stop myself from gagging while forcing down a cloying glucose concoction after which my blood was taken and retaken because a late scan of my daughter showed some things which might have indicated that I had gestational diabetes which could have threatened my pregnancy. (I didn’t have gestational diabetes.) I have had to lie with my legs clamped apart on an operating table while a surgeon stitched up my cervix because a scan showed I was at risk of going into another early labour. Being pregnant is a remarkable, life-changing experience, and I loved carrying my first child, but I have never felt more like a thing than when I was receiving maternity care. Most of the time I was being acted upon there was no reason for it, other than that my very able and dedicated doctors knew too much about what might be going on inside me.
‘In countries where abortion is legal clearly the foetus’s interests are not placed above the woman, but as soon as the foetus becomes a patient – and it necessarily becomes a patient whenever the pregnant women is being monitored or treated on behalf of the foetus – there is a strong expectation that the baby’s interests outweigh those of the mother,’ Anna says.
‘Which mothers go along with.’
‘Yeah. Because it’s part of showing that you are already a good mother. And there is almost no crime worse in our societies than being a bad mother.’
Anna is not a mother. She tells me without me asking about it. ‘I don’t have children and I’ve never wanted to have children, but I have at various times of my life been under some, er, pressure from various people to do so. One of the things that has struck me when I have been thinking about it as a possibility is, if I am pregnant – especially someone like me, who’s written all this stuff about pregnancy – everyone knows! The whole concept of medical confidentiality is just blown out of the water,’ she says. ‘That very public aspect of pregnancy was disturbing to me.’
I see how the idea of being visibly pregnant would be tricky for her. I never wanted the people I worked for to know I was pregnant, and my career isn’t predicated on the idea that pregnancy is barbaric.
‘I do have children,’ I say, ‘and I didn’t necessarily want everyone to know I was pregnant when I was, whereas my husband got to reveal it to whoever he wanted, whenever he wanted.’
Something changes in the room after I say this. I could be imagining it. But it feels like the personal information we have shared remains hanging in the air, drawing an invisible curtain between us. Her interest in ectogenesis is intellectual and academic; she can look at it through brutally logical eyes, and I can’t.
The crux of Anna’s argument is that human beings have evolved, both physically and socially, to the extent that the current way we have babies isn’t working. ‘There’s a lot of talk about how governments and employers need to accommodate pregnancy and reproduction, but you just can’t, because the most important years for women’s careers, where they are establishing their careers, are the ones in which medics are telling them they have to have babies. There is no way of being pregnant and having a baby without it having some impact on your work life.’ She seems to be assuming that the world of work and the trajectory through it is fixed and immutable, so the answer is not trying to change the workplace or the means of production, but the means of reproduction instead. It’s a depressing assessment of what needs to be done to give women true equality.
We are sitting in a spotlessly clean and ordered modernist university campus in Norway, one of the most progressive countries in the world, renowned for its generous parental leave and childcare options. This is one of the best places in the world to be a mother.
‘If we made it as easy for women everywhere to have babies as it is in Norway, wouldn’t so many of the inequalities that women face today disappear?’
‘Maybe, but then birth rates go down,’ she says simply. ‘That’s what’s happened in Norway.’
And she’s right – a few months previously, the Norwegian Prime Minister Erna Solberg made a public plea for her citizens to have more babies, fearing that current birth rates would mean the welfare state would collapse with so few young taxpayers to support it. ‘Norway needs more children,’ Solberg said. ‘I don’t think I need to tell anyone how this is done.’
‘Societies with very generous provisions tend to be wealthy,’ Anna continues. ‘That means women have greater educational opportunities. In Norway everyone goes to university, and nearly everyone does a master’s as well.’ She rolls her eyes comically. ‘It creates a sense of, “I have an education, I can look around, I can choose what sort of ide
ntity, what sort of career I want.” Having children becomes one of many possibilities. The time at which having a child becomes the all-important goal in life, if it happens at all, doesn’t happen until various other important goals have been achieved. If we don’t get ectogenesis, society has a really enormous need to reinforce this maternal role of women.’
Anna was ‘not very surprised’ when she first saw the images of CHOP’s lambs. ‘I would say that those people were clever in their –’ she chooses the word carefully – ‘marketing, with the image and the news that surrounded it. And of course, being unwilling to talk about ectogenesis is part of the PR sort of approach. Scientists are always very quick to say, “We’re not at all interested in ectogenesis, that couldn’t be further from our minds; all we are interested in is understanding gestation better and saving premature babies.” That, I think, is one of the things that really concerns me about the insidious movement towards ectogenesis as a means of saving babies, which I don’t think is at all likely to be beneficial for women.’
Instead of pouring resources into saving premature babies, Anna says we should be growing them in artificial wombs from the start. ‘It’s more likely that if we could find a whole alternative to gestation, then that would actually have better outcomes, because it’s a trauma for the foetus, being removed from the uterus, even if it then goes into a biobag and manages to survive.’
‘Full ectogenesis would actually be ethically preferable to the biobag?’
‘Yes.’
Anna clearly loves using cold, hard logic to poke hornets’ nests. She made headlines in 2013 when she wrote a paper which argued that compassion shouldn’t be a necessary requirement in heath care, and that compassionate doctors and nurses could become ‘ultimately dangerous’ because they were more likely to burn out. But her work on ectogenesis remains her most controversial. Her parents thought it was ‘horrific’, she says. And they weren’t the only ones.
‘I got a lot of hate mail.’
‘From what kinds of people?’
‘All kinds of people. Men, women, feminists, men’s rights activists. Conservatives and Catholics, of course, hated it.’
She tells me about the sarcastic message she got from a Vatican email address. The writer complained that he found shitting a degrading and painful process, and demanded that something was developed so digestion could take place outside the body and he would no longer be humiliated and damaged by it. (Anna replied saying he had her sympathies, but she was not an engineer and couldn’t offer him practical solutions.)
Like Oron Catts, Anna uses provocative, outrageous ideas to raise difficult questions. And it works: she has made me really think about how messed up our notions of what ‘normal’ childbirth, pregnancy and motherhood are.
If Anna’s perfect ectogenesis could ever exist, there is a long list of women who would want to use it. Women with epilepsy or bipolar disorder, for whom pregnancy would mean risking their lives by coming off medication that would damage their foetus. Women diagnosed with cancer while pregnant, who currently have to choose between saving their baby’s life by continuing their pregnancy, or saving their own by starting treatment – even partial ectogenesis would be transformative for them. Tokophobics, who have experienced sexual abuse that has led to a pathological fear of pregnancy and childbirth: women who desperately want children but are unable to bear the prospect of carrying them.
Then there are women without wombs. One in every 4,500 women is born with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome, meaning their uterus hasn’t developed. Others have had their wombs removed for medical reasons: survivors of uterine or cervical cancer, and women with severe and debilitating endometriosis (Lena Dunham has written about having a hysterectomy at thirty-one for that reason). These women currently qualify as possible candidates for uterus transplants. Since 2001 around forty women have had the procedure, resulting in the birth of around a dozen babies. But it requires immunosuppressant drugs and major surgery – on two healthy people, if the donor is alive (which has almost always been the case). The uterus is not a vital organ; while other transplant procedures save lives, this does not. If uterus transplants are rolled out on a wider scale, there will be even greater competition for access to transplant surgery than there is today. Artificial wombs bypass these ethical conundrums.
Ectogenesis will also help women in circumstances that are much less likely to attract public sympathy: Sahakian’s current social surrogacy clients, and older women, whose bodies are less able to support a pregnancy but whose male equivalents get to have babies without a thought. Ectogenesis would mean pregnancy emancipated from age. You could conceive an embryo while you’re young and grow it in a bag after you retire.
But perhaps the population most likely to be emancipated by this technology are those not born female. For the single men, gay men and trans women desperate for their own biological children, the artificial womb could be their key to reproductive equality.
* * *
It’s six thirty on a Friday night, and London’s Barbican Martini Bar is buzzing. Behind a velvet rope, beyond a sign saying, Fertility Fest Seed Reception – By Invitation Only, Michael Johnson-Ellis is surrounded by women in their late thirties and early forties. He’s making introductions like a matchmaker, shaking hands with his right, an espresso Martini in his left.
Michael has just given a talk at Fertility Fest with his husband Wes – entitled ‘Who’s The Daddy?’ – about all the awkward and offensive questions they get asked when people learn they’ve used a surrogate to become parents. Known as ‘TwoDaddies’, the Johnson-Ellises are bloggers from Worcestershire who promote UK surrogacy and run an online support group for intended fathers. Together since 2012 and married since 2014, they have a two-year-old daughter, Tallulah, and a son on the way, as well as Wes’s older daughter from a previous straight relationship.
Michael spots me and waves me over to a quietish seat near the balcony. We sink into one of the tub chairs, and he launches into the story of the ‘journey’ he and Wes have taken to become parents.
‘I had been in straight relationships. I got married at twenty,’ Michael says in his gentle Brummie accent, laughing at the absurdity of the idea. ‘I know! ’
‘Did you always want kids?’
‘Oh God, yeah.’ His face darkens. ‘My decision to come out was either, do I stay married and commit suicide, or do I come out and sign off that I will never be a dad? Back in 2001, I knew no gay men that were being fathers, so I had written it off. I’ve witnessed so many men within my community hang themselves, take tablets, and I didn’t want to do that to my parents. I was at a crossroads: trading off being a dad, if it means being happy with someone I love, or being in a relationship where I’ll have kids, but it won’t end well.’
By the time he and Wes met, the world had changed: gay couples were beginning to have babies together. ‘It was probably within the first week that I said to him, “Look, I’m going to sound like a real crazy woman, but do you want kids?”’ Within a month, they had moved in together. A few weeks later, they were engaged. ‘And then, about a year in, we were like, “Right. How do we create a family?”’
Wes joins us with a pink Martini in his hand. He apologizes for being late. ‘Everybody wants a little piece of us tonight.’
For a couple that likes to act fast, surrogacy was painfully slow. They spent three and a half years trying to work out how to do it. ‘We looked at Nepal, we looked at India, we looked at Thailand, we looked at Guadalajara…’ Michael says.
‘It was all changing as we were doing it…’ Wes adds.
‘It was all going to shit,’ Michael nods. ‘We started with Thailand, and then the Australians screwed that up because there was that case.’ He means the Gammy case. ‘Then India turned against the gays and you had to pretend you were married to your surrogate.’
‘And then wasn’t there an earthquake in Nepal?’ Wes asks.
‘Yes, and loads of embryos got ki
lled. Then we went to Spain, to a clinic that had links to Mexico, and we were almost there. And I remember saying to the clinic manager, “How many British people have left with their child?” “Well, none yet.” And I was like, “No, no, no.”’
Wes felt it would be safer to have a commercial relationship with a woman overseas. ‘When you decide to use a surrogate, all those natural things go through your mind, like, Will she run off with the baby? Going abroad would mitigate the risk. We would then have our baby, come back to the UK and never see that person again. The link was cut and we were back into our own world. We couldn’t bump into them in Sainsbury’s.’
Running out of options, Michael created a profile on the international site surrogatefinder.com, and within four weeks a British woman emailed saying she’d like to meet them. They drove up to meet her and her husband, and for once everything felt right. She ended up carrying their daughter, Tallulah, and is now pregnant with their son.
‘She’s part of our life now, which we never wanted and never set out to make happen,’ Wes says.
‘The relationship we’ve got with her now is not the relationship that we wanted at the beginning, but we couldn’t imagine it any other way,’ Michael adds.
‘We wanted this very black and white transactional relationship, but actually now we’re very comfortable, we already tell Tallulah who she is, how she brought her into the world.’
‘Tallulah knows that she’s growing her brother, and when he is big enough, he’s going to come home.’
It sounds like they would have much preferred to have what Anna would call an ‘ectogenetic gestator’ – but human warmth got in the way, and they are pleased with how things have turned out. Of course, there would be no delicate relationships to navigate with an artificial womb, no one’s goodwill to depend on, no one to bump into at the supermarket and cause an awkward scene.
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