‘When we talk about rescuing very premature babies, there’s a risk that we might start to see a desire to rescue babies out of their mothers’ wombs because their mother is not fit to have the foetus in her uterus,’ she says.
If you can save a vulnerable baby from the dangers of premature birth, would you not be prepared save it from the dangerous behaviour of a reckless mother? You wouldn’t need the perfect ectogenesis Anna imagines for that, or even full ectogenesis. You could just use a biobag.
CHAPTER TWELVE ‘Finally. Women made obsolete’
It is five a.m. on a Wednesday in the city of Mobile, Alabama, and the queue outside the Mobile Metro Treatment Center snakes around the block. Middle-aged men in suits wait in line, women in waitress uniforms, weary couples holding hands. Most are in their twenties and thirties, and white, even though over half Mobile’s population is black. They are here this morning, and every morning, to get the methadone they need to function. The relentless late-May Alabama sun has yet to rise, and they quietly stare at their shoes under the orange street lamps while they wait for the doors to open.
Barbara Harris has driven nine hours from North Carolina to be here. She is sixty-five and not very steady on her feet, but what she lacks in agility she makes up for with her presence, her unwavering self-assurance. She shuffles down the queue, smiling warmly to the jittery people.
‘Do you know anyone using drugs who could get pregnant?’ she asks each person, pressing pink business cards into their hands. ATTENTION DRUG ADDICTS/ALCOHOLICS, reads the red lettering on the cards, GET BIRTH CONTROL GET $300 CASH. In the top right corner, there is a colour photo of an impossibly small, angry-red premature baby in a NICU, engulfed by tubes, just like the babies in the CHOP promotional film.
Since she founded her non-profit, Project Prevention, in 1997, Barbara has bought the fertility of over 7,200 addicts and alcoholics. The overwhelming majority – 95 per cent – are female. Her mission, she says, is ‘to reduce the number of substance-exposed births to zero’, but the birth control she offers isn’t condoms and pills, it’s IUDs, implants and sterilization. Project Prevention doesn’t perform the procedures itself, for legal reasons; instead, Barbara asks for doctors’ letters to confirm the patient is on long-term or permanent birth control. The clients who choose to be sterilized get their $300 in a lump sum; the women who go for less permanent options are paid in smaller instalments so long as they can prove the contraceptive is still in place. Perhaps that’s why thousands of the women she pays have opted for tubal ligation.
Barbara drives around the US recruiting new addicts in her Project Prevention-branded RV. It’s covered with posed colour images – babies asleep next to trays with thick lines of coke, pregnant teens injecting themselves – under the slogan Babies deserve to be DRUG & ALCOHOL FREE. (The models in the photos are actually some of Barbara’s ten children and baby grandchildren.) The number plate is SENDUS$$. Barbara tells me she gets anything up to half a million dollars in donations every year. Most of her donors are white men.
‘I think if there’s anything that everybody can agree on – the left, the right and everybody in the middle – it’s that it’s not OK to abuse children,’ she tells me at the table inside her air-conditioned RV. Her bleached hair is pulled back into a tight ponytail; her brown eyes brim with confidence. ‘That’s why we have such huge financial support.’
‘Having a child when you’re drinking and taking drugs is child abuse?’
‘Yes,’ she nods. ‘Well, they say don’t even drink caffeine when you’re pregnant, so I don’t know how meth could be good for a baby.’
Barbara isn’t the right-wing zealot you might expect her to be. She believes in God, but doesn’t attend church regularly. She’s pro-choice, but not when drug addicts use abortion instead of contraception. She’s been accused of racism because she’s a white woman and over 30 per cent of her clients have been people of colour, but her husband is black and her children are either black or mixed race. She’s the adoptive mother of five black children, all born in quick succession to the same crack-addicted mother.
‘I’ve seen these children first-hand. I know many people that have adopted children who have feeding tubes and breathing tubes and some that don’t even make it,’ she continues. ‘Yes, some do survive and some will go on to be normal – I’ve got proof of that living in my home. But many don’t. So it’s a gamble. And it just depends on whether you’re willing to take a gamble with the lives of innocent children.’
It is all so straightforward for Barbara. If you love kids, how can you disagree with her?
‘Having money gives you a lot of power over the people you come into contact with,’ I say. ‘Do you feel that they’re making a free choice when they’re dealing with you? Is it really informed consent when they’re in a chaotic situation?’
‘That’s between them and their doctor,’ she declares. ‘He has to decide whether he thinks they’re able to get birth control. My thoughts are for the children. Nobody has a right to force feed any child drugs and then deliver a child that may die or may have lifelong illnesses. Nobody has that right.’ She shrugs, as if she can’t believe she’s had to explain this to anyone.
Lots of people agree, especially here in Alabama. Since the 1950s, at least forty-five US states have prosecuted women for using drugs while pregnant. There are no laws specifically aimed at pregnant women, but states have applied existing legislation to criminalize them. Alabama’s ‘chemical endangerment’ law was passed in 2006, targeting parents who turn their family homes into meth labs. Within months it was being applied to pregnant women ruled to be endangering their foetuses, even if they went on to give birth to healthy babies. Mothers face up to ten years in prison if their baby survives the pregnancy unharmed; if the baby dies, they are looking at a sentence of up to ninety-nine years. By 2015, 479 pregnant women in Alabama had been prosecuted under the chemical endangerment law. The most common drug they used was marijuana.
Drug screening for pregnant women has become routine – not just in Alabama, but across the US. Women in South Carolina who use drugs or alcohol from the late second trimester can be charged with felony child abuse. Under Wisconsin’s Children’s Code, a.k.a. the ‘Cocaine Mom’ law, a woman can be detained in a hospital or rehab programme against her will for the duration of her pregnancy. The foetus gets its own court-appointed lawyer; the mother doesn’t.
The biobag is designed to save very sick, very vulnerable babies. It will be released into a political climate where drug abuse is child abuse, and ‘very sick’ is open to interpretation. The actual risks posed to foetuses of using heroin, crack, marijuana and meth during pregnancy remain unclear. Babies born to heroin-addicted mothers go through agonizing withdrawal for several weeks, but heroin is not known to cause birth defects. Prenatal cocaine exposure has not been definitively linked to any long-term effect on children’s growth or intellectual development. The greatest risk babies born to drug-abusing parents face is most likely to come from growing up in a chaotic home, or being exposed to legal substances in the womb, like tobacco, alcohol and some prescription medications, which are known to cause severe birth defects. But in a culture where the drug-abuse-equals-child-abuse argument has so much traction, it’s unlikely that there will be nuance in the debate once an ectogenetic solution to the problem is a reality.
Barbara came to Mobile because someone sent her an article about a woman here who had been jailed three times for using heroin during three separate pregnancies. ‘Putting these women in jail is not the solution,’ Barbara says. ‘They’ll do their time, but nothing’s going to guarantee when they get out that they don’t get back on drugs and have the chance to endanger another child. That’s not the solution.’ Her answer is to prevent these women from being able to have babies at all. By that reckoning, ectogenesis is not the solution, either. Yet if protecting children at all costs is the bottom line, an artificial womb will always be preferable to an ‘irresponsible’ pregnant woman. If you can’t
prevent a baby from being born to an addict – and, despite Barbara’s best efforts, Project Prevention has been a drop in the ocean of the number of women who are pregnant and using drugs in the US – you can at least ‘rescue’ it as early as possible.
It would be easy to dismiss this as American craziness, but foetal rescue – or a version of it by another name – is happening already, in countries that like to think of themselves as among the most progressive in the world, and to women that aren’t even taking drugs.
In a notorious case from 2012, a pregnant Italian woman flew to England for a two-week Ryanair training course in Stansted. She had a panic attack at her hotel, and called the police, who spoke to her mother on the phone. She explained that her daughter was probably suffering the effects of not taking her medication for bipolar disorder. The police took her to a psychiatric hospital, where she was sectioned under the Mental Health Act. Five weeks later, under a Court of Protection order obtained by Mid-Essex NHS Trust, the woman was forcibly sedated and her baby was then delivered by caesarean section without her consent. Essex social services immediately took the daughter she gave birth to into care, and the mother was escorted back to Italy without her baby. When the few details that could legally be made public were reported a year later, Essex social services defended themselves by saying they were acting in the best interests of the child.
Even in supposedly liberal and enlightened Norway, the state’s desire to protect babies often overrides the rights of the women who carry them. Between 2008 and 2014, the number of newborns removed from their mothers immediately after birth by the Norwegian child protection service tripled. By far the most common reason given wasn’t drug or alcohol abuse but ‘lack of parenting skills’, a vague term that includes mothers from cultures where smacking is condoned, mothers with mental health problems, and mothers known to have had lived chaotic lifestyles in the past.
If some mothers can’t be trusted to look after a newborn, will they be trusted to be pregnant when an alternative method of gestation exists? Could a mother unfit to look after her own child ever be a responsible incubator?
If the future of birth means a choice between ectogenesis and natural pregnancy, our attitude to ‘natural’ will change forever. It’s easy to imagine a future where the kind of ‘help’ already offered by employers in Silicon Valley and beyond, enabling staff to freeze their eggs so they can focus on the most productive years of their careers, might include the option for employees to grow their babies in an artificial womb so they can continue working throughout gestation and birth. Using a real womb, inside the body, could ultimately become a sign of low status, of poverty, of chaotic lives, of unplanned pregnancy, or of being a borderline-dangerous earth mother, in the same way that we consider ‘freebirthers’ who choose to have their babies without any medical input during pregnancy or delivery. ‘Natural’ birth itself could become the irresponsible and reckless option.
* * *
The greatest existential threat faced by unborn babies today doesn’t come from drugs, alcohol or women ‘unfit’ to be pregnant, but from unwilling mothers. Ectogenesis will be able to ‘rescue’ aborted foetuses: they could be transferred into an artificial womb and given to parents who want them. In the UK, abortion limits are pegged to viability outside the uterus – that’s why the limit changed from twenty-eight to twenty-four weeks in 1990. Full ectogenesis would mean all foetuses – even embryos – become viable, and any unborn child could be deemed to have a right to life.
Even partial ectogenesis will turn the abortion debate on its head. We think of abortion as one choice – the decision to terminate a foetus – but it’s actually two: the decision to stop carrying a baby and the decision to end that baby’s life. Ectogenesis will make those choices separate and distinct, for the first time. Once a woman’s body is no longer the incubator, abortion can be both pro-choice and pro-life. States will be able to allow women to choose what happens to their bodies at the same time as making it illegal to end the life of a foetus. Why should the mother alone decide that a baby should die if it can be rescued by technology?
The feminist activist and writer Soraya Chemaly was thinking about this five years before the lambs in the bags emerged live and kicking onto the world stage. In a 2012 essay for Rewire.News, she wrote that ‘the tension inherent in the current debate, between the rights of the woman and the state’s interest in the foetus, disappears when the woman and the foetus can be safely and immediately made independent of one another. The reproductive choices of men and women become equal and women lose the primacy now conferred on them as a result of gestation.’ Her piece ended with a bleak kick in the teeth for the right to choose. ‘The real dystopian future is one where we look back with nostalgia at the brief period during which Roe vs. Wade had its fragile relevance and impact as a high point in women’s reproductive freedom.’
I catch up with Soraya on the phone from Washington DC. I begin by asking her what she thought when she first heard about the biobag, and she laughs a long, dark laugh. ‘I’m quite cynical and fairly pessimistic about technology as it pertains to being truly disruptive or revolutionary. I always laugh when futurist technologists, who are still overwhelmingly men, overwhelmingly white, overwhelmingly elite, declare that their technologies are progressive and disruptive, because they produce so much of the patriarchy. They reproduce so much of the underlying inequalities of all societies. It’s like trying to explain to fish what water is.’
Even with the strides Matt Kemp at WIRF and the team at CHOP have been making, Soraya takes care to say she thinks it will be a couple of generations before full ectogenesis will be a viable and widespread reproductive technology. ‘It is incredibly complex and I still think it will take longer than some people believe,’ she says. ‘But I do think it’s inevitable.’ It is simply the next step in the fragmentation of motherhood. Artificial womb technology – overwhelmingly designed by men – would allow for women to be no more than gamete providers, as distinct from their gestating babies as men are.
Ultrasound images show how much female bodies are already seen as vestigial in reproductive medicine, Soraya says. ‘I’ve been arguing for years, don’t show pictures of fucking developing foetuses unless you show the entire woman’s body. I understand people getting pregnant and being excited, but I’m the terrible feminist killjoy; I’m like, “Oh, that’s nice, why don’t we just make it bigger ?” Ultrasound was very deliberately developed to show the foetus as though it were a planet in a void, in a vacuum, in a container, in a jar. A wallpaper of blackness around it. It completely erases the woman whose body is generative.’
I can’t see full-body ultrasounds catching on, but I can see what Soraya is getting at. Flake said one of the big selling points of the biobag was that it would allow both parents to view their baby in real time, as it is disembodied from any mother. And once mothers and fathers are equally separate from their babies, they have equal rights to them, an equality that comes from women surrendering their reproductive power.
Soraya accepts that ectogenesis has the potential to free women from the burdens that currently come alongside motherhood. ‘I’m really torn,’ she says. ‘You think, Finally, can we just be done with all of the cultural weight of having this be thought of as inherent in our natures, an inevitable primary role for all of us? And that’s kind of liberating.’ But Soraya is also ‘an avid fan of dystopian literature, particularly feminist dystopian literature,’ so she sees the dark potential for this technology to be used to disenfranchise women. Even in the most misogynistic societies, she says, women are prized for their ability to bear children, ‘at least as long as there remains a chance that she’ll give birth to a son.’ By making reproduction equal, ectogenesis will remove the one universal power that women unequivocally have and men do not.
This makes me think about how, in the ectogenetic future, there may be children growing up around the world who contain the genes of mothers who didn’t want them to exist. They w
ill be born at a time when there is greater access than ever to genetic parenthood, when parents like Wes and Michael, who yearn for their own children, have so many other technological solutions allowing them to create their families. To use Michael’s unintentionally brutal language, the supply would greatly outstrip the demand. These unwanted babies may have nowhere to go. In that world, some women might seek out backstreet abortions that will end their babies’ lives, rather than legal ones that would allow them to live.
It’s a horrifying thought. But this is what could happen if the foetus’s right to life trumps the right of a woman to refuse to become a mother.
‘At the moment,’ I say, ‘women have a right that men don’t have—’
‘Which is to end a pregnancy?’ Soraya interrupts.
‘Which is to not become a parent. Because ending a pregnancy means the death of the baby, the woman can choose whether to become a parent. That’s a right that men don’t have. This technology would be brutally equal, wouldn’t it?’
‘Yes it would. And it would totally wash that away.’
‘And women would lose that power that they have now.’
Soraya thinks about this for a minute. ‘You are describing an interesting legal equalization that will remain unmatched in terms of cultural responsibility,’ she says. The onus will still be on women to stop getting pregnant in the first place; women will still be the ones getting pregnant, after all. She pauses again. ‘I think that’s very interesting, and I think it might be a very good outcome, in terms of forcing people to come to terms with really profoundly embedded ideas about mothering.’
‘In one respect that’s a great thing,’ I say, ‘but I guess what I’m driving at is, is this a right that women want to lose?’
‘If you don’t need women because they are actually the only ones capable of reproducing, and you already show in the society such a disdain for women, what do you do? I don’t think we have an answer to that. Ideally, we could live in a world in which we were all people, and some people choose to reproduce and other people don’t, and they all have dignity and autonomy in their decisions.’ People, parents, rather than mothers and fathers per se. People like Juno, like Michael and Wes. ‘That’s the platonic ideal of a fair distribution.’ But the world we live in is far from ideal, or fair.
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