Not all babies are wanted, of course, which means that an artificial womb or a transplant into a ‘willing womb’ raises other thorny issues. Such as, if a baby could be made viable from day one using some newfangled contraption, where would that leave the abortion debate?
When a woman has an abortion, she is exercising her right to remove an unwanted pregnancy from her body, and quite a number of women exercise this right every year. In 2009, there were 189,100 abortions in England and Wales; in 2005, 820,151 were reported in the US. Around forty percent of terminated pregnancies are aborted for medical reasons related to the developing foetus, including the risk of potentially serious disabilities, for example, of damage to the nervous system or Down syndrome. (An estimated ninety-two percent of all women who receive a prenatal diagnosis of Down syndrome choose to terminate the pregnancy.) The remaining sixty percent of abortions are chosen for reasons related to the mother – her own physical or emotional health or her relationship to the father, among many other factors. It should be stated that a woman’s right to an abortion does not give her the right to kill a child; rather, the aim is to end a pregnancy. This is why, under the law, we consider the foetus to be a collection of cells, not a baby, until some demarcated point when the cells could live on their own outside the womb.
Before birth, the rights of babies – that is, foetuses – are not protected; under current UK, Canadian, and US law, foetuses have no rights at all. In a handful of cases, however, American mothers have been charged with child abuse for behaving in ways that allegedly harmed the foetus they were carrying. If an artificial womb were created in which a healthy foetus scheduled for abortion could survive to term, the issue of whether it should be nurtured there would become a matter for politicians and public policy to decide. Ninety-one percent of the abortions performed in the UK in 2009 were conducted when the foetuses were at thirteen or fewer weeks gestation – too early for today’s incubators. If they could conceivably be kept alive, would medical staff have an obligation to resuscitate them and place them in an artificial womb? Would it be better for society if these pregnancies were not aborted, if the embryos survived to become people with inalienable human rights?
Already, the relatively antiquated incubators in modern hospitals have proved to be an ethical minefield when conflicts arise between the desires of premature babies’ parents and the obligations of medical staff. One such battle began on 21 October 2003, when a baby who had only been in the womb for twenty-six weeks was born in Portsmouth, England. Tiny Charlotte Wyatt was only 12.7 centimetres (five inches) long at birth and weighed 458 grams (sixteen ounces), instead of the average 3.5 to four kilos (approximately 7.5 pounds) for a full-term baby. Charlotte was fragile; her organs – especially her lungs, heart, and brain – were extremely underdeveloped. She nearly died after delivery. After being resuscitated, Charlotte suffered severe brain damage and several of her organs failed; she was left blind and deaf, her kidneys were compromised, and her lungs were so severely injured that she required a constant supply of oxygen. The extreme immaturity of her body also meant that her immune system was unprepared for the world outside the womb, and any small infection could be lethal. There was little hope of her living beyond childhood.
Charlotte’s team of doctors contended that, however long she lived, she would not only need continual medical attention, but would also likely be in constant pain and experience a life of extremely poor quality. Medical opinion was weighted in favour of no longer resuscitating the child when she next suffered cardiopulmonary failure – as she had on three occasions – and instead allowing her to die with some measure of comfort. The medical staff argued that with every resuscitation they performed, Charlotte’s lungs became increasingly delicate, and aggressive treatment was not in the child’s best interests. Prolonging her life, in fact, appeared to constitute an assault of ‘inhumane and degrading treatment’ under Article 3 of the European Convention on Human Rights, as the potential long-lasting harms to the person would ultimately exceed the benefits. The doctors argued in favour of palliative care alone.
Charlotte’s parents disagreed. As committed Christians, the Wyatts believed that their daughter’s life should be preserved at all costs. So when doctors refused to resuscitate Charlotte for a fourth time, her case was brought to court. The doctors won the legal right to let her die, should her body shut down again. Yet, Charlotte did not die, as expected, and the ‘do not resuscitate’ order was eventually lifted, in 2005, when her parents showed that Charlotte was no longer in constant pain or unable to respond to stimuli.
Over those two years, however, the extreme stress of the situation had led to the breakdown of the Wyatts’ marriage, with the two parents visiting their severely disabled child only infrequently in the hospital ward. A second series of legal clashes ensued, this time over sustaining care for Charlotte. In the end, the child was placed with foster parents. By 2009, her father was visiting her monthly, according to an interview with the Daily Mail. He reported that, though Charlotte still needed some oxygen every day, she loved to listen to nursery rhymes and could stand and walk with the help of a walking frame. ‘Going through the courts to keep Charlotte alive totally drained me,’ he said. ‘But now, when I look at her smiling face, I know it was the best thing I ever did.’
While it is currently feasible to keep the very premature alive, good health and quality of life are by no means guaranteed – and there can be a devastating toll on both child and parents. An artificial womb that can sustain and continue the development of extremely young foetuses could completely reinvent the parameters of neonatal medicine, helping to give children like Charlotte a less traumatic life.
Regardless of such gains, a fully functional artificial womb will also present entirely new ethical dilemmas, including some we may not be ready to negotiate. What if a foetus that would otherwise be aborted could be removed from its mother’s body and gestated artificially? Would that improve the chances of adoption for a child, given that many couples prefer to adopt a baby rather than an older child? Would each year’s 189,574 aborted pregnancies, as occurred in 2010 in England and Wales, be viewed as the prospect of a joyful miracle in the tradition of the first test-tube babies, or would they be seen as supplanting the placement of older children needing a home?
How will this new technology alter the identity of a mother, a role that would cease to trigger a biological bond, even if her own egg is used? For instance, there has been a great deal of research into the hormones oxytocin and arginine vasopressin. In mammals, the levels of these hormones are elevated in mothers’ brains. Oxytocin levels also increase during labour and reach a peak at the time of delivery. Both oxytocin and vasopressin have been linked to the instinct towards maternal care and mother–child and other affectionate, family bonding. The hormones have even been seen to rise when mothers engage in other supportive and bonding behaviours, long after pregnancy, though it is not known how and why this occurs. If a mother did not experience the increase in hormones related to pregnancy, would it make a difference later in life? Would it be possible to give a mother a dose of the hormones, in place of this natural release? It is apparent, from the experiences of many adoptive mothers, that a mother–child bond forms even in the absence of pregnancy, but it may be that those who choose to adopt happen also to have a strong instinct for maternal care. It may be that separating the physical experience of pregnancy from the body of a mother also requires separating it from the mother’s biological brain.
Further, since a child’s identity is in part shaped by the communication of hormones and other information from mother to foetus, pregnancy via an artificial womb would redefine what it means to be a biological parent. Perhaps in the future a mother who uses an artificial womb will primarily be seen as a genetic and social parent, since all of the biological exchanges of pregnancy will gain new significance. Could the artificial womb become yet another symbol of the ways in which a woman is or is not a ‘good mother’? By relinquis
hing the chance to shape her child’s development from embryo to full term, a mother might be ensuring a more resilient temperament for her offspring, after all. In a case where a woman uses a donor egg and an artificial womb (by choice or necessity), the baby will have neither gestated with the mother nor bear any of her genes. Would the egg donor have more legal rights to the child in this case? In these ways, the very concept of an artificial womb reveals how societies view women. Even in the twenty-first century, a woman is still often defined by her role in procreation.
Consider, for instance, surrogacy, the practice of using another person’s womb to carry your embryo to term. The role of surrogate mother, sometimes described as putting up a ‘womb for rent’, is considered by some to be exploitation, especially as the practice has been more and more often outsourced to countries where a high proportion of the population live in poverty. Countries such as India.
Since 2002, when the Indian government legalized paid surrogate pregnancy – critics say they did so in the hopes of giving birth to a new ‘pink-collar’ industry – young Indian women have been queuing up to become surrogate mothers. There are doctors in nearly every major Indian city working with women who want to be surrogates; there is even a town in the state of Gujarat – its name is Anand, which in Sanskrit means ‘bliss’ – that is poised to claim the mantle of the nation’s go-to centre for paid pregnancy. In 2009, one Mumbai doctor told the London Evening Standard newspaper that she delivers more than fifteen babies for British couples every month – about one every forty-eight hours. (Unfortunately, despite the legalization of the service, the government does not keep reliable numbers of how many women have become surrogates.)
It’s not surprising that Indian women are signing up in hordes – they are paid between $6000 and $10,000 (£3700–£6000) to be a surrogate, which amounts to about fifteen years’ wages, on average. The rise in infertility in industrial nations is certainly fuelling this ‘business’, as commercial surrogacy is banned in most of Europe and in many US states. Couples, most commonly from the UK, US, Germany, Taiwan, Japan, and Australia, go to India to take advantage of these services, because, even with the travel costs, it will cost them just one third of what it would in their home countries.
There are complications to this outsourced labour. Women in India are sixty-nine times as likely to die from childbirth-related issues due to inadequate access to good medical facilities. The Indian government has not put in place any regulations to protect the rights of surrogate mothers. As it stands, surrogate mothers are looked after during their pregnancies, but they receive no compensation for medical difficulties that arise after childbirth. These women are at risk of long-term liver problems – a side effect of being pumped full of the hormones used to prepare the body for pregnancy. They also may face the common complications of pregnancy: the risks of toxaemia, anaesthesia, and haemorrhage, to name but a few. Further, it has been documented that many couples who have returned from using surrogate services in India have delivered twins. Multiple births generally mean lower birth weights for the babies and more dangers that arise to the mother during childbirth – so much so that implantation of more than one embryo during IVF is frowned upon by the National Health Service.
Plus, we just do not know what are the true risks of carrying a child to term who has no genetic relation to you. We do know that a mother who has been exposed to a partner’s sperm before she conceives his child is less likely to suffer from pre-eclampsia, a potentially life-threatening condition in which blood pressure and urine protein levels soar. Pre-eclampsia may be related to immune recognition, that is, when the mother’s immune system antibodies, after being exposed to the father’s foreign antigens, allow the placenta to penetrate the wall of her uterus more deeply. Researchers have found that the many genes that control the growth of the placenta are expressed from only the father’s DNA. This could mean that the growth of an embryo and its supporting placenta in the body of a woman who has never been exposed to the genetic father’s antigens, and who herself has given no genetic input into that embryo, may be up against an as-yet-uncatalogued threat to her immune system – as well as that of the foetus she is carrying.
There are also looming issues unrelated to health. In one recent case, a Japanese couple who had paid an Indian surrogate ended up divorcing, and the ex-wife no longer wanted the baby – who had not yet been born. The surrogate mother didn’t want the baby either, and under Indian law, she was prevented from handing over the child to the father. After much legal wrangling, the paternal grandmother was given custody of the infant.
Surrogacy in India is a lucrative business, and family hierarchies in the country still hold great power – especially over their female members – which raises the question of whether all of the women caught up in the system are truly doing so out of choice. Could some families be putting pressure on their young women to join the ranks of surrogate mothers in order to benefit household economics? One family, for instance, was recorded to have three sisters pregnant as surrogates at the same time; their sister-in-law was pregnant with her second surrogate child too. Likewise, many surrogate mothers live in houses that have been described as akin to a fertility reality show. For the duration of their pregnancy, up to fifteen expectant mothers may be packed into a house, where they are overseen, Big Brother-style, by a former surrogate mother.
A doctor who implants embryos in surrogate mothers at a prominent Mumbai clinic reported to the London Evening Standard that business is very fertile indeed. ‘Surrogacy is spreading at a very fast pace here and there have been very few complaints,’ he said. ‘Our email inquiry box is full of messages from people from all over the West.’ Another fertility specialist at the clinic emphasizes the convenience in his pitch: ‘There is no paperwork involved; the couples don’t have to go through any lawyers; it’s a clean issue – and there is no litigation.’ While such loopholes may be attractive to the doctors’ relatively wealthy clients, the Women’s Protection League of India disagrees that surrogacy is a positive development for the surrogates themselves, especially with respect to their health. A spokesperson for the group said, in no uncertain terms, ‘This is exploitation and I totally condemn surrogacy.’
An artificial womb could be the great equalizer for women – a way to end the exploitation of another woman’s body in order to bear a child when one woman discovers that her own body cannot do so for her, or even if she decides that it’s simply not convenient to do so. It would mean that a woman’s big life choice would be whether she will bear her child, rather than when she might do it. And this liberated mother could carry on with her life as usual up until the moment of birth, much as most fathers do.
The invention of a human artificial womb might also mean that the divide between mother and father can be dispensed with; a womb outside a woman’s body would serve women without wombs, transsexual men, and male same-sex couples equally without prejudice. For this reason, some feminists have argued that the quest for the artificial womb comes from a deep-seated desire to displace women and dissociate birth from the maternal body – effectively, to erase the mother. And in a case of fact being stranger than philosophical fiction, an internet forum for fathers campaigning for parental rights when marriages dissolve has seen messages advocating for an artificial womb – because it would free fathers from the tyranny of those mothers who keep men apart from their children.
The cultural divide between mothers and fathers appears to be closing, at least in some parts of the world. Two generations ago, fathers were not as hands-on and engaged with child-rearing as they are today. There hasn’t been a change in the biology of sex in that time; the change has come through our culture, including the tools available to us to equalize the distribution of labour (in the sense of work). When an artificial womb becomes available, an equal distribution of labour (in the sense of childbirth) will finally be within reach. This will mean that women will be freed from the dangers of pregnancy and will be able to work produ
ctively throughout gestation; it will also give men an essential tool towards being able to have a child entirely without a woman, should they choose. But it also means we will have to consider the most basic questions of gender: why are the roles of mother and father still seen as different to most people on the planet? Why can’t a man be a ‘mother’? Why do we care so much about what it means to be a ‘mother’ rather than to be a ‘parent’?
By all reasonable estimates, in the near future we will conquer the tyranny of time and the tyranny of the womb. The question remains if we can also conquer the tyranny of human prejudice too.
9
GOING SOLO
There are plenty of reasons not to put up with the world as it is.
José Saramago, interview with the Guardian, April 2006
The UK Office for National Statistics’ 2012 study of lone parents with dependant children reports that the traditional family household of a married couple with a child or children is now three times less common than it was just a generation ago. Families headed by only one parent comprise twenty-five percent of households in the UK and twenty-eight percent in the US, and in the US, the so-called nuclear family now accounts for fewer than twenty-five percent of households, compared to forty percent in 1970.
The majority of single-parent families are created by circumstance – separation, divorce or the death of a partner. Recent decades have also seen the rise, however, of the solo parent, a name used to distinguish these single-parents-by-choice from other single-parent families where a two-adult household has been broken apart, often with economic consequences, and for that reason is often associated with disadvantage and, sometimes, pity.
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