This book is about selective reproduction in the twenty-first century. Although selective reproductive practices have existed for a long time (Gammeltoft and Wahlberg 2014), twenty-first-century biomedicine provides historically unprecedented possibilities for technological interventions in childbearing processes. In the past 40 years, human reproduction has been technologically parcelled out into specialized fields of insemination, fertilization, implantation, gestation, termination and (preterm) birth. Such developments have separated reproduction from sex as well as genetics from gestation. As such, in the twenty-first century, selective reproduction increasingly takes place through decisions about which gametes to fertilize, which embryos to implant or which foetuses to abort. These new possibilities for decision-making and choice raise urgent questions for social scientists.
In this volume, we use the term selective reproduction to refer to practices that aim to prevent or promote the birth of particular kinds of children. What we collectively show in the following chapters is how selective reproductive technologies (SRTs) have been developed and routinizedāwhich is to say taken up, practised and experiencedāaround the world over the last few decades. Selective reproduction is ubiquitous and not limited to any specific parts of the world, although the ways in which SRTs gain traction and stabilize are multiple. With the increasing availability of SRTs, selective reproduction is taking place on a historically unprecedented scale, through sex-selective abortion following ultrasound scans, abortion following detection of foetal anomalies during routinized prenatal screening and testing programmes, the development of preimplantation genetic diagnosis (PGD) techniques as well as the screening of potential gamete donors by egg agencies and sperm banks (see Table 1.1). 1
Table 1.1
Major forms of selective reproduction in the twenty-first century
Objective of selection | Type of selection (SRT) | Scope |
|---|---|---|
Selecting for desired sex (sex selection) | ā¢ Sex-selective abortion following prenatal determination of foetal sex ā¢ Sex-selective implantation of embryos following in vitro fertilization (IVF) and embryo biopsy (PGD) ā¢ Sex-selective fertilization of gametes following the MicroSortingĀ® of sperm cells in a semen sample based on the chromosome they are carrying (can only influence sex of embryo) | Sex-selective abortion is legally prohibited in most countries of the world. Nevertheless, millions of especially female foetuses are aborted annually around the world. In countries like China, India and Vietnam, obstetric ultrasound has contributed to unprecedented sex ratios at birth as high as 120 boys for every 100 girls. While sex-selective abortion is often considered to be a problem of the so-called Global South linked to son preference, sex-selective fertilization of gametes or implantation of embryos (as opposed to abortion) is often described as āfamily balancingā or ālifestyleā sex selection in the Global North. While prohibited in some countries, thousands of cycles of MicroSortĀ® insemination and PGD for sex-selective purposes are carried out each year globally |
Selecting for a healthy/normal child (prevention of disease/disability) | ā¢ Selective abortion of foetuses following detection of āseriousā foetal abnormality, chromosomal disorder or genetic disease ā¢ Selective implantation of only unaffected/healthy embryos following IVF and embryo biopsy (PGD) ā¢ Sex-selective fertilization of gametes following the MicroSortingĀ® of sperm cells in a semen sample based on the chromosome they are carrying (can only influence sex of embryo) in order to avoid transmitting a sex-linked genetic disease ā¢ Selective fertilization of gametes following medical screening of gamete donors to prevent transmission of infectious or genetic disease | Prenatal screening programmes have been routinized throughout the world covering millions of women (there are an estimated 213 million pregnancies globally every year, not all are screened) involving combinations of maternal serum screening, free foetal DNA screening, obstetric ultrasound scans and invasive prenatal diagnosis. Legislation varies with some countries allowing for late-term abortions if a āseriousā condition is detected. Such terminations remain controversial in many countries and there is no consensus as to what conditions (if any) are considered serious enough to warrant an abortion. Following the detection of foetal abnormalities, chromosomal disorders or genetic diseases/conditions, hundreds of thousands of pregnancies are terminated annually (legally and illegally) around the world (there are an estimated 45 million induced abortions globally every year; we estimate between 0.2 and 1 % of abortions are on grounds of substantial risk that the child would be seriously affected if the pregnancy is not terminated). Thousands of cycles of MicroSortĀ® insemination and/or PGD are carried out around the world to prevent transmission of a genetic disease. |
Selecting for desired traits (donor selection) | ā¢ Selective fertilization of gametes following the choosing of a suitable gamete donor based on available information about donor health, eye colour, hair colour, blood type, height, intelligence, beauty, race/ethnicity, and so on ā¢ Selective implantation of embryos with disabilities by parents with disabilities (e.g., deafness or dwarfism) | Sperm banks and egg brokers screen thousands of potential gamete donors every year. Of these, between 10 and 20% are selected as qualified donors according to screening criteria. Legislation varies with some countries prohibiting all gamete donation and others allowing infertile couples, single women and/or lesbian and gay couples to access donor gametes. Studies have shown that infertile heterosexual couples are mostly concerned with health and less concerned with traits while gay couples, lesbian couples and single women often select for traits that are familiar to them and their families. Hundreds of thousands of donor babies have been born worldwide, the first major cohort of which (born in the 1980s) is now actively seeking out donor siblings and their biological fathers or mothers |
Selecting for saviour siblings (HLA matching) | ā¢ Selective implantation of histologically compatible embryos following IVF, embryo biopsy and HLA (human leukocyte antigen) typing (using PGD) in order to treat a sick sibling | Hundreds of saviour siblings have been created using PGD throughout the world starting in the USA in 2000. Using PGD to create saviour siblings remains controversial (because of concerns about the welfare and instrumentalization of the saviour child) and not all countries allow it |
From āHelping Handā to āGuiding Handā
Over the last three decades or so, social scientists have followed assisted reproductive technologies (ARTs) on routes of routinization and globalization, examining their development by clinicians and scientists as well as their impact on the daily lives of involuntarily childless couples in different cultural and socio-economic settings. Indeed, Marilyn Strathernās reflections on such reproductive technologies as ānature assistedā have provided an entire generation of social scientists with conceptual tools for analysing supposed nature-artifice divides in the field of human reproduction as well as for troubling separations of the natural from the social. āNature assistedā, as she wrote in Reproducing the Future, ācompromises the definition of nature as those conditions of life from which intervention is absent; what is given is no longer given by nature itself but is visibly circumscribed by technological capacityā (1992: 57). Writing in the early years of reproductive technologies, Strathern was referring mostly to ARTs: āartificial insemination, in-vitro fertilisation, or other practices such as GIFT (gamete intra-fallopian transfer) simply stand in, so the justification goes, for natural body processesā (Strathern 1998: 186). āIf nature canāt deliverā, as one medical company put it in early 1990s marketing material, then ānature sometimes needs a helping handā (Strathern 1992: 56, 57; see also Edwards et al. 1993).
Such technologies have become routine throughout the world, to an extent that the birth of the worldās 5-millionth IVF baby was celebrated by the European Society of Human Reproduction and Embryology in July 2012. A string of ethnographies over the last two decades have shown how IVF is construed as a solution to the disruptions of infertility and can become a way of a life for many involuntarily childless couples as treatment appointments, drug regimens, oocyte retrievals and embryo transfers take over their daily lives with many couples opting for multiple cycles in the face of repeated failure (Franklin 1997; Becker 2000; Thompson 2007). We have also seen how the development and practice of ART comes to be shaped by local moralities as well as national aspirations and programmes in so-called pro-natalist countries like Egypt, Israel, India and China (Inhorn 2003; Kahn 2000; Handwerker 2002; Bharadwaj 2016; Wahlberg 2016). Finally, as couples are increasingly prepared to travel in pursuit of conception, social scientists have turned their attention towards the phenomenon of āreproductive tourismā or āreproductive travelā as involuntarily childless couplesāāreproductive exilesāācross international borders as a way to circumvent local restrictions, seek better quality care or more affordable treatment (Inhorn and GĆ¼rtin 2011; Inhorn 2015; Stockey-Bridge, this volume).
In recent years, similar ethnographic attention has been directed at what we term selective reproductive technologies (SRTs) (Gammeltoft and Wahlberg 2014). It is important to distinguish between ARTs and SRTs, not least because of the...