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Overcoming Motherhood

Sunday, December 1, 2002

To invoke prometheus, the figure of Greek myth who was punished by Zeus for stealing fire from Hephaestus and giving it to humans, has become a popular warning against scientific hubris in our new age of biotechnology and genetic engineering. But the second half of the Promethean myth offers a further warning: Prometheus’s defiant act led Zeus to dispatch a woman, Pandora, to unleash her box of evils on the human race — and thus eliminate the power differential that access to fire briefly had given mankind.

Pandora’s box of dark arts is an apt metaphor for human reproductive technologies. Despite being hailed as important scientific advances and having succeeded in allowing many infertile couples to have children, the next generation of these technologies offers us a power that could prove harmful to our understanding of what motherhood is. This new generation of reproductive technologies allows us to control not merely the timing and quantity of the children we bear, but their quality as well. Techniques of human genetic engineering tempt us to alter our genes not merely for therapy, but for enhancement. In this, these technologies pose moral challenges that are fundamentally different from any we have faced before.

Contemporary human reproductive technologies range from the now widely accepted practice of in-vitro fertilization (ivf), where physicians unite egg and sperm outside the woman’s body and then implant the fertilized egg into the womb, to sophisticated sex selection techniques and preimplantation genetic diagnosis of disease and disability in embryos. Today, for-profit clinics, such as Conceptual Options in California, offer a cafeteria-like approach to human reproduction with services such as ivf, sex selection screening, and even “social surrogacy” arrangements where women who prefer not to endure the physical challenges of pregnancy rent other women’s wombs. New techniques such as cytoplasmic cell transfer threaten to upend our conceptions of genetic parenthood; the procedure, which involves the introduction of cytoplasm from a donor egg into another woman’s egg to encourage fertilization, could result in a child born of three genetic parents — the father, the mother, and the cytoplasm donor — since trace amounts of genetic material reside in the donor cytoplasm. Doctors in China recently performed the first successful ovary and fallopian tube transplant, from one sister to another, which will allow the transplant recipient to conceive children — but from eggs that are genetically her sister’s, not her own.

The near future will bring uterus transplants and artificial wombs. Scientists at Cornell University are perfecting the former, while researchers at Juntendou University in Tokyo, who have already had success keeping goat fetuses alive in artificial wombs for short spans of time, predict the creation of a fully functional artificial womb for human beings in just six years. Cloning technologies eventually could fulfill even the most utopian of feminist yearnings: procreation without men via parthenogenesis, something that excited the passions of Simone de Beauvoir in 1953. “Perhaps in time,” she mused in The Second Sex, “the cooperation of the male will become unnecessary in procreation — the answer, it would seem, to many a woman’s prayer.”

De Beauvoir was correct to identify women’s hopes as a powerful force in modern challenges to old-fashioned procreation, but these hopes also pose serious ethical challenges. Contemporary feminism’s valorization of “choice” in reproductive matters and its exaltation of individualism — powerful arguments for access to contraceptives and first-generation reproductive techniques — offer few ethical moorings as we confront these fundamentally new technologies. In fact, the extreme individualism of the feminist position is encouraging women to take these technologies to their logical, if morally dubious conclusion: a consumer-driven form of eugenics.

The primacy of choice

Our biotech era has exposed a serious contradiction in feminist thinking: Feminists want women to maintain absolute control over reproductive decisions, but thus far their arguments have rested on a feeble hope that women will not choose to do detrimental things. They have failed to construct a plausible and stable ethical basis upon which to make morally sound decisions about human reproductive technologies. The feminists’ approach to gene therapy for the purposes of enhancement, for example, is little different from their stance on plastic surgery — we are told that it does not serve women’s best interests but are given no ethical guidance on the elimination of these incorrect desires. What happens when women, as avid consumers, exercise that control and use sperm sorting to give birth only to sons, or as their justification for genetically manipulating their children?

The triumph of individual choice as an unassailable right also prevents us from engaging in important debates about the broader social implications of reproduction and the technologies that promise to change its meaning. Drawing the delicate line between genetic therapy and enhancement is a difficult task, and quality of life a malleable concept. Recently, a woman with a history of early-onset Alzheimer’s disease paid a fertility clinic to screen her ivf-created embryos for the defective gene, discard the embryos that were found to have it, and implant a “clean” embryo that did not carry the genetic marker. Is this eugenics, preventive therapy, or simply the neutral exercise of individual choice?

The desire to control reproduction and conquer biology was a central part of the feminist-driven political and sexual revolutions of the late twentieth century. In her 1970 manifesto, “The Dialectic of Sex,” radical feminist Shulamith Firestone wrote that the “first demand” of a feminist social order would be “the freeing of women from the tyranny of their reproductive biology by every means available.” In their push to populate classroom, courtroom, and boardroom, feminists implicitly endorsed Firestone’s goal, securing the contraceptive and abortion rights they saw as crucial for women’s advancement in the public realm. Feminism insisted that women try to overcome, or at least willfully ignore, biological realities.

By the late twentieth century, the feminist movement’s effort to liberate women from reproduction had produced unexpected results. A majority of women routinely used birth control, accepted abortion as a right, and viewed ivf and other first-generation reproductive technologies as useful tools of last resort for the infertile. But the women who embraced the feminist message about reproduction — the daughters of the sexual revolution — eventually felt that message’s sting personally. They found themselves entering middle age with ripe careers but declining fertility. Today they form a large portion of the fertility industry’s customers, spending tens of thousands of dollars for a single chance to cheat time. The facts are stark: According to a January 2002 report on aging and infertility in women, published by the American Society for Reproductive Medicine, a woman’s fertility begins to decline in her late twenties and drops precipitously around the age of 35. Although fertility experts quibble over precise odds, there is a consensus that by the time a woman is in her forties, her odds of having a child, even with some form of intervention, are less than 10 percent. For these women, reproduction is not the tyranny imagined by Firestone, but an unfulfilled hope. A recent educational campaign launched by the American Infertility Association and the American Society for Reproductive Medicine is directed at the daughters of this feminist generation; fertility specialists hope to combat the undue optimism of women in their twenties and thirties about their ability to have children as they get older.

As the controversy — and, in some quarters, consternation — that greeted Sylvia Ann Hewlett’s recent book, Creating a Life: Professional Women and the Quest for Children, revealed, we are still uncomfortable, as a society, with airing too many of these facts about fertility. Hewlett, who gently rebukes women for assuming that the fertility industry could extend their reproductive lives long enough for them to make partner (and chastises the fertility industry for insinuating that it could), nevertheless is herself wary of trampling the principle of choice. Instead, in interviews with childless women that speak poignantly to the intractability of biology, Hewlett uncovers something called “creeping non-choice,” a condition treatable, in her view, with a strong dose of government social policy and more “intentional” plotting by women of their reproductive futures.

What Hewlett and others overlook is a different and more disturbing facet of “choice,” the one that inexorably pulls us toward making “intentional” decisions about the kind of children we have. The sentiment is already gaining the sanction of clinical practitioners. A recent study conducted by University of Massachusetts public health professor Dorothy Wertz and University of Virginia bioethicist John Fletcher revealed that 62 percent of American geneticists would agree to perform sex-selection tests on fetuses (or refer them to specialists who would) for parents who stated ahead of time their desire to have an abortion if the fetus was the “wrong” sex. In the early 1970s, a similar study found that only 1 percent of physicians and ethicists would do the same.

Feminist bioethics

If clinicians are less inclined to question the limits of individual choice in these matters, our self-appointed ethical guides in the field of bioethics should. In fact, the burgeoning field of bioethics now supports a subdiscipline in feminist bioethics, with its own organizations and methodological assumptions and with a keen interest in reproductive technologies. Unfortunately, feminist bioethicists remain wedded to a misguided view of science and medicine as inherently biased against women, and they pursue a feminist worldview that applauds “difference” but offers few limits on the excessive individualism that is the logical conclusion of their emphasis on choice in reproductive matters.

Although resting along various points of the ideological spectrum, feminist bioethicists share certain core principles — most important, a concern that human reproductive technologies are being developed in the context of a society that has not yet granted women full equality. The International Network on Feminist Approaches to Bioethics, a consortium launched in 1992, is “committed to a non-hierarchical model of organization” and takes as its goal the development of “a more inclusive theory of bioethics encompassing the standpoints and experiences of women and other marginalized social groups.” The group’s mission statement also includes a vow to deconstruct “presuppositions embedded in the dominant bioethical discourse that privilege those already empowered.”

In this, feminist bioethics has its roots in broader feminist critiques of both science and ethics, two enterprises they view as inherently masculine and biased. Critics such as Lynda Birke of the University of Warwick and Sandra Harding of the University of California, Los Angeles, have argued for a “feminist science” that rejects objectivity in favor of intuition and seeks to supplant Francis Bacon’s metaphor of Mother Nature as a “common harlot” meant to be tamed and molded by men with more inclusive practices. Their critique of science has trickled down into popular culture through narratives, such as Naomi Wolf’s Misconceptions, that attack the male medical establishment for its treatment of pregnant women, and through manuals such as the popular alternative feminist health book, Our Bodies, Ourselves, which has been in print continuously since 1970.

The feminist critique of ethics is also intent on illuminating women’s subordination. As feminist bioethicist Rosemarie Tong of the University of North Carolina notes, feminist ethicists “ask questions about male domination and female subordination before they ask questions about good and evil, care and justice, mothers and children.” Moreover, women’s subordination “leads to women’s disempowerment morally and personally as well as politically, economically, and socially.” This twin focus on women’s disempowerment and the masculine bias of science serves an important exculpatory purpose — as ethical escape hatches — in the field of feminist bioethics.

The current reigning principle in bioethics is autonomy, which grants to individuals the freedom to choose for themselves what they want to do until they begin to infringe on the liberty of others or cause serious harm. Feminist bioethicists promote something different; they endorse the principle of “autokoenomy,” from the Greek for self (auto) and community (koinonia). As Tong notes, “unlike the autonomous man who thinks that his self is entirely separable from others . . . the autokoenomous woman realizes that she is inextricably related to other selves.” The implication is that autokoenomy fosters a humility that is otherwise lacking in strict autonomy, since it emphasizes a person’s place in a particular community, or an “epistemology of perspective.”

In practice, autokoenomy appears to foster confusion, not ethical guidance. As an ethical principle, it appears to allow nearly any ethical choice, including eugenic choices, as long as the choice is made in the service of gender equity. “It is to be hoped,” Tong writes, “that women will choose the characteristics of their fetuses in ways that will break down gender inequity and the host of other human oppressions to which it is related. In choosing for their fetuses, women will be choosing for themselves.” Laura Purdy, of the University of Toronto, is another feminist bioethicist who approves of genetic screening for the purpose of weeding out the unfit; she declares “unjustifiable” the “rejection of so-called quality control that uses genetic services to prevent the birth of babies at risk for serious physical or mental illness or disability.” Since women are primary caregivers to children, Purdy reasons, their autonomous interests are infringed upon when those children are burdened by genetic conditions that require more devoted parental care. Purdy concludes that failing to prevent the birth of a child with serious defects is “immoral.”

Autokoenomy can also begin to resemble a chilling utilitarian “community” of one. University of Chicago feminist bioethicist Mary Mahowald draws on the “ethics of care” and “maternal thinking” models of Carol Gilligan and Sara Ruddick to promote a “feminist standpoint theory” that parallels Rosemarie Tong’s autokoenomy. Mahowald’s feminist standpoint theory endorses women having babies for the explicit purpose of harvesting spare parts for themselves or loved ones. The ethic on which she relies would “support a decision to become pregnant in order to provide the [fetal] tissue to someone with whom one has a special relationship.” Moreover, Mahowald says, “a pregnant woman might herself be the recipient and could deliberately become pregnant in order to provide the fetal tissue that might lead to her own cure.” As Tong and Mahowald’s reasoning reveals, autokoenomy has little to say about the excesses of individual choice.

The technology of patriarchy?

At the other end of the spectrum are feminist bioethicists who do not so eagerly embrace reproductive and genetic technologies, although they do share with their autokoenomous sisters a devotion to feminist politics. As Tong says, “all feminist approaches to bioethics share a common methodology — namely, the methodology of feminist thought.” But feminist principles make for an awkward fit in the field of bioethics, for in focusing so keenly on science’s patriarchal bias, feminist critics of reproductive technologies miss the most serious challenges these new tools pose.

Australian feminist Robyn Rowland has been issuing warnings since the early 1980s about the dangers of male control of reproductive technologies. Men have “coveted” the power women have over reproduction, Rowland argues. “Now, with the possibilities offered by technology they are storming the last bastion and taking control of conception, fetal development, and birth.” But this is only part of a larger control men exercise over women, according to Rowland’s critique. “Being the dominant social group, men expect to control all social resources, including reproduction,” Rowland argues. They “use the vehicles of science, medicine and commerce to establish control over procreation.” Men, Rowland concludes, are making women into “patriarchy’s living laboratories.”

Another feminist critic of reproductive technologies, former New York Times reporter Gena Corea, assails as “propaganda” the notion that women should procreate. It is patriarchal society that pushes this pronatalism, Corea argues, and it “has a coercive power.” “It conditions a woman’s choices as well as her motivations to choose,” she says, leaving her incapable of rendering an authentic ethical choice about her reproductive options. Janice Raymond, a feminist theorist who teaches at the University of Massachusetts, has argued that new reproductive technologies might be used by the patriarchal medical establishment as a tool for the “previctimization” of women, eliminating or fundamentally altering females before they are even born. “Technological reproduction is brutality with a therapeutic face,” Raymond avers. In 1984, some of the more earnest skeptics of reproductive technologies organized finrrage — Feminist International Network of Resistance to Reproductive and Genetic Engineering — a small group that hosts conferences to raise awareness of the dangers of these new interventions.

Genetic technologies are also viewed with suspicion by feminists who fear they will undermine feminism’s valorization of “difference.” Maura Ryan, a professor of Christian Ethics at Notre Dame University, has argued that genetic technologies are “at odds with a feminist view of community where all are welcome and persons are challenged to deal creatively with difference.” Yet arguments for difference can take unexpected twists, as they did recently when they were invoked by a deaf lesbian couple in Bethesda, Maryland, who used sperm donated by a fifth-generation deaf man to ensure that their son and daughter would be born profoundly deaf. Since the women view deafness not as a disability, but as a sign of membership in a specific cultural community, they wanted to guarantee that their children would be part of that community as well.

What these feminist skeptics of reproductive technologies share is an assumption, guided by feminist politics and feminist critiques of science, that women lack control over even the most rudimentary reproductive decisions. This leaves them unwilling to tackle thorny ethical practices, such as sex selection, that rest on women’s own choices. Evidence from China and India indicates that women in those countries avidly rid themselves of female fetuses, usually by making use of ultrasound machines and abortion, creating a serious imbalance in male-to-female sex ratios in the process. In the United States, sex selection is gaining in popularity, with new techniques such as sperm sorting offered by many fertility clinics.

Feminists have a stock answer when questioned about the use of sex selection in countries such as India and China: Blame the sin, not the sinner. Because these women are living in undemocratic, patriarchal societies, they are eligible for feminist bioethicists’ ethical escape hatch. “The solution is not to take away abortion rights,” a spokesperson for the group Population Action International stated, “but rather to elevate the status of women so that the economic and cultural incentives for sex-selection abortion are no longer there.” This rationale is less compelling when applied closer to home, where feminist claims of patriarchal control do not ring true. Bioethicist Mary Mahowald suggests that “selection of either males or females is justifiable on medical grounds and morally defensible in other situations so long as the intention and the consequences are not sexist.” But how does one judge whether consequences are sexist? In the United States, many women use sex selection to have girls. “Women are the driving force, and women want daughters,” one fertility doctor told the New York Times in 1999.

Even mainstream feminist groups, such as the National Organization for Women, conveniently ignore incorrect expressions of choice. now has no official position on the use of sex-selective ultrasound and abortion or other sex-selection techniques, yet the group did endorse a resolution at its national conference last year calling for the protection of the rights of “intersex girls” (girls born with atypical sexual anatomy). The resolution, which called on parents to resist imposing hormone treatments and surgery on their daughters until the daughters themselves could choose whether or not they wanted to become fully female, was deemed part of the organization’s “movement for reproductive freedom and bodily integrity.”

Although feminist bioethicists have failed to come to terms with the impulse to control the quality of one’s offspring, especially among women, it is not a new one. In Spartan society, women were responsible for bearing sons who would be formidable warriors and for rigorously weeding out those who would not, leaving them to die of exposure in the chasm called the Apothetae. In the mid-nineteenth-century utopian community of Oneida in upstate New York, it was women more than men who eagerly volunteered for leader John Humphrey Noyes’s proto-eugenic experiments in breeding better children — an undertaking he likened to plant breeding and called “human stirpiculture.” During the heyday of the American eugenics movement, as historian Wendy Kline has found, women’s reform organizations were some of the most enthusiastic lobbyists for compulsory state sterilization laws meant to combat the menace of the so-called feebleminded. Women embraced an ideal of “scientific” and “responsible” motherhood that emphasized the quality of the children being born, and found in the eugenic impulse to “improve the human race through better breeding” a compelling justification for their efforts.

The birth control movement of the early twentieth century offers perhaps the most extended case study of this impulse. In her 1920 polemic, “Woman and the New Race,” birth control activist Margaret Sanger described how “millions of women are asserting their right to voluntary motherhood. They are determined to decide for themselves whether they shall become mothers, under what conditions, and when.” But the logic of that assertion encompassed more than control of quantity. Like many of her peers, Sanger shared her culture’s desire for eugenic “race improvement.” Fearful that the vaunted American melting pot was no longer assimilating new waves of immigrants from southern and eastern Europe, Sanger argued that contraception could alleviate the burden of bad stock. “Birth control, often denounced as a violation of natural law,” she wrote, “is nothing more or less than the facilitation of the process of weeding out the unfit, of preventing the birth of defectives, or of those who will become defectives.” The “voluntary motherhood” Sanger pursued had as its goal the “creation of a new race” and drew upon the language of choice and the individual rights of women to achieve it.

Many of Sanger’s more astute contemporaries understood the radical nature of the new ideal of motherhood she was promoting. In A Preface to Morals, Walter Lippmann urged society to consider the “full logic of birth control,” which he saw as making parenthood a “separate vocation,” detached from the “hard realities” and ambiguities of life and thus ultimately “efficient, responsible, and dull.” Birth control is like the automobile, Lippmann argued, capable of hurtling us along at terrifying speeds to new and exciting destinations, but a device whose “inherent possibilities do not fix the best uses to be made of it.”

Our reproductive future

Today our devices are more numerous and powerful, but contemporary feminist bioethicists remain mired in the individualistic rhetoric of the previous era’s technologies and politics. The end pursued by feminist bioethicists is an egalitarian feminist society, but they assume that this society would consist of feminist mothers choosing traits for their children that conform to “women’s values.” In this, feminist ethicists betray the fact that they have not strayed far from the utopian yearnings of their foremothers. Charlotte Perkins Gilman’s 1915 feminist utopian novel Herland found perfection in a world where men did not exist and where parthenogenic births produced only girl children; contemporary fiction writer Marge Piercy’s 1976 novel, Woman on the Edge of Time, offered a similar social vision. In Piercy’s world, citizens of the utopian society of Mattapoisett decide that to end sexism, classism, and racism, reproduction must be removed from the control of one particular sex. “It was part of women’s long revolution,” one of Piercy’s characters explains. “As long as we were biologically enchained, we’d never be equal. And males never would be humanized to be loving and tender. So we all became mothers. Every child has three. To break the nuclear bonding.”

We are not all mothers yet, but if we continue along the path our feminist ethical guides have laid down, we run the risk of ending up in a consumer-driven eugenic society. With ever more sophisticated ivf techniques, genetic screening, and artificial wombs, the physiological process of pregnancy and childbirth could become just another commodified “life experience.” Like climbing Mt. Everest or meditating on an ashram, seekers of the exotic could experience the “adventure” of childbirth the old-fashioned way, while some women would make use of artificial wombs to avoid the hassles of pregnancy.

Our new reproductive future also suggests a society where male responsibility and fatherhood take on a different form. Shotgun weddings and social stigmas that used to keep men close to their offspring have disappeared, but in an age where embryos are stored in fertility clinics like jewelry in safe deposit boxes, men have begun to claim paternal rights using the language of property. Popular culture has enlisted science to help them. Producers of daytime talk shows are leavening the sensationalism of their broadcasts with paternal “outings” using dna tests; men who suppose themselves the father of a child are told, on-air in front of a studio audience and their wayward partners, that dna tests have proven otherwise.

We are being eased into this bread-and-circuses world of reproduction by the very rhetoric that once promised to free women from the burdens of biology: the rhetoric of choice that feminists have long championed. Choice will allow us to begin crossing the line between genetic therapies and genetic enhancements — quietly at first, but eventually with ease. Genetic engineering could become just another reproductive right. But this normalization process comes with a cost that first-generation technologies such as ivf never posed: altering the human race and, in the process, fating for extinction biological motherhood as we have known it. With feminist principles guiding us and a public preternaturally optimistic about and desirous of new reproductive technologies, Pandora has met Dr. Pangloss. But all is not for the best in this best of all possible worlds.

One would hope that, having had glimpses of the logical conclusion of their principles, feminists would make a well-timed retreat from their glorification of choice in reproductive matters. Such a retreat is unlikely, however, for making it would require feminists finally to concede that there is no such thing as “women’s values” or the sisterhood for which they have served as self-appointed spokeswomen. Such a retreat would force feminists to confront the fact that some women make ethically unsound choices not because they are victims of male domination, but because they lack ethical moorings, and it would require them to recognize that in a world of unfettered individualism, women’s choices will not lead to a feminist vision of women’s liberation.