Does ectogestation have oppressive potential?

Abstract

Ectogestation refers to full or partial gestation of a fetus ex utero. Partial ectogestation refers to the removal of a developing fetus from the pregnant person's body and its placement into an artificial placenta1 to complete gestation (Kaczor, 2005). In this sense, it may be seen as an “alternative to neonatal intensive care,” (Romanis & Horn, 2020) or imagined as a more advanced version of methods already used in modern medicine to sustain premature babies in an incubator.2 In this article, however, we focus on full ectogestation, which could represent a “complete alternative to human gestation” (Räsänen & Smajdor, 2020), as eggs would be fertilized in vitro, and the resulting embryos directly placed in an artificial placenta for the whole gestational period. Building on the recent wealth of literature addressing ethical issues related to it,3 we aim to analyze some underexplored objections to full ectogestation.4 Our article investigates whether ectogestation might lead to certain forms of social oppression. First, we explore ectogestation's potential role in the unwarranted devaluing of certain aspects of female reproductive embodiment. We then consider whether ectogestation could exacerbate existing objectionable scrutiny over the reproductive choices of gestating persons. While also considering some counter-objections to these concerns in our paper, we maintain that public support for ectogestation should be conditional on rigorous critical reflection about the possibilities for social oppression that might arise from this technology, in addition to concrete preventive actions directed at mitigating such potential effects. Still, we also acknowledge that the prospect of ectogestation can be imagined and framed in a positive and emancipatory fashion. This has already been done by many feminist thinkers and bioethicists, in line with the practical suggestion to give people at the very least a (hypothetical) negative right to use ectogestation if they want it. (Benjamin, 2021). In principle, we are sympathetic to this notion that ectogestation can be purposed to emancipatory ends; when we link ectogestation with social oppression later in the article, our aim is to draw greater attention to the more troubling complexities and complications we might encounter with ectogestation, which require mitigation. But let us now briefly review and put into context the grounds that have been offered in support for a reality with ectogestation. Consider Shulamith Firestone's advocacy of a method of artificial gestation already from the 70's, as a way to “[free] women from the tyranny of reproduction” (Firestone, 2015). Her radical feminist view placed the reproductive differences between male and female sexes as the basis for gender inequality, claiming that detaching women from the role of “baby-makers” was a crucial step for women's liberation. Firestone hoped that society might “soon have the means to create life independently of sex—so that pregnancy, now freely acknowledged as clumsy, inefficient, and painful, would be indulged in, if at all, only as a tongue-in-cheek archaism, just as already women today wear virginal white to their weddings” (Firestone, 2015). Since then, other scholars have echoed similar ideas. For instance, Jennifer S. Bard posits that, by taking pregnancy out of the equation, “men and women stand on equal ground” (Bard, 2006), and Anna Smajdor has defended the need for a technological alternative to embodied gestation (Smajdor, 2007) given the burdens of pregnancy. Ectogestation could then offer an attractive alternative to childbearing for persons unable to get pregnant through traditional methods, including “post-menopausal women, or women at high risk for complications” (Sander-Staudt, 2006). Furthermore, even those who are able to gestate could avoid experiences like pregnancy-related discrimination, and be relieved of the psycho-physiological risks associated with pregnancy and childbirth (e.g., nausea, gestational diabetes, preeclampsia, depression, complications with delivery, and so forth) (Sander-Staudt, 2006). After all, some women already opt for surrogates to gestate on their behalf for medical or social reasons, so it does not seem too much of a stretch to anticipate that ectogestation might be utilized as a further viable alternative if it were to become available. Of course, we should acknowledge that risks to both the intended parent and third-parties might persist even with ectogestation, due to the necessity of egg retrieval for IVF, which would involve some health risks (such as pelvic infection or damage to organs near the ovaries) (American Society for Reproductive Medicine, 2015; Ber, 2000) as well as pelvic and abdominal pain. Moreover, as long as gametes cannot be produced from stem cells or via other painless techniques, the contribution in terms of gametes will still be unequal between the sexes, as egg extraction is much more burdensome relative to sperm extraction. However, the risks associated with egg retrieval are significantly inferior to those of pregnancy and childbirth. Ectogestation's emancipatory potential would also not be confined to cisgender women who medically struggle to get pregnant or prefer to avoid pregnancy-related discrimination or risks associated with gestation and childbirth. First, cisgender men aspiring to be parents but limited by their being single or in homosexual relationships could more easily achieve their parental goals, assuming the availability of donor eggs. While this is already possible in certain countries via surrogacy, that process might not be ideal as it generally requires surrogates to relinquish their parental rights, as they are still recognized as mothers by most legal systems (American Society for Reproductive Medicine, 2015; Ber, 2000). Moreover, ectogestation might benefit transgender individuals by detaching gestation from the concepts of womanhood and motherhood. As argued by Kathryn MacKay, when used to define womanhood, traditional pregnancy “privileges some women over others, both under the law and in moral and political imaginations” (Mac Kay, 2020). By conceptually breaking the exclusive relation between pregnancy and bodies with female physiology, ectogestation could disrupt oppressive trans-exclusive narratives framing trans women as “lacking” those female reproductive traits traditionally used “to delineate who counts as woman” (Mac Kay, 2020). For trans men, the benefit could be double. On the one hand, those not wanting or not able to gestate would have an additional way to be parents; on the other hand, a weaker link between pregnancy and perceived womanhood could help those trans men and nonbinary people who have the gendered term “mother” imposed on them, based solely on having gestated their children. In fact, in many systems people who give birth are registered as “mothers,” regardless of their legal gender (McConnell & Anor, 2020). In this context, it is crucial to note that queer persons rely on reproductive technologies significantly more than heteronormative persons do for their chances of becoming parents (Kimberly et al., 2020). While we have now recognized that the various emancipatory functions of ectogestation speak in its favor, our objective from here on out is to highlight some underexplored concerns associated with ectogestation, and demonstrate that support for ectogestation ought to remain conditional on addressing the issues we raise. Let us start by considering the limitations to the emancipatory appeal of this technology: Giulia Cavaliere has warned that “without a broader programme to end or mitigate gender-based oppression” (Cavaliere, 2020a), it is rather doubtful that the emancipatory objectives of ectogestation can be fully realized—especially for disadvantaged agents like poor or disabled women, women of color, and ethnic minorities (Cavaliere, 2020b). Others agree with this perspective, claiming that techno-medical interventions such as ectogestation cannot solve social issues since they are unable to effectively target the actual source of the problem, which is social, not medical, and therefore needs to be addressed by social measures (Campo-Engelstein, 2020). While not claiming that ectogestation is itself either intrinsically or inescapably problematic, we intend to examine its potential to exacerbate patriarchal oppression, by building on these socially informed critiques. As mentioned above, authors such as Giulia Cavaliere have already made critical arguments about ectogestation. One of Cavaliere's claims is, for instance, that advocating for ectogestation might problematically subscribe to assimilation as an ideal for liberation. That is, ectogestation seems to promote the obliteration of difference—such as the capacity to gestate—as a way of acquiring gender equality (Cavaliere, 2020b). Yet, if the issue originates not from the bodily reproductive capabilities, but from gender roles and oppressive social structures, ectogestation will not necessarily resolve gender inequality (Segers, 2021). Rather, a more apt emphasis might be on a world “in which pregnancy did not disadvantage women socially, physically and economically” (Horner, 2020). Building on these critical insights, we offer additional arguments for the oppressive potential of ectogestation by elaborating on how—in the context of a patriarchal society—the normalization of artificial gestation might contribute to a selective undervaluing of aspects of female reproductive embodiment, and contribute to objectionable kinds of scrutiny over gestating persons' reproductive choices. In this section, we investigate the contributory role that ectogestation might play in selectively devaluing and reinforcing stigmatization of certain aspects of female reproductive embodiment. Though ectogestation is, for now, merely a speculative method, we can take cues from our current society to inform the role that it may 1 day come to play to this end. We first consider what the embodiment of women's experiences involves, and explore the social norms of acceptability regarding, especially, cisgender women's bodies and female reproductive functions. Then, we assess how ectogestation, as an essentially disembodied form of procreation, might exacerbate some of the problematic ways in which biologically female bodies, in their sexual and reproductive potential, have been socio-historically perceived. Let us begin with a comparable scenario—the vexed cultures around menstruation. In many parts of the world, menstruation is still a cultural taboo; for instance, in parts of India, various myths lead to consider menses to be “dirty and impure” (Garg & Anand, 2015). This shows us that even entirely ordinary physical processes experienced by most girls and women—in fact, the very processes indicative of female reproductive ability—can be denigrated or perceived as unseemly when visible, talked about, and so forth. At the same time, though, the ability to menstruate is perceived as a requirement to be recognized as women, and many might experience menses positively “as a marker of sexuality and fertility” (Kieser, 2017). The menarche is often approached as a rite of passage into “womanhood”—such that girls who have their first menstruation “late,” or do not have it at all, might be shamed by society and its members for not experiencing something that other girls commonly go through in puberty. Menstruation is then both celebrated as a sign of fertility and seen as a taint, a taboo, something to be both ashamed of and shamed for. This ambivalent valuing and disvaluing of women's bodily functions, fluids, processes, does not end with menstruation; it affects all embodied aspects of female reproductive ability. The phenomenon of pregnancy is in fact a site of similar ongoing tension, flipping between attitudes of reverence and of revulsion. Religious iconography, like depictions of the Virgin Mary, quite literally “eradicate a pregnant woman's sensuality through claims of immaculate conception” (Putnam, 2018) and is meant to reinforce one particular outcome in female reproduction—the ability to bear and birth a child. has been a in pregnancy-related to focus on of pregnancy that for of the pregnant woman's either by from the entirely in or an role for the (Putnam, women of at least some of their embodied out but the that is which is the and of a child. At the same time, more and cultural of the may that of physical or in to be even as they are at the same celebrated for having childbirth. As some childbirth is a cultural that a is to physically as as or as having a has & attitudes negative to physical on by pregnancy, such as and to the this is for the people have to for instance, the with such as and et al., 2017). this modern of the the for a to a of the the fact that it is the body that to the of a a similar of about how we parts of female in We could go on with similar but the to take here is just that is in the social about how to women's bodies in The of how they should be in their embodied experiences all the and of women's reproductive and and this is in the cultural of women's bodies as As pregnant women are as both being and reproductive The of women's sexual in with the of embodied like or the potential of the public valuing of women's bodies, and their embodiment, is informed by the and for women to does this have to do with pregnancy is, generally of as to be that is only when resulting in the birth of a (Putnam, then ectogestation a technological for that and at least on the to resolve the mentioned The to gestation and avoid much of the embodied reality of female at the same out on the of be of as the at least in a context mothers having a body by the burdens of pregnancy and childbirth is a social disembodied women could still their reproductive of becoming their reproductive and therefore the ability to to the norms and imposed on their This context the ways that ectogestation to but only by the to to of as and to or to its and its in the The has a in body as an with a and a or & This context how under has become with et al., such that a of through & 2015). reproductive technologies such as ectogestation might also be to this On the we can acknowledge that some aspects of the embodied and experiences are in fact rather than or For as the cultural reverence of the ability to bear and birth a women recognized as cisgender and biologically female may be more if they can certain bodily seen as such as or being able to The valuing of these aspects of persist in of For the term with the or not only that and could their as processes over the of certain medical or but also that the experiences of the pregnant persons or (e.g., or are On a similar and human are the for and & 2015). The of human are related to and & for children. In this context, the of is often based on to the physical health of the to some of the et al., the negative and in persons has often been & has argued that the of a as the moral should not to the between and as the body and and therefore be as a of This is to our ongoing as it is possible to draw a moral between and ectogestation. While ectogestation the potential to pregnancy in the way that could human ectogestation may a similar the of only to it as it more and the of pregnancy 2020). This is of the fact that embodied aspects of can further oppression by people to these gendered bodily as an this perspective, then, the of ectogestation can seem to an alternative which might the or that women can only use their other bodies to bear children. even in a like the above, the that ectogestation would be a for a social of women by valuing based on their reproductive Furthermore, concerns over ectogestation to the stigmatization of many aspects of embodied remain in By women to literally aspects of ectogestation could not only be used to reinforce some of the current placed on women's bodies, but to the that women should technological to these as For instance, norms women to to their bodies, or to between and pregnancy, would be by the of ectogestation. In fact, is a risk for those norms to be and even by ectogestation, since the to by and maintain such norms are of its Ectogestation that the body does not have to experience pregnancy and childbirth in the first but does not in itself us with to the and norms around reproductive embodiment as problematic for those who or do that they want to go through persons would experience ambivalent over their embodied reproductive Moreover, it is whether ectogestation would for or resolve the of embodied For instance, it is but that pregnant persons may be at risk of depression, gestation or & public and of this as well as other is to help those who might be by it. Yet, the attention given to these may be further if the put is the to not to as it that these issues are to be or in the public This potential such as the of pregnancy as a physical to be to issues related to pregnancy and and on people to the a around of various aspects of female reproductive embodiment, to be ectogestation also the might only benefit those who intend to the technology, being a of further oppression for those who do not to their social oppressive rather than the The of attitudes either those who to gestate or those who to have a through ectogestation could a further of oppression, between of aspiring parents scholars have for instance, that ectogestation might traits by the fact that many women the experience of being & 2020). may be that more from which to contribute to greater and around what counts as gestation in the a as well as such choices the kinds of for which we reproductive to greater Of course, this is all on the for valuing of gestation to in the that ectogestation one and on the that gestation will be a of we would it is to anticipate that over the or way to gestate will to the of gestation methods, and of aspiring is that unwarranted and attitudes female bodies and their functions and are to et al., is that, an that menstruation be pregnancy is In fact, pregnant is very to even by both and who their to be with how a pregnant is to their body and what is of it & The actual on how to the childbirth. This is assuming the gestating is to the pregnancy to term and have a however, when pregnant persons want have the to they are often if not et al., In a similar on childbirth are also to with or traditional narratives around what a or birth already those pregnant people who do not the The of childbirth is to highlight the of these As a pregnant cisgender women, a certain of persons in being as they their as if would the having their will (American & 2017). the to to such as which only from the it is that a like ectogestation will be by in of having babies in the more The whole process of female embodied including use of artificial would also be to scrutiny on all the around which and are from the by it would be to anticipate the same issues in the those to prefer artificial might a of those who prefer the way might the of pregnancy. As society to women to of as to be and women's reproductive those this capacity rely on in to become 2006). We can this in various to the stigmatization of women and women the of women on the whole as of their or et al., as well as in that reinforce a of women's et al., is therefore not that at least some women would to the of ectogestation, and their in the and of the by the concerns they about their to an That is, the that gestation is for mothers to form a with their can a to not ectogestation, for those women who such However, in a context, the of gestation via ectogestation may even be or for As by one of the for artificial is to the medical of pregnancy will a woman's health than 2006). of this would involve the stigmatization of pregnancy on the basis of much like how are countries they are socially over as well as choices made gestation for has become issue as the the use of for 2015). of the for (e.g., delivery, are associated with such as being unable to or a high risk to As a the and of the embodied experience of pregnancy women we do not have an in terms of choices over gestational However, given that we have this that stigmatization already attitudes would in choices related to For Cavaliere how women could be to take on the role even more of ectogestation, which would be if it did not require to gestate and give birth (Cavaliere, This shows us that that opt for that opt for ectogestation, and that opt for are all to be made to and that risk moral of their to the of reproductive that and the of the child. Ectogestation would not be from existing of the reproductive oppression that cisgender women especially, but rather have potential to become a for that oppression. The that reproductive technologies can even have of their emancipatory potential a greater to end gender-based oppression is a the of ectogestation social addressing existing oppressive attitudes and norms might be to reproductive The and of gestation by technological could put both those who would to use ectogestation, and those who would to be at risk of being made target of negative and as we have from the This may not only various aspiring parents to moral or even by various members of the but also and of aspiring we to have to issues of that might arise in an Our aim was to explore various that might be by the of ectogestation, necessarily that are certain gestational methods that aspiring parents ought to While the for ectogestation to as an emancipatory for least aspiring parents and social we put concerns related to how ectogestation could be used to create or existing forms of oppression. First, we at how ectogestation might contribute to a devaluing of female reproductive embodiment. we that ectogestation may exacerbate unwarranted scrutiny and further related to gestation when it to reproductive choices for women of these our is that ethical reflection is and that the support for technologies ought to on how we come to mitigate these We are to the for their support on this and a for the to on this The authors of is an at the of on related to reproductive is a at the of on the of ectogestation. is a at the of with in

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