Ectogenesis as equality-promoting

The argument that ectogenesis could promote equality and redress natural inequalities begins with the appreciation that there are fundamental inequalities between men and women7–9 and among women.7 Some of the inequalities between men and women are directly caused by biological differences and women’s unique capacity to beget children. According to this view, women carry all the burdens associated with biological reproduction: they bear physical burdens associated with gestation and childbirth7 8 15; they could suffer from poor physical and mental health during gestation, birth and post-delivery16–20; they could be subjected to complications of childbirth that can and often do result in death21 22; they are exposed to external control, monitoring and choice-restricting measures7–9; and they are likely to experience threats to bodily integrity and personal privacy.7–9 By contrast, men can become biological fathers without being exposed to any of these risks and burdens. Ectogenesis would be equality-promoting in that it would enable women to become mothers in the same way that men do, by reaping the benefits of having genetically related children while not experiencing the burdens associated with gestation and childbirth. For instance, following the work of radical feminist Shulamith Firestone, Singer and Wells argue that ectogenesis “can be supported on the ground that it would make a fundamental contribution toward sexual equality”.1 Similarly, Tuija Takala emphasises that “if and when ectogenesis becomes a safe option it will finally make true equality between humans possible”.10 The strongest case for ectogenesis in this respect is arguably Evie Kendal’s, who contends that:

When added to the unequal distribution of the physical, social and financial burdens associated with pregnancy and childbirth, the claim that reproductive difference constitutes a fundamental inequality between the sexes becomes especially convincing.7

According to the author, this represents a prima facie reason in favour of ectogenesis due to the potential of this practice to redress such inequalities.

In addition, ectogenesis could redress inequalities that are indirectly caused by biological differences and women’s unique capacity to beget children.9 14 Arguably, the burdens and responsibilities associated with social reproduction, namely, the sets of arrangements that enable a society to reproduce itself, such as domestic labour, pregnancies and childrearing, are currently largely borne by women.23–25 Following proponents of the equality-promoting potential of this practice, the burdens and responsibilities of social reproduction are placed on women due to their unique role in biological reproduction. Since ectogenesis enables the disentanglement of biological and social reproduction, the argument goes, it would succeed in redressing inequalities where other attempts to do so fail. The burdens and responsibilities of social reproduction would be more equally shared between men and women.7 10 For instance, Kendal argues that “ectogenesis could also provide a means of procreating that prevents many women from slipping into the regressive social norms governing childrearing”.7 Similarly, Takala contends that ectogenesis would remove the biggest difference between the sexes, as it would “take away the grounds for oppression and eventually, lead to true equality”.10 These views defend ectogenesis on the grounds that it has the potential to promote equality not only in begetting children but also in childrearing, which makes possible increased equality in the private sphere (ie, at home).

Another sort of male–female equality that ectogenesis promotes is in the workplace. According to this view, women’s unique role in begetting children condemns them to a less competitive role in the labour market, fewer career advancements, less remuneration and from accessing certain professions.10 15 Authors defending ectogenesis as an equality-promoting practice contend that these disadvantages and impediments to achieving full equality in the workplace are due to the breaks that women need to take to gestate children (due to their role in biological reproduction) and to fulfil childrearing responsibilities (due to their role in social reproduction). Ectogenesis would redress such inequalities by making women equally able to compete in the labour market7 11; to access certain professions requiring exposure to substances that can have teratogenic effects; and to fulfil roles that women cannot fulfil while gestating children due to their physical demandingness.7

Lastly, ectogenesis is defended on the grounds that it would promote equality among fertile, infertile, lesbian and transgender women.7 Ectogenesis enables women who are currently unable to gestate and birth children for social or biological reasons to have children in the same way as fertile women (ie, having children who are genetically related to them). This would equalise reproductive capacities in these different groups.

Ectogenesis as freedom-promoting

Several defences of ectogenesis are grounded in the liberating role and potential that this practice could have for women.14 15 It is hence not surprising then that the second set of arguments advanced in favour of ectogenesis revolves around its potential to promote women’s freedom. A first way in which ectogenesis would achieve this is by freeing women from all the risks and burdens associated with gestating, birthing and rearing children.7 8 12 Ectogenesis would be, in Firestone’s words, a means of “freeing women from the tyranny of their sexual-reproductive roles”.12 For instance, Anna Smajdor argues that:

[F]or expectant mothers, the fact of encompassing another life in their bodies often takes a serious toll on their autonomy. Pregnant women are routinely expected to subsume their appetites and desires into those that would be in keeping with the well-being of the fetus.8

Ectogenesis would remove this ‘serious toll’ on women’s autonomy by enabling them to have genetically related children whose well-being during gestation would not be achieved at significant costs to their mothers' freedom. Kendal makes a similar point by stressing how women’s bodily integrity is severely compromised during gestation and how the social, financial and health-related burdens associated with gestation restrict women’s freedom. These narratives emphasise how ectogenesis would promote women’s negative freedom, that is, ‘freedom from’ the restricting effects of pregnancy and childbirth.

A second way in which ectogenesis would promote women’s freedom is by expanding their range of significant options to pursue parenthood projects.1 13 14 According to this view, this practice would represent an ‘enhancement of individual freedom’1 and would be ‘in the best interests of women’13 as it would provide an alternative way to gestate and birth children. This additional option would promote the freedom of all women, but it would be particularly beneficial for those women who would not be able or would not want to gestate and birth children otherwise.14 For instance, women for whom gestating and birthing is potentially highly risky or life-threatening could use ectogenesis to fulfil their parenthood projects.7 This practice would also enable women whose social circumstances make gestation and childbirth either undesirable or impossible to have genetically related children. Among these women are for instance those whose professions are either incompatible with gestating children or would expose their pregnancies to high risks. As noted by Julien Murphy, women who are smokers, drug users, casual drinkers and ‘do not wish to alter their behaviour or place (their) fetus at risk’ could also benefit from ectogenesis.15 These views emphasise how this practice would promote women’s positive freedom, namely, the ‘freedom to’ beget children in ways that would not otherwise be possible. Authors advancing them directly or indirectly refer to the positive effects on and enhancement of women’s reproductive freedom, namely, the freedom to decide whether or not to have children and how to have children. While reproductive freedom is often conceptualised in negative-freedom terms26 (ie, in terms of freedom from external interferences in reproductive decisions), ectogenesis would promote women’s positive reproductive freedom by enabling them to beget children in the way they deem fit.

Equality and freedom, but for whom?

Ectogenesis is considered to be equality-promoting on two accounts: it promotes equality between men and women, and between biologically and socially infertile and fertile women. Despite this depiction, the reach of defences of ectogenesis appears limited. While health-related risks, burdens and deaths caused by gestation and childbirth affect all women and can indeed be framed in terms of a ‘natural inequality’,8 they are not equally distributed among all women. Documented evidence shows that women belonging to ethnic minorities, poor and disabled women are at a much higher risk of experiencing complications during gestation and childbirth and of dying as a result of these complications.19 27–30 This disparity in the distribution of the burdens and risks of gestating and birthing children among well-off, white and able women and other women can be witnessed both within and between countries.18 22 31 32

Now, one could argue that for ectogenesis to be equality-promoting, these groups may just need to be prioritised in their access to this practice (or at least their access to this practice would have to be secured). This would at least represent an incremental improvement of the status quo. There are, however, two sorts of barriers to achieving this: financial and cultural. Concerning financial barriers, Kendal’s central claim in her defence of ectogenesis is that this practice should be state-sponsored to promote and secure equal opportunities for women. Similarly, Smajdor argues that natural inequalities “may generate a prima facie right to restitution”.8 Both defences of ectogenesis hence take into consideration the potential financial constraints of developing this practice and the need for sponsoring it to enable equality-promotion for all women. The problem with these arguments is that even in developed countries with state-sponsored healthcare systems, some prioritisation decisions need to happen. For instance, in the UK, in vitro fertilisation is state-sponsored between one and three cycles, depending on one’s geographical region⁴.7 8 This means that if after the number of cycles paid for by the National Health Service (NHS) no pregnancy can be established, the prospective parents must either turn to other methods to have children or attempt more cycles using their own resources. Decisions concerning resource allocation and prioritisation mean that first, even in developed countries with state-sponsored healthcare systems, it is unlikely that all biologically and socially infertile women would be granted free access to ectogenesis. For instance, it is not impossible to foresee a scenario where the former group would be prioritised over the latter, thereby achieving only partial equality with men and with other (fertile) women. Second, in developing countries and in countries without state-sponsored healthcare systems, some (well-off) women would be able to access ectogenesis, while for the majority this practice would remain out of (financial) reach. Now one could argue that this is unjust and that a concern for justice would require a redress of these disparities.7 8 Alternatively, one could argue that state-sponsoring ectogenesis for all women may turn out to be cost-effective from a healthcare spending point of view.7 It is important to note that both these claims raise empirical questions that would need to be addressed for these claims to succeed. Addressing these questions is outside the scope of this paper. However, while I agree with Smajdor and Kendal on normative aspects of their proposals, I am sceptical as to their feasibility. The ways in which assisted reproductive technologies are currently offered in a developed country with state-sponsored assisted reproduction seems to provide a prima facie reason to be sceptical that ectogenesis would be widely accessible and would hence serve as a truly universal leveller.

As mentioned earlier, the second barrier is cultural. Assisted reproductive technologies have often been criticised for being designed for and mostly accessed by white and well-off women.33 While I do not consider this as a conclusive normative argument against developing and implementing assisted reproductive technologies, it is relevant for the present discussion as poor women and women of colour have been shown to be among the least common users of these technologies.33–36 Values surrounding assisted reproductive technologies and infertility, as well as cultural understandings of them could change. But, at present, it seems that ectogenesis would be accessed by—and promote the equality of—only certain women.37 Further, within equality-promoting and freedom-promoting arguments in favour of ectogenesis, the universal desirability of ends such as career advancements is taken as a given. Despite this, it is unclear whether all women would value these ends and whether women who find meaning and self-realisation in gestation and childbirth would necessarily connotate these experiences in such negative terms. Arguably, underlining claims of proponents of ectogenesis are conceptions of ‘the good life’ that not all women are likely to subscribe to. For many, these conceptions would seem ‘WEIRD’, namely, reflecting the value systems and preferences of ‘Western, Educated, Industrialised, Rich and Democratic (WEIRD)’ societies.38 Defenders of ectogenesis note this and contend that this practice would not be imposed on women. However, this means, on the one hand, that ectogenesis furthers the interests and preferences of only some women; on the other hand, that it may end up undermining women who find meaning and self-fulfilment in gestation and childbirth. Their decisions to beget and birth children ‘naturally’ may be regarded as at odds with conceptions of the good life such as those advanced by proponents of ectogenesis, making opting out increasingly difficult. Ectogenesis might hence not turn out to be equality-promoting, but rather “increase divisions of class within the sexes, as well as maintaining gender differences for some groups in society”.37

In addition to defences of ectogenesis emphasising its equality-promoting potential, this practice is defended as it could promote women’s freedom from the risks, burdens and invasive, autonomy-constraining measures that are often associated with gestation and childbirth. But while many if not all women experience these burdens, risks and constraints, the degree to which these are experienced varies greatly among women. Both historical and contemporary examples of control over women’s (gestating) bodies indicate that control is exercised much more on the bodies of disadvantaged members of society, such as women of colour, members of ethnic minorities, and disabled and poor women.33 39 40 For them, ectogenesis might not be liberating and might not promote freedom from external interference and control but rather become another instrument of oppression. The risk is that certain women, especially from disadvantaged groups, would be regarded as substandard gestators. This, in turn, may open the door to increased control and pressure to use ectogenesis to secure the safety of the fetus. Indeed, ectogenesis could favour a problematic shift of focus from women’s interests to fetal interests, depending on who the users of this practice are and on how they are regarded in society. Further, as discussed in the previous paragraph, ectogenesis may end up curtailing the free enjoyment of ‘natural’ gestation and childbirth for women who find meaning and self-fulfilment in these experiences. Assisted reproductive technologies such as ectogenesis could promote equality and freedom, but whether they turn out to be able to do so depends on the conditions under which they become available, on the context in which they are introduced, on who is involved in these processes and on the sort of values that frame their introduction⁵. This brings me to the second limitation that I identify with the defences of ectogenesis outlined in the previous sections, namely, the narrow scope of these defences.

A matter of context

Ectogenesis is thought to be equality-promoting both at the level of biological reproduction and at the level of social reproduction. Moreover, ectogenesis would not only promote equality in the private sphere of the home but also in the workplace. While ectogenesis seems to be able to promote equality in biological reproduction (although not for all women, as discussed in the previous section) it is unclear whether severing the tie between biological reproduction and women would be sufficient to obtain equality in social reproduction.41 It seems that more than ectogenesis would be necessary to achieve this kind of equality. While it is possible that women’s biology and their unique role in begetting children is at the root of their primary role in childrearing, this role has been socialised and has become predominant in many societies. Granted, values and norms surrounding childrearing can change and the introduction of ectogenesis could shape such values and norms. However, one issue must be noted. Other assisted reproductive technologies have created new family structures and new ways of interpreting social and biological ties,42 but have also reinforced dominant and widespread beliefs on the importance of the ‘genetic tie’43 and failed to challenge ‘the existing order’.44 They are:

[I]n no way aimed to challenge the nuclear family, to enable women to be less defined by their reproductive capacity, to develop more feminist definitions of biology, or to dissolve the patriarchal structures of society.45

This is relevant to the present discussion as only introducing a new reproductive technology or practice (even one that so radically changes biological reproduction) does not determine how and whether such a technology or practice will go about shaping current arrangements, and social values and norms. The way technologies go about shaping extant arrangements and norms seem to depend more on how these technologies are designed, implemented and regulated, and to serve whose interests, than on the technologies themselves.

In addition to enabling equality in childrearing, ectogenesis is defended as it would allow women to equally compete with men in the labour market. Thanks to ectogenesis, women would be able to access career advancements, certain occupations that were not hitherto available to them due to their role in biological and social reproduction and be eligible for professions that would be dangerous or impossible to undertake while gestating. Defenders of ectogenesis rightly point out that the playing field is not level. Despite this, there is a sense whereby the benefit of equally competing in the labour market under the current conditions of how the labour market is organised may not be beneficial. In other words, the risk is that from the ‘tyranny of pregnancy’ and childbirth, women would be delivered into the tyrannical hands of a precarious, unfair and potentially exploitative labour market. The achieved equality with men would end up being the possibility of being equally exploited. Defending ectogenesis as a solution to inequality in the workplace is problematic for two reasons. First, it locates the problem in women’s roles and responsibilities in gestation and childrearing rather than in an unfair and exploitative labour market. Ex hypothesis, the obstacles that women face in the workplace are the product of a system that does not accommodate (biological) differences, that does not favour a free and equal participation of both sexes in social reproduction, and that tolerates oppressive practices. Second, such framing of ectogenesis as a means to address workplace inequalities calls for solutions that change the way society reproduces itself rather than a labour market that prevents equal treatment of men and women. More attention should be devoted to changing policies, practices and values that prevent equal access to goods such as promotions and pay rises, and that do not incentivise workers to share childrearing responsibilities⁶. It is unclear, then, how ectogenesis would be desirable in this context. These shortcomings point to the importance of considering the context in which new (reproductive) technologies are developed and offered. In societies characterised by oppressive conditions, an exploitative labour market and disparities in terms of capacity to access and enjoy reproductive health and care benefits, ectogenesis may not be enough to subvert negative externalities generated by these features.