Freedom

It has been argued that partial ectogenesis offers pregnant people an increasing range of choices about pregnancy, and thus is freedom promoting. With the availability of artificial wombs people experiencing pregnancies that are, or are perceived as, dangerous might welcome the opportunity to opt to end their pregnancy (opting out of gestation) without necessarily having to make the decision not to reproduce.4 5 These arguments assume the availability of such choices both legally and socially. Access to technology during pregnancy is strictly medically controlled (and equally dictated). Doctors are installed by the law as gatekeepers to decisions about ending pregnancy.1 and childbirth,2 and the law is likely to place doctors in the position of gatekeepers to partial ectogenesis as well.5 The suggestion that persons with female biology, predominantly women, will be subject to a lesser burden in pregnancy because of partial ectogenesis has little merit, unless there is legal reform to address the fact that pregnant people themselves are not legally empowered to determine the level of tolerable risk in pregnancy.5 Legal reform is also necessary to mitigate how social circumstances may limit women’s freedom to make the choice to opt for assistance with late-term gestation. It may be that pregnant people wanting to opt for extra uterum gestation for health reasons would be subject to the same stigma as women who request a caesarean (in place of vaginal delivery). These women are often labelled selfish, or ‘too posh to push’3 ,6 despite the reality that those who make this decision do so because they believe it is best for their well-being.7 Social conditions can make decisions about a pregnancy much harder for pregnant people to access and this will be no less true for people considering ectogenesis (full or partial). The law perpetuates harmful social conditions by labelling decisions about pregnancy as requiring explanation and supervision, thus subjecting pregnant people to unwarranted stigma.8

It is also possible that constructing the artificial womb as an ‘alternative’ to later-term gestation may come to limit pregnant people’s freedom. Cavaliere highlights the risk that ‘certain women, especially from disadvantaged groups, would be regarded as substandard gestators’ and notes the potential for ‘increased control and pressure to use ectogenesis to secure the safety of the fetus’.1 Ectogenesis is frequently cited as a welcome development to provide a more secure ‘uterine experience’9 for a fetus when maternal behaviour is thought to be concerning, for example because of substance misuse.9 10 The narrative of an accessible ‘alternative’ can be mechanised as a powerful tool for increased monitoring of pregnant women. In the context of pregnancy false alternatives are frequently deployed to regulate behaviour; pregnant people are systematically denied access to abortion after ‘viability’ because it is advocated that the fetus could survive in an alternate space (and this is enshrined in law),4 and pernicious narratives persist about birth control and the necessity of abortion.

Legal reform must accompany technological developments. A reproductive agenda that is genuinely freedom-promoting must place emphasis on scaling back excessive medical control over, and legislative interference into, female reproductive health, and foster trust in women and pregnant people to make decisions for themselves.

Equality

Cavaliere explains that the proposals for ‘state sponsored ectogenesis’ by Kendal3 and others are infeasible, and thus there are likely to be financial barriers to accessing ectogenesis.1 Such concerns are also evident in the context of partial ectogenesis, because if the technology has the capacity to be revolutionary in minimising the risks that pregnant people have to tolerate in gestation,5 or the likelihood of human entities dying after delivery due to prematurity, equal access to such technology must be ensured. In public and private health systems alike, there are already significant inequities in access to prenatal and postnatal care, as well as neonatal intensive care.11 Horn and I have argued that these disparities risk worsening if some pregnant people have the means to opt out of full-term pregnancy and others do not.11

Political perspective

Cavaliere concludes that ‘ectogenesis should be defended as a provocation, one that demands: better medical and social services for gestating women; a decrease in the medical hazards associated with gestation and childbirth; better working … conditions for future mothers, gestating mothers, mothers and women more generally; and a true redistribution of the burdens of responsibilities of social reproduction’.1 Ectogenesis makes for an interesting theoretical perspective to highlight how present conditions (including gestation taking place inside a person of female biology) have resulted in some structural inequalities. Examining the law surrounding partial ectogenesis is useful to demonstrate quite how restrictive the law is in relation to gestation and female reproductive health.5 Historically, technology has been politically captured to afford increased legitimacy for measures that subject pregnant people to greater control. Better neonatal intensive care has resulted in increased legal restrictions on abortion,5 and birth control has resulted in legal and political manoeuvres to determine who is allowed to reproduce.12 In the literature, as well as those writing from the perspective that ectogenesis presents a possible tool for female liberation,3 there are equally those claiming that ectogenesis is a justification for restricting access to reproductive healthcare (namely, abortion).13 Carefully framed political provocation, analysing ‘the risks and burdens of pregnancy and childbirth, as well as the unfair distribution of childbearing responsibilities between men and women’1 through the prism of value in social reproduction, can prevent political capture of technology. Focusing on the extent to which society’s treatment of the (potentially) gestating person, both before, during and after gestation, has resulted in structural inequality in the labour market and beyond, emphasises the importance of good reproductive healthcare to better guarantee equality and freedom.