NEW HAVEN: The website of IVF Sunrise in Thailand states, “You have to weigh how important it is for you to have a child who is truly your own flesh and blood.”
And after a 30-year-old schoolteacher and her husband in India failed to conceive, they tried in vitro fertilization before signing up for surrogacy. “When I can have my own child through IVF or surrogacy, then why adopt?”
The use of the word “own” in these two separate examples encapsulates a widespread and potent sociocultural belief that values biological parenthood over other forms. The shame of involuntary childlessness has global currency, though in varying cultural textures and degrees. Defining human relatedness through genes and blood has been a predominant and often unquestioned notion across most cultures.
In the light of these pervasive notions, the global demand for assisted reproductive technologies, or ARTs, is no surprise. The European Society of Human Reproduction and Embryology reports that 1 million babies were born in the first 25 years of IVF between 1978 and 2003 and more than 5 million estimated to have been born by the end of 2013. The International Committee Monitoring New Reproductive Technologies reports that on average 350,000 babies per year have already been born from such treatments.
The United States and Japan use these technologies the most. Falling global birthrates and declining fertility rates in many countries have pushed governments to rely on and offer financial support for infertility treatments, including Israel, South Korea, Australia, Singapore, Japan, among others. News reports have documented the leap in cross-border baby-shopping, with West Europeans traveling to Georgia or Ukraine, rich Chinese heading to the United States.
Many prospective parents also travel to India. Cheap labor and first-rate (private) medical facilities have turned it into the epicenter of surrogacy.
On the other hand, international adoption numbers indicate a global decline. As per a survey conducted by Peter Selman of Newcastle University, among countries that have seen the highest international adoptions, the plunge has been rather significant: from 45,299 in 2004 to 23,626 in 2011. A minefield of regulations and a crackdown on illegal adoptions and child abductions through the Hague Adoption Convention are often cited as primary reasons for this slump. Not all orphaned and destitute children make it to adoption centers, and 25 million children were without one or both parents in 2010, nearly doubled from 18 million in 2001, according to UNICEF.
Only large-scale research could trace links between the rise in fertility “treatments” and fall in adoptions – and shed light on how the childless with financial access make their choices. Given the forbiddingly high costs of these treatments and other sociocultural restraints, the access is limited to the privileged few. The impact may not be large, and besides, looking for the impact of reproductive technologies via numbers may be an incomplete and misleading exercise.
Jagannath Pati, joint director of the Central Adoption Resource Agency, India’s adoption regulation authority, rules out big impact: “There are adoptive parents who first tried IVF…but the costs limit the numbers of those who try. But then infertility is growing and so a greater number of couples seek medical help. On the other hand, there is also increasing social acceptability of adoption than ever before….in many cases, couples want to adopt a girl child as their first choice which was not the case some years back.”
Amid the loud celebrations of the benefits of reproductive technology as well as concerns for the commercialization, society may have ignored its own role in the idealization of “natural” – read biological – kinship. While laboratories have demystified fertility processes, the aura around the natural seems to have become more prominent with deep desires for “normal” families.
Even as fertility interventions have been normalized and gained greater acceptability, involuntary childlessness has not. And reproductive technology may have played an insidious role. Heather Paxson’s 2006 study in Athens, published in Culture, Medicine and Psychiatry, showed how urban Greeks and doctors employed ideologies of motherhood and reproduction-as-spirituality to defy church disapproval of ARTs. Marcia Inhorn’s work, The New Arab Man: Emergent Masculinities, Technologies, and Islam in the Middle East, demonstrates how Middle Eastern men challenge religious authorities to try ARTs. The gravity of psychosocial pressure on women to give birth is revealed by the high incidence of depression and suicidal tendencies among those trying or unable to bear children, according to a 2014 study by Kimiko Tanaka and Nan E. Johnson, published by the Journal of Family Issues. Meenakshi Sahu, senior gynecologist and infertility specialist in Delhi, said: “Since the childless undergo a lot of social, emotional trauma, sometimes it even affects marital life and leads to divorce or second marriages. And most do prefer biological children far more anyway. I think that to a certain extent, yes, reproductive options have decreased adoption. Those with money can afford expensive treatments such as IVF or surrogacy which is beyond the reach of the average person.”
The reproductive technology market contributes to the discourse around naturalized parenthood. Fertility clinics, gynecologists, surrogacy specialists, doulas and others romanticize pregnancy as the epitome of womanhood and family life, if not human life itself. In offering biological redress, society may have unwittingly legitimized the need for biological progeny as also the accompanying shame. The need for one’s “own” biological children has become so compelling that risks posed to women’s long-term health are neglected.
Margaret Homans, professor of English and of Women's, Gender, & Sexuality Studies at Yale University and author of The Imprint of Another Life: Adoption Narratives and Human Possibility raises pertinent questions on the motivation behind the development of such technologies: “If medical science can now create a human embryo with donated mitochondria (and thus from three biological "parents"), to enable a woman who might otherwise transmit mitochondrial disease to bear a healthy child that is genetically hers, we may applaud the technical achievement, but we should also be asking what social good is served by bringing a child into the world in this way.” Homans also wonders why parents care so much about bearing children who are genetically "theirs" and asks: “Do we as a society really think it is better to expend resources in this way than, say, in creating social and economic justice for already born children who are living in poverty?”
Despite this genetic obsession, there is some hope. While adoption of children has so far been the path taken by the involuntarily childless and unmarried, a small but growing community offers a counter-narrative. Those who adopt or choose to live without children may be fewer in number than the pronatalist multitude, yet form a growing tribe spurred on by environmental concerns, altruism, diverse conceptions of fulfillment and purpose of life. Their choices, deemed by some as unnatural, will perhaps goad society to expand its ideas about family-making. Homans clarifies: “Adoption can seem like a difficult choice for some, requiring family ties to be deliberately made rather than taken for granted, yet perhaps that difficulty arises from the embeddedness of adoptive families in a society that so overvalues biogenetic and racial sameness and so undervalues diversity.”
Social scientists have called reproductive technologies a medical cure for a social problem. De-stigmatizing both voluntary and involuntary childlessness could broaden our definitions of human belonging.
Amrita Nandy is a Fox International Fellow (2013-2014) at Yale University and a doctoral candidate at the Jawaharlal Nehru University in Delhi, India. Her research explores motherhood and choice via voluntary non-mothers and non-normative mothers (including the voluntarily adoptive, unwed, sex worker and queer mothers, among others), all of whom defy different tenets of the motherhood ideology and its biological and heteronormative essentialisms.