Would you chose external gestation if you could? What do artificial wombs mean for reproductive rights - including abortion, equality and the role of women in society? The moral, ethical, legal and societal consequences are profound and we are unprepared for them.

What happens when women, like men, can be parents without bearing children? Does one form of gestation become a status symbol? Another a stigma? Who decides which gestation environment is healthier or more economical? You? Your gamete-partner? Your priest? Your employer? Your insurance company? If we think we have a complicated debate now, just wait. The current War on Women pales in comparison to the potential impact that ectogenesis, a technology in which a human fetus gestates completely out of a mother’s body, will have. It is, in its ultimate manifestation, qualitatively different from birth control or other assisted reproductive technologies. This change has the power to alter, in unprecedented ways, the interests, rights and responsibilities of women, men and the state.

J.B.S. Haldane, a British scientist, who predicted that by 2074 live human births would make up less than 30 percent of all births, first coined the term ectogenesis in 1924. His prediction was ambitious, but not unrealistic. Despite the sci-fi horrors evoked by “artificial wombs,” this isn’t the stuff of dark dystopias. It is a partially realized, life-saving technology. Since the 1920s, researchers have seen the development of artificial wombs as a final goal of assisted reproductive technologies. Research focuses variously on helping premature babies to survive to finding substitutes for women’s bodies as baby machines. In the past 30 years, our reproductive technologies have achieved what would have previously been considered miraculous. Artificial wombs, a form of life support, are the logical conclusion of those efforts.

Current Research

There are two commonly cited endeavors in progess. Focusing on finding ways to save premature babies, Japanese professor Dr. Yoshinori Kuwabara of Juntendo University, has successfully gestated goat embryos in a machine that holds amniotic fluid in tanks. On the other end of the process focusing on helping women unable to conceive and gestate babies, is Dr. Helen Hung-Ching Liu, Director of the Reproductive Endocrine Laboratory at the Center for Reproductive Medicine and Infertility at Cornell University. Quietly, in 2003, she and her team succeeded in growing a mouse embryo, almost to full term, by adding engineered endometrium tissue to a bio-engineered, extra-uterine “scaffold.” More recently, she grew a human embryo, for ten days in an artificial womb. Her work is limited by legislation that imposes a 14-day limit on research project of this nature. As complicated as it is, her goal is a functioning external womb.

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Predictions for the full realization of what scholars Scott Gelfand and John Shook call “immaculate gestation”* range from 10 to 60 years. However, it is already partially possible and entirely within the spectrum of acceptable practices. Even if it takes scientists several decades, medical advancements are steadily narrowing the gap between in vitro conception and fetal viability outside of the womb. When the gap closes then babies, navel-less, will no longer have to be “born” through women.

Is that an advantageous human adaptation?

Medical Benefits

The medical benefits seem clearest – the technology will help infertile couples, enable premature babies to survive, create an alternative to surrogacy when needed, and help women unable to carry their own babies. Ectogenesis can provide safe, healthy gestational environments – free from drugs and alcohol. It will give gay couples new fertility options. Other benefits posited by advocates of the technology range from better-adjusted children, freed from mothers who are overly invested in them, to, although morally repugnant, the steady supply of “spare parts” that could be harvested from “bottled” embryos.

Societal Consequences

The moral, ethical, legal and societal consequences are profound and we are unprepared for them. Definitions and distinctions, the meanings of words like “life,” “human,” “embryo,” “natural,” and even “mother,” that we’ve historically relied on to make ethical decisions, are dissolving faster than we are adapting. What happens when both men and women contribute equally – by providing only gametes – to reproduction? Do women have to carry human babies? What if they don’t want to? Who decides? What does it mean to sever human “birth” from the human body? This connection, between women and babies, is one of the sole sources of power that women have in some societies.

Abortion, Reproductive Rights and Equality

In immediate terms, the foundations on which a woman’s rights to choose are predicated in Roe v. Wade, namely the issue of fetal viability and the right to privacy (the right not to be pregnant), will be rendered virtually meaningless. First, once a fetus can be safely and entirely gestated outside of a biological womb, it can be removed from its mother. Second, ectogenesis means that viability starts with conception. Both consequences radically alter the terms of the pro-choice debate as it is currently framed and understood. The tension inherent in the current debate, between the rights of the woman and the state’s interest in the fetus, disappears when the woman and the fetus can be safely and immediately made independent of one another. The reproductive choices of men and women become equal and women lose the primacy now conferred on them as a result of gestation. States could require women to have their fetuses extracted as an alternative to abortion, with serious long-term negative impacts. Reproductive rights and social justice issues will take on an even more surreal dimension.

Feminists, not surprisingly, have extensively considered what ectogenesis could mean for women’s rights, the structure of the family, class, and society. Right wing anti-choice activists, although perhaps initially delighted to have an alternative to abortion, will have to contend with a radical redefinition of “motherhood” and the hierarchical and gendered societal relationships for which it is an antecedent. There is no guarantee that these changes will be good for women who currently already struggle to defend reproductive freedoms. Feminist critique ranges from one extreme to the other in terms of whether ectogenesis will liberate or further oppress women.

In her seminal work, The Dialectic of Sex, written in 1970, Shulamith Firestone argued that inequality between genders, and women’s virtual imprisonment in the home, was the direct result of biological reproductive differences and women’s correlating investments in mothering. For her, ectogenesis, accompanied by revolutionary social changes, was the way to free women from the tyranny of their own biology put in the employ of patriarchal structures, including the traditional family. She noted that, so far, these technical and social changes have been impeded by medicine’s domination by men, who have no vested interest in upsetting the traditional status quo.

This same status quo has demonstrated the extent to which it is willing to view mothers as flesh and blood mother machines**. Ann Oakley’s book The Captured Womb: A History of the Medical Care of Pregnant Women illustrates how ectogenesis would be part of a long-standing process by which virtually all male and often misogynistic medical cultures have taken control of birth and women’s wombs in the name of science. In this framework, ectogenesis will potentially exaggerate preexisting inequities and biases. In this equation women aren’t liberated, they are further subjugated and alienated from their own bodies and abilities. This Handmaiden’s Tale scenario is fairly believable if you pay any attention to, for example, Rick Santorum’s antediluvian reproductive rights agenda and the number of people willing to vote for him.

Prominent feminists and activists, including Andrea Dworkin and Janice Raymond, have concluded that not only will women be further marginalized and oppressed by this eventuality, but they will become obsolete.

Fertility, and the ability to be the species’ reproductive engine, are virtually the only resources that women collectively control, they argue. And, although women do have other “value” in a patriarchal society–child rearing, for example–gestation remains, worldwide, the most important. Even in the most female-denigrating cultures women are prized, if only, for their childbearing. If you take that away, then what? This technology becomes another form of violence.

Other feminist analyses takes into account the class and race implications of the enthusiastic adoption of assisted reproductive technologies by the wealthy. Some, eco-feminists, relate the eventuality to correlating a general campaign against nature. Ectogenesis also opens up the real possibility of men becoming mothers and primary care takers.***

Who controls ectogenesis and how it is utilized is the key to whether or not it is a tool of liberation or oppression for women. Men rule, literally, and until we have more gender balanced representative leadership in all sectors of society, that has predictable consequences. Women are outnumbered as researchers and scientists in the field of reproductive technology, as opinion-shaping media commentators and pundits, as clerical and religious leaders, and as governmental policy makers and regulators. In this context, as with the current contraception/Catholic church debacle, is highly unlikely that woman-centered reproductive agendas, especially those that take into account the needs and health of poor women and women of color, will result.

Bioethics and Regulation

Scientists are the first to admit the complexity of gestation. They don’t understand the subtle interactions – everything from the nature of the mother-child bond to the necessary and ideal balance of temperature, sounds, fluids and hormones – between women’s bodies and the bodies and development of fetuses. As with all new technologies, particularly biotechnological ones like in vitro and cloning, bioethicists are thinking about the social, legal and ethical implications. But, compared to other developed countries, the United States has very little regulation regarding assisted reproductive technology. And, although lots of people in Congress are eager to wax on about the moral status of embryos and the definition of personhood there are currently virtually no federal or state regulations regarding the impact of how we use gametes, embryos, artificial wombs and engineered birth to define those terms. A quick search of the Presidential Council on Bioethics’ website for “artificial womb,” “ectogenesis,” “gestation,” yielded only one result on the not-specific-to-reproduction moral science of limiting human subject research. A 2004 Presidential Commission on Regulation of New Biotechnologies was concerned with commercialization of ova and sperm donations, insurance coverage, truth in advertising and patent issues. The NIH is primarily in the business of monitoring stem cell research. The FDA with regulating substances used in IVF.

Any integrated, comprehensive pragmatic and/or philosophical approaches are political nightmares in this country. However, not any longer in others. Britain, for example, established a Human Fertilization and Embryology Authority (HFEA) in 1990. HFEA has authority, independent from the health and research facilities and the government, to regulate assisted reproductions services and products.

Decisions about reproductive technologies are more often then not made by doctors and individuals in the absence of a social justice framework. Progressive people, interested in equality and social justice, need to prepare for how rapidly evolving technology will shift reproductive rights and responsibilities. The real dystopian future is one where we look back with nostalgia at the brief period during which Roe vs. Wade had its fragile relevance and impact as a high point in women’s reproductive freedom. It may sound alarmist, but really, we have time to consider the ethical, moral, societal ramifications of this technology and frame the arguments of the future before others do it for us. We have some time, but, not much.

Sources and Additional Reading

* Scott Gelfand and Shook, John R., eds., Ectogeneis: Artificial Womb Technology and The Future of Human Reproduction, Editions Rodopi, B.V., 2006

** Gena Corea, The Mother Machine: Reproductive Technologies From Artificial Insemination To Artificial Wombs, Harper Collins, 1985

***Maureen Sander-Staudt, Of Machine Born?, Ectogeneis: Artificial Womb Technology and The Future of Human Reproduction,Editions Rodopi, B.V., 2006

Richard T. Hull, Ethical Issues in the New Reproductive Technologies, Prometheus Books, 2007

Christopher Kaczor, The Ethics of Abortion: Women’s Rights, Human Life, and the Question of Justice, Routledge, 2011

Jessica Pierce and Georgle Randels, Contemporary Bioethics: A Reader with Cases, Oxford University Press, 2010

J.B.S. Haldane, Daedalus Revisited, Oxford University Press, 1995

Shulamith Firestone, The Dialectic of Sex, 1970

Ann Oakley, The Captured Womb: A History of the Medical Care of Pregnant Women, Blackwell Publishers, 1985