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Dedrick, Elizabeth A.
The politics of being an egg "donor" and shifting notions of reproductive freedom
h [electronic resource] /
by Elizabeth A. Dedrick.
[Tampa, Fla.] :
University of South Florida,
Thesis (M.A.)--University of South Florida, 2004.
Includes bibliographical references.
Text (Electronic thesis) in PDF format.
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ABSTRACT: As an Assisted Reproductive Technology (ART) that has been available for over twenty years, the transfer of healthy eggs from a presumably fertile woman into the womb of a woman diagnosed as infertile has become a common part of the landscape of human reproduction in the United States. Yet the general societal acceptance of this practice commonly known as "egg donation" oversimplifies the complex medical, ethical, and societal issues ignited by its use. In light of the limited critical discussions presently occurring about egg transfer, I will interrogate some of the silences and more ambiguous issues invoked by its practice. By giving particular attention to the often ignored experiences of egg "donors," I will analyze the popularly used discourses around this ART. In doing so, I will investigate the ways in which egg donation complicates notions of altruism, autonomy, and exploitation as well as what consequences this has for women's reproductive freedoms as envisioned by many U.S. feminists.
Adviser: DiPalma, Carolyn
assisted reproductive technology.
x Women's Studies
t USF Electronic Theses and Dissertations.
The Politics of Being an Egg Donor and Shifting Notions of Reproductive Freedom by Elizabeth A. Dedrick A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts College of Arts and Sciences Un iversity of South Florida Major Professor: Carolyn Di P alma Ph.D. Marilyn Myerson, Ph.D. Cheryl Rodriguez, Ph.D. Date of Approval: March 31, 2004 Keywords: egg donation, feminism, autonomy, altruism, exploitation, assisted reproductive technology Copyright 2004 Elizabeth A. Dedrick
Acknowledgements I express my greatest gratitude to my committee members for their enthusiastic academic and personal support throughout both the process of writing this thesis, and my entire time at the University of South Florida. In particu lar, I am truly grateful for the careful and insightful guidance provided by my major professor, Dr. Carolyn DiPalma. In continuously nudging me to jettison some of the more peripheral storylines from the start, she played a tremendous role in helping me to keep this project focused, but rich. My sincerest thanks also go out to my friends and colleagues in the USF Womens Studies Department, as their support sustained me through the most trying moments of this journey. And finally, in recognizing that th e production of this work was much larger than a single semester of writing, I am forever indebted to my family and friends for their unyielding support for all of my hopes and endeavors
i Table of Contents Abstract ii Prologue 1 Introduction 6 The Practices of Egg Transfer 6 Contextualizing Current Perceptions of Egg Transfer 10 Chapter 1: Lost in the Transfer 16 Analysis of Profe ssional ART Literature on Egg Transfer 18 Analysis of Egg Donor Program Websites 24 Coinciding Representations of Maximized Altruism and Minimized Risk 32 Chapter 2: Analyzing the Choice and Gender Assumption behind Donation 36 Autonomy as a Ba sis for Altruism 37 Assumptions of Womens Natural Altruism 47 Disrupted Assumptions of Altruism 51 Chapter 3: Deciphering Donor Fees 54 What is the Donor Fee for? 55 Does this Form of Commodification Evolve into Exploitatio n? 60 Contesting Claims of the Harmlessness of Commodifying Eggs 65 Chapter 4: Re conceiving Reproductive Freedom 68 Egg Stewardship 70 Shattering Images of Choice and Disrupting Stewardship Discourses 75 Epilogue: The Current Status o f Reproductive Freedom 82 References 86
ii The Politics of Being an Egg Donor and Shifting Notions of Reproductive Freedom Elizabeth A. Dedrick ABSTRACT As an Assisted Reproductive Technology (ART) that has been available for over twenty years, the transfer of healthy eggs from a presuma bly fertile woman into the womb of a woman diagnosed as infertile has become a common part of the landscape of human reproduction in the United States. Yet the general societal acceptance of this practice commonly known as egg donation oversimplifies th e complex medical, ethical, and societal issues ignited by its use. In light of the limited critical discussions presently occurring about egg transfer, I will interrogate some of the silences and more ambiguous issues invoked by its practice. By giving particular attention to the often ignored experiences of egg donors, I will analyze the popularly used discourses around this ART. In doing so, I will investigate the ways in which egg donation complicates notions of altruism, autonomy, and exploitation as well as what consequences this has for womens reproductive freedoms as envisioned by many U.S. feminists.
1 Prologue I have been keeping a secret for the past year. I realize that such a confession is not a typical beginning for a thesis. Yet as a feminist researcher and scholar, I am conscious of the significance of my own experiences and beliefs to th e directions and content of my scholarship, and thus feel that now is the time to bring this secret to light. To divulge this secret outright, I have discovered that I can pay my way through graduate school by participating in a highly profitable marketin g scheme in which my body serves as the merchandise. While this prospect may seem offensive to many in U.S. society perhaps even those who are fiercely capitalistic disclosing this fact as a feminist is certain to raise even more critical eyebrows amo ng my colleagues and peers, because of the central role the body has played in feminist struggles throughout history. And isnt this prospect of profiting from the use of womens bodies directly illustrative of the many dilemmas with which feminists, and women in general are typically confronted? The female body as the target of violence and rape, the sexualized object of male fantasy and fetishization, an incubator for breeding slave or labor forces, or the object of numerous other abuses throughout t he past and present has, and continues to be simultaneously a main source, and site of womens oppression. With such a legacy of manipulation, abuse, and degradation of female bodies, I could not help but feel that my willing participation in practices which involved my procurement of
2 financial gain through the use of my body would be seen as unacceptable and purely un feminist by many of my peers. Some points of clarification are certainly necessary here, as our society has concocted numerous ways in which women can profit from the use of our bodies not all of which are objected to by all feminists. These lucrative uses of womens bodies may be based on aspects ranging from our appearance, to our sexuality, to our reproductive capabilities. 1 The l ast category is the one on which I will focus because the marketing scheme with which I involved myself is an Assisted Reproductive Technology (ART) typically referred to as egg donation 2 or as I will refer to it, egg transfer. The practices of egg t ransfer raise many technological, ethical, and moral issues for any society in which they are used. Through my exploration of this topic of egg transfer, I will focus specifically on the issues of altruism, exploitation, choice (as understood within fem inist frameworks of reproduction), and their significance within the contexts of ART for contemporary womens reproductive freedom. Obviously, numerous other concerns and questions arise in relation to these issues, including: what does it mean to have a child of ones own and why has our society placed so much value on families that are based on biological and/or genetic relationships? What consequences could egg transfer have on a donors health in the distant future particularly in light of the fac t that this has not been studied yet? Who should have access to egg transfer and should it be covered by health insurance? How might egg transfer be forwarding a eugenic agenda? What role are racist, classist, and heterocentric stereotypes playing in st ructuring access to egg transfer and other ARTs? How does a lesbians use of her partners egg subvert legislation in
3 many U.S. states that make it difficult or impossible for same sex parents to have joint custody of their children? And most fundamental ly, are researchers, practitioners, and user of ARTs conscionably justified in spending billions of dollars on improving and employing such high tech methods of reproduction when countless women all over the world cannot gain access to even low tech re sources such as condoms and contraceptives, or adequate pre natal care? This broad range of inquiries offers merely a sampling of questions that are sparked by egg transfer, and other ARTs. Therefore a thorough study of this topic would require the explor ation of a wide range of topics spanning from our changing notions and definitions of family, kinship, and motherhood, to the ways in which egg transfer and ARTs in general perpetuate the conflation of womanhood with motherhood. My hope is that my examina tion of altruism, exploitation, and choice as they relate to egg transfer may offer new perspectives on these broader related issues. Considering the issues of egg transfer in relation to both the donor and recipient expands this field of inquiry expo nentially. However, a preliminary glance at the pool of information available on egg transfer shows that the experiences and concerns of infertile women who utilize donated eggs have already been the focus of extensive research, political debate, and soci al policy, while the experiences of egg donors have been largely ignored. Thus, I believe the situation of egg donors deserves much greater attention. 3 My opinion on the need to consider donors experiences is significantly based on my own association w ith this ART, as well as my observations of contemporary representations of egg donors. To explain further my own involvement with the practices of egg transfer, there was a time during which I found several aspects of the egg transfer
4 process (i.e. the f inancial compensation, the prospect of helping women suffering from infertility, and the opportunity to pass on some genes that I have experienced as being rather good) to be quite appealing. At that time, these attractive components of being an egg donor prompted me to consider it seriously enough to undergo some of the initial screening phases for becoming an egg donor at two local infertility clinics. Ultimately, I chose not to offer my eggs to these or any donor programs, mainly because I could not r econcile several of the tensions that will be addressed in the following chapters. While I have never been an egg donor, my interactions with the staff of donor programs, as well as serious contemplation of how my participation in this process might impac t my life, is what largely sparked my intrigue in this research topic. Thus, questions about the egg transfer process within my own experiences are significantly responsible for my research into the implications of this ART for women donating their eggs a nd our society as a whole. 4 Without question, the issue of egg transfer is monumentally significant to both donors and recipients, as it inevitably has serious and long lasting effects on both womens bodies, psyches, and emotional selves. My objective in focusing on the experiences of egg donors is not meant to disparage or demonize the women using those eggs they obviously are driven by a wide range of social and personal motivations which largely reflect the painful personal and social burdens that accompany infertility (see Becker, 2000). Yet as Haraway (1997) argues, continuing to examine situations such as egg transfer from the privileged perspectives of egg recipients constructs a very exclusionary portrayal of these scenarios. In speaking ab out reproductive freedom more widely,
5 Haraway states, Working uncritic ally from the viewpoint of the standard group is the best way to come up with a particularly parochial and limited analysis of technoscientific knowledge or policy, which then masquer ades as a general account that stands a good chance of reinforcing unequal privilege (p.197). In the interests of contesting such situations of unequal privilege and broadening the current discussion on womens reproductive freedom, I will examine the im plications of altruism, exploitation, and choice by bringing forth the typically marginalized interests and concerns of egg donors. 1 I see it as no coincidence that each of the realms in which womens bodies are typically mar keted fit within one of the two gendered scenarios that have defined womens existence throughout much of Western history, i.e. the (virgin) Mother or the whore. 2 The large majority of medical, infertility, and popular literature unproblematically refer t o the practices I am discussing as egg donation. I however, find this terminology to be a misnomer in many of the instances of its use because monetary exchange or other means of compensation are awarded to the egg donor (i.e. the woman who produces t he eggs). While I would ideally prefer to refer to the process as egg transfer throughout this paper as Shanley (2001) does, I think such efforts would seriously hinder the clarity of my discussion by frequently resulting in excessive wordiness. Where possible, I will substitute the terminology of egg transfer, but I ask that my readers remain conscious of my objections to the terms of egg donors and the process of egg donation, even as I utilize them in my vocabulary. 3 Any discussion of the expe riences of egg donors obviously invokes consideration of the male process of gamete donation known as sperm donation. Because egg and sperm donation both involve the contribution of ones gametes to a child that the donor does not intend to parent, many p eople are tempted to compare these practices. Although contrasting the perceptions of these two practices can be useful in examining their gendered contexts, I find that the differing levels of participation and consequences for each type of donor, as wel l as the different expectations of each type of donor (based on gender norms), make it problematic to assume that egg and sperm donation can simply be paralleled. See Haimes (1993) for an expanded version of this argument. 4 I offer my apologies to any of my readers who feel deceived by the initial disclosure of my secret. The intentional vagueness I applied in terms of having discovered that I can pay my way through graduate school with egg donation is not meant to be misleading purely for the sake o f trickery. The following discussion is intended to challenge and disrupt many of the presumptions about women, bodies, and reproduction that are harbored by much of American society. Thus, I felt that it would be important for my readers to consider wha t assumptions about egg donation they are carrying into their reading of this paper.
6 Introduction In order to examine the many medical and societal intricacies involved in egg transfer in any depth, I think establishing some background information on the processes of egg transfer, and their contexts within ARTs more generally, is nec essary. Thus, I will begin with a brief explanation of how egg donors are matched with recipients and the medical procedures involved. 1 The Practices of Egg Transfer Egg transfer is the retrieval of anywhere from fifteen to twenty 2 presumably healthy eggs 3 from one woman to be fertilized and implanted into another woman, with the hopes and intentions of resolving infertility 4 (Shanley, 2001; Borrero, 2001) The development of egg transfer, first successfully conducted in 1983 5 was enabled by the inno vation of in vitro fertilization (IVF) technologies five years earlier in 1978. Following the emergence of IVF, a whole string of new biotechnologies, including egg transfer, rapidly emerged to transform the practices of human reproduction by offering peo ple opportunities they had never had before to treat their infertility (Lindheim, 1998; Davis, 2003) Egg transfer begins with a diagnosis of infertility because without such conditions, the need for procuring healthy eggs would be obviated. Once an in fertile person or couple decides to use egg transfer, they must be coordinated with a woman who
7 is willing to provide her eggs, which typically is arranged in one of two ways. In some instances, this process may take place within a family or among friends in which case it is referred to as known donor. The alternative arrangement is known as anonymous donation in which infertility clinics or egg donor programs recruit women often through advertisements in community or college newspapers, billboard s, or word of mouth to provide their eggs (Borrero, 2001 ; Gorrill, 1998 ). In these instances, donors frequently receive financial compensation for their time and inconvenience, usually ranging in amount from $1,500 to $5,000 6 (Macklin, 1996; Merrick & Blank, 2003) Some instances have been documented in which people independently seeking donor eggs (i.e. not through a clinic or egg donor program) have placed advertisements for donors whom they wish to possess very select and elite characteristics 7 S uch solicitation ads have been quoted to involve compensatory donor fees running as high as $100,000 (Gurmankin, 2001). Anonymous donation may also occur in situations of egg sharing in which women undergoing infertility treatment agree to give half of t heir retrieved eggs to another infertile woman in exchange for a reduction in the costs of t he i r own infertility treatment. As Gorrill (1998) indicates, the frequency of egg sharing has greatly reduced since recent technologies enabled cryopreservation of fertilized embryos to be used at a later time. Whether egg transfer involves known or anonymous donation, both the infertile individual or couple and the egg donor must submit to extensive medical and psychological screening to determine their physical and emotional fitness for undergoing this process (Gorrill, 1998) In cases of anonymous donation, the medical and psychological history and status of potential donors is included in a profile compiled by
8 donor programs that also generally include s physic al descriptions of the women, information on their sexual and reproductive history, details of their family relationships, and descriptions of their interests. These profiles are then scrutinized by potential egg recipients as they search for the donor wh o best meets their criteria (Blacksher, 2000) When a willing donor has been matched with a recipient, the medical aspects of the egg transfer process may begin. The transfer of eggs from the donor to recipient is initiated by the suppression of the ov aries of both parties by daily self injection of gonadotropin releasing hormone (GnRH). These injections, which typically produce menopause like sympto m s such as hot flashes and insomnia, are used to synchronize the menstrual cycles of the donor and recip ient so that the maturation and readiness for fertilization of the donors eggs will match the recipients period of endometrial receptivity 8 (Shanley, 2001; Buster, 1998). Following about three weeks of GnRH injection, the donor s witches to injections of follicle stimulating hormones (FSH) to hyperstimulate her ovaries causing them to mature an unusually large number of eggs. While the donor injects FSH, the recipient takes an exogenous hormonal regiment that simulates the pattern of hormone secret ion occurring in the natural menstrual cycle (Borrero, 2001, p. 170) to prepare her uterine wall for implantation of the fertilized egg. After the donors egg containing follicles have had time to mature, she takes human chorionic gonadotropic (hCG) to p rompt ovulation. Between thirty four and thirty six hours after this final injection, the donor is sedated intravenously with a local anesthetic and a doctor retrieves the eggs by transvaginal oocyte aspiration. This procedure involves the doctor locat ing the egg
9 follicles via ultrasound, inserting a needle through the vaginal wall, and capturing the eggs by sucking them into the needle. If the eggs are to be fertilized in vitro (as opposed to in the recipients body), they are placed in a culture dish with the sperm. After about twenty four hours, the eggs and sperm that have fertilized are placed in an incubator for an additional day, after which, the strongest three or four embryos are introduced into the uterus of the recipient via a small cathet er. In most instances, the recipient must continue taking additional hormonal injections for a short period following the transfer in order to facilitate the implantation of the embryo in the endometrial wall (Shanley, 2001; Borrero, 2001; Buster, 1998) During the twenty years of it s use, the processes of egg transfer have increased in sophistication and effectiveness to the point that procedures using fresh (i.e. not cryopreserved) donor eggs have the highest rates of all ARTs in terms of both pregnan cy and live births at 51% and 44 %, respectively (Wright, Schieve, Reynolds, & Jeng, 2003) Yet despite these notable success rates most infertile people typically decide to utilize donated eggs only after several years of failed attempts with other A RT treatments (Becker, 2000) 9 Even in light of the apparent hesitancy of people to resort to egg transfer, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) offers specific figures indicating that the egg transfer process affects the lives of many Americans. According to the NCCDPHP (2003) report, d onor eggs or embryos were used in slightly more than 10% of all ART cycles carried out [in the U.S.] in 2000, or 10,389 cycles. Based on recent trends, figures indicating ev en higher uses of don o r eggs over the past four years have been anticipated.
10 Contextualizing C urrent P erceptions of E gg T ransfer With upwards of 10,000 cycles of egg transfer occurring each year there surely must be thousands of women if not more, who have provided their eggs to other women dealing with infertility. In returning to the confession I made at the beginning of this thesis, s uch contexts may lead my readers to wonder why I felt so compelled to keep my consideration of becoming an egg donor a secret. Granted, a willingness to donate and the act of aiding others in their quest for parenthood is certainly a noble undertaking. The goodness of egg donors inherent within this willingness to aide people they may not even know, has been widely emphasized through heightened attention to the apparent altruistic nature of womens participation as donors. Additionally, womens ability to control their own bodies and make free choices about the use of their bodies (as some feminists argue egg donati on is) can be viewed positively as a form of womens empowerment. Furthermore, in an era when the first American generation to include individuals who se conception occurred in a Petri dish rather than their biological mothers body are now adults our society certainly is familiar with the transformation of practices and perceptions of reproduction prompted by ARTs. Yet many of the dynamics involved in the egg transfer process particularly those that may pertain to feminist conceptions of reproducti ve freedom make the admirability of egg donation much more ambiguous. Unequivocally asserting a well defined set of f eminist beliefs about reproductive freedom or reproductive rights is impossible. Just as feminist theories and beliefs vary by groups and individuals and across time so too do visions of what counts as, and is encompassed by the concept of reproductive freedom. Despite the variety of feminist
11 standpoints I think it is safe to contend that reproductive freedom in general is grounded in feminists belief that women should be able to choose to have or not have children in contexts that are free from coercion and exploitation. I n reflecting back upon my own experiences, I think I felt the ambiguity of egg donations admirability very intensely due to my commitment to feminist ideologies. I believe that my desire to keep the use of my eggs for financial gain hidden from my feminist cohort is due to my fear that it would be perceived as a disregard or even assault on some of the belief s that have been most fiercely defended by feminists throughout U.S. history. Namely, as a woman, the act of profiting financially from the use of ones body could be viewed as counteracting centuries of feminist efforts aimed at enabling women to control their own bodies and freeing them from situations of bodily exploitation in all of its forms (Tong, 1996 ; Petchesky, 1995) Such a position presents an obvious contradiction to my earlier comments that egg donations is seen by some feminists as a form of womens empowerment. This contradiction begins to illustrate the wide variety of feminist perspectives on reproductive freedom. Within current contexts of egg transfer in the U.S., the component of financial compensation for donors and the risks they undertake present the greatest points of debate in terms of applying feminist notions of reproductive freedom to this ART I n defense of the practices involved in egg transfer, the argument can be, and frequently is made that women are not being exploited through the use of their bodies (or parts of their bodies) in this way (Dickens, 2001 Dill, 2001) At no point are women forced or coerced into participation, as there are numerous other ways in which graduate students ( such as myself, for example ) or o ther financially strapped women can procure needed
12 funds including employment, loans, grants, etc. In fact, could womens decision to donate their eggs actually reflect the gains won by feminism in that women make the choice on their own to use their bod ies in whatever manner they wish ? As some feminists contend, m ight this be just one more way in which feminist battles for reproductive freedom have empowered women ? Such questions concerning the status of womens reproductive freedom within the context s of egg transfer prompt the interrogation of issues such as womens bodily autonomy and the potential for exploitation of donors. As a result, debates over the utilization of egg transfer held both within and outside of feminist contexts are shifting o ur societal views of contemporary womens reproductive freedom. In considering the weight of womens motives to become donors as well as the personal and social consequences of their participation the arguments made both for and against the practices of egg donation present several confounding points of tension to feminists theoretical and practical efforts to protect and empower women. Thus, I contend that the time is ripe for a c lose examination of this topic and the complex dynamics it entails in or der to confront the implications it has for the ways we think about women and their bodies, as well as the reproduction of our species and society In the following chapters, I will specifically attend to the impact s of egg transfer on feminist framewor ks about reproductive freedom In order to accomplish this, I will examine how the discourses around egg transfer and the representations they produce complicate notions of altruism, autonomy, exploitation and choice. Chapter 1, Lost in the Transfer: Disappearing risks through the idealization of altruism will p rovide a framework for this discussion by identifying the ways in which representations of egg
13 transfer construct narrative s that highlight the altruistic motives of donors and minimize the ri sks and consequences they face More specifically, the emphasis on altruism is magnified and the attention to risks disappear s in the translation of professional egg transfer literature for lay members of society. In considering the gaps between these re presentations, I will explore the contributions of ART practitioners to cultural perspective s of egg transfer and their impact on the experiences of donors. Chapter 2, Analyzing the Choice and Gendered Assumptions behind Donation will conduct a more i n depth analysis of the consequences that emerge from the hyper emphasis placed on altruism as a donor motive in representations of egg donation. Specifically, I will examine the ways in which the notion of bodily autonomy is foundational in making the re presentations of donor altruism plausible. The connection between the premises of altruism and autonomy will be woven to include their influence in reifying normative gender expectations through hidden discourses of self sacrifice and maternal giving. Fu rthermore, the issues of info rmed consent and the appropriation of pro choice rhetoric perpetuated by assumptions of altruism will be challenged Chapter 3, Deciphering Donor Fees: The dynamics of commodifying and exploiting egg donors will build off of the fir st two chapters which function to pull financial incentive as a donor motive out from under the conveniently prominent guise of altruism as the only factor motivating donors. By considering egg transfer as a means of commodifying bodies or parts of bodies I will discuss the degree to which this results in situations of donor exploitation as well as how this may be shaping contemporary perspectives of women
14 To integrate the discussions of altruism and autonomy with that of the potential for ex ploitation c hapter 4 Re conceiving Reproductive Freedom will attempt to assess the ways in which these three concepts operate simultaneously within the representations of egg donation. In doing so, I will explain how current representations of egg tr ansfer reflect discourses that equate womens reproductive freedom with stewardship. Because such notions are a shift from earlier perspectives of reproductive freedom, this concluding chapter will use the concepts of altruism and donors freedom from exp loitation explored in prior chapters to consider the ways in which the development and increasing use of ARTs such as egg transfer are impacting common perceptions of womens bodies and rights. 1 While the medical procedure s involved in egg transfer are the same for most cases within the U.S. and in other parts of the world, the social and political dynamics around this ART certainly vary within different societies. Unless otherwise indicated, my discussion is regarding egg transfer only in the U.S. 2 The number of retrieved eggs can of course be lower, but some reports indicate that upwards of 45 eggs have been obtained from single retrieval cycles (Kalfoglou & Geller, 2000). 3 Medical and scientific literature also refers to eggs as oocytes and ova. 4 Generally, infertility refers to an inability to conceive after one year of unprotected heterosexual intercourse (Becker, 2000). In cases involving egg transfer, the causes of infertility include early onset and physiologic m enopause, surgical sterilization, as well as ovarian failure due to such experiences as radiation, chemotherapy, or increasing age (Lindheim, 1998). Cases eligible for egg transfer may also result from women carrying transmittable genetic abnormalities w hich could affect their offspring (Davis, 2003). I also recognize that other uses of egg transfer are emerging as its use is becoming more commonplace. For instance, a fertile woman may be implanted with a fertilized embryo (not using her own egg) for t he purposes of surrogacy, or joint biological motherhood within a lesbian couple. While these scenarios certainly raise many important issues, my discussion of egg transfer will exclude situations involving surrogacy and shared biological motherhood bec ause I can not do justice to the significance of these issues within the contexts of this paper. 5 Although the first successful human egg transfer procedures occurred in 1983, the first births from the initial uses were not reported until early 1984 (Bus ter, 1998). 6 The provision of financial compensation to egg donors is the practice that, by and large, differentiates uses of egg transfer in the U.S. from all other countries that utilize this practice (Sauer, 2001; Mead, 1999). 7 The elite characteris tics that tend to be sought after by such advertisements include high intelligence (usually as measured by SAT scores), fair skin, tall, light colored hair and eyes, as well as athletic and
15 musical talents (Mead, 1999; Wilding, 1999). The potential impact of such selection criteria has been criticized for contributing to a new eugenics kind of thinking that risks the promotion of some societal characteristics at the cost of eliminating others which are viewed as less desirable (Becker, 2000; subRosa, 200 2) 8 If the recipient has already undergone menopause or does not have ovarian function for another reason, the hormonal injections are unnecessary for her. Also, if the recipient intends to freeze the fertilized egg for later use, the injection of hormo nes to synchronize her cycle with the donors cycles is again unnecessary. 9 Becker (2000) indicates that the resistance to immediately utilizing the more successful practices of egg transfer is due in large part to peoples desire to have a child of one s own (i.e. one conceived from the gametes of the people who wish to be parents). These same feelings are used to explain why many people ultimately choose to use egg transfer rather than adopt a child that will be biologically unrelated to the parents t hat intend to raise the child.
16 Chapter 1 Lost in the Transfer : D isappearing risks through the idealization of altruism Donors are as much our patients as the recipients we so eagerly serve. They too need our best efforts and professional talents to safely guide them through a co mplicated and potentially dangerous therapy (Sauer, 2001). The above quotation by Mark Sauer, a renowned Reproductive Endocrinologist and leading scholar in the field of egg transfer seems to be the mantra of ART practitioners in their professional lite rature on the topic of egg donation In devoted adherence to the principles of the Hippocratic Oath practitioners of egg transfer have committed themselves to ensuring the ethical soundness and medical safety of donors treatment Or so they apparently like to tell one another. While professional ART literature may encourage such conduct, the representations of egg transfer produced by ART practitioners for mass consumption can be read in a somewhat different way. A significant disparity between how practitioners professionally and popularly portray egg donation is apparent through an examin ation of the ways in which the details of egg transfer are (or are not) presented to potential egg donors, recipients, an d general members of the public. Specific ally, the risks associated with egg transfer for donor women and representations of their perceived motives are emphasized differently between information created by ART professionals for their colleagues as opposed to that geared toward lay people. To attend to these inconsistent representations of egg transfer, this chapter will provide an analysis of both professional ART literature and the websites created to
17 support infertile people and recruit donors. In doing so, I will highlight some of the dis courses and ideologies that are prevalent within each type of text B y dissecting these differing representations and the related discourses of egg transfer I will establish the groundwork for my later analysis of the significance that concepts of altruis m and exploitation have for egg transfer and womens reproductive decisions in general. Furthermore, I will show how the treatment of these topics in texts about egg transfer eclipse concerns around the risks and consequences for womens bodies and health During the twenty year period of the existence of egg transfer, ART practitioners have compiled an abundant quantity of internet resources as well as a wealth of literature on the topic. Fully addressing such a great magnitude of sources in a single ch apter is obviously impossible. Therefore, my objective is not to prov ide a complete overview of this copious collection of sources. Instead, I wish to bring forth several key examples that will demonstrate the attitudes and beliefs that generally support the uses of egg transfer. The representations of different aspects of egg donation by ART prac titioners requires examination because through their words and cyber representations these individuals play a highly significant role in shaping both our cultural ideas about these practices as well as womens likelihood as potential donors to participate. But an equally important reason for interrogating the work of ART practitioners is because they are the people who determine and administer the treatmen t and care given to egg donors during the actual procedures of egg transfer. Thus, the attitudes of ART practitioners that are expressed in their literature will largely determine the quality of egg donors experiences.
18 T he vast majority of individuals producing information on egg donation whether it is designed for public and professional consumption, or the designation of restrictions on practitioners behaviors and practices clearly are interested in increasing the accessibility and breadth of kno wledge about this practice to other professionals and people who may utilize ARTs Yet the professional esteem and personal financial profit that authors of these materials are set to gain through promotion of this practice cannot be denied. As such, ART practitioners undoubtedly have a vested interest in maximizing positive perceptions of egg transfer. My analysis will proceed with awareness of this bias. Analysis of Professional ART Literature on Egg Transfer Although the self interest of ART practiti oners undoubtedly plays a role in the representations of egg transfer that they provide to other s t he quotation that opens this chapter expresses a sentiment that seems to permeate much of the professional literature on this topic 1 Throughout the majori ty of the se texts, ART practitioners seemingly express concern for protecting both recipients and donors from physical and psychological harm. The most apparent evidence of practitioners concern for donors is exhibited by the establishment and regular up date of guidelines for the practices of egg transfer by The American Society of Reproductive Medicine (ASRM). In the absence of any national legislation or regulation of the practices of egg transfer ASRM, an organization composed of medical practitioner s, has laid out a set of guidelines for ensuring the safe and ethical practice of egg transfer (see American Society of Reproductive Medicine, 2002) Many of the guidelines that ASRM establish relate to indications for using egg transfer, medical and psyc hological screening of recipients, and
19 the screening and selection of potential donors. Clauses of the ASRM guidelines that are geared specifically toward protecting donors and thus those that are most rel evant to the present discussion include the neces sity of informed consent and regulation of monetary compensation Demanding and d efining i nformed c onsent According to the ASRM guidelines, informed consent is a necessary component of the egg transfer process. Specifically, they state, All individua ls involved in ovum donation should be explicitly advised of the risks and adverse effects of ovarian stimulation and retrieval, and this process should be documented by informed consent (American Society of Reproductive Medicine, 2003) Related to the i ssue of informed consent, the ASRM also contends that donors should be assured of confidentiality according to local statutes, should contractually establish their rights, limits, and duties toward any resulting children, and should be advised to seek lega l council if their concerns are not addressed. The professional ART literature produced by practitioners provides elaboration on the ASRM descriptions of informed consent, by identifying what information must be communicated to and clearly understood by the donor women in order to adhere to ethical standards for egg transfer According to Gorrill (1998), the information presented to donors during the s creening process should include: types of infertility problems treated with egg donation and chances f or success, rationale and steps involved with ovulation induction/monitoring, side effects of medications and anticipated discomfort, details and risks of egg retrieval, type of anesthesia used, and risks of ovarian hyperstimulation syndrome (OHSS). Empha sis on use of effective contraception beginning in the cycle in which the GnRH agonist is started is important. The unknown long term effects of egg donation and the u n known risk of ovarian cancer associated with the use of ovulation induction agents is d iscussed (p.46). 2
20 Other topics that Gorrill (1998) indicates are discussed with donors are the distribution and/or storage of retrieved eggs, monetary compensation including partial compensation for incomplete cycles, the handling of donor medical compl ications, and how the anonymity of donors is maintained. In addition to demanding the full disclosure of all potential risks and effects to donors, most professional literature also indicates that this information must be explained in ways that are fully comprehensible to the donors, which may require taking the donors level of education into consideration (Gorrill, 1998). Obviously there is a lot of information that needs to be clearly and thoroughly communicated to potential donors to ensure that th ey have a complete opportunity to consider the complex implications of their decision to donate. Within their professional literature, t he willingness of ART practitioners to openly discuss the risks donors face as well as the ethical challenges introduce d by egg donation illust rate an apparent commitment to ensuring that donor s choice to participate in egg transfer is made with an awareness of all the relevant conditions and procedures. Monitoring m onetary c ompensation The second issue particularly p ertaining to egg donors within the ASRM guidelines regards the use of monetary compensation for donors participation in the egg transfer process. In relation to this issue ASRM asserts the following procedures : A. Compensation to the donor s ho uld be in co mpliance with the ASRM Ethics Committee Report [ Fertil Steril 2000; 74:216 20]. 3 B. Monetary compensation of the donor should reflect the time, inconvenience, and physical and emotional demands and risks associated with oocyte donation and should be at a leve l that minimizes the possibility of undue inducement of donors and the suggestion that payment is for the oocytes themselves. C. Financial obligations and responsibilities in the event of complications or medical expenses of a donor should be contractually ag r e ed upon prior to initiation of a stimulation cycle.
21 D. Payment may be prorated based on the number of steps completed in the procedure. E. Payment should not be predicated on clinical outcome. (2002, p.S8) Specifically in light of the ASRMs provisions for informed consent, t hese suggested regulations for monetary compensation indicate that ASRM members wish to eliminate, or at the very least minimize the potential for financially exploiting donors and commodifying their eggs. Yet the absence of speci ficity on any of these guidelines leaves much room for interpretation in actual practice. For instance, at what rate should donors in incomplete cycles be prorated? How far into the cycle must they go before receiving any level of compensation? Even if responsibility for the donors medical costs are predetermined in a contract, would it be acceptable for the stipulation to place the financial obligation on the donor? At what level of monetary compensation does the financial incentive become undue indu cement? Could undue inducement be measured differently for donors who are in dissimilar life situations? M any of the issues raised in the above questions are those that ART practitioners attempt to philosophically address in their professional literatur e but their core concerns seem to most emphasize the issues of compensating donors appropriately and preventing undue pressure to donate from financial incentives McGee, Anchor, & Caplan (1998) summarize the issue s discussed by most practitioners nicely in stating the donor of reproductive material must be compensated both at a level and in a manner consistent with the real risks involved in particular procedures, respect for the dignity of the donor, and in financial amounts that are reasonable for th e expected use of the materials (p.225). These authors thus assert the commonly held practitioner assumption that egg
22 donors willingness to undertake the significant inconvenience as well as discomfort and risks (American Society for Reproductive Medi cine, 2003, p.S6) that accompany participation as an egg donor necessitates some sort of appropriate financial reward. At the same time, McGee, Anchor, & Caplans statement hint s at the potential for the coercive impact of donor fees if they overcompens ate for the attendant risks In reference to this latter concern, Gorrill (1998) indicates that potential donors who appear to be overly persuaded to donate by the prospect of financial gain are typically eliminated from consideration. She writes, All o vum donors, whether anonymous or known, are screened for voluntariness. In the case of anonymous donation, financial coercion is a major concern. The donors financial status and legal history, including filing of bankruptcy, are explored to ensure that donation is not done as an act of desperation (p.45). This apparent practitioner sensitivity to awarding donors an adequate but not exorbitant amount of compensation suggests that this aspect of donation requires a delicate balance. On another interesti ng, and rather telling note, in almost all of the professional ART texts I examined, the discussion of monetary compensation, and by default donors financial motives, inevitably initiated from, or devolved into a discussion of donors altruistic motives. For instance, Rosenthal (1998) claimed that, while initially attracted by the financial remuneration, other motivations, including a feeling of altruism or identification with the infertile, became more primary (p. 189, my emphasis). Similarly, Gorril l (1998) begins her discussion of Screening for Motivation and Voluntariness by saying, Most women who want to become an oocyte donor express an altruistic desire to help another woman as an important part of their motivation (p.45).
23 Clearly, these st atements, organized by societal notions of gender, indicate practitioners desire to represent altruistic motivations as the prima facie reason for a woman to donate her eggs. By positioning altruistic motives of donors in this way, practitioners are able to both preemptively deny the undue influence of donor fees and provide evidence that financial gain is not acting as the predominant influence in donors decisions. Regulating e gg t ransfer in t heory and p ractice Based on the concerns expressed by pra ctitioners of egg transfer in their self determined ASRM guidelines, and through the dominant topics of their professional literature, it seems as though the underlying concerns for donors safety center on the risks they encounter and their motives for ta king on these risks. By focusing their discussions and debates around the practices of financial compensation and informed consent, ART practitioners can supposedly ensure that they are taking measures to safeguard donors informed decision making abiliti es, so their choices to become donors are not coerced or manipulated by outside forces. In other words, by attending to the risks and potential for donor exploitation, while simultaneously identifying mechanisms (e.g. monetary caps, psychological counseli ng) and regulations they have enacted to avert the negative consequences of egg transfer for donors, professional ART texts demonstrate practitioners commitment to maintaining the ethical and safe involvement of donors. While the ASRM guidelines and prac titioners debates of them attempt to make egg transfer as safe and ethical as possible for all involved several critics of egg transfer and some practitioners themselves acknowledge that adherence to the ASRM guidelines for egg donation is not policed or monitored in any fashion. Sauer (2001) concedes that the problems arising from the absence of practitioner accountability materialize because
24 practitioners self regulation is assumed. He states, it remains unclear whether physicians heed such tenets ( as those established by ASRM), because policing is nonexistent and sanctions have never been levied against violators (p. 1). Furthermore, some critics of egg transfer have expressed skepticism about ART practitioners ability to det ermine the acceptabil ity of their own practices (Kalfoglou & Geller, 2000) 4 Many critiques of egg transfer identify an inevitable conflict of interest in this situation. Although these shortcomings of the ASRM guidelines that I have identified are not plainly visible withi n professional texts on egg transfer, t he absence of enforcement for the regulations and conflicts of interest embedded within these guidelines becomes much more apparent when the professional texts are compared to the information provided to the general public ( including egg donors and recipients ) In particular, practitioners concerns about informed consent and the potential impacts of financial compensation seem to get lost in the transfer from professional readership to its general public audience. And as a side effect of this disappearance of practitioners reservations about egg transfer, the attention to the health risks and bodily consequences fac ed by donors is also diverted. To more fully illustrate the disappearance of risks and atten tion to financial compensation, I will now turn to an examination of how representations of egg transfer prepared for lay people fail to exhibit the same standards that are expressed in the professional literature. Analysis of Egg Donor Program Websites In orde r to consider the representations of egg donation provided to the general public by ART practitioners, I will analyze t he websites of two egg donor program s: Egg Donation, Inc., and The Egg Donor Program and The Surrogacy Program
25 These particular sit es were chosen because they incorporate several of the components that seem to be common to many infertility clinic and donor program websites. The fact that the donor program websites are designed for a different audience than the professional literature does not negate the fact that the information they provide is basically produced by the same parties. In some instances, t he websites created to assist infertile people and potential donors are maintained by clinics run by the same practitioners who are contributing to professional literature. Several sites many of which are for donor programs in particular may not be maintained specifically by medical ART practitioners, but they are fashioned by people who work very closely with practitioners, and thu s are an integral part of their success The case of William Bill Handel offers just one example of how intricately involved ART practitioners are in the simultaneous production of professional literature and the representations of egg transfer provid ed for mass consumption. As a co author of one of the chapters in Mark Sauers edited textbook, Principles of Oocyte and Embryo Donation (1998), William Handel clearly holds a position of respect an d authority as a practitioner in the field of egg transfe r. Although I was not aware of the connection before selecting the websites I will be analyzing, Bill Handel coincidentally is also the founding director of Egg Donation, Inc. 5 In this latter position, Handel certainly has significant influence over the character and content of Egg Donation, Inc.s website. Surely Bill here is not the only instance of overlap between these sources of information. Yet even if producers of professional literature and more popularized representations of egg donation are not produced by the self same people, it still seems fair to assume that they share and are working for the same interests. Given this
26 connection, it seems somewhat peculiar that these two sources of representations of egg transfer tell somewhat differen t stories of the use of this ART. To support this assertion, I will offer some of my observations on the popularized representations of egg donation as illustrated on the donor program websites. In particular, I will examine the ways in which donor moti ves and the risks they encounter the two concerns that composed the underlying issues throughout most of the professional literature are portrayed (or not) In doing so, I will demonstrate how ART practitioners have failed to maintain their commitment to ethics and donor safety when their theories are translated into information for egg donors and recipients. Minimizing r isks to d onors The first website, http://www.eggdonation.com is a production of The E gg Donor Program and The Surrogacy Program (ED P) 6 based out of Los Angeles, California. The second website at http://www.eggdonor.com is for Egg Donation, Inc. another donor program based out of Encino, Californi a. Both of these websites mainly serve clients who reside near their clinics, but they are willing to accommodate recipients and donors from international locations as well as from other locations within the U.S. Currently, Egg Donation, Inc. maintains c linics on both the east and west coasts of the U nited S tates To a great extent, the imagery found on these web pages including headshots of gorgeous sample donors, cuddly cartoon babies, relics of idealistic childhood, and Judeo Christian imagery of the creation of Adam comes off as blatant propaganda which maximizes the admirability, benefits, and desirability of egg transfer, while making its detrimental aspects almost entirely invisible. This imagery is certainly not benign as it
27 serves as a vis ual accompaniment to the, at times, almost romanticized description of the processes of egg transfer. 7 Neither EDP nor Egg Donation, Inc. really differs from professional literature in their apparent intent to ensure the safety and welfare of all people involved in the egg transfer processes EDP repeatedly emphasizes this commitment in stating that they work with clinics staffed onl y by doctors who meet (the programs) stringent requirements for care, safety, ethics and kindness. Yet this commitment to safety and ethics is left rather ambiguous because EDP never elaborates on the substance of these stringent requirements. This lack of specificity by itself could be viewed as just a careless omission, but a general sense of vagueness or the absence of details about the practices of egg transfer throughout these websites seems to undermine practitioners alleged commitment to safety and ethics. A more obvious and less excusable instance of this charge is evident in the failure of the EDP and Egg D onation, Inc. websites to openly and fully address the risks women undertake in becoming donors. Although the dual objective of EDPs website seems to be the recruitment of both egg donors and people seeking eggs, the website makes virtually no mention of the challenges or risks that a potential donor may face. In fact, t he only part of the website which bears any information about negative consequences of donation is in a section of the site designated for letters between donors and recipients. As one s upposed donor wrote to her eggs recipient s The things that I must endure in this process are a mere speck of sand in comparison to what the both of you have had to go through physically and mentally 8 (Egg Donation Program and Surrogacy Program, 2004). As the only indication of any negative aspects of being a donor on the EDP
28 website, this minimization of the risks donors do take on by referring to them as merely things which must be tolerated clearly offers a misleading image of the egg transfer pr ocesses. In comparison to the extensive discussion on risks within professional ART literature and ASRM guidelines dictating the necessity of full disclosure, the omission of risk information on the EDP website seems particularly detrimental to potential donors who may visit the site. Even if EDP intends to disclose the risks and other components necessary for informed consent later in the process, the failure to make any mention at all of even the existence of the risks involved could mislead some potent ial donors about what their involvement might entail (Gurmankin, 2001) T he Egg Donation, Inc. website provides a much more detailed description of the donor and recipient matching, screening, and medical processes than does EDP. Even still, the Egg Do nation, Inc. site does not really acknowledge the risks donors may face. In describing the medical procedures of transfer, this website acknowledges donors use of hormones, the occurrence of a clinical procedure to retrieve the eggs, and possibility of d onors disappointment if the egg transfer does not r esult in a successful pregnancy. However, these aspects of egg transfer are presented in relatively neutral terms which seem to avoid acknowledging the potential for negative outcomes or effects. For in stance, omitting information on the side effects that typically result from the use of fertility hormones, or saying that the egg retrieval is performed under sedation rather than under anesthesia, may make the processes seem much less consequential to d onors than they actually are.
29 As further evidence of their disinclination to identify any negative outcomes of egg donation, in their Medical Overview section, Egg Donation, Inc. claims, Perhaps a preface to this guide should be a reminder that fertil ity and achieving a pregnancy is not an exact science. There are so many unknown factors influencing fertility, that even with all the advances in reproductive technology, conception remains as much an art as a science (Egg Donation, Inc., 2004 ). As ref reshing as it may be to hear medical practitioners admit that they do not have all the answers, this preface seems to function as a disclaimer The implications of this caveat enable Egg Donation, Inc. to avoid a discussion on their website of the risks a nd health concerns for both donors and recipients that accompany egg donation and its success as measured by pregnancy EDP and Egg Donation, Inc.s avoidance of any serious mention of the risks involved in being a donor on their websites clearly is a breech of the guidelines established by ASRM and supported by ART practitioners in their professional literature. In addition, both websites fail to acknowledge the possible coercive influence of financial compensation for donors, which yet again subvert s the process of informed consent Whereas the prof essional literature written by ART practitioners openly confronts and mollifies claims that paying egg donor s results in their commodification and the potential for exploiting them the donor program webs ites take a more subtle approach to silencing these critiques of egg donation. The first step these websites take to avert accusations of exploiting donors or coercing them to participate through financial incentive is to make almost no mention of the f ee women will receive for providing their eggs. The EDP website makes just one brief mention of their $5000 fee to donors at the very end of the Information for
30 Donors page. The Egg Donor, Inc. website appears to be even more elusive on the matter of d onor fees. This site makes a few references to the donor fee, such as participation in the program guarantees compensation for the donor and that the medical procedures will not begin until the couple 9 has deposited the donor fee. But throughout these references, Egg Donation, Inc. provides no specifics about the amount given for a completed cycle. The potential for a different reading one in which the minimal attention to donor fees on these sites is an attempt to minimize the manipulation of dono rs motives by the prospect of substantial monetary sums certainly exists. Yet, the extensive emphasis these websites place on another donor motive, namely altruism, suggests that these websites may be attempting to offset or even mask the influence of financial motives in donors decisions. 10 Maximizing the a dmirability of d onor a ltruism Both EDP and Egg Donors, Inc. incessant ly characterize the donors in their programs as kind hearted, giving and big hearted people and empathetic women who i nvariably have humanitarian motives or rea sons for wanting to donate, a lovely spirit, and an immense desire and willingness to help people. These websites also contain numerous references to the provision of ones eggs as a gift or precious gift to the recipients. Representations such as th e s e contribute to the portrayal of donors as self sacrificing and unconditionally good natured people. The thinly veiled efforts of these websites to portray altruism as their donors primary ( and perhaps on ly ) motive for participating is epitomized by a list of the
31 motivations to become an egg donor on the A Typical Egg Donor Profile page of the Egg Donation, Inc. website. This list reads as follows: a. An opportunity to be of service and provide help b. Empa thy for childless couples without having to carry a pregnancy for them c. Recognition of the importance of having children in their own lives d. Have a child that is intellectually gifted e. Pride in her genetic background and family looks f. An opportunity to make a unique contribution g. Financial gain for her family Based on all of the other evidence on this website, the listing of financial gain as the last possible motive for a donor is not merely coincidental. Furthermore, in listing the financial benefits as a motive for donation because it would be a gain for her family, Egg Donation, Inc. has even converted monetary gain into an altruistic act by making it about her familys needs rather than meeting her own needs! In addition, much of the imagery on the websites ( which I described earlier as nearly propaganda ) perpetuates the notion of donors embodying the ideal of altruism. For instance, the logo on the EDP website, while somewhat difficult to decipher, appears to be an angel holding an infant. This lo go also coincides nicely with a series of pictures of the programs supposed angels (a.k.a. supermodel caliber donors) that appears on the opening page of the site. According to the sample donor profile provide on EDPs general access website, the donor s in their database are identified by their Angel number (e.g. Angel 9999) Now take a moment to imagine if such images and descriptions were used to recruit and/or advertise sperm donors. What if the empathetic Angel number 1834 was compelled to don ate his sperm for financial gain for his family? Alterna tively, what if these supposed defining qualities were used in cases of people donating even more vital
32 organs such as kidneys? Within these other contexts, these representations used to portray e gg donors seem almost ridiculous! The gendered assumptions embedded in ideas of egg donors altruism become evident when one acknowledges that kind hearted, giving, and self sacrificing are not characteristics typically used to describe sperm donors (Haim es, 1993). 11 While these terms may in fact be applied to donors of other organs, the propagandistic and blatantly gendered quality of the imagery and portrayals of egg transfer make them unsuited for other types of donation. To place as much emphasis on altruistic donor motives as these websites do, there must be something more invested in maintaining the images of egg donors more admirable motives as opp osed to their financial motives than merely granting praise and acknowledgement to the good deeds of women donors. As one point of insight to this assertion, t he pages of both web site s that provide information specifically to potential donors explain that the typical donor has a sincere inter est in helping infertile people T his element of decidin g to donate may well be the case for many women donors but the compulsion of these two websites and most others like them to remind potential donors of why they might want to donate seems almost pre scriptive 12 In light of such seemingly rigid doctrine, o ne must wonder what is at stake in believing that women might actually be indifferent enough to sell off pieces of their bodies rather than donate their eggs out of some altruistic impulse Coinciding Representations of Maximized Altruism and Minimized Ri sk A ltruism may undoubtedly be one factor that contributes to womens decisions to donate their eggs Yet my analysis of the content of the EDP and Egg Donation, Inc.
33 websites suggests that the exaggerated attention these sites devote to the goodness of donors and the purely altruistic motives of their donation specifically within contexts which ignore the risks of donation and the impact of sub stantial financial compensation operates to eliminate any thought of these women being exploited. When pla cing this analysis alongside of an examination of ART professional texts on egg transfer, it becomes clear that the anticipated audience largely dictates the level of ART practitioners disclosure about the risks donors face in terms of both the transfer p rocedures and the potential for being exploited. With the fact that these incongruent representations of egg transfer between the professional literat ure and donor program websites are both created by ART practitioners, the purpose of the variation in representations must certainly be questioned Ultimately, even though the disparity in representation of egg transfer may seem incongruous, the tendency of both types of representation s is to offer practitioners and those who participate in egg transfe r justification for its use. Yet even this acknowledgement does not fully consider the complexity of the various representations of egg transfer and the intentions of all the people involved. This chapter revealed the ways in which acknowledgement of t he risks and complicating factors of egg transfer disappear between the discussions of egg transfer professionally and the representations fed to the general populace. My observations and analyses of some ART professional texts on egg donation and two egg donor program website s offer some speculation and explanation of the particular functions served by the variation in representations of egg donation provided to the general public. In scrutinizing these representations of egg transfer, I have somewhat un raveled
34 practitioner s claims of working in the best interest of egg donors. In the following chapters, I will interrogate more deeply the implications of the altruistic motives and financial compensation for donors, while keeping in mind the se practi ti on er produced and widely consumed representations of egg transfer 1 My research suggests that the prominence and magnitude of professional and popular literature that specifically addresses the experiences of egg donors is largely overshadowed by that which considers the experiences of recipients. While this fact is itself telling about the cultural significance that has been attributed to the role of donors, I think the larger story here lies in the content of the literature that does address the role of donors, and what that content says about practitioners beliefs and practices. 2 The known physical risks of being an egg donor have been identified as menopausal symptoms (e.g. hot flashes, vaginal dryness, and dyspareunia), or ov arian hyperstimulation syndrome (OHSS) due to hormonal regimens. In rare instances, thromboembolism, stroke, or death have resulted. Risks from needle injury, hemorrhage, and infection are also infrequent, but may result from the retrieval process, and c ould potentially affect sterilization. The use of GnRH has been documented to result in a minimal number of unwanted pregnancies for the donor. Speculation about long term health consequences of donation suggest that there may be a link between the use o f fertility drugs and later development of ovarian cancer, but no conclusive evidence exists to either support or discount this possibility (Morris, 1998). Short and long term psychological risks are also a factor. They could include any outcomes ranging from temporary regret to difficulty later in life for the donor if she herself faces infertility (Handel, Vorzimer, & Shafton, 1998). 3 The indicated report suggests that Monetary compensation should reflect the time, inconvenience, and physical and emot ional demands associated with the oocyte donation process (pp.218 219). Through an analysis of the ethical issues raised by egg donation, and a comparison with the typical rates of compensation for sperm donors, the Committee determines that at this tim e sums of $5,000 or more require justification and sums above $10,000 go beyond what is appropriate (Ethics Committee of the American Society for Reproductive Medicine, 2000, p.219). 4 Corea (1991) offers a similar perspective of technodocs (a term self selected by an ART practitioner) in her critique of a 1986 report by the American Fertility Society (a precursor to ASRM) titled Ethical Considerations of the New Reproductive Technologies. Corea sarcastically comments, Surprise: the technodocs determ ined, after 18 months of serious deliberation, that what they do is ethical (p.71). 5 The biographical notes about contributors in Sauers book indicate that Handel is affiliated with the Center for Surrogate Parenting and Egg Donation, Inc. Thus, it is highly unlikely that this coincidence is merely a case of mistaken identity. 6 The Egg Donor Program and Surrogacy Program does not indicate the abbreviation of its name through any acronyms. Due to the length of this programs name, I have created EDP as an acronym for my convenience and readability. 7 The very fact that these images are intelligible within U.S. society speaks to the power of what Haraway (1997) terms sociotechnical production. Haraway describes, By sociotechnical productions I mean t he knowledge power processes that inscribe and materialize the world in some forms rather than others (p. 7). In particular, Haraway goes on to comment on the significance of Christian influences (such as those I identified from the websites) on practici ng science in the U.S. She says, Despite the extraordinary multicultural, multiethnic, multireligious populations in the United States, with quite various traditions of signifying time and community, U.S. scientific culture is replete with figures and st ories that can only be called Christian. Figural realism infuses Christian discourse in all of that religious traditions contested and polyvocal variety, and this kind of figuration shapes much of the technoscientific sense of history and progress (p.10 ). 8 While websites in general provide no certain evidence of whether a text was truly produced by the person who allegedly composed it, authorship really is not relevant to my argument here. The fact is that these
35 representations of egg transfer exist, a nd as part of the content of the EDP website, these letters contribute to the perceptions of egg transfer, whether or not the letters are legitimate. 9 EDP and Egg Donation, Inc. provide no indication of denying treatment to single women or lesbian couples as seems to be true of many infertility clinics and egg donor programs. Despite the absence of a discriminatory policy, the terminology that these programs and many like them utilize illustrates their assumption or belief that their clients will all be heterosexual (typically married) couples. 10 In her article Semen as Gift, Semen as Goods, Tober (2001) made an identical observation of the focus placed on altruistic motives of ART related websites which contained profiles of both sperm and egg donors. She comments, This focus on altruism is an attempt to remove such donations from the realm of market transactions in order to imbue them with a higher meaning (p.155). 11 Although I have noted previously the inappropriateness of a parallel between e gg donation and sperm donation, I am using the comparison in this particular instance to draw attention to the unproblematized deployment of specifically gendered norms in perspectives of the donation of womens genetic material. 12 The dogmatic fixation o n donors altruistic motives and the poorly masked directives that they act upon such intentions certainly relates to Foucaults (1977) notions of discipline and docile bodies. The implications of these concepts for the case of egg donation will be consid ered more extensively in Chapter 4.
36 Chapter 2 Analyzing the C hoice and G endered A ssumptions behind D onation In thinking about the emphasis within ART professional literature and websites that is place d on the altruism of a woman donating her eggs and thus its resulting prominence in formulating popular perceptions of egg transfer the designation of this ART as egg donation really is no surprise. The very term altruism invokes notions of gift giving, sacrifice, and providing something of ones own to another in need without any expectations of reimbursement. By defining the practice of egg transfer as donation and the women who make it possible as donors, it becomes impossible to even think about these practices outside of contexts of altruism. Yet as C hapter 1 uncover ed the typical uses of egg transfer in the U.S. present several challenges to general assumptions of the altruism embedded within womens decisions to donate their eggs. W ithin these contexts the emphasis placed on donors altruistic motives appear s exa ggerated and, as a result, become s questionable. Thus, this chapter will further deconstruct the notions set up in Chapter 1 that identified donors primary motives as purely altruistic. In an attempt to look more critically at the significance of percep tions of altruism in the practices of egg donation I will consider a two part premise upon which these ideas of altruism are based. In order to establish the validity of the assumptions of donors altruistic drives to participate in egg transfer, one must believe that women choose to
37 donate their eggs, at least in some part, out of the goodness of their own hearts. The first part of this premise, that women choose to donate, relies on a belief in womens right to bodily autonomy. The second half of the p remise, i n alignment with contemporary gendered assumptions of womens nature, su ggests that all egg donors are good natured and kind hearted people In this chapter, my intent is to look at the cultural ideologies and belief systems that enable the domin ance of altruistic representations such as those that were identified in Chapter 1. Specifically, I will draw out the weaknesses in informed consent, the manipulation of feminist ideologies, and the utilization of traditional gendered expectations as rep resentative of th re e central flaws in assumptions of egg donors altruism. Autonomy as a Basis for Altruism Autonomy, the first assumed predicate of egg donors altruistic motives, is a complex philosophical idea that indicates voluntary and well informe d actions, behaviors, and thoughts. In terms of womens reproductive decisions the notion of autonomy concerns womens ability and freedom to control what happens in and to their own bodies. As discussed earlier, egg donors face a barrage of potential p hysical, emotional, and social consequences for volunteering their eggs. Thus, w hen placed within the contexts of contemporary uses of egg transfer in the U.S., notions of autonomy become specific to women knowingly, and completely of their own volition, undertaking the various consequences of all related aspects of this ART (Dickens, 2001; Gurmankin, 2001; Kuhse, 2001, Petchesky, 1995).
38 Within this series of assertions, two central issues become relevant to womens decisions to donate their eggs, and thu s to their ability to altruistically choose to participate in egg transfer. First the status of egg donors autonomy ( as is true of any individual ) depends heavily upon their ability to give informed consent 1 (Kuhse, 2001) The second issue derives from the fact that any discussion about womens bodily autonomy in relation to topics of reproduction must inevitably intertwine with westernized perceptions of the importance of bodily integrity (Bordo, 1993) and feminist s commitment to womens reproductive freedom (Petchesky, 1996) In an attempt to interrogate the degree to which discourses of egg donors bodily autonomy support the prevalent representations of altruism, the next part of this chapter will be devoted to investigating these issues of informe d consent and constructs of reproductive freedom. Difficulties in a ttaining i nformed c onsent As Kuhse (2001) indicates, the autonomy of health care decisions in general are captured in the notion of informed consent (p.308). She contends that conditio ns of being autonomous require that a decision to participate in an ART include, adequate and accurate information and understanding of the potential risks and benefits of alternative courses of action, and that it be voluntary (that is, free from coercio n and undue inducement) (p.308). Gurmankin (2001) seconds this view of informed consent when she claims, It would violate the right to autonomy to withhold risk information that is crucial to the ability to weigh the costs and benefits of donating (p.1 1). Thus full disclosure to egg donors of the risks they undertake in participating in egg transfer have
39 been identified as one component that must be present for women to be able to make autonomous decisions. As my readers will recall Chapter 1 exhibit s the emphasis which ART professional literature places on informed consent as a necessary component of the ethical use of egg transfer. While conditions of informed consent seem unproblematic in theory, some difficulties arise when these principles are a ctually applied. The previous chapter addresses one way in which informed consent may be impeded by acknowledging that ART practitioners financial and professional gain s specifically from persuading women to donate their eggs may l ead them to minimi ze the risks associated with donation. Yet, for complex reasons even practitioners with the best intentions of fully adhering to procedures of informed consent may still fall short of facilitating autonomous decision making by donors. The possible failu re of ART practitioners in assuring egg donors autonomous choice through the presence of informed consent is due to the fact that some ambiguity is inevitable. R egardless of how clear the ASRM guidelines are about the protection of donors from unnecessar y harm, the rather subjective question of what may actually count as harm to donors or perhaps more accurately, unacceptable harm makes the provision of informed consent much more complicated (Gurmankin, 2001) Are the use of hormones and the hypers timulation of a donor s ovaries excessively harmful to her now? Will it be so twenty years from now? Does deciding to disconnect from part of ones body in par ticular ones genetic material pose the threat of psychological or emotional harm to the do nor? Is it possible that the practices of egg
40 transfer may involve more risks to some donors than others based on factors that we may not even be able to anticipate due to the brief history of egg transfer? Furthermore, can any harm be justified, seein g a s donors undertake these risks for someone other than themselves? Those who ground their theories within the significance of social networks may answer this last question affirmatively, or at least by asserting conditional agreement. And, in previewin g the discussion in the next chapter, what amount of money creates undue inducement how is the exact monetary figure that crosses into the category of excessive determined? Assuming that a compensatory sum, regardless of size, is provided, can donors participation be completely voluntary? With all of these questions, and an infinite number of others, continuously circulating around the practices of egg transfer, can any ART practitioner definitively say that he or she can inform donors fully of the consequences of their decisions? Certainly, based on problems in previous cases, practitioners are conscious of medical and health risks of which donors should be made aware. However, there is no clear answer to the question of practitioners ability to ensure informed consent because, as I stated earlier, so many of the measures involved in this decision are subjective. While these are important questions that warrant consideration, it must be recognized th at they are in actuality only in quiring about the theoretical status of informed consent. The ways in which informed consent is used in the actual practices of egg transfer provide much greater room for variation in the level of information provided to, and understood by donors Two recent studies by Gurmankin (2001) and Kalfoglou & Geller (2000) provide some insight into actual experiences of donors in terms of informed consent.
41 Gurmankins study investigated the level of disclosure about the risks to potential egg donors during a preliminary inq uiry phone call. Of nineteen donor programs Gurmakin polled, 57% were found to provide potential donors with risk information that was inaccurate or incomplete in some ways. Gurmankin acknowledges that her study applies specifically to the preliminary co ntact between potential donors and donor programs, and therefore may not be completely representative of the information that the programs offer donors before receiving their consent. Even still, Gurmankin c ites research suggesting that peoples decisions made in analogous situations are often influenced by the initial information people receive Gurmankin also comments that donors, having actually visited the donor program offices, may feel committed to donate prior to becoming fully informed. In a st udy of donors relationships to the lawyers, psychologists, and health care providers involved with egg donation, Kalfoglou & Geller (2000) found that approximately half of the 33 donors whom they interviewed indicated that the care and information they re ceived were not at all influenced by the fact that they were being paid or that they were receiving treatment for the benefit of another (paying) patient. Thus, based on the findings from these studies that show informed consent to be inconsistently appli ed, the presence of informed consent appears to be hit or miss, depending on both the practitioners an d donors involved. In general, all commentators those working inside the ART field, as well as those critiquing it seem to indicate that if donors we re si mply provided with informed consent, their autonomy would be maintained in choosing to participate. But clearly this issue goes beyond the complexities of whether donors are receiving informed consent to
42 questions of what values are being priorit ize d by the specific content and what quality of the information that is thought to enable autonomous decision making. Appropriatio n of p ro choice rhetoric or empowerment? Long a feminist of a liberal stripe, I did not want to think that this was a choice I should not have. I did not want to think that this is a choice no one should have (Blacksher, 2000, p. 30). While general ideas of autonomy are central to many philosophies about human rights woman specific conceptions of bodily autonomy ar e deeply embedded within feminist histories of womens battles against discrimination and oppression Womens bodies have historically been recurrent sites of sexual, reproductive, and labor based exploitation and abuse which have functioned as central so urces of womens oppression (Petchesky, 1995, Raymond, 1993 ) In recognition of such dynamics, many of the objectives of womens movements around the world have been to empower women in reclaim ing ownership of and control over their own bodies. Petches ky (1995) indicates that assertions of womens bodily autonomy are empowering for women both personally and as a political collect ivity She describes that for many womens movements around the globe, the idea of women owning their bodies is . not an individualist, exclusionary interest but rather a fundamental condition for womens development and strength as a social group and thus for their full participation as citizens (p.403). This excerpt indicates that even though bodily autonomy is an is sue of each woman having the pow er to control her own body, this empowerment of individual women has implications for the status of all women. A s such, ideas of womens abilit y to control their own bodies specifically through access
43 to safe, legal abort ion and birth control has been a core element of historical and contemporary western feminist battles for all womens liberation and empowerment. 2 The implications of altruistic representations and conceptions of egg transfer that paint donor participat ion as womens choice thus necessarily invokes this history of feminist struggle (subRosa, 2002) Yet e ven as several generations of feminists have logged many victories for womens bodily autonomy in all spheres of life, numerous gray areas which conti nue to complicate womens rights to control their own bodies remain particularly when issues of race, class, ability and sexual orientation are factored in 3 C ontem porary contexts of reproduction which are largely defined by the increasing use of new ARTs and are equally shaped by racial, class, and other forms of social inequality 4 compose just one such area in which womens right to autonomy remains hazy. In part, these unclear definitions are a reflection of even feminists inability to unanimou sly assert definitive components of womens bodily autonomy and reproductive freedom. As Rosemarie Tong (1996) demonstrates in her essay Toward a Feminist Perspective on Gamete Donation and Reception Policies, different groups of feminists have suppor ted or contested the use of egg transfer based on their varying perceptions of what counts as womens autonomy According to Tong, s ome approach egg transfer from a Marxist feminist perspective in which womens choice to donate her eggs merely reflect s the selection of the lesser of two evils (p.143) i.e. the choice of suffering in conditions of poverty, or of endangering her health by subjecting her body to the capitalist practice of selling her eggs.
44 Similarly, those who Tong terms radical f eminists see the potential donors choice as lying between two negative options, but they believe that the option involving exploitation may have some other basis than economic s The radical feminist perspective problematizes egg donation further by in dicating that it is a process under the control of both the medical establishment and profiteering infertility clinic (Tong, 1996, p. 145), and thereby is out of womens control. In contrast to Marxist and radical feminist perspectives those who appr oach egg transfer from what Tong terms a liberal feminist perspective support both anonymity and monetary compensation for donors. In assuming the presence of informed consent, liberal feminists contend that failing to pay egg donors for their efforts, time, and inconvenience would be the true source of womens exploitation within the use of this ART. The liberal feminist viewpoint thus acknowledges that women may very well be motivated to donate eggs by the promise of financial gain. However, they con dition their support of these practices on the presence of informed consent. As is evident in the Marxist, radical, and liberal feminist perspectives on egg transfer that Tong outlined, feminists work from at least two somewhat conflicting notions of wome ns bodily autonomy. Radical and Marxist feminists theorize from the belief that women do not have autonomy because of the forces of oppression in their lives. Whether women are oppressed on the basis of their sex, class, race, or other characteristics, they will not be able to attain bodily autonomy unless all forms of oppression are eradicated. However, liberal feminists view womens autonomy as pre existing, or part of the human condition, which thus leads to the conclusion that womens choice is ev idence of their autonomy. Thus even though all feminists are concerned
45 with protecting the rights and welfare of donors, their beliefs about how to go about doing that may be grounded in completely contradictory theoretical perspectives Now s urely th e liberation battles fought by feminists for social, economic, legal, and reproductive rights were not waged to ensure that the women of the 21 st century (or any other time period, for that matter) would have the right to profit from the direct sale of the ir bodies. Or were they? Perhaps these battles waged by feminists across the decades were designed to liberate women in order to make these sorts of decisions within the contexts of their own lives. Is it not possible that the battles for choice and aut onomy were meant to say that, Provided that a woman is legally competent and a medically appropriate candidate for gamete donation or, as the case may be, gamete reception, it is her business whether she decides to sell her eggs to help her way through co llege or, whether at the postmenopausal age of 55, she decides to purchase an egg in order to get pregnant ( Tong, 1 996, p.143 ; my emphasis ). Clearly, if a solution to this puzzle of how all womens autonomy can be established and protected exists, it wil l not be simple. Even though varying theoretical frameworks may be employed, this brief acknowledgement of the basic premises that many feminists contend must be present in order for w omens bodily autonomy to exist hints that the contemporary uses of egg transfer seem to fall short of protecting womens autonomy. In situation s in which the provision of informed consent is uncertain and the amount of appropriate compensation (if any) seems impossible to determine, the status of womens bodily autonomy see ms to remain equally precarious As such, the practices of egg transfer, as they are currently used in the United States, seem to only provide fuel for Petcheskys assertion that For womens movements globally, the idea that a woman owns her body stands not as a
46 description of reality but as a rhetorical achievement (1996, p.403). In this statement, Petchesky is basically suggesting that bodily ownership and thus implicitly autonomy do not exist beyond a mere theoretical ideal Yet, as is evidenc ed in the feminist views of egg transfer I just discussed and the overall emphasis on altruism in representations and discussions of it s practice, some feminists and non feminists alike are utilizing the presumption that women do have bodily autonomy and t hus can make free and informed choices about their reproductive capabilities. So in actuality, Petcheskys statement, while raising an important question about exactly what the status of womens bodily autonomy is, really drives more to the heart of the problems that arise from embedding discourses of donors altruism within feminist notions of choice and womens right to control their own bodies. This problem is one that similarly has been identified by subRosas (2002) article Stolen Rhetoric: The ap propriation of choice by the ART Industry In this article, subRosa suggests that a politics of autonomy and liberation had been transformed into a rhetoric of choice . which became identified with the pro choice movement (pp.135 136). They l ater go on to claim that the rhetoric of choice is used to make controversial issues acceptable (p.139). In the contexts of my current discussion, subRosas assertions about the appropriation of pro choice rhetoric can equally be applied to the hyper em phasis on altruism within representations of egg donation. B y applying the heavily invested femin ist notions of choice to the practices of egg donation, a womans decision to donate her eggs appears to be embracing and even furthering notions of womens reproductive freedoms an argument which seems to be completely overshadowing any real exploration of how egg transfer might be affecting
47 womens reproductive rights. In pairing donors supposed altruism with choice in this way, feminist demands for w omens full control of their bodies are undermined Assumptions of Womens Natural Altruism In the United Kingdom, where paymen t to sperm donors is acceptable but payment to egg donors has been deemed inappropriate, it is assumed that women will dona te for altruistic motives (Fielding, et. al, 1999, p.274). This assumption suggests that there is something about women something embedded in their biology or nature that compels them to act on an altruistic basis. T he situation in the U.K. obviousl y cannot directly speak to the specific ideologies behind use of egg donors in the U.S. At the same time, the highly emphasized representations of donors altruistic motives that were revealed in Chapter 1 indicate that a cross cultural parallel does in f act exist. This correlation presents a clear example of t he second premise upon which ideas of egg donors altruism seem to lie i.e. that all egg donors are good natured and kindhearte d women This second premise of donors altruism is a little less difficult to explain because it is directly drawn from gendered notions of womanhood that are filtered throughout all of our everyday interactions. Specifically, the emphasis placed on donors altruism is asserted on the basis of womens assumed natural roles as nurturers and mothers (Haimes, 1993; Wilding, 1999 , Hartouni, 1997 ) In other words, the success of representations of donors altruistic motives lie deeply embedded in societal notions of what it means to inhabit the very position of woman. Raymond (1993 ) articulates the ba sis of this relationship between womanhood and altruism nicely in stating, The cultural norm of the altruistic woman who is infinitely giving and eternally accessible
48 derives from a social context in which women give and are given away, but also from a moral tradition that celebrates womens duty to meet and satisfy the needs of others (p. 50). Raymonds description here explains how our societal norms both shape and reward the enactments of womanhood that embrace altrui sm as a guideline for every aspect of womens existence. 5 In speaking specifically of U.S. culture, Tong (1996) extends this ideology identified by Raymond to the situation of egg donors. Tong comments on the ways in which societ y has not only establish ed the assumption that egg donors are altruistic, but even provides a means for making such an assumption true by engraining in w o mens minds the idea that they must embrace altruistic roles in order even to be considered a woman. Tong states, we live in a society that repeatedly teaches women that it is womens role to be the givers par excellence . many women feel guilty if they are not as self sacrificial as possible if they are not giving other people everything they can give them, including their sexual and reproductive services (Tong, 1996, p. 144). Raymond (1993) further accentuates the ideas expressed by Tong in saying, It is the discourse of maternalism, which traditionally has equated devotion and dedication with women abandoning thei r own needs. It is also the discourse of maternal destiny in which a real woman is a mother or one who acts like a mother or, more specifically, one who acts like the self sacrificing, nurturant, and caretaking mother a woman is supposed to be (p.51). Th us, this idea of donors as altruistic fits right into and simultaneously privileges certain cultural narratives of womanhood over others. Furthermore, Tongs suggestion that women may feel guilt or regret for not adequately meeting societal expectations of womens self sacrifice, points to the self policing in which women engage to adhere to
49 societal gender norms and the definitions that Raymond identifies (i.e. self sacrificial, nurturing, caretaking) 6 Not only do the assumptions and exaggerated repr esentations of d o nors altruistic nature portray them as humanitarian members of society, but they often rely on the powerful equation of a donor as a generous, kindhearted person within familial or kinship contexts (Haimes, 1993) 7 For this reason, the n arratives focusing on women as care giving show how their familial and societal roles position them in ways that make a request to be a known donor from a family member or friend nearly impossible to refuse. Tong asserts this fact when she says, Women typically find it very difficult to disappoint friends and relatives to refuse to help them in their hour of need (Tong, 1996, p. 144). While recognizing the impacts of familial and kinship association to discourses of altruism, Strathern (1995) explai ns how such notions of kinship are broadened to account for situations utilizing ARTs (including egg transfer) in which familial blood relationships are absent. She states, making visible the detachment of the procreative act from the way the family prod uces a child adds new possibilities to the conceptualization of intimacy in relationships. However minimal the role of those involved, dispersed conception may provide a model for relations that can take on a kinship character even where they cannot take on a family one (p. 353). Stratherns assertion here points to the fact that although narratives of altruism end up building off of womens sense of obligation to people whom they care about these feelings of relation may ultimately be extended to peop le whom the donors may not even know.
50 The discourses of altruism and kinship become even more powerful through frequent mention of the fact that some (though the image producers would rather their audience believe it to be a typical characteristic) donor s have children of their own and presumably husbands too, of course. In the eyes of potential egg recipients, suggestions that many donors are already mothers offers them reassurance that the donor s eggs are likely to be viable Such implications ba sed in ideologies that frame motherhood as the essence or pinnacle of female existences (Raymond, 1993, p. 29) also affirm that the donor is caring and nurturing, and thus must be motivated to donate by her altruistic nature. Although familial ties and obligations may be strong motivating fa ctors for women who are in the positions just mentioned the fact remains that many women are not already parents when donating their eggs, and they donate their eggs anonymously. Thus, forwarding representations of donors as altruistic members of family networks function s to communicate the acceptab i lity of egg donation as proper womanly behavior. After all, if the models of womanhood i.e. (white, heterosexual, middle class) mothers and extremely family orient ed women can express their love and concern for the ir family by donating their eggs either to relatives or close friends, or even to unknown couples who undoubtedly deserve the wonderful family life they have themselves, certainly it must be an appropria te act of womanhood to donate ones eggs. In other words, egg donation comes to define womanhood itself. Wilding (2002) really draws forth this function of the numerous altruistic representations of egg donation in saying, marketing cynically plays on t he so called natural maternal instinct ascribed to all women. The cyberbaby industry exploits
51 womens assumed need to produce children, in some form or other, in service of ever expanding technological intervention into the body for profit. Donor a ds seem to appeal to the donors empathy and generosity. And in appealing to that empathy and generosity, recruitment of donors and representations of such practices both invoke and reify the cultural beliefs that giving and self sacrifice are synonymous with womens nature. Disrupted Assumptions of Altruism With the apparent power and predominance of notions of choice and altruism throughout representations and discussions of egg transfer, one must wonder what it means for women to encounter such narr atives. For women who are uncertain about offering their eggs for transfer, insinuations that egg donation is demonstrative of culturally valued qualities i.e. those of reproductive freedom for women and the gendered expectations of females kindness, s acrifice, and overall maternal instincts may offer reassurance, or even justification for womens decisions to donate. However, the flaws in assumptions of womens altruism that are examined in this chapter indicate that uncritically accepting the ide ologies embedded in these discourses denies the much broader complexities that are factored into donors decisions. E ven the present practices of egg transfer in the United States sugges t that altruistic feelings alone do not provide enough incentive to m otivate many women to donate their eggs. For instance, even as Kuhse (2001) suggest s that, donations to the extent that they do not involve substantial payments are clearly altruistic and beyond the call of du ty (p.310), s he ultimately concedes tha t in the presence of substantial sums, egg donors may be more motivated by monetary compensation than altruism.
52 As a study of egg donors experiences conducted by Kalfoglou & Geller (2000) suggests, sizable sums of money, which are involved in many of th e egg transfers in the U.S., do play a very real role in influencing womens decisions to donate. Yet even more interestingly, this study suggests that donors are well aware of the expectations that their motives are based in altruism. Kalfoglou & Geller (2000) found that during their meetings with psychologists as part of the screening processes for donor selection, some women felt the need to downplay their financial motivation because they thought it would look bad (p. 228). This example alone revea ls only a few of the problems associated with the countless instances of exaggerated emphasis placed on altruism being the primary, or perhaps only motive for women to donate In bringing forth the contexts of limited definitions of informed consent, ma nipulation of feminist notions of choice, and the utilization of traditional expectations of womanhood this chapter has raised the question of whether the actions of egg donors may be viewed as altruistic at all let alone primarily motivated by altruis m 8 But even in adhering to the more common conceptions of altruism, this chapter has at a minimum, significantly weakened the assumed basis on which donors altruism is founded. By theoretically unpacking these premises of the presumption of donor altr uism, the discussion in this chapter has disrupted the assumptions of altruism as egg donors primary motive. In doing so, I have revealed common discourses of egg transfer to be falsely representing the actual utilization of egg transfer in the U.S. 1 Susan Bordos (1993) explanation of informed consent seems particularly useful in these contexts of egg transfer, and reproductive processes more broadly. She states, The doctrine of informed consent is, in a very real sense, a p rotection of the subjectivity of the person involved that is, it is an acknowledgement that the body can never be regarded merely as a site of quantifiable processes that can be assessed
53 objectively, but must be treated as invested with personal meaning, history, and value that are ultimately determinable only by the subject who lives within it (pp.73 74; emphasis in the original). 2 As numerous feminist academics and activists from around the world have observed, the individualistic concerns of North American and western feminist movements, which focus on such issues as body politics and reproductive rights, may not represent the most pressing concerns of womens movement in various regions around the globe. See for example, Mikell (1995). Correa & Petchesky (1994), expand this discussion by pointing out that when western feminists consider issues of reproductive rights, they may overlook concerns of maternal and infant mortality, infertility, unwanted sterilization, malnutrition of girls and wome n, female genital mutilation, sexual violence, and sexually transmitted diseases (p.89) that shape the reproductive decisions of women all over the world. 3 Bordo (1993) provides several examples of how women who are marginalized (i.e. women who are not white, middle class, heterosexual, and able bodied) are least likely to have benefited from feminist victories in terms of reproductive freedoms. Bordo evidences this assertion through a parallel of historical sterilization abuses based on racist and abl eist eugenics to contemporary sterilization (and Norplant) abuses against women on welfare. (See also Davis, 1991). 4 According to Hartouni (1997), the incidence of infertility is one and a half times higher among poorer, nonwhite populations than in mid dle class white ones, or higher in precisely those segments of our society in whom medical science appears to have the least interest and who, in any event, have the least access to its assistance (p.75). 5 Many of the theoretical analyses on which I ha ve drawn to show that the links between altruism, motherhood, and the gendered expectations that women encounter, are blatantly lacking a critical consciousness of the implications of racial and class identities to these issues. In particular, a discussio n of how such identity markers influence perspectives of fit mothers greatly affects the clarity of the assumptions that womanhood, motherhood, and altruism are synonymous (see Hartouni, 1997, Davis, 1991). Such a critique deserves much greater consider ation than I can provide here. However, I think it is necessary to note that racial and class differences are conspicuously absent from both popular and professional representations of egg transfer as well as representations of the women who donate their eggs. 6 My reference to self policing carries obvious reference to Foucaults (1977) ideas of the ways in which power works through disciplinary, rather than physically punitive means. In this sense, social norms are maintained through individual self sur veillance and self correction rather than the dictates of an authority. 7 Raymond (1993) describes a parallel expectation within relations of surrogacy. She states, When a surrogate arrangement is represented as generosity to a family member in need, t he ideal of altruism binds the woman to the norms of family duty (p.54). 8 A more fundamental question that may be relevant here is whether any action can be interpreted as altruistic, regardless of whether it is embedded in the processes of capitalism. As several social psychologists have argued, many of the actions that are typically perceived by be altruistic may actually reflect egoistic involvement where the actor is enacting helping behavior to either avoid punishment or gain rewards for him or he rself. These researchers have thus defined true altruism as a motivational state with the ultimate goal of increasing anothers welfare that is qualified by a desire to help regardless of the potential reward or punishment involved. Despite these findi ngs, many of these psychologists still view both altruistic and egoistically motivated helping behavior positively because of its prosocial impacts (Schroeder, Penner, Dovidio, & Piliavin, 1995).
54 Chapter 3 Deciphering D onor F ees: T he dynam ics of commodifying and exploi ting egg donors By somewhat deflating the certainty of donor al truism, the arguments posed in C hapter 2 have opened the door for consideration of another influential factor th at has been lurking in the shadows namely, the motive of financial gain. In critiquing the vagueness of the ASRM guidelines for monetary compensation to donors in Chapter 1, I raised the question, At what level of mo n etary compensation does the financi al incentive become undue inducement? While this question is certainly relevant to contemporary uses of egg transfer in the U.S., perhaps a more broadly probing question would inquire why the U.S. is the only country that allows the payment of sizable fees to donors. The reasoning implicated in both of these considerations requires thorough interrogation to elucidate the significance of financial comp ensation in shaping donors decisions and experiences. In attempting to establish expectations for e thical use of egg transfer, ART practitioners and feminists alike have argued both sides of the payment debate one side contending that financial compensation, or sums of specific amounts are resulting in donor exploitation because they are being coerced into the decision to donate ; the opposing position claiming that not pay ing women for the time and inconveniences the y undertake in donating their eggs would result in exploitation (subRosa, 2002; Dickens, 2001 ; Macklin, 1996 ) In an effort to decipher t he impact s of substantial compensation
55 payment s this chapter will consider the complexities of both sides of the debate about the potential for commodification and exploitation of egg donors and their bodies. What is the D onor F ee for? Debates of whether the practices of egg transfer result in the commodification of donor s eggs are rooted in the question of exactly what is being compensated for by the donor fee. The argument that payment of the donor fee in direct exchange for a womans egg s is not commo dification is impossible to defend. T he very meaning of the word commodification indicates that object s in this case, the donors eggs are used in such a way that they provide an advantage (financial or otherwise) or that they are made into object s of commerce To combat the automatic equation of payment with commodification, many people who support the issuance of financial compensation to donors contend that donors receive remuneration for their time and effort, rather than the reproductive piec es of their bodies. Although they provide no justification or evidence for their claims, the ASRM Ethics Committee contends that Compensation based on a reasonable assessment of the time, inconvenience, and discomfort associated with oocyte retrieval can be distinguished from payment for the oocytes themselves (2000, p. 217). A s supposed evidence of this, ASRM ( 2002 ) indicates that donors should be compensated for their time and efforts regardless of the clinical outcome of the transfer In other words the donor fee should not be dependent upon the number of eggs retrieved (if any at all), nor their employment in a successful pregnancy At a first glance basing arguments in support of payment on the grounds that donors compensation is not outcome ba sed seems perf ectly reasonable. Y et upon close r
56 examination, this perception may prove to contain some inherent flaws. One commonly unexamined problem emerging from this logic l ies i n the claim that the financial compensation of donors is, in part, to of fset the inconveniences and discomfort that may result from their participation in egg transfer. Admittedly, proponents of donor compensation argue that donors eggs are not being commodified by this process, never making any mention of the potential for commodifying womens bodies in general. Yet o ne might argue that the provision of donor fees as compensation for the health risks and (perceivably unwelcome) bodily changes that may result from donating is commodifying donors bodies and health status (Di ckens, 2001; Kuhse, 2001) In addition this set of practices involves the removal of reproductive cells from donors bodies and thus has very real impacts and consequences on their bodies As such can a donor possibly weigh the prospects of payment f or her time and effort as separate from the idea that she is being paid for the pieces of her body being extracted during her participation in egg transfer ? In providing donors monetary compensation for accepting conditions that directly impact their bodi es, how can donors bodies conceivably not be commodified by this process ? Yet, proponents of donor fees continue to utilize the language of compensating donors for their time and inconvenience so as to avoid accusations of commodifying womens bodies. Another rarely considered reading of the use of donor fees is that, i f donors are in fact being financially compensated for t heir time rather than their eggs perhaps because payment for eggs is view ed as too crude and capitalistic why is the commodifi cation of donors time not seen as unethical as well (Macklin, 1996) ? 1 Perhaps our grounding in a capitalistic society makes it seem perfectly reasonable for people to be paid for time spent
57 d oing something for another in other words, their labor. Or a s Macklin (1996) describes, The implication . seems to be that payment to people for their services is ethically permissible but paying them for bodily products is not. Payment to women for time and effort sounds like paying people for their work, surely an ethically acceptable if not obligatory social practice (p.109). However, the failure to acknowledge the reproductive nature of the labor performed by egg donors in the time for which they are paid seems to draw on historically prevalent ideas that womens reproductive labor should be required as unpaid work. T o unquestioningly assume that womens time, but not their reproductive labor should be monetarily valued, takes for granted many of our cultural beliefs about both assigning value, and wo mens worth. But more importantly, doing so fails to recognize that the labor for which women will be compensated is performed in and by the very bodies that are purportedly not being commodif i ed by payment to donors On the whole, t his question of wh ether it is possible to separate compensation for time from payment for eggs is phenomenologically impossible for even donors themselves let alone policy makers to answer Yet perhaps a consideration of a hypothetical situation in which this donation scenario is able to occur separate from donor womens bodies may offer some additional theoretical perspective. Suppose that, instead of donating eggs produced by a womans ovary, donor women were able to artificially manufacture egg s to give to an infert ile woman. As within any good capitalist system such as ours, it would be anticipated that these donor women would be compensated for their time and efforts in producing these eggs. In this scenario, how
58 could the donor woman not see the payment she rece ives as being for her eggs i.e. the products of her labor? Even in considering the argument by many supporters of donor fees that women are compensated regardless of the clinical outcome the dynamics of a capitalist system automatically anticipate that some products will be f lawed, or not suitable for sale. Yet even in such instances, laborer s are still paid for their work or in the case of this example, their work as egg makers. So using the argument that women are compensated regardless of th e clinical outcome to indicate that donors are not being paid for their eggs seems to be marred on several counts. For advocates of compensation to base their argument on the irrelevance of clinical outcome is the equivalent of saying that donors would be just as likely to be compensated for providing finely crafted, intricately and uniquely designed Easter eggs as the eggs created by their ovaries, which is clearly just absurd. Furthermore, it is highly unlikely that any donors would receive monetary c ompensation without proof that this procedure is successful. Unless ART users and practitioners can anticipate that the majority of egg retrievals will produce numerous eggs for fertilization, it would be unprofitable to maintain a policy of compensating donors on the basis of their time and inconvenience rather than the actual number of eggs retrieved. With the highest success rates of all ART procedures in terms of pregnancies and live births, egg transfer clearly has a history that indicates the likelih ood of such desirable outcomes These success rates thus serve to justify payment for donors participation rather than their eggs.
59 A final flaw in the contentions that egg donors are not paid for their eggs generates from the fact that egg donors in th e U.S. are not compensated uniformly. Whereas most donors will receive fees between $2,500 and $5,000, depending on geographical region and practitioner s preference s some instances have recorded much higher sums being awarded to donors at times in exc ess of $50,000 (Gurmankin, 2000) These instances are due in large part to what Becker (2000) describes as marketing designer eggs (p.153), in which the pedigree or c haracteristics (e.g. intelligence, ethnicity, athleticism appearance, etc.) of donor s become major determinants of the amount they can procure for donating. If donors were truly being compensated for the time and effort exerted through numerous clinic visits, injections of hormones, and ultrasounds, not to mention the tedious screening p rocesses and the actual retrieval process itself, why would they all not receive uniform compensation? 2 Thus, t he numerous holes in this proclaimed intent of donor fees suggest that claiming women are paid for their labor rather than their eggs is untena ble in actual practice. However, the more troubling implications of supposedly paying women for their time and inconvenience, instead of their eggs, is that do ing so positions womens eggs ( and their reproductive capabilities in general) as completely ab stracted from the rest of womens bodies. The contexts of egg transfer that I have brought forth in this examination of commodification clearly indicate that womens bodies much more so than their schedules are bearing the costs of p a rticipatin g in eg g transfer. Considering the bodily consequences of egg transfer, contending that donor fees are not compensating for the costs womens bodies are incurring including lost eggs is insulting. I n this light, the involvement of financial compensation do es seem to result
60 in the commodification of donated eggs and by implication, donors bodies regardless of whether or not that is the direct intent of payment 3 T hus, t he following discussion will proceed from this deduction that both donors eggs and bodies are commodified during egg transfer, when sizable compensation for donors is present. Does this F orm of C ommodification E volve into E xploitation? As the previous section demonstrates, the contemporary uses of egg transfer in the United States (i .e. those in which payments to donors are acceptable) result in the commodification of donors bodies and reproductive body parts. The extensive lengths to which ART practitioners users, donors themselves, and society in general go in order to forward ro manticized narratives and representations that do not point to the commodification of donors eggs makes apparent our presumption that commodifying bodies and their parts is an undesirable or unacceptable condition. But what exactly is it about the idea of commodifying bodies that we find so unsavory? Or, as Nancy Scheper Hughes (2001) questions, Why are markets in human bodies, body parts, sexual favors, reproductive material or blood sports (like boxing) so disturbing, so hard to take (p.2) ? Estab lishing the relationship between commodification and exploitation Becker (2000) offers a response to Scheper Hughes question which seems to strike at the core of our discomfort over the idea of commodifying donor bodies and parts She states, The commo dification of donor gametes represents an ethical dilemma for many people because it raises questions of d ise nfranchisement and exploitation (Becker, 2000, p.153). As Becker suggests the notion that we could market and profit from our bodies is not what is offensive to society. R ather the implications that such capitalistic practices could both unfairly take advantage of, and disempower the people
61 whose bodies are marketed provides the basis for concerns about exploiting donors Yet Beckers statement i ndicates that the processes of commodification are not necessarily always accompanied by exploitation she merely notes that such possibilities do exist This suggestion, however, indicates that even though womens bodies are commodified by egg transfer does not necessarily mean that egg donors are being exploited. As a comparative situation in which exploitation supposedly remains absent from commodification, Blacksher (2000) acknowledges that the capital istic contexts in which we live often encourage people to utilize their talents and characteristics for personal and financial gain. She suggests that most people ultimately commodify some part of themselves to advance in the world. She says people sell all sorts of things that are importantly a p art of them. We are encouraged to develop and maintain personal and professional capacities and talents so we can do just that: market them. People cultivate and hone their analytic capacities, their athletic and musical talents, their entrepreneurial kn ow how, even their physical beauty, to earn a fee, make a living. Why not my eggs? (p. 30). As Blacksher inquires what is it about financial compensation for womens reproductive material that produces such a sharp reaction when we spend so much of th e rest of our lives selling our best qualities to get by? In applying the logic that Blacksher uses above, m ight it also be possible to conclude that the bodies of egg donors have been commodified in ways that avoid the detriment of exploitation, and as such are purely beneficial to all parties involved? Is the commodification of womens eggs justifiable if situations of exploitation are occluded? And if so, why is most of American society persist e nt in demanding that donor fees are not payment for wome ns eggs?
62 Any attempt to answer these question s as Blacksher indicates requires consideration of whether donors are being disempowered or taken advantage of in the process of egg transfer. Based on current uses of egg transfer in the U.S., these ques tions necessarily raise the three issues of appropriate levels of compensation, the implementation of informed consent, and donor vulnerability The careful deployment of discourses demonstrating adequate donor fees, proper informed consent, and measures to protect vulnerable potential donors, provide strategic support to the use of egg transfer by making the exploitation of donors seem impossible. However the strength of these supposed protections of potential donors is questionable at best. The issue o f whether donors are being appropriately compensated for the transfer of their commodities (i.e. their eggs) to recipients is actually indeterminable In considering whether donors are receiving either more or less money than their eggs are worth, one enc ounters a philosophical and ethical conundrum. As potential sources of human life, womens eggs are invaluable because to name any sum no matter how high, would devalue and disregard the inherent dignity of human life (The Ethics Committee of the America n Society of Reproductive Medicine, 2000) On the other hand, it can be argued that donor womens eggs when left to disintegrate in the ovary, are valueless because they are resources that the donors themselves do not intend to use ( Macklin, 1996 ) 4 Thu s, the appropriateness of the level of compensation for the commodity transfer in egg donation is impossible to assess due to the fact that eggs can simultaneously be priceless and worthless. T herefore determining a suitable payment for eggs is ineffect ive as a gauge for whether donors are being exploited.
63 Turning to an examination of donors vulnerability to being exploited provides another, perhaps more useful, measure of wheth er egg donation disempowers or takes advantage of them The component of i nformed consent that has been mandated by the ASRM is incorporated in acknowledgement of the very fact that women who are vulnerable as a result of financial need should not be accepted as donors (Dickens, 2001; Gurmankin, 2001) Yet, in questioning the c ontent and quality of informed consent applied in the processes of egg transfer, C hapter 2 exhibit s that the application of informed consent in the practices of egg donation are highly complex and have many inherent difficulties. The weaknesses of infor med consent become even more complicated when the financial incentives and motives are factored in. In discounting the exploitation of donors, many practitioners point to the fact that during the screening process, they try to weed out potential donors w ho are vulnerable through poverty who have no other means of earning (Dickens, 2001, p. 341). Yet close examination of the screening process shows that it is not flawless. For instance, Gorrill (1998), whom I quoted in the first chapter, contends that donors motives are explored to ensure that donation is not done as an act of desperation (p.45). This objec tive of the screening process ( and many others) interestingly diverts attention away from examining the actual practices of egg transfer by psych logizing the potential donors. Thus, the screening processes are used as a measure of individual potential donors ability to tolerate the conditions of egg transfer while the broader ethics and acceptability of these procedures remain largely unproblemat ized.
64 The use of donor screening processes warrant further critique because, even though the use of screening to avert financial exploitation (or pressure from family members in the case of known donors) 5 may reduce many instances of outright manipulati on, can the degree of a womans desperation really be judged by another? Is not the assessment of this experience really subjective? The ability of a psychologist to determine a potential donors level of desperation is further complicated by a finding of Kalfoglou & Gellers (2000) research on the experiences of egg d onors. Their research indicates that, Because donors did not have the reassurance that information they provided would not be used to exclude them or be kept confidential, and because th ey did not always understand the purpose for some of the questions, there was information that donors felt they had to conceal from the psychologists (p.228). Thus, in feeling compelled to disguise the extent o f t he i r need for the donor fee, potential do nors may conceal the very desperation that ART practitioners might otherwise use to exclude them from donating. On a similar note some practitioners acknowledge that students are also an inappropriate population to serve as egg donors because of their characteristically precarious financial status. For example, Gorrill (1998) indicates that, Some ART programs specifically do not target students as egg donor candidates because of the concern this group may be particularly vulnerable to the coercive pow er of money ( p. 49) Yet this claim stands in complete contradiction to the majority of donor narratives and investigative reports on egg transfer that appear in the popular press (e.g. Watson, 1997; Mead, 1999; Blacksher, 2000; Healy, 2003) as well as i n the attitudes of many practitioners. Rosenthal (1998), for instance, declares that, Many of our most prized
65 donors are college or graduate students in their early 20s whose value as donors is based on their intelligence and the youthful age of their eggs (p.190). Practitioners claims that they try to protect vulnerable potential donors are hard to take seriously when sentiments such as Rosenthals are stated out right and also appear more subtly in descriptions of the ideal donor or solicitation e fforts aimed directly at student populations. By focusing concerns about exploiting donors on the psychological status of individual donors rather than the contexts of egg transfer and ARTs, just one more parallel to historical attempts to pin reproduct ive problems on women is established. Yet even if one does take the screening processes seriously as a means for protecting donors form exploitation, numerous contradictions become apparent in attempts to identify and exclude particularly vulnerable pot ential donors. These various inconsistencies seem to suggest that the prospect of exploiting donors is an issue that receives only token attention or concern from those who are best positioned to eliminate it i.e. practitioners and egg recipients. Conte sting Claims of the Harmlessness of Commodifying Eggs This chapter has been devoted to breaking down the various justifications offered for the financial compensation that is uniquely paid to egg donors in the United States. Based on the impossibility o f determining eggs value, the shortcomings of informed consent, and superficial attempts to prevent particularly vulnerable populations of women from donating all of which were demonstrated in this chapter the bodies of donors are apparently being bot h commodified and exploited by most instances of egg transfer in the U.S.
66 Obviously, these assertions may not apply to all donors. Yet while appropriate precautions are theoretically taken to avoid disempowerment and taking advantage of donors, the potent ial for exploitation in practice is much higher than our society is led t o believe by common representations of egg transfer. The moral and ethical repugnance of such prospects make sense of Americans insistence on clinging so tightly to the belief that donors are not being paid for their eggs. If one steps back for a moment though, a rather overt, yet unacknowledged message lies right at the surface of the ways in which financial compensation to donors is explained. The fact that (despite the bodily cos ts they incur) donors are paid for other things as opposed to their eggs indicates that womens bodies particularly womens reproductive bodies are not valued by our society. While the debates over donor fees get entangled in efforts to protect donors from exploitation and coercion, U.S. society totally loses sight of the fact that the subject of these debates affects womens experiences of their bodies, and that the practices of egg transfer have serious consequences for womens bodies. Of course, if one acknowledges that the conclusions drawn from the payment debates are not even seriously applied to the situations of egg donors, an even stronger statement is made about the worth our society attr ibutes to women. As I suggest in the previous section o f this chapter, the protection of vulnerable potential donors receives only token attention. Becker (2000) provides evidence of this in saying that even though many people utilizing donated eggs recognize and express concern about the potential for the disenfranchisement and exploitation of donors, in all cases, they went ahead with their plans (p.153). This callous disregard of the plight faced by donors clearly
67 asserts that womens reproductive bodies are actually valued, but that the women who ar e donating their reproductive cells are not The fragmentation of womens bodies that has occurred as a result of attempting to establish justifiable compensatory practices within uses of egg transfer has thus produced a new version of the objectification of womens bodies and the presumption that the primary function of womens bodies is still reproduction. 1 This seemingly arbitrary distinction seems to parallel the fine line drawn between other practices in which women profi t from the use of their bodies. For instance, prostitution has been criminalized in the U.S. for commodifying womens embodied sexuality whereas erotic dancing is a legal form of entertainment. 2 Clearly, the majority of my discussion has seemingly excl uded women who receive no monetary compensation for their participation in egg transfer one example of which would be known donors. Yet in actuality, many women who donate to family and friends with no expectations of compensation can justifiably be clu mped together with women who receive monetary compensation due to the fact that they may receive material or non material rewards (e.g. increased status or respect within the family, receipt of favors, etc.) which may easily simulate the exchange that occu rs through financial compensation of anonymous donors. 3 In suggesting that the commodification of donors bodies is automatically assumed by the commodification of their eggs, I am treading on some treacherous ground. This extension fails to consider the idea that once eggs are removed from a womans body, they are no longer part of her body. Is there a point when a donors eggs are no longer considered pieces of her body? When they have been retrieved? Or implanted in another womans body? When it be comes a gestating fetus inside another womans body? If the fact that the eggs are produced from a womans body indicates that they will always be a part of her body, whether they remain inside her body or not, is a child produced from a womans egg thus also eternally part of her body? Would the answer to these questions differ in the case of sperm donors? 4 Initially, some concern was voiced over the possibility that by donating their eggs, donors may reduce the number of eggs they have themselves, sho uld they desire a child at a later time. This fear was quelled by researchers reassurance that this would not be the base because several oocytes go to waste each menstrual cycle, as numerous follicles are released, but only one matures. It will be inte resting to see if this fear is further alleviated by newly breaking research (based on lab mice) suggesting that women may in fact produce eggs across the lifespan, rather than have a set number of eggs at birth (see Angier, 2004 for a description of these findings). 5 As Raymond (1991) argues, The potential for womens exploitation is not necessarily less, merely because no money is involved and the arrangements may take place within a family setting. The family has hardly been a safe place for women (p .64). Based on the alarming prevalence of emotional, physical, and sexual abuse that women and girls encounter within family contexts, Raymonds assertions are well grounded in claiming that the family may also be a source of womens exploitation.
68 Chapter 4: Re conceiving Reproductive Freedom At the time Meads 1999 story on egg donation was printed in the New Yorker Cindy Schiller, the central character and supposed paradigmatic egg donor, was an intelligent, attractive, light skinned, blu e eyed, graduate student who had donated her eggs while both an undergraduate and graduate student. Among Schillers many accomplishments and activities of note that are wove n throughout the story of her involvement with this ART is mention of her central role in an organization called Students for Reproductive Freedom. Schillers involvement with this particular organization probably ignited little interest from the average reader, a s this affiliatio n is listed among several of her other activist inter ests. Yet in light of my own consideration of the implications of egg donation for womens reproductive freedom, I could not help but contemplate the implication of Schillers association with this organization. In considering Schillers identification as a reproductive rights activist, I entertained questions such as, if ( as Chapter 3 shows ) the processes of egg transfer do commodify donors eggs and bodies, are such uses of ones reproductive capabilities contradictory to not ions of reproductive freed om? I f so, i s there a discrepancy here between Schillers willingness to commodify her reproductive capabilities, while simultaneously working to promote and protect womens reproductive freedoms? In other words, does Schillers donation of her eggs dama ge or contradict the very
69 reproductive rights she is committed to supporting? Less consequentially, i s this yet one more example of the contradictory situations conjured by the practices of egg donation? Or is it indicative of a more significant shift i n the very ways in which we conceive of notions of reproductive freedom? In reflecting on the discourses around egg donation that have e n abled the production of representations such as those examined in earlier chapters, Schillers situation seems to indi cate that notions of womens reproductive freedom are in fact transforming through our current uses of ARTs such as egg transfer. T he ability to describe concisely a complex notion such as reproductive freedom is rare However the central characteristic of contemporary discourses of womens reproductive freedom can actually be summarized in a single word: stewardship. A s a whole, t he representations of egg transfer that I have drawn on in previous chapters demonstrate the ways in which our operative def initions of reproductive freedom have shifted away from previous notions of reproductive freedom that emphasized womens power to define their own roles as sexual and/or reproductive women in our society. Instead, current perspectives of reproductive free dom now seem to be focusing womens ability to steward their reproductive capabilities Admittedly, this is a very subtle discursive shift, but by elucidating the dynamics and ideologies of our present discourses I will argue that this shift has signif icant impacts on the objectives of contemporary womens movements. In order to build this argument clearly, I will need to identify current common ly held perspectives of reproductive freedoms, as well as the ir significance for women today To do so the first part of this chapter will explain how discourses of stewardship function to establish
70 womens reproductive freedom specifically by drawing on the appearance of these discourses in current representations of egg transfer that were analyzed in C hapte r 1. The second part of this chapter will pry at the gaps and incongruities within these discourses to show that equations of stewardship with womens reproductive freedom may in fact not be adding up properly Egg Stewardship: Proper management of repr oductive resources The characterization of discourses about egg transfer as based in stewardship is not one I have pulled out of thin air. Several critics, scholars, and practitioners have both explicit ly and implicitly implemented ideologies of stewards hip to the practices of egg transfer (e.g. Shanley, 2001; Blacksher, 2000; Mead, 1999; Healy, 2003; ASRM, 2000 ) and ARTs more broadly (Sawicki, 1999; Becker, 2000; Dill, 2001) As a general concept, stewardship invokes notions of responsible or careful management, or administration of valuable resources. In applying this idea specifically to womens reproductive freedom one must consider what is the object that requires stewardship, or what is being managed by whom, and why? T he predominant represent atio ns of egg transfer analyzed in C hapter 1 offer some insight into how these questions might be answered. Specifically, through the implementation of ideas of donors altruism and freedom from exploitation, common representations of egg transfer demonst rate how stewardship discourses are now equated with womens reproductive freedom. To elucidate how these discourses have become viable metonyms for womens reproductive freedom, I will examine how typical components of egg transfer representations make s uch connections possible.
71 How w omen have b ecome e gg s tewards In contemporary discourses around egg transfer the portrayal of donors reproductive freedom as stewardship both initiates from and perpetuates ideas of their eggs as the valuable resources t hat require careful management. 1 A few of the individuals who critique this ART actually directly use the perception of eggs as resources to establish the relevance of stewardship to our contempora ry narratives of reproduction. For example, in her discus sion of egg and sperm donation, Shanley (2001) declares, A persons relationship to his or her genetic material is better thought of as a kind of stewardship than as ownership. Thinking about what is involved in gamete transfer should turn us away from th ose strands of the liberal tradition that emphasize the individual and property in the body, and toward those strands that rest on a deeper understanding of the person rooted in multiple and complex relationships to family and civil society (Shanley, 2001, p.95). In this passage, Shanley raises some points that are important for construing donors eggs as resources and in need of administration which thus supports notions of stewardship. First Shanley determines that peoples genetic material specif ically their eggs and sperm is not a commodi ty that can be sold or bartered This aspect of stewardship discourses is apparent in the various representation s of egg transfer discussed in earlier chapters which attempt to forward only depictions in which eggs are not commodified and donors are free from exploitation. In fact, the idea that women are merely managers of their eggs coordinates perfectly with the assertion critiqued in Chapter 3 that donor fees are compensation for time and inconvenience rat her than womens eggs. If the eggs being provided for ART procedures are managed by women, rather than being seen as parts of their bodies, it becomes nearly impossible to conceive of donors being exploited
72 by the eggs use especially when the donors ar e being handsomely rewarded for their time administering these eggs. Additionally, by implanting the ideas that womens relationships to their eggs are m uch greater than mere ownership within the contexts of social responsibilities, Shanley elevated the status of ova to a position of resource that bear s significance to society, not just individual women. As such, the humanitarian goodness that is portrayed as a hallmark of egg donors fits seamlessly into the story line of women as stewards of their eggs The emphasized representations of donors altruism which were identified in the first chapter and deposed in the second, provide the ideal fuel for the idea that women are acting merely as stewards of reproductive resources and capabilities and ultim ately their bodies for the good of all members of society. Blacksher (2000) provides some additional perspective on the idea of gametes, and eggs in particular, as resources requiring stewardship. In the process of debating the idea of donating her eggs Blacksher echoes the above passage from Shanley, as she comes to the conclusion that she does not own her eggs as one owns a material commodity. Instead, she describes, The biologic potential of this human material to throw into being another singular human, an entity that would transcend its material origins, began to give me pause. Complex and unique individuals were born out of this highly improbable, chance event, and this suggested to me that these precursors to life deserved my thoughtful steward ship (p.29). As Blacksher suggests, womens eggs as societally significant resources draw their value or rather, the fact that they are invaluable from the potential they have to produce human life. By stating eggs relevance to the formation of hu man life, Blacksher
73 invokes their significance as links to both the past and the future of the human continuum. As such, they have priceless potential outcomes, and thus clearly need someone to ensure their proper use. Also, by qualifying the necessary s tewardship of womens eggs as thoughtful, Bl a cksher shows how women have been granted the privilege of deciding the fate of these precious resources, accompanied by the knowledge and responsibility that whatever choice s they make will carry great consequ ence for both themselves and all of humankind. M anaging r esources through c hoice While this discussion of eggs as resources that are managed by women certainly supports the application of the term stewardship to donors role in egg transfer, at this point, one might be wondering how this relates to womens reproductive freedom. Drawing on th e above excerpt from Blacksher, her implication (even though she does not specifically articulate it) is that women have a choice of how to administer their eggs In fact, framing practices of egg donation with the concept of stewardship assumes that women have free reign over their eggs and may manage them in any way they see fit. As egg stewards, women are purportedly recognized as the sole executors of these eggs, which potentially could be a very empowering situation for women. How the eggs in womens ovaries are administered is thus seemingly their choice, which rests the fate of humanity in womens hands, or more literally, their ovaries. As Chapter 2 in dicates, this presumed decision making power of donors is read though the cultural lenses of choice that are shaped and informed by feminist histories of women battling for the freedom of both their bodies and destinies through control of their own repro ductive lives. Thus, the supposed presence of donors autonomous choice in managing eggs
74 becomes conflated with the similar, but more politically invested concept of choice as is understood in terms of reproductive freedom. This connection between women s administration of their eggs and reproductive freedom is affirmed further by Shanleys insinua tion (which grounded womens relationship to their eggs within societal obligation) that womens stewardship or donation of their eggs is based in altruism and freedom from exploitation wh ich the previous chapters determined are both concepts that are hinged upon the assumption or supposed precondition of donors autonomous choice to participate in egg transfer. Thus, by embedding the discourses of stewardshi p within constructions of altruism, societal obligations, freedom from exploitation, and ultimately within notions of choice, stewardship has metonymically come to index contemporary conceptions of womens reproductive freedom. In stepping back to exam ine how notions of stewardship, altruism, and the absence of exploitation cooperate to influence our current perceptions of egg transfer, and womens reproductive freedom more broadly, the presumed presence of donors free choice to participate in this ART serves as a central pillar in assembling favorable perspectives of egg donation. Yet as C hapters 2 and 3 exhibit, womens ability to autonomously choose to donate their eggs is weakly constructed In metaphorical terms, it is almost as if our current r epresentations and awareness of egg transfer exist as a house of mirrors in which donors altruism, the absence of exploitation, and choice, repetitively reflect off one another in such ways so as to construct an image which equates donor stewardship wit h their reproductive freedom. As a result, womens rights and responsibilities to manage their eggs are seen as a perfect
75 picture of womens bodily rights. Yet if one of these mirrors was to break or if one of these central images was disrupted the ref lections of all the other images would be distorted. In other words, because the ideas of choice, donor altruism, and freedom from exploitation are so intricately reliant upon one another, the disruption of one image alters all other reflected images in this house of mirrors, including that of donors stewardship as reproductive freedom. Thus, in light of the incongruities raised around autonomous donor choice in previous chapters, I will now unearth some of the gaps in stewardship discourses that are t ypically glossed over in contemporary representations of egg transfer. Shattering Images of Choice and Disrupting Stewardship Discourses The questionable status of donors autonomous choice that is brought forth in both C hapters 2 and 3 suggests that th e presumption of donors reproductive freedom may be more problematic than is implied by the stewardship discourses For instance, the gaps within the processes of informed consent, manipulation of womens feelings of empowerment through the appropriation of feminist ideologies, and utilization of gendered kin relationships, which may all factor into womens decisions to donate their eggs, endanger their ability to make the autonomous choice to participate (see C hapter 2). Additionally, the indeterminate impact of monetary compensation and the inability of ART practitioners to weed out all financially vulnerable potential donors, further jeopardize dono rs reproductive freedoms (see C hapter 3). In sum, when considered together, the ques tions raised in C hap ters 2 and 3 about altruism, autonomy, and exploitation, ultimately contest whether a decision to donate ones eggs on the bases of altruism and autonomy can truly exist specifically within
76 contexts of financial gain (regardless of the intended object of p ayment) and the cultural pressures that burden women with a sense of duty to reproduce and/or nurture others Thus, as persuasively configured are the discourses of women as stewards of their reproductive capabilities, the arguments bu ilt in C hapters 2 an d 3 challenge the validity of such discourses. Stewardship as a false vision of reproductive freedom E ven if one take s for granted the existenc e of free choice for egg donors ( as is the case in representations of egg transfer ) this ART still poses several problems in equating stewardship of reproductive capabilities with reproductive freedom. On the surface, the stewardship discourses may be read as affirming of womens rights because if anyone is going to be a steward of womens reproductive capabilities including her eggs, it is desirable for each woman to maintain this responsibility herself. Although the agency implied in this reading may be experienced as empowering by some women, it ultimately devalues all womens worth by using very limited aspect s of individual women as the scale by which all women are measured Furthermore, by fragmenting womens bodies both literally and ideologically, ideas of egg donation as stewardship encourage women to (yet again) see parts of their bodies as resources that require management. 2 The stewardship discourses position womens eggs as natural resources as was indicated by the biological and genetic emphases of the excerpts from Shanley and Blacksher earlier in this chapter that have invaluable potential outcomes. 3 In this sense, the proper management of womens eggs is as much a public concern as is, say, preventing deforestation of wilderness areas or maintaining healthy citizens in order to form a standing army In following this line of
77 thinking, i f a woman fails to properly utilize the eggs she is stewarding (i.e. through donati on or pregnancy), is she harming or short changing society or the nation, by allowing such valuable resources to go to waste? The obligations embedded in this question sh ow that even as notions of stewardship provide women with the privilege of determining the fate of the eggs in their ovaries, women simultaneously are granted the hefty responsibility of determining the future of human existence. Thus, women have been thr ust into roles as stewards, or nurturing managers of the past, present, and future of U.S. society, and ultimately the human race. Consequently the high stakes of egg stewardship appear to have spawned yet one more permutation of the seemingly eternal im perative for women to be active in procreation in order to qualify as true women i.e. biological and cultural reproducers of society The pressure that women experience to embody true womanhood provides a salient example of biopower 4 as theorized by Foucault (1978), because i n forwarding such traditional gender ideology the stewardship discourses have crafted womens proper management of their eggs into more of an imperative than a choice. In other words, the constructions of women as egg steward s presents a disciplining and restricting force on womens choice rather than an endowment of rights and freedom. As such, the stewardship discourses are enacting social and psychological control over women which compel s them to be complicit with narro wly defined roles as reproducing machines (Foucault, 1977; Bartky, 1998). Through embracing the notions of their obligation and social responsibility to steward their reproductive capabilities women are both abiding by, and helping to construct a framework built upon stewardship, that limits
78 the very realm of what women and society are even able to recognize as the options from which women are able to choose (subRosa, 2002) Such gendered ideology is carried over into the belief that womens sense of stewa rdship over their eggs will compel them to monitor and maximize the use of their eggs not with the objective of protecting their own interests, but with that of serving the believed interests of humanity. Womens own interests are superceded by what Sha nley (2001) describes as their multiple and complex relationships to family and civil society (p.95). These gendered expectations of self sacrifice are deeply embedded in nostalgic societal imaginings of motherhood (and by implication, womanhood) that c all upon assumptions of womens nature as essentially good, kind, and altruistic. However, by positioning women as egg stewards in this way, feminist objectives of womens liberation are negated in at least two ways. In t h e first place, the gendered expec tations embedded in i d eas of stewardship provide very restricting constructions of what womens reproductive freedom might look like. In other words, the stewardship discourses offer a limited view of the appropriate intentions and outcomes of womens rep roductive behaviors (e.g. constructing heterosexual nuclear families, reifying traditional gender roles, etc.) and therefore perpetuate restrictive categories and roles of womanhood from which many feminists believe women need to be liberated. A second wa y in which feminist visions of reproductive freedom are negated by these discourses exists in the very fact that ideas of stewardship place anyone elses need over those of individual women. By prioritizing the interest s of womens families, communities, and society as well as members of past and future generations over the well being and bodily integrity of the very women who are accepting (arguably
79 unnecessary risks) by agreeing to participate in egg transfer, the stewardship discourses undeniably de viate from the mission of womens liberation and empowerment sought by feminist movements. 5 Of course, my contention that womens interest should be attended to first reveals a fundamental conflict between the objectives of womens liberation and definitio ns of stewardship (i.e. s tewards should act primarily for the good of the whole i.e. womens communities or society ). This is not to say that the goal of womens reproductive freedom is to completely individualize their reproductive choices. To clarify my point here, I am not arguing that earlier feminist visions of reproductive freedom attempted to remove womens reproductive lives from the social contexts in which they made decisions, acted, and/or were acted upon. Rather, it seems that the stewardsh ip discourses enable the de contextualization and disembodiment of donors by conveniently remaining oblivious to the gendered, racist, and classist conditions influencing donors experiences. Historically and contemporarily, considering womens reproduct ive freedom as embedded within complex sociological frameworks is both appropriate and necessary in all attempts to establish and protect womens reproductive freedoms (Roberts, 1997; Corea, Hanmer, Klein, Raymond, & Rowland, 1987) But problem s a rise whe n the social connections and obligation s are forwarded as the raison d etre of womens reproductive freedom (as in the case of egg transfer) In other words, stewardship discourses foreground and attribute greater importance to the interests of society a t the cost of donors embodied experiences receiving adequate acknowledgement Much of this problem stems from the fact that the resources women are charged with stewarding are
80 actually part of the womens bodies. Perhaps this suggests then, that steward ship is not an appropriate framework for thinking about womens use of their eggs, or any aspect of their reproductive lives for that matter. However, a s a consequence of these imbalanced priorities of societys interest over womens needs individual wo mens right s to act in ways that first and foremost benefit themselves, rather than other individuals or even humanity as a whole are denied While these assertions may sound purely selfish, assuming that an individual is capable of making any decision c ompletely separate from their social contexts is impossible (Petchesky, 1995; Shanley, 2001) Yet in getting caught up in the ideas that women as the supposed innately self sacrificial beings are obligated to manage their reproducti ve abilities to spe cific ends ( primarily in the interest of their family, society, race, or species ), the objective of ever establishing womens reproductive freedom gets lost by minimizing the consideration of individual and collective womens personal concerns. Thus, in s haping individual womens decisions with societal interests, stewardship discourses transform and shift the individual politics of reproductive practices for women as a collective. Judging from the various chasms in the continuity of stewardship discourse s that I have identified here, maintaining the presumption that womens reproductive freedom is universally promoted by egg transfer and ARTS more generally is impossible. To return to the metaphor of the house of mirrors, my arguments have exposed th e fragility of the representations of donor altruism, freedom from exploitation, and choice. In doing so, I have exposed the vulnerability of the perception that egg stewardship is representative of reproductive freedom. Thus, if the equation of egg do nors reproductive
81 freedom with stewardship of their eggs remains dependent upon a myopic concentration on donors altruism and the premise that donors are not being exploited, a false vision of reproductive freedom will continue to be fostered and perpetu ated. 1 The reason for my use of the terminology of resources in reference to womens eggs in this chapter is a reflection of the ideologies forwarded by the discourses being examined. The identification of womens eggs as res ources in this chapter is not necessarily contrary to the arguments made in Chapter 3 that womens eggs have become commodities. However, the shift in terminology is accompanied by some different connotations. 2 This argument, that females can utiliz e their bodies as various types of resources for advancement, is not limited to the realm of reproduction. In fact, the idea that women can use their supposed bodily assets (e.g. attractive appearance, sexuality, physical weakness, etc.) which are embed ded in sexism and traditional ideas of gender to obtain gains (e.g. avoiding speeding tickets, getting into clubs, acquiring employment, etc.), is one that I often hear voiced by students in my Introduction to Womens Studies class. 3 My purpose in p lacing the term natural in quotation marks in this passage is two fold. First, I am playing off our typical conception of what is meant when the phrase natural resources is used (e.g. petroleum reserves, clean water, etc.). More importantly, my second intent is to point to the fact that while ova generally form within most womens bodies without intervention of any kind, the practices of extracting them en masse from womens bodies clearly cannot be categorized as natural processes. 4 Haraway (1997) off ers a useful explanation of this term. She states, I understand Foucaults (1978) concept of biopower to refer to the practices of administration, therapeutics, and surveillance of bodies that discursively constitute, increase, and manage the forces of l iving organisms (p.11). 5 These arguments are also frequently used to combat the increasingly prominent conservative and anti choice efforts to establish fetal rights. Over the past ten to fifteen years, opponents of abortion have fought for, and gai ned much ground in creating policy and legislation that recognizes the rights of unborn fetuses as independent from the rights of the women carrying the fetus. Fetal rights advocates hope that in obtaining these rights for fetuses, they will be able to revoke womens freedom of reproductive choice that was established by the landmark 1973 Roe v. Wade Supreme Court case. Such efforts have been reflected in the prosecution of pregnant women drug users for such crimes as fetal abuse (see Hartouni, 1997). The battle for fetus rights is also apparent in the current Congressional debate over the Unborn victims of Violence Law (also know as Laci and Connors Law, so called in remembrance of the brutally murdered Laci Peterson in 2002, during her eighth mo nth of pregnancy). Womens rights advocates coming from a wide variety of theoretical and political perspectives contest the arguments for fetal rights on the basis that they are clearly misogynistic in undermining the rights of mature, living women in the interests of unborn fetuses (National Organization for Women, 2004).
82 Epilogue: The Current Status of Reproductive Freedom I f the current situation of egg transfer is taken as a model, as I suggested in the last chapter, what can be concluded about the present status of womens reproductive freedom? In looking at the case of egg donors, even though they have the apparent ability to choose whether they will participate in egg transfer, their reproductive freedom is evidently undermined by the mythical proportions of both donors perceived altruism and the humanitarian c oncerns women are believed to be demonstrating by donating their eggs. In illuminating the contextual conditionality of womens reproductive choices, the situation of egg donors speaks more broadly to the ways in which all of womens reproductive decisi ons are deeply embedded within a complicated network of personal and societal factors. Corea, et al (1987) explain the political significance of womens personal reproductive decisions in stating, Claims for a right to choose cannot take place outside of the general revolutionary movement for womens freedom. And we cannot use individualistic solutions to deal with social problems. Choice is only meaningful when material and social conditions are such that we may truly exercise it in equity and wit hout threatening the survival or the rights of all women (p.8 9). Thus, according to Corea and her colleagues, in supposedly altruistically choosing to donate their eggs, women are exhibiting their personal needs and desires as well as the societal and cu ltural influences that shape such individual motives.
83 Although recognition of this simultaneous expression of personal and societal impulses to donate may seem like an obvious observation, this point actually identifies the underlying danger that curren t U.S. uses of egg transfer bear in terms of womens reproductive freedom. As I have demonstrated throughout this examination of egg transfer, the material and social conditions (e.g. financial need, familial expectations pro natalist pressure etc.) tha t women as potenti al egg donors face are largely ignored in favor of the nearly hypnotizing notions of altruism. Through this erasure of the contexts around egg donation, many people have come to see egg transfer and other ARTs as promoting womens reprod uctive freedom by expanding their reproductive options (e.g. by allegedly increasing the reproductive lifespan of countless women). However, by unearthing egg donors often disregarded bodily experiences from the obsessive attention devoted to the opposit ionally framed motives of altruism and financial gain, I have revealed egg transfer to be a form of stratified reproduction. 1 Application of this term to the dynamics of egg transfer seems strikingly appropriate as there is clearly a class division betw een who is able to benefit from its practice and who must sacrifice for its success. 2 Yet this division is conveniently hidden from view by the domineering presence of the stewardship discourses based on the allegation of all womens choice. The extent to which stewardship discourses and ideas of choice gloss over the hierarchical division and injustice of egg transfer is evident when one or all of the images in the house of mirrors is shattered. Through the disruption of such representations and dis courses, some of the impacts of stratified reproduction on broader notions of reproductive freedom may be acknowledged and addressed.
84 However employing this term stratified reproduction to egg donation is not to say that the women at the bottom of this particular stratified system (i.e. egg donors) are the only ones negatively impacted by such practices. As Coreas quotation above suggest s by impinging on the ability of any woman to make autonomous reproductive choice, the freedom of all women is endan gered. This point is evidenced by both the implications and prevalence of stewardship discourses. In reinforcing gendered cultural ideologies in which altruism is an expected aspect of womens nature, stewardship discourses contribute to restrictive defi nitions of all womens reproductive roles. These same notions of stewardship have clearly been applied much more broadly than just to the experiences of egg donors. For example, in acknowledging the various regimens, schedules, and treatments that infert ile women are expected to undergo in their battle s against infertility, the perceived necessity of these women managing (or stewarding) their reproductive capabilities becomes undisputable (see Becker, 2000; subRosa, 2002). As a more disturbing case in po int, the impacts of stewardship are seen through the hyper vigilance exercised over pregnant women that recently justified the arrest of a woman in Utah for refusing a caesarean section a decision which purportedly could have pr evented the death of one of the twin fetuses she was carrying. 3 Such cases, which are not infrequent, reinforce the idea that womens reproductive practices are purely in the service of others. As this last example demonstrates, the seemingly innocuous (and perhaps even admirab le) repercussions of perceiving womens reproductive choice in terms of stewardship enable an overt assault on the ideological concept of reproductive freedom and its bodily consequences This onslaught is relevant to all women, regardless of their
85 place in reproductive hierarchies. As the current Bush administrations fondness for infringing upon womens reproductive rights serves as a guide for policy and legislation, 4 the increasingly conservative climate being witnessed in the contemporary U.S. is exh ibiting escalating hostility toward womens rights and the protection of their bodily integrity Thus, if we as a society continue to tolerate, rationalize, or excuse portrayals of womens reproductive abilities and resources as both separate from their bodies and persons, as well as selflessly provided for the greater good as has been done in the case of egg transfer we will in essence be facilitating even further erosion of all womens reproductive freedom. 1 Ginsburg & R app (1995) briefly explain the idea of stratified reproduction in describing it as the power relations by which some categories of people are empowered to nurture and reproduce, while others are disempowered (p.3). Shellee Colen (1995), who originally coined this phrase, provides an expanded definition in saying, By stratified reproduction I mean that physical and social reproductive tasks are accomplished differentially according to inequalities that are based on hierarchies of class, race, ethnicity gender, place in a global economy, and migration status and that are structured by social, economic, and political forces. . Stratified reproduction, particularly with the increasing commodification of reproductive labor, itself reproduces strati fication by reflecting, reinforcing, and intensifying the inequalities on which it is based (p.78). 2 A prime example of the inequalities inherent in the stratified reproductive practices of egg transfer is brought forth through an identical situation wit h surrogacy, identified by Raymond (1993). She asks, If women were truly lining up to become surrogate mothers out of altruism and concern for the infertile, we would have middle and upper class women bearing the babies of lower class couples, where the added gift of aiding those who cannot afford to pay would be an even greater expression of altruism. Presumably, altruism is a cross class phenomenon, but it does not appear to work that way in surrogacy situations (p.45). All indications suggest that t he same inequalities are exhibited in practices of egg donation. 3 See Ellen Goodmans (2004) editorial for a more extensive discussion of this case and previous related cases. 4 For instance, the Bush administrations most widely known attacks on womens reproductive freedom include staunch support of abstinence only sex education in public schools, the imposition of the global gag rule which denies funding to international organization that counsel women on abortion, passage of legislation that bans l ate term abortions even when medically necessary and making life time appointments of firmly anti choice judges to federal courts without Congressional approval And the list goes on .
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