17 August 2015
By Dr Anna Smajdor
Lecturer in Ethics, University of East Anglia
Appeared in BioNews 815
Recently a number of articles have been written about the restrictions apparently being imposed on single Chinese women who want to freeze their eggs in order to increase their reproductive options (see BioNews 814). Freezing eggs may give a woman a chance to delay having a child until she deems herself to be in suitable circumstances to do so, though success is not guaranteed. However, this may seem an acceptable risk for women who know their fertility will be on the wane once they are past 35; at least if they freeze their eggs they still have a chance. Without this option, a woman may forego having children at all, or she may wait and find it is too late.
The problem is that China does not want its young women to wait before becoming pregnant. In this, China is no different from many other countries, including the UK. Across the globe, where women have the option, they are having fewer children, later in life. And on the whole in these countries the state does not like the picture it sees before it.
There are a variety of political and economic reasons for this. 'Delayed' reproduction is rather an unknown quantity and we do not yet know exactly what its effects may be, but it seems possible that it may cause economic upheavals as the demographic balance changes and fewer young people are working to support a burgeoning older population. The question is whether young women, at the time of realising they might want to freeze their eggs, should be prevented from doing so because of broader state concerns over economic and demographic issues.
The UK has dealt with its worry over 'postponement' of reproduction by issuing messages urging women to have children earlier in life. The reasons given are that women are ignorant of the medical risks of later reproduction – if they knew, they would make better choices. The problem with this assumption is that, across the globe, it is the most educated women who are implicated in the trend towards lower birth rates and later motherhood. Can it really be that the cleverest women are making the worst reproductive choices?
Bewley et al seem to find no contradiction here, but I think there is a bigger issue at stake. Pregnancy and childbirth are risky at any age, and when we ask women to eschew the possibilities that technology seems to offer, the reasons for requiring this sacrifice require careful consideration.
In the West, fallout from eugenics has stifled the debate on how the interests of state and reproducer should be balanced. The horrors of the Nazi era, and the memory of their own shady eugenic pasts, have left many Western liberal democracies tongue-tied and furtive about their interests in controlling or influencing their citizens' reproductive choices. Despite this, pressure is put on women to meet certain reproductive expectations. This pressure tends to be covert, emotionally loaded, poorly defined and inadequately justified. Although in the West we think ourselves somehow healthier or cleaner because we contort our reasoning to fit a medical framework, it takes only a little unpicking to show how state concern for women's medical welfare is a thin veneer over much broader social, political and economic agendas.
Unlike some commentators, I do not view the state's interest – whether in China or the UK or elsewhere – as being inherently sinister. Bioethics has got it wrong in taking reproduction to be an entirely individual concern – the very term 'reproductive autonomy' is indicative of a failure of reasoning here. Of course reproduction is a matter of social interest – all the more so in view of the increasing concerns about economic and ecological sustainability.
What is sinister is the tendency to cloak the rhetoric in quasi-medical terms. China's 'one child' policy was an attempt to forestall a population crisis. Accordingly, it made no claim to be based on benign medical paternalistic concern for individuals, but explicitly set itself out as a means of avoiding social, political and economic catastrophe. One may disagree with the political process by which the policy was formulated and enforced, but the reasoning behind it is perfectly clear.
Western liberal democracies are reluctant to discuss their reproductive policies and strategies, preferring to regard this as a purely private or medical matter. Increasingly, however, it is becoming apparent that fertility trends are an issue that governments have to grapple with. Developments in technology have called into question what exactly we mean by reproduction, and what might be protected by reproductive rights and autonomy. States, unless they leave clinics entirely unregulated, have to step in and define what procedures may be carried out, how, and to whom.
From a Western perspective, China may seem excessively restrictive in preventing citizens from paying for egg freezing services. In Western democracies, we expect to negotiate restrictions on our liberties. Yet this negotiation has not happened. Women are still bombarded with messages to sacrifice the interests that they have in delaying or foregoing reproduction. I suggest that this failure to use the democratic space we have to negotiate state policies in reproduction, results from the ongoing insistence on a medical paradigm for reproduction as well as the squeamishness about eugenics.
Delayed motherhood is already widely being discussed in terms of its impact on productivity, on the workforce. I would argue that women should take up this gauntlet. Rather than passive recipients of medical care, women should see themselves as reproductive workers, whose efforts are of the utmost importance to the state. Women do not choose to be born as society's reproducers, yet their opportunities in society are constrained by a combination of biological facts and social expectations. Women are, in some senses, the reproductive slaves of their societies.
If we construe reproduction as work, we can look at reproducers' interests from a different ethical and political perspective. Like military personnel, or police or firefighters, reproducers provide a valuable service to society, and one which involves some risks in the fulfilment of their activities. A careful balance is required to ensure that these workers are reasonably compensated for their activities. When governments or societies ask too much, reproducers should consider what their negotiating strategies might be. Here in the UK we have seen a number of tube strikes recently as the sacrifices required to extend the service were regarded as too costly for the personnel involved. When this happens, workers and policymakers have to negotiate a balance. On this view, there is no intrinsic answer as to what the outcome must be – it depends on the negotiations concerned.
What would happen if we saw a strike among reproducers? Perhaps it might be agreed that societies that value equality of opportunity, educational attainment and career satisfaction for women and men should provide egg freezing to its female reproducers so they can fulfil this valuable social and personal aspiration without compromising the other things our societies hold valuable.