by Kristy Evans and Ann Elisabeth S. Samson
This article was originally published in AWID (Association for Women’s Rights in Development) under the themed publication, Young Women and Leadership: Gender Equality and New Technologies, in issue No. 8, June 2004.
The realization of women’s sexual and reproductive health and rights, including ensuring access to appropriate reproductive technologies, has been a cornerstone in the fights for women’s human rights and freedoms.
Reproductive technologies (RTs) traditionally refers to a range of devices and procedures for assisting, preventing and/or manipulating contraception, fertility and reproductive practices. What makes new reproductive technologies (NRTs) different is not only their increasing effectiveness and invasiveness, but the globalized system of profit seeking and control in which they are being advanced. Not only are these technologies being used to manipulate contraception, fertility and reproductive practices, but they are creating new ways to have and influence characteristics of potential children. Never before have reproductive technologies been manufactured and marketed with such intensity. Vast amounts of resources are being put into these discoveries. Yet, the dialogue as to the ethics, potential dangers and consequences on women’s bodies remains largely uncritical and unbalanced, often neglecting to examine the different experiences of NRTs depending on location, class, race, and gender.
Rich or poor, from the North or the South, women will encounter NRTs. The question is how, when and what NRT they will come across. Do young women have access to information about sexual and reproductive health and rights including contraceptives and reproductive technologies? Younger women in certain parts of the world are more accustomed to NRTs and use them readily, often without realizing the battles fought by earlier generations to ensure availability of these technologies and reproductive rights. For others, their reproductive choices are a constant battle. Yet, for the current generation constantly bombarded with new technologies of all kinds, new challenges arise. These young women have been brought up in a world where unprecedented resources are filtered into the fields of science and technology. This means they must engage with and advocate in their own interests and in their own contexts—as NRTs affect young women differently.
Young women should be considering the following questions:
Without critical interrogation of NRTs, women remain passive recipients and the pawns of multi-billion dollar NRT industries. As debates emerge around NRTs and their potential for misuse, and as young women become more aware of their reproductive rights, women can be a crucial force in critiquing and ensuring just and safe production and marketing of these technologies. They are also a new generation within women’s movements and have an opportunity to shed light on issues that are of importance to them, shifting the debates and contextualizing critical issues.
As NRTs become more common and as more are promised, it is important to remember their historical and social context. Women’s previous experiences with contraceptive and other technologies can be applied to NRTs, particularly as control of women’s bodies and choices is taking new forms and greater invasiveness. Reproductive technologies enable control and choice over reproductive decisions. Women have always controlled their own fertility, largely without the direction of a predominantly male medical establishment. Over the course of the 19th and 20th centuries, medicine became a profession performed in hospitals and doctors’ offices, taking healing out of the hands of women. Doctors began taking over childbirth and other reproductive health matters from midwives and traditional healers. Western medicine developed very specific expertise and control over women’s bodies.
As women’s health and reproduction became increasingly medicalized, there were other powerful ideas taking hold in North America and Europe. Scientist Francis Galton coined the term, eugenics, in 1883 to describe how theories of heredity could be applied to improving humanity by encouraging the ablest and healthiest to reproduce. Eugenics was used in the early 20th century to justify involuntary sterilizations, laws forbidding interracial marriages, and restrictive immigration in North America and Europe. Adolf Hitler used these ideas to justify his Nazi science experiments in the 1930s and 40s. Today, eugenic ideas still haunt family planning programs and reproductive decisions, particularly for women living in poverty who tend to be the targets of population control policies.
Other influential ideas were those of Thomas Malthus and his successors who focused on population control as a solution to the problems of poverty and hunger. These ideas still permeate population control and family planning, as well as NRT development. The technological infusion of materials, chemicals, hormones and pharmaceuticals changed earlier women-controlled contraceptive methods. Only in the early 20th century did doctors and scientists develop the capability to directly manipulate
reproductive functioning with contraceptives and birth control interventions. New methods of contraception and birth control exploded after the 1950s. This boom in RTs over the following two decades included the discovery and use of a variety of different types of birth control pills and intrauterine devices (IUDs)—some much more helpful or harmful to women than others. Feminists have long been involved in debates surrounding reproductive technologies, fighting for access to birth control and abortion, and in the 1970s and 80s, focusing on a more holistic vision of health and well being and working for reproductive rights.
One of the problems we are facing in developing countries in Latin America is that we have prenatal testing but no abortion. Why are these [new technologies] being brought into our countries without full reproductive rights? They want to bring them in without engaging in the possible problems of them. – Florencia Luna (Argentina)
The late 1970s marked a shift away from a focus on contraception to assisted fertility technologies. The first test tube baby was born in 1978. In 1990, the Human Genome Project was launched, and the ‘genome revolution’ began with health, pharmaceutical, and fertility research focused predominantly on genes as the fundamental determinants of health. At the same time, processes of globalization have eliminated barriers to research, development, and dissemination of new reproductive technologies. In a very short time, an explosion of technologies related to assisted reproduction and ‘new and improved’ contraceptive measures came into research and development, followed by critiques from a wide range of players including gender equality advocates. Spanning the decade of the 90s, developments such as microbicides, female condoms, improvements in IVF (in vitro fertilization) and other fertility treatments, numerous experiments on genetic manipulation, and cloning all came into fruition.
In addition to the technological developments mentioned here, there has been a major shift of control of women’s fertility to governments, family planning agencies, and development organizations in recent decades. Uneven control, Malthusian beliefs on population and even eugenics have haunted many family planning policies. Now, critics of the unrestrained development of new human genetic technologies claim they have the potential to further technologize new eugenic or racist ideologies as well as exacerbate the differences between rich and poor.
Debates around NRTs are becoming increasingly complex for a few reasons:
‘Choice’ implies that you have options. In a market context, this means that you have things to buy and money to buy them. In an increasingly globalized, corporatized world, marketing of NRTs has become an important influence on their use and perception by women. For instance, some birth control pills in North America have been marketed to young women as treatments for acne. Increasingly, reproductive technologies are being marketed in both the North and the South. Some have identified an emerging trend in ‘reproductive tourism’. Women will travel to other countries to either avoid the legal restrictions in their home country or take advantage of lower prices for NRTs. For example, an IVF clinic in India advertises on the internet that their prices are cheaper than in the US and UK because, Indian doctors, like Indian computer professionals, have proven they are as good as anyone in the world, but because India is still a developing country, they charge much less than their colleagues in the West.
Marketing of technologies is an incredibly contentious issue, particularly as multinational pharmaceutical companies spend more money on promoting their drugs than on research and development. The marketing of ‘next generation’ assisted fertility technologies is an example of this and it also plays on the desire for the ‘perfect baby’—by encouraging women to use NRTs to filter out perceived defects and choose socially desirable characteristics of their future children. The technological pursuit of ‘perfection’ reinforces the notion that perfection exists, and can be purchased, or ensured through techno-fixes. Many critics argue that the motivations behind ‘improving’ our children are dangerously close to a new kind of market-based eugenics where those who can afford the genetic analysis to screen out ‘defects’ and select for desirable characteristics will be able to do so through technology.
Bioethicist Arthur Caplan believes that “parents will leap at the chance to make their children smarter, fitter and prettier. Ethical concerns will be overtaken by the realization that technology simply makes for better children.”
Many fundamentalist ideologies seek to impose an ideal of the family or of women that limits reproductive rights and autonomy. We have seen this for some time in the approach to abortion and access to contraceptives. We are seeing a mixture of responses to NRTs. These forces tend to be pro-life, pro-family, and pro-natalist focused on promoting fertility within the boundaries of the ‘traditional’ family.
Most NRTs are developed within a Western-based model consisting of the ‘medical, male, rational’ as the ‘expert’ who designs ways to control women’s bodies—mostly in relation to fertility control. Historically, women have been seen as irrational; their bodies to be tamed, controlled or colonized. The development and marketing of NRTs is moving control of procreation, not just contraception, further into this male, rational and controllable world.
In the meantime, women’s wombs are becoming laboratories for invasive and often risky reproductive technological interventions.
The development and use of NRTs has been lead by men, seldom focused on women’s needs, or on women’s health and rights. In fact, many of the new fertility technologies, including sperm sorting and cloning, were originally developed for animals, for use in food production. They have now been aimed at women. Women’s bodies are increasingly becoming the suppliers of genetic material for creating life outside of the womb and providing the raw material for scientific research driven by a patriarchal agenda.
NRTs do both—help and hinder women’s rights. When women have access to them, NRTs enhance women’s reproductive freedom, allowing them to further control their own fertility. But when NRTs are used as a part of population control policies and forced sterilizations, women’s rights are certainly violated. Women’s rights are also hindered when their bodies are used as testing sites for new reproductive technologies without adequate protection for their rights, health, and for prior informed consent. NRTs are increasingly able to help manipulate the very characteristics, ways and qualities for which eggs, embryos, and eventually children are created and selected.
Some of the issues and new questions potentially impacting on women’s rights and gender equality are:
Quinacrine, originally used as a malaria drug, has been used to chemically sterilize more than 100,000 women in around twenty developing countries.
“The Council for Responsible Genetics (based in the U.S.) unequivocally supports a woman’s right to make her own reproductive decisions. However, we oppose the utilization of human eggs and embryos for experimental manipulations and as items of commerce because of the potential for eugenic applications and health risks to women and their offspring”.
HOW THE FORCES COLLIDE
The evolution of the HIV/AIDS pandemic has necessitated new technologies protecting people from not only unwanted pregnancy (e.g. the Pill) but also from transmission of STIs—especially HIV (e.g. microbicides and the female condom). Questions surrounding the efficacy of such technologies have been rife, including: Why are we focusing on women-controlled methods of protection? Are women really in a better place to negotiate their sexual interactions than they were two decades ago? Don’t these technologies essentially put responsibility for the pandemic in the private sphere and in the hands of women? When are we going to start focusing on gender inequalities and male responsibility for reproduction and protection from STIs and HIV? Questionable use of resources and time are also key issues being raised when developing NRTs. Who will be able to access these? Who is really going to benefit—those vulnerable to HIV, those who can afford to buy the NRTs or the companies manufacturing these products? Who is dictating the research agenda for HIV/AIDS and how are decisions surrounding the funding of initiatives and campaigns being made; and by whom? The responses to HIV/AIDS are an illustration of how seemingly medical issues become intertwined with political, social and gender inequalities—often times fuelling them.
In order to promote women’s health and rights everywhere, we must be aware of new and changing debates and ensure that critical analysis takes into account the real effects of NRTs on women’s lives throughout the world: