Assisted Reproductive Technology: A Medical Anthropology Perspective. By: Crystal Vergin

Assisted Reproductive Technology: A Medical Anthropology Perspective

            New reproductive technologies (NRTs) are a growing field in the Global Health arena. While the NRT’s may not pose a problem in the form of malaria or tuberculosis, they are of concern. As with any new technology, assisted reproductive technologies (ARTs) have the potential to create health inequalities. Not all techniques and technologies are available to all people in all parts of the world. New reproductive technologies are, according to Global Health Watch 3, are “a broad constellation of technologies aimed at facilitating, preventing or otherwise intervening in the process of reproduction”(2011). I will examine some of the barriers patients face when seeking out these ARTs, particularly in vitro fertilization (IVF) within the Middle Eastern context. Medical anthropology theory and tools will be applied to this complex global health concern, especially the ethnographic work of Marcia C. Inhorn. The ethnographic fieldwork of anthropology allows individual perspectives to come to light that might not otherwise have been seen; through this perspective various inequalities are verified or discounted. Biopower, gender, access and global flows will also be more closely.

GENDER DYNAMICS

Gender plays a dynamic role in the use and access of reproductive technology. Women bear the most of the reproductive burden, and certainly with the increasing use of surrogates women play a major role in the reproscape, but men must not be left out of the equation. ARTs often require gametes from both sexes, meaning that it is not just oocytes (eggs) that require donation but also sperm. Often it is married couples who seek out ARTs and this is definitely so in the Middle Eastern context. Therefore, both genders are users of the ARTs and in the Middle Eastern context it is couples that seek these technologies together. Power struggles between genders may also contribute to inequalities when considering the new reproductive technologies.

 Women may not have the agency to choose what reproductive technologies that they do and do not use because of religious or cultural norms that put women at a disadvantage in the power dynamic. One example of is the AIDS epidemic in Africa. If women were allowed to choose protection in the form of condom use without the threat of being ostracized or abused, outcomes may be much different. Open to speculation is the capacity of Huda, the infertile woman in Inhorn’s article, we are never told how she feels about the use of a donor egg being implanted in her uterus, we only hear her husband’s perspective (2011). Medical anthropology is concerned with the issue of gender because women may carry the most reproductive burden but may also have the least amount of choice in what reproductive technologies they use. The male role in the access of ARTs is much larger than that of females, especially in the Middle Eastern context. Through more detailed ethnographic work anthropology may be able to get at the heart of this inequality to offer solutions to women without agency.

ACCESS AND RELIGION

            Access to NRTs is another way in which inequalities are magnified. Access to ARTs and NRTs also drives reproductive tourism. Recently discussed in class, medical tourism took form in the context of North Americans seeking inexpensive cosmetic surgery in Costa Rica. Here, we discuss a repro tourism in the Middle Eastern context. Existing literature has cited eight factors contributing to reproductive tourism, out of which, four are directly related to access. For example, services may be unavailable do to lack of gametes, equipment or medical specialization; procedures may be considered unsafe in certain countries, or some patients may not receive services based on expense to national healthcare programs, marital status, sexual orientation or age. Besides the former reasons some countries prohibit certain services for religious or ethical reasons (Inhorn, 2011).

           In the context of the Middle East religion plays a large role in the availability and use of ARTs and NRTs.  The vast majority of patients seeking these reproductive therapies in the Middle East are Muslim. Within the Islamic tradition there are two paths the Sunni and Shia. Religious opinion on the ARTs differs between the two. Both sects offer fatwas- non-legally binding authoritative decrees. The first fatwa on ARTs was announced in 1980, two years after the first test tube baby was born in the UK (Inhorn, 2011). The Sunni position permits IVF (in vitro fertilization) but only using eggs from the sperm of the husband of a couple; no third party is allowed involvement. In other words, no donor sperm or eggs are to be used. Not only does this break the sanctity of the marriage for Muslims, a donor gamete calls paternity into question. According to Inhorn, Sunni Muslims agreed in interviews that no third party should be introduced into a marriage. A child born of a donor gamete would not know their nasab or linage, which “confuses kinship, paternity, descent and inheritance.” This can be psychologically damaging for the child (Inhorn, 2011).

 Shia religious authorities mostly agree with Sunni authorities excepting for the form of individual religious reasoning known as, ijtihad. This reasoning has brought about disagreement and raised questions: (1) the third-party rule has been called into question. (2) In the case of male infertility should the donor gamete go by the donor’s name? (3) Should anonymous donation be allowed? (4) Should temporary marriages be allowed to avoid adultery? This type of temporary marriage is allowable for Shia’s but not for Sunni’s (Inhorn, 2011). The Shia religious thinkers raise these questions but Inhorn found that even some Sunni couples used donor gametes despite the fatwa against it and were able to keep this a secret through repro tourism (2011). From this is it is clear that ARTs are socially represented as both acceptable and taboo. The couple interviewed in Inhorn’s article, were willing to accept the social and religious taboo of using a donor gamete. The Husband Hatem, rationalized that because his sperm was being used to fertilized the consensual donor egg, this form of IVF was acceptable from his point of view. It is interesting to note that Hatem the husband of the couple interviewed is the one to speak for both him and his wife. Medical anthropology researches much further than biomedicine. Anthropology examines more than just the clinical data of biomedicine, but is capable of highly contextualizing both data and individual perspectives and representations. In Rachel Chapman’s article this allowed for the reality of the situation in Mozambique to come to the surface and for the problem of perinatal care to be explained in terms that led to better outcomes for the community. Recently we discussed in class anthropology’s synthetic quality that sets it apart from other disciplines. Anthropologists don’t merely pull apart an issue to look at its parts, rather the parts are closely examined to see how they function, then put back with the whole to see how all the parts function together (Lecture, A. Ceron, 12/12). Through this process global flows are taken into account, whereby we can see the biopolitics at the macro and micro levels.

POLICY AND THE REPRO SCAPE

The biopolitics of ARTs has reached an international level. Many countries have enacted policy regarding ARTs; these policies are also tied to the availability and access of ARTs. Some Western nations including Great Britain, Canada, Norway and Italy, have legislation prohibiting the donation of gametes, especially by anonymous donors and surrogacy. This means that Western Europeans seeking “white” donor gametes are flocking to Eastern Europe where policies are more lenient (Inhorn, 2011). Young women in post- soviet bloc countries sell their bodies in whatever way they can to survive. Inhorn mentions the parallels between sexual tourism and reproductive tourism; this is a prime example of body commodification.

       This entire process is historical, and global, we can see movement at various levels producing a both a global flow and a “glocal” culture. Within Appadurai’s framework Inhorn proposes the use of the “reproscape” to encompass “a kind of ‘meta-scape’ combining numerous dimensions of globalizations and global flows”(Inhorn, 2011). Cultural anthropologist Arjun Appadurai is a major theorist of globalization. Inhorn references Appadurai’s theory of global movements that are characterized by “scapes.” Globalization, according to Appadurai is characterized by the movement of images (mediascapes), people (ethnocacapes) and other “scapes,” these follow complex trajectories that move at different speeds across the globe (Inhorn, 2011).           

        The buying and selling of gametes on the open market, links the commodification of bodies with the issue of human rights. While we may not think of the gamete market in these specific terms we see it almost every time we read a classified section of a newspaper. I see ads in the UW Daily asking for egg donors of a specific ethnic background and/or eye and hair color, age, height and sometimes even a GPA. It is this transfer of human DNA on a global scale that Ruth Deech questions in her article, ‘Reproductive Tourism in Europe’ (2003,425, as cited in Inhorn, 2011).

            The couple in Inhorn’s article could be labeled reproductive tourists; they travel from Syria in some secrecy to Beirut for IVF treatments. While their families know that they are traveling for “treatment” they do not know what sort of treatment. It is clear from the interview that Huda (wife) suffers as a childless woman living in a large extended family surrounded by her relative’s children while she has none of her own (Inhorn, 2011). Across cultures and history it is general knowledge that infertility has been and still is considered both an illness and a sickness. Biomedicine has the ability to categorize and medicalize infertility into a disease.

            Medical anthropologists are equipped with the tools needed to further explore the global “reproscape” as it grows and changes with the demands of infertile couples around the world. Inhorn’s article points to the anthropologists’ ability to collect ethnographic information, a key role anthropology should play (2011). In addition anthropologists can do more than ethnographic investigation, we can see the whole and it’s parts. We know that health cannot be divorced from social contexts, that what may true in one context is not true in another. If we look to highly contextualize a scenario as Rachel Chapman’s article encouraged us to do we may be capable of discovering clearer paths to answering global health questions.

Bibliography

Ceron, Alejandro. “ Untitled Lecture, A 215.” Lecture, University of Washington, Seattle, WA, December 7,2012.

Chapman RR. 2003. "Endangering safe motherhood in Mozambique: prenatal care as pregnancy            risk". Social Science & Medicine (1982). 57 (2): 355-74.

Deech, Ruth. 2003. Reproductive tourism in Europe: Infertility and human rights. Global          Governance 9: 425–32.

Global health watch 3: an alternative world health report. 2011. London: Zed

Inhorn, Marcia C. “Globalization and gametes: reproductive ‘tourism,’ Islamic bioethics, and Middle Eastern modernity.” Anthropology & Medicine Volume Number, no. 18 Issue Number 1 (2011): Pages 87-103.