The situation in the US
A new trend: Money-back guarantees
The legal situation in the United States
Feminist Position on the IVF
Notes
Bibliography

Many feminists ground their scepticism towards new reproductive technologies on the crucial role of reproduction in the relationship between men and women. First, I will discuss this argument before I will examine in vitro fertilization in the United States and the feminist response to it. Many feminists see the main source of conflict on this issue in the fact that all human beings share one experience: we are all born of a woman. It is argued that men are jealous and fearful of women's reproductive ability because women have the continuation of the human race in their hands, with the fetus absolutely dependent on the woman who carries it. Most important for men is the fact that natural or biological circumstances exclude them from a large part of the reproductive process. Adrienne Rich describes the feeling of dependency of men upon women as follows:

"All human life on the planet is born of woman. The one unifying incontrovertible experience shared by all women and men is that months-long period we spend unfolding inside a woman's body ... most of us first know both love and disappointment, power and tenderness, in the person of a woman ... we carry the imprint of this experience for life, even into our dying."1

Feminist theorists such as Adrienne Rich argue that men, out of this situation of dependency, "created a system which turned against women her own organic nature, the source of her awe and her original powers."2 Controlling women's reproduction through motherhood or other social constructs does not allow men to participate in or influence the process of reproduction itself to a larger extent. A larger involvement is only possible through a technical development which demystifies birth and allows men to influence and, at the end, to control reproduction. In this century such technologies have arrived under the classification of new reproductive technology. Susan Sherwin describes two major changes in human reproduction:

"The first stage of the revolution in human reproduction began in the 1960s, with the introduction of the pill and other contraceptive innovations that made possible the separation of reproduction from sexual intercourse. ... Precipitating the second phase is an array of techniques that effectively make sexual intercourse unnecessary as a prerequisite for reproduction."3 New reproductive technologies enable men to become actively involved in the reproductive process. Although men are not able to 're-produce' children totally independently from women they have increased their involvement enormously.

What is forgotten quite often in this context is the shift of insecurity from men to women. Originally men could not be absolutely sure about their paternity. Large improvements in genetics allow genome matching which allows the verification of paternity and end men's insecurity in this regard. Through new reproductive technologies women face the same insecurity about 'motherhood'. A woman cannot be absolutely sure that she gets implanted her own eggs, and genome matching may become necessary in her case as well. Through new reproductive technologies men and women face similar insecurity about motherhood or paternity. Robin Rowland describes the process of a further alienation of women from their own bodies and a loss of control over an unique source of power quite well:

"In the process of trying to end their own alienation, men have made procreation alienation a reality for women, divorcing women from their wombs, eggs and embryos – from their own bodily selves and their sense of procreative continuity. They have made children products of the nexus between commerce, science and medicine, calling experimentation on women and human society 'therapy' and camouflaging the intention to map and control human genetics with the rhetoric of 'helping the infertile'. In this process women have become the experimental raw material in the masculine desire to control the creation of life; patriarchy's living laboratories."4 [Top]

The situation in the US

About 10 to 15 percent of North American couples are infertile.5 Generally speaking these couples have the following options:

1. they can consider infertility testing and treatment;
2. adopting a child;
3. if the husband is infertile they can use artificial insemination with donor sperm;
4. IVF, GIFT, ICSI etc.6

A new trend: Money-back guarantees

Examining the money-back plan of Pacific it becomes clear that one must investigate the conditions of the treatment contract very carefully and using these program is playing the odds. Ann Wozencraft9 demonstrates this with the example of Diana Cummings, a 36-year-old woman, who seeks IVF treatment with Pacific. In the standard plan she would pay $ 14,625 each try ($ 7,725 for the basic plan, and $ 7,900 for drugs and other incidentals). In comparison, Pacific's money-back plan refunds 90% of the treatment costs for the attempts that fail before the 12th week of pregnancy. However, 'incidental' costs – all $ 7,900 – are not refunded. Furthermore, Ms. Cummings' bill is not itemized, making additional coverage, through outside insurance, infeasible. (Other clinics frequently help patients get outside coverage by supplying additional financial information about their treatment.) In effect, the clinic is now providing an internal insurance program which to some extent limits Ms. Cummings' risks by charging extra for the initial treatment. It is only after a single failed attempt that a woman breaks even; and only after two failed attempts does the plan actually save her money. The cost of a single attempt with the standard plan is $ 14,625; for three attempts it is $ 46,875, regardless of success. For the partially insured plan Ms. Cummings would pay $ 23,400 for a single successful attempt, with failure costing $ 8,900. If successful after three attempts, she would pay $ 40,800, with failure costing $ 24,600. Besides the financial aspects of the money-back plan we must consider the impact of the marketing strategy on the behavior of the clinic and the patient. Clinics, offering the money-back guarantee, claim that it reduces financial and emotional stress for couples and increases the confidence in the clinic and helps offset the disappointment of an unsuccessful attempt to become pregnant. As we have seen in the financial analysis above the procedure still is quite costly and suggests that women would get 90% of their costs refunded but in reality the much higher treatment costs from the beginning and many costs are not refundable. Because of this it is questionable if a money-back program gives real peace in mind. On the other hand we have to consider the drawbacks involved in such a strategy. I will mention just a few:

• medicine becomes more like a classical business encouraging a profits-over-patients mentality;
• the clinic can extend its influence on women (e.g. if you do not follow our instruction you will not be elegitable for refund);
• encourage doctors to practice risky medicine to increase success rates and avoid having to give rebates;
• offering the program only to patients with the best chances of becoming pregnant;
• offers could increase false hope in procedure, and increases the likelihood of multiple attempts.

The Ethical Committee of the American Fertility Society provides rather minimalist recommendations for certain procedures. In 1992 President Bush signed a law, which has been fully enforced since 1994, which addresses assisted reproductive technology programs and the evaluation of their services and success rates, the certification of embryo laboratories, the accreditation of organizations, certification revocation and suspension, and the publication of success rates.11

A uniform decision on the health insurance coverage of the IVF treatment through health insurance has not been reached. Six states mandate that IVF be covered by health insurance but the coverage through Medicaid varies among states. Federal Funding of embryo research is an ongoing dabate. Since 1975 the Department of Health and Human Services (DHHS) keeps an effective moratorium for embryo research which, despite many attempts, stays in force.

Tabitha Powledge argues that "Reproductive technologies have turned out to be creatures of the marketplace, a fact we did not foresee. Because of this commercialization, women must be as careful in selecting a clinic as in buying a used car. Where initially it appeared that government would impose test-tube babies and genetic engineering on society, the great irony is that we now look to government to protect us from the Brave New World ... The recent history of reproductive technologies like IVF and sex choice should be teaching us a great truth: that there is enormous consumer demand for them, and that commercial enterprises are only too happy to meet the demand. With reproductive technologies, we are dealing not with government but with the marketplace, and it looks to me as if we're not going to get to vote."12 [Top]

Feminist Position on the IVF

At first glance new reproductive technologies seem to help infertile persons to have genetically related offspring but further examination shows that these technologies reinforce and intensify patriarchal structures and at least part of purpose is to enlarge men's control over women. Women are not only made more passive objects by these technologies but they are also not seen as whole unique persons anymore. New reproductive technologies make women objects for manipulation and experimentation. Antiinterventionalists believe that the negative external effects of new reproductive technologies outweigh the benefits for the individual woman and thus conclude that these technologies must be opposed. The following two quotations describe some of the arguments in more depth. Maria Mies and Chris Shore view the issue from an anthropological and historical perspective; for instance:

"The lesson from anthropology is that every society has a vested interest in controlling reproduction, and in each we tend to find dominant institutions – the church, the state, the medical profession, or whatever – competing to monopolize the discourses through which legitimate reproduction is conceptualized. In the case of spiritual kinship this control is effected through the symbolic rebirth of baptism. In the case of the new reproductive technologies, modern science offers the potential to go far beyond the symbolic or ritual sublimation of natural birth. The unease this generates, particularly among women, is summed up by Stanworth's remark that 'feminists have increasingly seen in the new reproductive technologies nothing less than an attempt to appropriate the reproductive capacities which have been, in the past, women's unique source of power.'"15

Robyn Rowland addresses especially the dangerous aspects of in vitro fertilization and shows what may happen when women are self-alienated by modern technology. In Rowlands words:

"In vitro fertilization is a procedure which uses women's bodies as living laboratories and invades their lives and their sense of self. Healthy fertile women are often placed on programmes for their husband's infertility and end up undergoing dangerous procedures .... The development of new 'improved' technologies which are more invasive, such as 'reduction' to limit multiple births, and the development of egg banks open up further avenues for the abuse of women. Finally the drag-net of in vitro fertilization is thrown wider and wider, through, for example, 'sister surrogacy' and the microinjection of sperm, seducing more and more women into experimental programmes that endanger women's lives and health."16

All these criticisms have in common that they underestimate the potential benefits of new reproductive technologies for the individual woman. Their scepticism and warnings against these technologies might be correct and to a certain extent helpful but they do not provide real solutions for handling these technologies. Interventionalists believe that opposing technological development will not be successful in the long run. There are two main explanations for this assumption. First, a logical one: further scientific development is unavoidable because a thought which is possible in principle will be thought sooner or later. Restrictions may delay a scientific development but they cannot prevent them. Second, prohibition of research at the national level: if a single country decides to prohibit research in a certain area it faces two major dilemmas. Although research is not allowed in one country it does not necessarily mean that it is prohibited world wide. Research can only be prohibited successfully through international conventions or agreements. Interventionalists believe that technologies can be beneficial for women if women exert control of these technologies and direct future research. Global economy and cross-national research projects make it necessary for such influence at the national and international levels. The following quotation by Adrienne Rich shows that we must acknowledge historical and conventional structure of society, and that lamenting past developments will not help with present problems and future challenges:

"Patriarchal man created [...] out of a mixture of sexual and affective frustration, blind need, physical force, ignorance, and intelligence split from its emotional grounding, a system which turned against woman her own organic nature, the source of her awe and her original powers. In a sense female evolution was mutilated, and we have no way now of imagining what its development hitherto might have been; we can only try, at last, to take it into female hands."17

It seems rather idealistic to assume that women as individuals can take the future development into their hands and influence national and international decision making processes by state and private actors. In regard to new reproductive technologies women have to acknowledge that the individual choice of whether or not to use these technologies has large social and political implications, and that their 'informed consent' is made on the basis of choices which have already been limited.18 The following quotation explains this argument in more depth:

"Private decision making cannot be sufficient for evaluating a new reproductive technology if its introduction is likely to produce political, social, and economic changes beyond its effects on specific users. ... Because effective forms of reproductive technology increase the possibilities for human intervention in reproduction, they create opportunities for greater power in the hands of whoever controls that technology. Until quite recently, the male-dominated medical, religious, and legal communities conspired to keep contraceptive knowledge from women."19

In short, I agree with the interventionalists. I would argue that an opposition or denial of new reproductive technologies can work only temporarily and, in the long run, it is better to accept new reproductive technologies and to integrate them with a democratic decision making process. To do this we must acknowledge that 'informed consent' to use IVF is made under preconditions which limit our choices from the very beginning and using these technologies is not as straight forward as buying the 'normal' goods and services of the marketplace. The social and political implications of these technologies extend beyond the private realm and must be discussed in the public sphere. As the use of these technologies is more than a mere "market" or "consumer" choice, the state must be responsible for regulating and influencing future development and use. Furthermore I argue that women need organizations which provide information independently from their physicians, and help women see beyond their own infertility, to the background of power relations between state, corporations, science and medical profession. These organisations would lead to a greater involvement in the regulation of new reproductive technologies by those most affected by them: women. They could help the state create standards, ensuring that this area of medicine does not remain an uncontrolled subfield of politics. [Top]

Notes
(Click on the note to go back to the text)

1. Rich, Adrienne Cecile (1977), 11.
2. Rich, Adrienne Cecile (1976), 127.
3. Merrik, Janna C. (1995), 85.
4. Rowland, Robyn (1992), 13-14.
5. Williams, Linda S. (1992), 261.
6. Williams, Linda S. (1992), 261.
7. Bronniksen, Andrea L. (1989), 29.
8. Merrick, Janna C. (1995), 89.
9. Wozencraft, A. (1996), Section 3.
10. New York Times, August 25, 1996, 11.
11. A comparison of success rates of clinics can be ordered from a subgroup of the American Society of Reproductive Medicine, Society for Assisted Reproductive Technology, a self-regulating group in Birmingham, Ala., by calling (205) 978-500.
12. Powledge, Tabitha (1988), 203, 209.
13. Elshtain, Jean Bethke (1995), 34. Jean B. Elshtain puts Gena Corea in the category of antiinterventionists. She says: "Gena Corea, perhaps the most visible North American feminist antiinterventionist and founder of Feminist International Network of Resistance to Reproductive and Genetic Engineering (FINRAGE), insists that the patriarchal state reduces 'women to Matter'. She portrays men as having such total control that they compel the choices 'women learn to want to make.'" (34-35).
14. Elshtain, Jean Bethke (1995), 32.
15. Shore, Cris (1992), 301.
16. Rowland, Robyn (1992), 80.
17. Rich, Adrienne Cecile (1976), 127.
18. See Merreck, Jana (1995), 102.
19. Sherwin, Susan (1995), 149.

Bibliography

• Bonnicksen, Andrea L. (1989): In Vitro Fertilization. Building Policy from Laboratories to Legislatures. NY: Columbia UP.
• Elsthain, Jean Bethke. (1995): The New Eugenics and Feminist Quandaries. In: Elsthain, Jean Bethke, J. Timothy Cloyd. Politics and the Human Body: Assault on Dignity. Nashville, London: Vanderbilt UP, 24-41.
• Gunning, Jenniffer, Veronica English (1993): Human in vitro fertilization. A case Study in the regulation of Medical Innovation, Dartmouth, Aldershot.
• Merrick, Janna C., Robert Blank. (1995): Human Reproduction, Emerging Technologies, and Conflicting Rights. Washington, D.C.: CQ P
• Powledge, Tabitha (1988): Reproductive Technologies and the Bottom Line. In: Baruch, Elaine Hoffman, Amadeo F.D'Adamo, Jr., and Joni Seager (eds.). Embryos, Ethics and Women's Rights: Exploring the New Reproductive Technologies. NY, London: The Haworth Press, 203-235.
• Rich, Adrienne Cecile (1976): Of woman born. Motherhood as experience and institution. NY: Norton.
• Rich, Adrienne Cecile (1977): Of woman born. Motherhood as experience and institution. London: Virgago.
• Rowland, Robyn (1992): Living Laboratories. Women and Reproductive Technologies. Bloomington: Indiana UP.
• Sherwin, Susan (1995): New Reproductive Technologies. In: Bushnell, Dana E. "Nagging" Questions: Feminist Ethics in Everday Life. Lanham, MD: Rowman and Little, 1995, 147-169.
• Shore, Cris (1992): Virgin Births and Sterile Debates. Anthropology and the New Reproductive Technologies. In: Current Anthropology 33 (June 1992): 295-314.
• Wozencraft, Ann (1996): It's a Baby or it's your money back - Fertility clinics test consumer rebates. In: The New York Times, August 25, 1996, Section 3, 2F, 10F, 11F.
• Williams, Linda S. (1992): Biology or society? Parenthood motivation in a sample of Canadian Women seeking in Vitro Fertilization. In: Holmes, Helen: Issues in Reproductive Technology I. Anthology. New York: Garland Pub., 261-274.