An Ethnography of Assisted Reproduction Practices in Argentina
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CONFLICTED CONCEPTIONS: AN ETHNOGRAPHY OF ASSISTED REPRODUCTION PRACTICES IN ARGENTINA Kelly Amanda Raspberry A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Anthropology. Chapel Hill 2007 Approved By: Sue Estroff Marisol de la Cadena Judith Farquhar William Lachicotte Michele Rivkin-Fish Barry Saunders ©2007 Kelly Amanda Raspberry ALL RIGHTS RESERVED ii ABSTRACT Kelly Amanda Raspberry: Conflicted Conceptions: An Ethnography of Assisted Reproduction Practices in Argentina (Under the direction of Sue Estroff) In this ethnography, I focus on the community of reproductive medicine professionals in Argentina to examine how assisted reproductive technologies (ART) are transformed according to local conditions of practice, as well as how they are transformative of the societies they newly inhabit. Based on three continuous years of ethnographic, interview and archival research conducted primarily in Buenos Aires, my findings reveal that the production of ART in a given place is not a culturally-neutral process, but rather involves local forms of science, medicine, modernity, morality and choice. In chapter one, I give a contextual history of how ART began in Argentina, and locate today’s Argentine infertility specialists within a transnational network of training, scientific prestige, innovation and competition. In chapter two, I examine the specificities of the local production of ART in Buenos Aires, which include a series of moral positions on family, motherhood, and the role of the Catholic Church in medical practice, as well as creative maneuverings around legal, economic and political constraints. In chapter three, I analyze the practice of gamete donation in Argentina, in which beliefs about genetic inheritance, options for family making, and the market-side of reproductive medicine all intersect. In chapter four, I focus on the problematic of the morally and iii legally ambiguous embryo, and examine two techniques in particular, embryo cryopreservation and preimplantation genetic diagnosis (PGD), to illustrate how medical and scientific protocols are translated to fit local conditions of practice. Throughout these chapters I argue that the production of these medical technologies are shifting deeply rooted beliefs about the sanctity of human life and the role of technology in manipulating that life. I conclude that currently in Argentina the reproductive medicine professionals who provide ART to the public are society’s moral guardians, diagnosing the healthy body and family, defining when personhood begins, and dictating what protections are due human life. In the last instance, this cultural analysis is revealing not only of assisted reproduction practices in Argentina, but also circulates back to inform the production of ART as a global medical technology. iv ACKNOWLEDGMENTS This dissertation would not have been possible without the support of many people. Dissertation field research was generously supported by the National Science Foundation Cultural Anthropology division (Dissertation Improvement Grant), the Social Science Research Council (International Dissertation Field Research Fellowship), and the Wenner Gren Foundation (Dissertation Fieldwork Grant). Pre-dissertation field research was supported by the Ford Foundation (Summer Research Grant) and the Tinker Foundation (Field Research Travel Grant). Dissertation writing was made possible through generous assistance from the UNC-Chapel Hill Graduate School (On-Campus Dissertation Completion Research Fellowship). My deepest gratitude goes to those in Argentina and Chile who allowed me access to their clinics, laboratories and thoughts. In particular I thank the many people in Buenos Aires who welcomed me into their professional and personal lives. Special mention goes to my porteño friends who helped me make this research a reality: Natalia Adamo for her excellent transcription work, Sabrina de Vincentiis for her explanations and enthusiasm, and Fabio Tirra for listening. Thank you also to Sara Ackerman, Mary Ajideh, Joy Noel Baumgartner, Monika Bieri, Michelle Cohen, Kathy Julian, and Brenda Werth: you enrich my life with love. Thank you to my non-traditional family, Colleen, Jody, Kabir, Laura, and Mac, for your years of support. To my advisors, I have learned so much from all of you. Marisol de la Cadena, Sue Estroff, Judith Farquhar, William Lachicotte, v Michele Rivkin-Fish, Barry Saunders: thank you. And finally, thank you Miguel for helping me to understand the untranslatable of life and love. vi TABLE OF CONTENTS LIST OF TABLES...................................................................................................…...viii LIST OF FIGURES………………………………………………………………..……ix ABBREVIATIONS……………………………………………………………….....…xii INTRODUCTION: Life Under the Microscope and the Cultural Politics of Assisted Reproduction in Argentina…………….……………............1 INTERLUDE I: Living and Working with Assisted Reproductive Technology……………………………………………………………………...45 CHAPTER ONE: The Gestation and Birth of ART in Argentina…………………...….61 INTERLUDE II: “High Complexity” Aspirations and Transferences: The In Vitro Meeting of Egg and Sperm in a Buenos Aires Infertility Clinic....120 CHAPTER TWO: Ideologies In Vitro and the Daily Performance of Assisted Reproductive Technologies………………….……...………….….151 INTERLUDE III: Twelve Tries, One Daughter……………………………………….226 CHAPTER THREE: “The Fertile Market”: Argentine Variations on Adoption and Donation……………………………………………………...233 INTERLUDE IV: “I Would Not Freeze My Children”: Cryopreserved Embryos and a Legal Guardian in Buenos Aires.................................................287 CHAPTER FOUR: The Genesis of Embryos and Ethics In Vitro: Embryo Cryopreservation and PGD………………………..……………294 INTERLUDE V: “God Answered our Prayers”: The Miracle of IVF at a Reduced Cost………………………………………………...……………..337 CONCLUSION: Life Beyond the Microscope…………………………………………342 BIBLIOGRAPHY………………………………………………………………………353 vii LIST OF TABLES Table 1. Chronology of significant political and ART-related events for a contextual history of ART in Argentina………………………...…………70 2. Biological developmental stages of the in vitro embryo……………….………300 3. Laboratory procedures in Argentina based on biological stages of embryo development…………………………………………………304 viii LIST OF FIGURES Figure 1. Tradition and modernity in Buenos Aires………………………….…...……..1 2. "With a little help from science." Viva magazine cover-story on ART treatments in Argentina……………………….…...…...19 3. Typical "street scene" in Buenos Aires: child performer in Recoleta neighborhood………………………………………….………...30 4. Plaza San Martin: downtown Buenos Aires…………………………………36 5. Surgery area in ART center in Buenos Aires……………………………..…39 6. Embryology lab and scopes in Buenos Aires……………………………..…40 7. Embryos as visual decoration at the FLASEF 2002 meetings in Punta del Este……....…………………………………..…42 8. Clarín article: "The First Babies Created by Fertilization in the Country Turn 18 Years Old."…………………………....61 9. "IVF 1985" with names of original CEGyR team…………………………...91 10. Painting on wall inside diagnostic reproductive medicine lab (L). Cross hanging inside director’s personal office (R)……...................95 11. Bank Boston in the downtown area of Buenos Aires……………………...109 12. Tanks and Armed Police in front of the Casa Rosada in Buenos Aires. First anniversary of 2001 protest: December 20, 2002……..111 13. Red Cross volunteers. First anniversary of 2001 protest: December 20, 2002………………………………………………...111 14. Las Madres de la Plaza de Mayo protesting payment of the external debt………………………………………………………....112 15. "We are all Argentines." Government ad for a public celebration of 25th of May (the national revolution day) at the Plaza de Mayo…………..116 ix 16. Chart of International Relationships and Formation of ART clinics in Argentina……………………………………...………...119 17. Surgery area—where aspirations and transferences are performed—in an infertility clinic in Buenos Aires……………………120 18. Scope and Thermal Plate in workchamber…………………………………129 19. Eggs Ready for ICSI injection, after hyaluronidase wash and stripping of the cumulus cells………………………………………….132 20. Makler Counting Chamber (L). Sperm under Makler counting chamber (R)………………………………………………………135 21. Micromanipulation microscope…………………………………………….136 22. Micropipette and sperm selected for ICSI………………………………….139 23. ICSI: two seconds post-injection of sperm into egg, the mark of the pipette is still visible……………………………………….140 24. Nine Day Three embryos (not Augustina’s), varying in quality. Five to eight cells………………………...………………...…...142 25. Small Cryopreservation Machine……………………………………...…...145 26. Cryopreservation tank……………………………………………………....145 27. Monitor in the surgery room connected to microscope in the laboratory, used to view in vitro embryos…………………………..148 28. Nativity scene in Entre Ríos province of Argentina………………………..151 29. Full-page advertisement in a magazine: "The ticking clock that you carry within”………………………………………………………165 30. Logo for a shop inside the Abasto shopping mall in Buenos Aires that sells baby accessories……………………………………………165 31. National Congress Building in downtown Buenos Aires…………………..176 32. Catholic Church Cathedrals in the city of Salta, Salta Province (L); and San Isidro, Greater Buenos Aires (R)…………………...182 33. Mural outside a public hospital in Buenos Aires…………………………...209 34. Public hospital in Buenos