City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 2011 Mother Country: Reproductive Tourism in the Age of Globalization Lauren Jade Martin Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/1795 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] MOTHER COUNTRY: REPRODUCTIVE TOURISM IN THE AGE OF GLOBALIZATION by LAUREN JADE MARTIN A dissertation submitted to the Graduate Faculty in Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2011 © 2011 LAUREN JADE MARTIN All Rights Reserved ii This manuscript has been read and accepted for the Graduate Faculty in Sociology in satisfaction of the Dissertation requirement for the degree of Doctor of Philosophy. Barbara Katz Rothman June 7, 2011 Date Chair of Examining Committee Philip Kasinitz June 23, 2011 Date Executive Officer Hester Eisenstein Frances Fox Piven Supervisory Committee THE CITY UNIVERSITY OF NEW YORK iii Abstract MOTHER COUNTRY: REPRODUCTIVE TOURISM IN THE AGE OF GLOBALIZATION by Lauren Jade Martin Adviser: Professor Barbara Katz Rothman Mother Country is a multi-sited, qualitative study of the United States fertility industry. I analyze the industry in two dimensions: as a particularly American institution and nascent profession, and as a destination for “reproductive tourism.” The United States fertility industry, buttressed by lax federal regulation, free market principles, and high technology resources, is organized to benefit certain classes of American citizens and foreign nationals in their quest to have children. As such, the United States has become a prime destination for people seeking assisted fertility services such as commercial surrogacy, egg donation, and sex selection, which are unavailable, inaccessible, or illegal in many countries. I employed a grounded theory and mixed-methods approach to my topic: I used participant observation and in-depth semi-structured interviews in three major metropolitan regions (New York City, Los Angeles, and San Francisco), to generate thick, empirical data about the fertility industry in these respective cities. I also employed ethnographic content analysis of medical and scientific journals, newspaper reports, and industry marketing materials, and comparative policy analysis on the state, federal, and international level to identify trends and patterns about the global state of the field. iv I find that the United States produces ideal conditions for a fertility industry with a global reach. It boasts a robust network of fertility doctors, family law attorneys, and egg donation and surrogacy brokers, in addition to advanced technologies, high success rates, and lax federal regulation that enables clients to obtain services in locales with policies amenable to their needs and desires. Moreover, the profession itself has situated itself in such a way that enables it to secure its position as an autonomous body with gatekeeping functions, as professional organizations establish norms of self-regulation absent the teeth or enforcement of law. v ACKNOWLEDGMENTS There are many, many people I would like to acknowledge for their support through my graduate career and the writing of this dissertation. First of all, I would like to thank the physicians, lawyers, egg and surrogate brokers, and other fertility industry professionals who took time out of their very busy lives to meet with me to discuss their work. I hope that I have accurately and respectfully recorded and portrayed their views and words. This project would not have been possible without their generosity. Barbara Katz Rothman has been an advisor, mentor, and colleague extraordinaire—thank you for all of the conversations about the weird wide world of infertility and reproductive technology. Hester Eisenstein and Frances Fox Piven have not only been supportive committee members, but they have also provided wonderful models of how to be actively engaged public intellectuals. Props to Juan Battle and Victoria Pitts-Taylor for their help and guidance on numerous occasions, and to Rosalind Petchesky for her insights on Foucault and biopower. Soniya Munshi, Julie Netherland, Danielle Jackson, Wilma Borrelli and I have been meeting as an informal support group since the Age of Orals, and I could not have done this without their advice, problem-solving, and cheerleading. Thanks also to the folks from study groups of yore: Patrick Inglis, Jeff London, Karen Gregory, Carlene Buchanan, Marcos Tejeda, and Yvonne Liu, and to the rest of my CUNY family: Josh Howard, Nazreen Bacchus, my bros Kim Cunningham and Kate Jenkins, Craig Willse, Mitra Rastegar, Diana Rickard, Mike Jolley, and Erynn Masi de Casanova. Thank you to Daisy Deomampo for comparing notes about reproductive tourism in India. vi Thank you to Eleanor Whitney, Keight Bergmann, Brian Ford, Adrienna Moy, Rana Boland, everyone who contributed to the “Baby Needs a New Computer” Fund, and all the friends that are too numerous to name. Thank you to Andreas Martin and Irene Martin for being there and believing. The research and writing of this project would also not have been possible without financial support from CUNY, including the CUNY Writing Fellowship, a Doctoral Student Research Grant for travel to California, the Nina Fortin Dissertation Proposal Award from the Women’s Studies Certificate Program, and a Baruch College Bernard L. Schwartz Communication Institute Communication Fellowship. vii Table of Contents Abstract iv Acknowledgements vi Lists of Tables and Illustrations ix Introduction 1 Chapter One: Reproductive Tourism: A Global Perspective 27 Chapter Two: The Logic of Reproductive Tourism: The United States as 48 Destination Chapter Three: The “American” Character of the United States Fertility 80 Industry Chapter Four: “You Don’t Go to Jail if you Didn’t Follow Guidelines”: 118 Ethics, Professional Autonomy and the United States Fertility Industry Chapter Five: The Genetic Imperative: Compulsory Motherhood Meets the 160 New Eugenics Chapter Six: Anticipating Infertility: Egg Freezing, Genetic Preservation, 187 and Risk Conclusion: Governmentality, Biocitizenship, and the Neoliberal 206 Exception References 215 viii Tables and Illustrations Tables I.1 Recruitment 20 I.2 Providers interviewed 20 I.3 Levels of policy analysis 24 1.1 Availability of reproductive technologies in four countries 38 2.1 Absolute and per capita number of fertility centers in 9 countries 55 2.2 Existence of national laws and policies regulating ART 57 3.1 Insurance mandates 87 3.2 Concentration and number of fertility clinics in United States 93 (including D.C. and Puerto Rico) 3.3 States with laws regarding assisted reproductive technologies 106 3.4 Organizations in which providers claim membership 111 5.1 The genetic imperative in assisted fertility services and 168 technologies 5.2 Mothers’ biological relatedness 172 5.3 Biological relatedness of intended parents 173 Figures 4.1 Medicalization 126 4.2 Commodification 127 4.3 Tangle of roles and statuses 128 ix Introduction When I walked into Deirdre’s1 family law office in a suburb of San Francisco, the first thing I noticed, aside from a life-sized statue of a Dalmatian, were four giant bulletin boards absolutely filled with photographs of babies. Although there were an overwhelming number of them, I was not shocked by the sight of so many babies. I’d been seeing them everywhere, ever since I started conducting research on the United States fertility industry. Practically every waiting room I’d spent time in—in New York City, in Los Angeles, in San Francisco—it was babies, babies, everywhere. Deirdre was just one of twenty people I interviewed about their experiences helping international clients obtain assisted fertility services in this country. Over a lunch of mediocre Chinese food, Deirdre answered questions and told me stories about how some of those babies featured on her bulletin boards came to be. Thus I learned about a couple she worked with from Japan, where surrogacy is not legally recognized: The woman didn’t want anyone to know it was a surrogacy, so she got pictures of the surrogate, and every week added a new pillow. And said to people that she was coming to the United States for the last eight weeks of pregnancy because there was something wrong with the baby, and they could do surgery on the baby in the womb, so she was coming here, and she was going to stay here [in case she needed to be] hospitalized. And then she returned with the baby, and it all worked, but it was like, wow! This case may have the element of sensation, but it also typifies many aspects of what traveling to the United States for assisted fertility services has to offer: circumvention of law, anonymity and privacy, and high-tech resources. Reproduction—including conception, pregnancy, parturition, and childrearing—is a deeply private matter involving deeply private choices. Yet procreative decision-making is not only a personal issue. Private choices about 1 Not her real name. 1 family building are made in the context of national and global phenomena such as market forces, scientific innovation, state policies, and multilateral agreements. Procreation has been commodified since