Reviewing the Womb Elizabeth Chloe Romanis , Dunja Begović, Margot R Brazier, Alexandra Katherine Mullock
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Extended essay J Med Ethics: first published as 10.1136/medethics-2020-106160 on 29 July 2020. Downloaded from Reviewing the womb Elizabeth Chloe Romanis , Dunja Begović, Margot R Brazier, Alexandra Katherine Mullock Centre for Social Ethics and ABSTRACT from their view. Pernicious narratives about conflict Policy, Department of Law, Throughout most of human history women have and danger, born from ignorance, have endured University of Manchester, and transmuted into modern, medicalised tropes. Manchester, UK been defined by their biological role in reproduction, seen first and foremost as gestators, which has led to New reproductive technologies, heralded as Correspondence to the reproductive system being subjected to outside increasing reproductive choice for women, equally Elizabeth Chloe Romanis, interference. The womb was perceived as dangerous foreshadow exacerbation of maternal–fetal conflict Centre for Social Ethics and and an object which husbands, doctors and the state and medical hegemony over women’s choices. We Policy, University of Manchester had a legitimate interest in controlling. In this article, we illuminate this problem and argue that such atti- Manchester School of Law, tudes must not be permitted to direct ethico-legal Manchester M13 9PL, UK; consider how notions of conflict surrounding the womb elizabeth. romanis@ manchester. have endured over time. We demonstrate how concerns approaches to emerging technology. ac. uk seemingly generated by the invisibility of reproduction Until recently, the womb was an exclusively and the inaccessibility of the womb have translated into natural, static female organ, but medical science Received 27 February 2020 similar arguments for controlling women, as technology is now delivering opportunities to transplantii or Revised 19 May 2020 iii Accepted 8 June 2020 increases the accessibility of the female body and the emulate the function of the womb. Women who womb. Developments in reproductive medicine, from in suffer from uterine factor infertility can now receive vitro fertilisation (IVF) to surrogacy, have enabled women a uterus transplant, and it seems feasible that soon and men who would otherwise have been childless trans women and cis men wanting to gestate their to become parents. Uterus transplants and ’artificial own child could too.iv Such advances may poten- wombs’ could provide additional alternatives to natural tially degenderv gestation. On the horizon, there gestation. An era of ’womb technology’ dawns. Some is the promise of ‘artificial wombs’vi creating argue that such technology providing an alternative to further options for the wombless and those who ’natural’ gestation could be a source of liberation for want a child but not to gestate. More choices for female persons because reproduction will no longer all putative parents and better healthcare for the be something necessarily confined to the female body. fetus, whether in a parent’s biological uterus or ’Womb technology’, however, also has the potential to a ‘machine,’ appear to represent progress which exacerbate the labelling of the female body as a source should be welcomed. of danger and an ’imperfect’ site of gestation, thus History, however, suggests that a note of replaying rudimentary and regressive arguments about caution must be voiced about the impact of such controlling female behaviour. We argue that pernicious narratives about control, conflict and the womb http://jme.bmj.com/ ii In December 2014 the first baby was born from a must be addressed in the face of these technological transplanted uterus in Sweden.99 developments. iii In 2017 a team of fetal scientists and surgeons in Philadelphia revealed an AW prototype that had ‘As all historians know, the past is a great darkness, yielded promising results in animal testing (the and filled with echoes.’ Biobag). Another research team, based in Western ― Margaret Atwood, The Handmaid's Tale Australia/Japan, has reported similar results from testing their prototype AW, the EVE platform. In on September 24, 2021 by guest. Protected copyright. 2019 a third research team in the Netherlands announced they had received Horizon 2020 funding INTRODUCTION to build their AW prototype.71–73 This article traces how attitudes to female repro- iv Medical objections to uterus transplantation duction, shaped by historical misunderstandings of in non- biologically female persons (that formed procreation and the female body, have perpetuated the basis of the Montreal Criteria about ethical an approach that continues to subjugate and ‘other’ uterus transplantation) do not appear to be well- founded.100 women,i especially as they gestate and bear children. v Claims that artificial wombs will de-gender gesta- From classical times, the womb garnered suspicion tion are frequently made in the literature.96 98 101 102 and fear among ‘medical men’, theologians and For an explanation of why these claims are inaccu- ordinary people partly because it was obscured rate see.103 vi © Author(s) (or their Kingma and Finn note that it is more appropriate employer(s)) 2020. Re- use to refer to ectogestation and the specific names of i It is important to acknowledge that it is persons designed prototypes because describing the technol- permitted under CC BY. 58 Published by BMJ. of female biology, regardless of the gender they ogies as ‘artificial wombs’ is inaccurate, and as we live in or identify as, that can become pregnant. will demonstrate the notion of an ‘artificial’ womb To cite: Romanis EC, In this article, we refer to women and pregnant might perpetuate harmful narratives about the need Begović D, Brazier MR, et al. women because throughout history the fact that the to control gestation. Here, we use the term ‘artifi- J Med Ethics Epub ahead of majority of pregnant people identified as, or were cial womb’ because this is how they are popularly print: [please include Day assumed to be, women because of their biology referred to and understood, and because this term Month Year]. doi:10.1136/ has impacted on how pregnancy has been and is is an important part of our argument about how medethics-2020-106160 conceptualised and how pregnant people were and language is used in this context to create narratives are treated. about women. Romanis EC, et al. J Med Ethics 2020;0:1–10. doi:10.1136/medethics-2020-106160 1 Extended essay J Med Ethics: first published as 10.1136/medethics-2020-106160 on 29 July 2020. Downloaded from developments on women’s rights and role in society more gener- 1991,4 husbands enjoyed something akin to what we might clas- ally. Fascination with the womb, coupled with the capacity for sify today as a right to procreate, and wives a duty to provide the others to intervene for the benefit of the fetus, has culminated means by which he might do so.vii in the notion of ‘maternal–fetal’ conflict, in which the interests A husband’s interest in the child was magnified by the firm of pregnant woman and the fetus are presented as incompat- belief that the child was ‘his’, the product of his body; he had the ible with, or in competition with, each other. While advances in strongest of interests in ensuring that no other man’s ‘animal- reproductive technologies offer hope and important solutions cule’ was carried in the wife’s womb and passed off as his. He for putative parents, there may be unintended side effects that had a further strong interest in ensuring that the behaviour of negatively affect pregnant women because of prevailing narra- the ‘gestational carrier’ did not compromise his reproductive tives within healthcare, maternity care and wider society. enterprise. That sadly did not mean that all husbands acted posi- In this paper, we recall how frameworks based on the womb as tively to promote the health of the wife. The high rates of child a site of conflict, and concerns about the need to control women mortality and at many times in history the surplus of women because of their wombs, are evident in medical practice and law over men might mean that quantity in reproduction was the throughout history. We then consider how these narratives have primary objective, to generate as many children as possible and prevailed as advances in medical technologies have provided us replace ‘worn out wombs’ with fresh stock. The desire for sons with a ‘view into the womb’, and demonstrate why the conflict and primogeniture begin to make sense. If you accepted animal- framework is not only conceptually and evidentially unjustified, culism, a son when he reproduced begat a grandson who shared but also potentially harmful. Finally, we examine this danger your blood. Daughters will bear a child formed by her husband’s in connection with future reproductive technology, focusing ‘animalcule’, unrelated to its maternal grandfather. on ‘artificial womb’ technology, to interrogate these issues in a A working womb did not necessarily benefit the woman, contemporary context. We consider the development of ecto- but to be barren might have been a worse fate. From classical gestation and argue that such technology exemplifies further times, theologians and physicians declared barren women to be why we need a wholescale shift in medicine, ethics and law away monstrous. In Ancient Greek myth, the grisly Gorgon queen from narratives that consider pregnancy and the womb as a site Medusa, whose gaze turned men to stone, was said by some of danger. to be barren. The empty womb was dangerous, but so was any womb, dangerous to the woman and to others. Secreted far from public view, wombs were judged the cause of many female ills, or HIDDEN FROM VIEW rather conditions styled ‘ills’ by men. Possession of a womb has not always been a blessing. In the past, Women, learnt men declared, were defective creatures the woman who successfully gestated children faced an agonising possessing weak intellectual capacity and unregulated emotions.