By Hedva Eyal

Great advances have been made in reproductive technologies in recent decades;   however, those advances also gave rise to new problems and vulnerabilities. The variety of possibilities and access to reproductive assistance for people who wish to become parents, including purchase of eggs and surrogacy, raises questions about the ways medical technologies influence our society and especially the health and status of women all over the world.

 In many different societies, motherhood and procreation is still considered the essential natural component of women's identity. The creation of a child is considered fulfillment of the social convention of an acceptable family. The longing for a child, and the availability of reproductive technologies for privileged people, intensifies the social pressure on women to give birth at almost any price. This strong social construction, combined with powerful economic interests of the local and global fertility industry, creates a "need" for finding solutions to the growing difficulties in becoming parents.

There is plenty of scientific knowledge and understanding of health risks as a result of hormone treatments associated with in vitro fertilization (IVF).1 This raises questions about the widespread use of this procedure, especially when women are exposed to these health risks not for themselves but to conform to other people's desires. Establishing surrogacy as a prevalent, accepted way of bringing children into the world entails significant risks to the surrogate mother herself, to the child, and to society.

In recent years, surrogacy and egg selling have been taken for granted as the next step in reproductive assistance, accepted as technologies that can be used when pregnancy is not achieved through individual fertility treatments. Conceiving pregnancy and childbirth for another couple or individual solely as a financial business transaction raises ethical and feminist reservations. "Surrogacy in Israel," a report published by  Israeli feminist organization Isha l'Isha, raises concerns about the likelihood of exploitation in the complex relationships between the different actors in commercial surrogacy-especially when organizations with private financial interests are involved.

I hasten to acknowledge that regulating surrogacy and ending egg selling would not eliminate this risk; it would only help diminish the exposure to economic exploitation and trafficking. At the same time, however, it may increase its legitimization on the social level.

Removing the social, bureaucratic and economic barriers from the application for surrogacy strengthens the message that motherhood should be the center of a woman's life. It makes the acceptance of one's infertility less and less legitimate and increases the social and family pressure on women and couples to invest all their resources in attempts to achieve parenthood.

Moreover, the widespread accessibility to surrogacy harms the currently existing social perceptions of the importance of the relationship between the mother and the baby in her womb, and conveys a social message that this relationship has no actual emotional, health, or legal significance. As the use of surrogacy increases, this message becomes stronger and undermines the concept of motherhood as well as having a negative impact on the status of women in relation to their children. Another significant consequence for women's status is the growing commoditization of women's bodies for the purpose of trading in reproductive organs.

Supporters of surrogacy and egg selling claim that these uses of her body are legitimate acts of a woman as part of her free choice. They see these transactions as a contract between two adult parties who are responsible for their actions. Against this claim, we face a harsh reality in which the notion of free choice obscures poverty and desperate solutions to economic distress. The Israeli journalist Ran Reznick recently published an article on Ukrainian women who are selling eggs to Israeli couples. Resnick met the Israeli couples and the women who sell their eggs. He described the reality of those two sides as frustrating and sad. All the parties involved are aware of the suffering caused to the women who are selling their eggs.

In the article, Resnick interviews one of the clinic managers. "Ask me instead of her why is she doing that," the manager says, "and I will answer: for the money. There were cases where women asked for an advance payment for the eggs, because they had no money to feed their children." A local lawyer who represents Israeli couples said in the interview: "There are also questions about fairness expressed in the gap between the payments that those women are receiving and the money that goes to all those involved in the treatment. Selling eggs is not unusual in Ukraine... people in circle of poverty are driven to do so... People are forced to sell eggs or their kidneys. There are also women slipping into prostitution."

In the same article, an Israeli gynecologist, Eli Geva, described the Ukrainian women slightly differently, saying that "those women are not sad, they are submissive." The medical professional plays an important role in the "reproductive tourism"-or to call it what it is, trafficking. It raises questions about their role in creating this industry. How does it go along with their oath to avoid doing harm? How is it legitimate to use medical knowledge and technology that were created in order to heal and cure people, in a way which risks women's health?

These gaps raise difficult and complex questions with no obvious or absolute answers. How are we to face the local and global constellation in which the more affluent are more protected? Are we aware of the situations in which there are people who have to sell body parts in order to survive? Do we, as a society, take equal care of women from different socio-economic status? How should social responsibility be translated into actions? Who will make sure that the rights of women who sell their reproductive organs are not violated, and how will their safety be ensured?

Not all the procedures of selling eggs and surrogacy should necessarily be considered trafficking in human organs. Surrogacy is sometimes handled with mutual respect and responsibility-but these cases are the minority. Further, even when we overcome this problem, the health risks still exist.

The reality women face in a world of globalization and advanced medical technologies seems to preserve patriarchal patterns. Women are more exposed to poverty and therefore more exposed to exploitation. Advanced reproductive technologies are not necessarily serving women, nor do they create a just society. These new technologies reinforce old patterns about women's duties as mothers and use women's difficulties to promote the economic interests of others.

Hedva Eyal is Women & Medical Technologies Project Coordinator at Isha L'Isha (Woman to Woman) Haifa Feminist Center in Israel.



1. D. Sperling (2010). "Commanding the "Be Fruitful and Multiply" Directive: Reproductive Ethics. Law, and Policy in Israel," Cambridge Quarterly of Healthcare Ethics, 19: 363-371.

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