Journalist Jenny Kleeman was devastated when she lost her 20 week healthy baby due to appendicitis. The infection caused her cervix to open and forced her into labor—killing her baby in the process. It is women like Kleeman that ectogenesis or artificial wombs seek to aid [1]. Ectogenesis seeks to address the long term effects of preterm pregnancies—particularly on POC women—in addition to allowing more flexibility of how pregnancy is experienced in the future. However, there are some potential drawbacks in who would have access to this expensive technology, in addition to changing the social role of pregnancy.
Ectogenesis is currently being explored with lambs at the Children’s Hospital of Philadelphia using Biobag systems. These Biobags act like an amniotic sac with fluid that the fetus would breathe in. The replacement placenta is an oxygenator plugged into the umbilical cord which delivers nutrients and allows for gas exchange. This would allow parents to watch their fetus grow to full-term if born prematurely between 20-24 weeks [1].
One of the biggest benefits of this approach is reducing preterm birth deaths and the associated disabilities. Premature births account for 10.5% of live births and is the leading cause of death among children under 5 [1]. Eighty-seven percent of children born prematurely experience disabilities related to their bowels, brain damage, blindness, poor growth, cerebral palsy, learning difficulties, and lung disease [2].
Therefore, these new incubators would allow for the process of gestation to continue—preventing future disability or long term consequences related to premature birth. This process has not yet been explored for the entire process of pregnancy which is more technically complicated, but allows for the improvement of fetus viability. Although this is far in the future, the early stage of this research provides hope for those who may be at higher risk for preterm birth including those who have diabetes, pregnancies with multiple births, high maternal age, a lack of prenatal care, struggle with chronic stress, hypertension etc [3].
Black women face the highest rates of maternal mortality, accounting for 14.2% of premature births [3]—higher than any other racial group. Consequently, this places more Black children born with disabilities within the 30% of Black children who are impoverished [4]. With a higher likelihood of being subjected to both poverty and disability, Black children face severe systematic oppression regarding healthcare access, education access, food security, and insurance access. Therefore, families that face complications from preterm birth may be unequipped to deal with the health-related issues associated with the birthing process with little to poor government or social assistance. Additionally, with poor prenatal care, one in nine women lacking health insurance coverage [4], and obesity being key risk factors for premature birth, Black women in poverty are systematically disadvantaged without education of reproductive resources, the capitalist marketing of cheap, unhealthy diets, and no access to healthcare. Therefore, even before birth, POC women are told that their health and the health of their children doesn’t matter by dismissing and failing to provide adequate prenatal or general healthcare. By researchers taking the initiative to find solutions related to high rates of maternal mortality and preterm birth disability, they are providing hope to numerous POC mothers by prioritizing the health of those who are affected most. This can begin to deconstruct the inherent disadvantages that non-white children in lower socioeconomic groups are facing—closing the ever-widening gap with the middle class.
The future of ectogenesis involves the development of external wombs that can be used on embryos, which would aid in the preservation of maternal health. Not every woman’s body can handle the potentially trauma-inducing consequences of pregnancy including those who have to take life-saving medications for epilepsy, bipolar disorder, or cancer [1]. Not to mention the numerous health-related issues that may arise during pregnancy, including gestational diabetes, high blood pressure, depression, and anxiety [5]. This means that women would no longer have to choose between their desire for motherhood and the health of their fetus, and their own health. This frees women from the implications of the birthing process that wreak havoc on their mental and physical health—in addition to allowing women who are deemed to have ‘unviable’ uteruses to have children. With similar arguments being made in favor of IVF and egg freezing, this provides women with the opportunity to have a more flexible timeline and choice to their motherhood.
In addition, this would address the harmful birthing process itself that is only the beginning of the dismissal for the symptoms women experience to be dismissed as ‘normal.’ Heartburn, incontinence, nausea, and anemia would be considered pathological in any other context, except pregnancy where they are brushed aside as being typical [1]. This constant dismissal of symptoms represents a pattern of expecting women to endure extreme pain throughout pregnancy and the birthing process By removing the experience of pregnancy and these symptoms as ‘just a part of being a woman,’ this may combat the societal dismissal of legitimate medical concerns and push individuals to take medical concerns presented by women more seriously without pushing them aside just based on their fertility and gestational status.
Another benefit of ectogenesis is its changing of the role of parenthood. This may allow for the expansion of the archaic depiction of women as exclusively being the childbearers and caretakers. With the ability to raise children without a mother, both genders can participate equally in the birthing process—developing a similar connection and social role associated with the child. This would allow for women to be viewed beyond their reproductive capacity, in addition to preventing the social devaluation of those who are unable to carry to term or have a viable pregnancy.
However, there are some potential ethical drawbacks to artificial womb development. Currently, technologies like IVF and egg freezing which inspire this research cost anywhere from $15,000 to $30,000 per round [6]. This means that although this technology would theoretically help thousands of POC, low-income children and mothers, it would most likely only be accessible to high-income populations. This would also have the potential to widen the existing socioeconomic gaps. Fewer high-income children would be dealing with the severe disability and long-term complications associated with preterm birth, while low-income children would be left to deal with poverty and poor healthcare access—exacerbating systematic issues related to health and socioeconomic status.
Moreover, this could create a form of ‘marking’ of the female body depending on socioeconomic status. Those who may have unplanned pregnancies or those who cannot afford ectogenesis could be placed in a social hierarchy below those who have external wombs. The physical designation of a woman as being pregnant would make these individuals easier to identify and ostracize. This could unfairly label a woman as poor, careless or an unfit mother [1].
Beyond this, those who don’t want to have children who opt for abortion have the potential for these embryos or developing fetuses to be saved without the mother’s consent. This would impose motherhood on someone who has exercised a choice to not be a mother—worsening the social designation of women as being pressured into their roles as mothers. With abortion being a woman’s choice, the preservation of embryos jeopardizes the mother’s wishes to not have the pregnancy at all. The possibility to preserve the embryos for donation would therefore exacerbate the already controversial dichotomy of pro life versus pro choice movements. This continues to limit the choice for women to have bodily autonomy and exercise their right to choose.
Moreover, gestational processes have many benefits for the women who take power in their role as being able to carry and grow another human being. Many women enjoy the embodiment of being pregnant and the unique bond that forms between themselves and the child. The closeness that is experienced during those 9 months may help women connect and solidify their relationship with their unborn children. On a biological level, oxytocin levels increase during birth to promote contractions but also decrease stress and reinforce the mother-child bond after birth [7]. As a result, taking the experience away would also affect women hormonally and throughout their role as a mother.
Although this technology is in the very early stages of its development, it signals a continuous push for innovation. Despite the potential ethical dilemmas of favoring service to the white, middle-class, in addition to changing the definition of motherhood, I believe that this still allows women more reproductive options. This would provide unprecedented opportunity for women to be appreciated beyond their gestational role, in addition to acknowledging and providing care to the POC women most impacted by premature births.
References:
[1] Guardian News and Media. (2020, June 27). 'parents can look at their foetus in Real time':
Are artificial wombs the future? The Guardian. Retrieved April 3, 2023, from https://www.theguardian.com/lifeandstyle/2020/jun/27/parents-can-look-foetus-real-time artificial-wombs-future
[2] Short and long-term effects of preterm birth. UK HealthCare. (n.d.). Retrieved April 3, 2023,
from
https://ukhealthcare.uky.edu/wellness-community/health-information/short-long-term-eff ects-preterm-birth
[3] A Profile on Prematurity in the United States. Prematurity profile. (n.d.). Retrieved April 3, 2023, from https://www.marchofdimes.org/peristats/tools/prematurityprofile.aspx?reg=99 [4] Child poverty increased nationally during COVID, especially among Latino and black
children - child trends. ChildTrends. (n.d.). Retrieved April 3, 2023, from https://www.childtrends.org/publications/child-poverty-increased-nationally-during-covid -especially-among-latino-and-black-children
[5] U.S. Department of Health and Human Services. (n.d.). What are some common
complications of pregnancy? Eunice Kennedy Shriver National Institute of Child Health and Human Development. Retrieved April 3, 2023, from
https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/complications [6] Forbes Magazine. (2023, March 7). How much does IVF cost? Forbes. Retrieved April 3, 2023, from https://www.forbes.com/health/family/how-much-does-ivf-cost/ [7] Uvnäs-Moberg, K., Ekström-Bergström, A., Berg, M., Buckley, S., Pajalic, Z.,
Hadjigeorgiou, E., ... & Dencker, A. (2019). Maternal plasma levels of oxytocin during physiological childbirth–a systematic review with implications for uterine contractions and central actions of oxytocin. BMC pregnancy and childbirth, 19, 1-17.