Critical Tech Talk 5: Artificial Wombs: The Disobedient Future of Birth
Um so welcome to Critical Tech Talk five. I'm super excited um these speakers we met last week and they came early today and they have a lot to say and it's super interesting. I wish we could have invited you to all of those discussions. Um before we get to that I do have some preliminaries. I hope it's not it's not too long we have um we have an introduction and I wanted to get some "thank yous" out of the way first of all before we get into things. So first thing I want to do is thank the opposite research for funding this the Critical Tech Talk series. I also want to thank all six faculties at the University
of Waterloo, I think it's great to see that every faculty on campus has endorsed this speaker series which demonstrates a great commitment to um to responsible innovation among other things. I also want to thank Communitech, which is where we're located right now, where the Critical Media Lab is located, they've also helped fund this and I want to thank Wendy Philpott in the Faculty of Arts for setting up this Critical Tech Talk website and Elena Hines Sabrina McAllister Communitech for their assistance with promotion. And finally Alexi Orchard who's running the whole show right now and uh has been very instrumental in getting these events planned and off the ground. So I mentioned that all six faculties support the Critical Tech talk series and I've invited each time the dean of that faculty to say a few words beforehand, so in this case it's Dean Lily Liu of the Faculty of Health. And I'm going to share my screen and Dean Liu has actually recorded
um uh some opening statements which I think are quite lovely and a land acknowledgment so I will share my screen now and hand it over to Dean Liu. Good evening my name is Lily Liu and as Dean of the Faculty of Health, I am pleased to provide the land acknowledgment and some introductory remarks. The University of Waterloo acknowledges that our work takes place on the traditional territory of the Neutral, Anishinaabe, and Haudenosaunee peoples. Our main campus is situated on the Haldimand Tract, the land granted to the Six Nations that include six miles on each side of the Grand River. Our active work toward reconciliation takes place across our campuses through research learning, teaching, and community building and is coordinated by our Office of Indigenous Relations. Last February, we invited Elder Myeengun Henry to join the Faculty of Health as our Indigenous Knowledge Keeper. On June 20th 2022, on behalf
of the Faculty of Health, I made a commitment with Elder Henry who represented the Indigenous Community to uphold the commitments made in the response to the calls to action of the Truth and Reconciliation Commission. President Vivek Goel acknowledged the University's full commitment to reconciliation, indigenization, and decolonization through a formal ceremony on September 22nd 2022. I would like to extend a special Welcome to our speakers Claire Horn, Killam postdoctoral research fellow from Dalhousie University's Health Law Institute, Alana Cattapan CRC Research Chair in the Politics of Reproduction and assistant professor in the Department of Political Science, and Margaret Mutumba a PhD candidate in the School of Public Health Sciences at the University of Waterloo. Our moderator is Marcel O'Gorman, professor in the English Department. Critical Tech Talk is produced by the Critical Media Lab at the University of Waterloo. This series is sponsored by Communitech the office of research and each of the six faculties. This
is the fifth in the series and is fitting that this talk is co-hosted by The Faculty of Health. Today's topic by Dr. Claire Horn titled Artificial Wombs: The Disobedient Future of Birth, is certainly going to generate an uncomfortable dialogue around ectogenesis or artificial wombs. This dialogue challenges us to adhere to an ethos of responsible innovation or Tech for Good, which is the purpose of each Critical Tech Talk. About 16 percent or one in six couples in Canada experience infertility. This prevalence increases to one in four couples in developing countries.
Artificial womb technology promises to provide an opportunity for women who do not have a uterus to bear children. Conventional treatments for infertility is currently inconsistently accessible across Canada highlighting the inequities across socioeconomic status and other indicators. This divide would only widen with the introduction of expensive innovations, such as artificial wombs. A more unsettling thought is the current promotion of artificial
wombs not as a health intervention but as a social intervention to address perceived inequities such as biases and discrimination. For example, one can find on social media quotes like "artificial wombs allow the birth of a child without risking the potential health in career hazards that come with being pregnant. They can also help a woman compete on a more level playing field in a sexist world that discriminates against pregnant women." Like all new innovations, just because we can do it the question is should we and if yes under what conditions, what regulations are needed to be in place to ensure that we use technology responsibly. I anticipate this evening's
discussion will stretch us beyond our comfort zones and push us to reflect on our values as we question not what the technology can do but how we as a society can use this technology for good. Sorry it was great uh it was a great introduction, uh thank you Dr. Liu for that uh you've saved me some work actually with with my introductions. Uh before we begin though, I just I'm sorry I just want to add one thing and then I'll shut up. This talk was inspired in part, I hate to say it, by a Twitter exchange between uh Elon Musk's uh Gumroad founder Sahil Lavignia and Ethereum co-founder of Vitalik Buterin, who happens to be University of Waterloo alumnus. In the exchange,
the three founders muse over the possibility of synthetic wombs as a way to liberate women from childbirth, allow them to contribute more fully to the workforce, and uh and ease the the problem of um of an underpopulated world. Um I won't comment on this at length but I would say that it also speaks to the opening of Dr. Liu's statement about about colonialism and I don't want to trivialize the notion of colonialism or the land acknowledgment that she gave but the concept of tech colonialism speaks to the idea that um Big Tech quite consciously draws in the function of colonial power to appropriate and exploit everything from outer space to minerals in the earth to private data and yes possibly even the human uterus if given the opportunity. So as much as I want to ignore that Twitter match uh Twitter conversation I think it's important to acknowledge what's at stake in it. And anyway I'm not here, you're not here to listen to me or
listen to me rant. I want to introduce our esteem speaker who, unlike me, is an expert on this topic. So Dr. Claire Horn, as you of heard, is a Killam postdoctoral research fellow at Dalhousie uh in the Health Law Institute. She's previously held research fellowships that welcome trust and modern law review her work over the last six years is focused on law and policy governing sexual and reproductive health rights and technologies with specific interest in ectogenesis. And note her book, Eve: The Disobedient Future of Birth, just came out in the UK last week, I think that's right uh Claire, and I understand the book will be available in Canada in September of this year. So I'm going to stop talking now and hand things over to Dr. Claire Horn, thank you.
Thanks Marcel I feel like I have all of this uh pre-buzz starting out the talk with uh with Elon Musk as a specter over us, um I'm gonna just move into screen share and then I'll get straight. Okay so before I begin, I just want to acknowledge that I am actually speaking to you from Mi'kma'ki which is the ancestral and unceded territory of the Mi'kmaq people, who are the past present and future caretakers of this land. Um I want to thank uh Marcel and Alexi for organizing and Margaret and Alana for being here as respondents. Um what I really want to do and I think that we've kind of had the stage set for this already, is just to provide us with some grounds for a broader discussion about artificial wombs and about reproductive technologies uh more broadly.
So I'm actually currently on parental leave, I wrote my book Eve uh while pregnant with my first child and they happened to kind of arrive about the same time. Um but I'm glad to be able to dip back into this work as as my book, like Marcel said, was published about a week ago in the UK. So I'm hoping to speak for just about 20 minutes and with an eye on the time what I thought I'd do is give you a bit of an overview of artificial womb technology, and then uh kind of the Kohl's notes version of of my book, um and then I wanna I wanna get into a specific example that I'm really interested in. So when people hear ectogenesis, external gestation, or artificial womb, I think it's extremely easy and very compelling to kind of leap into speculating on dystopian or utopian possibilities for this technology. Um what Eve is really about is arguing that artificial wombs of course are neither fundamentally good or bad on their own, they'll be shaped by the social context into which they arrive. So it's about kind of
grounding the technology within the existing limitations of the world we live in today. So like I said to round out the talk, I'm going to get into one example and specifically the implications of artificial wombs within the context of contemporary health inequity, uh specifically for pregnant people and pre-term babies. And then I just want to really open up the question of how we could reframe our discussion of artificial wombs and their development by taking an approach to this technology that's informed by justice. Okay, what am I doing here. So prematurity remains the leading cause of death globally for children under the age of five and in a well-resourced wealthy hospital today, the point at which an extremely pre-term baby stands a chance of survival sits around 23 to 24 weeks; but before 28 weeks morbidity remains extremely high, simply because these pre-term babies, their organs have not yet sufficiently developed to be able to survive in the outside world. In 2017, research groups based in the US and working across Australia and Japan, respectively, created platforms in which they gestated land fetuses from the equivalent of approximately 23 weeks in a human, for four weeks in an artificial womb, bridging this really important developmental period. These technologies work by replicating
the environment of the uterus, so they submerge the fetus in continually circulated artificial amniotic fluid that is pumped by the fetus's own heartbeat, and they're paired with an artificial placenta that delivers nutrients and flushes toxins. And there's differences in these platforms which have been called Extend and Eve, we can talk about that more in our discussion, but they share a similar approach and there's also a group now working in the Netherlands and I believe there's a team working at Sick Kids in Toronto, too. So what makes these technologies really distinct from existing forms of neonatal care, is that the technology that we currently have it acts as an emergency intervention to redress the complications of preterm births. But the intention of these technologies is to effectively prevent those complications from arising to begin with by allowing the fetus to continue to develop as though it had not yet been born. So the immediate goal of these technologies is to act as a form of emergency life supports, to extend the developmental period into the point where the pre-term baby has a better chance of survival and health outcomes. Um and there's been successful animal trials of this technology and I believe each group is hoping to move to clinical trials with humans within the next five to ten years.
Um as a kind of sidebar, one of the the research teams actually recently released a paper looking at how they might manage um birth or movement from the pregnant person's body into the technology without the fetus ever physiologically becoming a baby. Meaning moving it from the uh the pregnant person's body into the tech without ever breathing air. So I think there's a whole slew of ethical questions around consent that we might want to dip into there as well. Um concurrently with this work in neonatology, there's been research and embryology over the last several years towards the cultivation of embryos outside the body. So two research teams at
Rockefeller and Cambridge University were able to successfully grow embryos up to 13 days. And this was quite significant because prior to this point, it was believed that embryos would need input from a maternal body to continue to develop at around seven days, so this showed that the embryos could actually self-organize in the absence of maternal tissues. This research only stopped due to what's called the "14-day Limit." This is a strict law or research guideline in a number of countries but it's actually in the process of revision in some places, and Alana maybe you can talk about that a little bit after as well. More recently, two groups based in Israel and the UK respectively were able to grow mice from embryos into fetuses with fully formed organs using a mechanical artificial womb. So this was quite remarkable this is the first time that mammals have been
externally gestated in this way and the scientists hope to take the mice to full term and eventually replicate the experiment with human embryos, if they are able to get ethical approval. So there's much discussion in the in the social scientific literature about whether these forms of research will one day meet in the middle and will have achieved what's called full ectogenesis. So that would be the gestation of a baby in an artificial womb from the stage of embryo implantation through to removal from the artificial womb. Um there are significant scientific and regulatory barriers to this and I delve into all of these in Eve in pretty substantive detail. Um I think there is a
really important question here about whether this actually is possible. Uh but for the purposes of this talk I'm interested in both full ectogenesis but I also want to sort of offer a focus on some of the ethical questions uh surrounding artificial rooms as neonatal technology. So I wrote Eve because as I think many of us here know scientific research often moves faster than cultural conversations and so I think now is the right time to have a public dialogue about the implications of ectogenesis for parenthood, for human and reproductive rights, for health inequality, among many other ethical issues. These technologies really pose a breadth of legal, social, and ethical questions and as I mentioned before I think time and time again with these kinds of promissory technologies and development um we tend to go down the path of imagining extremes. These utopian or dystopian scenarios and in Eve I really tried to bring it back to looking at the contemporary limitations of the world we live in today. Um so looking at specific legal contexts in specific countries for instance to kind of think about what the actual implications of these artificial wombs - artificial womb technologies are. But I want to turn to a
brief example and offer some questions that I hope will be generative for us kind of leaping into our discussion. So I want to talk about artificial wombs in the context of contemporary health inequality. The scientists that are working on neonatal technologies, like Eve and Extend, they intend them to alleviate the very real harms of extremely preterm birth. So again,
um these technologies could prevent complications from arising potentially as early as 21 weeks gestation, so that's just past the halfway point of a full-term human pregnancy. And this is actually quite remarkable um and there may also be uses in the care of pregnant people. So for instance, delivering treatments to a preterm baby, to a fetus, without exposing the pregnant person to harmful substances. Uh or further down the line, for use for health issues in the later stages of pregnancy pose a danger to the pregnant person. Again, there are issues of consent that we can think and talk about here. But from well before the current developments, social scientists have really extolled artificial wombs as revolutionary for the potential to ease the dangers of pregnancy. Which can include like threatening conditions, like pre-eclampsia.
And there's also a framing in the feminist literature in particular of artificial wombs as a potential new reproductive choice. And in this framing, there's often a discussion of this choice occurring initially for health reasons and then potentially further down the line as an alternative means of reproduction. Um I think these ideas are compelling, they're interesting, but the streaming really needs to be grounded in contemporary structural context. So first of all, the reality is that these platforms and progress are costly, they're labor intensive, they require expert training, and they're really designed for limited uses in the most well-equipped neonatal intensive care units. Each patented piece of this biotechnology is going to be very pricey and their stakeholders already across numerous companies with collaborations across computer programming, engineering, and biotechnology more broadly. And then the social conditions into which this
technology arrives are starkly inequitable and they are that way specifically for the groups that external gestation is intended to benefit, so pregnant people and pre-term babies. According to the World Health Organization, ninety-four of perinatal deaths globally occur in low and lower-medium income countries and infants in these regions are significantly more likely to be born preterm. Ninety percent of extremely pre-term babies that are born in low-income countries, die in the first few days of life, compared to ten percent high income countries.
As of 2022, the World Health Organization reports that in low-income settings, half of all babies born at or below 32 weeks, which is significantly further along than these technologies are targeted at, die due to a lack of feasible cost-effective care; such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high income countries, almost all of these babies survive. And of course these disparities are not down to a lack of technology, this is down to an inequitable distribution of low-cost resources, like antibiotics, steroids, and safe culturally sensitive and appropriate midwifery care. Within wealthy nations, despite the broader availability of these resources that I've mentioned, racialized inequity in outcomes for babies and pregnant people is stark. So in Canada, Black and Indigenous women are more at
risk of having pre-term and stillborn babies and Indigenous women are more at risk of death and complications during the perinatal period and the limited data that we have suggested this is also true for Black mothers in Canada. These kinds of racialized inequities in the rates of preterm births and complications from these births, as well as the perinatal outcomes, map across other wealthy nations like Australia, the US, and the United Kingdom. So for instance in the UK, the rates of preterm birth and complications for Black women and their babies are in fact increasing. These problems are down to issues including structural racism, biased, and insufficient care, the legacy of colonialism, as I believe Marcel mentioned, and inequitable distribution of birth centers and resources. So even as we see artificial wombs celebrated in the humanities literature as a game changer, we really need to ask the question "for who?" So there's no current reason to believe the technologies and development are going to do anything other than really increase existing stratification or leave it as it is. Um the idea that ectogenesis, and this is
a quote from uh Takala, would not only free women from pregnancy and provide an additional choice in care but also potentially eventually lead to true equality, that comes up in much of the literature, it's challenged by the stratifications that that currently exist in reproductive care. So to put it very simply, technology doesn't solve social problems, so if you introduce it without having touched the social causes of inequity, you leave those disparities unaddressed. Um and I think there's very real questions to ask here, about whether we should be creating these technologies at all, right? So um the physician and the founder of the US-based National Birth Equity Collaborative, Dr. Joy career pairing notes, that a consistent problem that perpetuates inequity in reproductive health is investment in biotechnologies rather than people. So for instance investing in these kinds of technologies, like artificial wombs,
over for instance, programming to train and support midwives, opening birth centres in places with little access, support for traditional birth practices within communities, and measures to understand the causes and reduce uh pre-term birth rates in the first entrance. And just to as much as I hate to go back to Elon Musk, we can flag here that if Musk and his buddies, for lack of a better term, genuinely cared about uh women, than they would invest in all of these kinds of issues. They would put their billions into these issues the research that's already occurring on the ground; rather than speculating about artificial wombs. But research towards artificial worm platforms is already occurring. So it's already been granted quite significant funding, in a number of wealthy nations, and this is the context that it's taking place in, so these inequalities exist and the research has been funded. So with that sort of acknowledged, I want to close out with just framing how we might have a different kind of conversation about artificial wombs and I hope this can sort of push us into our discussion.
So the position that I take in Eve, is that the precondition, for a future in which we could actually use artificial wombs in compelling progressive or feminist ways, is a world grounded in reproductive justice and I think we can also have a chat about what constitutes a progressive use of this technology, right? Um and I don't think that the pursuit of artificial wombs, as a means of redressing very real risks to pregnant people and pre-term babies, uh is not a worthy pursuit and I think emerging projects that consider the artificial womb as a way to improve reproductive health choices, within a different context, I think that that those ideas again, are compelling. But I think this is about emphasizing that this technology is likely to enter a context of substantive inequity and I think that by acknowledging that we can re-bring questions about how the technology could be designed adapted introduced and regulated. Um I'm informed by a reproductive justice framework when I'm thinking of about considering this technologies against contemporary realities. And just as an explainer, reproductive justice is a Grassroots initiative founded by Black women in the United States. The
sister song, Women of Colour: Reproductive Justice Collective, defines the framework as quote "the complete physical, mental, spiritual, political, social, and economic well-being of women and girls based on the full achievement and protection of human rights." The framework emphasizes the importance of quote "fighting equally for the right to have a child, the right not to have a child, and the right to parent the children we have, as well as to control our birthing options, and the enabling conditions to realize these rights." Loretta Ross, who is one of the founders of the movement, notes that for reproductive care to be granted, so for these necessary enabling conditions to occur, people have to be provided with the resources to experience care in a way that is safe, affordable, accessible, and acceptable to them. So being informed by this framework, to me, in this in this specific context of this technology, means situating discussions of reproductive technologies within their social context and understanding the ways that race, class, gender, global location, immigration status, sexuality, among other aspects of people's identities and experiences, shape access to and quality of reproductive care. So understanding how a person's ability to act on reproductive choices is really shaped by the conditions in their community and by social, structural, and institutional factors. And I think engaging a framework that's informed by reproductive justice to consider the artificial womb, is a way to compel us to look beyond a focus on whether the technology could act as, this is a quote from Evie Kendall, "a new reproductive alternative." It requires us to ask who might be
excluded from the choices that the technology is purported to increase. And the aim here is one of re-situating, so what would happen if we granted an analysis of the technology, within a discourse of reproductive justice and freedom, rather than within a discourse of liberal choice? How can we reframe discussions about the implications of artificial wombs? And again I just want to offer a starting point here for us to kind of explore. Um so I want to offer a few questions and I think um it's important to emphasize that I don't want to situate myself as the person that should be answering these questions. I just want to put them forward and maybe we can we can sort of get
into some of them in our discussion and we can also just leave some of them hanging there too. Uh so firstly, what if justice was foregrounded as these technologies were designed, developed, and implemented? Is it possible to conceive of the future with artificial wombs in a different way? What happens if we were to leave with the question of capacity for safe use in low resource environments? Current research on artificial rooms is happening within wealthy nations, how might collaboration with organizations and practitioners working in low-income nations alter the impact of artificial wombs, or couldn't? What if questions of accessibility, adaptability to spaces outside the NICU for instance, by midwives, doulas, pregnant people themselves, were raised? What are the materials, at issue, in artificial womb construction? So where are these materials sourced? What do they cost to assemble them and who has stakes in their use? What infrastructures are required for safe assembly? Who is included as a stakeholder? As someone that has an essential perspective on the development of this technology, are we talking only engineers and physicians and neonatologists? What about midwives, pregnant people, birth workers? Um and I think there's also issues we need to really think through with regard to the ethics of trials of this technology and consent to use, I mentioned this briefly, um but I think that this is important and I write about this in in Eve as well but maybe we can read this into our discussion too. So when we think about the role of regulation, there are uses of this technology that a workable framework and future might promote or might protect against. Um and I think the real one of the real key issues here, is who is centred in these discussions? So right now conversations about artificial wombs are very much happening in kind of conservative, bioethical spaces and in uh sort of legal, scholarship uh circles, if you will. Um and I'm interested in what would happen if questions of how this technology could or should be used and where, were formulated not by bioethicists and scientists, but by pregnant people, intending parents of all genders, nurses, doulas, midwives, and again birth workers within communities. So I realize I just put out a lot of um questions,, it's kind of my thing um but I hope that it provides us a sort of generative fodder uh to get into a conversation, thank you. And I have a long slide here with some references,
um I'll just put it up briefly if anyone wants to take a quick screenshot. Claire that was brilliant, thank you, thank you so much, so much to think about. Uh uh yeah who is the human and human-centered technology um amazing. So again um, I'm just going to quickly reintroduce our two respondents and conversants here, same conversants, Alana Cattapan, Canada Research Chair and the Politics of Reproduction and assistant professor in the Department of Political Science the University of Waterloo. And Margaret
Mutumba is a PhD student in Public Health and Health Systems at the University of Waterloo. Um Margaret also have there, I'm going to give them a like a minute to talk about their work, so I'm not going to do any more introducing except to say that Margaret is defending her PhD dissertation this week, which I think crazy. Thank you so much for agreeing to be with us, so Margaret why don't we start with you, just say a few words about your own work um so we have some context and then we'll move on to Alana, who can do the same, then we went to the conversation part, thank you. Thank you Marcel, um good evening everyone. Um well my work is centred around infertility or access to fertility services, primarily in sub-Saharan Africa, so very much uh connected to Claire's presentation and just thinking about how that technology has been utilized in those spaces. So my PhD research is on examining access and affordability through a public health lens,
which is my background, and I also have a entrepreneurship um endeavour through mid-atlas, where we're connecting doctors to specialist healthcare, in particular fertility specialists as well, and that's a little bit about me I think. Gotta find the unmute button, which I never do. You feel like after years of being on Zoom I would get the get the deal. Okay, hello um I'm Alana, I'm the politics, the lead of the Politics of Reproduction Research Group also at the University of Waterloo. You can find us at the politicsofreproduction.ca um and my work um, in this role, is to examine how law and policy work together to reify inequalities related to the governance and politics of reproduction. So for me, that question is
about how do state actions and inactions regulate and govern reproductive decision making and who gets seen as potentially reproductive and who's excluded from those conversations. Um Margaret did I interrupt you? I feel like you, okay you were totally done. I have such trouble on Zoom like reading people's faces. Okay, so my work right now is centred around a few empirical
projects, it's always centred around empirical projects, I'm a social scientist. So I'm in the midst of three separate empirical projects right now with people who are left out or not always seen as priorities in decision making about the use of reproductive technologies in Canada. So that's people who have been surrogates, people have been egg donors, and people who are freezing their eggs, and our teams are asking about their experiences and factors that inform their decision making, as much as we can in an hour and a half interview or a survey. Um I'm also part of a large collaboration at the University of Saskatchewan where I'm an adjunct professor, where we're collaborating with an Indigenous health research group and an organization called Sanctum 1.5, which is a 10 bed pre- and post-natal home with these adorable little babies, that supports HIV positive pregnant women and those at risk of having their infants taken at birth. And so we collaborate in thinking about how women want to make decisions about raising or not raising their babies and making decisions about how to live their lives. And
um I'll wrap up real quick Marcel, sorry there are other projects as well about the concept of reproductive age in my group and how it shapes the decision making and autonomy of different people, on transgender diverse folks access to care, genetic and genomic governance on the commercialization of body parts, including reproductive tissues, but we're also looking at blood plasma. And my students are doing incredible work on midwifery, endometriosis, visual depictions of pregnant bodies, and abortion, amongst other critical topics. So I'll stop there and I'm so excited to talk about this work, Claire. Amazing, um I'm going to ask I'm going to ask Margaret to go first and Claire wrote a bunch of questions but you probably had your own questions or things that came to mind during the talk or beforehand, so go ahead Margaret. Thank you and yeah, um I really appreciated the presentation and a couple of things came up but I think one of the questions Claire did pose is whether um artificial wombs could be a reality um and what that could look like. I have confidence in the human race and I do think that that can be a reality. Um going back to when, you know my background obviously is in fertility and IVF, but in the 1970s, when IVF technologies were being developed, um a lot of individuals and scholars and researchers critiqued it but also assumed that it would not be a possibility. And you know 30 years down the road, here we are, it's part of clinical
practice and it's being utilized. So I think it's very much a possibility and from a public health lens, I think there's a strong argument around communities or countries where they're having a population decline, wanting to pursue this, you know, line of of reproduction because it gives you more control over the process. Already we have, I think in my opinion, over medicalized the birthing process and so this is just another step in that direction. You don't have to depend on a woman, in this case, or a person with a womb to be able to do that, you can do that excluding all those individuals. And so, in a world where power is held amongst a handful of people, um what does that look like in terms of equity, again to your point Claire, who's going to be making those decisions? Who is going to be able to afford these sorts of technologies? I will say for the moment, at least for the argument around low income context and and you know poor birthing outcomes, especially for pre-terms, I don't think that argument would be applicable in this case because this technology and the infrastructure for that to successfully happen does not exist in those low resource contexts and I don't see it existing for a long time. And so I think that
the basis of that argument is already flawed and maybe thinking about folks who are already financially advantaged and just want to give their pre-term um babies a better outcome, um is a more realistic argument to put forward and those are my initial comments. Sorry, I just writing down your comments. Should I respond, no yeah. Um thank you, Margaret. That is so many so many really compelling points that you made um to think about. Um I'm just looking at what I've noted down and I wanted to ask you more about a couple things. Well first, um I think to your point about the that kind of um potential
for engagement within low-income contexts. I think that's a really important point because certainly while the artificial womb differs from, substantively differs from incubator technology, we can already look at existing technologies and think about these various attempts right have um incubators that are more adaptable to low resource settings. But then also the fact that we haven't seen this kind of massive ship in the construction and creation of incubators. Um and so there is a point there of why would we then expect that artificial wombs could um translate. Um so I wonder if you can talk a little bit more about that and then I also wanted to ask you to say more because I completely agree with your point about um this existing problem of already over medicalizing birth. And this is a major concern for me and I think I mentioned briefly in the talk about um some of this discussion of trying to physiologically make sure that the pre-term remains uh in the state of a fetus as opposed to a baby and how that would kind of work. Um but could you talk a little bit more about your point,
both the point around um the uh sort of the flaw in that idea of the artificial womb and the low income setting and also a little bit more about the over medicalization of birth. Absolutely. Um so the one, of course the biggest issue, that I'm glad you highlighted, is that many times these technologies are developed in wealthy countries, on their own, and then they want to then carry that technology and translate it into a low income context. Which is one, um very, what's the word, discriminatory. Um and two, you cannot expect folks to automatically buy into um a system that you've established solely from the perspective of a western context or a wealthy context. That is quite unacceptable and in my own work um through IVF research,
I've heard many practitioners, clinicians in the low resource context, saying one, we are not engaging in that process and two, um why do you then want us to adopt it without also considering whatever the societal and contextual issues around that technology are, that could be incorporated early on to avoid issues down the road. So if you say, for example incubators, um that's most likely a technology that was not developed in the lower resource context. And just using that technology in many hospitals you have to think about infrastructure challenges, like lack of consistent electricity. I mean for an artificial womb, that's already a dead end, there is no way you're going to be able to sustain that. Number two hygiene. Hygiene, sanitation, and access to clean water are things that are still very much um challenging in those contexts, which um this sort of technology would require. But then you also have to realize that in many low resources, and I will speak specifically for African context, is our power structures sometimes are very, are not as Democratic. For instance I'll say for
Uganda, for instance, we've had the same president for 32 years now, right? So they are power structures which are monopolized and so how would this technology be used in context where that control and lack of regulation exists. And automatically, actually when you're talking, I thought about the genocide in Rwanda and how they wanted to eliminate a whole ethnic group and so if someone has power with this sort of technology, maybe they can generate a whole ethnic group that they might find desirable. So it's it's very very dangerous in context where you know politics is not practiced fairly or power is not distributed fairly. But the also the question around over medicalization, just briefly I'll touch on. The history of birthing in many African contexts, is a very intimate cultural practice where before you had midwives we had traditional birth attendants. And these were normally older women in the community who knew these mothers, who had probably raised them in some way, and it was a very intimate, personal experience.
With the medicalization of that birthing process, a woman goes to into a health um centre and is helped through this process by someone she's never met, by someone she doesn't know, so that human connection is lost. And now we're furthering the process by saying, actually, probably you won't even need midwives at this point to this artificial birthing process. You just need a few scientists, a few engineers, so it's further dehumanizing in my opinion, the experience of birthing and reproduction. I understand the argument for folks who are having preterm, or have pre-existing conditions, and so on. But they're real, unintended consequences that could come out of this technology and I think it's worth having that discussion. Um I just want to say briefly, Margaret. Uh thank you, that was
um like really really uh generative thoughts and I want to say also to your point about the dangerous ways that this technology could be used. So this is something that I talk a lot about in the book, um that we do have, it is not hard to find examples of pregnant people um having their control over their bodies, taken over, um particularly by uh the state. And so it's something that comes up that has been flagged in the literature before. And you get some of
these arguments in some of the the bioethical um literature, that is very dismissive of that idea, that's sort of like oh it would never happen but precisely as you pointed out it, has already happened. It has happened many times and so why would we not um look to the possibility that it could happen and then talk about how we prevent that. Alana, good time for you to jump in here, I bet. Yeah it was just unmuting. You know I keep thinking Claire, I'm like,
as you were talking about the possibility of autonomy being overruled in this case, drawing on what Margaret said, you know I think about the language of liberation that surrounds this, that we mentioned before, that Marcel opened with a little bit. I think about Sheila McFirestone and, of course I had to cover my eyes for some reason to remember her name. Um but the idea of surrogacy and in vitro fertilization is liberating and then there was a big you know excitement about egg freezing for the same reason, about egg donation, about human nuclear genome transfer mitochondrial replacement, whatever you want to call it.
I was just attending, Margaret and I were talking about this, the other day the third International Human Summit on Human Genome Editing. Excitement about um in vitrogenetogenesis, like there are so many technologies that may or may not be possible, but increasingly shape how we think about reproduction. But there is not a great move towards liberation in this kind of language. And you know your talk has really made me think about, not only how this creates stratification, but the false promises of a new ideal. That if only we could realize another technology, we will be liberated from a repressive bodies, and therefore find equality. But we don't hear about
things like I don't know addressing, you know of the Dean Liu opened with um the note of one in six people being infertile. But we don't talk about addressing sexually transmitted infections that often cause that, delayed parenthood which may cause that, exposure to environmental toxicants which can cause that. There are so many ways in which which were offloading the problem to the promises of the future ideal technology in a way that, I think you pointed out really beautiful here. So I wanted to point you to sort of two things. One is the language of choice, which you mentioned, and the sort of liberal framing of this technology is potentially liberatory in an entirely individual way. Which I think your framing of this as a matter of reproductive justice addresses but I wonder if you could speak more specifically to the language of choice that's often used to talk about reproduction and how it operates here in useful, but also insidious ways. And the other thing I wanted to bring up is something that we've been having an email conversation about, Marcel you have not seen this, but Margaret and Claire and I have been talking over the last few days about the concept of fetal viability. And the way that the the potential to
move fetal viability backwards one week,, two weeks three weeks,. might have implications for legal constructions of fetal personhood and laws governing other things including abortion Wow, yeah. So um another question came up for me there for both uh both Margaret and Alana that we can maybe put in a pin in, which is that I would love to hear both of your thoughts on how some of these kinds of ideas of the promise of artificial wombs are also wrapped up in discussions of fertility technology, so how you've sort of seen some of those things before. Margaret I know you touched on it briefly but I would be really curious to hear more about that. Um uh to just, so these two these two like big meaty questions about choice and the concept of fetal viability.
Um firstly on choice, you know it's I think that um it is just such a consistent problem throughout discussions of reproductive care. That this idea that uh it's simply about providing choices to people and then we've kind of done enough. Um this is exactly what has landed, what has caused this kind of um mess in many many places around abortion rights. Where abortion is, in theory, protected by law but impossible for people
to access because "the choice is protected by law" but access isn't protected. And it's very easy to just continue to peel away at access to all forms of reproductive care in this way of offering that choice has been protected because the law says that you can choose what kind of uh care you want but making access impossible in practice. Um and I think that also goes back to both these issues, that I think are useful to think of in conjunction with this discourse on artificial wombs, um so around both access to abortion and to fertility technologies. Um where I think we all know in the work that we do, that in fact um there is this promise, for instance, around uh medication abortion and around IVF, that look at all of the ways that this is going to change uh the world and be so empowering. Um and then in fact all of those those ideals are struck down by the fact that choice without access and without context means absolutely nothing. Um and then to the point about fetal viability, so there's two things that I would touch on. One
is that what actually got me into this topic in the first place was that when I was doing my PhD, I came across the term ectogenesis and understood that this research was happening. And then uh I was just floored by how much of the literature on this topic from legal scholars, was vested in making the claim that if artificial wound technology existed, people would no longer be morally permitted or legally permitted to have abortions. And the claim here is basically that um abortion is protected because uh pregnancy occurs in a person's body and therefore their autonomy is affected. However if it was possible to simply transfer that pregnancy out of their
body, thus no longer involving their body in the equation, um we would require people to do that instead of seeking termination. Um and so a lot of my writing has just been me being so angry that this claim gets made and you know pointing out how regressive and anti-feminist it is and also how it totally fails to recognize all of the reasons why people would seek abortion, right? Um which people shouldn't have to provide a reason for seeking an abortion to begin with. Um and then the other sort of more um I guess jarring aspect of this is that the law in many places where abortion is still criminalized but is permitted under a series of exceptions, the law does bake in fetal viability or personhood as a kind of limitation around the abortion right. So for instance in the UK, um abortion is still criminalized under the abortion act and one of the exceptions under which abortion is permitted is that you can access it prior to fetal viability. And so the danger is that there is this sort of the theoretical plane but then there's also the legal problem, which is that because we have these limited insufficient abortion law, there shouldn't there doesn't need to be law on abortion to begin with, right? Um there is a potential legal challenge that I think we do actually have to be uh keeping an eye on and it's not I think it's also important that it's not a new challenge to abortion rights, it's just another tool in a long-standing challenge to those rights. Yeah, I think that one of the exchanges we were having was about how many of these technologies could be extremely liberating, extremely helpful, extremely generative, in context where different family forms are supported, where there is real equality in substantive ways, like in an ideal world perhaps we could have this conversation but the preconditions for that simply are, so feel so far away. I think I used in our exchange, like impossible to imagine.
I think that I think that actually maybe addresses a couple of the questions that we're getting from um from attendees. You know the question about um the issue um would women, would artificial wombs, impact women's rights to abortion. Especially with women choose not to use artificial wombs. Um and how could ectogenesis be applied by the state, for example, or other sources in that case and that's a question that um someone has asked. And then the other question uh just about uh the problem of the the issue of um uh of reproductive justice, including a right to ectogenesis as a form of securing safety in childbirth, in the future.
Maybe that's more getting more toward a utopian future where ectogenesis is available to everyone. Um but I think you're I just want to address a couple of those questions from um from the audience. But we don't have to address all of them and I'm sure you have more to say so I don't interrupt the conversation. One thing that amazes me is that, I was just looking up there's an article from 1995 on cyber feminism that references ectogenesis and this discourse fits perfectly in along with the rhetoric and discourse of disembodiment in technology for everything from the internet to virtual reality. Um praising this idea of transcending the human body, it's like
trans-humanist way of understanding technology and ectogenesis, this discussion really brings that down to earth in a very real way. Sorry I don't want to interrupt, I'm sure you have more to say. No no, I just feel like - it's not in the 90s. I feel like you could if you kept looking you'd find stuff from the 70s that's doing that. And science fiction, as one of our - a couple of our attendees have pointed out - that there is a history in science fiction about these very ideas as well so. The 20s, it goes so far back. Yeah. Um yeah there - I'm not going to ask questions. I'm sure you have more to say,
so if Margaret or Alana, if you have something else you wanted to bring up, please do so. Um I just wanted to address maybe the question um around it being a viable choice for women, um with healthcare challenges and I think we have reiterated in this discussion, that it does make sense for people with pre-existing conditions, people with high risk pregnancies, people who are at risk of you know uh fatalities from current or pregnancy, and yes this technology can support that and it would be good for that. The issue is it's application, I think is what our discussion is saying here. Um because that was the same promise with IVF, right? Any woman who's struggling to have a child who have - oh a couple - will have this technology but the reality on the ground, and I think this is what Claire's um book Eve is saying, is that these technologies are not applied universally. And so IVF or surrogacy for instance, um in many African countries um, including Uganda where I'm from, surrogacy is legal but the cost of IVF in addition to surrogacy is exponential. And so it's only wealthy people that have access to one, to IVF but two,
to surrogacy because that's an additional cost. And so if we live in a context where it's still capitalist, and you know of course the cost of this treatment is expensive, and only if you have access to it, it means that only a few are going to benefit from that technology. Which is the issue we're bringing with the reproductive justice lens is that is this really going to be fair? Um but there was someone here who also asked the question around the reproductive justice lens, including spirituality, especially for people for colour, and that work has actually been very close to the kind of work I'm doing. Whereby even the current services we are providing, in
terms of IVF or infertility, it's very much from a biomedical lens, and yet when you think about it from a contextual or cultural perspective, that the ability or the inability to have children has very spiritual implications on different cultures, right? And so in what I've seen, at least in Africa, is that these services are often provided in collaboration with spiritual leaders, especially around the psychological and emotional burden of infertility and treatment. Often the psychologists that will be provided to those patients are in Uganda because it's a predominantly Christian country, will likely be Christian. But we also work with Tanzania, which is predominantly Muslim, and so the type of support they'll get there is probably going to be attuned to the Muslim culture. So they do incorporate that spiritual element and I have met clinicians who are actually religious and will share - that you know our work, as clinicians, is to do our part and we leave the rest up to God. That's the kind of discourse that you're going to
hear in many cultures where spirituality is still very much part and parcel of that culture. Now this question around artificial wombs, in the context of religion, is going to obviously be a very contentious issue because for many religions, um birthing is a god-given right, that's how they word it, it's you know children are a blessing from God. Think about all the cultural um terms that we use normally that will now be you know should I say disintegrated by this artificial womb technology, we are no longer you know thinking about this from a spiritual perspective or from a mythical perspective because now as humans we're able to do this on our own. And so I think there will be a quite a significant amount of resistance there. I will tell you that for many
religious countries, even providing IVF, they'll only provide it to couples who are married, they'll only provide to relations which are heterosexual. I know in many Muslim countries, they will not um accept third-party donation because for their lineage is very important you know, and surrogacy for instance, also some countries will not accept it. So these technologies are going to be interpreted based on the context and we cannot control that, right? You cannot develop a technology in the UK and control how South Korea decides to use it, you know. So it's almost like the person who developed the atomic bomb, it was for one reason but in the end it was used for you know such disastrous um implications. So that's that's my contribution.
Brilliant I want to stay on this topic a little bit. Uh Alana and you'll probably talk about this, but um you - the three of you are coming from pretty different uh you're covering pretty different cultural contexts in your work, which makes it really interesting. And Claire you've been doing a lot of work in the UK. Alana, you do work specifically you've done work on the ground in British Columbia and in Saskatchewan, is that right? Um and and Margaret you just told us about your experience. We have a question here about the United States, um you know the idea of ectogenesis as an alternative to abortion, is being fairly widely discussed. Um so maybe you could say a little bit more, Claire and Alana, about this cultural context and what your experiences with what you've been what you've been working in with, culturally.
Alana do you want to jump in? Exactly the same time we unmuted. Yeah, I - you know I have some difficulty answering this question. My work has been in Saskatchewan, in Nova Scotia, and um in Ontario, not in BC yet, we're starting a new project though. Um but I'll say the idea of ectogenesis being an alternative to abortion, or like an an idea a viability, makes me want to revisit the question of what problem is ectogenesis aiming to solve? Like when we are thinking about any biotechnological inner innovation or as an innovation, like what is the purpose? Um Claire you raises, or I guess this is in Dean Liu introduction right, just because we can, does that mean that we should. And there has
to be as there said a compelling reason to invest, to engage, to work with these technologies. And it's really easy for us, in the current context, to imagine compelling people to provide their biological material or generating babies for the sake of people who can pay for and desire babies, to otherwise restrict reproductive rights using these technologies. And it's really difficult for us to imagine liberatory possibilities, or at least it is for me, I feel like such a cynic when I talk about these things. And so Susan, I see your q
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