Critical Tech Talk 5: Artificial Wombs: The Disobedient Future of Birth

Critical Tech Talk 5: Artificial Wombs: The Disobedient Future of Birth

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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   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

2023-07-31 05:46

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