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ASSISTED REPRODUCTIVE TECHNOLOGY AND WOMENS REPRODUCTIVE HEALTH
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ASSISTED REPRODUCTIVE TECHNOLOGY AND WOMEN'S
REPRODUCTIVE HEALTH
AUTHORED BY - SHUBHRANGANA PUNDIR
Introduction to the topic-
The body of
a human is a great machine, the workings of which remain a mystery. The future of
childbirth in the form of test tube babies and surrogate motherhood has introduced
previously unimagined potentials in the sexual arena. When human procreation is
separated from sexual relationships, spouses can rapidly become entities for
sex. It becomes difficult to recognize the dignity in one another, particularly
in the unborn child. Science and technology, on the other hand, have made huge
contributions to society. However, it is not morally justifiable and is rather
controversial.
Birth and
family are considered the most fundamental roots of life, and infertility is
one of humanity's most serious problems. Surrogacy is one of the assisted
reproductive techniques that employ the use of a third party. Given the absence
of a specific reproductive and sexual health care program for surrogate mothers
in Iran, as well as the challenges that these women will face, the findings of
this study are useful sources of information for the necessary interventions to
promote their reproductive and sexual health.
Fertility
is regarded as a significant value in most cultures, and the desire to have a
child is regarded as one of the most basic motivators in humans. Humans have made
numerous attempts to overcome infertility since ancient times. These techniques
were developed in response to the needs of infertile couples. Where conditions or
diseases make it impossible to carry a pregnancy, third-party reproduction may be
considered. This is known as gestational surrogacy. Meanwhile, gestational
surrogacy may be one of the infertility treatments. This method takes the form
of an agreement in which the woman agrees to carry a pregnancy and then hand
over the child to the intended couple at the time of birth.
Congenital absence
or abnormal uterus, hysterectomy, Mullerian anomaly, unexplained recurrent miscarriages,
repeated failures in infertility treatments, inability in embryo implantation,
prenatal medical conditions when pregnancy would increase the chances to her health,
use of teratogenic drugs by the mother to treat the disease, and finally a poor
obstetric history are the most common indicators necessitating gestational surrogacy
(GS). Surrogate mothers face a variety of pregnancy and delivery issues
that other women do not because of the peculiar
characteristics of gestational surrogacy.
Women’s health
issues within the realm of
Artificial
Reproductive Technology-
Surrogate
mother reproductive and sexual health care is not well covered in standard
obstetric textbooks, and there are few clinical practice guidelines on the subject.
Surrogacy is becoming increasingly common, so providers of reproductive health
care must be aware of the related ethical, legal, and birth issues. This phenomenon
has sparked public debate about the potential consequences of surrogacy, including
economic oppression, ethical ambiguity, and psychological harm to the surrogate
mother. Surrogacy raises more questions about healthcare, legitimate, and psychological
screening, counseling, antenatal care and delivery, legal, breastfeeding, and psychological
issues after birth. All of these issues necessitate a collaborative approach by
all participants, including obstetricians, gynecologists, midwives, psychotherapists,
lawyers, surrogate mothers and envisioned couples, infertility clinics, aid agencies,
and hospitals.
Even though
surrogacy has been practiced since the 1980s, it is still regarded as a novel method
that necessitates evaluation, policy formulation, programming, and a
comprehensive and in-depth introduction from various perspectives, and each field
of science should contribute to illuminating its various aspects. When it comes
to surrogacy, it is critical to consider not only the scientific, medical, and
even legal aspects of the procedure, but also the feelings, experiences, and concerns
of the women who use it.
With
advancements in medical sciences and technology, especially in assisted
reproductive techniques that have revolutionized the reproductive environment
with techniques such as donor insemination, embryo transfer methods, and so on,
methods such as surrogacy are also gaining popularity for a variety of reasons.
A surrogate mother, as the term is commonly used, is a woman who is paid to bear
a child for her employer and then returns the child at birth. The term 'surrogate'
means substitute.[1]
Aside from
surrogacy arrangements occurring within the family, community, state, and
country as a result of low-cost
medical facilities combined with advanced reproductive technological know-how,
India is gradually
but steadily becoming
a great attraction for surrogacy arrangements to several
foreigners, particularly wealthy
Westerners. When financial
arrangements are made in exchange for the surrogate child, the child
becomes a 'saleable commodity,'
complications arise and issues such as the privileges of the surrogate mother,
the child, and the commissioning
parents become involved. To address and regulate surrogacy arrangements the Government of India has
taken certain steps such as the introduction and implementation of National Guidelines for Accreditation, Supervision and
Regulation of Assisted Reproductive
Technology (ART) Clinics in India, 2005 by the Indian Council of Medical Research (ICMR) under the Ministry
of Health and Family Welfare, Government of India.[2]
Despite the growing popularity of surrogacy, this treatment method is fraught
with complications. Surrogate
mothers' reproductive and sexual health care is not well covered in obstetric
textbooks, and there are few clinical practice guidelines on the subject.
The Feminist
and Radical Viewpoint-
From their
first use in the late 1970s until the mid-1990s, ART was a topic of serious
concern for feminists internationally.[3]
Issues ranged from assessing health risks to ethical and political issues raised
by these technologies. Radical feminists addressed issues of choice as controversial:
despite the assertions of preference surrounding ART, it has not increased women's
reproductive freedom. Indeed, the healthcare, legal, and commercial
advancements of ART, as well as the shift in social perception of motherhood
brought about by the use of IVF and surrogacy, have set up forms of authority over
female reproduction.
Over the
last two decades, there has been a rapid increase in the number of technologies
that aid reproduction, increasing the likelihood of conception and carrying a
pregnancy through to term. The term "Assisted Reproductive Technologies"
(ARTs) incorporates multiple procedures, ranging from the relatively simple intrauterine
insemination (IUI) to variants\s of in-vitro fertilization and embryo transfer
(IVF-ET), also referred \s to as IVF and more commonly known as "test-tube
baby technology". These technologies have advanced at a rapid pace since the
latter half of the twentieth century. They have also had an impact on how society
views pregnancy, reproduction, and motherhood.
The first
IVF baby in India may have been born just a few months after Louise Brown, the world's
first IVF baby, was born in the UK in 1978. Dr. Subhas Mukherjee of Kolkata claimed
responsibility for Durga, the world's second IVF baby. However, his claim was
rejected because it was deemed insufficiently documented. 1 On August 6, 1986, India's
first "scientifically documented" IVF baby was born. Harsha Chawla
was born as a result of the collaborative scientific research of the Indian Council
of Medical Research's (ICMR) Institute for Research in Reproduction and Mumbai's
King Edward Memorial Hospital. [ICMR 2005].
As a
result, the pull towards ART services is not the same for people all over the
world. Infertility in the West is not subject to the oppression of social
stigma that the infertile face in India. The contributory factors in this context
are legal prohibitions or hassles, delays, and cost differential. Unlike
overcoming the stigma associated with infertility, exercising choice in childbirth
is important for Western couples seeking ARTs across national borders. The
worth of children and having them raise and/or form families varies by culture.
While having
one's child to raise and form a family may be a priority for gay and single people
- married
or unmarried - and couples from non-Asian societies, for NRIs and South Asian couples,
eradicating the stigma of infertility and starting a family may be a bigger
draw for ART.
India is quickly
becoming a top location for reproductive tourism. The considerable number of ART
clinics and fertility centers in company hospitals in the private health sector
offer cutting-edge technology and expert medical care to those seeking to have their
child. Infertility clinics displaying their services and achievements, particularly
in terms of survival rates with pictures of babies born from ART procedures,
are becoming more common.
ARTs are
used to treat infertility in women, such as blocked fallopian tubes and poor
ovarian function. Even in cases of severe medical impairment, such as a lacking
uterus or impaired egg production, ARTs attempt to treat female infertility
through egg donation and/or surrogacy services. Since the first IVF baby was born
in 1978, these services have grown exponentially. They have given hope to millions
of aspiring adults, including those who are past reproductive age, to have
their children. Many stories about the success of medical feats are widely publicized,
and they inspire admiration for ART’s achievements.
India’s vantage point-
The Surrogacy (Regulation) Bill,
which was introduced in the Lok Sabha on July 15, 2019, was referred to a
select committee. The report was tabled before the standing committee on February
5, 2020, following a thorough revision of the Bill. The Bill was later passed
by both houses of Parliament during the winter session of 2021. The President
signed it, and it goes into effect in January 2022. Surrogacy is defined in the
Act as a practice in which a woman bears a child for a commissioning couple to
hand it over to them after the birth. It is only permitted for charitable
purposes or for couples suffering from proven infertility or disease. Surrogacy
for commercial purposes, including the sale, prostitution, or any other form of
exploitation, is prohibited.
Furthermore, once the child is born, it
will be considered the couple's biological child. Abortion of such a fetus is permitted
only with the consent of the surrogate mother and by the provisions of the Medical
Termination of Pregnancy Act.
Increased technological intervention
in the processes by which women conceive strengthens the male-dominated medical
profession's control over procreation, inevitably leading to greater
social control of women by men. With discussions of "harvesting" eggs and "uterine environments," the language of reproductive technology
already vividly illustrates the extent to
which women's bodies are dehumanized. The development of the concept of a
"surrogate mother" is linked to the rise of these
technologies. The term itself is misleading. The woman is not
a surrogate; she is the child's biological mother. Business companies can more
easily control and exploit the
woman's pregnancy by naming her as a surrogate and rejecting her biological relationship with her child.
Surrogacy issues are too complex
to discuss here, but in summary,
surrogacy promotes women's economic, physical, and emotional exploitation. In exchange for money, a woman who engages
her body as a "surrogate" mother concurs to give up power over her pregnant
body. She may face a future of grief similar
to that of women who have given up their children for adoption. It is acknowledged that some women experience
emotional problems in handing over the baby or
as a result of the reactions around them, these
feelings appeared to lessen
during the weeks following the birth.[4]
There is also a growing debate about the rights of the fetus to
be regarded as a "patient," which
arises from how reproductive technologies separate women from the embryo/fetus. The representation
of women as merely capsules or packaging for the fetus in discussions of the fetus as a "patient" is
horrifying. In debates over a
coercive cesarian section, doctors have asserted the power to restrain a woman and perform the surgery under court order
if the woman refuses surgery
and the fetus is said to be in danger.
Motherhood and Women’s
Reproductive Autonomy, through the lens of Artificial
Reproductive Technology-
Surrogate
motherhood as an arrangement, in which a woman takes no ownership of the child born, has raised moral, ethical
social, and legal questions about both woman and the ‘Commissioned baby’.[5] The commercialization of new reproductive technologies and surrogacy has promoted profit-driven
research (as opposed to public health services).
These technologies also attract significant federal money in Australia,
diverting research and resources
away from the less glamorous work of infertility prevention.
This
scenario's problems include the verification
of upper-middle-class definitions of the perfect baby, an inability
to recognize infertility, mortality, and imperfection, and the consequences for human society of the
split between sexuality and procreation. Because women have always had complete control over reproduction, even
in patriarchal cultures, technological advances have disturbing ramifications for
our lives.
For many women—past, present, and future—childbearing is the primary
source of power
from which to deal with the conditions of their existence. According to research, problems can arise
in families where babies were created through
"donation" of gametes
or surrogacy. The lack of a
"bio-social connection" with the surrogate mother hurts children's
psychological well-being. According to the researchers, the absence of a correlation with the surrogate
mother (who gives birth to them) is more troublesome for children than the absence
of a link with the genetic
donors. In other words, while the terms "paternity" and
"maternity" are socially conditioned, nine months of a conceptual relationship cannot be dismissed
as a purely biological issue. The surrogate mother is more than just a
"carrier," she is one of two elements of a living dead, exchanging biological, emotional, and some
genetic information with the developing
child.
An intentional mother receiving a genetically unrelated
HET embryo with donated gametes
has the option of growing the
child in her womb, forming a significant physiological tie with him/her during pregnancy, delivery, and
nursing. In the case of gestational surrogacy, on the other hand, such elements of connection are completely absent.
In the last decade, researchers have
looked into the consequences of separating a newborn baby from the woman who
just gave birth to him or her. The
surrogate's breasts are full of milk after birth, and she must undergo
hormonal treatments to stop the milk flow (lactogenesis). After
delivery, the surrogate mother may feel psychologically attached to the child she
conceived during pregnancy and to whom
she gave birth.
Surrogacy
is not a new concept in India. Commercial surrogacy, also known as "womb
for rent," is a thriving
industry in India. In India, an English-speaking environment and lower-cost services attract eager customers. Surrogacy
practice's future projections range from the opportunity
to exploitation - from rural women in India lifted out of poverty to a
dystopian nightmare of developing country
baby farms. In the case of surrogacy in India, it is difficult
to determine whether these
women are exercising their rights or are coerced into becoming surrogate mothers by their mother-in-law
or husband's desire to meet material and financial needs.
Surrogacy
opponents argue that the practice is morally equal to prostitution and that, as
such, it should be prohibited.
Surrogacy contracts are "dehumanizing and alienating" because they deny the credibility of the surrogate's pregnancy perspective. The surrogate mother
attempts to avoid
developing a special
bond with the child in her womb and views the pregnancy
as merely a means of earning much-needed funds. Payment for bodily offerings
dehumanizes the surrogate mother
and misuses her reproductive organs and capacity for the wealthy's
gain.
Surrogacy outsourcing is a fraudulent practice. There is presently no law in place to safeguard surrogate mothers in the incident of
birth complications, forced abortion, or other similar situations. Artificial insemination has been nearly legal in
India since 2002, and the country has
surfaced as a sort of pioneer in the field. This is why critics believe that
the surrogacy industry utilizes
poor women in countries like India, where maternal
mortality is already high.
In India,
the Ministry of Women and Child Development is investigating the issue of surrogate motherhood to draft comprehensive
legislation. The Indian Council of Medical Research (ICMR) has proposed
strict penalties for violators and tight regulation of Assisted Reproductive Techniques in draught
legislation on surrogacy (ART). The proposed law limits the number of embryo transfers a mother can undergo for the
same couple to three if the first two
attempts fail, and it also states that no woman should behave as a surrogate
for more than three live births in
her lifetime. The ICMR and the Ministry of Health and Family Welfare issued only these guidelines in 2005.
"A relative, a known person, or a person unknown to the couple may act as a surrogate mother for
the couple," according to ICMR guidelines. If a relative is acting as a surrogate, the relative must be of the
same generation as the woman seeking the surrogate."
Before
accepting a woman as a potential surrogate for a specific couple, the ART
Clinic must ensure (and document)
that the woman meets all testable criteria for a successful full-term pregnancy." These guidelines are lopsided and rash. The fragmented role of women in surrogate structures has prompted a
reconsideration of the definition of motherhood and the classification of maternal rights. Surrogacy opponents argue
that the practice is morally equal to prostitution and that, as such, it should be prohibited. Surrogacy
contracts are "dehumanizing and alienating"
because they deny the validity of the surrogate's pregnancy perspective. The surrogate mother attempts
to avoid developing a special bond with the child in her womb and views the pregnancy as merely a means of earning
much-needed funds. Compensation for bodily services
dehumanizes the surrogate mother and misuses
her reproductive organs and capacity for the
wealthy's gain.
Conclusion-
In this
paper, I discussed various physical and psychosocial issues affecting women who
use IVF, egg suppliers, surrogate
mothers, commissioning parents, and children conceived using these technologies. Much more research on
all aspects of ART is required: We are witnessing the emergence of a breeder
category: women from poor countries or migrants, women
of color, or women from the white lower
classes—often in need of paying
their mortgage debt or sending
their children to college—who are producing children for (economically
better off) third parties. What a
social process cannot be regarded as unproblematic or as a personal matter. In feminist research and the social
sciences, the interpretive task of creating a baby should be reconsidered through the lens of an
intersectional approach. This is particularly important because, as analyzed in this paper, there is a long list of
recorded serious short- and long-term health hazards
in peer-reviewed journal
articles for women
and children born from ART, which
should be discussed alongside the social and ethical issues I have raised.
Other issues concern the right
of several subjects
involved in ART to know and risk disclosure about potential harm.
Problems involved
Mothers are
not fully briefed about the risks to their health as a result of current
medical research studies. Should
intended parents (whether infertile couples, single women, lesbians, gay men, intersexual or transsexual
people) be denied the right to know about the negative health effects of ART on the children they pay for? Should
children born through gamete donation and/or
surrogacy not be aware of their biological origins and who gave birth to them?
Do these children not have the right to a healthy birth? Fertility in
both men and women is unquestionably
declining in developed countries, and
ART could become an even more
widespread occurrence. We all know that environmental pollution and the widespread presence
of chemical and physical hazards. Chemical carcinogens hurt our genetic structure, reproductive potential, and the health of our progeny in the
future. Today, sensitivity to chemical and physical carcinogens causes harm to future generations and reduces their
reproductive capacities. Answers may be found in ecologically based
prevention policies, cultural shifts
around the concept
of maternity and parenting, and legislation that allows single
women, LGBT members,
and alternative families
to live together. Women's health has historically
been a common ground for feminist activism; it should reclaim the center of the ART debate
as a
political priority and non-divisive goal.
It can be
depressing to consider the barriers to reproductive justice, the backlash
against women's rights movements'
gains, the failure of public officials to enforce laws that guarantee women's rights, and the engrained
traditions and political views that motivate politicians to deny funding for women's reproductive
health and to enact laws that close clinics that provide necessary services.
As a sad
paradox, men run governments, train doctors, manufacture birth-control devices, distribute grant money, decide on the
accessibility of abortion, and run the businesses that market the products and make money. As Jalna Hanmer and Pat Allen have said, women act as individual
and social power agents.[6] We proceed to conspire against
ourselves. The revived positive
attitude toward motherhood discussed ordinarily supposes
that all women can become pregnant voluntarily and easily
through sexual intercourse. It existed before
the emergence of the technologies
discussed here. Ironically, this shift toward positively valuing women's
reproductive roles has provided technopatriarchs in medical research
with justification for
maintaining control over and experimentation on women's bodies in the name of mothering
power.
We need to
rethink what "choice" means for women in the context of biomedical
and its complement, genetic
engineering. As Barbara Katz Rothman has
commented, in gaining the choice to control the quality of our children, we may lose the choice not to
control the quality, that is, the choice of simply accepting
them as they are. She points out that we also forfeit the right not to know some things, like the
sex of the unborn child.[7]
One of the fundamental elements of
the women's movement has been to ensure and safeguard the right to choose sexuality
and reproduction. We demanded the ability to choose whether
or not to have children
and gained access to both
contraception and abortion.
[1] Karkal M.
Surrogacy from a feminist perspective. Issues med ethics. 1997
oct-dec;5(4):115-6. PMID: 16267915.
[2] National Guidelines for Assisted Reproductive Technology: Ethical Issues
in Surrogacy - Paper presented by Dr.
R.S. Sharma, DDG (SG),
Division of RHN, Indian Council of Medical Research, New Delhi at the
meeting-cum workshop organized by the Ministry
of Women and Child Development, Govt. of India on 25th June 2008 at India
Islamic Centre, New Delhi.
[3] Corradi, Laura Maria (2021)
"Assisted Reproductive Technologies and Health-Related Issues Among Women and Children: A Research Review,"
Dignity: A Journal of Analysis of Exploitation and Violence: Vol. 6: Iss. 2, Article
2.
[4] Jadva V, Murray C, Lycett E, MacCallum
F, Golombok S. Surrogacy: The experiences of surrogate mothers.
Hum Reprod 2003; 18:2196-204.
[5] A, Kumar P, Inder D, Sharma N. Surrogacy and women's right to
health in India: Issues and perspective. Indian J Public Health 2013; 57:65-70.
[6] Jalna Hanmer and Pat Allen,
"Reproductive Engineering: The Final Solution?" in Alice through the Microscope: The Power of Science in Women's Lives,
ed. Brighton Women
and Science Group (London: Virago,
1980).
[7] Barbara Katz Rothman, "The
Meanings of Choice in Reproductive Technology," in Arditti et al. (n. 22
above).
Article Information
ASSISTED REPRODUCTIVE TECHNOLOGY AND WOMENS REPRODUCTIVE HEALTH
Authors: SHUBHRANGANA PUNDIR
- Journal IJLRA
- ISSN 2582-6433
- Published 2023/10/28
- Issue 7
About Journal
International Journal for Legal Research and Analysis
- Abbreviation IJLRA
- ISSN 2582-6433
- Access Open Access
- License CC 4.0
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