Assisted reproductive technologies: reviewing recent perspectives and addressing research gaps in medical anthropology

Guest post by Jessica Grebeldinger

ICSI is a common form of IVF in which sperm is injected directly into the egg. Photo courtesy of Wikimedia.

In 1978, Brigitte Jordan published her foundational cross-cultural ethnography Birth in Four Cultures, declaring that childbirth “is everywhere socially marked and shaped” (Jordan 1993[1978]:3). This publication signaled the birth of reproduction as a focused field of anthropological inquiry. That same year, the world’s first “test tube baby” conceived through in vitro fertilization (IVF) was born, ushering in the age of assisted reproductive technologies (ARTs). Over thirty years later, both biomedical reproductive technologies and anthropological attention to technological approaches to reproduction have increased substantially. Anthropologists are engaged in studying the intersections of technologies and reproduction because they are deeply connected, indeed, central, to many other aspects of human life, including gender, kinship and notions of the family, individual identity, religion, social inequality, globalization, and health care policy. Concerning ARTs, Rapp has stated that “there can be no more hallowed or classic ground on which anthropological interpretation reverentially and critically occurs” (2006:421).

Birth in Four Cultures by Brigitte Jordan

ARTs developed and spread rapidly, if not evenly, throughout the globe after the birth of the first baby conceived through IVF. An estimated 5 million babies have been born using ARTs since 1978, with an average 27% of treatment cycles resulting in the birth of a baby, the majority of these resulting from traditional IVF or intracytoplasmic sperm injection (ICSI), in which fertilization is achieved by injecting a single sperm into the egg (ESHRE 2012). Assisted reproductive technologies created new opportunities to study biomedicine’s involvement in conception, and, indeed, medical anthropologists have answered Ginsburg and Rapp’s (1995) call to situate reproduction at the center of social analysis. The importance of ARTs to this effort is evidenced by the number of edited volumes produced in the last 15 years that are devoted either completely or in part to the study of these technologies (Birenbaum-Carmeli and Inhorn 2009; Browner and Sargent 2011; Culley et al. 2009; Dumit and Davis-Floyd 1998; Davis-Floyd and Sargent 1997; Franklin and Ragoné 1998; Inhorn 2007a; Inhorn and van Balen 2002; Inhorn et al. 2009; Morgan and Michaels 1999).

The review that follows presents a survey of some of the most recent anthropological literature on reproductive technologies, focusing on those published in the last 5 years (2007 and forward). The review demonstrates the breadth of this field of research, which has produced important insights on such topics as infertility experiences, the commodification of reproductive bodies, the phenomenon of international reproductive travel, new kinship configurations, among others. However, the review reveals that this research area has also suffered from a narrowed field of focus resulting from certain gaps in the literature along racial, socioeconomic, geographic, and gender lines. These imbalances problematize our ability to document the varied uses and impacts of reproductive technologies at global and local levels. I discuss this problem after the review section and underscore some recent studies that point the way toward a more inclusive and complete field of reproduction-focused medical anthropology.

Infertility, Inequality, and Gender

A review of recent anthropological literature on assisted reproductive technologies would be incomplete without positioning the use of these technologies within the global terrain of infertility and infertility treatments. Infertility has been estimated to affect roughly 80 million adults of reproductive age globally (Nachtigall 2006). The actual prevalence of infertility is difficult to determine, however, due to the lack of a uniform definition for the problem (Gurunath et al. 2011; Mascarenhas et al. 2012), as well as the existence of infertility disparities at national levels (Nachtigall 2006). Studies show that the problem of infertility is particularly severe in the developing world, especially northern and sub-Saharan Africa (the “infertility belt”), south Asia, and Latin America, in large part due to inadequately treated sexually transmitted infections (Nachtigall 2006).

Disparities also exist in terms of access to treatment for infertility. Effective and affordable fertility treatment and access to ARTs is often nonexistent in those areas of the world with the highest levels of infertility, and although many Western countries subsidize infertility treatment, restrictive eligibility criteria still impede access for many infertile persons (Franklin 2011; Inhorn and Birenbaum-Carmeli 2008; Inhorn and Patrizio 2012; Whittaker and Speier 2010). In the US, where ARTs are not subsidized by the state and private insurance rarely covers all of the costs associated with ARTs, treatment is often restricted to those who are able to pay out of pocket (Inhorn and Birenbaum-Carmeli 2008; Nachtigall 2006).

The global terrain of infertility and its inequalities in terms of access to treatment is an immensely important area of study for anthropologists and other scholars. Research shows that lack of access to ARTs in some regions of the world is prompting some infertile persons to travel internationally for reproductive reasons (Inhorn and Patrizio 2012). Europe, North America, the Middle East, Latin America, and South, East, and Southeast Asia have well-established ART industries and some of these regions have developed as receiving hubs for this practice of cross-border reproductive care (CBRC) (Inhorn and Gürtin 2011). Other regions of the world that lack domestic ART access, including Central Asia, Oceania, former Soviet-bloc countries, and sub-Saharan Africa (Nachtigall 2006), are producing consumers of CBRC as elites from these resource-poor countries travel internationally in the hopes of conceiving (Inhorn and Patrizio 2012).

The experience of infertility is also paramount to examinations of ARTs (Culley et al. 2009; Inhorn and van Balen 2002). Infertility is often a devastating condition, especially in social settings that are pronatalist and patriarchical (Abbasi-Shavazi and Inhorn 2008:2). Stigma, ostracism, and marital problems are several forms of social suffering experienced by infertile couples in countries such as Iran (Abbasi-Shavazi et al. 2008; Culley et al. 2009) and India (Bharadwaj 2011). Research shows that at a global level women shoulder the majority of the burden of infertility and may be subject to divorce or abandonment, ostracism, emotional or physical abuse, and psychological problems, among other forms of suffering (Dudgeon and Inhorn 2004). Part of the gendered nature of these infertility experiences can be traced to the tendency for infertility to be blamed on women, even when male infertility is a factor in approximately half of all cases (Dudgeon and Inhorn 2004:1388). However, anthropologists have also recognized that research on infertility experiences has suffered from a significant gender bias with most anthropological research focusing on women and very little considering men’s infertility experiences (Inhorn and van Balen 2002).

Medical anthropologist Marcia Inhorn. Photo courtesy of Marcia Inhorn/Wikimedia Commons

The invisibility of men in the literature on infertility and ARTs is symptomatic of the larger marginalization of men within social scientific studies of reproduction, bespeaking the tendency to view men as disassociated from reproduction (Inhorn et al. 2009). A number of recent ethnographies have answered Inhorn et al.’s (2009:1) call to rectify the position of men as the “second sex” in studies of infertility by producing male-centered social analyses, several of which are discussed below.

Goldberg’s (2009) study in Israeli fertility clinics showed that male fertility is closely associated with notions of sexual intercourse. Despite the fact that infertility does not, in medical terms, signify impotence, the stigma and silence around male infertility in Israel is symbolically associated with ideas of failed manhood, sexual dysfunction, and defective sperm, leading to practices in fertility clinics that seek to shield men from these stigmatizing ideas.

Inhorn (2009) examined male genital cutting among infertile and fertile Middle Eastern men. Her research discovered that many men in Lebanon and Egypt undergo variocelectomy, an operation thought to enhance fertility by removing varicose veins from the testicles, and testicular aspirations and biopsies, a procedure in which sperm are removed directly from the testicles for use with ARTs. These forms of male genital cutting are painful, may involve medical complications, and, in the case of variocelectomy, are rarely effective. Inhorn finds that men undergo these forms of genital cutting because they are willing to share the burden of suffering caused by infertility with their wives, a fact she connects with changing gender relations and relationships between spouses in the Middle East.

Cross-Border Reproductive Care

A relatively new research area in the anthropology of reproduction focuses on the transnational ART market and industry that involves the movement of reproductive substances, ART equipment, and fertile or infertile bodies around the globe. Cross-border reproductive care (CRBC) is a growing global phenomenon and ethnographic research in this area has expanded greatly, producing a large body of work in recent years (Franklin 2011; Inhorn 2011a; Inhorn and Birenbaum-Carmeli 2008; Inhorn and Gürtin 2011; Inhorn and Patrizio 2012). Research in this field has described some of the characteristics of CBRC, showing that infertile persons seek fertility treatment internationally for a variety of reasons, including treatment in their home/native country that is too expensive or of poor quality, has long wait times, excludes certain people (such as same-sex or unmarried couples, unmarried single men or women, or women who are ineligible as a result of age restrictions), or because of legal restrictions on certain ART technologies (e.g. surrogacy) (Bergmann 2011; Inhorn and Gürtin 2011; Pfeffer 2011; Whittaker and Speier 2010).

Anthropologists studying CBRC have discovered that infertile CBRC consumers may engage in touristic pursuits while undergoing treatment and that doing so has been made possible by expanded and diversified tourism industries in some countries (Bergmann 2011:282). Some anthropologists have thus proposed to name the practice “reproductive tourism,” which also emphasizes that CBRC is deeply embedded within the global capitalist system in which medical tourism is a multibillion dollar profit-oriented industry and that CBRC bears numerous similarities with other forms of medical tourism (Franklin 2011; Pfeffer 2011).

Some scholars object to the allusions to enjoyment-seeking contained in the term “tourism,” pointing out a need to foreground the emotional and physical hardship associated with infertility and its treatments (Whittaker and Speier 2010). These issues are brought to the fore in the proposed term “reproductive exile,” which frames CBRC consumers as victims of the medical systems of their countries of residence that fail to provide accessible and adequate infertility treatment (Inhorn and Patrizio 2009). Reproductive exile also references that many infertile persons feel “forced” to travel internationally to access infertility treatments due to inequalities and deficiencies in domestic treatments (Inhorn 2011c:90).

Nancy Scheper-Hughes. Courtesy of University of California, Berkeley.

Among the research trajectories that have emerged in the recent literature on CBRC is attention to the commodification of reproductive body parts and substances to service the transnational ARTs industry (Inhorn 2011c:92). Sperm, ova, embryos, and the gestational services of commercial surrogates have all become commodified in this market. Following in the footsteps of body commodification research by ethnographers of organ trafficking, scholars and others have expressed concern with the exploitative potential of CBRC, particularly as it affects vendors of eggs and surrogate mothers. Scheper-Hughes observed that the circulation of human kidneys “follows established routes of capital from South to North, from East to West, from poorer to more affluent bodies, from black and brown bodies to white ones, and from female to male or from poor low status men to more affluent men” (2003:1645). Pfeffer (2011) views the trade in human eggs as having remarkable similarities with kidney trade routes but also stresses the highly gendered nature of the exploitation produced through CBRC. Pfeffer situates the egg trade within the forces and policies of neoliberal globalization; women, she contends have suffered more harmful effects as a result of neoliberal policies which privilege the reproduction of elite women and create a pool of “bioavailable” (Cohen 2005:83) poor women of the global South willing to engage in the potentially risky sale of their eggs for moderate financial gain.

These observations regarding the exploitative nature of the trade in human ova are linked with views expressed by a number of anthropologists who argue that CBRC stratifies reproduction (see Bergmann 2011; Inhorn 2011a; Markens 2012; Whittaker and Speier 2010:374). Stratified reproduction describes how power relations are implicated in enabling certain categories of people to reproduce while disabling others, making it possible for anthropologists to study how reproductive features held by some people are valued while others are despised (Ginsburg and Rapp 1995:3). A number of researchers contend that CBRC stratifies reproduction by empowering the reproduction of persons with relative affluence (middle and upper class persons from Western nations) who are able to travel internationally for fertility treatment while disempowering the fertility of many people from the developing world, as well as for ethnic minorities within Western nations (Abbasi-Shavazi et al. 2008; Franklin 2011; Inhorn 2011c; Markens 2012; Pfeffer 2011; Whittaker and Speier 2010).

Stratified reproduction is produced through the institutional practices of CBRC intermediary agencies and fertility clinics which draw on and reinforce notions around the differential valuation of parenthood, gender, race, class, and nationality, stratifying reproduction based on these categories (Whittaker and Speier 2010). This has become a particularly salient issue for investigating the experiences of reproductive workers, primarily women, who service the CBRC industry. It is not only infertile people who travel internationally to access the CBRC industry but also egg vendors, who may migrate to countries that attract infertile patients from overseas (Whittaker and Speier 2010). Bergmann’s (2011) study described how in some of these countries that attract reproductive travelers, potential egg donors are actively recruited, possibly even coerced, by fertility clinics that seek women displaying phenotypic characteristics based on notions of “whiteness” in demand among their international clientele (Bergmann 2011). In this way CBRC has created gendered job markets for the European migrant women who embody these racial characteristics (Bergmann 2011:285).

Research has begun to unveil the contours of this emergent labor market and, in particular, its implications for the women who comprise the labor force. A recent study that focused on egg sellers was undertaken by Nahman (2011) who examined the growing practice of “reverse traffic,” whereby international travel is carried out by ART industry specialists and equipment, rather than patients or gamete vendors (Nahman 2011:627). Nahman’s study followed Israeli doctors to Romania, where ova harvested from Romanian women are fertilized with frozen sperm from the Israeli father and then returned to Israel for implantation in the intended mother’s womb. Nahman shows that reverse traffic reinforces existing disparities based on nationality, race, and gender and also involves increased health risks for egg vendors. Nahman contends that Romanian women are eager to sell their eggs, despite health risks and relatively low compensation rates, in part due to their country’s history, in which the patriarchical and pronatalist Communist state exerted control over women’s reproduction bodies. For Romanian women, giving over their bodies to the international gametes trade is thus a means by which to assert autonomy over their reproduction.

Commercial gestational surrogacy has emerged as a compelling infertility treatment option for prospective parents and as an important form of reproductive labor for women in some countries. Gestational surrogacy, in which a woman receives payment for gestating and giving birth to a baby to whom she has no genetic connection, has been the subject of most anthropological research on CBRC, as it is estimated to take place in 95% of surrogacy cases (Markens 2007:299). Despite the fact that a number of countries have flourishing commercial surrogacy markets, those in India have garnered the most public attention as well as the most ethnographic focus. For some rural, poor Indian women, surrogacy has become a “survival strategy and temporary occupation, where women are recruited systematically by fertility clinics and matched with clients from India and abroad” (Pande 2010:971). Pande argues that commercial surrogacy in India should be analyzed as a form of women’s labor in order to recognize its role as a survival and advancement strategy for women and also to overcome the limitations of a priori perspectives that would cast surrogates as victims of structural inequalities (Pande 2010:971-972). In Pande’s view, positioning surrogates as workers enables us to better understand how commercial surrogacy may be both exploitative and empowering and also reveals other dimensions of surrogates’ experiences, such as the processes through which they are disciplined by fertility clinics to become “good” surrogates.

ARTs and Local Moral Worlds

Anthropologists of reproduction have drawn attention to the need to situate the use of ARTs within local moral worlds (Abbasi-Shavazi et al. 2008; Birenbaum-Carmeli and Inhorn 2009; Inhorn 2007a; Inhorn 2011c). Kleinman describes local moral worlds as “the commitments of social participants in a local world about what is at stake in everyday experience” (1995:45). The intersections of ARTs with body commodification and the interruption of notions of “natural” parenthood may challenge and disrupt moral worlds (Inhorn and Birenbaum-Carmeli 2008). The biomedical model of disease takes for granted that biomedical technologies are applied uniformly on local bodies across the globe; however, anthropological research shows that the acceptance and use of these technologies greatly cross-culturally and is shaped by local ethical, cultural, or religious considerations (Birenbaum-Carmeli and Inhorn 2009).

Inhorn (2011b, 2011c) describes how in the Muslim world there exist very different approaches to ARTs by Sunnis and Shias given divergent sectarian opinions on the use of donor gametes. Sunni fatwas ban the use of third party donor gametes based on strict beliefs regarding biological lineage and incest, whereas Shia religious authorities have been more flexible regarding donor gametes. As a result, nearly all Sunni-dominated countries in the Middle East (such as Egypt, Saudi Arabia, and Jordan) now ban the use of third party donor gametes while at least two Shia-majority countries (Iran and Lebanon) practice gamete donation. Despite the Sunni fatwas, fertility clinics operating in Iran and Lebanon provide third party gametes to infertile Shia and Sunni Muslim couples; attracting many Sunni Muslim couples from countries such as the United Arab Emirates and Egypt to secretly travel internationally to seek infertility treatment.

This is contrasted with Kahn’s (2006) research in Israel in which rabbis have carefully debated and produced halakhic (rabbinical) laws regarding the appropriate uses of ARTs. These rabbinical debates and decisions have had a direct impact on IVF practices used by Israeli citizens. For instance, practices have been embraced that are considered to confer Jewish identity to the offspring, including third party egg donation from single Jewish women and the use of Jewish surrogate mothers. The pronatalist Israeli state has also adopted relatively permissive policies and practices that promote ARTs as a means by which to reproduce the nation through the birth of Jewish babies (Teman 2010).

The Catholic Church, on the other hand, has expressed complete opposition to ARTs, which are considered reprehensible given that the Church views embryos as human life (Roberts 2011:234). Despite the Church’s firm stance on ARTs, many Catholic countries have well-developed ART industries (Inhorn and Birenbaum-Carmeli 2008:185). For instance, Roberts (2007) details that in Ecuador, a Catholic country, the church’s position is just one of a myriad of forces that determine the disposal practices of surplus embryos produced through IVF, with family ethics and folk interpretations of “God’s will” playing a large role in shaping understandings around and acceptance of ARTs.

Bharadwaj’s (2011) research describes the practices developed by the Indian state in order to procure legal stem cells by compelling infertile Indian couples to give away surplus embryos created through IVF to “scientific research.” Infertile Indian couples were found to draw heavily on their experiences of social suffering caused by infertility in choosing to give away “spare” embryos in the hopes that doing so would spare another couple such suffering. Embryo donation, framed as altruistic acts by IVF practitioners, obscures the commercial objectives of the Indian state in becoming a leader in global embryonic stem cell generation.

ARTs and Kinship

Surrogacy Poster. Courtesy of Surrogacyclinics.com

Since the advent and spread of IVF, cultural anthropologists have expressed great interest in the kinship implications of assisted reproductive technologies (Franklin 1997; Hartouni 1997; Levine 2008; Strathern 1995, 1992). Ethnographic studies of ARTs demonstrate that biogenetic kinship, wherein genetic parents are considered “real” parents (Ragoné 1998:129), remains the preferred means of constructing a family, particularly throughout Euro-America. This preference has caused many infertile couples to undergo protracted, expensive, sometimes painful, and usually emotionally stressful infertility treatments in the hopes of producing a child using their own gametes (Franklin 1997; Inhorn & Birenbaum-Carmeli 2008:182; Levine 2008; Satz 2007).

Biogenetic kinship notions have become institutionalized in fertility clinic practices whereby phenotypic matching of egg donors to clients is routine (and sometimes compulsory in some European countries), in efforts to produce offspring for the client that can “pass” as a “natural” (phenotypically similar) member of the family (Bergmann 2011). Quiroga’s (2007) study of US IVF clinics that use donor sperm showed that institutional practices reinforce kinship models based on ideas of racial purity and patriarchy through procedures such as separating sperm donations by the racial status of the donor and assuming that women seeking artificial insemination will want a sperm donor who matches the racial category and physical characteristics of the male partner. Quiroga (2007:147) thus contends that US fertility clinic practices privilege and replicate white heteropatriachical family models.

While biogenetic ties remain the preferred means of affirming kinship with offspring, ARTs have introduced individuals outside of the biogenetic family into the reproductive equation. Given that up to three individuals may contribute biologically to the birth of a child conceived through ARTs (sperm donor, egg donor, surrogate) and none of these individuals may care for the child after its birth, a number of kinship configurations are possible (Almeling 2011:142). Collard and Kashmeri’s (2011) study with donating and adopting families participating in a US embryo adoption program described families’ preference for genetic relatedness between children, regardless of whether the children were genetically related to parents. Some families expressed their belief that being raised together by the same parents is of greater importance for establishing kinship than genetic relatedness, however, the notion of biological siblingship (gestation in the same womb) was not considered important to defining the sibling bond.

Research on surplus embryos created through IVF has also demonstrated that possible futures envisioned for embryos are shaped by culturally-specific notions of kinship. Roberts’ (2011) study in Ecuador and the US demonstrated that in Ecuador the embryo is conceived of as an integral part of a family unit and maintaining the boundaries of that family take precedence over individual “rights,” leading many Ecuadorian families to opt to destroy the embryo rather than “abandoning” it through long-term cryopreservation, adoption, or donation to scientific research. For these Ecuadorian families, relatedness effectively takes precedence over notions of the transcendent value of the embryo’s individual “life” prevalent in US discussions around embryo disposition (Roberts 2011; Morgan 2003).

Almeling (2011) studied how egg and sperm donors in the US understand their connectedness to the children produced through IVF and to whom they are genetically related. She found that sperm donors generally felt connected and related to their genetic offspring, considering themselves “fathers,” whereas egg donors did not feel that they were “mothers” to children born through IVF and instead constructed close bonds with intended mothers. The distinct ways the US egg and sperm donors in Almeling’s study understand relatedness to offspring is embedded in clinic practices that frame egg donors as altruistic givers of the gift of motherhood to other women (Almeling 2011:163). On the contrary, identity-release programs through sperm banks emphasize genetic relatedness between sperm donor and offspring. Thus, while egg donors rarely become involved in the lives of their genetic offspring, sperm donors, particularly those involved in identity-release programs, may develop relationships with genetic offspring. These practices underscore the salience of Euro-American cultural ideas of gendered parenthood, in which motherhood is separable into social and biological roles, while fatherhood continues to be equated with male genetic contributions (Almeling 2011:164).

While Euro-American kinship notions stress biogenetic links, Pashigian (2009) found that in Vietnam social responses to IVF reveal a deep-seated and pervasive cultural emphasis on the womb as a site for creating relatedness, or “womb-centrism” (Pashigian 2009:34). The Vietnamese state has enshrined this womb-centrism through laws that award legal custody of any child conceived through ARTs to the woman who gestates and gives birth to the child.

Surrogacy presents particular and unique challenges to traditional forms of Euro-American kinship and gendered notions of motherhood given that “it introduces contractual arrangements into private affairs, fragments motherhood (into genetic, gestational, and social components), and implies an adulterous relationship…[and] has also raised concerns about women being exploited, reproduction being commodified, and children being trafficked” (Levine 2008:382). A number of surrogacy studies reveal how gestational surrogacy in Western societies are constructing kinship configurations that stress a bond between the surrogate and intended mother. This is the case in Elly Teman’s (2010) study in Israel, in which surrogates become emotionally detached from the babies they carry but frequently develop intimate and often lasting relationships with intended mothers. The experience of pregnancy becomes a means through which the surrogate sheds any maternal claim to the fetus she is gestating while the intended mother asserts her role as the baby’s mother. In a similar way, the US gestational surrogates in Berend’s (2010) study did not view the babies they gestated as kin, stressing their role as enabling intended mothers to fulfill their parental aspirations.

In contrast to these studies in Western societies, Pande (2009) found that Indian surrogates constructed kinship bonds with the children they gestated and with intended mothers. Surrogates expressed a notion of relatedness with the gestated baby through shared bodily substances (blood and breast milk) and labor (bodily engagement in gestation and giving birth to the child). These surrogates understand they are not genetically related to the babies they gestate, but consider the substances they share with the fetus and the labor involved in gestation and childbirth, and sometimes breastfeeding the baby after birth, of equal or greater importance to genetic ties (Pande 2009:384).

Addressing Research Gaps in the Anthropology of Reproductive Technologies

This review of recent anthropological studies on assisted reproductive technologies demonstrates the considerable depth, breadth, and value of the work that is being done in this rapidly expanding research area. However, the review also reveals certain biases that present challenges and opportunities for future research in this area. Firstly, a geographic bias has emerged, with studies often clustered in Western countries (particularly Europe, the US, and Israel) with exceptions for recent studies that are being carried out in the Middle East (Abbasi-Shavazi et al. 2008; Inhorn 2004, 2007a, 2009, 2011a, 2011b, 2011c; Inhorn and Wentzell 2011) and Asia (Bharadwaj 2011; Pashigian 2009; Pande 2009, 2010; Whittaker and Speier 2010) as well as Ecuador (Roberts 2007, 2011). The second research gap that has emerged is demographic; recent studies most often focus on relatively wealthy ART patients with very few qualitative studies carried out with the marginalized, poor women who comprise the reproductive labor force (with the exception of Nahman 2011) or with persons excluded from access to infertility treatment, such as poor minorities within Western countries or non-elites living in resource-poor countries (with the exception of Bharadwaj 2011).

In part, the social scientific focus on elite, upper-middle-class patients may be due to the exclusion of infertile persons who are poor and marginalized from biomedical infertility treatments, which social scientists have noted and criticized (Inhorn et al. 2009). However, given our knowledge of global disparities in rates of infertility and access to ARTs, some anthropologists of reproduction have also speculated that the scholarly silence on this issue may indicate a tacit view that the poor and marginal are unworthy of infertility treatment, reflecting Western concerns about global population growth and the threat of excessive subaltern fertility (Inhorn 2003; van Balen and Inhorn 2002).

Fortunately, several recent studies seek to rectify the demographic neglect of the poor and marginal. Culley et al. (2009:2) attempt to address the “research lacuna” with respect to the infertility experiences of ethnic minorities within Western nations by foregrounding the experiences of marginalized racial and ethnic minorities in the edited volume Marginalized Reproduction. In so doing, the authors demonstrate that social and cultural contexts are critical to infertility experiences and infertility treatments and also counter a notion prevalent in Western countries that infertility is primarily a concern of wealthy white couples whose reproduction is privileged while marginalized groups’ fertility is stigmatized.

Birenbaum-Carmeli and Inhorn (2009) also seek to address geographic and demographic gaps in Assisting Reproduction, Testing Genes through compiling ethnographic work on local experiences of reproduction in mostly non-Euro-American sites. The intent of the volume is to expand the geographic breadth of research on ARTs, particularly to include areas of the world where infertility is greatly stigmatized. One of the contributions of this volume is attention to processes of technological indigenization in which “those who actually use new reproductive and genetic technologies imbue their practice with particular local sensibilities” (Birenbaum-Carmeli and Inhorn 2009:3).

The third and final prominent gap in the literature on technologies of reproduction has been mentioned above but deserves greater attention. As has been the case with gender studies historically, research on reproduction in general and ARTs in particular have often excluded the experiences and perspectives of men (Layne 2006). Anthropologists of reproduction have recognized that excluding men from the study of reproduction may have the effect of essentializing and naturalizing their bodies and attitudes (Inhorn and Wentzell 2011). Recent research has attempted to rectify the marginalization of men’s experiences through focused research on male experiences with infertility and assisted reproductive technologies (Inhorn 2004, 2007a; Inhorn and Wentzell 2011; van Balen and Inhorn 2002). The field of masculinities research, described in Inhorn, Tjørnhøj-Thomsen, Goldberg, and la Cour Mosegaard’s 2009 Reconceiving the Second Sex, holds great promise for broadening the anthropology of reproduction and moving men from its margins by reconceptualizing their reproductive roles.

Conclusion

This analytical review discussed many recent studies in the area of the anthropology of reproduction. They enhance our understanding of the effects of assisted reproductive technologies (ARTs) on the lives of many people around the world. The wide scope of anthropological research on ARTs, of which this essay provides a rich sample, reveals many important findings related to kinship, gender, identity, social inequality, and ethics.

Research consistently shows that infertility is a condition that often represents grievous social suffering for women and men around the world. Compounding this problem are the numerous inequalities that define the global terrain of infertility, including international disparities in terms of the burden of infertility and access to effective treatment. This situation has played a role in the explosive growth of the practice of cross-border reproductive care, which anthropologists argue has stratified reproduction along national, racial, economic, and gender lines, commodifying the bodies of some to benefit the reproduction of others. The commodification of reproductive bodies enabled through ARTs highlights the local moral worlds in which these technologies are situated that may challenge existing religious, legal, or ethical arrangements. Religious and ethical authorities have developed a range of responses to ARTs that shape their use among infertile men and women. Studies among consumers of ARTs demonstrates that the kinship arrangements made possible through these technologies are often shaped to fit existing cultural notions of relatedness and that these norms are frequently hardened through ARTs. Despite this finding, new kinship configurations are also being enunciated by users of ARTs, demonstrating the transformational power of these technologies.

Although the literature has provided numerous insights into the impact of ARTs on social relations, a number of geographic and demographic oversights have limited the scope of research. These research omissions have produced gaps in our knowledge of the infertility experiences and uses of ARTs among men and women living in many resource-poor parts of the world, among ethnic and racial minorities in the Western world, and among men. Fortunately, the field has defined new research directions to address these scholarly imbalances, providing a road map for moving the anthropological study of reproductive technologies forward.

The ethnographic insights described in this essay provide evidence for the importance of ARTs to understanding the interface between human social life and technologies. As the many anthropologists pursuing research on ARTs recognize, focusing the ethnographic lens on ARTs provides opportunities to explore a number of dimensions of contemporary social relations during a period defined by change. The continuing challenge for anthropologists of reproduction will be to engage with the fluid, procreative, and transformative nature of assisted reproductive technologies into the future.

Acknowledgements

This is a revised version of a paper the author originally wrote for an independent study with Professor Barbara Miller in the summer of 2012 at the George Washington University.

Jessica Grebeldinger has a B.A. in Anthropology from McMaster University in Hamilton, Ontario, Canada, where she graduated Summa Cum Laude and minored in Hispanic Studies. In January 2013 she graduated with an M.A. in anthropology from the George Washington University where she concentrated on both medical anthropology and international development. Prior to joining GWU she managed Summits of the Americas programs at the Organization of American States (OAS). She currently spends her time raising an energetic toddler, living a paleo lifestyle, and seeking a new professional opportunity.

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6 thoughts on “Assisted reproductive technologies: reviewing recent perspectives and addressing research gaps in medical anthropology

  1. Pingback: Anthropology Update & Book, Race: Are We So Different? | Anthropology Report

  2. Nadia

    Hello,

    I wish to cite your work in my Postgraduate dissertation (MSc Medical Anthropology, at Edinburgh University). How can I cite this paper? Which is the year published? Thanks a lot in advance,

    Best,
    Nadia Bemtgen

    Like

  3. Barbara Miller

    Dear Nadia,

    Thanks so much for your interest in Jessica’s research. The Institute for Global and International Studies will be publishing it soon as an IGIS Working Paper (it should appear this week, I hope). I will send you the link. I think that will be a better citation format than as a blog post, but the latter would work, too.

    Best wishes to you in your research,
    Barbara

    Like

  4. Linda Larsson

    Dear Barbara,

    I wish to cite this blogpost too in my MPH dissertation. I would really appriciate receiving the link to the IGIS working paper.

    Many thanks in advance.

    Linda

    Like

  5. Pingback: Mythmaking: Evolution, Infertility, and the Mythos of Barrenness | Ba'slan shev'la - A Strategic Disappearance

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