Technologies that make assisted reproduction possible are advancing rapidly – getting faster, cheaper, and more accessible with each passing year. Indeed, technological developments often outpace research about their global impact. Assisting Reproduction, Testing Genes addresses this issue. Within each of its 11 chapters, authors interrogate the relationship between assisted reproductive technologies (ARTs) and different political, economic, and sociocultural environments. Together, these contributions paint a picture about the globalization of ARTs, shaking any assumptions that these technologies are value-free and easily translatable across the world.
The first scene-setting chapter points out that infertility affects millions of women and men in the non-Western world; that the lack of available ARTs is justified as a means of population control, as well as saving already scarce health resources and prioritizing diseases like HIV; and that most public and private healthcare systems set eligibility criteria that restrict access to the middle and upper middle classes alone. At the same time as facing these restrictions, non-Western couples – especially women – are under extreme societal pressure to have children, and voluntary childlessness is an unheard-of concept. However, despite bringing promise, ARTs do not always herald good news for those who can access them.
The remaining chapters are divided into three parts. The first centers on gender and technology, and on cultures that are in a state of flux. In a chapter that stands out because of its relevance to today's so-called refugee crisis, Lisa Vanderlinden investigates German-Turks’ use of IVF. She highlights that Germany admitted the largest number of foreign laborers, refugees, and asylum-seekers in Europe during the second half of the twentieth century, and these newer residents continue to face stigma and marginalization in the country. Couples’ experiences of IVF are consistent with this treatment. German-Turks feel discriminated against by health professionals; they fear fueling their image as “over-populators” among white Germans; and they experience distress at undergoing cycle after cycle of IVF without their family, and the warmth, food, and language of home. Concurrently, they feel extraordinarily privileged to access such treatment – something they would never feel able to do in Turkey.
Part 2 concentrates on the formal and informal use of gamete donors and surrogates. Within this section, Elizabeth Roberts writes about Ecuadorian women who use familial egg donors. The main message, in contrast to Vanderlinden's chapter, is that familial egg donation is empowering rather than repressing. Roberts draws on work by Levi-Strauss, Bourdieu, and their critics, as well the concepts “biovalue” and “bioavailability,” to contend that donation is a way for women to enter a marketplace. There, women are able to literally repay debt to family members, or use donation as a way to honor perceived obligations to them. These are not “hidden exchanges,” but the “central, official, maybe even structural sureties of women who are full and central players in the economy of kinship” (36). Arguably, egg donation is integrated easily into these women's lives and relationships, despite being a new social and technological process.
The third part looks more closely at genetics and cell biology. Aditya Bharadwaj's chapter is particularly interesting as it outlines the relationship between two global powers, that is, India's receipt of US federal funding for human embryonic stem cell research. Through a detailed analysis, Bharadwaj posits that such research serves India's neoliberalist boom, but can lead to exploitation of everyday people who make the research possible. He criticizes one aspect of neoliberal ideology in particular: that individuals in society are autonomous, informed, and rational producers and consumers. Indeed, his interviews with couples receiving IVF, from whom the embryos are taken, suggest otherwise. Women and men appear to be victims of the market and see “donation” as an emotional sacrifice, rather than a rational and informed choice. Once again, we arrive at a conclusion that ARTs and related technologies are a double-edged sword, bringing hope and promise, as well as repression and exploitation.
A final chapter to summarize key themes, interrogate differences, and identify future directions, would have improved this volume. Such an addition would move the discussion away from each chapter's “local” insight, toward a more global overview. There was also little focus on genomics – a possible area for a revised edition. These minor issues aside, this volume is compelling and highly readable to postgraduates and above in social science, ethics, and medicine. It gives voice to people who often go unheard, describes contexts that are frequently overlooked, and brings these narratives together in a comprehensive and insightful way.