“Cycling Overseas”: Care, Commodification, and Stratification in Cross-Border Reproductive Travel

Abstract

Cross-border reproductive travel involves the movement of patients to undertake assisted reproductive treatment through technologies, such as in vitro fertilization and associated procedures otherwise denied to them due to cost, access, or regulatory restrictions. Based on fieldwork in Thailand, the United States, and the Czech Republic, we explore the commodification of reproductive bodies within this trade and the reduction of the nurturing affective labor of reproduction to exchange value. Second, we examine the intensification and globalization of the stratification of reproduction. These inequalities are illustrated though discussion of the trade in poor women's bodies for surrogacy and ova donation. Even reproductive body parts, ova, sperm, and embryos are stratified—marketed according to place of origin, the characteristics of their donors, and gender.

Key Words:

• assisted reproduction
• cross-border reproductive care
• Czech Republic
• IVF
• reproductive travel
• Thailand

ACKNOWLEDGMENTS

Research in the Czech Republic was granted ethical approval through Lawrence University institutional review board (IRB) No. 0812. Research in Thailand was funded by the Australian government through an Australian Research Council Discovery Project grant (DP0557227). Ethical clearance to conduct the project was received from the University of Melbourne Human Research Ethics Committee (HREC 060504X.2), the Faculty of Medicine, Mahidol University (016/2550), and clearances obtained through all participating hospitals and the National Research Council of Thailand (No. 0002.3/2069).

Notes

Recent estimates suggests that women have rates of primary infertility of 7.7 percent and secondary infertility rates of 8.5 percent in developed countries and primary infertility of 4.4 percent and secondary infertility rates of 13.4 percent in developing countries (Boivin et al. 2009).

The proposed draft legislation would strictly regulate the use of ARTs. It would prohibit pre-implantation genetic diagnosis for non-medical sex selection purposes and commercial surrogacy. The draft legislation clarifies parental status so that when using donor gametes the woman who carries the pregnancy and her husband (not the biological donors) will be the legal parents. In surrogacy, however, the social parents (i.e., not the surrogate) are the legal parents. No written contracts are allowed (Thai Law Forum 2007).

No data are available of the percentage of Thai-foreign clients at these clinics. Access to caseload records would clarify this point.

For example, the IVF Holiday website claims 60 percent success in using donor eggs and 50 percent success in using IVF (www.ivfvacation.com/Testimonials2.html, accessed October 11, 2010). No information is provided on how these figures should be interpreted.

Additional information

Notes on contributors

Andrea Whittaker

ANDREA WHITTAKER is Associate Professor in Medical Anthropology at the School of Population Health, University of Queensland, Australia. Current research supported by an Australian Research Council Discovery Project grant (DP1094895) involves ethnographic work on cardiac and orthopedic surgery in Malaysia and Thailand, building on previous work on reproductive travel in Thailand.

Amy Speier

Amy SPEIER is Assistant Professor of Anthropology, Eckerd College, St. Petersburg, Florida, USA. She is interested in health tourism, with a particular focus on the multiple motivations for different groups to travel to the Czech Republic for health reasons. Her previous research has focused on the transformation of balneotherapy, a traditional Czech healing technique that involves complex drinking and bathing therapies, as it was increasingly being incorporated into the development of a Czech health tourism industry.