Scientific motherhood, responsibility, and hope: umbilical cord blood banking in South Korea

Abstract

This paper explores how concepts of hope, motherhood, responsibility, and science are mobilized and transformed in the marketing strategies of private cord blood banks in South Korea. Cord blood banking provides a useful case study of the “political economy of hope,” which emphasizes future expectations over current utility. In particular, appeals to hope are rendered natural as being applied in relation to various concepts of motherhood (e.g. “scientific motherhood” and “consumer motherhood”), thereby refiguring ideas of a mother's responsibility to her child. In South Korea, cord blood banks rely heavily on the discourse of “scientific motherhood,” which is based on certain gender norms and ideas about science, modernity, and “advanced society.” By exploring the discourse of scientific motherhood, this study reexamines the “political economy of hope” through the lenses of gender and transnationalism.

Keywords:

• cord blood banking
• scientific motherhood
• political economy of hope

Introduction

Umbilical cord blood, once considered waste, is now widely considered to be valuable as an alternative to bone marrow for treating children with serious medical conditions, such as leukemia. Moreover, cord blood has received more attention as a source of stem cells for research and regenerative medicine that may treat a number of diseases in both adults and children. Stem cells from cord blood are believed to be able to regenerate blood and the immune system, as well as other damaged tissues and organs. However, many of the proposed clinical applications have not yet been medically proven.

In South Korea, stem cells from cord blood have emerged as an “alternative” source for stem cell research on ova and embryos, particularly in the wake of the scandal involving the Korean stem cell researcher Woo Suk Hwang's problematic use of human ova for embryonic stem cell research.¹ Both cord blood banks and scientists have repeatedly claimed that, unlike embryonic stem cell research, stem cell research using cord blood is “free of ethical issues” (e.g. Rogers and Casper 2004). Despite such claims, the collection, study, and sale of umbilical cord blood involves a number of critical bioethical and sociopolitical issues that have not been adequately discussed.

Previous social studies of cord blood banking have yielded important insights on the marketing strategies of private cord blood banks (e.g. Brown 2005; Brown and Kraft 2006; Waldby 2006; Dickenson 2007; Martin, Brown, and Turner 2008; Brown, Machin, and McLeod 2011). In particular, these studies have demonstrated how private cord blood banks, like many emerging biotechnologies, rely heavily on notions of hope, emphasizing future expectations rather than current utility (Good et al. 1990; Mulkay 1993; Moreira and Palladino 2005; Rose and Novas 2005; Rose 2007). For instance, Martin, Brown, and Turner (2008) described how private cord blood banks “capitalize hope” by mobilizing “promissory expectations” for future medicine in a neoliberal market (Martin, Brown, and Turner 2008). As Rose and Novas (2005) explain, in the “political economy of hope,” hope is more than just a set of beliefs; it involves many material practices that shape what kind of science is considered important, funded, and sold. Rose (2007) argues that, in this new biotechnological era, new meanings and subjectivities are formed in relation to hope that present scientific practices will yield future cures or treatments. For Rose, life, once considered a matter of fate, is now understood as a matter of deliberation, management, and investment in relation to new biotechnologies (2007).

The discourse around private cord blood banking exemplifies the “political economy of hope,” but previous research has not paid sufficient attention to how cord blood banks construct notions of hope in conjunction with developing conceptions of motherhood and transnationalism. In short, appeals to hope are rendered natural as being attached to old and new notions of motherhood (e.g. “scientific motherhood” and “consumer motherhood”), thereby reconfiguring ideas of a mother's basic responsibilities to her child. In the case of cord blood, not only hope for future medicine, but also anxiety about the future health of her child play an important role. This paper aimed to unravel how the discourse around cord blood banking redefines “motherhood,” particularly in conjunction with the “political economy of hope.”

Moreover, the transnational context of South Korean case merits further exploration. In South Korea, cord blood banks rely heavily on the discourse of “scientific motherhood,” which invokes certain gender norms and ideas about science. In South Korea, ideas of what it means to be a “good mother” have historically been formed in relation to what Lee describes as “scientific motherhood,” which involves modernity, “Western” science,² and class (2003, 2004). The notion of scientific motherhood has gained credence as a “technical rationality” through discourse of modern hygiene, discipline, and education, to the extent that Korean mothers are now expected to develop expertise in “scientific childrearing.” Ideas of scientific motherhood, combined with the political economy of hope, form the core of marketing strategies for cord blood banks in South Korea. By exploring the discourse of scientific motherhood, this study re-examines the political economy of hope discourse through the lenses of gender and transnationalism.

In South Korea, unlike in Europe or the USA, private cord blood banks are more prevalent than public cord blood banks (Lee 2006). Also, South Korea has an extraordinarily high rate of umbilical cord blood storage, with cord blood from 15% to 17% of newborns being stored each year, as compared to Europe (0.6%), the USA (2.6%), and Taiwan (8–10%).³ The current status of cord blood banking in South Korea has been presented in government reports (Lee 2006, 2010) and legal examinations (Lee and Song 2005; Song 2008), and surveys have been conducted to assess Korean women's knowledge and attitudes toward cord blood banking (Kim et al. 2009; Shin et al. 2010). These studies provide details on the status and direction of current government policies and laws, but they fail to analyze the cultural meanings of cord blood banking, including the political economy of hope and the construction of motherhood.

This paper first explores current practices of cord blood banking in South Korea, and then examines how concepts of hope, scientific motherhood, and transnationalism are mobilized and transformed in the marketing strategies of private cord blood banks.

Method

This study is based on intermittent fieldwork pursued in South Korea between 2008 and 2012. I interviewed 12 people, including 6 expectant parents who donated, privately stored, or rejected the storage of, cord blood, as well as clinicians and bioethicists. I also read consumers' blogs to further understand the hopes and concerns of expectant parents with regard to cord blood banking. I examined websites and advertisements of the main private cord blood banks, including their consent forms and materials that introduce their products. I called five cord blood banks for clarification of the forms and information they provided on their websites. I collected media reports and governmental reports on cord blood banking in Korea to analyze how social expectations of cord blood banking are shaped.

Cord blood banking in South Korea

Public banking, private banking, and hybrid forms

In South Korea, cord blood banking practices can be divided into three basic categories: “donation” (ki-jŭng), “family” (ka-jok), and “sharing” (kong-yo˘). The “donation” category comprises cord blood that is donated and stored primarily at public cord blood banks for transplantation to patients or research purposes. For “family” banking, parents pay to have cord blood stored exclusively for possible future use for the child or another member of the family. In South Korea, this option currently costs between 680,000 and 2,700,000 KRW (Korean Won), or between $650 and $2500,⁴ depending on the period and conditions of storage. Most “family” cord blood banking is done through private cord blood banks, which operate as for-profit businesses.

Interestingly, some private cord blood banks provide not only “family” banking, but also “donation,” as well as a third option: “sharing.” This “hybrid” model is also found in other countries,⁵ but is more common in South Korea (Table 1). The “sharing” type of cord blood banking combines elements of “donation” and “family” banking. This model costs less than “family” banking because the cord blood is not held exclusively for family use; it can be used for research or treatment of non-family members. However, throughout the length of the contract, the family is guaranteed priority access to matching cord blood from the pool preserved in the bank.

Table 1. Cord blood banks in South Korea.

Name	Donation/family/sharing	Units stored
Total		421,454
Sungkyunkwan University School of Medicine Samsung Medical Center Cord Blood Bank	Donation	96
Catholic University Hematopoietic Stem Cell Bank	Donation	3316
Pusan, Kyoung-Nam Area Cord Blood Bank	Donation	332
Young-Nam University Hospital Cord Blood Bank	Donation	144
Seoul Metropolitan Public Cord Blood Bank	Donation	17,409
Yonsei University Severance Hospital Cord Blood Bank	Family and donation	128
Histostem (Seoul Cord Bank)	Family and sharing	90,962
Medipost (Celltree)	Family and donation	131,307
Daegu Patima Hospital Cord Blood Bank	Family and donation	1642
CHA Biotech (ICORD)	Family and donation	55,990
Green Cross (Lifeline)	Family and donation	14,584
Good Gene Cord Blood Bank	Family	117
Life Cord Cord Blood Bank	Family and donation	42,872
Sewon Cellontech (BabyCell)	Family	36,591
Innocell (DreamCord)	Family	2190
Boryung Biopharma (Boryung I. Mom CellBank)	Family	20,628
Pharmicell (Twelve Baby)	Family	624
Hurim Biocell (Help Cell Bank)	Family and donation	228
RNL Bio (A-Cord Cord Blood Bank)	Family and sharing	2294

Source: Data collected by the Ministry of Health and Welfare (MOHW) in June 2010 quoted in Lee 2010, 8.

As of 2010, there were 19 cord blood banks in South Korea (Table 1). In South Korea in 2005, more than 95% of the total cord blood donated for public use was stored at private banks, and private banks had twice as many units of family cord blood as public banks (Lee 2006). Public banks in South Korea have not been continuously funded (Lee 2006), allowing private banks to attract customers away from both public and family banking.

Clinical risks to mother and newborn

Both public and private cord blood banks assert that there is no risk for the baby and mother because cord blood is harvested from the placenta and umbilical cord “after birth.” The ease of collection is often emphasized as one of the merits of using cord blood stem cells (e.g. Rocha and Locatelli 2008). None of the websites or consent forms that I examined mention any possibility of risk. I called five of the cord blood banks to inquire about health risks, and each one claimed that there is absolutely no harm in collecting cord blood. All of the women I interviewed also said that they had not heard or received any information about possible health risks.

However, cord blood is usually captured in the third stage of labor, when the placenta is still attached and blood is still flowing through the cord. Notably, this is the stage of labor when hemorrhaging and shock are most likely to occur. Given that postpartum hemorrhaging is the leading cause of maternal death, there is clearly some risk involved with the collection of cord blood (Abouzahr 1998, quoted in Dickenson 2007). The process of retrieving cord blood may well increase the length and risk of labor whereas mothers need a speedy and safe third stage to minimize risk (Dickenson 2007, 85). With regard to the baby's health, some bioethicists worry that an obstetrician charged with collecting cord blood may clamp the cord too early, resulting in an increased risk of neonatal anemia (Dickenson 2007, 89–91; Fox, Chervenak, and McCullough 2008, 179).

It is also crucial to note that a sufficient amount of cord blood must be collected in order for it to be suitable for storage and use (Lee 2006, 28, 32). In fact, if cord blood cannot be stored because of insufficient quantity or other reasons, Korean banks are sometimes required to refund the payment for family banking.⁶ Data suggest that more cord blood can be collected before the placenta is delivered,⁷ so it is not surprising that private banks prefer to collect the blood before the delivery of the placenta, rather than after. While the risk of collecting cord blood is usually less than that of donating bone marrow or ova, it is still highly problematic that women considering storing or donating cord blood are not given any information about possible risks.

Channels of information on family cord blood banking

Private cord blood banks advertise the merits of the practice through various channels. They offer free childbirth classes, which include sessions not only about cord blood, but also about breastfeeding and other topics. By covering general issues related to pregnancy and childbirth, the classes entice more pregnant women to attend and, eventually, to feel that cord blood banking is an essential part of childbirth. Childbirth exhibitions (often called “Baby Fairs”), which offer a range of childbirth products for expectant parents, usually have booths for cord blood banks (Figure 1). One research participant said that there were about 30 representatives from cord blood banks at a Baby Fair she attended in 2009. Salespeople from private cord blood banks can also be found in some obstetric clinics (Figure 2), where they seek to interact with patients before or after their appointment. In some cases, they even assist the regular nurses as if they are staff members of the clinic.

Figure 1. Booth for a cord blood bank at an exhibition on childbirth.

Source: Li and So 2012. Reprinted with permission.

Figure 2. A sales representative from a family cord blood bank waiting for possible customers in the hallway of a women's clinic. Sales representatives have often worn white lab coats for about 10 years. Soon after the media report in 2012, the Ministry of Health and Welfare recommended that sales representatives should not wear white lab coats, and they do not wear them thereafter.

Source: Li and So 2012. Reprinted with permission.

The cord blood banks also employ more traditional ways of advertising, including TV, newspaper, and subway advertisements. One of the most important sources that my research participants mentioned was online sources, such as online shopping websites, cord blood banks' websites, blogs, and web-based communities concerned with childbirth and childrearing.

Various cord blood banks and storage options are listed on online shopping websites. As simple as ordering a crib or stroller, online shoppers can purchase cord blood bank options with a credit card (Figure 3). Once an online order is received, the bank sends a collection kit that the buyer brings to her doctor.

Figure 3. Search result of “cord blood banking” retrieved from Gmarket (www.gmarket.co.kr), one of the largest retailers in South Korea. Accessed on May 30, 2010. Reprinted with permission. Private cord blood banks provide various options, including different storage periods and financial support to help cover the cost of a possible transplant.

Marketing strategies of family banking: hope, scientific motherhood, and transnationalism

Political economy of hope

One of the important marketing points of private cord blood banks is the potential of open-ended stem cell research. For example, the bank Life Cord says:

Cord blood stem cells are being used for research and treatment of genetic and other diseases. Therefore, your newborn's cord blood can be the key to treating those diseases in the future. By freezing and preserving cord blood stem cells, you can have peace of mind because you can always use genetically identical hematopoietic stem cells whenever one of your family members needs it in an emergency. (Life Cord website)

In this way, private banks mobilize a promising image of the future based on hope. Their advertisements employ phrases such as “biological insurance” (Life Line website), “once in a lifetime opportunity” (ICORD website), and “the first gift for your baby” (Dream Cord and ICORD websites).

One of the mothers I interviewed, Jeongwon, was openly critical of private banks' marketing strategy:

It's like getting vaccinated. We're scared of suffering from serious diseases, and it's hard to weigh the importance at that time. So new parents want to do everything they can … I think it is a kind of commercialism that uses parents’ desire to do the best things for their newborns, and spare no expense. (Jeongwon, gave birth in 2008, donation banking)⁸

As Jeongwon attests, such advertisements target expectant mothers (and parents), who are in a quite vulnerable situation and have a relatively short time to make an informed decision (Brown 2005, 342–343). As Waldby and Mitchell argue, while public banks transform cord blood into clinical value through the redistributive process, private banks transform it into biological venture capital with futuristic terms (Waldby and Mitchell 2006, 120). In this way, private cord blood banking provides a useful case study of the “political economy of hope” (Rose and Novas 2005; Rose 2007). Like many other biotechnologies, private cord blood banking places a strong emphasis on the promise of the future.

The ideas promoted by private cord blood banks in this political economy of hope are based on neoliberal virtues. As Waldby suggests, a neoliberal value system emphasizes the virtues of private property, entrepreneurial investment, and technocratic progress. Like the neoliberal principles of private insurance, private cord blood banks offer personalized risk management services as a hedge against the uncertainties of the future (Waldby 2006, 59). This is in contrast to public banking, wherein donation is encouraged through ideas of altruism and solidarity (Titmuss 1970). The advertising of private cord blood banks also tends to emphasize the reliability of individualizing the risk management system, thereby appealing to neoliberal virtues of a weakened state, wherein the final decision is controlled by the consumer.

The neoliberal narrative about individual “choice,” however, often obscures the politics of power, especially in the case of biopolitics. As Braun argues, it is still important to ask, “what it means to ‘exercise choice’ in the self-management of the body” (Braun 2007, 12). The “choice” is always conditioned by various factors, such as socioeconomic status and social norms. Not everyone can afford family cord blood preservation, and information on the social and ethical issues of cord blood banking is very limited. As Franklin notes, “new technological options produce a forced choice: once a choice exists, it must either be pursued or refused” (1998, 108). In her analysis of assisted reproduction, Franklin points out how reproductive technology does not “solve” the infertile couple's desire for children, nor the desire for “peace of mind” produced by the belief that they have at least tried everything they could, but actually produces a greater desire than which existed at the outset. This is a good example of how hope is produced and mobilized in relation to biotechnology. It would be hard to call it a “free choice” when the technological option is combined with conventional ideas of a “normal” or “ideal” family. The politics of choice become more complex when combined with particular ideas of motherhood in relation to cord blood banking.

Motherhood and hope

The discourse of hope in cord blood banking intersects with particular ideas of motherhood, thereby conditioning women's choices. Particular norms of motherhood are used to naturalize the hope for new biotechnology in the neoliberal market, and new biotechnology demands new forms of consumption and motherhood. Motherhood is often understood as a natural instinct, a sacred ability, something that requires no explanation. Although many feminists have criticized the naturalization and universalization of motherhood by pointing out how women's experiences of motherhood are historically, socially, and culturally constituted (e.g. Rich 1976; Shim, Chung, and Yoon 1999), the tendency to think of motherhood as “natural” remains quite strong. With regard to cord blood banking, conventional ideas of motherhood effectively naturalize and de-politicize the hope for future medicine in the name of a mother's responsibility and strengthen the appeal of private cord blood banks by capitalizing “motherhood.”

For example, one advertisement for a private cord blood bank features the following catchphrase: “Whoever you are, if you are a mother … ” (“O˘m-ma ra-myo˘n nuguna,” Celltree Bank website). The ellipsis implies that every mother must do everything she can to ensure her child's health and well-being, which in this case means preserving her baby's cord blood. Hence, the advertisement effectively reshapes what it means to be a mother by insinuating that cord blood banking is now part of a mother's responsibility. At the same time, the opinion that banking cord blood is necessary for a baby becomes a “fact.” In this way, the refusal to subscribe to new technologies becomes morally charged, as noted by Franklin (1998) with regard to the politics of choice.

Another advertisement reads, “What's more important than fetal education (taekyo)? It's your baby's health. Celltree Bank preserves a mother's hope for her baby's health” (Figure 4). In this image, a pregnant woman listening to music places speakers on her abdomen, ostensibly allowing the fetus to listen. The concept of taekyo is based on the belief that a mother's behavior and environment can affect the baby's personality, intelligence, health, and more. The need for taekyo is often used to prescribe what pregnant women should or should not do. The advertisement encourages consumers to imagine the mother's hopes and expectations for her baby, at the same time suggesting what an expectant mother should do during her pregnancy in addition to (or instead of) taekyo, that is to prepare for cord blood banking. Again, the advertisement conveys the message that cord blood banking is an essential part of a mother's duty to her child and, like taekyo, is directly linked to pregnancy and motherhood.

As in the taekyo discourse, pregnant women in South Korea are often told what they should or should not do for their baby's health. Most women are encouraged to have sonograms and undergo various prenatal tests for birth defects and other “abnormalities.” Such tests often end up leaving expectant mothers even more worried about their baby's health. Cord blood banking, in effect, relies upon the success of other new prenatal technologies and the anxieties they produce through increased visibility and knowledge of the fetus. Cord blood banking answers these anxieties in a particular way. In this vulnerable time, the appeals of private cord blood banks emphasizing the importance of preserving the cord blood for the baby's future health can affect women's decision-making.

Responsibility and blame

Connotations of motherhood invoke particular assumptions about responsibility, particularly in relation to a mother's expected roles in both family and society. Crucially, that responsibility involves not only specific duties, such as searching for information or going to clinics, but also the “moral accountability for those actions and their outcomes” (Throsby 2004, 134). As Throsby demonstrated in the case of assisted reproduction, when the technological intervention is successful (i.e. results in a healthy, “normal” baby), the success is attributed to medical science, while the woman's contribution is not acknowledged. However, if anything should go wrong in the procedure, the mother usually receives the blame. Similarly, women are pressed to submit to an array of prenatal tests, largely motivated by the impending guilt and opprobrium (both familial and social) they would be subject to, should the child be born with an illness or disability (Lupton 1994; Rapp 1998, 1999; Throsby 2004, 135). This gendered politics of blame is related to the dominant “construction of reproduction as women's responsibility” (Throsby 2004, 135).

Now, with cord blood banking, women's responsibility is extended beyond the birth of a healthy baby to encompass the open-ended future of the child. If the child experiences any health issues in the future, it will be the mother who will bear the guilt. One of my interviewees, Minsoo, expressed the guilt she felt over not having stored her first child's cord blood:

I regretted not storing my first child's cord blood, so I had it stored for my second child. We're sorry for our first child. I know many have suspicions about self-transplantation of cord blood, but it's too good to be thrown away anyway. There are lots of stem cells in it, so it would be good to give it to someone sick, just in case. (Minsoo, gave birth in 2005 and 2008, family banking)

One blogger wrote about how she changed her mind at the last minute, and decided to bank cord blood despite the high price. For her, cord blood banking seemed to offer some insurance against future regrets:

I've been thinking that I wouldn't [store the cord blood], but during my final visit yesterday, I got a survey about the forms of childbirth and so on, and there was a question about whether or not to store cord blood. Then my mind waivered … I thought maybe I could just get a consultation, so I checked the ‘under consideration’ box and consulted a person from a cord blood bank, who usually stays at the clinic. One million won [about $952] is a lot of money … but I thought, if I don't do it, what if something happens and I really regret it deep in my heart … I stored cord blood just in case, but I hope nothing happens and we never have to use it. (Blogger 1, gave birth in 2010, family banking, posted on 13 April 2010)

Seeing options for cord blood banking presented as part of a clinical survey can strengthen the belief that deciding whether to store cord blood is an essential step in the childbirth process. Decisions about whether or not to preserve the cord blood and which cord blood bank is most suitable for storage are understood as a mother's responsibility.

Rose and Novas (2005) have explained that hope is not passive, but rather requires active deliberation and engagement with the biological aspects of one's life. As such, the mother's expanded role as a consumer of biotechnologies can be a sign of her growing agency in terms of active investigations and choices. Yet it is presented as more of a duty than a right, and if something should go wrong, a mother may receive the blame and suffer feelings of “being a deficient mother,” or failing to be a “scientific mother.” Thus, the choice is not free from the politics of power.

Scientific motherhood

In South Korea, the roles of mothers are complicated by a child-centered notion of the family. Since the 1990s, Korean mothers' roles in their children's education have expanded, and a child's success has increasingly been taken as a measure of a woman's ability as a mother (Shim 1999, 377). With children often being seen as the “hope for a family” and the means for class mobility, the family has increasingly become a site for strategic investment in children's educational success (Shim 1999, 377).

In this context, the norms of “scientific motherhood” or “professional motherhood” have become strong in the discourse of scientific childrearing (Lee 2003, 2004). These norms define the “perfect mother” as someone who continuously improves her knowledge and expertise in scientific childrearing. In the context of childbirth and childrearing, “science” is understood to entail tested methods for improving a child's health, success, or well-being. The “scientific” mother's ability is identified with a mother's love (Lee 2009, 167). The “scientific motherhood” norm has been commercialized not only in education, but also in areas such as health and nutrition (Lee 2003, 171). The quantity and diversity of childcare books being published have markedly expanded, and various enterprises related to childcare and childbirth, such as a market for “science-based” nutrition and healthcare for children, have thrived. In particular, the role and the subsequent burden for the mother have increased in families that lack social support.

In this context, cord blood banking becomes an important decision for expectant mothers in the name of children's health.

For example, one interviewee, Eunjoo, changed her mind at the last minute and agreed to store cord blood:

[The salesperson] said that my doctor had stored her own baby's cord blood at the bank and showed me her consent form … When I arrived at the clinic in labor, I suddenly thought I should do it. I had the dreadful thought that my baby might need the cord blood sometime in the future. Who knows? … The cost of storing cord blood for ten years was about 1,300,000 KRW, and I thought it would be better to spend the money that way than to buy expensive baby furniture or clothes. So I ended up doing it. (Eunjoo, gave birth in 2008, family banking)

As Eunjoo's case illustrates, the claim that health is more important than material goods is quite effective, and private cord blood banks leverage this hierarchical value system in terms of investing for children. Moreover, the salesperson effectively used the fact that Eunjoo's doctor was storing her cord blood, knowing that doctors are considered experts in all matters of health and medical science. In a related strategy, cord blood bank representatives and salespeople sometimes wore white lab coats in order to look like doctors, scientists, or medical experts (Figures 1 and 2). In this way, cord blood banking actively seeks to differentiate itself from other consumer products for babies.

In a neoliberal consumer culture, mothers are expected to investigate and decode complex meanings of commodities and services, and choose the right options for their family and children. Sorting through the various choices and prices for cord blood banking encourages them to become “competent mothers” who decipher complex signifiers based on their lifestyle and class (Lee 2009, 160–161). Moreover, with the increasing visibility of biotechnology, mothers are required to become proficient in decoding scientific information provided by the marketplace. As another interviewee, Soyeon, stated, “Women are usually responsible for buying things for the baby, so I researched a lot of information on cord blood banking” (Soyeon, gave birth in 2010, no banking). As Eunjoo also mentioned in her interview, “There's been a lot of information [about cord blood banking], but I wanted to find good information that I could trust.” When little social knowledge is provided, it becomes more difficult to “study” possible options and make choices, particularly for those with few resources.

The fact that many Korean families have only one or two children makes families' investment in their children even more critical (Hwang 2005). One blogger touched upon the relationship between the number of children and the financial investment required to store cord blood:

Of course it's not a small amount of money, but I'm not going to have many children, and this baby is very precious. So I just did it in case of emergency. (Blogger 2, gave birth in 2005, family banking, posted on 23 November 2008)

Particular notions of family and motherhood have fostered the growth of many private cord blood banks in South Korea. As mentioned, not everyone can afford the cost of family cord blood banking. Thus, the commercialization of parents' wishes to do everything possible for their child's health reinforces the middle-class ideal of motherhood. Mothers are expected to choose nothing but the “best” for their child.

Concerns and skepticism

Mothers, however, are not a homogeneous group, and not all of them are convinced of the merits of cord blood banking. Soyeon expressed criticism and skepticism about family banking:

It's been seven to eight years since cord blood banking boomed, but contrary to their promises, I don't believe that there's been any particularly good outcome from the research using cord blood yet. Also, I think private banks urge people to think only about themselves and their baby, rather than the public good. And I haven't yet found any public bank I can trust. (Soyeon, gave birth in 2010, no banking)

Jiyoung seemed to agree:

I was thinking about it when I had my first child [in 2006] because there was a boom at that time, but this year, for my second child [in 2010], I didn't think much about it. I think the banks are hard to trust since news about the administrative problems of private cord blood banking emerged. (Jiyoung, gave birth in 2006 and 2010, no banking)

As Jiyoung mentioned, several news and TV programs have reported on administrative problems at some cord blood banks. For example, some banks went bankrupt, and their customers had no way of retrieving their babies' cord blood. Some companies were found to have contaminated units of cord blood rendering them basically useless.⁹ The increased media coverage of these problems has made some mothers more anxious about choosing whether to store cord blood.

Moreover, the discourse of hope raises questions about the extent to which expectant mothers should trust and invest in the new technology. As Soyeon mentioned, doubts have been raised about the efficacy of cord blood banking. In this context, advertisements for cord blood banks often mobilize the practices and images of cord blood banks in other countries in order to demonstrate the reliability and importance of cord blood banking, as will be shown later in the paper.

Scientific motherhood in a transnational context

One of the strategies cord blood banks employ to address customer concerns is to invoke the transnational context. In fact, many of my research participants asked me whether cord blood banking is common in “foreign countries,” that is high-income countries in North America and Europe. Because cord blood technology is relatively new, and its effectiveness has not been verified, women in Korea are curious to know the current status of the technology in the so-called advanced societies. As such, in response to the uncertainties evoked by the discourse of hope, women try to predict the future and justify their decisions with incomplete information about “advanced” societies.

In this context, cord blood banks emphasize that preserving cord blood is popular not only in South Korea, but also in other (high-income) countries. For example, the website of one cord blood bank refers to the company as a “World Standard (Kuk-je pyo-jun) Cord Blood Bank.” Then, under the subtitle “World Trend,” the text states that “public … and family cord blood banks have been already established or are in the process of being established in the U.S., Europe, Japan, and other countries” (Lifecord website). In utilizing high-income countries as a reference point, Korean cord blood banks are relying on the implicit belief that science and technology are more advanced in those places, and that the people of those countries (particularly mothers) can be counted on to make rational decisions. Notably, family cord blood banking is more common in some Asian countries, while public banking is more common in the USA and Europe, but this distinction is not mentioned in any advertisements.

As Figures 4 and 5 demonstrate, many cord blood bank advertisements and websites also prominently feature images of “white” women and scientists who do not look like “typical” Koreans, even though the advertisements clearly target Korean consumers. Through these images, cord blood banks emphasize that preserving cord blood is popular in the “West.” The frequent images of white mothers are intended to persuade parents that the practice of storing cord blood is part of a value system which links “whiteness” or “Western” society, advanced technology, and the principles of being a “good mother.”

Figure 4. Celltree advertisement at http://www.celltree.co.kr. Reprinted with permission from Medipost.

Figure 5. Website of Seoul Cord Bank (www.seoulcord.co.kr). Reprinted with permission from Histostem.

Amid the process of modernization and capitalization in South Korea, the discourse of scientific motherhood has become embedded as a “technical rationality” involving modern principles of hygiene, discipline, and education. Today, “good mothers” are expected to develop expert knowledge in these and many other areas related to raising children. Cord blood banks in Korea actively utilize the concept of scientific motherhood on their websites and advertisements, through a strategic mix of images and ideas related to race, advanced science, and principles of motherhood.

Trans/nationalism and reliability

The advertisements suggest that the Korean banks are part of a cooperative transnational network of cord blood banks, thereby reinforcing the reliability and technological advancement of Korean banks. In some cases, the export of “Korean blood” is advertised as a source of pride that proves the efficacy and management of Korean blood banks, while at the same time promoting international banking and trading in cord blood as an emerging bioeconomy (Brown, Machin, and McLeod 2011).¹⁰ The export of cord blood is advertised as evidence that the banks' preservation system is of high quality and has been approved by authorities in other high-income countries.

For example, an advertisement for one private cord blood bank featured a news report about exported cord blood:

The U.S. National Marrow Donor Program (NMDP) requested cord blood from KoreaCORD, and Medipost's cord blood was selected to be used for a patient in Pennsylvania. The United States is famous for its very strict standards of quality control. The export of our cord blood to the U.S. demonstrates that the high quality of our bank's cord blood and our preservation technology is recognized internationally.¹¹

Seoul Cord Bank also emphasizes the fact that it “has provided cord blood to Japanese, Taiwanese, Cambodian, Thai, and American patients” (Seoul Cord Bank website). The internationalization of cord blood banking is stressed to inspire confidence in Korean consumers.

Moreover, the boom of the cord blood industry is often portrayed as evidence of Korea's biotechnological development. For instance, the website of Medipost, a private cord blood bank, advertises the institution as “The Future of Korean Biotech.” Among its services, Medipost offers a cord blood stem cell therapy for regenerating cartilage, called “Cartistem,” which was approved by the Korea Food and Drug Association and became available for sale in early 2012. In an effort to promote stem cell science, the government has recently eased regulations on stem cell therapy, and cord blood stem cells are expected to help eclipse the memory of the Hwang scandal.¹² Science and technology are considered vital to South Korea's efforts to “catch up” with or even “lead” Western countries in the global competition for stem cell research. Thus, the idea of science as the “hope of the nation” helps to create a positive image of cord blood banking in South Korea.

In this context, nationalistic feelings about the quality of Korean blood are connected to parents' belief in the need to secure their baby's blood for possible future use. Titmuss (1970) explained the dualism that exists between donation and commercialization, and between nationalism and individualism. He claimed that the intention to help one's fellow citizens based on feelings of nationalism was a greater impetus to encouraging donation, while commercialization is based on individualism. Here, the nationalistic pride comes from the promotion of Korea as a scientifically advanced nation where cord blood is well managed. In this case, however, nationalism is used to encourage commercialization, rather than donation.

Concluding remarks

Around the world, commercial and scientific interests in human biological materials are rapidly increasing. Particularly, biomaterials related to women's reproductive biology, such as oocytes, embryos, fetal tissue, menstrual blood, and umbilical cord blood have become important raw materials for stem cell research and regenerative medicine¹³ (Waldby and Mitchell 2006). The practice of Korean cord blood banks is a good example that shows the more general development and expansion of regenerative medicine as a new technology.

In effect, the business of storing bodily materials is emerging based on the promises of new biotechnologies. The political economy of hope that new biotechnologies regularly invoke becomes more powerful when deployed in conjunction with particular ideals of motherhood in the advertisements of umbilical cord blood banks. Such advertisements target expectant mothers at their most vulnerable time, when they are likely to be very anxious about their baby's health and their own uncertain future as a mother. Cord blood banks work to convince mothers that they must not risk their baby's health by failing to collect stem cells that might be needed later. I have argued that cord blood banking has a definite gender dimension, and that motherhood is the core concept in the discourse around cord blood banking. Of course, the cord blood is collected from women's pregnant bodies, but women also generally assume all the major responsibilities related to childbirth and childrearing.

Another point I have argued is the transnational aspect of the technology. In South Korea, cord blood banking has become more popular by connecting itself to an ideal of “scientific motherhood,” which historically involves conceptions of science, gender norms, and so-called advanced society. Advertisements for cord blood banks often feature images of “Western” women and scientists, as well as accounts of global cord blood banking systems, thus reinforcing the international acceptance of the practice. In addition, the idea of science as the “hope of the nation” helps to create a positive image of cord blood banking in South Korea. Women are configured as consumers of this science, and are made to believe that acquiring full knowledge about biotechnological options is an essential responsibility of motherhood. Thus, scientific motherhood emerges as the new authentic motherhood.

As the powerful notion of scientific motherhood gets combined with the political economy of hope, incorporating future medical advances, anxieties about a baby's future health, and the nation's future, the voices and concerns of women are often erased. Health risks involved in collecting cord blood are underplayed or even ignored as cord blood is formulated as an “uncontroversial” source for stem cells. The political economy of hope that surrounds this new biotechnology invokes specific notions of motherhood that effectively naturalize and de-politicize the ethical and social issues related to cord blood banking. Beyond the emphasis on individual choices, the broader contexts of the social meaning, history, and economy of this biotechnology must be further examined.

Acknowledgments

I thank Susan Craddock, Jacquelyn Zita, Karen-Sue Taussig, Bruce Braun, Jonathan Metzl, Sang-Hyun Kim, and Todd Henry for their very helpful comments on the earlier version of this paper. The fieldwork was funded by the Graduate School and Office of International Programs at the University of Minnesota. This work was also supported by Bioethics Policy Research Center designated by the Korean Ministry of Health and Welfare, and National Research Foundation of Korea Grant funded by the Korean Government [NRF-2008–361-A00005].

Notes

1. In 2004 and 2005, Dr Hwang Woo-suk published research in the journal Science in which he claimed to have grown stem cells from the world's first cloned human embryos. But in November 2005, the research was found to be fraudulent. Dr Hwang's team had obtained 2221 eggs from donors, including two junior researchers and other paid donors. He originally claimed that all of the donors had volunteered for the study in order to help other patients and contribute to Korea's scientific advancement. However, inquiries revealed that many of the donors were in fact impoverished women who provided their eggs without sufficient explanation, and subsequently experienced side effects from the hormones used for egg extraction. According to scientists I interviewed, since the Dr Hwang scandal, it has become very difficult to obtain permission and funding to use embryos and eggs for research in South Korea. Most of the interviewees indicated they have now turned to adult or animal stem cells, although some, including Dr Hyung-Min Chung at Cha Biotech, affirmed the need to continue embryonic stem cell research.

2. In South Korea, the concept of “science” has historically been associated with the West. After Japan became the first Asian nation to industrialize, postcolonial countries in Asia sought Western knowledge as a tool for national empowerment, although there were also tensions between Western rationalities and cultural values (Ong 2010, 7). Later, in the 1960s and 1970s, Koreans experienced Western birth control technologies in the context of family planning policies, further strengthening the association of Western science and technology with modernity and advancement (Cho 2012).

3. Economic Daily News, January 9, 2008, D6, quoted in Rei (2010).

4. By the current exchange rate, $1 is approximately 1050 KRW. In the USA, the initial fee for private cord blood banking ranges from around $1000 to $2000, along with annual storage fees of $100–150 (Percer 2009, 220).

5. These banks include Cryobanks International (USA), Cord Blood Registry (Canada), and Virgin Health Bank (UK) (Martin, Brown, and Turner 2008, 140–141).

6. Some banks in South Korea offer a partial or full refund if the cord blood unit is not acceptable for storage due to low volume or contamination, according to the terms of the contract. This would seem to challenge the criticism of private banks as exploitative. However, private cord blood banks are not obligated to conduct a full diagnostic check of the quality of the units, because relevant laws passed in 2011 apply only to donated cord blood. Hence, family cord blood banks can store cord blood without conducting tests that would reveal the non-viability of the units. In addition, there is wide national and international variance in how cord blood banks control the quality of units, as well as in the refund policy.

7. Most donations of public cord blood (65.66%) were considered unsuitable for storage because the amount of cord blood collected was less than 60 ml. In a recent government report, many private banks did not list the reason why cord blood was not stored after being collected. In some cases, the blood is not stored because it is somehow contaminated (Lee 2006, 28, 32).

8. Based on her online search of expert opinions, Jeongwon eventually decided to donate cord blood to a public bank, which she felt was more beneficial than family banking.

9. For example, see “Poor management of umbilical cord blood makes mothers angry.” Financial News, March 3, 2009.

10. According to Martin et al., the cord blood units stored in the New York Blood Center's National Cord Blood Program (NCBP), the largest public bank in the world, had been used for 2199 transplants (about one-third of all transplants undertaken) in 199 centers in over 30 countries worldwide. They point out that “American blood” is also being exported and distributed internationally (Martin, Brown, and Turner 2008, 136–137).

11. Medipost's advertisement at Gmarket.com

12. “Reviving stem cell business which was trapped in ‘Woo Suk Hwang scandal',” Hankook Kyung-je, September 15, 2011 and “Can Korean stem cell therapy be recognized as the ‘top class’?” Kook-Min Ilbo, March 31, 2011.

13. A cord blood bank in the USA has begun preserving menstrual blood. Its advertisement says:

When it comes to making major life decisions, there is no time like the present. And when it comes to something as important as collecting potentially life-saving stem cells found naturally in menstrual blood, the ideal time is NOW. Thanks to Célle's patent-pending technology, and easy-to-use collection kit, you have the reassurance and peace of mind you need, when it comes to collecting, isolating and preserving menstrual blood. Welcome to Célle—where every month holds a miracle. (Célle website)

This advertisement employs the same rhetoric of hope that is pervasive among the rhetoric employed by cord blood banks.