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ABSTRACT
Global demand for human ova in in vitro fertilization has led to its expansion in countries with falling average incomes and rising female unemployment. Paid egg donation in the context of national, regional, and global inequalities has the potential to exploit women who are socioeconomically vulnerable, and indeed there is ample evidence that it does. Structural injustices that render women in middle-income countries – and even some high-income countries – economically vulnerable contribute to a context of ‘omissive coercion’ (Wilkinson Citation2003) that is morally troubling. When egg brokers or fertility clinics take advantage of these background structural injustices and prospective ova providers’ vulnerability in order to pay them less than they need to meet their livelihood needs, they engage in exploitation. Analyzing paid egg donation as a form of reproductive labor, however, can direct our attention to reforms that would reduce exploitative instances of this practice. In contrast to those who see egg provision as inescapably commodifying and harmful, I argue that compensated egg provision can be made less exploitative. I defend my approach against commodification-driven analyses of egg donation and concerns about undue inducement, and conclude by discussing some of the ways in which policy-makers and medical practitioners might reduce the harms that may result from this global practice.
Acknowledgment
My thanks to Vida Panitch, Christine Straehle, and Heather Widdows for feedback on earlier versions of this article, and to Eric Palmer and anonymous reviewers for JGE for their incisive comments and suggestions.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes
1. I use the terms ‘egg provision' and ‘paid egg donation' (and their noun correlates) interchangeably in this article. The terms egg (or oocyte) donation, egg donor, and donor egg IVF are still commonly used in reproductive medicine, even when donors are paid or compensated.
2. While some egg donors in the US and other rich states face socioeconomic vulnerability caused by structural injustices, I have chose to focus here on egg donors in MICs as well as those HICs with high female unemployment.
3. The European figures are an underestimate, as some countries known to offer commercial donor egg IVF did not report in 2010 (e.g. Croatia, Cyprus, Latvia, and Estonia) and several reporting countries with commercial donor egg IVF (e.g. Greece) had low clinic participation rates (Kupka et al. Citation2014).
4. See also http://weareeggdonors.com/category/egg-donor-stories/, where donors recount being flown to Canada, Australia, South Africa, and Thailand for oocyte extraction.
5. Companies like (Australia-based) The World Egg Bank (http://www.theworldeggbank.com) arrange for donor eggs to be shipped frozen abroad, either from the clinic where the extraction occurs or from their own egg bank.
7. This way of connecting consent and coercion ‘tracks an “intuitive” distinction between exploitative and non-exploitative cases of underpayment’ (Wilkinson Citation2003, 178), because voluntary underpayment, absent conditions of socioeconomic vulnerability, is usually not exploitative.
8. This does raise the serious question of distributive justice in access to donor egg IVF, but there are other means to consider, such as ‘national altruistic self-sufficiency in human eggs’ (Baylis and Downie Citation2014) and publically funded health insurance for fertility treatment (Panitch Citation2015).
9. Resnik (Citation2001, 23) rejects the flat-fee approach that compensates women for their services, on the grounds that ‘women would need to be paid much less than the market price for their eggs’; but it is not clear why the flat fee could not be set fairly high.
10. Russia and Spain, with commercialized ART, report the highest numbers of OHSS in Europe (401 and 180, respectively). IFFS Surveillance (Citation2013).
11. The maximum number of donation cycles permitted in Spain, and recommended by the ASRM, is 6. Some countries also stipulate a maximum number of offspring from donor egg cycles (and/or sperm donation) – for example, 3 in Latvia and 6 in Spain. IFFS Surveillance (Citation2013).