Did Margaret Atwood get it right? Reflecting on the social, economic and technological transformation of human reproduction

I first read The Handmaid’s Tale as an undergraduate sociology student and would have been hard-pressed to predict just how much resonance with contemporary events the novel, and most notably the recent TV adaptation of her work, would hold. Fast-forward to my professorial inaugural lecture this February, where I returned to Atwood’s dystopian vision as a lens to consider shifts we have witnessed in reproductive practices, technologies and politics. In this piece I give a brief overview of the central points from that lecture and offer my reflections on where we stand in the recent aftermath of IVF’s 40th birthday, and some 34 years on since the novel was first published.

Reproduction gone awry?
Atwood’s novel is set in the fictional state of Gilead where women belong to one of five castes, one of whom – the ‘Handmaids’ – bear children for another – the wives of infertile couples. Whilst their much-prized fertility places Handmaids in a position of relative advantage [in what we are led to assume is a post-environmental apocalypse], their value as a scarce bio-political resource also means that they are subject to significant state control. The related themes of exploitation, stratification, and inequality, which can be read off Atwood’s work, have struck a chord with contemporary debates about reproduction, bodily autonomy and gender politics. Parallels have been drawn for example, between her particular version of reproductive servitude and recent developments in international surrogacy, where women in Cambodia, Thailand and until recently, India, gestate babies for wealthy intending parents from the US, Australia and Europe. Perhaps most visibly, the now somewhat iconic red cloak of her handmaids has become co-opted as a symbol of protest in abortion activism and debate, despite Atwood’s own stated ambivalence about the novel’s feminist sympathies.

Atwood’s work, along with other popular cultural texts in recent years [e.g. Gattaca, Never Let Me Go, Children of Men], can be seen as representative of the on-going cultural fascination with what might be considered reproduction ‘gone awry’. Genetic manipulation, state-controlled reproduction and organ transplantation, artificial wombs, human milk farming and cloning, are also illustrative of how new imaginaries about baby-making and the fate of the human species are entangled with contemporary social, political and technological changes. In this framing, old certainties about how babies are made appear far from where we find ourselves in terms of scientific technicalities and imagined possibilities. In the rest of this piece I briefly consider what I identify as five key shifts in the landscape of contemporary reproduction.

The changing demographic landscape
As the news headlines continually remind us, whether and when people have babies is changing in significant ways. Most notably, fertility rates are declining globally as people are having fewer babies. This trend is commonly attributed to a number of factors, including: later child-bearing; access to contraceptives; women’s entry to the labour market; increased urbanisation; and more recently, economic instability and market uncertainty. A trend towards lower fertility rates in developed countries is being accompanied by an expansion in parenthood amongst groups who have been traditionally excluded by political, normative and technical barriers – for example families headed by same sex couples, or parents who are single by choice. Such changes to the reproductive landscape have been broad-scale enough for some demographers to argue that we are now experiencing an entirely new phase in the fertility rates of populations, one which is characterised by both sub-replacement fertility levels and greater plurality of living arrangements and household structures (e.g. Lesthaeghe, 2010).

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Increased technologisation
Estimates suggest that since its inception 40 years ago, IVF births now constitute more than 2% of births in the UK leading some to suggest that IVF is becoming a ‘routine’ technology (Wahlberg, 2016). IVF and related techniques directly modify processes of reproduction via technology: a literal ‘re-tooling’ of reproduction (Franklin, 2013). Increased technologisation brings with it new social categories, new relationships and new markets. For example, the availability of egg donation and egg freezing has made the category of post-menopausal motherhood a possibility. As reproduction scholars, we need to pay close attention to these processes as they pave the way for an expansion of techniques as well as their implications for kinship and intimate relationships, their increasing intersection with financialisation, and in particular, for the continued reliance of these processes on the biomedicalization of [mainly women’s] bodies.

Mapping life itself: the genomic ‘revolution’
When the scandal of the gene-edited twins broke in November 2018 , attention was once again drawn to the significance of genomic technologies for reshaping reproduction. Commentators were quick to highlight the considerable concerns this case raises. Whilst news of this birth marks a troubling new watershed in the ethics of reproductive genetics, we should not be distracted from developments in what are increasingly routinized forms of genetic testing in reproductive medicine. Techniques such as pre-conception expanded carrier screening (a form of pan-ethnic screening for hundreds of diseases, some with lower frequency or severity than are usually included in standard carrier screening) raise novel questions related to the identification and categorisation of genetic risk. These techniques are contributing towards a more general shift towards the ‘optimisation’ of reproduction and the desire for a perfect pregnancy. Such developments have considerable implications for perceptions of the prevention of disease, when so little is still known about how genetic susceptibility works beyond a small number of single gene disorders.

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Digitalisation
The digital revolution represents a major social, cultural and commercial shift, which intersects with and shapes reproduction in a range of intriguing ways. One such juncture relates to an increase in the development of what has been referred to as “Femtech ” [e.g. Apps for period-tracking, online pregnancy calendars and digital hardware such as wearable monitors]. The tracking of bodily materialities and practices has implications for the re-shaping of reproduction via new forms of gendered responsibilisation and digital labour (Lupton, 2015). This is particularly apparent in relation to pre-conception and the related preparation of bodies for reproduction. Digitalisation has also catalysed new (and diverse) online reproductive socialities, for example amongst new groups of donor-conceived siblings in the US or abortion activist networks in Ireland, Brazil and Poland. These fast-moving but highly significant developments in digital tech are only recently coming to the attention of scholars of reproduction, but as part of broader socio-cultural change, are worthy of closer consideration.

Commercialisation
Most of the shifts outlined above are entangled with the growing influence of capital markets and their intermediaries and processes into contemporary reproductive life. The debate about the for-profit fertility sector rages on with IVF ‘add-ons’ recently identified as one symptom of this growing marketplace, where clinics have been criticised for offering un-proven treatments often at high costs to patients. We are also witnessing an increase in the private financing of globalised fertility clinics groups and fertility start-ups, illustrating how fertility anxieties and lucrative new markets are co-produced. The impact of these shifts is entwined with the long-standing affects of reproductive stratification, a phenomenon that takes on new forms under neoliberal capitalism. In the UK context, inequality of access to reproductive technologies is exacerbated by the persistent under-funding of fertility treatment: the recent HFEA Fertility Trends report highlights for example that only 35% of cycles of licensed treatment cycles in England are funded by the NHS. The intersection of commercialisation, marketization and financialisation with reproduction is therefore a pressing concern for social and political scientists.

Was Atwood right?
The revival of Atwood’s work with its focus on reproductive (in)justice and exploitation has clear resonance with current anxieties around the curtailing of reproductive rights, a re-emphasis on an imperative to reproduce, reproductive stratifications and women’s unique position in this nexus. The themes outlined above echo these concerns and raise additional questions relating to the particular technologized and commercialised logics that underpin contemporary reproduction. Not all technological developments are negative of course – let us not forget that innovations in reproductive technologies have brought the pill, lower rates of maternal and infant mortality, and the genetic revolution is leading to the detection and management of some forms of life limiting genetic disease. Whilst some changes are progressive, others have further entrenched divisions and inequalities and this is where we can see parallels with Atwood’s dystopia. Increased and deepening divisions between haves and have-nots in reproduction, especially along lines of class and race, are particularly stark when we consider reproductive healthcare provision in the global south where there is little access to even basic care, let alone IVF. The pouring of billions of pounds into the development of apps and new ways of tracking cycles is in serious question when basic reproductive healthcare is so lacking in parts of the world.

We also need to turn our collective gaze to the question of under-medicalization – i.e. reproductive processes and conditions that remain under-researched and importantly, under politicised. Conditions such as endometriosis, pelvic pain, polycystic ovarian syndrome, fibroids, less visible experiences such as menstruation and menopause, and the significance of men’s experiences, need further emphasis and attention in research and public discourse. Many of these topics are included in those we are working on in the Centre for Reproduction Research . We must ensure they don’t escape our collective gaze in the field when there is so much emphasis on new technologies and novelty.

The post-IVF world is one where old certainties of reproduction have been disrupted and where reproduction and fertility have been recast in myriad ways, raising significant social and ethical questions that are perhaps a world away from those even first imagined by Margaret Atwood.

Written by Professor Nicky Hudson

References

Franklin, S. (2013). Biological relatives: IVF, stem cells, and the future of kinship. Duke University Press.
Lesthaeghe, R. (2010). The unfolding story of the second demographic transition. Population and development review, 36(2), 211-251.
Lupton, D. (2016). Mastering your fertility: the digitised reproductive citizen In: McCosker A, Vivienne S and Johns A (eds) Negotiating Digital Citizenship: Control, Contest and Culture.
Wahlberg, A. (2016). The birth and routinization of IVF in China. Reproductive biomedicine & society online, 2, 97-107.

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