A year ago, a baby girl was born by caesarean section in a hospital in São Paulo, Brazil, after being conceived by IVF. What made the birth unique was that the child had been gestated in a womb transplanted from a 45-year-old woman who had died.
Births resulting from uterus transplants have been happening since 2014, but for all previous children conceived this way, the donor was alive. That, understandably, places severe limits on the availability of the organs. This demonstration, reported in the Lancet – that a uterus can be successfully preserved and transplanted from a deceased person – could relax the supply bottleneck for women otherwise unable to conceive because of uterine problems.
The recipient in this case was a 32-year-old born with a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. It affects one in 4,500 women and means that the womb fails to develop. Before she was given the transplant in 2016 it was unclear if a uterus could remain capable of gestating a baby if it had been deprived of blood supply for some time after the death of the donor. The baby weighed 2.5kg at birth on 15 December 2017, and both mother and child remain healthy. The transplanted uterus was removed from the mother during the delivery.
All this sounds like good news for women who, because of injury, illness, surgery (hysterectomy) or congenital conditions, would need a transplant in order to bear a child.
But not everyone will see it as an unqualified good. Since the first uterine transplants, opinion has been split about their merits. Some bioethicists point to risks of complications for the recipient and the foetus, as well as the high cost. Some question whether these drawbacks are outweighed by the benefits when the alternative of surrogacy exists – although that of course has its own problems, and it would be naive to draw an equivalence between them.
But uterus transplants also raise complicated questions for feminism. “There is a feminist position that supports the uterus transplant, arguing that it allows women … to be included in an experience that is, for some, central to and defining of femaleness,” wrote body theorist Sharrona Pearl. But, she added, that is part of the problem: “The uterus transplant supports the social norm of pregnancy as fundamental to being a woman.” Uterus transplants imply that the risks of the procedure are worth it, says Pearl, “in order to fulfil women’s alleged biological destiny as carriers of future children”.
This tension is nothing new. Ever since the early discussions of assisted reproductive technologies (ART) such as IVF in the 1920s, they have split opinion about the implications for gender roles and female choices in particular. The idea promoted then by biologists such as JBS Haldane of gestation in artificial wombs – ectogenesis – was welcomed by progressives as an emancipating technology that would free women from the duties of childbearing and the associated constraints on opportunity.
In the 1970s, Shulamith Firestone, author of The Dialectic of Sex, was an enthusiastic advocate of ectogenesis for those reasons, saying that only by being relieved of responsibility for childbearing could women hope for social equality. To Firestone, pregnancy was “barbaric” and tyrannical. Others feared that an artificial womb (which remains beyond the means of today’s technology) would sever the mother-child bond and deprive women of their role. “If that last power is taken and controlled by men,” wrote sociologist Robyn Rowland, “what role is envisaged for women in the new world?”
IVF itself has elicited similar concerns. For all that it offers some women their only chance of pregnancy and childbirth, it can seem too much like the commodification of a woman’s body by a male-dominated techno-elite. In the mid-1980s, the German radical feminist group Rote Zora bombed IVF clinics and stole documents, while the feminist network FINRRAGE (Feminist International Network of Resistance to Reproductive and Genetic Engineering) has long expressed scepticism about assisted reproductive technology from feminist and socialist perspectives.
There’s a danger, as with objections to uterus transplants, that, as social historian Naomi Pfeffer has charged, the critics consult the views of all women except those who actually suffer from infertility. But it’s quite right that advances in ART be interrogated as much more than neutral medical options.
By making pregnancy potentially available to trans women and even to cis men (with hormone treatments), uterus transplants could challenge social norms and preconceptions, just as IVF has done by creating new family structures. But equally, by insisting on a particular route to motherhood these transplants could reinforce those norms and stereotypes, just as anthropologist Sarah Franklin has argued that anxieties about IVF have motivated social conformity in the way it is presented and practiced.
As a man, I know I will be sensitive to only a fraction of these currents. But I hope they can be discussed frankly, tolerantly and with compassion. Few issues are more emotive than conception and child-rearing – but that’s precisely because there are no easy answers.
• Philip Ball is a science writer
