Why do uterus transplants make us feel weird?
Yesterday, the New York Times published a report on a team of U.S. doctors that is working towards transplanting a uterus harvested from a donor into an infertile woman so that she can conceive. A few of us here started emailing about it. We ventured opinions. We thought about it; we changed our minds; we changed them again. We went home and talked about it with our partners and our friends and then we came back this morning and talked about it some more. There are all sorts of complex, thorny issues at play here: motherhood and identity, tradition and technology, ethics and economics, judgment and choice. We tried to untangle them and we got tangled up further.
We know we're not the only women having this conversation, so we thought about putting our discussion up in a post. And then we immediately thought about not doing that. We know we have blind spots. We know how easy it is to judge from afar, and how hostile the Internet can be to opinions on reproductive rights. And we were all born with a uterus, so none of us knows what it would be like to view this procedure not as an abstract option but as a medical breakthrough that might make pregnancy possible.
But we kept wanting to talk about it, which suggested to us that other people probably did, too. So please consider this an imperfect beginning to an important conversation that we hope you'll (respectfully!) continue in the comments below.
Christina Vardanis: So. Uterus transplants. I admit to having a visceral, negative reaction when I read the story. I hated that boatloads of money and time had been spent developing a procedure that valourizes the notion of pregnancy above all other means and ways of becoming a parent. I hated the idea of a woman putting herself through multiple risky surgeries, and years of anti-rejection drugs, all just to go through pregnancy. I hated that it will almost definitely be prohibitively expensive.
But then I started to play devil’s advocate. I have a uterus. I have a child. She was born via C-section, and my pregnancy was by all accounts pretty easy. What if I had been born without the thing that, society would tell me my entire life, is what makes me a woman? What if I got to the age where I desperately not just wanted kids, but desperately wanted to experience pregnancy — and medical advancement had made it possible? We want control over our bodies. We want to make choices about pregnancy without judgment. So what’s so wrong with the option of a uterine transplant existing for me? What’s so different between it and, say, IVF?
Danielle Groen: Oh man, am I having a hard time untangling my thoughts on this one. In theory, I should be all for uterus transplants — it's a new reproductive option, and reproductive options are great! Let's have boatloads of them! Everyone gets a choice! And then I remember: Well, no, in practice, only affluent women get a choice here. This procedure will carry a price tag well beyond the vast majority of women. And I do have a knee-jerk negative reaction to yet another way reproductive health options are determined by economic means.
So should science back off from uterus transplants? No, of course not — medical advancement is great, too! But it's notable to me that, as it stands, this medical advancement is in pretty explicit service of a very traditional (two-parent, heterosexual) kind of family. According to the Times, candidates for the procedure "must be in a stable relationship," which assumes that a romantic relationship is where they'll locate the "help and support" they need. And a candidate's eggs will be fertilized with "her partner's sperm," which seems to discount lesbian couples.
I know that this is just the clinical trial stage. But I do worry that in valourizing both pregnancy and (at least right now) the traditional family unit, this particular reproductive option perpetuates a hierarchy of parenthood that says biological mother > adopted mother > biological father > everyone else. And that hierarchy is a pretty pernicious one.
Sadiya Ansari: In the story, John Hopkins medical ethicist Jeffrey Kahn said uterus transplants fall in the “spectrum” of existing ways medicine is helping people have babies. One of the surgeons, Dr. Andreas G. Tzakis, went further to say this option was more ethically sound than surrogacy, which he characterized as a procedure that creates a class of people who “rent their uterus.” But a uterus transplant is temporary and the organ needs to be removed after a woman has a maximum of two children — isn’t that just a different way of “renting” a uterus?
And there is another source of discomfort for me — this incredibly invasive, elective procedure exploits women’s insecurities about the meaning of motherhood and “feeling” like a woman. Do many other fertility treatments do the same thing? Probably. But is it truly justifiable to say experiencing pregnancy — not having a child — is a quality of life issue that demands an organ transplant?
Katie Underwood: As someone who has a uterus (but no kids), I’m going to focus on the logistical side of things. The goal of uterine transplants is not only having a child but having a pregnancy. This is a major, complicated surgery — and it’s elective. I’m not saying a uterine transplant is tantamount to a nose job or a tummy tuck, but I would place these three surgeries in the same general category. (Read: Not essential for your biological wellbeing.)
I am vaguely uncomfortable with the way this phenomenon plays on women’s fertility insecurities, but the Libertarian in me says that if you want to get a uterine transplant and you can pay for it, get a uterine transplant. However, I think it highlights some persistent, sticky ideas around what constitutes a “real” family. By society's standards, children should be gestated by a blood parent. Not everyone sees it that way.
Sarah Boesveld: In so many insidious ways, our society can make a woman feel like less of a woman if she can't carry a child; like she cannot fulfill the one role for which her body was made. But if a woman feels like being physically able to have a baby is integral to her identity — if she really, truly, to the core of her being feels this way — I think this surgery should be an option available to her. I don't know what it's like to feel like my body is not aligned with my identity — however socially programmed that identity may be.
I don't think we're great at measuring the impact of these insidious cultural messages. But we are great at judging one another without truly understanding an experience. We did that for a long, long time with the trans community. Ontario has only just announced improved access to sex reassignment surgery. The province is now providing some funding for in-vitro fertilization, too. Is this not just another advancement in our awakening to the importance of identity and choice?
Christina: Danielle, IVF and adoption can also be prohibitively expensive. That ship has sailed. I’m not saying it’s right (it’s not), but it’s hard to argue that this particular procedure is any different from the others in terms of accessibility. And Sadiya, I bet those who have struggled with fertility would argue it is a significant quality of life issue.
Sadiya: I don’t have children and have not faced the challenge of infertility, but I imagine for those who have faced this painful battle, a new option would provide renewed hope. But I worry about false hope being created for even those who do have the means. Medical advancements should be celebrated but we should proceed with caution.
Christina: Does it perpetuate an outdated view of what a “real” family is? Or simply qualify as one? (Among all the others: adoptive, surrogate, IVF, blended, etc.)
Katie: Keeping in mind my thesis that women who want to do it should just do it, I still feel that the procedure does exploit the very real anxieties of women who have been told over and over again that unless they give drug-free vaginal birth to a kid who shares their genes — a.k.a. the pioneer way — it doesn’t count.
But Sarah, I just don’t know how I feel about the pregnancy-as-identity thing. Can infertility really be compared to gender dysphoria?
Sarah: But if you feel like being pregnant will complete you as a person, then why withhold a medical advancement that might help someone realize this?
Danielle: Oh, no, Sarah, I don't think anyone's suggesting that we withhold this surgery — or, Christina, that there aren't crazy expensive reproductive alternatives out there already. I'll take Katie's point a little farther: I worry not only that the procedure exploits the anxieties of women who've been told that birth is best, but it slaps another monetary value on this cultural expectation. Doesn’t that compound the idea that pregnancy must be really super important, if women are willing to pay so much for the experience?
But I can talk myself out of that, because people are willing to pay a lot of money to do a lot of things that aren't remotely important, like become a space tourist (space is terrifying!) or build the biggest residential pool on Earth (cough, Drake). I think I've landed on one opinion about this procedure and then the ground shifts and I believe something else entirely. Can we talk about this again tomorrow?
Update
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