New Reproductive Technologies

1
New Reproductive Technologies

• Presented by
• Christina, Katie, Lisa R.,
• Lisa V., Shelley

2
Overview

• Infertility
• -Failure to conceive after at least one year of
  unprotected coitus
• -80 million people affected worldwide
• Primary vs. Secondary Infertility
• -primary no prior pregnancy
• -secondary infertility following a
• prior pregnancy

3
New Reproductive Technologies/Assisted
Reproductive Technologies

• Methods developed to prevent or control the
  natural process of reproduction and to help
  individuals who cannot reproduce.
• Comprises of methods that cause conception when
  it does not occur naturally, monitor or attempt
  to improve conception, prevent conception, stop
  reproduction after conception, or handle problems
  with compromised newborns.
• (www.ibis.sfu.ca/cmns353/Projects/GroupF/R-D
  efn)

4
Types of NRTs

• In Vitro Fertilization (IVF)
• -involves removing eggs from ovaries,
  fertilizing in lab, and then replacing embryos
  into uterus.
• Intracytoplasmic Sperm Injection (ICSI)
• -injection of single sperm into cytoplasm of an
  oocyte.
• Gestational Carrier (Surrogacy)
• -implanting of the fertilized embryo into the
  uterus of a woman (carrier).

5
Knowledge and NRTs

• In Egypt

6
Models of procreative knowledge

• Different belief systems about human reproduction
  exist

7
Models of procreative knowledge

• Monogenetic inheritance
• a.k.a. preformation model
• Men carry preformed fetuses in their sperm and
  plant these into womens wombs
• In Egypt, this scientific tradition dates back to
  at least 4000 years ago

• Duogenetic inheritance
• Sperm-ovum union theory
• Equal contributions of ovum and sperm
• Model on which NRT is based

8
Cognitive dissonance and class

• Lower to middle class, educated Egyptians are
  well versed in the duogenetic sperm-ovum theory
• Lesser educated people are much less likely to
  espouse this view of women as egg producersthey
  are likely to deem womens eggs as much less
  important, either contributing less than half,
  little or nothing at all to conception itself
  (Inhorn 2003, 65).

9
Consequences of Introduction of NRTs in Egypt

• Cognitive dissonance
• -Women have eggs that can be removed and
  returned to their bodies in different forms.
  This problematizes the idea that children are
  conceived through heterosexual marital
  penetrative male-orgasmic sex
• -Men do not contribute everything to the
  procreation of offspring
• -Womens eggs contribute actual biogenetic
  substance to the creation of offspring.
  Contribution is of equal weight. This gives
  woman biological ownership of their children.

10
Duogenetic model and women

• Introduction of duogenetic inheritance model has
  heightened the pre-existing level of blame
  based on women for reproductive failures (Inhorn
  2003, 65).
• Infertility problems seen as a problem of female
  reception of mens sperm

11
Acquisition of scientific knowledge

• Acquisition of type and level of knowledge
  depends on class
• Middle and upper class literate people
• -Books and other printed materials
• -From doctors and other patients
• Illiterate lower class
• -Mainly media, some knowledge from physicians

12
The Media and NRTs

• Media promotes awareness of NRTs by providing
  information through science and health reportage.
• Media have covered ongoing developments in the
  global arena.
• Media have created a lively, public, moral debate
  on the uses of NRT in Egypt and abroad.
• Media helps to set the moral standard of NRT
  applications.
• Media have served to normalize NRT to a certain
  degree over time.

13
Multiple gamble quiz50/50 chance

• Many Egyptians experience infertility as a
  disease. Is this a cultural or an explanatory
  model?
• I read a lot periodicals, newspapers, books.
  Because we are suffering for sixteen years, Im
  following up on this (in Inhorn 2003, 73). Is
  this a cultural or an explanatory model?

14
Religion and NRTs

• In Egypt

15
Arguments

• Religion (Sunni Islam Coptic Christianity)
  NRTs are interwoven phenomenon
• -Visible in
• a) Infertility methods available in
• Egypt
• b) the practice of legal system,
• religious institutions, clients
• practitioners behaviour

16
Arguments (contd)

• Religion as a constraint (analytical conclusion,
  not empirical conception)
• -Emic vs Etic distinction (Inhorn 2003, 89)

17
Arguments (contd)

• Anthropologists
• Have done too little to examine the global spread
  of sensitive reproduction technologies and how
  local religion/moral effect decision-making
  (Ethno-ethics -- Gammeltoft in Inhorn 2003, 91)
• Must become more involved in bioethical debates
  (Inhorn 2003, 91)

18
Ethical vs. Moral concepts

• Kleinman distinguishes between dominant
  bioethical discourse local moral worlds
  (Inhorn 2003, 92)

19
Bio-ethical discourse

• International codes of bioethics built on 4
  universal bio-ethical principles
• - respect for autonomy
• - beneficence
• - nonmaleficence
• - justice
• Western philosophical tradition dominant,
  ethnocentric approach to health and health care

20
Bio-ethical discourse (contd)

• Codified, abstract expert knowledge about the
  good
• Little applicability to local lived experience
• ?focus on local moral worlds
• the commitments of social participants in a
  local world about what is at stake in everyday
  experience (Kleinman 1995, 45).

21
Conclusions of Inhorns religion chapter

• Reproduction NRT are subject to competing
  institutions (Shore).
• -However, in Egypt, the religious institutions
  provide guidelines for morally correct behaviour.
  Unlike other places in the world religious
  prohibitions against surrogacy and third party
  donors are followed in practice, and not
  contested (Shore, 100-119)

22
Conclusions of Inhorns religion chapter (contd)

• Islamic religious stress on biogenetic
  relatedness (Strathern 2003, 120)
• -pure lineage knowledge of descent ? marriage,
  inheritance and incest issues (Inhorn 2003,
  105-7)
• -adoption prohibitions change adopted childs
  name, lack of feelings and conception as own
  child (Inhorn 2003, 109)
• ?reasons for popularity of IVF/ICSI (no other
  choice) (Inhorn 2003, 120)

23
Conclusions of Inhorns religion chapter (contd)

• Paradox
• -NRT reinforces local conceptions of family,
  biological relatedness (local morals).
• -But, creates insecurity regarding 3rd-party
  donation pure lineage, mixing of sperm, misuse
  (corrupted morals)

24
Conclusion of Inhorns religion chapter

• Through NRT local moral worlds are compared
• -Egypt morally superior to the West
• Religion is a constraint
• -ideal woman motherhood
• -but religion limits the technological options
  (Inhorn 2003, 121)

25
Critique and data

• Why the coherence between religious
  institutions/prohibitions practice?
• Inhorn has been criticized for overestimating the
  coherence between religious prescriptions and
  peoples practice in Egypt. According to the
  critics Inhorn does not distinguish between what
  people say they do and what they do (Inhorn
  2003, 89).

26
Critique and data (contd)

• To refute this critic Inhorn provides data that
  says
• Egypt has experienced a religious revitalization
  in the last two decades (Inhorn 2003, 100).
• Informants express the importance of moral
  acceptability to be a good muslim (Inhorn
  2003, 101).
• Infertility, the use of all available
  technologies and the (un)successful outcome of
  IVF is conceptualized as one Gods will (Inhorn
  2003, 102).

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Critique and data (contd)

• Selection of physicians and country affected by
  religious considerations.
• The informant consults religious experts on moral
  concerns (Inhorn 2003, 103).
• Bargaining with God successful IVF for
  religious act/symbol (Inhorn 2003, 103).

28
Critique and data (contd)

• Correlation between local morals and religious
  restrictions against 3rd party donation is
  visible in practice
• Clinic practice caution of mixing,
  video-surveillance, emphasis on moral standards.
• Client behaviour constant need for reassurance
  of doctors standards, viewing doctor as
  responsible to God (Inhorn 2003, 116-8).

29
Critique and data (contd)

• Although Inhorn provides data as evidence, she
  points to a weakness in her research The
  interview setting only done interviews in
  clinic settings ? observed how practice may
  change in other settings (ex. Conflicts in home),
  observed the work in the IVF laboratories (Inhorn
  2003, 27-8).
• One might speculate that Inhorn would get
  different data about official morals/norms from
  overhearing casual conversations, than direct
  interviews.

30
Feminism and NRTs
Reading Franklin, S. (1995) Postmodern
Procreation A Cultural Account of Assisted
Reproduction.

• Reproduction is a significant focus of
  feminist theory and politics because of the way
  in which its control has been seen as
  instrumental to the subordination of women in a
  patriarchal culture (Franklin 1995, 323).
• Reproduction is increasingly subject to (and the
  object of) the hegemonic gaze of the clinician,
  and his (or, increasingly in the field of
  assisted reproduction, her) technological
  apparatus of monitoring, management, and
  surveillance is perceived as threatening
  (Franklin 1995, 323).

31
Infertility in India

• Reading Bhardwaj, A. (2003) Why Adoption is Not
  an Option in India The Visibility of
  Infertility, the Secrecy of Donor Insemination,
  and Other Cultural Complexities

• Infertility issues in India share some
  similarities with those of Egypt
• - fear of third party involvement
• adoption is not an acceptable solution because it
  disrupts the parent-child bond

32
Infertility in India (contd)

• Emphasis and pressure on having children
  (especially sons) because they are seen as the
  perpetuation of the self if a man cannot have
  children, he is faced with the consequence of a
  complete genetic death
• Third party involvement is more widely (although
  secretly) accepted in India because it ensures
  the link between mother and child remains intact

33
Infertility in India (contd)

• Concerns are focused on the outcome of a
  pregnancy (i.e. the means used to become
  pregnant, whether its IVF, AID, or surrogacy,
  dont matter as long as the pregnancy has a
  successful outcome)
• Efforts to overcome infertility are undertaken
  with a greater amount of secrecy, the outcomes
  and attempts of which are often kept secret from
  the community and sometimes even the families

34
Infertility in Japan
Reading Lock, Margaret (1998) Perfecting
Society reproductive technologies, genetic
testing, and the planned family in Japan.

• Similar beliefs regarding fertility and
  infertility issues
• -fear of third party involvement, adoption seen
  as last option if an option at all
• Lock mentions the term BIOPOWER
• -term used to describe power and control which
  is exerted on an individual by more dominant
  institutions

35
Infertility in Israela look at ultraorthodox Jews
Reading Kahn, S.M. (2002) Rabbis and
reproduction The uses of New Reproductive
Technologies among Ultraorthodox Jews in Israel.

• Definition of Ultraorthodox
• NRTs widely available to all Jewish citizens at
  no cost up to 2 children
• Overt pronatalist country
• Primary goal of ultraorthodox women dedicate
  lives to bearing children
• -infertile women seek out treatments under
  strict rabbinic guidance
• Mashgichots individual responsible in
  monitoring every procedure to ensure no mixing of
  sperm or eggs

36
Infertility in Israela look at ultraorthodox Jews

• Does artificial insemination with Jewish donor
  sperm from 3rd party constitute adultery? (Kahn
  2002, 289)
• ?Rabbinic definition of adultery illicit sexual
  union between Jews
• -Jewish donor sperm from 3rd party adultery
  prohibited
• -non-Jewish donor sperm from 3rd party not
  adultery allowed
• ?Because Jewishness is traced through the
  matriline (mother)!!

37
Religion Discussion

• My baby must be mine, and from my husband. This
  is logical. A mother will never feel this is her
  child if it is from another mans donated sperm
  or ova. Its only natural. Everything must occur
  naturally. If the child is from the father and
  mother, they will feel this is actually our baby.
  If not, well not be a family. You feel youre
  acting, making a movie, living a life that is not
  true. (in Inhorn 2003, 108)

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Religion Discussion (contd)

• What does the quote express?
• How does this quote relate to the definition of
  Reproductive gone awry (Jenkins Inhorn 2003,
  1832)?
• Can the quote be seen as actively
  reproducing/constructing culture/cultural
  models? If so, how?

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Informed opinion questions

• Do you agree with Inhorn that knowledge poses one
  of the most fundamental arenas of constraints on
  the utilization of NRTs in Egypt? In Canada?
• Do you think that the introduction of NRTs in
  Egypt will eventually replace the monogenetic
  inheritance model?