The impact of Assisted Reproductive Technologies (ARTs) on Anthropology

Ever since the first “test-tube” baby was born in 1978, assisted reproductive technologies (ARTs) have proliferated and evolved dramatically.

Initially ARTs were designed to enable couples struggling with infertility to conceive a child and carry it to term. The main procedures available consisted of intrauterine insemination (IUI), where sperm is injected directly into the uterus at the time of ovulation to increase the chances of conception, donor insemination (DI) which is effectively IUI but using donated sperm in cases of male infertility, or in vitro fertilization (IVF) for women with blocked fallopian tubes, where eggs are extracted from the ovaries and fertilized by sperm in a laboratory before being transferred into the uterus.

In 1992 Intracytoplasmic sperm injection (ICSI) became available, making it possible for doctors to enable men with infertility issues to become biological fathers by injecting their “weak” sperm directly into unfertilized eggs (Inhorn, Birenbaum-Carmeli 2008).

Once ARTs became available, it quickly became evident that their use could extend beyond the treatment of couples who were not able to conceive.

The entrance of “third parties” such as egg donors, sperm donors and gestational surrogates into the reproductive equation meant that these technologies could also be used by same-sex couples or single men and women who want to have children without a partner.

Nowadays, families with children born using assisted reproductive techniques come in different shapes and configurations, ranging from heterosexual couples who set up traditional nuclear families, to male homosexual couples who have a child using a donated egg and a gestational surrogate, lesbian couples who have a child using donated sperm, or one-parent families.

“We regard the changes over the past half century as a diversification of family types rather than a replacement of the nuclear form. … even though an ever-declining portion of the population resides in two-biological-parent households. Cultural acceptance of alternative structures such as same-sex marriage, intimate partnerships outside of marriage, and shared parenting across households has increased in most if not all nations with high-income economies and a growing number of low- and middle-income countries ….”

Furstenberg, Harris et al. 2020 p. 1405

Assisted Reproductive Technologies created a seismic shift in the study of kinship in anthropology

There is no doubt that these developments shook “what twentieth-century ‘English’ culture had taken for granted as the foundation for relations between kin and for the formation of family life” (Strathern 1992 p. 5).

Anthropologists were faced with a seismic shift in how family relations “are held to be constituted. Having sex, transmitting genes, giving birth: these facts of life were once taken as the basis for those relations between spouses, siblings, parents and children which were, in turn, taken as the basis of kin relations” (Strathern 1992 p. 5).

Clearly the choices that had become available through assisted reproductive technologies had destabilised the old meanings associated with family formation and by extension the understanding of what constituted kinship.

Ethnography – Gay Families in San Francisco

In 1997, anthropologist Kath Weston (cited in Furstenberg, Harris et al. 2020) conducted research on gay families in San Francisco. She found that these families often resorted to different family-formation processes than those used by “traditional” families, where kinship ties were formed automatically by biological relatedness.

In many cases, these “non-traditional” families go through a process of “intentionality” and “redefinition,” building a kinship network and community based not solely on biological ties, but also on friendship and love, essentially defining their “family of choice” (Oswald, as cited in Furstenberg, Harris et al. 2020).

In doing so they provided a “countervailing model to straight kinship and a critique of the privilege accorded to a biogenetically grounded mode of determining which relationships count as kin” (Furstenberg, Harris et al. 2020 p. 1413).

The impact of assisted reproductive technologies on anthropology – a shift in the demographics of child bearing

Another major change made possible by ARTs is the fact that we are seeing women having children much later in life, in some cases even after menopause, when under normal circumstances it is biologically impossible to have a child.

This is done by using hormonal therapy or donated eggs to achieve IVF pregnancies, upending the normal reproductive cycle (Inhorn, Birenbaum-Carmeli 2008).

The advanced age of the mother has implications for the kinship network that the child is born into – in many cases they are unlikely to have grandparents still alive, and other siblings or cousins would likely be much older than them.

In this case, as in the case of gay families, alternative family-formation methods most often come into play, creating kinship based on a mix of blood and social connections.

The impact of assisted reproductive technologies on anthropology – consideration on genetic illnesses, sex selection & “Saviour Siblings”

Other, more recent, ART developments include Preimplantation Genetic Diagnosis (PGD), where embryos are biopsied and tested for genetic illnesses prior to implantation in the uterus (Gammeltoft, Wahlberg 2014).

This is of course very useful in cases where couples have a high chance of passing on a hereditary disease to their child, but it also has other repercussions because it can be used for sex selection in countries such as India, where there is a strong preference of male children (Inhorn, Birenbaum-Carmeli 2008).

These types of interventions are commonly known as selective reproduction technologies (SRTs), and if used widely they can unnaturally skew local demographics, as has happened in India and China (Gammeltoft, Wahlberg 2014).

There are also ethical concerns about the use of PGD to select embryos to act as “saviour siblings” to act as cord blood or bone marrow donors for siblings who would otherwise not survive (Gammeltoft, Wahlberg 2014).

Mitochondrial replacement therapy, on the other hand, stops the passing on of mitochondrial diseases from mother to child.

The process involves getting a donor egg and removing the nucleus, replacing it with a nucleus from an egg taken from the mother-to-be. The resulting egg would have mitochondria from the donor and the nucleus from the mother.

The baby would thus have three genetic parents, a totally new constellation of kinship that requires study by anthropologists (Inhorn, Birenbaum-Carmeli 2008).

Complications in family composition after birth

The family units and kinship networks formed through these processes are further complicated when the third parties involved in the reproductive process remain in the life of the child after giving birth.

This happens when the surrogate mother, or donors of the eggs or sperm used in the process, are biologically linked to the parents, creating “linked families” or “donor sibling networks” (Hertz, Nelson, & Kramer, as cited in Furstenberg, Harris et al. 2020) that create relational possibilities that were previously impossible.

A landmark case is the story of Melanie Boivin, whose daughter Flavie has a condition called Turner’s Syndrome that makes the ovaries malfunction. Concerned that her daughter would one day want a child but be unable to conceive, Boivin harvested and froze her eggs in 2007, so when her daughter reached childbearing age, she would have the option of using her mother’s eggs instead of those of an unknown donor. If Flavie opts to use the frozen eggs, she would give birth to a child who would be her half-sibling, while Melanie would be both the biological mother and the grandmother of the child (Roberts 2007).

Deep rooted implications for the formation of kinship groups

Clearly, all these combinations and permutations of ways for people to become parents have massive implications for the formation of kinship groups, “unseating core notions of kinship and undermining the traditional family by introducing a whole range of quasi-, semi-, or pseudobiological forms of parenting” (Inhorn, Birenbaum-Carmeli 2008 p. 182), thus becoming a subject of great interest for anthropological research.

The concepts of kinship, marriage and the family are fundamental in anthropology, so it was inevitable that anthropologists took notice when ARTs initially started to become available in the US and Europe, making it possible for people to have children who previously would not have been able to, creating new types of kin relations and disrupting alternative family-formation mechanisms such as adoption.

As ARTs became more widely available, particularly in Muslim countries and Israel, new considerations came into play, including the impact of religion and national culture on the use of these technologies.

Nowadays, almost fifty years after the birth of Louise Brown (the first child born via IVF), we are witnessing a wave of legal and ethical issues in relation to the use of ARTs, with anthropologists noting phenomena such as “reproductive tourism” where wealthy would-be parents travel to countries where they can purchase gametes or sign a contract with a surrogate mother to carry the child for them (Inhorn, Birenbaum-Carmeli 2008).

“The ethnographic field of reproductive potential is thus one that brings together interests that are personal, medical, economic, political, and ethical and, more- over, these interests are increasingly both intranational and indigenous as well as international and exogenous.”

Simpson 2013 p. S92

In Anthropology the tendency has been to view the impact of Assisted Reproductive Technologies on kinship in one of two ways.

Some anthropologists argue that ARTs have fundamentally altered our understanding of kinship and relatedness, while other maintain that people using ARTs often do so in manners that align with their society’s traditional beliefs about blood relationships and family formation (Furstenberg, Harris et al. 2020).

In fact, various ethnographies have shown that the way ARTs are implemented and how they are received within a society very much depends on the local religion and customs.

Ethnography – The impact of ARTs in Sri Lanka

In Sri Lanka, for example, Bob Simpson (2013) found that the take-up of IVF was facilitated by the Buddhist beliefs that are prevalent on the island, which viewed the alleviation of infertility as a blessing, and the donation of eggs, sperm and embryos as an act of altruism, locally referred to as dana.

However, both Simpson and the fertility doctors he worked with were initially surprised to find that couples often asked to use sperm from a close family member, instead of using sperm from an unknown donor as is considered ethical best practice.

After delving into the matter Simpson discovered that the requests to use familial sperm were linked to the fact that the locals used to practice polyandry until the British outlawed it in 1859 – “… it is well known that an earlier system of indigenous laws (Kandyan law) gave women particular marital rights and allowed for the recognition of multiple paternity” (Simpson 2013 p. S89).

“The availability of a vestigial memory of polyandry as part of a distinctively local mapping of relationality provided a vernacular model for copaternity. This could be drawn on to make sense of transactions involving sperm in ways simply not available within Western traditions of marriage and descent. That couples should make this request emerged out of a cultural logic that made it both obvious and expedient. It was consistent with ideas of blood (le¯) as a metaphor for shared descent as well as ideas of fraternal solidarity within the sibling group. Couples acting within the context of a new biomedical modernity were seeing relational potentials that the “ethical” management of ARTs simple did not allow. In making this connection, a tension was evident between local preferences and the medicolegal constructs of relationality that arrive prepackaged with ARTs.”

Simpson 2013 p. S89

Ethnography – Pakistani couples in the UK

A study of Muslim Pakistani couples who use IVF in the UK uncovered a very different reaction to assisted procreation.

In this case, as in the one before, the official position taken by Islamic scholars is that IVF is acceptable and inline with recommendations made in the Qu’ran, provided that the semen, eggs and fertilized ova used originate only from the couple seeking treatment.

According to Islamic tenets, if the sperm of another man is used, this would be tantamount to the woman committing adultery (zina) and the child would be considered illegitimate, having broken the line of agnatic descent (nasab) (Simpson 2013).

“We have read up on the religious side to it, and he [husband] has talked to people about it in the mosque, and, to be honest, we don’t believe it’s wrong because as long as it’s my eggs and his sperm there is nothing wrong with that, it’s only wrong when we start using someone else’s sperm or if I use somebody else’s eggs, that’s when it’s wrong, so we are alright with it, and hopefully we are doing the right thing. It makes sense as well, and we are both using our own stuff, it’s just we are not doing it the normal way how people do it, we are getting help”

Simpson 2013 p. S89

ARTs as seen in different religions and cultures

Other religions also have different takes on ARTs. The Roman Catholic Church prohibits all forms of assisted procreation, based on the position that all embryos are human beings and therefore manipulating them, freezing them, discarding them or donating them is unacceptable. This has led to legislation that seriously restricts these biomedical technologies in Catholic countries such as Costa Rica, Ireland and Italy (Inhorn, Birenbaum-Carmeli 2008).

The issue of ethics in ARTs and the mechanics of embryo disposition, particularly in cases where IVF laboratories end up with many frozen embryos in countries which restrict abortion, is another field that requires serious study by anthropologists.

In Israel, on the other hand, ARTs have been welcomed and are widely used, since they are seen as a way of following the biblical injunction to “be fruitful and multiply” (Inhorn, Birenbaum-Carmeli 2008 p. 184). It is also politically expedient, since it is in the interest of the Nation to have as many Jewish babies as possible.

The religious emphasis on procreation, plus the fear of being outnumbered by non-Jews on Israeli soil, has served to promote one of the most aggressive and proactive ART regimes in the world, in which single and lesbian women, surrogates, gamete donors, and recipients all participate in the ontological choreography of making Jewish babies in Israeli IVF clinics.”

Inhorn, Birenbaum-Carmeli 2008 p. 184

Final thoughts on Assisted Reproductive Technologies and Anthropology

It is therefore clear that the development and routinisation of increasingly sophisticated biomedical technologies that aim to prevent or promote the birth of particular kinds of children raise a myriad of questions, radically changing the old meanings associated with family formation and by extension the understanding of what constitutes kinship.

Anthropologists have increasingly come to study who uses these reproductive technologies and what they mean to those who use them. Other questions address how the technologies are regulated (or not), and the short-term and long-term implications for the societies in which they are used.

Anthropologists all over the world have been grappling with the issues raised by assisted reproductive technologies’ for many years, and there is no doubt that anthropology will continue to do so for many more.

Bibliography

Franklin, S. (2019) “Developmental Landmarks and the Warnock Report: A Sociological Account of Biological Translation.” Comparative Studies in Society and History; Comp Stud Soc Hist, 61(4), pp. 743-773.

Franklin, S. (2006) “Origin stories revisited: IVF as an Anthropological Project.” Culture, Medicine and Psychiatry; Cult Med Psychiatry, 30(4), pp. 547-555.

Franklin, S. (1997) Embodied Progress: A Cultural Account of Assisted Conception.  London: Routledge.

Furstenberg, F.F. (2020) “Kinship Reconsidered: Research on a Neglected Topic.” Journal of Marriage and Family82(1), pp. 364-382.

Furstenberg, F.F., Harris, L.E., Pesando, L.M. and Reed, M.N. (2020) “Kinship Practices Among Alternative Family Forms in Western Industrialized Societies.” Journal of Marriage and Family, 82(5), pp. 1403-1430.

Gammeltoft, T.M. and Wahlberg, A. (2014) “Selective Reproductive Technologies.”  Annual Review of Anthropology, 43(1), pp. 201-216.

Hampshire, K. and Simpson, B. (2015) Assisted Reproductive Technologies in the Third Phase: Global Encounters and Emerging Moral Worlds (Fertility, Reproduction and Sexuality; volume 31). 1 edn. New York, NY: Berghahn Books.

Inhorn, M.C. and Birembaum-Carmeli, D. (2008) “Assisted Reproductive Technologies and Culture Change.” Annual Review of Anthropology, 37(1), pp. 177-196.

Roberts, M., (2007) “Girl could give birth to sibling.” BBC News.

Simpson, B. (2013) “Managing Potential in Assisted Reproductive Technologies: Reflections on Gifts, Kinship, and the Process of Vernacularization.” Current Anthropology, 54, pp. S87-S96.

Strathern, M. (1992) Reproducing the Future: Essays on Anthropology, Kinship, and the New Reproductive Technologies. Routledge.

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