The use of expensive technology to assist couples to have children is now common with the global IVF market expected to exceed $20 billion by 2020. In Australia, after a typical government subsidy of around $3000, just a single cycle of IVF can cost a couple up to $6000. Because we regard having a child as an inherently good thing we rarely pause to ask whether there are any reasons why we should be concerned about how or at what cost this generation and handing over of children is being achieved.
Some questions are now being raised about IVF efficacy and appropriateness. A 2014 paper in the British Medical Journal cited various studies which reflect that IVF is being overused and driven by private health systems 'where the focus on commercial returns has resulted in less academic oversight of who receives treatment and when' with the greatest growth occurring in groups with mild infertility where 'no absolute barrier to conception can be proved'. The authors of the BMJ paper also cite concerns about the long term health risks for children of IVF and urge caution about 'using IVF in couples where the benefit is uncertain or the chances of natural conception are still reasonable'.â€¨â€¨
The impact of IVF is no longer limited to a single individual or couple who desire a child. Increasingly others are engaged as surrogates. In India over the past 5 years there has been a threefold increase in the number of Australian couples seeking surrogate mothers. Public debate is often focused on the genuine desire of adults to have a child whom they can raise as their own. But IVF is never just about those adults.
The assisted reproduction industry is driven by market forces and has its own momentum. It seems to give scant consideration to any infringement on the rights of surrogate mothers or children. Chief Judge John Pascoe late last year expressed his concerns about the great potential for human rights violations and the growing evidence of the exploitation of women who act as surrogates. Commissioning couples often prefer a caesarean birth because they can choose the child's birthday even though the procedure has added risks. One Indian woman died after being turned out of a surrogacy clinic following her caesarean. Other press reports have cited the dark side of surrogacy in Thailand, baby-selling rings in the US, and the deportation by China of Myanmar women who had been sold as surrogate mothers.
In 2012 the feminist journal Affilia cited how surrogacy is often marketed to poor women as a preferable option to 'being forced into prostitution internally or trafficked for sex in other countries...where women face brutal conditions.' Recently the International Journal of Gynecology and Obstetrics commented that 'the international market of industrialized reproduction necessitates the uterus to be viewed as a mere commodity...a gestational surrogate is essentially seen as a glorified incubator".â€¨â€¨
Currently there are varying laws within Australian jurisdictions regarding surrogacy. In general they recognise only altruistic surrogacy. Commercial surrogacy, advertising for a surrogate and engaging in overseas surrogacy arrangements is currently illegal.
If there is scope to reinforce the cultural and legal prohibitions around buying babies this should be considered. In cases where egg or sperm donors have been used, children should continue to have their entire genetic biological heritage detailed on their birth certificate so they can access it later.
Emotional coercion within families, however subtle, is also a serious possibility. Independent and mandatory counselling especially for the surrogate mother, about the emotional and psychological effects of surrogacy on her and her child is vital.
The Centre for Family Research at Cambridge recently concluded that 'the absence of a gestational connection to the mother may be more problematic for children than the absence of a genetic link'. Bans on commercial surrogacy here and on the recognition of any overseas arrangements are important. Whatever of the intentions of the commissioning adults, when money changes hands they are effectively buying a child and this is an offence against the dignity of that child. Partial surrogacy arrangements contracted overseas where donor gametes are used directly infringe on a child's right to know their biological parents.
Big biotech is essentially driven by a financial imperative and Australians have an obligation to try and rein in its excesses. The IVF industry needs closer scrutiny given the scope for exploitation of vulnerable couples and surrogate mothers. The matter of the dignity of every child and the importance of respecting them as a person with rights also needs greater consideration within public policy debate.
Children are not commodities and no one has a right to a child. Children have a right to be created by means that are respectful of their dignity as persons. These should not be overridden by adult desires, however genuine and heartfelt. We need a broader debate around the use of IVF and the various reproductive technologies. As one child born of surrogacy decried in the Cumberland Law Review, "somewhere between (the) narcissistic, selfish or desperate need for a child and the desire to make a buck, everyone else's needs and wants are put before the kid's needs". If we are really serious about the best interests of children and of women we need to have a closer look at what is happening within big biotech.
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