The Governance gap in assisted human reproduction

Text Size: Normal / Medium / Large
Printer-friendly versionPrinter-friendly version
Publication Date: 
Mon, 2013-12-02

At the same time assisted human reproduction is more than a matter of women’s health, and its implications go beyond addressing infertility. Participants expressed concern about the emphasis on infertility in the context of the nuclear, heterosexual family and the idea that biological children represent the most desirable form of family. The participants challenged assumptions about biology, sexuality and gender identity too-often apparent in discussions of assisted human reproduction and agreed that feminist perspectives could offer a broader understanding of family building wherein adoption, assisted reproduction, and other ways of forming kin relations throughout the life cycle would be recognized as equally valuable.  

Participants also agreed that family law and issues of parentage need consideration and reform. There is a pressing need for laws to recognize family structures that include three or more parents which reflect kin relatedness beyond the nuclear heterosexual family. Feminist legal scholars are developing a proposal for a legal regime that would protect LGBTQ families in relation to assisted human reproduction, including the protection of families with more than two parents. In addition, current practices for recording vital statistics/registering births do not reflect the reality of many families using assisted human reproduction, including the possibility of making a clear distinction between parents and gamete providers. Birth certificates, for instance, are not designed to record the parentage of children carried by surrogate mothers or those conceived using donated genetic material such as sperm. 

“Fertility Inc.”—the economic complex linking fertility clinics and the pharmaceutical and medical technology industries—was also a concern. Commercial secrecy has made it difficult to access information about the growing private AHR industry. Access to for-profit fertility clinics is determined by the ability to pay, screening out those who lack funds. Fertility Inc. is also associated with a semi-legal and sometimes illegal-but-tolerated market in reproductive tissues. The for-profit fertility industry is resistant to advocacy for women’s and children’s health concerns. Industry resistance to the regulation of assisted human reproduction has been supported by the inaction of the federal government, which here, as elsewhere, conflates public and corporate interests.

The weak standard of counselling in private fertility clinics was another common concern among participants. Many counsellors lack specialized training, and some work in a conflict-of-interest situation as they are employed by clinics that have an institutional interest in promoting medical treatments that are ultimately funded by their clients. Some participants also expressed concern regarding the role of counsellors as “gate keepers” to fertility services. 

Finally, participants identified the need to consider and promote the interests of children born of reproductive technologies as an often-overlooked aspect of the governance of assisted human reproduction. Advancing the needs of children born of reproductive technologies is critical to ethical policymaking in this area.

Areas for further discussion

While opinion converged on many issues, it diverged on others.

Participants largely agreed that there are concerns around the health outcomes of women providing their eggs for others, but they disagreed about the current ban on payment for reproductive tissues. Some saw the outright ban on payment for gestational services and egg provision as an impediment to the safe and transparent use of reproductive technologies, while others supported the ban on payment to prevent the further commercialization and commodification of human reproductive labour and tissues. Participants also spoke out about the discord between banning payment to gamete providers when “everyone else” from the clinic to the pharmaceutical industry is profiting from gamete transactions.

There was also some disagreement about the desirability of public funding for assisted human reproduction.  Some participants were opposed to social inequalities related to access, particularly for those with limited incomes or who are otherwise marginalized. Others took issue with directing limited public health funds to reproductive technologies of limited effect when provincial health care budgets/programs are already strained to cover essential services, especially when there are legitimate alternative ways of family-making (e.g., adoption) that are not paid for by the state.

While participants agreed that the interests of children born through assisted human reproduction must be central to policy making, there was disagreement about donor anonymity. Most participants agreed that children should be able to access information about their genetic and gestational parentage; however, this raised a concern about the emphasis that this would put on the place of “blood relations” in recognizing and not recognizing family members. Requiring donors to release information about their personal identities could place women and LGBTQ-led families in a position of vulnerability to unwanted legal claims to parentage. Participants generally opposed total anonymity in gamete donation, but could not collectively agree on how to move forward on this issue.