reproductive tourism

Why I Wrote a Wishy-Washy Book

In re-reading Kathleen Norris’s sort-of-memoir Acedia and Me: A Marriage, Monks, and a Writer’s Life, I came across this declaration:

I am telling stories, not writing prescriptions.

And I thought, Yes! Yes. Me too.

In writing about her experience with acedia (a state of spiritual malaise and indifference), Norris might end up helping readers recognize and combat this sin in their own lives. But the book is first and foremost Norris’s story, not a how-to book with step-by-step instructions for how readers can snap out of it.

Likewise, in writing about my experiences of having a disabling genetic condition, parenting a child with the same condition, and exploring preimplantation genetic diagnosis (PGD) to ensure that the next child would not also inherit the condition, I hope to inform and support readers as they face their own fraught reproductive decisions. But No Easy Choice is not an advice manual that concludes with a clear directive concerning whether or not Christians should use reproductive technology. As I write in my concluding chapter,

There is no moral to my story. This is not a fable ending with a quotable object lesson…I’m not going to conclude with a pronouncement about whether or not reproductive technology is morally acceptable, or offer a step-by-step guide for Christians who are contemplating whether to use IVF, PGD, or other technologies to have a baby.

While, as I wrote yesterday, I’ve been gratified by the positive feedback the book has received from a relatively diverse audience, there is one group of readers who are universally critical of No Easy Choice—readers who object to my refusal to communicate a firm conclusion about the morality of reproductive technology. In some cases, I suspect, critics are objecting not so much to my failure to communicate a clear agenda, as to my failure to communicate their agenda.

But setting that suspicion aside for the moment, what about my failure to render a clear judgment? Why have I chosen the wishy-washy way—raising questions without providing clear answers, valuing conversation over conviction?

Because conversations around reproductive ethics don’t need more certainties. They need better questions. The abortion debate is Exhibit A for what happens when people focus on communicating their crystal-clear agenda rather than asking questions and really listening to the answers: We talk past each other, trading barbs and pre-packaged slogans. We make inaccurate and demeaning assumptions about those whose opinion differs from ours.

I do actually have an agenda for No Easy Choice: to foster more robust, informed, and respectful conversation around these vital and intimate questions. Our usual way of talking about reproductive technologies, consisting mostly of knee-jerk reactions to the latest superficial and sensational media account, doesn’t actually help people make thoughtful decisions.

Because people making intimate reproductive decisions aren’t going to do what I tell them they should do. Read any honest account of difficult reproductive decisions, from people who received a dire prenatal diagnosis, dealt with infertility, or chose to have or not have an abortion, and you’ll find one consistent thread: People discover that when faced with their own fraught choices, what they thought they knew about their “position” on reproductive matters flies out the window. People find the certainties they used to hang their hat on to be inadequate. People who are passionately pro-life sometimes choose to terminate pregnancies. People who are passionately pro-choice realize they cannot possibly make the choice they have so vocally supported. Even those who ultimately make choices in line with their previously held positions will admit that such choices are not nearly as clear-cut as they used to think they were.

My focus is therefore not on dispensing advice, but on informing readers (head and heart) so that when they or someone they love are facing a complex reproductive decision, they will ask good questions, engage in helpful conversation, and know where to find resources.

Because a book focused on questions instead of answers will reach a broader audience. It’s a sad truth of modern public discourse that we tend to preach to the choir. Think about recent controversies, over Susan G. Komen and Planned Parenthood, over Catholic institutions and contraception. Think about all those impassioned blog posts and Facebook status updates and Tweets that people threw around. Do you think that any of that righteous indignation changed anyone’s mind? I don’t. I think all it did was reassure everyone that their opinion was obviously the right opinion, and those nuts on the other side are just…well…nuts.

If I wrote a book that reached a firm conclusion about whether or not Christians should use reproductive technologies, I would make a bunch of people happy—the ones who agree. And I would provide fodder for a bunch of other people to write righteously indignant blog posts, status updates, and Tweets about how misguided I am. But I doubt my book would actually help anyone. I doubt my book would actually make someone think, “You know, I’ve never thought of it that way before.”

But people are telling me that the book I wrote actually is making them think and question their assumptions. Just as I hoped.

Because I honestly don’t know whether Christian use of reproductive technology is right or wrong. This is the real reason I chose to write an open-ended book that raises lots of questions and offers few answers. Because I don’t know the answers. At the heart of my book is my own story. And I can’t say without a doubt that the decisions Daniel and I made were absolutely right or wrong. We did one cycle of PGD. It failed. We chose not to do another, for ethical, financial, and emotional reasons. We went on to conceive two more children naturally, neither of whom inherited my bone disorder. I love the children I have. So in that sense, I guess I’m glad we abandoned PGD. But what if our PGD cycle didn’t fail? What if we had a baby as a result? I would adore that baby as much as I adore the children I ended up with. Might I see things differently in that case? Possibly.

I wrote a wishy-washy book—a book that asks lots of questions but provides few answers—because that was the only book I could write. And I think (boldly, but with a good dose of humility too—I’m plenty familiar with the odds against any book becoming a hit) that this book might actually make a difference in people’s lives, and in our cultural conversations around these most intimate, troubling, and difficult questions of whether and how to have our beloved children.

“I am telling stories, not writing prescriptions.” Because we need more stories. We don’t need more prescriptions.

Reproductive Tourism Lays Bare the Fertility Industry’s Market Orientation

A reader sent me a link to a Slate article about the burgeoning practice of reproductive or fertility “tourism.” This is an increasingly common practice by which infertile people from one country access fertility services in another country, often for economic reasons, but also for regulatory reasons. For example, people from relatively wealthy Western nations hire low-income Indian women to serve as surrogates, often also procuring donated gametes through the same clinics that recruit and care for the surrogates. In a different example, British couples travel to American clinics for IVF using donated eggs, because British fertility clinics are government-regulated and thus cannot compensate egg donors at the levels that American clinics can. Here, a lack of clear guidelines on how donors are compensated means that donors are often paid thousands of dollars, and we thus have a much larger pool of donated eggs from which to choose.

The Slate article points out that, in an attempt to make use of Indian surrogates more cost-effective, clients can choose to have fertilized eggs implanted in more than one surrogate at the same time. While the provider this article focuses on used to allow clients to then terminate one of the pregnancies if both surrogates became pregnant, the company now says that clients who opt for two surrogates must agree to keep all of the babies produced.

The article concludes by insisting that, despite the appealing idea that Indian surrogacy arrangements are mutually beneficial because couples get the babies they want and Indian women get far more income than they could otherwise (Oprah has even cited such arrangements as examples of “women helping women”) the economic motives so clearly involved are troubling. As the writer says,

If for-profit companies are going to continue to approach baby-making like an import-export business, maybe it’s time for governments to start treating it that way, adapting oversight and protections for all parties involved. In the meantime, in the absence of meaningful regulation, the rights of surrogate mothers are being bought, sold, and signed away.

The article is worth reading in full. It brought me up to speed on some developments in this troubling industry, including the use of two surrogates, as well as the requirement that some clinics impose saying that surrogates will always deliver their babies via c-section for the “safety” of all involved (despite data that c-sections are not necessarily safer than vaginal births, and the risk this imposes on the surrogates should they get pregnant with their own babies in the future and deliver vaginally). The article reminded me as well of the documentary Google Baby that aired on HBO2 in 2010. In that film, which followed several people involved in an Indian surrogacy clinic, one disturbing scene showed Doron, an Israeli broker specializing in matching couples with surrogacy services in India, on the phone with a father-to-be. Doron floats the idea of using two surrogates to maximize the chance of success. After chuckling a bit at the idea of having multiple babies as a result, the client says that it’s fine, because selective reduction (terminating embryos in a multiple pregnancy to control the number of babies born) was always an option he was open to. Apparently, such a response to ending up with multiple babies via multiple surrogates is no longer allowed by some providers. It’s a step in the right direction, but still far too small. (I wrote about this scene and several others from Google Baby here.)

As I wrote for Christianity Today in 2010:

Fertility tourism might be one area of reproductive ethics where conservative Christians, who traditionally focus on the sanctity of human life, and liberal Christians, who traditionally focus on human rights, particularly for women, can speak out together for justice and compassion. We don’t have to project some dystopian future to witness instances in which human dignity — the dignity of Indian mothers serving as surrogates and the babies they deliver — is violated by clinics, entrepreneurs, and aspiring parents who are turning procreation into a fee-for-service market.

Why I Wrote a Wishy-Washy Book