Reproductive Empires and Perverse Markets: Unpacking the Paradoxical Dynamics of ART Market Expansion in Non-urban India and Beyond

The global use of assisted reproductive technologies (ARTs) to address structural infertility has burgeoned since the early 2000s. Large corporate in vitro fertilization (IVF) providers from the metropolitan north quickly identified India as a prime location for service delivery, creating satellite clinics in its metropolitan centers. Having learnt from their European masters the colonizer’s art of exporting ART services from the metropolitan core to the periphery, a leading cabal of senior Indian reproductive specialists have since created their own “reproductive empires” perfusing service provision into peri-urban and even semi-rural localities in India and equally underserved emerging markets in Africa, the Middle East, and Latin America. In this paper, we chart the contours of these new empires and explore the implications of this progressive colonization for the quality of service delivery. We argue that the vast scale of expansion has resulted in unwelcome stratification as unscrupulous providers dilute the quality of services to render them affordable to lower socioeconomic groups. Weakly formulated iterations of ART legislation have also allowed this market to thrive under chaotic and uncertain conditions. These dynamics, we argue, create perverse markets that increase, rather than reduce, patient infertility, by holding unsuspecting clients in extended regimes of indentured therapy. In unpacking the drivers of this phenomenon, we identify several key factors: the neoliberalism of health service provision in India; the privatization and corporatization of care; gendered competitiveness; and potent cultural preferences for biologically related children.