Does ectogestation have oppressive potential?

Ectogestation refers to full or partial gestation of a fetus ex utero. Partial ectogestation refers to the removal of a developing fetus from the pregnant person's body and its placement into an artificial placenta¹ to complete gestation (Kaczor, 2005). In this sense, it may be seen as an “alternative to neonatal intensive care,” (Romanis & Horn, 2020) or imagined as a more advanced version of methods already used in modern medicine to sustain premature babies in an incubator.² In this article, however, we focus on full ectogestation, which could represent a “complete alternative to human gestation” (Räsänen & Smajdor, 2020), as eggs would be fertilized in vitro, and the resulting embryos directly placed in an artificial placenta for the whole gestational period. Building on the recent wealth of literature addressing ethical issues related to it,³ we aim to analyze some underexplored objections to full ectogestation.⁴

Our article investigates whether ectogestation might lead to certain forms of social oppression. First, we explore ectogestation's potential role in the unwarranted devaluing of certain aspects of female reproductive embodiment. We then consider whether ectogestation could exacerbate existing objectionable scrutiny over the reproductive choices of gestating persons. While also considering some counter-objections to these concerns in our paper, we maintain that public support for ectogestation should be conditional on rigorous critical reflection about the possibilities for social oppression that might arise from this technology, in addition to concrete preventive actions directed at mitigating such potential effects.

Still, we also acknowledge that the prospect of ectogestation can be imagined and framed in a positive and emancipatory fashion. This has already been done by many feminist thinkers and bioethicists, in line with the practical suggestion to give people at the very least a (hypothetical) negative right to use ectogestation if they want it. (Benjamin, 2021). In principle, we are sympathetic to this notion that ectogestation can be purposed to emancipatory ends; when we link ectogestation with social oppression later in the article, our aim is to draw greater attention to the more troubling complexities and complications we might encounter with ectogestation, which require mitigation. But let us now briefly review and put into context the grounds that have been offered in support for a reality with ectogestation. Consider Shulamith Firestone's advocacy of a method of artificial gestation already from the 70's, as a way to “[free] women from the tyranny of reproduction” (Firestone, 2015). Her radical feminist view placed the reproductive differences between male and female sexes as the basis for gender inequality, claiming that detaching women from the role of “baby-makers” was a crucial step for women's liberation. Firestone hoped that society might “soon have the means to create life independently of sex—so that pregnancy, now freely acknowledged as clumsy, inefficient, and painful, would be indulged in, if at all, only as a tongue-in-cheek archaism, just as already women today wear virginal white to their weddings” (Firestone, 2015). Since then, other scholars have echoed similar ideas. For instance, Jennifer S. Bard posits that, by taking pregnancy out of the equation, “men and women stand on equal ground” (Bard, 2006), and Anna Smajdor has defended the need for a technological alternative to embodied gestation (Smajdor, 2007) given the burdens of pregnancy.

Ectogestation could then offer an attractive alternative to childbearing for persons unable to get pregnant through traditional methods, including “post-menopausal women, or women at high risk for complications” (Sander-Staudt, 2006). Furthermore, even those who are able to gestate could avoid experiences like pregnancy-related discrimination, and be relieved of the psycho-physiological risks associated with pregnancy and childbirth (e.g., nausea, gestational diabetes, preeclampsia, depression, complications with delivery, and so forth) (Sander-Staudt, 2006). After all, some women already opt for surrogates to gestate on their behalf for medical or social reasons, so it does not seem too much of a stretch to anticipate that ectogestation might be utilized as a further viable alternative if it were to become available. Of course, we should acknowledge that risks to both the intended parent and third-parties might persist even with ectogestation, due to the necessity of egg retrieval for IVF, which would involve some health risks (such as pelvic infection or damage to organs near the ovaries) (American Society for Reproductive Medicine, 2015; Ber, 2000) as well as pelvic and abdominal pain. Moreover, as long as gametes cannot be produced from stem cells or via other painless techniques, the contribution in terms of gametes will still be unequal between the sexes, as egg extraction is much more burdensome relative to sperm extraction. However, the risks associated with egg retrieval are significantly inferior to those of pregnancy and childbirth.

Ectogestation's emancipatory potential would also not be confined to cisgender women who medically struggle to get pregnant or prefer to avoid pregnancy-related discrimination or risks associated with gestation and childbirth. First, cisgender men aspiring to be parents but limited by their being single or in homosexual relationships could more easily achieve their parental goals, assuming the availability of donor eggs. While this is already possible in certain countries via surrogacy, that process might not be ideal as it generally requires surrogates to relinquish their parental rights, as they are still recognized as mothers by most legal systems (American Society for Reproductive Medicine, 2015; Ber, 2000). Moreover, ectogestation might benefit transgender individuals by detaching gestation from the concepts of womanhood and motherhood. As argued by Kathryn MacKay, when used to define womanhood, traditional pregnancy “privileges some women over others, both under the law and in moral and political imaginations” (Mac Kay, 2020). By conceptually breaking the exclusive relation between pregnancy and bodies with female physiology, ectogestation could disrupt oppressive trans-exclusive narratives framing trans women as “lacking” those female reproductive traits traditionally used “to delineate who counts as woman” (Mac Kay, 2020). For trans men, the benefit could be double. On the one hand, those not wanting or not able to gestate would have an additional way to be parents; on the other hand, a weaker link between pregnancy and perceived womanhood could help those trans men and nonbinary people who have the gendered term “mother” imposed on them, based solely on having gestated their children. In fact, in many systems people who give birth are registered as “mothers,” regardless of their legal gender (McConnell & Anor, 2020). In this context, it is crucial to note that queer persons rely on reproductive technologies significantly more than heteronormative persons do for their chances of becoming parents (Kimberly et al., 2020).

While we have now recognized that the various emancipatory functions of ectogestation speak in its favor, our objective from here on out is to highlight some underexplored concerns associated with ectogestation, and demonstrate that support for ectogestation ought to remain conditional on addressing the issues we raise. Let us start by considering the limitations to the emancipatory appeal of this technology: Giulia Cavaliere has warned that “without a broader programme to end or mitigate gender-based oppression” (Cavaliere, 2020a), it is rather doubtful that the emancipatory objectives of ectogestation can be fully realized—especially for disadvantaged agents like poor or disabled women, women of color, and ethnic minorities (Cavaliere, 2020b). Others agree with this perspective, claiming that techno-medical interventions such as ectogestation cannot solve social issues since they are unable to effectively target the actual source of the problem, which is social, not medical, and therefore needs to be addressed by social measures (Campo-Engelstein, 2020). While not claiming that ectogestation is itself either intrinsically or inescapably problematic, we intend to examine its potential to exacerbate patriarchal oppression, by building on these socially informed critiques.

As mentioned above, authors such as Giulia Cavaliere have already made critical arguments about ectogestation. One of Cavaliere's claims is, for instance, that advocating for ectogestation might problematically subscribe to assimilation as an ideal for liberation. That is, ectogestation seems to promote the obliteration of difference—such as the capacity to gestate—as a way of acquiring gender equality (Cavaliere, 2020b). Yet, if the issue originates not from the bodily reproductive capabilities, but from gender roles and oppressive social structures, ectogestation will not necessarily resolve gender inequality (Segers, 2021). Rather, a more apt emphasis might be on a world “in which pregnancy did not disadvantage women socially, physically and economically” (Horner, 2020).

Building on these critical insights, we offer additional arguments for the oppressive potential of ectogestation by elaborating on how—in the context of a patriarchal society—the normalization of artificial gestation might contribute to a selective undervaluing of aspects of female reproductive embodiment, and contribute to objectionable kinds of scrutiny over gestating persons' reproductive choices.

Overall, we hope to have brought to light several interconnected issues of value conflict that might arise in an ectogestation-adjusted world. Our aim was to explore various dilemmas that might be generated by the existence of ectogestation, without necessarily suggesting that there are certain gestational methods that individual aspiring parents ought to prefer. While acknowledging the possibility for ectogestation to serve as an emancipatory tool for (at least some) aspiring parents and social groups, we put forward concerns related to how ectogestation could be used to create new or strengthen existing forms of oppression. First, we looked at how ectogestation might contribute to a devaluing of female reproductive embodiment. Second, we suggested that ectogestation may exacerbate unwarranted scrutiny and further destabilize value hierarchies related to “good” gestation when it comes to reproductive choices for women especially. Because of these issues, our position is that continued ethical reflection is necessary, and that the support for ectogestative technologies ought to depend on how we come to mitigate these concerns.

The authors declare no conflicts of interest.