Book Review: Birth Rites and Rights

We inherit our biological identity at conception but our humanity in a process beginning at birth. Nothing reminds us of this more than the rites and rituals surrounding birth and the way our rights change as we stop being a part of our mother and become a 'person'.

The words of Oxford Law Fellow, Jonathan Herring, one of the contributors to 'Birth Rites and Rights', are apt. 'The court cannot care for a child, or order that others should do so until the child is born: only the mother can'. Is this self-evident though? Notice that on 8 November this year, Mississippi's electorate felt it had to vote down a far-reaching (had it come off) move to change their state constitution to redefine 'personhood' as beginning with fertilisation.

The book's roots are found in the collision between the evolutionary imperatives of our biology, and the world of values and institutions we have created for ourselves: the meshwork of obligation and constraint knit by marriage, medicine, law and employment; by notions of fairness, justice, human rights in general and women's rights in particular; personal morality and national and religious ethics. Somewhere in the mix are natural science and its bed-mate technology. By extending our conceptual grasp of ─ and physical control over ─ the natural world, they change our behaviour, its consequences, and so our values.

Here is a relevant example. This is Peter Braude, head of women's health at King's College London, and his colleague, Tarek El-Toukhy, writing in one chapter: 'There is incontrovertible evidence of a shift in age at which women are giving birth to their first babies'. There is a widely promoted and shared view that it is a good thing for women to exercise choice over the age at which they start their reproductive careers. Any age is as good as another if it is what your job and lifestyle demand. Evolution has other ideas, witness: 'Natural conception declines with age… this decline is not overcome by assisted conception'. For reasons now deeply embedded in our biological history, women are not intended to have babies once they are into their late 40s. As things are now in the West, a woman's life expectancy exceeds her reproductive life by 35 years.

Consciously or not, medicine makes its livelihood in overcoming the consequences of evolution — repairing a body that was 'designed' by evolution for its own good biological reasons which is now defective. In other words, the natural default state is for women to be fertile at any age, and reproductive medicine must strive to achieve this if the woman cannot do it on her own.

'However as reproductive medicine continues to develop no palpable effort has been made to explain the real meaning of these advancements to women', states Irene Daly. 'A culture of faith in science and technology has resulted in the misconception that biological clocks can be slowed down through the use of assisted reproductive technologies. This may indeed be the future; it is certainly not the present'. One of the problems with modern scientific and biotechnological medicine is that it simply forgets about, or overlooks, the most fundamental aspects of the relationship between a mother and her baby. Here is what 'GT', one of the mothers interviewed for the chapter 'Becoming a mother' said: 'So nobody came to tell me about breastfeeding or how to take care of my baby. Nothing'.

'Birth rites and rights' is rich both in information and in ideas. It is good to see a subject looked at simultaneously from this many vantage points. The most interesting and, for some I guess, provocative chapter is that by Francoise Barbira Freedman on the idea that medical practice around childbirth is itself a ritualised behaviour, albeit one whose justification is that it is based in science and, more importantly, in technology: 'The [first] hospital scan serves as a ritualised threshold pregnancy'. While we may not be too clear about what science is about, we know technology works because it is all around us (of course that isn't always the case).

What is missing from the book and which, to me, sometimes conferred an air of abstraction, was any real sense of what things cost. Treatment for infertility is very expensive and can be very profitable. I could not help wondering why a chapter on that had not been included. It seems a bit idiosyncratic in this day and age. Medicine has always been about money. Or am I mistaken?

Buy The Reproductive System at a Glance from Amazon UK.