Book Review: Selective Reproduction in the 21st Century

In 2012, social scientists representing 20 different countries and all five continents gathered to discuss the 'routinization' and globalisation of selective reproductive technologies in Copenhagen, Denmark. The editors of this book, Professors Ayo Wahlberg and Tine M. Gammeltoft, anthropologists at the University of Copenhagen, organised the conference in response to what they saw as an urgent need to explore the ethical, social and political questions surrounding the emerging field of selective reproductive technologies (SRTs) - as distinct from the more established and well-researched field of assistive reproductive technologies (ARTs). This book is a synthesis of that conference: each chapter a contribution from an attendee presenting their research into SRTs.

As a collection of ethnographic studies, I found this book to be informative, thorough and balanced. But in addition, the voices that are heard in these chapters - the intimate portraits of women and families and their hopes and fears - make this book an engrossing and sometimes a highly emotional read.

Professors Wahlberg and Gammeltoft deftly articulate the distinction between ARTs and SRTs in their introductory chapter 'From Helping Hand to Guiding Hand'. ARTs, like IVF, are a 'helping hand' and seek only to overcome childlessness. In contrast, SRTs go further than this, explicitly directing the course of nature by selecting which gametes, embryos or fetuses will be taken to term, using technologies such as PGS (preimplantation genetic screening).

SRTs have the power to prevent the birth of children with hereditary diseases and disabilities. They have therefore been called 'soft eugenics', particularly in countries where their use is promoted by the state. But the controversy one might expect to surround such a technology has, in some countries, been knowingly suppressed by scientists, clinicians, marketers and governments - each with their own agendas - who write the policy and frame the conversations surrounding SRTs, argues the book. This is brilliantly articulated in Chapter 3, which describes how scientists from the US and UK working on SRTs carefully dissociate their research on sex selection technologies from Chinese and Indian sex-selective practices, which are widely condemned, instead aligning with the less morally problematic ARTs.

The American reproductive technology market, then continued this process of normalisation by presenting sex selection under the innocuous guise of 'family balancing', argue the authors. In different countries, we learn that women and families are being sheltered from the reality that, in using SRTs, they are making 'concrete and embodied decisions about the standard of entry into the human community'.

Professors Wahlberg and Gammeltoft go on to elaborate their title theme in 'Tracking Routes of Routinization' and carefully lay out the methodology in the book into four empirical routes of investigation; policies and regulations surrounding SRTs, people who use SRTs, the sites where SRTs are deployed and the technologies themselves. With these signposts as a starting point they set out to elucidate the 'variegated patterns of acceptance [of SRTs] in different countries: from pioneering "breakthroughs", at times followed by periods of concern and resistance, then regulation and eventually routinisation'.

Different contributors choose different routes of investigation, which makes for a rather idiosyncratic selection of case studies. For example, Chapter 3 is a detailed historical account of the evolution of the sex selection technology MicroSort from its conception in a weapons laboratory, through to its adoption by the agriculture industry, and its eventual status as a technology embodying neo-liberal ideas of self-determination.

In contrast, 'Tracing Taiwanese Women's Experience of PST [prenatal screening and testing]' in Chapter 5 focuses solely on the anecdotal experiences of women and their partners and includes drawings done by interviewees in response to the question 'what is your experience of PST?'. This creative form of fieldwork reveals a deep insight; when the male partners are asked to make the same drawings they never place themselves in the image, but rather depict the woman and the clinician. The author interprets this as reflecting their emotional distance from the experience. The broad range of approaches and styles does not detract from the focus of the book but rather resonates with the diversity of social, political and religious landscapes described in each chapter, as well keeping the reader entertained throughout.

The seven chapters are grouped into three sections each relating to one of the three primary uses of SRTs; sex selection,preventing disease and disability, and selecting traits. This grouping emphasises how women from different countries using SRTs with the same objective can have starkly contrasting experiences. This is most striking in the juxtaposed case studies from Denmark and Taiwan on the use of PGS. This is used to detect abnormalities in a fetus, such as Down's syndrome, and is offered free to pregnant women in both countries. Excerpts from interviews with Danish women undergoing PGS reveal a cool, matter-of-factness; they speak of 'opting out' of a pregnancy and keep the 'moral and ethical predicaments [of PGS] at arms length'. The study suggests that availability of the technology and its highly institutionalised status allows Danish women to abnegate their own individual responsibility to a collective authority- a kind of 'techno-shaping' of morality. By contrast, in Taiwan it is the woman who is charged with the burden of choice and ultimate responsibility for the unborn child. This societal pressure triggers deep anxiety and distress in the Taiwanese women, unlike their Danish counterparts, even though PGS and therapeutic abortions are not viewed negatively.

That women's experiences of SRTs are determined by societal forces is made clear from the second and most harrowing chapter in the book 'Coping with Sex-Selective Abortions in Vietnam', which includes a moving and unflinching account of a late-term termination. In Vietnam, the one-or-two child policy enforces small family sizes but there is also huge cultural pressure for male heirs. Sex selective termination is widespread, but it is considered a sin and there is great stigma and shame apportioned to women who go through it. This chapter was the most personal of them all; Professor Gammeltoft even recounts a traumatic nightmare she had following the time she spent with her interviewees, adding depth and colour to the study.

Overall this compendium of ethnographies gives great insight into the complex and far-reaching topic of how SRTs are being shaped by, and are shaping different societies across the globe, and how this in turn affects the women and families using them. The accounts are clear, well-articulated and mercifully free of statistics and jargon. The diversity of voices and stories presented is testament to the power of international, collaborative research.

Selective Reproduction in the 21st Century is available from Amazon UK.