Much of the debate about elderly motherhood has focussed on the anomalous situation of a woman simultaneously qualifying for an old age pension and child benefit. It is an engaging topic, but the discussion needs to be widened to include a consideration of global/national responsibilities: the relationship of a woman who provides an egg to, following its fertilisation, the woman in whom the embryo is implanted.
Older women seeking to achieve biological motherhood must find a source of human eggs. The age limit imposed by licensed UK clinics forces them to travel overseas, usually to a nation where the infertility industry is barely regulated, where female poverty is the norm, corruption is rife, and civil society weak. While the identity of several older women who have achieved motherhood through this route can be found on the internet, little is known of egg 'donors'. Journalist Fran Abrams tracked down a Romanian carpet factory worker who had received the equivalent of three months' wages to act as an egg 'donor' (1). The transaction was undoubtedly a commercial one, but how should it be described?
If the infertility industry is comparable to, say, the carpet industry then egg 'donation' might constitute work and any money an egg 'donor' receives, her wages. However, it is her body, not her labour, which is sought. A more appropriate analogy may be drawn between so-called international tourism for the purposes of egg 'donation' and kidney transplantation. Both use the bodies of disadvantaged, marginalised 'others' in developing or transitional economies by frustrated, but relatively wealthy, people. Anthropologist Nancy Scheper-Hughes, who has documented how the globalised market in kidneys operates, describes recovery of organs from living people as 'neo-cannibalism' or 'sacrificial violence' (2).
This highlights that the health, even life, of a live kidney 'donor' is at risk. It also applies to egg 'donors'. Their ovaries are stimulated using powerful hormones, a technique which carries the real risk of death, especially in places where women are unable to access or afford appropriate treatment. Egg recovery is a surgical procedure and is associated with pain and health risks. Abrams reported that the Romanian egg 'donor 'subsequently experienced health problems, which adversely affected her future fertility.
Scheper-Hughes does not clarify the nature of the transaction, perhaps because there is a consensus that an international market in human kidneys is undesirable. But a more relaxed attitude is evident in relation to human eggs. Indeed, in the UK, the prohibition on buying and selling human body parts remains, but is circumvented for gametes by claiming they are 'donated' altruistically and any money 'donors' receive is not payment, but reimbursement of expenses incurred. The payments allowed under current Human Fertilisation and Embryology Authority (HFEA) guidelines are relatively modest: donors can claim expenses directly related to the procedure of £55.19 for each full day, up to a maximum of £250 for each cycle in which eggs are retrieved. However, the HFEA also allows licensed clinics to operate what is euphemistically called an 'egg-sharing' scheme (a misnomer as an egg cannot be shared). Here, women who allow some of their own eggs to be used by another patient pay a reduced price for their own treatment - it costs between £4,000 and £8,000 for a single cycle of IVF. The financial incentive offered to encourage so-called egg sharing is more controversial - by no stretch of the imagination can it be called 'expenses'. Furthermore, it targets economically disadvantaged women, and confronts them with the real and tragic possibility of remaining childless while unknown, and perhaps more affluent, women conceive a pregnancy with their eggs.
This relaxed attitude towards payment for human eggs suggests the reproductive organs of disadvantaged women do not warrant the legal and ethical protection afforded to wealthier women and all other human body parts. Egg 'donation' in exchange for cash is tolerated in much the same way as societies tolerate female prostitution. It follows that reproductive tourism is analogous to sex tourism: the attraction in both is reduced costs for 'services' in the destination country, along with indifferent law enforcement. Rumour has it the same networks through which women are trafficked for prostitution 'recruit' egg donors.
This might sound extreme. Perhaps why it does is because it is unusual for women to exploit another woman's body. But there is a historical precedent: wet nursing, where wealthy women farmed out their babies to be suckled by disadvantaged women whose own baby often lost its life.
Where does this place UK infertility doctors who channel older women overseas? They are expected to adhere to the laws and regulations governing clinical practice here (3). But, unfortunately, as we have seen, the HFEA has a relaxed attitude towards remuneration in exchange for eggs.
The International Federation of Social Workers (IFSW) is particularly concerned with the welfare of children conceived as a result of reproductive tourism (4). However, as Lucy Frith pointed out in Bionews 542, the HFEA places women under no moral obligation to 'tell'.