Catherine Waldby, "Citizenship, Labor, and the Biopolitics of the Bioeconomy: Recruiting Female Tissue Donors for Stem-Cell Research"
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I also want to talk about the stem-cell industries, more broadly, because there again, women constitute the primary tissue donors in the stem-cell industries, which require high volumes of human embryos, oöcytes, fetal tissue, and umbilical cord blood. But in this case, their participation is often given for free even though the nature of the donation is quite onerous in that it requires a lot of reproductive labor in order to produce the actual material that you give away.

A stem cell is basically an undifferentiated cell that can both renew itself and give rise to one or more specialized cell types with specific function in the body. The ones we hear most about are the pluripotent stem cells—the type of stem cell that you get in the embryo—and it has the capacity to develop into almost all of the body's tissue types. Recent research suggests it may be possible to produce large numbers of pluripotent stem cells that differentiate on demand, providing an unlimited supply of transplantable tissue.

The whole stem-cell area is the hope (and hype) that the process of organ transplant will be able to be replaced by stem-cell tissue transplanting. So if you have a faulty heart, instead of having to wait on some wretched waiting list for years and years and hope that someone dies so that you can get their heart, you'll be able to have an infusion of cardio myocytes that will then go about repairing your heart. Your heart will be regenerated, and so we reach the whole logic of regenerative medicine that presides over stem-cell research. The stem-cell sciences, with the use of embryos, cord blood, fetal material and oöcytes, work to transform the generative capacity of female reproductive biology into regenerative capacity—to divert productivity away from the generation of new babies, towards the regeneration of existing populations. Essentially, it is a kind of redistribution of vitality where you take a kind of surplus vitality from the site of reproductive biology and you redistribute it to the aging population and their lack of vitality, and you hopefully regenerate people who have things like Parkinson's, Alzheimer's, heart defects, kidney disease, Type 1 and Type 2 diabetes, and so forth.

But to secure this regenerative potential involves negotiating with different groups of women in various kinds of ways. I'll just very quickly talk about the ways in which women are mobilized through these different kinds of tissue donation. From 2000 and on, a number of the OECD countries have developed regulatory systems which permit IVF clinics to solicit surplus embryos for stem-cell research. How an embryo is designated a spare embryo is quite a complex process, and there's been a lot of ethnographic work into this. But this whole idea of the surplus is crucial to the logic of the field. Surplus is constantly appealed to, in that these are spare; they'll just go to waste, we'll just kill them unless you give them to us. But if you use this surplus, they can be transformed into life-saving research. So, embryos are now fairly well-regulated. Embryo donations are a fairly well-regulated phenomenon in most places in the world.

Now, fetal material, which is harvested from pregnancy terminations, is somewhat different. In the U.K., if you have a termination, you may be approached to donate the fetus to medical research. The thing that is striking about the difference between fetal donation and embryo donation is that unlike embryo donation, which has this kind of amazingly ceremonious and complex consent process around it and a great deal of respect is shown to the embryo in the procedures, in the U.K. at least, fetal donation is much less ceremonious. It tends to be something that the woman signs over and there is not a huge amount of discussion about it.

Cord blood. There is a whole arm of the stem-cell industry which is organized around private cord blood banking. Companies like Pluristem solicit pregnant women to open a private cord blood account for their child. The logic of this is that if you keep the cord blood and your child develops leukemia or a severe blood disorder, instead of trying to find a bone marrow match, in theory, you can go back to the private cord blood account that you have kept and paid for. Despite this being clinically counter-indicated in many cases, it is still a thriving industry. But here we see the waste of the cord blood transformed into a kind of biological investment where you invest in the future of your child. You also invest in the promise of stem-cell science, because more and more, the cord blood companies are appealing to the promissory value of the stem cell industries and saying, "here, this will be your private stem cell account, and when stem cells can do all the kinds of nifty things we think they might be able to do, then you'll have this autologous tissue there at your disposal."

Finally, oöcytes, or eggs. Now, I've been doing a lot of work about oöcytes because they are the most unstable type of tissue in the stem cell industry, and they've proved the most difficult to recruit. This is in part because there is already a worldwide shortage, a huge amount of demand in the IVF clinics for reproductive use of eggs, plus fertile oöcytes are needed for somatic cell nuclear transfer research. You can't freeze them because the freezing technology is not very good. The fact that you can't freeze a tissue has enormous implications for the ways in which it circulates and the kinds of values you can produce from them. Plus we now have this discourse about declining fertility so that oöcytes have developed an enormous scarcity value and the scarcity value is increasing more and more. Because of their scarcity value, it's very hard to designate them as a surplus and there has thus been very little success in securing sufficient numbers of oöcytes for somatic cell nuclear transfer (therapeutic cloning) research to go ahead. In fact, many clinics have had to give away that side of their research program because they just cannot get the material that they need.

It is interesting that even in Britain, which has a very highly developed bioethical discourse about the gift relation, they have developed a system called 'egg sharing,' whereby, if you go to IVF and you promise to give a certain number of oöcytes to stem cell research, you get discounted IVF treatment. So it's not a fee transaction but it's nevertheless a type of transaction. In the United States too, there is a lot of debate about fees—if they should pay fees, what kind of fees they should pay. I saw an article just recently where New York State has legislated so that stem cell scientists can pay women up to $10,000 to sell eggs for stem cell research. It remains to be seen whether that will be enough.

So, having described these different forms of procurement, it seems to me that one of the things we're looking at in the clinical labor book is that, with the globalization of biomedical research, we have this process where different populations are scanned for different types of value. And different types of biomedical industries, different types of biomedical disciplines, scan different populations for particular kinds of biological or socioeconomic or regulatory affordances. That is, points where you can get traction on that population. You can then mobilize in different kinds of ways. You might be able to mobilize them simply through fees because they need the money or you might need to mobilize them through more complex kinds of discourse around surplus and around the idea that you can contribute to the good that the medical research might do—an appeal to citizenship and the good of future generations. Another affordance is this kind of regulatory boundary that divides a phenotypically-similar population.

So that is the kind of model I'm working on at the moment: we see different female populations integrated into the lower echelons of the stem cell industries and the fertility outsourcing industries as essential productive agents through various contractual mechanisms, institutional arrangements, and regulatory systems that are designed to secure a surplus of biological potential in different ways.

Now, as I said at the beginning, these practices range from, frankly, transactional, i.e. surrogacy is a transaction where there is no doubt what is going on, to the most sanctified and ceremonious kind of gift relation. At the surrogacy facility outsourcing end, the relationship to the type of labor seems fairly self-evident, but it is a much harder argument to make at the gift relation end. But nevertheless, we are trying to make the argument, and one of the ways we have done this is by going back to an old debate in feminism known as the reproductive labor debates. You may recall this was a debate generated primarily by Marxist feminists in the 1970s and 1980s. Michele Barrett, Christine Delphy, and Nancy Hartsock are some of the names associated with this debate about how to understand the relationship between reproduction and production. This is the reason that we have returned to that debate—it seems to me that that relationship is absolutely central to what we are interrogating in this process.

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