Wendy Chavkin offered remarks on "globalized motherhood" in the context of her remarks as a participant in the session "ART: Where are We Now?" a panel discussion at The Scholar & Feminist Conference 2009, "The Politics of Reproduction: New Technologies of Life," held on February 28 at Barnard College in New York City.[1]

Watch video of Dr. Chavkin's full talk.
Listen to a podcast of of the panel discussion "ART: Where are We Now?"

I want to suggest a context for us to think about the dramatic increase in use of assisted reproductive technologies (ART) over the last two decades, and to better understand not just how or why women in general use them, but to think about how different women are involved in these processes. I use the construct of "Globalized Motherhood" to think about this.

First, let's start with the fact that I was born at the tail end of the baby boom. Right after World War II, we had a high-fertility period. Death and destruction, followed by a period in which people had more children. At that time, the "Total Fertility Rate," which is the average number of kids each woman has in a given area, in a given time, went up.[2] The total fertility rate at which a population reproduces itself (meaning that its size will stay steady) is 2.1 kids per woman. That makes intuitive sense. Back in the days when you had two parents, if you had two kids, you were holding steady.

Well, since the 60s, shortly after the end of the baby boom, we see a dramatic decline in the number of kids per woman all over the world. Sub-Saharan Africa is the only part of the world that has not experienced this yet, although Northern Africa has, so the Total Fertility Rate has declined in Africa as a whole, too. If you look at every other part of the world, you see that there is this same consistent pattern, and of course, Europe is at the very lowest level, below the replacement level. The United States is at replacement level, and that may be part of the reason we are not participating in the very sophisticated policy conversations that are going on in Europe around this issue.

So you have this dramatic decline in number of kids per woman taking place over the last several decades. What's this about? I don't pretend to offer you a clear-cut explanation, but I can tell you several things that happened at the same time.

One is the advent of modern contraception and legal abortion. Another is women's education. There's also women's participation in the labor force, and delayed age of marriage. And when I say these things, I'm talking broad strokes; I'm not just talking United States, but all over Europe and in different swathes, in other parts of the world: both later age at first marriage and later age at first birth. The final common pathway that's going to link me back to Assisted Reproductive Technologies is later age at first birth.

Now, here's the mean Mother Nature bit of it all. Fertility, meaning your ability to get pregnant and carry a pregnancy to term—I'm sorry—it declines with age. It really does. I teach graduate students in public health and medical residents and they hate this, which is why I'm saying it so apologetically. In fact, I've had people tell me that they can't bear to take the course.

So, what we have seen is a dramatic increase in women getting educated,[3] women working,[4] and women deferring first birth.[5] There is a host of policy responses that one government could have to this issue. Again, in Europe there is pretty much consensus that you have to have what are called work/family reconciliation policies, meaning a whole bunch of policies that make it possible for women and men to be parents and to participate in the paid labor force at the same time. They include things like: paid parental leave, time off to take care of sick children, subsidized and high-quality child care; there's a whole bevy of them.

In the rest of the highly-developed world, there is consensus that this is a necessary part of how a society must address the decline in number of births per woman and the delay in maternal age. As you may have noticed, we are not having that conversation here. So what you see is the fact that our social realities and our biological realities are out of sync now, especially in the U.S.

However, even in places where they are having the conversation, the actual benefits that are being provided are quite uneven and vary in their ability to make people have comfortable and easy lives. I would say the two spots that we should look to and really study are the Scandinavian countries and France.

Okay, so now I'm going to get over to my "Globalized Motherhood" notion. I hope to have been persuasive that this is a worldwide phenomenon. And what you see is that, as this has happened, we see a dramatic increase in the use of reproductive technologies. For example, consider the number of procedures being done. Because fertility treatment involves a sequence of steps rather than the discrete procedures, this is counted by "ART cycles," which the U.S. Centers for Disease Control defines as a period of approximately two weeks that starts "when a woman begins taking drugs to stimulate egg production or starts ovarian monitoring with the intent of having embryos transferred."[6] The number of ART cycles per year more than doubled in the decade between 1995 and 2004.[7] Again, it's not just the U.S. The numbers are uneven, but you see the same general pattern for many of the other parts of the world I talked about.

As other speakers have mentioned, we have seen a dramatic increase in recent years in ova donation.[8] And here, you see a real spottiness—it's not increasing everywhere, but in specific places, among specific women. I think for the rest of the day's discussion, when people really try to talk in a more fine-tuned way about issues of exploitation, and issues of which women are getting which body bits from which other women, it's a complicated story. Those of you who are Barnard and Columbia students of privilege know that you too are being targeted, and being asked to be ova donors. That group in Spain, that high-level group, those are college students.

At the same time, we have also seen a dramatic increase in the transport of babies around the world,[9] known as intra-country adoption. There has been a slight falling off in the last couple of years, and that has been due partly to a variety of scandals, a variety of concerns, and somewhat, to China becoming both concerned about some internal pushback and also concerned about the fact that single mothers were adopting Chinese girls, and they made that more difficult.

Nonetheless, in a kind of time parallel, we've started seeing dramatic increase in people from one part of the world getting hold of babies from other parts of the world. In the United States, one way we can measure this is in the number of immigrant visas given to infants,[10] and this has also dramatically increased during the same time period. If we don't just think about the movement of babies generally, or look at specific families, but look at a national level at the top "Sending Countries" versus "Receiving Countries," you will see that the patterns are not simple. And the patterns don't stay exactly steady over different five-year periods, so you see this is in real flux. For example, the U.S. is the top receiver; that's consistent. But otherwise it is complex. You have countries with very low fertility rates, like China and Korea and Eastern European countries, sending babies to countries whose fertility rates are perhaps even a little bit higher than theirs, like the U.S. and western European countries.

The adoption scholars, and I am not one, say that the sort of ground settings for high levels of sending were war, poverty, and gender discrimination, which include stigma on unmarried motherhood. I think that too has gotten more complicated in recent years.

And the final piece I'd like to interject into this notion of "Globalized Motherhood" is that, as the women of the highly-developed world struggle to work very hard and try to have children, and are still disproportionately responsible for the domestic side of life, they are importing women from all around the world to take care of these domestic tasks.

So the third piece I would like to suggest is the global traveling of women to do nanny work for other women. Both Debora [Spar] and Lori [Andrews] have talked about many, many of the questions that we have about all this stuff.

And we could go all day just listing the questions this raises, much less even ever getting to talk about any of them, but I think the implications for women, for their health, for their relationship to themselves in terms of body bits, include things like this: how are you relating to yourself as a producer of eggs? As a uterus? As a purchaser of somebody else's eggs or uterus? As a provider of genetic material? I mean, these are really weird questions that need to be thought through.

How are you relating to yourself in terms of gender roles? What does it mean to be so eager to have "your own baby," that you are going to have a whole bunch of other people's genetic and gestational services? What does it mean? What are we even talking about?

What does it mean for the babies? A lot of these questions have been raised—about identity, about commodity, about citizenship. There's been a lot of pushback from the Korean girls who are adopted here, and are now back in Korea, angry and looking for their birth mothers.

We have yet to see what's going to happen for these very complicated heritage children that we're talking about now, with the use of these technologies. And also, let me just say that in the adoption setting, some of the sending countries are now very keen to get remittances from those grown-up children who have been sent to wealthier lands, and are now able to produce monies.

What does it mean for countries? Lori [Andrews] talked about the lack of regulation we have in the United States, and contrasted it with a more regulatory system in the U.K. Nowadays, people travel. They travel; they use the Internet. And our ability to maintain our own regulatory schema—whoever "we" are, whatever country "we" are—are really, really tested. So it becomes, I think, really tough for us to think about, and really tough to figure out what kinds of policies we would even like to advocate.

Then there's the obvious: the relationship between the more and the less affluent parts of the world, and the various players involved. There are also questions about how religions enter into this. There's not time today to go into it, but just as a teaser, I'll tell you that aside from Catholicism, which flat-out says no to all of it, branches of most of the other religions have accommodated these things in fascinating ways, and managed to reinterpret doctrine and text to incorporate this.

What does it mean—back to being a country—about your national health system? There's been reference to the question of is it fair or not fair that insurance covers some of this stuff? Well, okay, imagine that you lived in a country that actually had a rational national health system.

[LAUGHTER]

Imagine. "Coming soon to you here."

What's a rational health system to do? What are you going to cover? How are you going to make a decision? You might say an easy "no" to octuplets, but there are a lot of other questions, including the question of what are you diverting the resources away from when you divert towards the coverage of this stuff?

So this is all a great big tease, as you can tell. I have no answers. I'm only trying to say that I think that as we try to figure it out in the United States, we should think of ourselves as being global citizens, and part and parcel of patterns that are happening to lots of other folks. And then maybe we can try to figure out the question of what it means to have these most intimate activities and relationships in this brave new world. Thanks.

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ART: Where are We Now? - Podcast Description
Debora Spar gives opening remarks and introduces the first panel discussion of this year's conference, which includes panelists Lori Andrews, Wendy Chavkin, Leith Mullings and Loretta Ross. Increased demand for assisted reproductive technology (ART) and transnational adoption has been propelled by a number of factors, including the development of new technologies and changes in familial form - such as childrearing in second or third marriages; lesbian, gay, and transgendered families; and delays in childbearing and subsequent difficulties in conception - that make ART helpful. Other relevant factors include environmental changes that have negatively affected fertility levels, new levels of transnational migration and interaction that have fueled awareness of babies available for and in need of adoption, and concerns about genetic diseases and disabilities. Effectively, the various imperatives and the desires, both cultural and personal, that the use of ART fosters and responds to, have created a "baby business" that is largely unregulated and that raises a number of important social and ethical questions. Do these new technologies place women and children at risk? How should we respond ethically to the ability of these technologies to test for genetic illnesses? And how can we ensure that marginalized individuals, for example, people with disabilities, women of color, and low-income women, have equal access to these new technologies and adoption practices? And, similarly, how do we ensure that transnational surrogacy and adoption practices are not exploitative? These questions and many others on the global social, economic and political repercussions of these new forms of reproduction were the focus of this year's Scholar and Feminist Conference, "The Politics of Reproduction: New Technologies of Life," which took place on February 28, 2009 at Barnard College.

Endnotes

1. This paper is an excerpted and slightly modified transcript from a talk at the The Scholar & Feminist Conference, Barnard Center for Research on Women, February 2009: "The Politics of Reproduction: New Technologies of Life." For a much fuller elaboration of the trends and issues described in this paper, see Wendy Chavkin, "The Globalization of Motherhood," in The Globalization of Motherhood: Deconstructions and Reconstructions of Biology and Care (London and New York: Routledge, 2011): Chapter 1. [Return to text]

2. For data on all references in this paper to changes in total fertility rate, see "Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat," World Population Prospects: The 2008 Revision. [Return to text]

3. "Historical Summary of Faculty, Students, Degrees, and Finances in Degree-Granting Institutions: Selected Years, 1869-70 through 2005-06," Digest of Education Statistics. [Return to text]

4. "Employment Status of the Civilian Noninstitutional Population 16 Years and Over by Sex, 1973 to Date, U.S. Bureau of Labor Statistics. [Return to text]

5. "National Vital Statistics System, Council of Europe, Vienna Institute of Demography, Statistics Canada, and Japanese Ministry of Health, Labour and Welfare," CDC/NCHS. [Return to text]

6. "Commonly Asked Questions, 2008 ART Report, Division of Reproductive Health," CDC. [Return to text]

7. MISSING ENDNOTE 7 [Return to text]

8. Catherine Elton, "As Egg Donations Mount, So Do Health Concerns," TIME, 31 March 2009. [Return to text]

9. See Wendy Chavkin, "The Globalization of Motherhood," in The Globalization of Motherhood: Deconstructions and Reconstructions of Biology and Care (London and New York: Routledge, 2011). [Return to text]

10. United States Department of State, Office of Children's Issues, Intercountry Adoption. [Return to text]