Caesarians and Reprogenetics: A Post-Roe Exploration

Since the Dobbs decision overturned the previous precedent, motherhood in the United States has begun to shift meanings. The concept and practice of motherhood is now more reliant on and reminiscent of power structures than ever before. If we take this a step further to focus on power dynamics outside of and in relation to the United States, we can complicate these concepts by ways of racial and socioeconomic disparities. These differences should not be taken lightly, as when we speak of the state of motherhood, we speak to the state of healthcare accessibility, future workforce availability, and the rights of all individuals. In this way, motherhood encompasses everything we know about humanity. But are mothers treated humanely in the modern world? To dissect this, let us first dive into surrogacy and the class-divided experience of pregnancy, in comparison to the eventual birth of a child under sub-par conditions, including the overuse of Caesarian section surgeries from a feminist, ethical perspective.

With newer reproductive technology and techniques, the debate surrounding surrogacy continues. The critics of the reprogenetic technology are revealed as the surrogate mothers themselves, while advocates of the technology are families the technology has benefited by allowing them to have children of their own. The differing positionalities of these opposing sides are intentional, although seemingly invisible under the guise of technological breakthrough. Because mostly rich, white families have the economic means to buy the bodies of the surrogate mothers (who are usually low-income, minority women), the surrogate mothers are forced into an occupation comparable to slavery in which they sell their bodies, but do not receive the respect typical of other occupations. Further, it is important to consider the economically unequal starting positionalities of the opposing women, as this bears a huge weight on their “choice” to go through with this type of work. This is a fascinating system because of its relation to concepts including possession through whiteness (accompanied by biocitizenship and biocapital) and eugenics through reprogenetics. The surrogate mothers described in the New York Times’ article propose a limitation of sex affective labor and biological work, inclusive of societal value placed on their bodies as they do this type of labor with the help of technology.

At its conception, reprogenetic technology seemed to be ahead of social and political institutions and attitudes. In this way, surrogacy can be viewed through a dystopian lens because the consequences of the invention of this technology were not fully thought through originally. This is common of technology in general as most of it is viewed as revolutionary; thus, people rarely consider the downsides of a new invention. With technology’s fast-moving pace, it is not surprising that societal attitude, legislation, and policy tend to drag behind. While this view of technology is not uncommon, it is uncommon for technologies to impact people’s lives as deeply as surrogacy does. Because of the slow societal change in response to technology, the world is left in situations where the populations fighting to be heard do not possess the same amount of power as those who encourage these technological advances. Therefore, while this reprogenetic technology is criticized by surrogate mothers, they lack the power to make significant change.

Referencing the concept of reprogenetics in her work “Indian Transnational Surrogacy and the Commodification of Vital Energy,” Professor and Director of the Feminist Research Institute, Kalindi Vora defines and problematizes this technology as “assisted reproductive technologies allow[ing] women to sell the service of gestating a fetus, [while] maintain[ing] little or no claim to the product of that labor: the child itself.” Thus, the concept of reprogenetics allows rich, white families to achieve a lifelong dream, while the surrogate mother receives a mere wage, just as any job provides. In the New York Times’ article, the surrogacy debate is expanded by reprogenetics being gendered as only certain bodies have the capability to grow and birth a baby. Reprogenetics is also influenced by race because of the differing power dynamics at play which influence low-income, minority women to sell their bodies while rich, white women buy them for their abilities to produce a product—a clear link to slavery. This highlights the intensity of the conflict as both opposing sides feel their rights are being infringed upon, yet only the surrogate mothers’ side is at a severe disadvantage because of their worldly positionality.

The concept of possession through whiteness is described by Professor of History and Gender Studies, Maile Arvin as settler-colonial power. Settler colonial power lingers in the inherently racist institutions built today, one of which, I argue (with reference to the New York Times’ quotation: “opponents say that surrogacy, like the other technologies, exploits women, particularly those from lower economic classes”) is surrogacy. It is also important to point out the difference between biocapital and societal value, as the women selling their bodies are doing so for a profit. However, the surrogate mother’s (literal) labor of the child is devalued through this system in order for the white mother to envision herself going through this process and ending up with its product. Further, the system allows the white mother to claim rights not only to the child, but also to possess the surrogate mother as there was an exchange of goods (her body) for services (the birth of the child). This creates a larger gap between the already economic disparities surrounding both mothers. Further, we can also take biocitizenship into account through the case study represented in the New York Times’ article in which the surrogate mother, Allejandra Munoz, is fighting to claim rights to her daughter, who is currently living in the United States while Munoz resides in Mexico. This raises the issue of racism as lawyers might try to influence the jury through stereotypes and Conservative values regarding where and to whom the child belongs. Cases like these expand the issues of the surrogacy debate to real-life situations that affect people’s lives.

Finally, eugenics is raised as an issue within the confines of surrogacy and built on through Dorothy Roberts, the Raymond Pace and Sadie Tanner Mossell Alexander Professor of Civil Rights. As Roberts describes, by creating a medical model that aims to eliminate genetic risk rather than promoting the dismantling of discrimination against differently-abled people, state-sanctioned means to carefully curate life is upheld under shady means. This directly problematizes the New York Times’ claim that “new reproductive technologies provide a new means not only for conceiving but also of insuring healthy babies. […] Scientists hope to use one or a combination of these technologies to eradicate some of the 3,000 known diseases of heredity.” In comparing these statements, it is clear that mainstream, scientific dogma aims to convince the general population that “designer babies” are the way of the future and have the infant’s best interest at heart, even though these fetuses clearly cannot be asked their opinions on the matter. However, feminist scholars would argue that since reprogenetic technology is so far ahead of the socio-political scope, it is concerning to question just how far this technology could go in the coming years. As Roberts describes, this technology devalues differently-abled bodies, their capabilities, and their culture. It is entirely possible for these individuals to live normal, healthy lives undeterred by their abilities. In fact, the focus on these reprogenetic technologies, DNA, and surrogacy, tends to take away from the humanity at the base of it all: these technologies were created to bring human beings into the world, and for this reason, all human beings should be deemed acceptable and be given the same rights, including and especially the surrogate mothers.

When it comes to labor and birth experiences, caesarian section deliveries have been steadily rising globally over the past decade or so. According to a new study, more than one in every five childbirths is through caesarian section. These rates are even higher in Brazil, the former plastic surgery capital of the world, with some journals reporting numbers as high as 57% of all births. With the growing public interest and knowledge about maternal mortality rates stemming from the Black Lives Matter protests of 2020 and recent movie releases like Aftershock, these rates should be explored and policy should be enacted to decrease these rates in pursuit of the Kantian version of the common good.

Kant’s case for human rights depends on the idea that humans are rational beings worthy of respect and dignity who should be treated not as a means to an end, but as the ends themselves. Lowering unnecessary caesarian deliveries would decrease maternal mortality rates. Although the caesarian section procedure can be a lifesaving surgery when medically necessary, if used outside of emergency situations, it can be risky for the life of the birther. The risk of postpartum maternal death is almost three times higher through caesarian delivery versus vaginal delivery because of factors such as complications from anesthesia or hemorrhage. A significant portion of this risk is due to post-delivery blood loss being higher in caesarian deliveries than in vaginal deliveries. For this reason, it is imperative that hospitals administering non-medically necessary caesarian sections have adequate aftercare to prevent infections and respect the whole autonomy of the birther, in following Kant’s view of true freedom, which is harder to come by in developing nations such as Brazil. Limiting the use of caesarian section deliveries when not medically necessary is an attainable step to reducing risk factors associated with maternal mortality.

Educating birthers and their medical personnel team, through culturally-inclusive opportunities, is a crucial step in reducing these rates. By involving both the medical team and the birther in these educational steps, all people are being respected as ends. Countries with lower caesarian section delivery rates were also more likely to have higher socioeconomic development, women’s education, urbanization, and availability of physicians. The World Health Organization recommends educational interventions that engage women in their family planning methods and care for their mental health before, during, and after any birth to reduce these numbers. In this way, justice is achieved in terms of the happiness and welfare of everyone involved without infringing on the freedom of any. Making both medical professionals and birthers aware of these statistics, as well as giving them alternate options for birth, can help ensure safe future childbirths as well as the recognition of these people as their own rational beings.

To be sure, simply aiming to reduce caesarian section delivery rates is a dangerous assertion, because there are areas of the world where available medical surgery might serve the local community in many ways. Further, in certain emergency times when caesarian sections are needed, they should be discussed and then provided. Therefore, these topics should be approached with caution and full education, so that birthers can make informed decisions on what is best for them; this is certainly not a “one size fits all” occasion. Places like Brazil simply offer intriguing case studies for global maternal mortality rates as they provide insight on developing nations reaching to access available medical services and education around these topics while also experiencing the everyday joys of childbirth. As caesarian section delivery rates continue to climb, new statistics and studies offer the opportunity to engage with these rational communities on alternate options for their healthcare, which would, in turn, create global equity for traditionally underserved and under-respected communities.

Thus, the humanity of these projects is made invisible by the present gendered and racialized power structures. These power structures become visible only through careful analysis, which in itself is a privilege that many do not have the time or resources to conduct. This technology, therefore, becomes reliant on desperate women in false-emergency situations in order for their scientific processes to work. Yet only the technology is considered miraculous. But what of the mother’s body? Is this not miraculous by mere existence? Furthermore, conceptually, this technology dares us to ask, “what is a ‘mother?’” Through gendered logic, this technology becomes thought of as revolutionary, while leaving the mother behind. Is a mother the person who undergoes gestation and birth? Is a mother less so if they deliver their baby through surgical means? Or, is a mother the person who raises the child? Can or should both of these people be separate but have equal claims to the child? As well, ultimately, do all women need to be mothers? I might argue that the very act of surrogacy work is an act of rebellion against the power structures surrounding it (whether or not surrogate mothers realize it), as these women are people who have chosen to do the work of gestation and birth without the unnecessary societal ties that usually belong to women-mothers, though, admittedly, this area needs more research to be fully actualized. In order for proper change based on the feminist critique of this system, education on these hidden concepts is necessary and should be discussed more openly.

By Emily Carriere