Unravelling the Fertility Industry:

Challenges and Strategies for Movement Building

International Consultation on Commercial, Economic and

Ethical Aspects of Assisted Reproductive Technologies
January 22 - 24, 2010, New Delhi

A Report

Sama - Resource Group for Women and Health

Unraveling the Fertility Industry: Challenges and Strategies
for Movement Building
International Consultation on Commercial, Economic and Ethical Aspects of
Assisted Reproductive Technologies (ARTs)

A Report

22- 24 January 2010, New Delhi

Organised by
Sama – Resource Group for Women and Health, New Delhi
The information provided in this report is for wider dissemination, and may be used by anyone
with due acknowledgement to Sama.

First published in 2010

Published by:
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 Contents

Acknowledgements
Day 1

The Consultation in Perspective 1

The Gene Express: Speeding Toward What Future? 4

Biogenetic Transactions: Politics and Economics 8

Global Experiences: Asia Pacific 21

Global Experiences: South Asia 30

Emerging Perspectives and Challenges: Towards a Global Movement 41

Day 2

Global Experiences: South Asia 44

Global Experiences: Middle East 56

Global Experiences: US, Canada and the Netherlands 67

Emerging Perspectives and Challenges 77

Day 3

Global Experiences: Latin America 80

In Pursuit of Tissues: Global Movement and the Biogenetic Form 94

Challenges and Strategies: Where do we go from here? 100

The Way Forward 106

Programme

About Sama

Speakers' and coordinators’ profiles

Participants
 Acknowledgements

Sama would like to acknowledge the invaluable contributions of the following towards this
consultation: Dr Aditya Bharadwaj, Dr Amit Sengupta, Dr Betsy Hartmann, Dr Manjeer
Mukherjee, Dr Mohan Rao, Dr Padmini Swaminathan, Pramada Menon, Sarah Sexton and
NB Sarojini.

We are grateful to the speakers and coordinators of the consultation: Dr Aditya Bharadwaj,
Dr Amar Jesani, Dr Amit Sengupta, Dr Betsy Hartmann, Chayanika Shah, Dr Elizabeth Roberts,
Farida Akhter, Hedva Eyal, Dr Imrana Qadeer, Judy Norsigian, Dr Jyotsna Agnihotri Gupta,
Dr Lakshmi Lingam, Dr Malini Bhattacharya, Manisha Gupte, Dr Marcia Inhorn, Dr Marcy
Darnovsky, Dr Marilena Correa, Dr Mohan Rao, Dr Nighat Khan, Dr Padmini Swaminathan,
Pinky Singh Rana, Pramada Menon, Dr Renate Klein, Renu Khanna, Sandhya Srinivasan,
Dr Sarah Hodges, Sarah Sexton, NB Sarojini, Dr Shree Mulay and Dr Young-Gyung Paik.

We deeply appreciate the active engagement of all consultation participants, who brought rich
detail and debate to the discussions.

We would like to acknowledge IDRC, HIVOS, students of the class on ‘Critical Issues in
International Women’s Health’ at Stanford University and other individuals who have
supported the consultation financially. We particularly thank Dr. Navsharan Singh from IDRC,
who has been a constant source of support and encouragement.

We thank Rukmini Datta for documenting the proceedings of the consultation, together with
inputs from Vrinda Marwah, Sarojini, Pramada and Anjali Shenoi.

We are grateful to our volunteers; Swati, Sakshi, Chandana and Priya. We thank Ritwik
and Ranjan De for putting together the photographs used in this document, and Pakhi for
the artwork.

And finally, a special mention for the Sama team; Deepa, Beenu, Susheela, Aastha, Preeti, Anjali,
Svetha, Bhawna, Ashok, Antony, Renuka, Vrinda and Sarojini.
 The Consultation in Perspective
Anjali Shenoi, Aastha Sharma and Pramada Menon

Sama’s engagement with issues of women and aspects, unchecked proliferation of

health evolved in the context of the women’s clinics, penetration of these technologies
movement, people’s health movement and into smaller towns and cities and the
other democratic rights movements, which underlying caste-class dimensions. Sama
link concerns of women’s health with larger has also been actively engaging with
social determinants. The organisation’s long government bodies and policy makers
standing engagement with women’s health with regard to the regulatory aspect of
and rights especially in the realm of coercive these technologies in India; voicing its
population policies, hazardous contraceptive concerns on related issues like the ICMR’s
technologies and the medicalisation of (Indian Council of Medical Research) National
women’s bodies has led to the understanding Guidelines for Accreditation, Supervision
that conceptive and contraceptive technologies and Regulation of ART clinics in India,
lie on the same continuum. These technologies the proposed Draft Assisted Reproductive
target women’s bodies by intervening in Technologies (Regulation) Bill and Rules and
and altering their physiological processes. advocating for a comprehensive legislation.
Moreover, they raise a number of complex
issues that emerge from the links between Sama has been creating platforms for collective
health, society and technology. debate, discussion and evolving strategies
around these issues through consultations
Within this context, it is important to give and workshops, both at the community
voice to women’s own experiences and their and policy levels. Sama has, through these,
perceptions of fertility, infertility, and to place attempted to draw inter-linkages between
women’s decisions within the context of their ARTs and issues like patriarchy, public health,
family dynamics and their social realities. nutrition, and social determinants of health.
It is with this approach that Sama has been In addition, Sama’s previous consultations
addressing the concerns around Assisted have also focused on unraveling the growth
Reproductive Technologies (ARTs) through and proliferation of ARTs in the context of
various strategies including action research, India. In this endeavour, inter-linkages were
advocacy and information sharing. made with other movements and networks
working on issues of health, women’s rights,
While the preliminary research, initiated in sexual rights, disability rights, child rights,
2004, revealed the unregulated practices of law, and bioethics, among others.
ART clinics and the implications of these
technologies on women and couples, the This consultation’s focus on the commercial,
current study is exploring the commercial economic and ethical aspects of ARTs was a

1
logical step ahead to understand the global money to have a child cuts across all classes.
discourse. In a time when tissues, gametes, What is also clear, in the case of egg donation
technologies, as well as the people who seek and surrogacy, is that it is the poorer and
these technologies, are crossing borders, more vulnerable who often become targets of
this issue has gone beyond national or even such technology.
regional boundaries.
Sama has attempted to bring into the ART
This consultation aimed to bring together a discourse perspectives from a range of
balanced representation of activists, scholars movements – women’s, health, disability
and researchers from different movements, rights, sexual rights and child rights. Some of
networks, and organisations from across the the issues of concern that have emerged from
world working on similar concerns. this synthesis are:
• How can we protect women’s health
Context of Assisted Reproductive and rights in a time when oocytes are
Technologies an important research ‘raw material’?
Global economic disparities, unregulated
Assisted reproductive procedures are more cross border trade in human biogenetic
than mere technology. They have deep
material (like aborted female foetuses)
roots in the existing social arrangements
and unregulated practices in ART clinics
and power relations and it is in this social
in some countries have led to unethical,
context that their development, practice and
uninformed sourcing of embryos and
propagation prevail. The premium placed
on motherhood and biological progeny, and oocytes.
the social stigma associated with infertility, • Can surrogacy be considered a form of
are largely responsible for the escalation of livelihood or is it becoming a temporary
birth technologies into a fertility industry. survival strategy for some economically
Today, we are witnessing the globalisation vulnerable women in countries like India?
of reproductive process, labour and tissues If it is the ‘noble deed’ that it is believed to
by cross border sourcing of reproductive be, why does it continue to be stigmatised
labour through surrogacy and egg donation, and carried out in secrecy, with women
medical tourism, which has facilitated the even leaving their houses and families for
commercialisation and commodification of nine months?
women’s bodies and reproductive tissues.
With the booming reproduction market, the • With varying laws across countries
consequent exploitation of women is a reality regarding citizenship and nationality,
in all aspects of their lives. In many countries how do we decide on the nationality
like India, such practices gain legitimacy by of the child born to a surrogate? For
virtue of a non-existent regulation; resulting instance, in a recent case, twins of a
in unethical practices by ART clinics and German couple born to a surrogate in
research centres. With newer aspects of India have been refused citizenship by
technology like embryonic stem cell research both the countries.
and cloning being rolled out, the law is lagging
far behind. • Do ARTs reinforce heteronormativity,
or do they de-link reproduction
It was earlier believed that such technology from sexuality, marriage and
was only going to be accessed by the rich, heterosexuality and actually make
but it is now seen that investing vast sums of biological parenthood an option for

2
 LGBTQIs (Lesbian, Gay, Bisexual, created conditions for people to undergo
Transgender, Queer and Intersex)? The these technologies.
current screening criteria do not make
these technologies available to LGBTQIs. At the end of the consultation, the following
Further, how can we ensure that ARTs are specific outcomes were sought to be
not abused for sex selection, or to create achieved:
only ‘able-bodied’ babies with ‘desirable’
gender and physical traits? • Information exchange from activism,
research, practices, policies and regulatory
mechanisms gathered from across the
Objectives of the Consultation
world;
The consultation expected to: discuss how • Culling out of strategies from various
ARTs are interacting with poverty, business countries and examining whether they
and commerce, religion, patriarchy and caste can be used trans-nationally;
in various contexts around the globe; unravel
the process through which the proliferation, • Building collaborations and networks
standardisation and routinisation of ARTs as an effort towards movement building
is taking the shape of an industry; learn around new reproductive and genetic
from the experiences of regions where technologies, while being aware of allies
these technologies are more advanced, and and collaborators in the effort towards
anticipate the trends to come in countries garnering health rights;
where these technologies are catching up;
know what strategies have been developed • Comprehension of the advancements
by activists and groups working on these and debates around scientific research
concerns and their challenges and outcomes; on infertility care, stem cells and cloning,
understand the differential perspectives and examining the research priorities in
of governments towards ARTs across the the context of access to basic health care;
globe, the roles assumed by them in dealing and
with these technologies, and the underlying
reasons for these. It sought to bring into focus • Mapping how different kinds of
concerns from a public health perspective, ‘infrastructure’, agencies and agents
addressing the underlying causes of infertility facilitate the movement of technologies
and the arguments of occupational patterns, and results of research; the movement
environmental changes, lifestyle changes that of those in search of such facilities, and
have negatively affected fertility levels and those willing to ‘host’ them.

3
 Key Note Address

The Gene Express: Speeding Toward What Future?

Betsy Hartmann

Developments in genetic research and prisoner is simultaneously a tool of authori-

Assisted Reproductive Technologies tarian surveillance; just as so-called individ-
are occurring with great speed, not just ual choice becomes individual burden when
technologically but also in terms of the the pregnant woman is told she is carrying
growth of new markets, in a world where the a disabled foetus; hopes of cures are dashed
compression of time and space is a hallmark against the rocks of exorbitant expense, bad
of capitalist globalisation. This speed poses a science and false pharmaceutical claims.
political challenge to us. To be able to build
a movement that takes on ARTs in all of its Geneticisation is at once reductionist and
complexity, there is a need to slow down expansive. It reduces us to smaller and smaller
and think together about certain thematic parts of ourselves at the same time as those
clusters. parts acquire value and enter national and
global economic circuits. Women’s bodies
in particular have become a kind of genetic
First are the broader contours of geneticisa-
capital for biotech research and reproductive
tion of which ARTs are one dimension, but
technologies. We are no longer whole, but are
not the only one. First coined by Abby Lipp-
instead, the sum of our parts.
man, ‘geneticisation’ is the process by which
genetics increasingly has come to explain not It is important to look not only at what
only health and disease but to normalise and geneticisation includes, but what it
naturalise social differences as biologically excludes: the structural violence of poverty,
based. The ‘genetic code’, a term originally discrimination, toxic environments and lack
derived from computer science, has now bur- of access to health care that produces the
geoned into a full-blown genetic discourse most widespread and serious risks of sickness
that shapes the knowledge and experiences of and death. Additionally, there are health risks
our bodies and the world, whether we like it or of ARTs themselves – the impact on women’s
not. Geneticisation is more than eugenics, and bodies of egg harvesting, surrogacy, multiple
it manifests differently depending on whether births. We need an affirmation of the right
you are rich or poor, young or old, black or to reclaim the meaning of risk, including
white, man or woman, gay or straight, from the right to determine what information and
the global North or from the global South. It knowledge are used to define it.
is double-edged, providing rewards as well as
punishments, posing risks at the same time as The second thematic cluster is that of the
it purports to minimise them. For instance, market, or rather markets. There is a need
the DNA test that frees the wrongly convicted to understand very concretely how ARTs

4
and related markets work, in order for any ARTs, and the ideological impact of both
endeavour to be politically effective. It is in terms of feeding market speculation.
not enough to just repeat the mantra of
• The politics of regulation, one of the
neo-liberalism; it is essential to consider the
trickiest issues, wherein some liberals
diversity of markets and the extent of state
argue that what is needed is clearer
support and facilitation of them in countries
establishment of property rights in order
such as India, China, South Korea, Singapore,
to regulate the ART market. Are body
the UK, Israel, the Czech Republic, and so
parts now the latest enclosure of the
on.
commons? What kind of regulation do
Some of the key issues that come up around we want, can we get, should we demand?
markets are:
A third cluster of issues relates to
• The connection between the fertility science. The corporatisation of scientific
industry and scientific research, for research in the last decades, as well as the
example, how spare eggs, embryos, increasingly porous borders between public
aborted foetuses, placentae, umbilical finance and private gain play out in the
cords and other tissues from the former ART field. In the US, for example, due to
supply the latter. changes in the law, universities and non-
• The transition of ARTs from a niche profit institutes can now patent federally
luxury market to a larger, if not mass funded research results. More than ever
market. before, the profit motive is helping to push
the direction of research towards commercial
• The relationship between reproductive applications One question to consider is: how
tourism and medical tourism – and even can progressive feminist epistemologies and
old-fashioned tourism. For example, egg interventions reshape the nature of genetic
‘donors’ are being wooed to India with research itself, from the framing of questions
promises of exciting tours afterwards down to laboratory experiments? There is
– ‘give your eggs and then go to the Taj a need to be bold and scientifically literate
Mahal’. enough to assess what role genetic research
• The way gestational surrogacy, in might play within a progressive, feminist
separating the components of conception, health framework.
helps to create a larger market for each, and
Last, but hardly the least, are the intersections
how Pre-implantation Genetic Diagnosis
between gender, sexuality, race, class,
(PGD) has expanded the market beyond
disability, nationality and ARTs. There are
infertile couples.
many obvious hierarchies and dichotomies
• The transformation of ethics and informed as well as less obvious ones. For instance,
consent from principles into marketable while white women’s reproduction continues
commodities, and similarly how to be valued and black women’s discouraged
‘donation’ is deployed to mask market (fertility treatments for white women,
transactions and to turn gifts of blood and population control for black women),
body parts into private property. Dorothy Roberts reminds us that the ART
market is now expanding in the US to target
• The role of advertising in boosting both more women of colour, particularly for PGD.
supply and demand, the role of media In addition, race as a genetic category is being
in normalising through sensationalising mobilised by the pharmaceutical industry in

5
order to obtain patent protection and drug reproductive norms. Yet, the notion of the
approval. biological middle class nuclear family actually
gets reinforced in the process. Further, is the
In the case of gestational surrogacy in focus on ARTs taking attention away from
India, hierarchies of gender, race, caste, the need to fight for the rights of lesbian, gay,
class, religion, ethnicity and nationality are bisexual, intersexual, and transsexual people
startlingly clear: at the apex, well-off couples to adopt?
from abroad and rich Indian clinic directors
(although those couples too can be exploited Scholars such as Rose and Novas argue that
by an industry based on patriarchal values and the nature of citizenship itself is changing:
false hopes); in the middle, medical personnel geneticisation is producing a new bio-citizen
and surrogate brokers; and at the bottom, who has the responsibility to manage health
poor women serving as rentable wombs. risks and live life through acts of calculation
and choice. What does this do to those who
Poor women are definitely exploited, receiv- have not achieved full citizenship in the
ing a small fraction of the fee, but that frac- traditional sense? What is the relationship
tion represents a considerable sum of money between the bio-citizen and the non-citizen?
to buy a house or business, send a child to Are there parallels between the immigrant
school, or pay for a family member’s medical who gets put on the fast track toward US
operation. Exploitation and opportunity are citizenship if he or she joins the army and
wound and bound up in one. the Latina immigrant who gets a green card
because she is willing to serve as a surrogate?
In terms of selection for disability, much The women in Anand, Gujarat are literally
has been written about the problematic producing citizens of other countries, while
they remain second or third class citizens in
context in which women are making the
their own, subject to a state-imposed two child
‘choice’ to abort a disabled foetus or in the
norm when it comes to their own offspring.
case of In Vitro Fertilisation (IVF), to screen
out embryos that carry the risk of future It is critical to remain attentive to how
disability or chronic disease. However, the health and psychological burdens of ARTs
there is a need to look at the results of this are profoundly gendered, falling mainly on
process further down the line. For example, women, while so much of the language used
disability rights activists in the US point to to analyse them is not. Concepts like bio-
how the population of people with Down’s citizenship, for example, are useful tools, but
syndrome is now shrinking, leading to more if we are not careful, they can obscure rather
isolation and lack of community. Meanwhile, than illuminate gender inequalities. Gender
the search for genetic cures for conditions must be central - as are the other intersections
such as autism takes attention and resources with sexuality, race, class, nationality and
away from desperately needed support disability - if we are to move our politics as
services for autistic people and their families. well as the theoretical dimensions of the ART
As the neoliberal safety net shrinks, class debate forward.
privilege comes to determine even more
than before who can afford services and who Some political dilemmas that need to be
cannot. confronted are:

As for sexuality, ARTs have allowed lesbian The issue of abortion rights (especially in
and gay couples to have biologically related the US) around disability is a minefield, but
children and make families, and thus has so is the question of whether or not strategic
been hailed by many as disrupting gendered alliances should be made with anti-abortion

6
groups opposed to the egg trade and other criminalise the most vulnerable people?
ARTs. A similar issue came up around Here there is a parallel with the controversy
population control when anti-abortion over whether to ban the use of ultrasound
activists actively sought to make common technologies used in sex selection.
cause around sterilisation abuse.
Common commitments to end
Second is the question of how we view patriarchy, ensure health care for everyone,
poor women being hired as gestational and work for social, economic and
surrogates. Clearly, they are performing a environmental justice in all their many
type of reproductive labor, so we do support forms must be affirmed. While keeping one
them to get better work conditions and fairer eye on ARTs, we need to keep the other on
remuneration? There are some of the same the broader political agenda that challenges
fault lines here as in the ‘support sex workers’ the very idea of geneticisation as the key to
rights’ vs. ‘end prostitution’ debate. progress. We must resist the individuality and
nano-partitioning that geneticisation pushes
Third regards whether or not to ban certain on us, with an alternative vision of community
reproductive and genetic technologies. Will and collectivity in which all of us are citizens
a ban drive them further underground and and all of us are whole.

7
 Biogenetic Transactions: Politics and Economics
Coordinators: Manisha Gupte and Judy Norsigian

Technology, Markets and the ‘All Muslim couples will be counseled regarding
Commoditisation of Life the proscription of their religion while selecting
an appropriate treatment modality. We will
Amit Sengupta ensure that none of the Shariat laws are broken
The fertility industry today is a multi-million while providing infertility treatment’
dollar, global business. Various means have
‘In all things it is better to hope than to despair
been used to try and present ARTs as designed
– every woman can become a mother’
to address the ‘needs’ of people, particularly
women. However, ARTs remain a business ‘Dream comes true…. because every couple has
enterprise despite the hard work that goes into a right to have their own child’
trying to make it appear like social service.
Though large parts of the entire health care In the US alone, trade in human eggs is an
industry are businesses too, the difference annual business of US $ 38 million. Just like
between the ART industry and other health in any other business, the quality of sperms
services is that the former is all about finally and eggs matters and there are egg brokers
arriving at a ‘product’ – the baby. who ensure a certain quality of eggs by
maintaining a large and increasing pool of egg
As in any good business, there are many donors, many of them college students who
components that are required to come have been profiled for quality. Sperm banks
together for its functioning: sperm, have been known to specify the requisite
ovum and the receptacle (womb). Fertility clin- height, colour and other traits of donors; have
ics, as the seat of this business enterprise, bring asked for medical information of both sides
these components together. They ensure that of their families and evidence of the absence
technology matches needs, that services are of any chronic health problems.
marketed and that there is collaboration be-
tween players like doctors, hospitals and 'pa- However, given the high cost of hiring
tients', among others. Thus, fertility clinics a womb (or a surrogate mother) in the
form the apex of this pyramid, referring pa- developed North, the business of hiring
tients from smaller clinics to those offering wombs has started crossing borders,
sophisticated technology in bigger cities. giving rise to the phenomenon of ‘wombs
sans frontiers’. In a globalised world, this
As in other businesses, clinics use well movement across borders to find wombs
thought-out advertising, appealing to that can be the receptacles of the sperm and
potential ‘patients’ and leveraging on hope: the ovum makes for reproductive tourism,

8
an extension of ‘medical tourism’. There are like oneself, encouraged also by literature,
two major drivers of the growing industry of mythology and folklore. Till about 30 years
reproductive tourism: variation in laws on back, there was nothing by way of infertility
ART regulation, and wide variation in costs. treatment that the industry had to offer. But
For both these reasons, India, Thailand and this changed in 1978 with the first in-vitro
China are popular international destinations fertilisation, and the huge pool of infertile men
for ARTs. For instance, the approximate cost and women became candidates for inclusion
of surrogacy in India is Rs 1 million (Rs 45 in the market for ARTs.
equals 1 USD) compared to Rs 2.5-3.5 million
in the US. Overall, Indian clinics report that Another powerful driver of the fertility
the incidence of surrogacy has more than industry is social conditioning, necessitating
doubled in the past three years taking it to an us to pass on our race. Class society, where
estimated national business size of US $ 445 private property is valued, reinforces the desire
million. for progeny as a means of passing on property.
Patriarchy bequeaths an inferior position to
These technologies are backed by women and a ‘desire’ for a male child. The
powerful interests and have now moved fertility industry is heralding the return of
beyond the domain of a few big doctors, as eugenics – decades after many believed
was the case 30 years back. Large corporations it had received a final burial in Nazi
and pharmaceutical companies are creating Germany – by fanning the demand for blue-
the myth of infertility as a disease which eyed, blonde-haired, Ivy League donors.
can be treated with drugs. More and more There is an attempt to create a super race
people are being brought into the new and of humans that does not have any defects,
broadening definition of infertility. Service or at least any perceived defects. This goes
providers are encouraged to shift to new hand-in-hand with capitalism and its need
drugs, influenced by aggressive promotion. for uniformity – everybody must wear the
same brands, shop at the same places and
Companies manufacturing equipment for
so on. There is a demand for a special kind
ARTs also have a large stake in the fertility
of human being with specific and similar
market.
characteristics. Difference is not considered
The research industry too has a high good for the consolidation of capital as it
stake in this business. Most researchers who moves around. This is highlighted particularly
are working to produce human embryonic well in the documentary ‘Frozen Angels’: “We
stem cells use embryos that were created, but see a minimally informed public, less critical
media coverage and only a small window
not used, during IVF procedures. Similarly,
of time remaining for informed democratic
eggs ‘donated’ for an entirely different purpose
discussion before it is slammed shut by the
are being used for research, thus raising a
ever increasing weight and interest of the
plethora of ethical issues. biotech industry who would like to have us
One of the powerful drivers of the believe the transition was inevitable”.
fertility industry is biology. No living species on
earth can boast of a cent percent fertility record, However, there is a need to engage with
so there will always be a pool of people who are the many facets of this issue by moving
infertile. For instance, about 2000 years ago, beyond the obvious. The bio-technology
the Charaka Samhita talked about infertility. industry today is re-drawing the contours
This is compounded by the atavistic need felt of a post-industrial society with the
by humans to procreate and produce someone race to secure rights over biological

9
material. Biotechnology has altered the Biotechnology firms are funded by venture
way human tissues are regarded in law, capitalists, especially in the US, based not
politics, economics, and society. Earlier, on what they know it can deliver but on
human organs were seen as ‘entangled’ speculations about what it might. Thirty
in the human body since they cannot be years back this would not have been possible
stored outside for a substantial length of time. because speculative financial flows were not
Now the embryo can be ‘disentangled’: banked, the drivers of the global capitalist economy,
copied, circulated, and, most importantly, and would not have been funding the biotech
protected by intellectual property. industry on the basis of what it promised
to deliver in future. But, today speculative
Informed consent is used as a mechanism financial capital looks for much larger returns
to formalise and regulate transfer of tissues than what you get from the brick and mortar
to researchers and industry, including their economy.
IPR (intellectual property rights). When one
signs an informed consent form, one is also There are some lessons to be learnt from the
signing off rights over one’s own body tissues. market control over the food market. For
This is important because it determines the instance, investment funds (through stock
transfer of intellectual property to attract market trading) control up to 60 per cent
venture capital for biotech companies. of the wheat traded on the world’s biggest
Even individuals who privately bank commodity markets. Billions of dollars
their cord-blood are investing in future bio- are being poured in as 'hot' money into
technologies. food commodities even in the midst of the
food crisis in order to escape sliding stock
The fertility industry is a cog in the giant
markets and the credit crunch. Though it is
wheel of global capital which is moving
not apparent from news reporting, we are
forward and seeks a potentially inexhaustible
going through a food crisis; the per capita
renewable commodity – the cell or the tissue.
availability of food in India has never been this
It requires little energy to reproduce. It is
low since Independence. Speculative money
not just the source of body parts but of food,
in commodities futures has ballooned from
medicines, fuel and new materials. This is
US $ 5 billion in 2000 to US $ 175 billion in
fuelling today the ‘engineering of life’ itself,
2007. We need to ask ourselves the question:
and at the core of the biotech industry lies
do we see the future of bio-technology and
the vision of the transformation of biological
life into a new source for surplus value. This post-industrial society in the likes of Bayer
may have been out of the realm of even AG, Monsanto and Syngenta?
science fiction fifty years back, but today it
In conclusion, science and technology are
falls within the realm of possibility, wherein
social creations. Not all advances will lead to
a new material can be made out of living
destruction, but just because we know how
tissue, protected by IPR and exploitative
to do something does not mean we should
companies. In a sense, life itself becomes the
new commodity of capitalism. do it. Perhaps we need to put part of the bio-
technology genie back into the bottle and
Living tissue is the commodity of the future, make the other part a friendly genie. Society
promoting the patenting of life itself. We has the task of shaping the boundaries
can see the consolidation of large food and within which science and technology will be
chemicals industries with bio-technology. applied.

10
Biogenetic Futures: Patents and and technical, financial markets essentially
Property, Speculation and Services operate as bookmakers.

Sarah Sexton The new financial futures markets and prac-

tices did not arise out of supply and demand,
It is important to look at some parallels,
but were actively planned, pushed and calcu-
connections and disjunctures between
lated to engineer demand for something that
modern finance and the fertility and biotech
few initially wanted. This involved construct-
industries, from which five themes emerge:
ing a ‘public interest’ argument to overcome
the future, speculation, patents, services, and
legislation that outlawed them.
regulation.
Financial futures have enabled the biotech
The future plays a key role in Assisted
industry through venture capital, particularly
Reproductive Technology and biogenetic
in the United States. Biotech companies
research. Promises and hopes create an
financed this way are valued not according
imagined future of a healthy child, even
to what they produce but according to the
though, four out of five ART attempts on
possibility of future productivity of profit.
average will not result in a ‘take-home baby’.
Within human-related biotech research, the To generate value in the present, however, the
imagined future is one in which diseases vision of the future does not in fact, need to
and conditions can be treated, cured, or do be realised or expectations fulfilled. What does
not occur in the first place. It is necessary to this suggest for our critiques of the potential
mobilise this hoped-for future so as to get dangers of the futures promised? Should we
public and financial support. take these promises at such face value?
The future also plays a key role in the modern For example, for over 10 years, it has been
financial world and the current financial crisis. said that human embryonic stem cells offer
Or rather ‘a’ future: a legal agreement to buy the best chance of enabling everyone to have
or sell a specified asset at a specified price on a personal repair kit when we get old or
a specified date in the future. The agreement sick; laws were changed in many countries
itself can be bought and sold; those who do to allow the research to go ahead – research
so are speculating on whether its price will that would require thousands of women’s
go up or down in the future so as to make a eggs. Many of us raised concerns about who
profit. The agreements, the futures, are based they would come from and how. Yet within
not only on the future prices of rice, grain and the past couple of years, stem cells from adult
other commodities but also of interest rates, skin cells (Induced Pluripotent Stem cells
exchange rates, currency rates and other or IPS cells) are now considered to be more
intangibles. promising. Would the human embryonic
stem cell future have collapsed long before it
Futures have been cross-linked and could be realised without any help from us?
embedded in yet more financial agreements What have our critiques achieved?
(such as options, swaps and forwards)
to such an extent that financial markets, Colonising the future is a means of capturing
rather than selling futures on tangible things, and depoliticising the present – debates ignore
are more in the business of, as Melinda the causes of infertility, ill-health and poverty,
Cooper puts it, “accumulating promise from for instance, or are silent on the lack of access
promise.” But despite seeming complicated to health care services. Decision-making is

11
channelised towards an imagined future, The patent games that pharmaceutical
distorting priorities, creating misplaced companies have long played cast doubt on
hopes and distracting us from acting on claims that patents are needed to protect and
the knowledge we already have about the fund innovation and research. The industry
prevention of illness and disease. spends more on marketing its products than
researching them; much of the research
Futures are closely allied with specu-lation, is funded by public sector funds anyway;
while speculative finance often drives and any money they do spend on research and
mirrors the speculation inherent in the bio- development is eligible for tax breaks; and
technology industry. In the financial world, new patents are often granted on old drugs.
speculators increase prices through their bets
on the future, especially in the commodities Patents and other IPR are also used by all
sector. “It is just like secretly hoarding food large companies to reduce the amount of tax
during a hunger crisis in order to make profits they have to pay on their profits. The practice
from increasing prices,” said financier and of ‘transfer pricing’ enables companies to
billionaire George Soros. When the prices of shift their profits offshore to subsidiaries in
food stuffs went up in 2007 by between 100 tax havens or secrecy jurisdictions.
and 400 per cent, the resulting food riots in
many parts of the world in 2008 because of Just as patents have become commodities,
food shortages were not attributed, however, so too have health care services, making
to financial speculation, but to ‘too many them unavailable or inaccessible to many.
people too little food’, middle class people In the process, health care has become yet
in China and India eating more meat, or another vehicle for financial speculation.
Europeans protesting against genetically- The United Kingdom (UK), for instance, has
engineered food. If women and their been privatising its publicly funded health
families are poor and hungry, it may seem service through the back door by means of
like a positive step to sell their reproductive outsourcing, contracting out and handing
powers within the ART and related over the buildings to the for-profit sector.
industries. Three-quarters of IVF cycles take place within
the private rather than the public sector. An
Patents lie at the heart of speculative capital, estimated 26,000 women from the UK go
particularly as it is deployed in the biotech abroad every year, particularly to countries
industry, and are a key mechanism of in Southern and Eastern Europe, for fertility
financial accumulation as well. Some 20 treatment because it is cheaper or because
per cent of the human genome has been it will be provided despite their age or so as
patented. In the biotech industry, patents are to obtain the donor eggs or sperm that are
less about protecting innovation than about not available in the UK. (The UK regulator,
attracting specu-lative investment. The patent the Human Fertilisation and Embryology
itself has become the commodity, more than Authority (HFEA)1, is now suggesting
any product the company might eventually that British law should be amended to increase
manufacture and sell, and more than the the amount of money that can be paid to
genetic sequence on which the patent is based. egg donors in the country so as to limit the
With a patent, it is more likely that a biotech exploitation of poorer women overseas).
company can attract investment. The patent Women who go to another country to
itself has speculative value. buy IVF and its related ‘services’ and

12
‘products’ are often labeled, perhaps ART industry over the past two decades; the
pejoratively, as ‘reproductive tourists’. UK now has, as Franklin and Roberts (2006)
Other descriptions of the practice are note, “the world’s most elaborate regulations
‘cross-border reproductive care’ and even governing reproductive medicine while also
‘cross-border reproductive labour markets’. offering one of the most liberal climates for
These terms remind us of the services experimental treatments and research”.
agreement of the WTO (World Trade
Organisation); GATS (General Agreement on Given that each new regulation is a new
Trade in Services) aims to enable more cross- opportunity for accumulation, commentators
border trade in services! on the financial crisis have stressed that
regulation will do little to undermine the
GATS has had significant consequences for
structures of power that support the finance
health and health care services in the 15 or so
industry unless policy reform is rooted in
years in which it has been in effect. It was first
wider grassroots mobilisation for change and
instigated in the seventies by two financial movement building that might contribute
services organisations with a couple of goals to deeper structural change. And that will
in mind: to obtain a multilateral agreement on create the political pressure to ensure that
investment that would enable capital to cross regulations are not weakened by the financial
borders with few restrictions, and to ward off services industry.
regulation of new financial innovations such
as futures. These two organisations were the
credit card company American Express and Coordinators’ Comments
the American Insurance Group (AIG) which Manisha Gupte
is one of the primary entities at the heart of
triggering the 2007-2008 financial collapse • There is a need to explore the business
through its speculative use of futures. interests behind the making of
‘healthy’ babies. The business of bio-
The financial crisis is often blamed on the lack technology is related to the politics of
of regulation, as are many of the unsafe and naturalising certain kinds of diseases,
exploitative practices associated with the ART by labeling some and not others.
industry and associated biotech research. In Are we looking at trans-nationalising
fact, much of the financial innovation of illnesses, with new illnesses (bird flu,
the past few decades was designed explicitly swine flu) coming in, without solving the
to get around laws and regulations or to
problems that exist in poor nations?
profit from different regulations in different
countries – something that also happens in
• To be able to grasp how pharmaceutical
the cross-border ART industry and in biotech
companies, surgeons and technologies
research.
are implicated in the ART industry,
In the financial world, whatever new the connection between the ‘moment
regulations are introduced, financiers will seek of birth industry' and the ‘moment of
a way around them and engender new risks death industry' need to be understood.
(and new profits) in the process. There is also A critical question here is that of power:
the risk of ‘regulatory capture’: those being who will have the power to own, decide
regulated taking charge of or influencing the and exercise control or regulation?
regulation such that it accommodates rather
than regulates them. The same process has • The ‘nothingness’ of a womb-person is
occurred within the UK’s regulation of the already evident, even as body parts like

13
 sperms and ova have the ability to pass on research, better treatments, when in fact,
citizenship and confer power that a whole patenting hinders competition for research
human cannot. for the best treatments and technologies.
We can use the same arguments that are
• The inter-linkages of bio-technology with used to preserve patents to undermine
power, caste, class, heteronormativity, them. This is what the ACLU (American
ableism, etc. have to be established, as Civil Liberties Union) is trying to do in an
ARTs cannot be disentangled from the ongoing lawsuit.
larger bio-technology industry.
• Information is key in the discussion on
Judy Norsigian fertility drugs. This is seriously lacking
today. A woman cannot give informed
• Challenging the culture of greed that is consent without enough information, and
worshipped in many of our communities enough evidence has not been collected
is a difficult yet important task. Without on safety risks.
regulation of the financial markets,
collapses are likely again and again.
Discussion Points1
During the recent financial crisis, low
income people who took mortgages were
• There are not only parallels between the
blamed rather than those who issued
trajectories of finance and bio-technology
them. Though some in Congress and in
(making it a business of hope), they are
Industry want regulation, powerful lobbies
also connected. Biotechnology and finance
like AIG continue to sway inordinate
markets both depend on futures, and are
power and control. Further, the people
intertwined in that they take something
themselves have not raised their voices
private and make a public offering (stock
and voted to make these issues central.
markets, for instance).
• In the US, the gestational mother is given • It is clear that politics and economics
the status of one of the mothers. We must intersect in ARTs. In fact, politics plays
insist that elements like this are preserved, an enabling role. The vision of the neo-
and also that peculiarities in different liberal Indian state and the vision of the
countries do not leave the offspring neo-liberal ART industry are similar. The
without an identity. Indian state is well aware that an entire
town in Gujarat has a surrogate in every
• The ideology of choice is being embraced second home, but has not proactively
unquestioningly. As feminists, we need regulated the phenomenon. While some
to say that sometimes choices have to be feminists want regulation of technology,
constrained in the larger interest. others do not, because regulation is seen as
always ‘light years behind the technology
• Despite laws in the United States that do itself’.
not allow the patenting of life forms, the
US Patent and Trade Office has patented • The problematic status of the citizenship
life forms like genes. These patents were of babies born through surrogacy reveals
granted to preserve the right to get, and to that governments are ill-equipped to
1
 e ‘Discussion Points’ capture the comments that were made either by participants from the floor, or by the speakers in response
Th
to questions by participants and co-ordinators.

14
 handle the situations arising out of ARTs. resisted the government’s attempt to
In recent times, a surrogacy case that has get them to lease their land for 99 years
got a lot of media coverage because of for AUS $ 60 million. The government
disputed citizenship is that of German thought they would get returns from the
twins born to an Indian surrogate mother. land in the future, which they wanted to
It is evident that the woman carrying the capitalise on. The aboriginal people held
foetus for nine months is invisibilised in out despite the promise of health and
the surrogacy process. other facilities, only to maintain their
intellectual property rights in the future.
• There is a need to discuss the ethics
of patenting biological material. The • ARTs are not just about trade in babies
industry supports patenting because but also about trade in women’s
they want to beat the competition. bodies, for instance through the
Even as we examine the colonisation hyperstimulation of ovaries and
of the future, we need to understand embryos to create more capital. There are
the recolonisation of the past, since similarities and differences between the
genes are from the past. Essentially all ART industry and sex work, particularly
intellectual property is the ‘inherited with respect to health. We need to
property’ of humankind. In 2008, a investigate what is considered ‘morally
group of aboriginal people in Australia reprehensible’ and why.

15
16
17
18
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 Global Experiences: Asia Pacific
Coordinators: Mohan Rao and Shree Mulay

From the Cutting Edge to ‘Business as in October 1987 to restrict embryo

Usual’: What does the future hold for women experimentation to 22 hours rather than
in Australia’s mainstreaming of ARTs? the 14 days that IVF scientists wanted. But
micro-injection had already been performed
Renate Klein in Sydney, where no restricting laws existed.
Twelve of the first fifteen test tube babies This shows that scientists will always find
after Louise Brown’s birth in 1978 were born loopholes, which is why resistance has to
in Australia, and many of the world’s ‘firsts’ start with opposition and not negotiations
(such as the first donor egg baby and the first on regulation.
ice baby) made regular headlines. Feminist A 1988 critique (Klein and Rowland) of
resistance formed quickly, with Robyn fertility drugs was ferociously attacked by the
Rowland as the most vocal critic. Following IVF industry, but a research from Los Angeles
up from the foundation of FINRRAGE in 1994 (Whittemore and Rossing) vindicated
(Feminist International Network of this work. A label mentioning the risk of
Resistance to Reproductive and Genetic ovarian cancer was placed on Clomiphene,
Engineering), critical community discussion though its usage has not stopped.
questioned the benevolence of these
technologies for women. The laws passed in For some time in the eighties and
Victoria in 1984 – the first anywhere in the early nineties, international feminist
world – held a lot of restrictions for the ART resistance was able to at least slow down
industry, amongst them a prohibition of all the technologies and to bring them
types of surrogacy that amazingly stayed in into mainstream discussion. FINRRAGE
place until 2008. successfully connected the two sides of
the coin: ‘new’ reproductive technologies and
In 1987, embryo experimentation for micro- ‘old’ ones such as harmful contraceptives, and
injection experiments was opposed because drew attention to the violence of population
it necessitated experimentation on women. control against women in the so-called Third
The eggs for the embryos are extracted from World versus the pro-natalist fertility industry
women’s bodies after dangerous drugs and in the global North and for the elites in the
egg harvesting procedures. Ironically, now global South.
twenty years later, the same words are being
used to oppose egg ‘donation’ for Somatic Now in the 21st century, Australia’s IVF
Cell Nucleus Transfer (SCNT) cloning industry has gone mainstream, consisting
research. Indeed, Victoria passed legislation of a number of clinics, including chains,

21
around the country. Little resistance or Kirkman case in the state of Victoria with
even community discussion is still alive. The a surrogacy arrangement between two
media is unresponsive, and a few journalists sisters producing baby Alice, in which
occasionally report on the high numbers power differences between the two women
of premature and multiple births, and the were extraordinarily stark. It was then that
increased post natal depression in women ‘gestational surrogacy’ was first spoken of,
after IVF births. Research published by and it was said by doctors that if the so-called
Australian epidemiologist Carol Bower in surrogate mother didn’t use her own eggs, she
2003 showed that children born through was not the baby’s ‘genetic’ mother and no
IVF are twice as likely to have birth defects, attachment could ensue. At the time, public
like Down’s Syndrome, Spina Bifida, etc., opinion was mostly against the Kirkman
than other children. American researchers sisters and in 1988 laws were enacted in
recently reported ‘epigenetic differences’ Victoria that made all forms of surrogacy a
in babies born from IVF that account for punishable offence.
‘greater risk of diseases such as obesity and
diabetes later in life’. It is puzzling that such This state of affairs began to change in 2006
scary results do not gain traction in the when a federal politician was involved in
public mind. Women who suffer ill-effects, a high-profile surrogacy arrangement. He
or their babies do, no longer speak out due and his wife had to travel back and forth
to the ‘choice trap’. They believe that since to Sydney in New South Wales, which
it was their ‘choice’ to use IVF, the problems does not have any laws on surrogacy (or
must be their fault. ARTs). Talk-back radio revealed the change
in public sentiment that had occurred:
The NHMRC (National Health and Medical overwhelmingly the Conroys were pitied
Research Council) did not follow through and restricting laws condemned. It was
on its recommendations in a 1995 report to quite disturbing that some women who
undertake a study of the health of women who had acted as so-called surrogate mothers in
had gone through IVF. It appears that such other states, called themselves ‘just an oven’
a study would have been too costly and too in one case, ‘a suitcase’ in another.
difficult. In other words, today no one links
the general health of the current cohort of National Guidelines on Surrogacy are yet to be
50+ years old Australian women to their IVF developed but in Victoria as of 1 January 2010
treatments in the eighties, which is serious the Assisted Reproductive Technology Bill
neglect. 2008 is being enacted. Its most distressing part,
from a women-centered perspective, is that it
As for the development of surrogacy in will make the birth mother invisible. It allows
Australia, as far as the uncritical mainstream for application to the court for ‘substitute
pro-natalist public is concerned, any kind parentage orders’, which will transfer legal
of infertility is a tragedy, and altruistic parentage from the surrogate mother and her
surrogacy is to be applauded. We are told partner (if any) to the commissioning parents.
that infertility is on the rise although there A new birth certificate will be issued to the
are no new surveys conducted on infertility commissioning parents once the substitute
rates and there is no comprehensive data. parentage order has been made. The state
will officially sanction the reduction of a real
The practice of surrogacy was controversial live woman to her womb, and will even deny
in the eighties. In 1988, there was the famous her the right to the ‘products’ of this womb.

22
This is reproductive slavery by another name, will be pointed out that as of 31 March 2009,
and signifies the ultimate legal elimination of only three out of 10 current embryo research
women. licences handed out since 2002, use SCNT
research. Although a staggering number of
In terms of bio-technology, and in particular eggs were granted, no embryonic stem cell
the international hype around embryonic lines have been created. The source of the
stem cells, Australia today is not the ‘world eggs was not specified, other than saying they
leader’ it would have liked to be. This, despite were ‘clinically unusable’. If and when eggs
the government’s endorsement and generous from women will be used, it remains to be
funding of the Australian Stem Cell Centre. seen if any mention is made in the Licencing
Also, in 2002, Federal parliament cleared Committee’s report on their state of health
the way for stem cell research using left- during and after the said egg provision.
over embryos from IVF while prohibiting
the Dolly method: the production of SCNT In Australia, feminist resistance waned in the
embryos which necessitate unfertilised eggs. second half of the nineties and the women’s
But, four years later in 2006, this Act was health movement was crumbling as well. In
amended and SCNT cloning is now allowed. 1996, the Women’s Health Policy was axed
because it was perceived as discriminating
Visible feminist resistance sprang into action as against men. News stories are increasingly
FINRRAGE and CATWA (Coalition Against endorsing the pharmaceutical sales pitch
Trafficking in Women, Australia) joined hands that miracle technologies will save us from
with the international group Hands Off Our all ills. Measuring, testing, ticking boxes
Ovaries to point out the dangers for is fast becoming the proper way of health
women, of ‘donating’ eggs. Although the assessment, unfortunately, very much
campaign – using the term ‘eggsploitation’ endorsed by the current technology-friendly
– garnered some media sympathy, Labour government. ‘Personalised medicine’
the common public view supporting is the catch-cry for the rich of the world and
embryonic stem cell research – as ‘choice’ the magic word, except the choice to
progressive science that reduces suffering say ‘no’ to technologies and treatments that
– remained unchanged. The central violate bodily integrity and turn most of us
and dangerous role of women as egg into walking diseases and ‘chemical citizens’.
donors remained invisible. Nevertheless, It is no wonder that within such a framework,
the feminist campaign almost succeeded; reproductive technologies are simply seen as
the Federal Cloning Amendment Bill good tools in the ‘war chest’ of the health
2006 won with only one vote in the Senate. technologists.

Despite the Australian Stem Cell Centre’s But, what about the remaining women’s
particularly bad year in 2007, unfortunately health movement? Sadly, managerialism
in 2010, the Amendment Act 2006 will come now dominates what is left of its public
up for review and this year’s battleground presence. Caution must be observed to avoid
will centre around the quest for payment of the trivialisation of feminist concerns. For
egg ‘donors’. instance, in the feminist campaign against
SCNT cloning in 2006, reproductive choice
Weary of any new miracle technologies, the advocate Lesley Cannold famously claimed
upcoming feminist campaign will continue that ‘donating’ eggs was no different than a
to focus on the health risks for women. It blood transfusion.

23
Young people concerned with ecology in the can exist to enable the bio-technological
context of climate change, must be made to research industry.
recognise the similarities between treating
the bodies of women as experimental objects In Korea, the bioethical regulations that are
and the violence against land and indigenous considered necessary to facilitate research
peoples. As we hope for a new politicisation and industry exist now, but it is difficult to
(and re-politicisation), we must also note the say if ARTs are being better regulated than
need to reassess current liberal regulation at the time of the Hwang scandal. Moreover,
policies, given that since scientists go as by forbidding ova donation exclusively for
far as they can, regulation just presents an research and making researchers use only
opportunity to find loopholes. There should 'remaining' ova, the close connection between
be a moratorium on these technologies and fertility clinics and human embryonic
studies should be conducted to investigate stem cell research has been reinforced. A
the health of women who have been harmed new Act forbidding the commercial trade
by reproductive technologies and genetic of gametes became effective in 2008. The
engineering. cases of internet-based ova trafficking and
surrogacy were reported and some traders
Assisted Reproductive Technologies at were arrested by the police. Unlike the
the Crossroads: Neoliberal Economy, previous instance where agencies were
National Depopulation Crisis and the involved at least in the area of ova donation,
Politics of Reproduction in South Korea which now mostly takes the form of voluntary
transaction between two private parties
Young-Gyung Paik pretending to be relatives or close friends,
and cannot be detected and prosecuted easily.
While the regulation of ova extraction and IVF While the Act allows the compensation of
had been a feminist concern even before the actual expenses only, even the official amount
Hwang Woo Suk scandal, the case provided of compensation can be up to US $ 1200,
an impetus for the regulation of ARTs in which is enough money to lure young women
South Korea. The discourse of the national in need, especially in a financial crisis. The
depopulation crisis has framed the policy actual price of ova donation is known to be
concerns and public debates on bioethical around two or three times more.
issues in contemporary South Korea. Solving
the reproductive and economic crisis of the In 2009, after a long debate, the National
country through stem cell research and IVF has Bioethics Committee granted permission
taken priority over ethical considerations. for human embryonic stem cell research to
a bio-company affiliated to one of the most
In recent years, the extremely low fertility famous fertility clinics. In this sense, despite
rate (1.19 children per woman in 2007) and the changes after the Hwang scandal, many
the rapid ageing of the population has been problematic situations continue. While
a source of concern for the Korean state and human embryonic stem cell research had
society. There is a conflict of interest between been suspended for three years, following the
the state’s need to encourage stem cell revision of the Bioethics and Safety Act, the
research and IVF to ‘save the nation’, and the field of somatic stem cell began to flourish
introduction of ethical regulations and global as an ethics-free alternative to conduct stem
standards at the same time. Yet, it is clear from cell research. Cosmetic products containing
the UK case that well-established regulation stem cells are becoming popular with

24
consumers. Soft tissue augmentation using in South Korea. In response, the Bioethics
fat derived stem cells has been applied to a and Safety Act was enacted in 2004 (and
range of augmentations like breast, penis, came into effect in 2005) ‘to secure safety
rhinoplasty, etc. In fact, the drive behind the and ethics of bio-technology’ in the
stem cell therapy boom at local clinics was to country. However, the Act was criticised by
find services that were not covered by national sections of the citizenry, including academics,
health insurance. Especially since the IMF legal professionals and religious leaders, for
(International Monetary Fund) economic not pursuing safety and ethics aggressively,
crisis in the late nineties, local clinics providing but functioning instead to promote bio-
primary health care have been the victims technology. The contentious issue at this
of neo-liberalisation. At the same time, soft point was not about ova, but whether to allow
tissue augmentation with ESC (Embryonic embryo cloning. Feminist groups pointed out
Stem Cell) injection has accelerated the that because there were no official regulations
commercialisation of the health care system, on IVF procedures in South Korea, there
and has been extracting local clinicians from were no means to regulate the sale of eggs,
non-lucrative but essential medical services. surrogacy or the creation of embryos at
fertility clinics. The warning was to prove
In a major shift since the Hwang prophetic.
scandal, these issues have begun to be
understood as bioethical or technical In 2005, the Hwang Woo Suk scandal and
issues rather than activist concerns; the arrest of international ova traffickers
the institutionalisation and profession- exposed infertility clinics as the loci of
alisation of bioethics has taken place; the commodified ova supply both for research
authority of experts has been emphasised and for infertility treatment in South
in the area of bioethics; and the role of Korea. In early November 2005, the Korean
women’s rights activists has been even National Police Cyber Crime Investigation
more marginalised. While this trend arrested a company called DNA bank and
itself is problematic, this institutionalised several other egg brokers, accusing them
bioethics has shown a particular incapacity of ova trafficking through the internet.
Soon after, there was a report that Hwang’s
to deal with pro-natalist policy, or the ever-
team used trafficked ova for their stem cell
growing force of market.
research. A public debate on the bioethical
issues in Assisted Reproduction followed,
The first legal attempt in Korea to incorporate
and the Ministry of Health and Welfare,
bioethical issues was the enacting of the the ruling party, the opposition party and a
Genetic Engineering Promotion Law (now feminist NGO each prepared a different bill
known as the Biotechnology Promotion of bioethics law (4 in total) to regulate the
Law), submitted by members of the National legitimate use of ARTs.
Assembly in 1983. Encouraged by foreign
successes, groups of Korean scientists In April 2007, the Ministry of Health and
joined in on research for human embryonic Welfare synthesised the different Bills and
cloning. A series of attempts to produce finalised two closely connected Bills to be
human embryonic stem cells in the early presented to the National Assembly: one
2000s sparked debate among religious was a revision of the Bioethics and Safety
and civic groups, some of which started Act and the other served to introduce the
to advocate the need for the bioethical Protection and Regulation of Germ Cells Act.
regulation on the issue of stem cell research

25
The reformed Bioethics Law was passed in the in order to secure the future of the nation.
National Assembly in April 2007, and became In the debate over the current population
effective in May 2008. Some of the provisions crisis, a more lenient immigration policy
of the law are: is regarded as inevitable, while at the same
time, deemed a source of crisis destroying
• Ova donation was allowed for infertility ethnic homogeneity. Therefore, the issue
treatment, but prohibited for the exclusive is not simply how to increase the overall
purpose of scientific research. population of South Koreans, but how to
encourage childbirth among the ‘right’ sector
• Only ‘remaining eggs’, obtained for
of normative middle class married South
infertility treatment but unused, or those
Koreans.
that failed to fertilise, could be used for
stem cell research with the informed
Therefore, in 2006, even after the back-
consent of donors.
scratching alliance of fertility clinics and
Interest groups had reservations about the stem cell research was revealed, the state
new bills. Many religious groups, especially simply decided to promote and subsidise
Catholics and Protestants, expressed their IVF procedures for infertile couples without
dissatisfaction that the new Bills would still introducing comprehensive regulation of
allow research on human cloning. The gravest fertility clinics. At the same time, measures to
problem was the concept of ‘remaining eggs’. enhance reproductive health in general have
Bio-technologists, scientists and medical been ignored. An anti-abortion campaign is
doctors argued that the concept of 'remaining being supported by the state and regulation
eggs' was ridiculous. What they needed of abortion is being tightened. Yet, the
for stem cell research was not poor quality distribution of contraceptives or education
leftover eggs but fresh and mature eggs. They in sexual and reproductive health for young
argued that the new eggs would make stem adults is under-funded and does not get policy
cell research impossible in South Korea. The attention.
new Bills were, in fact, self contradictory.
While allowing or even trying to promote The state was criticised by experts for
stem cell research, it denied a legitimate way encouraging unnecessarily invasive
to obtain a substantial number of eggs that procedures and was suspected of having
can be used for research. They were seen as interests in promoting bio-technology and
the result of a compromise between the ethical the fertility industry. In fact, the Ministry
problems and the fear of losing initiative of Health and Welfare once called plastic
in international competition in the bio- surgery, health screening and the IVF
technological research industry, compounded industry the three ‘most promising’ fields
by fears of depopulation. Producing one’s for medical tourism in South Korea. It was
own offspring came to take priority over the also evident that the state was less interested
ethical concerns about the commodification in introducing the regulation of IVF for
of eggs, surrogacy or the indiscriminate use of women’s health than it was in promoting
IVF technologies. the South Korean IVF industry and bio-
technology, both highly dependent on
In the policy of subsidising IVF for South human ova supplies.
Korean couples, what is at stake is not only
how to increase the fertility rate, but also how In this context, surrogacy and assisted
to produce proper South Korean citizenry reproduction are also framed in the context

26
of national anxieties over low fertility rates The South Korean situation underscores the
and economic insecurity. Low fertility has importance of the wider context in which
framed the debates primarily as ‘plight of meanings of ARTs emerge. The proposed
the infertile’ in South Korea. This has been Bills had to find their ethical guarantee in a
double-edged for childless couples, as they normalised concept of family. Consequently,
have been subject to rhetoric that casts while the Bills were drafted to address
them as the source of the national crisis, ethical problems in stem cell research and
and are excluded from tax reforms and assisted reproduction, the ethics of the
housing programmes that favour families state depopulation policy, the ethics of the
with children. Many couples are relieved normative concept of Korean family and
that infertility has moved from being a Korean nation, or the ethics of the public health
private misfortune to a state-recognised care system, were seldom questioned. Despite
social problem, and they can now take official perceptions of surrogacy as unethical,
advantage of public funding. Yet, on the anxiety over the national fertility crisis has
other side, many now encounter greater framed surrogacy as the last means for the
pressure to undergo IVF. The language infertile to have children and consequently
of the safe population policy defines provide the much-needed future labour force
infertility as a disease requiring of the country.
immediate medical intervention, forcing
childless couples to obtain treatment. The discourse of the national crisis has framed
Celebrity doctors have told the media and conditioned the way the public imagines
that there is no ‘absolute infertility’. the kind of suffering that deserves public
recognition, the kind of people who have
Childless couples often imagine that IVF the right to reproduce by using ARTs and
procedures can help them get pregnant quickly eventually the right and duty of the citizen
and patients of infertility clinics encourage in contemporary South Korea. Feminists in
others to skip artificial insemination and to South Korea have been facing difficulties in
start IVF treatment as soon as possible, in order their effort to regulate ARTs. In this rapidly
to save time, because the success rates of IVF globalising world, however, a situation in
are higher. After repeated IVF attempts, many one country also generates a context for
couples find their initial optimism misplaced other countries, making possible timely
and are left physically and financially and necessary feminist intervention beyond
exhausted, a state described as ‘torture by borders.
hope’. At such a time, some begin considering
surrogacy seriously. Presented as the last Coordinators’ Comments
means to have children, surrogacy can be
neither fully legalised nor prohibited by the Shree Mulay
South Korean state. Therefore, while debates
focus on how only altruistic surrogacy The tendency to conflate infertility rate with
can be fully allowed and not commercial birth rate must be avoided. There is a general
surrogacy, the reformed Acts provide only belief that the infertility rates have increased.
minimal legal regulation of surrogacy. Public We have to examine if this is being confused
bioethical debates often focus on regulation with people opting to not have children due
and institutional practice, while ethics is to the high costs of bringing them up, or with
understood as a person’s personal moral the fact that reproductive spans have reduced
judgement. due to children being born at a later age than

27
earlier generations. If the latter is the case, fact, relinquishing mothers have come
then increasing ‘infertility’ rates may actually forward to speak about the heartache that
be a natural course of fertility declining with adoption has caused them.
age.
• A liability case has been booked against
Mohan Rao a clinic in Canberra, Australia where a
lesbian couple had two children because
It is ironic that altruism and maternal love two embryos were implanted instead
(in surrogacy) is being reified in a neoliberal of one, despite their objection. The case
world that asserts competitiveness in every is still underway, and the couple has
other sphere of life. The difference between appealed on grounds of inability to bear
commercial and altruistic surrogacy needs to the costs of bringing up two children.
be identified.
• It is not that the IVF industry is
Discussion Points flourishing in South Korea because of a
declining fertility rate. The IVF business
• In 1984 there was a law prohibiting was flourishing even before the fertility
ARTs, including surrogacy, in the state of rates dropped, and was the basis of the
Victoria (Australia) but it took until 1988 bio-technology business. The difference
for it to be enacted. At the time, there was is that now IVF in Korea is subsidised by
a strong public debate around the issue, the state, and is also funded by private
particularly with the famous Kirkman corporations. There are so many IVF
sisters’ case. Now, especially for the doctors in Korea that they were not able
last ten years, the debate has died down to make much money, and so they lobbied
altogether. People simply don’t know for the state to do something about the
how low the success rates are and how declining fertility rate. But there really
dangerous the drugs used in infertility aren’t many interventions the state can
‘treatments’ are. The notion of the ‘good, initiate to raise the fertility rate. Unlike
altruistic’ woman is so strong that women family planning, people cannot be forced
surrogates call themselves ‘just a suitcase’. to have more babies.
It is not clear how this transition and
alienation from our bodies has • Korea has always been upheld as a
come about. Perhaps the notion that country where regulation of industry
technology can solve anything is all has worked. It has regulated ultrasounds
too prevalent now. and sex selection. However, it is evident
that a state which is capable of regulation
• Australia is a pro-natalist country that and implementation does not seem to
wants its people to have more babies. be doing what it could to regulate bio-
The fertility rate has been rising slightly. technology. This is because the state
In fact, two years back the former has vested interests in not regulating
treasurer said that Australian women bio-technology too much. Further,
should have three children - one for the the experience with sex selective
mother, one for the father and one for abortions is evidence that people
the country! However, it is very difficult find ways to evade regulations when
to adopt in Australia, and inter-country they are in place. Statistics from as
adoption has received some bad press. In recent as the late 1990s and early

28
 2000s show that there was a sex exporting orphans to other countries.
ratio problem in Korea. But more This has to do with international adoption
recently, cultural attitudes and people’s agencies that were established during the
expectations are changing. Now the sex Korean War. Now more people want to
ratio is within the normal range, with adopt within the country, but some issues
more girls than boys. remain, like disability. When children
have serious disabilities, they can go
• Regarding the kinship concept in South abroad but it is unlikely that they will be
Korea, the proposed bill encourages adopted within the country.
donation between siblings, because
the idea is that if gamete donation is • There is no scientific basis for the
happening among kin, then there will be requisite time gap between subsequent
no ‘problem’. It has even been suggested ova retrievals and an upper limit on the
that a father-in-law is the ideal sperm number retrieved, which is a different
donor for his grandchild because the figure in different countries. After heated
family genes will be passed on through debate, it was decided that for the South
different generations, without any Korean bill, the number of times women
confusion about the child’s identity can donate eggs will be increased from
and lineage. Like surrogacy, this is not two to three. This was a compromise
considered incest because there is no sex figure because scientist groups lobbied
involved. In addition to commercial and saying that while it is very hard to find
altruistic surrogacy, there is also now the donors, it is easier to persuade people
concept of a ‘natural’ surrogacy, wherein who have already donated before to
subsequent to a failed IVF surrogacy, donate again.
the surrogate sleeps with the man to
conceive. • More studies are needed to
understand the effect of the use of
• In South Korea, adoption is emerging as genetically modified foods, pesticides,
an option but there aren’t so many babies etc. on declining fertility rates and sperm
to begin with. Korea has a reputation for count.

29
 Global Experiences: South Asia
Coordinators: Imrana Qadeer and Farida Akhter

Medecins Sans Frontiers. This day and illnesses, communicable diseases and vaccine
This way! preventable diseases; and the high maternal
mortality rates are attributed to high fertility
Nighat Khan rates, low skilled birth attendance rate,
illiteracy, malnutrition, and insufficient access
A cross-country comparison for South to emergency obstetric services.
Asia highlights the uncomfortable regional
realities of the developing world and of In terms of human resource indicators, there
Pakistan in particular. Further, the situation are 7.4 doctors, 0.4 dentists, 3.4 nurses and
on the ground in Pakistan is probably far midwives, 6.5 hospital beds and 0.9 primary
more dismal than is represented by statistics health units for every 10,000 people. While
from the Federal Bureau of Pakistan. the actual percentage of GDP spent on health
is two per cent, an unconvincing 4 per cent is
Some of the key demographic indicators from projected by the Federal Bureau of Statistics.
the WHO's (World Health Organisation) A third of the population has no access to
country profile for Pakistan point to an potable water. Only 35 per cent women have
estimated population of anywhere between access to trained personnel during pregnancy
160 and 200 million, of which 20 per cent and only 33 per cent of them have a trained
live below the poverty line of US $ 1.25 a birth attendant by their side during labour.
day. Pakistan is the sixth most populous Clearly, South Asia still has a long way to go to
country in the world, ahead of Russia, with meet the United Nations MDGs (Millennium
a life expectancy for men of 62 years and for Development Goals) for maternal and child
women of 63 years. The mortality rate below mortality. This was highlighted by a British
five years is 97 for every 1,000 live births. Medical Journal paper (ZA Bhutta et al 2004)
No accurate data is available related to the that compares death rates and other infant,
country’s fertility rate. neonatal, perinatal mortality rates of countries
in the South Asian region. The ‘ironies of
The WHO health profile indicates a high fortune’ or the disproportionate distribution
population growth rate in Pakistan, which of wealth is another jarring characteristic of
compounds the high infant and child this region.
mortality rates, high maternal mortality ratio
and the dual burden of communicable and The existing scenario in the infertility
non-communicable diseases. The high infant industry in Pakistan is difficult to change.
and child mortality rates are attributed to ARTs in Pakistan comprise a range of highly
malnutrition, diarrhoea, acute respiratory specialised and expensive treatments. There

30
are 10 IVF clinics in the country, all of poor kidney ‘donors’ cater to wealthy clients
which are privately owned. The average cost in the countries of the Middle East. There
of one cycle of assisted reproduction is Rs are a large number of ghost schools which
200,000 (84 Pakistani Rupees equals US $1). employ and pay salaries to teachers but have
The services on offer are IUI (Intra Uterine no infrastructure and no students.
Insemination), IVF (In Vitro Fertilisation),
ICSI (Intra Cytoplasmic Sperm Injection), Further, the state of ART regulation and
PGD (Preimplantation Genetic Diagnosis) and licensing in the country is alarming. While
even sex selection. A leading fertility doctor no centre can open or operate in the
from Lahore recently claimed in an interview West without strict checks and balances
that he aimed to ‘pioneer’ sex selection in by regulatory authorities like the HFEA,
the country. In such circumstances, the core anybody with the requisite finances can
concerns are not about the availability of IVF set up an IVF centre in Pakistan. There is
facilities, but rather, about the distribution no formal inspection or accreditation of
of wealth and disparity in health economics, the centres or their claims. Since IVF is
regulation and licensing, the franchising a lucrative business abroad, anyone who
of IVF clinics, 'patient hunting' by western visits foreign locations like London or
clinics, and surrogacy. Canberra can get hold of someone running
a fertility clinic, and start this service in
Pakistan ranks fairly high in Transparency
their home city. The health worker (like
International’s list of the most corrupt
gynaecologist or bio-technologist) is then
nations in the world. With increasing
trained by the parent clinic in the West for
accumulation of wealth by fewer segments
a week or so. Personnel from the parent
of society, a gradual disappearance of the
clinic come over for the setting up of the
middle class is being witnessed today. The
clinic, and leave soon after. The owner of
loss of the middle class means that a vast
one such privately owned centre claims,
majority in Pakistan is struggling to make
for instance, that his success rate is
ends meet, let alone afford a US $ 20,000
70 per cent.
IVF cycle for a baby. Ironically, it is cheaper
for a man to get a new wife than it is to get
IVF treatment! This picture of disparity The provision of ARTs in keeping with
raises the important question about whom ethical standards is left to the ‘good will’
the IVF clinics are catering to in Pakistan. of clinic owners and physicians, which is
The disparity in spending is all too evident highly questionable. Lord Winston, one of
– Rs 320 million were spent on building the UK’s early gynaecologists, has critiqued
a water fountain at a seaside resort, even IVF clinics in the West, questioning their
as many people have no roofs over their non-engagement with the public, non-
heads and sleep on the streets of Karachi. accountability and profiteering.
From transport to food, the gap in income
is glaring. In a country where the per capita The phenomenon of franchising has become
public health expenditure is a measly Rs rampant in setting up IVF centres in Pakistan.
360, the government spent Rs 65 million on Private IVF centres in the West, particularly
the overseas treatment of just 18 high profile Australian centers and even Kings College
‘V.I.Ps’ (Very Important Persons), mostly London, have been instrumental in setting
for diseases that could be treated within the up fertility clinics in Pakistan in exchange
country, at a fraction of the cost. Pakistan’s for hefty remunerations. The expenses for

31
setting up the clinics, in turn, are covered by resource poor settings. This ‘choice’ needs to be
pharmaceutical companies, most of whom questioned, especially since it is not expected
are big players in reproductive endocrinology of pharmaceutical companies to provide
medicines, thereby starting off a vicious cycle. cheaper drugs in resource poor countries.
In this franchising, the prices of IVF cycles ‘Minimal investigations’ are difficult and
too are determined by the parent clinics. what is meant by ‘low cost interventions’ is
Therefore, patient hunting and franchising unclear.
is carried out in countries that are already
resource poor. When franchises are set up in regions like
South Asia and consultants from the West are
One such example is that of Concept Fertility brought in by the pharmaceutical industry,
Centre, Australia, that has affiliated centers in the role of the pharmaceutical industry is very
Canberra, Karachi, Lahore, Kuala Lumpur; murky. This industry encourages western
and is currently negotiating to establish more specialists to venture out into the developing
such centers in South East Asian countries, world, and also provides financial incentives
and in India. An advertisement from this to trained personnel in developing countries.
centre’s website urgently seeks both egg and Specialists are routinely approached to set up
sperm donors, and claims to be ‘assisting fertility centres, with a large amount of cash
those couples who have difficulty conceiving’ upfront and embryology training on offer.
given the ‘current fertility rate of 15 per cent.’ This is the norm for western companies to
kick-start their businesses in the developing
Surrogacy is considered illegitimate and world.
immoral by the Sunnis, who form a majority
in the largely Muslim country of Pakistan. It In terms of possible solutions and steps for
is equated to any third party reproduction, the future, one way forward could be to
which is considered equivalent to infidelity. provide training and education in medical
However, the Shia sect in Iran has found ethics through departments in universities.
a way around this, and in fact encourages The attendees for such courses tend to be from
third party reproduction. An analogy can diverse backgrounds, including journalists
be drawn between surrogacy and organ and social scientists in addition to medical
donation. The poor continue to be exploited, practitioners. In conclusion, it becomes
similar to what we have seen in kidney important to speak of individual rights versus
transplant tourism. Therefore, simply because responsible practices when dealing with this
a practice is not encouraged in Islam does complex and multidimensional issue.
not mean it will not happen. Rising surrogacy
is a probable future scenario in a country, Assisted Reproductive Technologies in
where there are already instances of young Nepal: A Brief Picture
medical students donating sperms in exchange
Pinky Singh Rana
for a pass mark in their exams.
Nepal is one of the least developed countries
There has been some activity by Western in the world. It has to deal with a lot of
authorities on this front. The task force of the insurgency and is in a post-conflict state.
European Society of Human Reproduction The women’s movement is strong especially
and Embryology (ESHRE) makes the case compared to the rest of South Asia; however,
for ‘choice’ to be provided to infertile couples, ART is a new issue and has not been addressed
by making available affordable treatment in much till now. There is little information and

32
awareness on these technologies in the public vulnerability is taken advantage of and they
domain. go to any length without fully comprehending
the repercussions on their bodies. There
Prior to the initiation of ARTs in Nepal, India is lack of information on available services
was the destination for infertile couples, and and due to lack of government monitoring,
continues to be so. For those unable to bear there is no guarantee that quality services are
the financial burden of ARTs, faith healers, being provided.
fervent hopes and prayers are the only other
options. Women who are unable to bear Trials of a single mother: An economically
children are stigmatised as ‘barren’ and face well-off, single woman, based in Kathmandu
social discrimination, as well as mental and got ART treatment in India. She admits that
physical violence from their spouses and her social acceptance despite this ‘aberration’
family members. Despite scientific proof, might be because of her economic
patriarchal norms exonerate the male from independence. The hospital, however,
any blame. Polygamy is seen as an option for required her to provide a father’s name for
couples facing infertility. the child which was ‘cooked up’. After much
pursuit she has been able to obtain a birth
The first known test tube baby in Nepal certificate and other documents for the
was born in Kathmandu at Om Hospital in child.
February 2004. Today, the hospital claims a
‘success rate’ of 40 per cent for IVF and 20 per In conclusion, there is an urgent need for
cent for ICSI. Om Hospital also runs a sperm research to understand the current status
bank. Currently, a number of clinics are known of ARTs within Nepal – the number of
to be treating infertility in the capital and so institutes addressing it, guidelines being
far, 200 test tube babies are said to have been followed, profile of recipients, information
delivered. They offer a range of ART services, provided, etc. Research findings must be
the most common being IVF and ICSI. Om used to build the capacities of stakeholders
Hospital claims it is using the best medicines involved. There is also a need to learn from
in the world and is following international experiences of other countries, particularly
guidelines. Unlike India, Nepal is not seen as other South Asian countries.
a destination for medical tourism. However, Strong advocacy is necessary to ensure
Om hospital claims that people are coming that ART related guidelines are developed
from other parts of the world for treatment. and followed by those providing services.
Further, commercialisation and gender-
There is no initiative from the government to based exploitations must be delved into
regulate ARTs at the policy level. The NGO and necessary policies developed by the
(Non-Governmental Organisation) sector government to prevent them.
has given priority to issues like maternal
mortality, violence against women and
contraception. Consequently, these hospitals Coordinators’ Comments
and IVF centres are working as per their own Imrana Qadeer
rules and regulations.
• The issues that emerged from the
At the individual level, many women face presentations can be summarised as:
life-long discrimination since ART services financial attraction; the existence of the
are too costly for them. For others, their mythical baby which becomes a gateway

33
 into medical technology; the production go to India for treatment. However, the
of false knowledge by the industry; and doctors in Om clinic are Nepali doctors.
the position of competitive advantage of
South Asia and India in particular. • The priority and focus for Nepali feminists
have been issues like malnutrition and
• India’s proposed ART bill is the ‘best’ maternal mortality, which have reduced
legislation to promote business – how to a large extent. Although otherwise
much money we can make from ARTs and overall the Nepali women’s
seems to be its core concern. movement is extremely active, it has yet
to engage with the complexities within
Farida Akhter the new phenomenon of ARTs. With
the current political situation in Nepal,
• Some of the issues raised brought into the focus is on constitution building
focus discussions in South Asia that have and post-conflict insurgency. Further, in
hitherto centered on population control all South Asian countries, the NGO sector
and contraceptives. In the last 20 years, is dependent on INGOs (International
donor agencies have focused on ‘choice’ Non Government Organisation) that
in reproductive health as a women’s have their own agendas, on which ARTs
issue, but they have not questioned this do not really figure as a priority.
‘choice’.
• Legal guardianship of the child in
• Since ARTs are new technologies,
countries like Bangladesh is very
there is lack of information about
similar to adoption. Adoption is legal
them, even amongst women’s
in Pakistan, a country with a high
organisations. Issues of religion and
fertility rate where many children
economics need to be addressed in ARTs.
are in need of homes. A popular
No religious leader seems to be talking
shelter home run by the Edhi Foundation
about ARTs although they are being
has the longest waiting list for adoption.
practiced rampantly.
In fact, a famous pop star in Karachi is a
• In Dhaka, only middle class women single, unmarried woman who has recently
openly talk about having adopted. adopted. Islamic law states that adopted
Adoptive parents are given the status of children cannot inherit automatically, but
legal guardians, and at the time of the one can gift one’s inheritance to adopted
child’s marriage, the biological father’s children.
name is required.
• The clientele of IVF clinics in Pakistan
comprises mainly of the middle and
Discussion Points upper middle class. Even if the Pakistani
• A lot of women go from Nepal to India diaspora is accessing ARTs in Pakistan,
(Calcutta) for IVF treatment, and though the numbers are not as huge as in the
more Nepali women have been accessing case of India. If people want to have
ARTs within Nepal in recent years, the a child and can afford IVF treatment,
confidence in treatments across the they will overlook what religion says.
border is higher. Maybe because of easy In Pakistan, people are known to have
accessibility and the apparently higher sought treatment even from the more
success rates in India, the tendency is to conservative western parts of the

34
 country. Some families have sold their clinics. Most of them only need stress-
houses and land in pursuit of a male heir counseling, or better management of
of their own genetic origin. On the other preventable diseases rather than IVF.
hand, there is a different kind of stigma Even in cases where it is clear that there
that the upper middle classes in the US will be poor outcome, fertility treatment is
face if they can afford IVF but choose carried out to make money. For instance,
not to access it. women with endometriosis of advanced
• Although abortion is illegal in Pakistan, nature are put through IVF drugs
except on medical grounds, affluent and repeated cycles, although medical
people access abortion in private hospitals. treatment cannot yield results. Often what
For the rest of the population, abortion is is misunderstood as infertility is simply a
carried out under conditions that put the case of lack of awareness regarding the
health and life of women in jeopardy. natural fertility cycle.

• A large number of people in Pakistan have • Organ trade in Pakistan is a mix of local
been misguided by fertility management and international demand.

35
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40
 Emerging Perspectives and Challenges: Towards a
Global Movement
Coordinators: Sandhya Srinivasan and Jyotsna Agnihotri Gupta

• There is a need to identify simply travel to another country where it

feminist political strategies that is available. Given the specificities of each
can accommodate the diversity of country, we need to think more critically
country experiences with ARTs, as about blanket positions, particularly with
highlighted by the presentations from regard to regulation. Is regulation the
South Asia. While examining the issue of way to go? What regulation means, and
ARTs, connections need to be drawn with the way it is put into practice, is radically
old feminist debates on abortion, adoption different in every context. Does putting
and sex work. What are our positions on a regulation in place, even if it is not a
pro-business one, mean anything in
these issues in relation with ARTs? The
terms of practice? Although abortion is
feminist movement in India has been
illegal in almost every nation in Latin
confronted with the sudden rise of 250
America, it has the highest abortion rates
fertility clinics. ARTs are no longer being in the world. We need to be as specific
accessed only by a minor, elite cohort. as possible while thinking of the kind of
Although issues of population control activism that will be useful. All over the
have been the focus of feminist struggles world, there is a trend to leave regulation
in India, and are important even today, to the market. Vested interests are
India’s strong women’s health movement rapidly infiltrating regulatory bodies and
now needs to expand from contraceptive drafting committees for regulation bills,
to conceptive technologies. We need to like with Monsanto in GEAC (Genetic
decide on certain non-negotiables, which Engineering Approval Committee) or
will work as a framework for reviewing with baby foods. This is linked to the
our strategies. We need strategies within issue of IPR and bilateral ‘knowledge’
the movement, and vis-à-vis the state, initiatives. Where do we need to direct
industry, etc. Given that patriarchy will maximum energies in dealing with these
not go away in another 100 years, the issues? Further in India, where primary
question is what can women do in the health care services are dismal and the
interim? Let us not throw the biotech most basic regulatory laws in the health
baby out with the bathwater, and see how sector are not implemented effectively,
we can use bio-technology for collective how do we ensure that regulation on
betterment. bio-technology will be any different?
Will having an Act, even one that is to
• Regulation (and the lack thereof) is driving our acceptance, be able to tackle the
ARTs globally, because when a technology misuse of technologies? Therefore,
is unavailable in one country, people while it is absolutely urgent to work for

41
 regulation, it is also important to realise documents must be kept in mind while
that regulation alone is not sufficient. We strategising about the constitution and
need regulation to address certain issues, possible reconstitution of the family.
and need to stress that the social aspect of
• ARTs challenge and complicate our
these issues cannot be left to the market.
understanding of concepts like citizenship
We need to view ARTs through the same
and parenthood. How are sperm and ova
lens of critical analysis with which we
donors positioned in terms of the identity
view other powerful technologies, like
of the IVF child who emanates from
big dams and chemical pesticides.
their biological material? They certainly
• The issue of patents has a direct impact do not figure on the promotional
on commodification in biosciences, material of IVF clinics, which invariably
genes, genetic modification, GM show a heterosexual couple with a
foods and so on. The general baby, though the genetic inheritance
understanding in WTO circles is that the of that baby may be from elsewhere.
inherited property of humankind cannot So who is the parent? In the Draft ART
be patented. Bill, IVF clinics are legally prohibited
from divulging information about
• We need to think of how we can explicitly biological parents to the child, even when
open up the family as a site for feminist she/he is an adult. Is this not a violation
struggle. The problems that stem from of her/his rights? Another interesting
infertility particularly begin with the complication is that citizenship rights are
family. Some old philosophical issues are not granted immediately to babies born
also coming into play here. Patriarchy has to Indian surrogate mothers. There is a
always deployed notions of immortality tension here, wherein the state wants to
and immaterialism, of which afterlife, promote medical tourism, but does not
reincarnation and the production of want to grant citizenship to ‘foreigners’,
children are all part. including to Bangladeshi nationals
• The recent Law Commission Report on residing in India.
the ART Bill in India mentions that • There are differences of opinion on the
a woman is respected as a wife only legitimacy of surrogacy as an option, so
if she is the mother of a child, so that should surrogacy be brought within the
her husband’s ‘masculinity’ and ‘sexual ambit of discussions here? In discussions,
potency’ are proved, and the lineage some rural women from Tamil Nadu
continues. This is the state’s ideology have expressly said that they do not want
behind the ART Bill, with respect a blanket ban on surrogacy, and have
to women’s roles. With respect to made a distinction between altruistic and
surrogacy, it also mentions that one commercial surrogacy. Perhaps the issues
of the intended parents should be a around technology cannot be collapsed
donor as well, because the bond of love with the issues around surrogacy at all,
and affection with a child primarily as is the tendency in the media and the
emanates from a biological relationship. ART Bill. The latter debate is similar to
Further, the chances of various kinds of debates around sex work, labour and
child abuse, which have been noticed in reproductive labour, and raises questions
cases of adoption, will allegedly reduce about the choices and the vulnerability of
if there is a biological relationship. Such participating women.

42
• While the discussion has been focused is voluntary, with no penalties for
on the supply side of ARTs, we need to non-compliance. Younger people,
talk about the demand side as well – particularly, need media literacy training
size of the market, perceived need for so they can learn to be critical about the
ARTs, and other alternatives for assisted sources of the information they receive.
reproduction (traditional medicine, gurus
• A lot of infertility is amenable to simpler
and dargahs for instance). It cannot be
methods of treatment. Given that there is
denied that childlessness is a big problem,
mainly secondary infertility in the third
and it would be partial to say that it is
world, it is primary health care that needs
created completely by corporations.
strengthening. Yet, the state cites the
• A lot of work needs to be done to ‘needs’ of women to promote big business.
build awareness – about safe period, Today legislation is an instrument to
perceived infertility, male infertility promote corporate interest. We need to
(which is more than half of all infertility bring in capitalism when we talk about
cases), etc. Public education campaigns patriarchy, and we need to bring in men
can go a long way in taking some of when we talk about reproduction.
the burden of fertility off women in
• We need a multi-pronged strategy that
marriage. In Egypt, a new marriage
will work at different levels - the state
bill mandates pre-marriage semen
needs to be engaged legislatively, younger
analysis for men. The ongoing debate
people need to be given information,
on making sex education part of school
and the struggles of the working classes
curricula assumes significance here.
for livelihoods, dignity, survival and
However, sex education, which would
women’s rights, need to be supported.
be able to fill the existing knowledge
Media interventions through the news
gaps that contribute to infertility
and TV serials, as well as ethics in medical
and the demand for ARTs, is being
education are areas that need examination
opposed on religious grounds. Public
and work.
education is also required in order to
counter the distortions and baseless • ARTs, surrogacy and ‘donations’ need
claims of clinics circulated especially to be seen in the context of the tissue
through the internet. Sources of economy, wherein risk is manufactured
information, like registries, need to be to sell a kind of biological insurance.
made available to women before they Today there is a ‘digitisation’ of the
opt for the ART procedure. While the body going on, related to patents
CDC (Center for Disease Control) in and property rights over children,
the US does collect data from clinics, adoption, lineages, etc. Genetics has
it is very minimal and inadequate. implications for what our duties and
Clinics often get exclusive and responsibilities are, because not only
restrictive about who they will treat, does it seek to create the ‘perfect’ human
in order to have a higher success rate being, but also to encompass all that we
for projection later. The CDC registry are in life.

43
 Global Experiences: South Asia
Coordinators: Padmini Swaminathan and Betsy Hartmann

‘Doctor’s Babies’: The Scenario of who can inherit property or be a part of the
Unregulated Trade over Infertility in family occupation. A married woman’s job,
Bangladesh therefore, is to deliver a male baby. This is the
demand side of ARTs.
Farida Akhter
Although there are no official statistics,
Fertility has always been linked to the doctors in the business of ARTs have started
population issue and considered a problem coming up with some baseless figures.
in Bangladesh. The last population census Couples that do not have a baby after five
in 2001 put the figure at 130 million. years of married life, despite wanting to have
Population data varies from source to one, are identified as ‘infertile’ and the doctors
source. Current estimates are in the range claim that there are over 3 million identified
of 140 and 160 million people and these infertile couples, which is 10 to 15 per cent
large numbers are seen as the cause of many of couples in the country. Advertisements of
problems, including floods! Contraceptives clinics talk about technology bringing ‘hope’
are seen as the solution and there is a for infertile couples. The image used in such
constant search for new methods along with communication is always of a fair, blue-eyed
forced sterilisation, and the use and abuse of baby boy.
population control methods. Women have
been used as guinea pigs for all population Clinics have also started talking about male
control methods right from the sixties – pills, infertility because it means more business.
IUDs (Intra Uterine Devices), sterilisation, Socially, however, women’s infertility is still
Depo-Provera in the eighties, menstrual the issue. Men marry more than once in their
regulation, Norplant testing, Quinacrine, efforts to have a baby. Women face divorce or
RU 486, etc. have to accept polygamy. That is why women
prefer to get treated for infertility.
In the backdrop of 'burgeoning population',
it was always considered that IVF will be According to Bangladesh Fertility Society
irrelevant for Bangladesh. Ironically, the and Harvest Infertility Care Ltd., the causes
country has gone from fertility control to of infertility are many: drug addiction,
promotion of infertility management using environmental pollution, irregular menstrual
ARTs. Infertility is viewed as ‘bad luck’ cycles and delayed marriage; the use of
for married couples and is considered the detergent powder, chemical fertiliser,
woman’s incapacity or failure. This has to be pesticides, use of preservatives in food,
seen in the context of men marrying women excessive use of plastic materials, among
in order to have children (preferably male) others. Thus, there is a strong link between

44
the infertility industry and other related technology, makes it clear that only those
industries, like food production. who are strong enough to accept failure
must seek treatment. She compares infertility
There are increasing number of cases of treatment with a lottery: “you can try with
miscarriage, deformed babies, complicated equal chances of winning or losing”. The cost
pregnancies and other gynaecological of her treatment is around 80,000 Taka.
complications in villages due to exposure to
pesticides. However, neither these issues nor The trend has been of a larger number of girls
other reproductive problems are addressed. being born than boys. In one clinic, out of 26
cases of test tube babies, 17 were girls and nine
Since the early 2000s, a range of ARTs were boys. Among quadruplets three out of
(IVF, embryo transfer, frozen embryo, ICSI, four babies are girls; most twins are girls. This
IUI, etc.) have been used and more than 479 exists simultaneously with the wide use of this
babies are said to have been born. Over 20,000 technology for sex determination. Although
couples have sought treatment in different the general trend is towards seeking a male
clinics so far. However, the treatment is child, infertile couples are happy to have even
marked by poor consultation and discussion girl children since it helps them overcome the
between patients and doctors. The doctors, stigma of infertility.
trained in Singapore, UK, US, India and
Australia, are offered joint venture funding In a time span of five years, IVF clinics have
and assistance from other countries. been growing. Dr Parveen Fatima, who was
instrumental in the birth of Hira, Moni and
There is no follow up with parents who have Mukta in 2001, was employed as an Associate
undergone treatment or counselling about Professor in the Department of Gynaecology
the risks and dangers to the child or to the and Obstetrics in a government hospital, but
woman’s body. Most often quadruplets die soon she opened a private clinic – Centre for
after a few days, but the only cases that make Assisted Reproduction (CAR). She started
it to the news are the ‘successful’ ones. Once the clinic without any equipment, trained
the baby is born, all credit goes to the doctor, personnel or technical know-how.
hence, the term ‘doctor’s babies.’
Just as in family planning, which started
with the middle class and was considered
The birth of Hira, Moni, Mukta, the first test
empowering and then included the poor
tube babies (triplets) born through IVF (in
through coercion, there is a class issue in
2001), as well as their birthdays every year
infertility management too. Middle class
are celebrated by the media. Their parents,
couples can afford to pay for treatment,
Abu Hanif and Firoza Begum were delighted
whereas the poor sell assets to access it.
to have them after 16 years of their marriage.
They paid Taka 200,000 (70 Bangladeshi takas The commercialisation of the technical
equals US $ 1) for the treatment. After the birth solution to infertility means that profits are
of the babies, they were kept in incubators for being made by exploiting the desperation
close to a month, costing them Taka 7,000 of women. The question is whether this is
everyday. Today they say they cannot make really infertility treatment or merely another
ends meet to raise the three children. business. Since the component of ‘assistance’
is in doubt, should we continue calling
Dr Rashida Begum, an infertility management these technologies Assisted Reproductive
specialist known for using frozen embryo Technology?

45
Unraveling the Fertility Industry: ARTs of its advantage. The proliferation of ARTs
in the Indian Context is one of the best examples where state-of-
NB Sarojini the-art facilities have been marketed with the
justification by providers that it is the ‘need of
ARTs are becoming a standardised the hour’ and that they are merely responding
procedure for bypassing infertility, to the market demand, precisely the demand
although it is still a trial and error of ‘desperate women’ to become mothers. As
method, leading people to go for innumerable an IVF provider puts it, "people have to want
cycles of IUI, IVF, ICSI, IUI followed by something for it to survive in the market".
IVF, IVF followed by ICSI. In the absence
of a national registry, it is difficult to provide Providers have been exploiting the existing
accurate statistics about the number of stigma, ridicule (whether subtle or apparent)
infertility clinics. Recent media reports and violence against women due to infertility.
claim that there are 350 ART clinics in the There have been instances of women facing
country. The number of registered infertility violence, being denied their ancestral
clinics is said to have gone up four times in property, and husbands remarrying. Absence
recent years. There has been a steep rise in of or poor basic preventive infertility care
the membership of ISAR (Indian Society for in the public sector even at the tertiary level
Assisted Reproduction) from 184 members has also promoted the growth of ARTs in the
in 1997 to 600 members in 2005, which is, no private sector.
doubt, a conservative estimate.
While basic health services are almost nil or
The reach of ART clinics is no more
are rudimentary, two government hospitals
concentrated only in the metros and big
in Delhi have started offering state-of-the-
towns but is also reaching those semi-urban
art ART facilities. The logic of developing
townships and rural areas which lack basic
countries serving as destinations to procure
civic amenities and other necessary health
care facilities. ART clinics are varied in goods and services at cheap rates has been
terms of appearance, outreach and facilities, extended to the fertility industry; what is
depending on the locale and the clientele bought and sold here is reproductive material
they cater to. They are housed in shabby and reproductive labour.
places with inadequate infrastructure (when
measured against guidelines of the ICMR), As in the case of any consumer product, the
without backup electricity facilities and proper fertility industry is marketed by aggressive
laboratories; at the same time there are clinics advertisements to draw couples with promises
which are housed in corporate hospitals in of fulfilling dreams through taglines like:
flashy up-market areas.
‘The Miracle of Life…In-Vitro Fertilisation…
We make your dreams come true…’
Hence, it is futile to talk about a generalised
fertility industry and it is important to make it ‘When desolate homes resonate with children’s
clear at the outset that this fertility industry is laughter…’
as diverse as any other industry. Commercial
surrogacy and egg donor programmes are ‘500 childless couples have achieved
becoming an integral part of this industry. ‘happiness’.

Capitalist endeavour has always used Advertisements can be found on websites,

patriarchal normative ideology to the best fancy brochures, on walls and hoardings on

46
streets, at bus stops, near adoption agencies client’s treatment in India, including services
and local cable channels. of a nurse or guide (if required).

Lucrative bargains for egg and sperm donors India has been termed as the ‘mother
and surrogates are seen even in newspaper destination’ for drawing large numbers
classifieds: of couples for commercial surrogacy. The
country’s rapidly growing commercial
‘Wanted healthy lady, age 20-35 years. surrogacy industry is worth US $ 445 million
Unmarried/married widow lady to bear per year. Anand, a town in Gujarat, has
child for childless family through artificial become the epicenter of the commercial
insemination or IVF. Earn Rs 50,000 - surrogacy industry in India. We can see an
60,000...’ emergence of surrogacy centres and hostels
for surrogates and surrogate agents. A centre
Partnerships have been forged between well in Chennai claims that there are 15 cases of
known clinics (doctors) in metros and big surrogacy every month.
towns and upcoming clinics in semi-urban
and rural areas. New schemes have been New players, including franchises and law
developed to survive the competition in the firms, are entering the market, like Proactive
market like, money-back schemes, camps Family Solutions, Mumbai, which is a wing of
and service in batches. Camps and IVF in BestMed Journeys, Florida; Rotunda, Mumbai,
batches are becoming the specialty of semi- which is linked to Planet Hospital, California;
urban clinics, which depend on ‘mobile Indian Surrogacy Law Centre, Chennai, etc.
embryologists’ and ‘flying doctors’ (coming One of these firms said that in the last year,
from bigger cities). Discounts are given for about 27 couples registered at the US office.
on-the-spot registration in an effort to beat This essentially means that about 27 couples
the competition. IVF providers claim that are now at different stages of the surrogacy
they offer the third or fourth cycle free for process and are paying Rs 0.6 - 1 million in
patients who cannot afford them. In return three to four installments.
they hope that the clinic will be recommended
to others. The key reasons for India’s dominance
include:
The fertility industry is an integral part of the • Lower costs (a fourth of the cost in the
growing medical tourism industry, which is West);
supposed to bring additional revenue of US
• Large top-notch private health care
$ 1-2 billion by 2012 and is being seen as a
providers;
new avenue for drawing foreign ‘traveling’
patients and Non-Resident Indians (NRIs). A • English-speaking providers;
typical ‘medi-tour’ would offer a combination • A socio-political climate that encourages
of a therapy or treatment and recuperation at the outsourcing of Indian labour;
places of the client’s choice. The recuperation • Existence of world-famous tourist
would often include popular tourist activities. destinations;
Such ‘Special Care Packages’ include
providing facilitation letters for obtaining an • Large number of women willing to engage
Indian visa, designing pre and post holiday in surrogacy;
itineraries for the clients, a support system • The total absence of government
and human contact at all times during the regulation.

47
ART providers give the justification that and men from all sections of the society and
commercial surrogacy is opening up new even the remotest parts of the country are
avenues for women to earn money. They say seeking treatment as are NRIs. Sama’s study
that it is unfortunate that this is receiving also indicates a wide range of individuals who
an undue share of negative publicity. have accessed ARTs. In fact, although the
“Anyway women here normally have four technologies are accessed primarily by the
to five children. If she acts as a surrogate middle and upper class, the lower rung of the
once then what is wrong? She can earn population is also making an effort to use it.
Rs 2 - 2,50,000 from one surrogacy, and her The respondents include NRIs, IT executives,
family can get settled”. hoteliers, on the one hand, and landless
farmers, daily wage earners, on the other.
However, there are market anomalies that
operate in health care and the standard Although the technology is expensive, it is
competitive model does not apply to this said to be affordable for all classes, and is even
sector. The lack of standardisation in treatment being justified by comparisons with wedding
protocol is especially acute in ARTs leading to expenses and the cost of heart surgery! There
multiple trials based on how much a couple is evidence of people taking loans, selling
can afford to pay. Health risks associated with assets, and being 'broke' after repeated failed
these procedures are projected as insignificant cycles or after having a child. Nonetheless,
and safety regulations are minimal. Varied respondents have said that they will go to any
and exaggerated success rates are claimed extent to try to have their own child.
to woo patients. Clinics consider a positive
pregnancy test as a ‘successful case’ ignoring Moreover, while this industry is modeled and
any complications that may arise later, even operates largely on the lines of a capitalist
the child not being born. manufacturing industry, its legal, political
and ethical implications, within the country
There is no standardised cost structure and beyond, are still unfolding.
for ARTs and the variance is not only in
procedural costs but in those of drugs Hence, there is a need to initiate a discussion
as well. The cost of IUI varies from on strategies and plan collaborative research
Rs 1,500 to Rs 10,000 and of IVF varies and advocacy at the national and international
from Rs 75,000 to Rs 150,000. level. Alongside, a strong community-based
approach is essential because no advocacy can
Informed consent is a mere formality in ART bring the desired result if it is only at the level
treatment and there are cases of sex selection, of the market.
multiple embryo implantations and of post-
menopausal women having children. An ART In India till today, there is no legal mechanism
provider justifies using multiple embryos in place to regulate the fertility industry. The
by saying that they want to increase the guidelines of the Indian Council of Medical
chances of implantation. “Countries where Research (2005) are not legally binding. The
only one embryo is used are those where the draft ART bill (2008), with its innumerable
government sponsors IVF cycles”. shortcomings is yet to be finalised. A central
registry or any other such mechanism needs
Given the market scenario, the natural to be put in place to monitor ART clinics and
question that arises is who is the consumer. provide data on the number of ART clinics
A media report in 2007 claims that women and their outcomes, the number of cycles,

48
failed cycles, live births, the sex of the child legal framing of human embryonic stem cell
born, the number of surrogacy cases, etc. research in India, has all but displaced the
governance of bio-technology of these stem
There is a need to ask questions about the cells into the realm of the experimental. It is
measures to ensure women’s health and within this emergent neo-liberal reasoning that
safety in a context where there is a lack of the burgeoning growth of assisted conception
systematic research on the health implications and embryonic stem cell technologies are
of drugs, the invasive procedures used and a flourishing. In reviewing the experimental
concomitant suppression of existing literature state and the state of experiments in India,
highlighting side effects. two sites have to be grappled with that both,
facilitate and produce, human embryonic
Experimental State, State of Experiments: materials; the Indian state’s experiments in
State, Science, Citizens and Embryonic governance and broadly defined, the state of
Stem Cell Research in India scientific and clinical experiments in pursuit
of knowledge, commerce and profit.
Aditya Bharadwaj
There is a fundamental shift from the
Assisted conception technologies and stem capitalist mode of production to a neo-liberal
cell technologies are so completely intertwined mode of production. While the capitalist
that separating one from the other has become mode of production is preoccupied with
difficult. concerns around managing waste, in the neo-
liberal mode of production, the concern is
The notion of the ‘experimental’: In scientific predominantly of recycling the waste, to ensure
parlance, an ‘experiment’ would typically that nothing goes waste. Therefore, citizens
entail a test or procedure carried out under and sites that were previously considered
controlled conditions to determine the validity and articulated as wasteful and dispensable
of a hypothesis, or to make a discovery. At its are suddenly becoming a rich resource to
broadest, an experiment is an invitation or an be harnessed in some straightforward way,
opportunity to try something new. Specific and for their tissues and body parts to be
sites within Indian bio-technology that liquidated and fed to the booming neo-liberal
seldom get articulated as experimental range economy. So it is a win-win situation as far as
from the micro or bio-genetic, e.g. human the state is concerned. Yet, there is little to say
gametes and embryos, to infertile women or about the social and economic inequities that
men as macro anatomical sites for extraction distort real economies.
of such bio-genetic surplus, to the role of the
Indian State’s experiments with legislations, In neo-India today, women’s reproductive
bioethics and IPR. In India, these sites seldom potential has come to be viewed as both a
get capsulated as experimental, save in the scourge - most graphically illustrated in the
activist discourse, because they are either aggressive and gendered nature of population
enunciated as consent, choice and contract control policies pursued by the state - as well
between the state and the citizen or as pure as a boon in the shape of reproducers of the
epistemology and untainted science. This is Indian state and the economy itself. In great
achieved without ever explicitly marking the measure neo-India owes its rise to the army
infertile body’s spare embryos’ commercial, of its young workforce and a reserve pool
clinical and research interests as experimental of its staggering 500 million people under
sites and subjects. On the contrary, the ethical, the age of 19. In this respect, by fulfilling

49
their patriarchal requirement, set within the global locales has hastened the creation of
parameters by the state, Indian women make citizens who, from the point of view of the
their reproductive labour valuable in the neo- state and its legislative modalities, can be
liberal mode of production. imagined as imbued with individual rights
and possessing bodily autonomy, who, in turn,
To achieve an ethical and steady supply can be made well informed to consent from a
of human embryonic form (for participation in position of knowledge and courage to make
the global moral economy), the Indian state has choices reflecting free will. Not too dissimilar
embraced guidelines that are largely inspired assumptions are implicit in the arguments
by regulatory frameworks in the UK and US, favouring open commercialisation of organ
thus renewing the focus on women. So there is trade around the globe. How might this critical
an ironic shift from 'too many babies' (family frame help contextualise this deeply cultural
planning, two child norm) to 'no babies', and and socio-economic issue at stake in securing
in the new century, infertile women and their consent, contract and choice in embryo
technologically induced oocytes and embryos donation in India? This is especially sensitive
are rapidly becoming state subjects in need of when we pause to consider how infertility or
regulated development, production and most reproductive disruption on a similar scale is a
importantly circulation. profoundly disabling condition, especially in
the context of classic patriarchy, privileging
The language of gifting and altruistic and conflating motherhood with womanhood,
renunciation of human tissue is well and fatherhood with manhood.
established in the bio-medical and bio-
ethical discourse. The most notable insights However, ever since the bio-technology of
have emerged from studies examining the embryonic stem cells became thinkable,
global transactions in human organs such as the stifled ‘potentiality’ of reproduction
kidneys. Nancy Scheper-Hughes argues that has attracted both public and private sector
the language of gift, donation, heroic rescues attention in India. This is most graphically
and saving lives masks the extent to which illustrated in the proposed ethical guidelines
ethically questionable and even illegal means of the ICMR, on infertility management and
are used to obtain the desired object - kidney, embryonic procurement, which has created
or even embryo. The sacrifice is rendered a furore in the medical community in India.
invisible and hidden within the rhetoric of 'life The main bone of contention in the ICMR
saving' and 'gift giving'. The case of embryonic guidelines is the proposed prohibition of
gift however, is more complex, as it cannot be intra-familial gamete donation. The medical
simply recapsulated as a mere gift of life, but community has reportedly taken strong
rather in the case of embryonic stem cells, exception to the ban on sperm donation by a
as a gift of potential knowledge to a medical relative or a known friend of a wife or husband,
researcher. This is knowledge that produces fearing that this will trigger paid donation
value, through not mere circulation, but more and trade in semen. Some fertility experts
significantly through transferal into a derived and stem cell research scientists are fiercely
self product, with accompanying claims to opposed to this legislative move and for good
intellectual property and ownership detached reason. Should this guideline become a law,
from the point of embryonic conception. the consequences of such a move may in fact
impact on family forming strategies employed
The gifting of spare IVF embryos in India, within the confines of a clinical space, where
in line with the prevailing practice in other tactical alliances are formed between select

50
family members and clinicians to keep family cell lines was fostered by two international
forming as close to kin blood as possible. agreements, Convention on Biological
Diversity and GATT, TRIPS Agreement, now
The question arises as to why the Indian the WTA3. These international agreements
state is inserting the market and contractual were made legally binding in 1993 and 1994
commercial transactions into a domestic and led to the globalisation of intellectual
moral economy of exchange and kin relations. property laws. This meant that individuals
In many instances, intra-familial exchanges who donate their own body parts for research
are modern ways of doing tradition; purposes, do not retain property rights over
negotiating with patriarchal, gendered and certain materials nor can they participate in any
religious injunctions while conforming to profit that may result from the manipulation
the pro-natalist imperative. The neo-liberal of these materials. Lock describes a case where
state in India is however seeking to outlaw the US government made a patent claim on
these practices for reasons far more complex a cell line created out of blood taken from a
than mere social reform and protection of 26 year old Guaymi woman suffering from
women from the excessive demands made leukemia. Similar patent claims were made on
by the patriarchal, ideological order. On the cell lines obtained from several Hagahai and
contrary, the new laws hold the potential to New Guinea and native Solomon Islanders.
create a body of medicalised, childless citizens The Hagahai reportedly agreed to blood
that can be both harnessed and garnered for donation subsequent to the creation of cell
extracting embryos, gametes, etc. to fuel lines and their patenting, on the condition
the burgeoning global moral economy in that individuals claiming Hagahai ethnicity
stem cell creation. By putting in place strict would share half of any resulting profits from
informed consent procedures, instituting a vaccine or any other bio-product. However,
a further national ethics committee and all patent claims on Hagahai and Solomon
ensuring the provenance of any potential lines Islanders were eventually dropped as the
accruing from human embryos, the Indian resultant stem lines were deemed unprofitable
state is seeking to isolate the ethical sources of to pharmaceutical business. The above cases
producing raw material. These ethical sources provide a useful point of departure to better
are imagined as fully informed, rational and contextualise the emerging bio-politics
autonomous consumers seemingly liberated of embryonic stem cells in India in which
by the market from the fetters of out-moded infertile citizens and their bio-genetic capital
and traditional reliance on familial support are being invested with a promise of future
for assisting life. These autonomous citizens returns.
can now be enjoined to sacrifice their bio-
genetic spare embryos with the encrypted The ICMR guidelines on stem cell research
provenance in the service of a neo India. declare that research on stem cell lines and
their application may have considerable
Margaret Lock explains how the procurement value, and that appropriate intellectual
of human material to make immortalised property rights protection may be considered

3
 e World Trade Agreement (WTA) is a multilateral trade agreement consisting of a number of specific agreements on various
Th
issues relating to trade. The present agreement is the result of a series of negotiations during the period 1986 to 1994 as part of the
Uruguay round of GATT negotiations. TRIPS was negotiated at the end of the Uruguay Round of the General Agreement on Tariffs
and Trade (GATT) in 1994. Its inclusion was the culmination of a program of intense lobbying by the United States, supported by
the European Union, Japan and other developed nations. (http://www.vuatkerala.org/static/eng/wta/wta/structwta.htm and http://
en.wikipedia.org/wiki/Agreement_on_Trade-Related_Aspects_of_Intellectual_Property_Rights)

51
on the merits of each case. If these rights a disturbing, new, emerging trend for all
are commercially exploited, a proportion of classes of people. There is a new modality
benefit shall be ploughed into the community of offering IVF treatment emerging in
that has directly or indirectly contributed India - ‘spare IVF cycles for spare embryos’.
to the IPR. Community here includes all Often working class people from small
potential beneficiaries such as patient groups, towns and villages are made offers of free
research groups, etc. which is an interesting IVF cycles if they agree that spare embryos
point of departure. will be created or spare oocytes will be used
for human embryonic stem cell research.
Though seemingly far-sighted, there is However, in its desperate hurry to get into
a morality of another kind at work in an ethical embrace with the Euro-American
the economic calculation of the Indian benchmark of what an ethical practice
state, namely, how might the informed might look like, the Indian state has done a
citizen be enrolled in the production of spectacular cut-and-paste job, mostly from
knowledge which is both promissory the HFEA, in their proposed guidelines,
and profitable. The projected benefits where only spare IVF embryos are seen as
are two-fold: first, they offer hope for a legitimate source for human embryonic
cures for a spectrum of disorders and, in stem cell extraction.
that respect, the renunciation of a spare
embryo is a worthwhile investment.
When ‘ethical embryo’ is construed in that
Second, the promises of future returns are
light, it doubly implicates an IVF treatment
made tangible not merely as a therapeutic
seeker in very straightforward ways. On the
breakthrough, but by building commercial
one hand, these women are trying to escape
and economic stakes into the gift itself. The
unbelievable social ostracism and stigma –
contract with the state through consent
is predicated on the creation of a citizen a lot of them are in these clinics with very
imbued with the will to choose morality profound stories of suffering and complete
and profitability, as opposed to donate and utter social delegitimation. In such a
with the hope of alleviating suffering. Thus, context, the citizen is somehow enjoined to
there seems to be a fundamental shift here come up with a free and informed choice
from being altruistic to being commercial. regarding whether she would like her embryo
Nevertheless, despite the official interest to be used for stem cell research! Globally,
in IPR and profit-sharing, it would not be such a donation is repackaged as ethical,
at all surprising if in making a transition informed and consented and becomes the
from knowledge to practice, from science ethical basis for an embryonic stem line
to commerce, the IPR issue is dropped whose provenance is squeaky clean and
altogether, as logistically, commercially ethically audited.
and economically untenable, especially as
more private capital (as opposed to state To conclude, the Indian state is involved in a
investment) flows into bio-technologies. collusion with infertility clinics to an extent
that is making access to human embryos
The question is: why is this problematic that much easier and more straightforward.
and why does it have potential for more Of course, there are larger global politics
trouble than it is worth? Predominantly behind these laws, which are not so much for
because human embryonic stem cell the protection of human subjects but for the
research in India as a private initiative is protection of commercial interests.

52
Coordinators’ Comments these value and supply chains, and where
do we focus our collaborative research
Betsy Hartmann efforts?
• IVF camps bear a striking similarity with
sterilisation camps and are a reminder Discussion Points
that the parallels and intersections of
population control and ARTs have to be • Although there is a suspicion that poor
assessed strategically; both in terms of Bangladeshi women are being taken, even
success and failures, in different contexts trafficked, into India for surrogacy, there
as well as internationally. We should is as yet inconclusive information on this
draw on our history as the international front.
women’s health movement in fighting
population control. In the neo-liberal • One of our strategies has to be the critique
economic context of today, the basic of text books for medical students,
issues of informed consent, safety risks, especially forensic medicine. The ideas of
etc. are being articulated again. citizenship, ownership, body parts, etc.
have to be examined closely here. Further,
• The range of clinics and the variety of their there is no reliable public information
clientele is a new characteristic. This raises on the health risks of pesticides, GM
issues of research and experimentation on foods, or ARTs. There is a risk of ovarian
women’s bodies, especially the use of spare cancer (after repeated fertility treatment),
IVF embryos for stem cell technology. multiple gestation, miscarriage, tubal
We need to call attention to the nature of pregnancies and their recurrence; all of
‘experiment’ at multiple levels. which need to be highlighted, especially
for informed consent. We must not repeat
• Even if we cannot aim for accurate
our mistake in the general health sector,
registry, we need to be clear what kind of
wherein neglect of the public sector leads
transparency we are looking for.
people to the private sector.
• There is a need to draw trans-nationally
on movements that have critiqued and • The attempt to control the seed– be
changed international agreements for it in the plant or in the womb– has
regulation. to be challenged. Yet we cannot lose
sight of the real causative factors of
Padmini Swaminathan infertility. Infertility has to be seen both,
as a psychological state as well as a real
• While examining the ART industry, the condition. The fertility industry is up
perspective of its ‘demand’ side also needs and running because it is more demand-
to be taken into account. driven than supply-pushed. Women
• We need to understand how the ART turn to these technologies to ensure their
industry is located within population survival within patriarchy. Is it our job
control, and the dynamics that have to tell these women that they are living
made South Asia the hub of both, under a Marxist ‘false consciousness’,
overpopulation and infertility. and to then ‘educate and empower’
them? Does that not set up a different
• How do we view and analytically kind of hierarchy? Nonetheless, demand
segregate the different nodes of also cannot translate into a case of ‘out

53
 of the frying pan, into the fire’. Women need to learn from earlier struggles that
should not need to go from quacks to seemed equally implausible at the time,
irresponsible medicine to address their but were necessary and later, successful.
fertility needs. Legislation must be For instance, in Africa, opposition to
put in place to ensure some degree of female genital mutilation was successful
control and responsibility. For instance, a only when it was taken up by African
Karachi clinic is now advertising embryo women themselves, and not when it was
screening, which costs GBP 1000 and proposed by outsiders. Perhaps, there is
has no proven scientific value. It is just a some lesson for us there in our efforts to
gimmick to screen and test embryos for oppose ARTs.
huge sums of money, only to say later that
the embryo is not good enough. • Population control is not only about
numbers. It has eugenics, racism and other
• It is ironical that the Indian state is dimensions built into it, all of which are also
interested in promoting ARTs to create part of ARTs. Reproductive technologies
a larger workforce when it already has are even being promoted in advertisements
one. Perhaps, the point of departure for as a better alternative to natural
the state is not the amount of investment birth; because fathers can be completely
(which is not very high), but the state’s sure of their baby’s paternity in ART
manifesto and the need to lead the world treatment!
in bio-technology. The state wants to align
itself with the global north politically, • On issues of population control and sex-
ethically and ideologically. Former Prime selective abortions, feminists have gladly
Minister AB Vajpayee is on record as functioned against the state. To be able
saying ‘IT is India Tomorrow and BT is to broad-base our campaign, we brought
Bharat Tomorrow’, symbolising this shift in health activists and other groups that
with a slogan that really captures public were questioning the state, but often sharp
imagination. There is an international feminist perspectives and discourses got
moral economy that necessitates the left out. We tend to find commonality
creation of ethically-sourced products as long as we think of women as victims,
for guilt-free, untainted consumption, but we find ourselves at a loss when we
be it fair-trade coffee, child labour- free confront women as agents. The scenario
carpets or consented embryos. Ethics are today is no longer one of male doctors,
now being factored in as necessary costs, male researchers and poor women, but
alongside labour, etc. that must go into really one of women clients, women
the production process, and in this neo- doctors, surrogate women - all apparently
liberal consumption model, we are all happy with the IVF industry. In such a
implicated to a larger or lesser degree. scenario, how do we bring the family into
interrogation- particularly on issues of
• The family needs to be opened up biological motherhood, couples without
for critical scrutiny. The ‘mother’ children, single women and so on.
requirement has not shifted from the
woman. Stories of suffering of infertile • We must recognise the divisions within the
women make us think that maybe they women’s movement, and the co-option
should have access to ethical, regulated, of feminism by international funding
quality ART services. However, there is a agencies. There is a need to honestly

54
assess the outcome of our battle against • Further, in India the high percentage of
unsafe contraceptives. The oppressive sex-selective abortions leads to a rich
conditions under which Depo Provera source of germ cells. There is a need to
was being delivered have changed, but (the look into how aborted foetuses are being
market for) Depo has in fact proliferated. used for stem cell research.
If anything, activist language has been co-
opted and contraceptives are now being • Capitalism is a versatile beast that mutates
promoted as sensitive to culture and at a great speed, and our discourses and
women’s needs. In North America today, responses need to respond at the same
young women do not even see this as an pace. In our language of resistance, should
issue, and instead support Depo Provera we call these technologies ‘Assisted’
and Norplant. reproductive technologies at all?

55
 Global Experiences: Middle East
Coordinators: Malini Bhattacharya and Aditya Bharadwaj

Ova Donation Bill: the Israeli Case • A group of women in Israel who have
come together because of their need for
Hedva Eyal egg donation.

The Ova Donation Bill in Israel is in • Rabbinic authorities, who stress on the
the final process of legislation. It will allow concept of ‘mitzwah’ i.e. the need to
ova donation from donors who are not increase the Jewish population in the
undergoing fertility treatments for the world.
purposes of reproduction and stem cell • The organisation Isha L’Isha feels
research. The proposed legislation is a result this is an opportunity to delink
of the unification of two separate legislative womanhood and motherhood and look
documents: the Ova Donation Legislation, at issues of trafficking. When they began
and the Genetic Interference Prohibition Act looking at the new ova donation Bill it had
(related to Human Cloning). already been through the first hearing.
In Israel, IVF treatments are given free of The main concerns with the Bill include its
cost to citizens until they succeed in having failure to appropriately address the significant
their first child. The public health system health risks involved in the donation
strongly supports fertility treatments, process. It makes provision for basic health
which are considered to be a basic right insurance, which does not cover future health
of women. This creates a situation in complications. It overlooks the economic
which women who are unable to conceive exploitation whereby young, local women are
‘naturally’ are more or less automatically donating eggs.
urged to go in for IVF treatment, without
being given the space to think about the In Israel, egg donors do not necessarily
consequences of the treatments for themselves belong to the lower socio-economic strata
and for donor women. A woman’s decision but are mostly young women, looking for
to not undergo the treatment is considered an alternative means for further improving
highly irregular. their economic status. The proposed Bill
allows for structural conflict of interests
The main actors of the Ova Donation Bill are: between doctors and donor ‘patients’,
• Doctors and researchers, who portray their without considering the implications of such
efforts as those that are for the benefit of conflicts. The Bill overlooks the possibility of
women and declare that women’s groups conflict of interest wherein the same doctor
are anti-progress and anti-science. takes care of a woman who wants treatment,

56
of one who is donating eggs, and of another The next steps for Isha L’Isha include: following
who is donating for stem cell research. the political process of the Bill; investigating
Further, it opens doors for egg trafficking characteristics of local trafficking; action
and egg tourism by allowing donation from research on the different voices among egg
women who are not citizens. (Doctors donation ‘actors’; raising public awareness
maintain that eggs are tissues, and not organs about the connection between organ and
and, therefore, their trade does not amount egg trafficking; carrying out information
to trafficking.) At present, women come campaigns about the procedures and the
into Israel as tourists and go to undisclosed dilemmas of egg donation; engaging with
locations for treatment. religious parties.

In terms of research and informed Globalisation and Gametes: Reproductive

consent, the Bill proposes that 49 per Tourism, Islamic Bioethics and Middle
cent of the donated eggs can be used for Eastern Modernity
stem cell research, ignoring the regulations
with regard to human experimentation. There Marcia Inhorn
is no mention of the need for supervision and
Reproductive tourism has been variously de-
monitoring in the Bill.
fined to reflect the traveling of people from
one jurisdiction or country to another, to ob-
Isha L’Isha is faced with a number of
tain the kind of reproductive help they desire.
challenges in addressing the concerns with the
It is part of the larger phenomenon of medical
Bill. For one, it is facing ideological isolation
tourism. There are several factors promoting
since no other women’s organisation has
reproductive tourism:
joined it in this effort. There is a fear among
women’s organisations that raising this issue • The prohibition on the use of services
will be seen as working against women who in one country for religious or ethical
are in need of donated eggs in order to have reasons;
children. Further, there is a complete absence • The unavailability of expertise, equipment,
of the rights discourse and a reluctance to or donor gametes in one region;
talk about it since discussions have been
dominated by doctors. • The lack of a service because it is not
considered sufficiently safe or because its
An overriding contextual challenge also exists risks are unknown;
– one cannot come out in the open in Israel • Certain categories of individuals may not
and say that all women may not want to have receive a specific service on the basis of
children! age, marital status, or sexual orientation;
• Services operate on a market or quasi-
However, in the last two years, Isha L’Isha has market basis, thus affecting affordability
become an expert on this legislation, issuing and supply;
an extensive research report that had high
demand from policy makers and the public. It • Services may be cheaper in other
has been an integral part of all parliamentary countries;
meetings on the subject and has managed to • Privacy concerns.
involve many organisations and researchers,
thus forwarding its feminist perspective on the Globalisation can be defined briefly as
issue into mainstream political discussions. the development of ‘ever faster and ever

57
denser’ networks and streams around the that make up everyday experience. Fatwas4
world. Globalisation theorists understand issued by different clerics represent the moral/
globalisation through lenses such as global religious-authoritative position on ART. In
‘scapes’, assemblages, frictions and shadows. Sunni Islam, IVF is permitted provided the
Arjun Appadurai categorises ‘scapes’ as eggs and sperm used are the couple’s, and
ethnoscapes, technoscapes, financescapes, the fertilised embryo is transferred back to
mediascapes and ideoscapes. Additional the uterus of the wife. Third party donation
categories can be proposed which are of of any kind (including surrogacy) is not
concern to medical anthropology and global allowed. IOMS (Islamic Organisation for
health: bioscapes (pathogens, vectors), Medical Sciences), in 1997 issued a landmark
somatoscapes (gametes, organs, body parts), declaration that has put this ban in place in the
toxiscapes (pollutants, chemical substances), Sunni world. Many Muslim countries prohibit
pharmacoscapes (medications, illegal drugs), sperm donation (1997 global survey). Since
foodscapes (junk foods, McDonald’s), children from the same donor may meet and
lifescapes (sedentarism, addictions) and now, marry at some point, therefore, it amounts
reproscapes which are also linked to other to adultery and incest. It confuses kinship,
scapes: paternity, descent and inheritance. Since
the preservation of the ‘origin’ of each child
• Circulating reproductive technologies
is considered a moral imperative, as such,
(technoscapes);
third-party donation would destroy a child’s
• Circulating reproductive actors lineage. It implies a ‘mixture of relations’ and
(ethnoscapes); that a ‘stranger enters the family’. A child
born out of donation is called ibn haram
• Circulating body parts (somatoscapes);
(son of sin) and walad zina (child of rape).
• Large-scale global IVF industry Adoption in the Muslim world faces cultural
(financescapes); and legal prohibitions. However, a few Sunni
Muslim IVF patients are willing to go ‘against
• Images of making babies ‘on holiday’
religion’ and adopt.
(mediascapes);
• Ideas of test-tube babies (ideoscapes) Shia Islam’s highest religious authority, Sistani,
too opposes donation for reproduction.
The ART industry is booming in the Middle Ayatollah Ali Khamanei, however, has issued
East although it is not spoken about in the a fatwa that allows the acceptance of donor
Islamic Sciences. There are new forms of ARTs gametes (both egg and sperm). Both the donor
which are being made available: ICSI, third- and infertile parents must abide by religious
party gamete donation and surrogacy, multi- codes governing parenting and the donor
fetal pregnancy reduction, ooplasm transfer, child can only inherit from the donor. The
cryopreservation of unused embryos, PGD, infertile parents have the status of adoptive
embryonic stem cell research, and human parents.
cloning.
There are some points of disagreements
The notion of ‘local moral worlds’ can be used between those following the Ijtihad5 and those
to understand the commitments and stakes who abide by Shia prescriptions: whether

4
 fatwa is an Islamic religious ruling, issued by a recognised religious authority in Islam. (http://islam.about.com/od/law/g/fatwa.
A
htm)
5
Ijtihad is a technical term of Islamic law that describes the process of making a legal decision by independent interpretation of legal
sources, the Qur'an and the Sunnah (http://www.answers.com/topic/ijtihad).

58
third-party donation constitutes zina, or of donor babies to devout Muslim couples,
adultery (if there is no touch or gaze), whether reconsideration of biological kinship and social
the child follows the name of the infertile parenthood, weakening of the Sunni Muslim
father or the sperm donor, whether donation ban on third-party donation, Shia gametes
is permissible if donors are anonymous, and entering Sunni bodies, despite the supposed
whether the husband of an infertile woman rift, and a Middle Eastern modernity, despite
needs to do a mut’a marriage6, or temporary the purported ‘medieval theocracies’.
marriage, with an egg donor and whether
a married Shia woman can have a mut’a In conclusion, the notion of modernity
marriage with the sperm donor. In theory, is central to the understanding of ARTs,
only widowed or single women should wherein ARTs are held up, in countries like
accept donor sperm, but single motherhood Iran and Lebanon, as proof of modernity.
of a donor child is socially unacceptable. Despite its reputation as a backward medieval
Iran has recently made sperm donation theocracy run by Ayatollahs, Iran is in fact
illegal, but the route of temporary divorce charging ahead in fields like ARTs, donation,
continues to be used. vasectomy, nuclear energy, surrogacy,
transgender surgery, etc. ART clinics are thus,
In practice, Shia gamete donation is occurring used as a signifier of modernity.
in Shia majority areas like Iran and Lebanon.
It is considered a gesture of ‘marriage saviour’;
Discussion Points
helping to avoid ‘marital and psychological
disputes’. • Nationalism may be a part of the picture
with ARTs in Israel, but it is not the only
Where egg donation is taking place, the reason. Every citizen in Israel has the right
sources are other IVF patients, friends or to IVF, Jewish or Palestinian. In reality
relatives, anonymous donors, including of course, there is differential access, for
American women who travel to Lebanon to instance, there aren’t enough IVF clinics
anonymously donate eggs. The recipients in Palestinian areas. Jewish leaders would
are Shia Muslim couples (including from want more Jewish children even if they
the Hezbollah7) and Sunni Muslims who are were in Eastern Europe. For egg donation
‘reproductive tourists’. Sunni reproductive from Eastern Europe, religious men
tourism is conducted in the secrecy of a accompany the couples and claim that the
‘holiday’, maintaining the anonymity and women who donate eggs do so because
confidentiality of the ‘tourists’ as well as they really ‘care’ about the suffering of
phenotypic similarity. Sunni Gulf Arabs are other women. This also involves a process
known to travel to Tehran. of ‘becoming Jewish’.

The current Middle Eastern reproscape • As an organisation, Isha L’Isha does

is thus characterised by: significant medical not choose the actors it works with,
trans-nationalism and reproductive tourism, they are already there! Of course
mixing of gametes across national, ethnic, coalitions are problematic and have
racial and religious lines, birth of hundreds their limitations. We have to be very

6
 ut’a marriage is a fixed term contractual marriage in Shia Islam (source: http://en.wikipedia.org/wiki/Muta_marriage).
M
7
Hezbollah is a Shia Islamist political and paramilitary organisation based in Lebanon. Hezbollah is now a major provider of social
services, and a significant force in Lebanese politics (source: http://en.wikipedia.org/wiki/Hezbollah)

59
 careful when we work with rabbis. reaction to these technologies is negative.
We have faced similar problems in the However, the documented experiences of
past – in a coalition against pornography hundreds of infertile couples, who desire
that Isha L’Isha did not want to be a part children for the joy of having a baby, point
of, because participating rabbis included to the need to examine the implications of
kissing on TV, gay couples, etc. in their the restrictions imposed by, for instance,
definition of pornography! Egypt not allowing gamete donation
and forcing women to travel to Beirut.
• Although religious leaders are also Should we at all use value-loaded words
known to conveniently ask couples to like conservative, liberal, progressive,
have more children in the supposed traditional? Not all of ARTs are ‘bad’ and
interest of their religion or race, the not all of it is undesirable; it needs more
relationship between religion and ARTs control.
is complex. On the one hand, when
religious leaders do not allow ARTs, it is • The state is intervening in Egypt by
considered a suppression of individual trying to provide these services for the
choice with a geneticisation outlook. poor through state subsidized clinics,
On the other hand, when religious given that only the rich and the middle
leaders allow ARTs, it is seen as a victory class have access to what is being seen
of commercial interests over strong as a ‘reproductive right’. Israel has the
religious and cultural norms. Therefore, most generous subsidies in the world.
we are treading a thin line with religion, This is another feminist question: is it a
and the motivation behind allowing reproductive right for the poor to have
ARTs – whether it is a ‘liberal’ outlook or access to ARTs? Infertility in Sub-Saharan
commercialisation – is not clear. In their Africa is amongst the highest in the world,
desperation and desire for a child, couples and women from there have articulated
have been known to agree to gamete their demand for this technology that
donation and artificial insemination people everywhere else in the world are
despite religious prohibitions and laws. accessing. In such circumstances, it is
very hard to say whose agency, freedom
• In the Middle-Eastern world, states and rights are being denied.
are powerful as police states, but in
the bioethical world or the world of • In general, there are no laws relating to
medicine, they are incredibly weak. In ARTs in the Middle East. The United
the wealthy parts of the Arab Gulf, there Arab Emirates is working towards the
are so called ‘angel investors’ – sheikhs first law on ARTs in the region, which
who may be interested in infertility and has been passed. However, religious law
become patrons for clinics, which they is what is influencing the reproscape in
fund. States don’t regulate or legislate, the Middle East. Feminist groups have
and what is evident is a rather remarkable not taken up ARTs as an issue, and have
power of religion. Since the 1980s, the focused on other issues like female genital
ban on third party reproduction has held. cutting, honour killings and so on.
The few people who did bypass this ban,
did so by going out of the country. We are • Mut’a marriages are stigmatised, and were
definitely walking a thin line of judgment invoked after the Iran-Iraq war when
on religion. As feminists, our knee-jerk there were many male deaths, as a way for

60
 widows to get support through temporary in once the trafficking of eggs becomes
marriages. This has morphed into a sort as big a problem as the trafficking of
of prostitution now, though ART clinics women!
are now invoking it. There are mixed
responses to whether Mut’a marriages • In the Israeli Bill, the percentage of
are necessary for gamete donation to be eggs that go into research is probably
acceptable. ‘only’ 49%, because they didn’t want to
be greedy! This bill has tried to connect
• While Lebanon has had many war the so called ‘needs’ of research and of
orphans, long term guardianship women. After much discussion, it was
prevails and orphanages are run by Shia reduced to 20% or 2 eggs, whichever is
charities because of the prevention of lesser. Further, while the Israeli legislation
legal adoption. Therefore, people do allows lesbian couples to use their eggs
give money, but the idea of raising an and have babies, it does not help gay men.
orphan in your home is very uncommon Gay Israeli couples are buying eggs from
and is not considered a good option Israeli or American women and coming
by the Shias as well as the Sunnis. to India for surrogacy through agencies.
This further complicates the This has been documented in the film
problem of infertility. While adopting Google Baby.
orphans is not a problem in Israel,
there is a larger problem of adoption • The focus of Isha L’Isha’s campaign
because there aren’t many infants is to give information. Women can not
to adopt. be told not to donate eggs because it is
risky twenty years from now. They have
• Women are not at the centre of IVF in to be given material to think about; not
Israel. The doctors in their ‘generosity’ just about the procedure and the side
don’t even wait one year to begin infertility effects, but also on questions like – how
treatment. This is medicalisation of do we feel about some children around
women’s bodies, motivated by the the world not knowing about their
money in this business. Most women’s parents; what if you cannot have a child
organisations in Israel do not want to later (for whatever reason) and you know
take up the issue of the Bill, because it is there may be children from your egg
becoming a scenario where women are donation somewhere; how about not
up against other women. Moreover other being ‘anonymous’ and instead being a
problems like the occupation, economy, ‘new’ kind of family?
etc. are on their agenda. Further, Israel
is not a ‘third world country’, so no • One way to limit trafficking would be
foundation is willing to fund work on through laws in our different countries
these issues. Perhaps the money will come against fertility tourism.

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Global Experiences: US, Canada and the Netherlands
Coordinators: Amar Jesani and Sarah Hodges

Commercialisation of Reproductive and Europeans going to Eastern Europe or India

Genetic Technologies: What Lessons where costs are lower. But the US is also a
for Biotech Developments around the destination, with people with enough money
Globe? coming in to avoid regulations in their own
countries. In fact, the US has cornered the
Marcy Darnovsky global market on so-called ‘high end’ eggs
The US fertility industry is a lucrative and because unlike many other countries, there
ever-expanding business, operating with are no limits on compensation to young
very little by way of public regulation or women who provide their eggs. In campus
oversight. While most of the programmes newspapers, advertisements seeking eggs for
are concentrated in the private sector, few enormous amounts of money ($20-100,000)
are also operated by public universities. are routine. Since the onset of the financial
The industry has become highly competitive, and economic crisis, there has been a surge in
with estimated yearly revenues of US $ 3-5 the number of women applying to sell their
billion from more than 400 ART programmes, eggs or serve as surrogates.
seeking to attract customers who often have
no insurance coverage and pay for fertility Assisted reproduction is a political hot
treatments out-of-pocket. potato in the US, in large part because of
the continuing and deeply partisan struggle
Some fertility firms are now merging, or over abortion rights. As a result, there is little
opening branches in multiple cities. There public policy that directly addresses ARTs,
is a search for new marketing strategies like and the policies that exist in different states
money-back guarantees, discounts and special vary widely.
offers – prospective customers being lured to
an information session by offering a lottery The only federal law is the 1992 Fertility Clinic
for free donor eggs, etc. New market niches Success Rate and Certification Act. Beyond
are also being sought out, including people the CDC data, there are no federal mandates
who are not infertile in any medical sense, but to report or to study the outcomes of ARTs
who might be willing to pay for procedures for women or children; nor is there a federal
like sperm sorting for sex selection, and egg law addressing PGD, sex selection, sale of
freezing as a backup plan for women who gametes, surrogacy, reproductive cloning, or
want to postpone childbearing. inheritable genetic modification.

The term ‘reproductive tourism’ generally Food and Drug Administration (FDA)
conjures images of North Americans and regulates some of the drugs and devices used

67
in ARTs, but not ART practice per se. It is also openly violated, including those on social
mandated to look only at safety and efficacy, sex selection, compensation to third-party
not at other social consequences. egg providers, and numbers of embryos
transferred. According to CDC data, the
The state regulation that exists is a patchwork recommendation for the number of embryos
of very divergent laws. Fourteen out of the transferred is not followed by about 45% of
50 states have regulation of some sort about the clinics, and in California, this figure is as
insurance coverage for fertility treatment. high as 82%.
A few require that sperm and egg providers
be medically screened or specify who has The concerns of CGS came not directly
parental rights in the case of third-party out of work in women’s health, but out of
involvements. A few address compensation recognition that an advocacy campaign was
for eggs or surrogacy, which also vary widely. being run by a number of influential scientists
Louisiana bans the sale of eggs. California in favour of Inheritable Genetic Modification
law prohibits reimbursement beyond direct (IGM) and a new market based eugenics in
expenses for acquisition of eggs for SCNT the late 1990s and early 2000s. A key event
(Somatic Cell Nuclear Transfer). Some states was a conference held at UCLA (University of
void surrogacy contracts and some states are California at Los Angeles), called Engineering
known as surrogacy friendly. the Human Germ Line, organised by Nobel
scientists among others, who described this
There are now new battlegrounds because
event as their effort to win the acceptance of
right wing forces have been introducing (in
the American public for a new eugenic vision.
the states and at the federal level) bills to
CGS emerged in the context of a civil society
prohibit sex selective abortions. This is a bold
deficit in the face of the techno-utopian vision
attempt to co-opt some of the concerns that
of ‘designer babies’ through reproductive and
have been raised by feminist and women’s
genetic technologies.
health groups, and use it to chip away at
abortion rights.
From the beginning of its work, CGS saw
Courts have established a lot of the on-the- that these issues are necessarily global
ground policy in the United States. The most ones and that there will have to be
common litigation related to ARTs arises out international organising and agreements
of disputes about the custody or disposition on a few fundamentals like prohibition of
of stored embryos. There are also some high- the most socially dangerous applications
profile surrogacy cases. of reproductive and genetic technologies,
especially IGM and also reproductive
There are ethical guidelines issued by the cloning. For some audiences at least, it
practice and ethics committees of the is very powerful to point out that there
industry organisation, American Society is an emerging ‘international consensus
for Reproductive Medicine (ASRM). These against repro cloning and IGM’, that these
focus on safety, efficacy and privacy for applications have been prohibited by around
ART patients and address topics including four dozen countries and are addressed in
advertising, informed consent, disposal of Europe under the rubric of human rights and
abandoned embryos, sex selection, payment that there is strong sentiment internationally
levels for eggs and number of embryos against social sex selection, the use of
transferred. Compliance is entirely voluntary, embryo screening for cosmetic traits, and an
and many of the guidelines are widely and unrestricted market in eggs and wombs.

68
Some of the work CGS has done has been meeting. One result was that CGS was able
with women’s health and reproductive rights to secure funding to begin a programme on
groups. It was clear from the start that these Gender and Justice that focused intensively
technologies were already putting special on outreach to reproductive rights and
burdens on women, and that reproductive justice groups, LGBTQ, disability rights
rights and women’s health groups would be groups and racial justice organisations -
key constituencies in our work, along with through workshops, briefings, round table
disability rights, LGBT and racial justice discussions.
groups.
In 2007, the Gender and Justice Program
Unfortunately, reproductive rights became an independent organisation called
organisations in the US have not been natural Generations Ahead, whose initial aim
allies in these efforts. The ongoing attacks on was to put together a cross-constituency
abortion rights, especially during the Bush coalition focused on reproductive and
presidency, has pushed many mainstream genetic technologies. Unfortunately, due to
feminists further into what is called the deep funding cuts, they have had to cut back
‘choice trap’ – the libertarian position in those plans and are focusing this year on sex
which individual autonomy trumps social selective abortions in the US.
justice or the common good, for which
there doesn’t seem to be a counter political As a direct outcome of the meeting, a handful
vocabulary. In 2002, the Planned Parenthood of the participants began to focus on a measure
Federation of America (one of the largest on the November 2004 California ballot, the
national reproductive rights groups and California stem cell initiative8 that allocated
abortion providers) came very close to taking US $ 3 billion of public money to embryonic
an official organisational position in support stem cell research and research cloning based
of reproductive cloning as an extension of stem cell research. The CGS, along with a few
women’s right to choose. In a strategy to tackle other organisations like the California Nurses
the frosty reception from reproductive rights Association (labour organisation with about
groups, together with Our Bodies Ourselves 75,000 members), opposed the initiative,
(OBOS) and the Committee on Women, even though at the time, embryonic stem cell
Population and the Environment – some of the research had become a cause célèbre among
few feminist organisations to take these issues American liberals and progressives. It was a
on in a critical way – a meeting titled ‘Gender difficult position to be in, and the measure
and Justice in the Gene Age’ was organised in was sure to win; with its promises of cures by
the spring of 2004. Of the 65 people who were Christmas and the US $ 35 million spent on
invited, many were from women of colour its campaign and so on. But support for the
organisations developing a ‘reproductive measure fell from 70 per cent to 59 per cent, at
justice’ framework that was meant to address least in part, because of our efforts. Through
some of the other shortcomings of the choice this, we formed a small but important group
approach. This turned out to be a landmark called the Pro-Choice Alliance (PCA) against

8
 is measure established the California Institute for Regenerative Medicine to disperse the funds, set up a governing board dominated
Th
by the biotech industry and the research institutes that would be the recipients of public money, and exempted the agency from
state laws requiring open meetings and limiting conflicts of interest. In fact, the text of the measure included the provision that its
‘activities shall be exempt from any current and future state laws’. The one limitation the measure did contain was a prohibition
on payments for eggs for research that was there in the law – a provision that the authors of the measure soon regretted, and some
researchers tried repeatedly to undo.

69
Proposition 71, to show that there was a pro- justice, equality and the common good must
choice voice that was critical of this enterprise, be recalled.
not because of opposition to embryonic stem
cell research, but because this was poor use At this point, CGS is focusing on an annual
of public money, given other health care and meeting of people who are concerned about
research priorities, and the risk to women of these technologies. This was a decision that
egg extraction for cloning-based research. came out of a series of strategy meetings held
in 2008 in 6 cities, and out of the realisation
In the course of its work, the Pro-Choice that there are many people in the country
Alliance confronted strategic dilemmas working on overlapping concerns with regard
that continue to exist. For one, do you to these technologies who don’t even know
work with the right-wing? The main voice each other. We have been fortunate enough
against embryonic stem cell research was to get a minimal funding commitment to
the Catholic Church and other right wing hold an annual meeting for the next three
religious organisations, which reached out years, starting July, in Tarrytown, New York.
and wanted to work together. Although we The Tarrytown Meetings will bring together
decided not to, there were a couple of people scholars, civil society leaders, policy experts
in the pro-choice alliance who felt that they and others to try and find a way forward. We
were more willing to bracket the question hope to emulate what this meeting is doing
of abortion rights and work with right wing in terms of bringing rich detail to the on-
groups. Further, once the stem cell agency is the-ground activity, in the context of larger
established, there is the question of whether theoretical and political issues.
we should put pressure (through meetings,
letters) to reform some of their policies and Closing the Barn Door after the Horse
mitigate some of the bigger problems in the has Bolted: Canadian Experience
bill. The majority of the people in the Pro- with Regulating Assisted Human
Choice Alliance, including the CGS, decided Reproduction
to do that, and we have had some successes.
Some other women in the alliance felt this Shree Mulay
was a mistake that it was legitimising an
illegitimate institution. Therefore, they Canada has the distinction of many
formed Hands Off Our Ovaries and worked firsts. First, it has the largest coalition
with college students. Now in fact, we are of women’s organisations (over 500) to
coming together again to work. have lobbied for new reproductive
technologies’ legislation. The coalition
To be clear about not working with anti- includes trade unions, women’s committees,
abortion groups does not solve all problems women’s shelter workers, feminist
about who to work with. The question of community-based organisations and
just how big a tent do we need has been an women’s studies groups. Secondly, this
ongoing one. Similar to the situation described led to the establishment of the most
in Israel, we are also often accused of being expensive Royal Commission ($29 million)
anti-science and anti-progress! In the United on the study of New Reproductive
States, it is important to bring the message Technologies (NRTs). Thirdly, it has the
to progressives that the kind of neo-liberal distinction of being the country that took the
and libertarian temptations faced today need longest time from the creation of a report to
to be resisted, and commitments to social passage of legislation.

70
The NAC (National Action Committee)9, outspokenness. This was the only inside
along with many groups have consistently track that the advocacy groups had that
raised the question of why the government was also lost when these two women were
was permitting the proliferation of IVF fired.
clinics without conducting a larger debate
on the social, moral, ethical, and health Nonetheless, research into the use of
impact of these technologies on society. technologies ranging from ultrasound to
The conservative government’s response IVF and ICSI were examined and a final
was to set up a Royal Commission on New report of 1,275 pages, and two-volumes
Reproductive Technologies (NRTs) to receive with 293 recommendations was submitted.
‘advice’. The lengthy process meant that IVF The report entitled ‘Proceed with care’
clinics could carry on business as usual and banned some procedures altogether, like
introduce procedures quickly so that they making of inter-species chimeras, germ
were well established. line modification, sex selection for non-
medical purposes, payment for gametes,
Social movements like the NAC have had to etc. It proposed regulating other areas –
face many challenges: criteria for clinic license, number of eggs to
be implanted, etc.
• They had to mobilise and do consciousness-
raising at the grassroots level and at the The report gathered dust until the Liberal
same time interact with political power government came to power in 1995 and
structures to influence policy-making. the health minister introduced a Bill. This
• In the area of NRTs, the NAC delegated Bill had many flaws and was opposed by
responsibility to feminist ‘experts’ the right wing as well as progressive groups
to develop policy recommendations. albeit for different reasons. The Bill died on
They, nevertheless, did not have full the order paper when the parliament was
consultations. Very often grassroots dissolved.
organisations were left out and their
opinions not considered. A second Bill was introduced with many
revisions prepared in consultation with the
• Furthermore, NRTs were not the only advisory committee, but women’s groups
issue on the table. Access to abortion, were completely shut out with possibly one
childcare, minimum wages, and violence or two feminists on the advisory board who
against women were also issues to be were in a minority. Ten years after the Royal
tackled. Diversity and representation of Commission report, the Bill was finally
immigrants, and women of colour also passed in 2003 and became an Act in 2004.
occupied the internal political debates, By this time the Conservatives were back in
which at times were very contentious. power, this time led by Stephen Harper, who
was not only fiscally conservative but also
• Work by volunteer boards meant that
socially right-wing. The board of the agency
there was not sufficient time to develop a
Assisted Human Reproduction Agency of
consensus on all aspects of NRTs.
Canada (AHRAC) was hand-picked to make
• The Royal Commission fired two sure that no one had connections with the
feminist commissioners because of their grassroots movement.

9
The National Action Committee on the Status of Women is a Canadian feminist organisation.

71
Current scenario: • The widespread marketing of very costly
reproductive technologies and the burning
• In the intervening years from the Royal desire to be birth parents drives couples
Commission report to now (1993- to take risks which they would hesitate to
2009) ARTs have proliferated and some take in other matters. However, ‘caveat
things are being revisited (chimeras, for emptor’ (buyer beware) underscores
instance). the need for reliable information about
services and this needs to be made
• The AHRAC jurisdiction has been available in an easily understandable
challenged in two provinces. In Quebec, way.
the French national identity has been • Some countries have moved forward on
asserted to say that health is a provincial storage and disposal of frozen embryos
matter and the federal government and the circumstances under which they
has no right to decide what services may be used for stem-cell research, but
will be offered and how it will be paid a large majority of countries – the net
for. In Ontario, Prof Amir Attaran has exporters of CBRS – do not have clear
filed a human rights case stating that guidelines on these matters. These need
the AHRAC regulations discriminate to be addressed internationally.
because treatment is not covered by
public health care. We expect more • A matter of considerable concern is the
trafficking in oocytes and embryos for IVF
challenges to follow. The conservative
and research purposes. An international
government would be only too happy to
legal framework is needed to regulate and
use these challenges as an excuse to scrap to ensure that women are not exploited as
the agency if it can. a source of oocytes and embryos.
• In terms of public health initiatives on Areas for further study and research:
infertility in Canada, nothing is being
done! • The ICMART (International Committee
for Monitoring Assisted Reproductive
Suggestions: Technologies) has reported on the number
of IVF cycles and live births from data
• Since reproductive services are collected from 49 countries. However,
offered across national borders, it there needs to be specific monitoring of
is not sufficient to have a strong ART services in general, and the outcome
national regulatory framework. of multiple and ICSI pregnancies.
Rather, there is a need to harmonise
• Evaluation of IVF procedures, their
and regulate the trade in Cross
appropriateness and their psychosocial
Border Reproductive Services (CBRS)
impact on women serving as surrogates.
for the protection of the users to
ensure that the domestic health care • Cultural aspects of delivery of IVF and
system is not over-stretched as a result surrogacy services need to be studied to
of use of CBRS. Consumer protection develop a better understanding of their
laws for CBRS and other health-related long-term impact on society.
services are needed at the international
level. In this context, international • If we want to work for a paradigm shift
agreements on CBRS as a part of GATS in ARTs, we have to: assess our successes
are worth exploring. and failures in campaigns to eliminate and

72
 reduce harm from unsafe contraceptives; for ‘making babies’ and business was brisk.
use what we learn to develop a campaign Its promotion tagline was: ‘Sometimes nature
that can reach a wide range of women needs a helping hand; give yourself the best
in newer forms (social networks, blogs, chance.’
websites), in addition to materials for
women who do not have access to There were a range of service providers
these, especially for rural women; decide and businesses that had set up shop
on how we will interact with the state. It at the Fertility Show, like Chelsea &
is not a uniform monolithic with a well- Westminster Assisted Conception Unit, a
formed legislation agenda in any area. business that calls itself ‘Fertility Astrology’
They, whosoever ‘they’ may be, are first and claims to be able to assess the quality
and foremost subject to social forces and of your eggs by mapping your stars and
pressures. Innermost Secrets that encourages younger
women to check their fertility levels before it
Although feminists have had an uneasy is too late.
relationship with the state, yet the baby
steps that have been taken – whether A concept that needs examination in the
they are in the field of equity in wages, current scenario of the fertility market is
recognition of violence against women of ‘biocrossing’. A term coined by Aditya
and laws to prevent this, gun control – Bharadwaj, it is defined as ‘a crossing'
have happened with effective lobbying at between biology and machine, and across
federal and provincial levels. geo-political, commercial, ethical and moral
borders. Assisting conception has become
Bio-crossings and the Global Fertility
a thriving business globally and includes
Market crossing national borders. Clinics in Southern
European countries such as Spain, Crete,
Jyotsna Agnihotri Gupta Cyprus, offer ‘IVF holidays’ to relatively
wealthy North European couples seeking
Some of the striking features of the fertility assisted reproduction services, who have not
sector are the entrenchment of technology, been able to obtain the treatment in their
premium on the concept of motherhood, home countries, either due to legal or financial
viewing women as co-producers, and absence barriers or long waiting periods. Fertility
of self-regulation by the industry or by other clinics in the Ukraine and other countries of
agencies. A new vocabulary is emerging the former Soviet Union recruit young East
around fertility services – ‘Thinking of European women and send them to clinics
having a baby?’, ‘Finding it difficult to get in Spain and other locations, like Cyprus and
pregnant?’, ‘Want to know how fertile you Belize, to provide oocytes for North European
are?’, ‘Considering IVF?’ ‘Looking for some couples.
answers?’.
There are many facilitating factors for
A Fertility Show was organised in London this cross-border trade: opening up of the
in November 2009, of which, the Infertility European Union, making trade and travel
Network in the USA was a co-organiser. There within states easier; differences in regulation
were 300 stands at the show offering IVF between countries; easier access to information
holidays, sending people to other European through the Internet; neo-liberal market
countries. It was the first ever trade exhibition ideologies. Cross border trade arrangement

73
could include the recipient visiting the donor’s There are 13 IVF labs in the Netherlands. In
country, or the donor visiting the recipient’s, some regional hospitals, certain procedures
the transport of gametes and embryos, or (barring IVF) related to infertility treatment
medical doctors and researchers visiting the are available (blood tests, ultrasound, HIV and
source of supply of oocytes and the site of hepatitis tests). Every year about 1,500 embryos
financial and regulatory support. are left over after infertility treatment. The
choice is to cryopreserve them, donate them
Of the 20,000-25,000 Europeans who travel for research or destroy them. Most choose the
abroad for fertility treatments each year, 3,000-
last option. A maximum of two (often only
3,500 are from the Netherlands. Of the 43,000
one) embryo may be transferred to prevent
children born every year in the country, 25 per
complications associated with multiple
cent are born to women over 35 years of age.
pregnancies for mother and child(ren).
In 2003, around 7,000 women in the age-
group of 40 to 44 years gave birth to their first
child. Individuals or couples have to bring You can choose between English, Danish
their own donors who they must find within and Lithuanian language options are
their own family, friends, or ask if someone available on the website of the Danish fertility
is willing to be a donor through putting up company, Nordica, which offers oocytes
a call on dedicated websites. Egg donation, through a Spanish clinic. Their website states
however, is rare and accounts for no more – ‘we have a cooperation with a fertility clinic
than 100 pregnancies per year. in Spain. The clinic has a great experience
with egg donation and also offers eggs to
The legal norms governing the country do women with a Scandinavian look. If you
not allow commercial sperm, egg/embryo want egg donation abroad, all consultations,
donation or surrogacy. Egg donation and preliminary examinations and the medical
surrogacy are permitted only with people one treatment take place in the Nordica Fertility
knows (family or friend may act as a surrogate). Clinic. The fertilisation of the egg and the
With the promulgation of the law dealing with transfer of the fertilised egg take place in Spain.
registration of egg, embryo and sperm donors After your homecoming, the after-treatment
within artificial conception, anonymous takes place at Nordica’. In all, there are 10
donation is no more possible. Every donor is Nordica Fertility Centres worldwide. These
registered and every child born through this centres are part of an even larger network
procedure can have access to the donors’ data. of fertility specialists working together with
The data are maintained by the Foundation for Nordica.
Donor Data Artificial Conception, a national
registry of all data regarding egg, embryo and
The overriding issue in accessing fertility
sperm donors. In the case of a child born
services is that of commodification versus
through sperm donation, she/he has the right
self-determination.
to seek information about the donor at the
age of 16 years.
Coordinators’ Comments
The maximum age for accessing IVF is 45
years. There is a demand from the medical Sarah Hodges
community to increase it to 50 years. Lesbian
couples and single women are also eligible While we consider strategies that have
to access the services. Also, advances in the worked in the past, particularly the critical
technology of cryopreservation of eggs raise engagement with population control and
new hopes for women above 40 years. campaigns for safe contraceptives, we also

74
need to ask if the same strategies will work the social vision of gender equality.
here, given the difference in context today. However, there is a lack of political
Reproductive technologies are part of a new vocabulary, even on the American Left, to
neo-liberal world that seeks not to contain address questions of ethics and morals, as
people (in borders and populations) but seeks well as common good and solidarity.
instead, new markets and new material to
commoditise. • Apart from the Convention on Biological
Diversity and TRIPS, there are two other
agreements – GATS and WIPO (World
Discussion Points
Intellectual Property Organisation) – that
• Generations Ahead will focus their work need to be engaged with and critiqued,
this year on sex selective abortions. They especially since they regulate between
will do 3 things firstly, they will work states. An overarching convention is
with South Asian women’s groups since required that can bring in the perspectives
the latest US census shows that amongst of human rights, women’s rights,
certain Asian populations in the US, there CEDAW (Convention on the Elimination
is now a discernible sex ratio difference of all forms of Discrimination Against
because of son preference. Secondly, they Women), etc. There is a need to connect
will also work with fertility professionals international agreements with futures
who are disturbed with the growing sex and the betting on the products of spare
selection in the US. Thirdly, they will embryos. These rely on the disentangling
work with reproductive rights groups of women’s bodies and moving its parts
on opposing the bills that have been put away to a profitable space.
forward against sex selective abortions.
The hope, as a defensive strategy, is that • Is religion bowing down to the call of the
the reproductive rights groups that will market? Religion is always invoked as a
oppose the sex selective abortion bans factor in conversations about the Middle
will oppose them because they are against East and South Asia. We also need to
the attempt to undermine abortion discuss religious groups in America and
rights, without appearing to support sex Europe that have been active on abortion
selection. and stem cell issues, as well as church
organisations that are progressive on the
• The ‘choice trap’ is a ‘libertarian environment and other issues, including
temptation’ that has been strong for a lot the Pope. Efforts have been made in the
of elements on the American Left, and US by groups like the National Council of
for reproductive rights organisations in Churches and more liberal churches like
particular. It started as a tactical strategy the Methodists.
to struggle for abortion rights in terms of
privacy and choice. Privacy was a legal • An important strategy could be a research
strategy in the Supreme Court because project that looks at the way in which
of how the US constitution is structured. financial systems, based on certain
However this, together with other political definitions of property and risk, connect
and cultural dynamics, has worked to with the biotech and reprotech industries.
push reproductive rights advocates into We need to develop a strategy vis-à-vis
an unfortunate position, where we talk not just the state, but also big corporates
about individual liberties but not about and their functioning.

75
• We need to reflect about strategies is okay, why is sex work not okay? With
from the population control and the same body, women are either having
contraceptive campaigns; we have children without sex (in the case of
not as yet succeeded, as population surrogacy) or are having sex without
control continues to take place in children (in the case of sex work). Why
other forms. Though it was should one have a higher value, while
the feminist movement that was the other is criminalised? Further, if we
addressing issues within population put all these issues under the umbrella
control, all discourses (from official of exploitation, what do we stand to
articles to student dissertations) on gain and lose? We need to have a clear
reproductive health and rights begin from understanding of our bodies, in a way
the ICPD (International Conference on that goes beyond compartmentalised
Population and Development). Globally, and patriarchal ideas about our bodies,
public memory of feminist voices has even as feminists.
completely vanished. Feminist strategies
have always been against the state and • We need a series of maps – a map of
hence, very low key. bio-crossings that shows the global flow
of business, surrogacy, gametes; a map
Given the amount of cross-border of finance, from high level down to
movement today, which campaigns do street level; a map of international
we locate at the local level and which regulatory agencies and a map of
at the global level? We need to say that strategies from movements in different
women’s reproductive material cannot countries – laid out in a transparent way
be property under GATS or TRIPS, for activists to use.
or the latest insertion into a chain of
commodities – high yielding varieties • Perhaps, there is something to be
of seeds, cattle and now, women’s learnt from the promotion of breast
wombs. A different articulation of feeding in the fight against the baby foods
women’s reproductive rights and sexual industry. The promotion appealed to
health issues is needed. Further, we mothers because of evidence of linked
need to engage with the problems in malnutrition deaths.
the language of altruism, gift-giving,
donations and ask questions that are • What are the legal cases that have been
difficult even for feminists. If surrogacy registered against the ART industry?

76
 Emerging Perspectives and Challenges
Coordinators: Renu Khanna and Young-Gyung Paik

Renu Khanna Young-Gyung Paik

We need to assess our work with ARTs on the Challenges

following counts:
• We have to understand the components
• What are the challenges to movement of the term Assisted Reproductive
building? Technology. Is reproductive technology
really ‘assisted’?
• How do we build a coalition within
women’s groups with different • There is a need to map and keep track of
perspectives? what is going on in ARTs and its speed of
• How do we introduce the ART agenda development and expansion, in terms of
into other social movements? regions, nations, forms and class.

• How do we avoid co-option? • In assessing the demand for ARTs, it is

important to interrogate the concept of
• What is the common minimum agenda ‘family’ and ‘patriarchy’ and the conflict
that we should set for ourselves? of ‘rights’ within.
• What media products are we going to • There is an issue with too much
bring out and how will we disseminate information about some areas of
them in alternative information spaces? ARTs (aggressive advertising and
marketing) and too little information
• How do we talk to the various stakeholders
about other areas (risks, causes of
and use them at the strategy level? In order
infertility, statistics and clinical data).
to get credible sources of information,
There is a lot of false information going
we also need to build allies within other
around, even from medical authorities.
circles, like gynaecologists.

• Where is the demand for ART situated? • Citizenship remains an unresolved issue
in the case of surrogacy.
• We need to learn from earlier experiences
while deciding whether ban or regulation • Regulation and legislation of practices are
is the answer. potential sites for intervention.

• How can regulatory bodies be made • The concern with the lack of primary
transparent and accountable? health care is paramount.

77
• Should we be looking for analogies when groups, LGBT, disability groups, patient
we try to determine our strategy and with groups, etc.
what? Sex work? Organ donation? Blood
donation? Tissue donation? • Strengthening primary health care and
meeting basic needs.
• How can we achieve and maintain
solidarity in the area of reproductive • Making ‘low-tech’ options available.
technology?
• Expanding the public sector.
Strategies
Discussion Points
• Rename the term ‘ART’ in a way that it
can empower us and question concepts of
• There has to be clarity on the standpoint
‘altruism’ and ‘donation’.
on technology: is the group against
• Create interactive maps of actors, technology altogether and thinks it
movements and regulations. is problematic? Is it against assisted
reproductive technology only and thinks
• Production and dissemination of that is problematic? Or is it against
knowledge through action research, the way in which assisted reproductive
outreach and other means. technology is organised? The job of
technology providers must be restricted
• Engaging with the law through legislation, to the provision of the technology and
lobbying, consultation, review and should not spill over into decision-making
challenging of the existing or proposed regarding who can access this technology
regulations, and bringing cases to court. or the citizenship status of the child.

• Connecting with other issues • Strategies are required for the short and
(environmental, political, economic, long term. In the short-term there has
financial, intellectual property) and other to be ‘gap-filling’ to stop the practice
movements (within the country and temporarily, and in the long term a whole
across nations). paradigm shift is desirable. This can be
under the broad and comprehensive
• Identifying the different levels of action: umbrella of opposing medicalisation of
local, regional and beyond. women’s bodies. However, in the effort to
build strategy, a point of immobilisation
Non-negotiables
must not be reached where infertility
• Feminist perspectives and initiatives. treatment becomes inaccessible for even
those women who need and seek it.
• Social, economic and environment A possible research area that can feed
justice. into strategy is that of documenting the
narratives of women who have accessed
• Community-based action, empowering ARTs in different countries. In addition,
the groups whose rights are not different legal frameworks across countries
automatically acknowledged in the need to be mapped. Alliances have to be
existing discussion; those who are not built with people from other disciplines,
married, political and ethnic minority including ARTs, who want regulation. A

78
 list of non-negotiables should inform the imposed largely on poor and vulnerable
strategies and goals. Some fundamental women by a strong state. In the case of
definitions like sex selection need to be ARTs, the state seems to be a bystander
revisited. However, there cannot be one as well as the site of some degree of moral
universal strategy to address issues within discussion. Further, two public hospitals
ARTs because of contextual differences. are offering fertility services in Delhi. Is
The temptation to generalise has to be our stand on public sector provision of
avoided because of the diversity in ART ARTs the same as our stand on private
experiences and characteristics across the sector provision of ARTs?
world. Representatives from each country
have to volunteer to identify the problems • Children born through IVF suffer
in their own countries. harmful effects that are going un/under-
investigated. Women, too, do not know
• The relationship between ARTs and the effects of IVF on their health.
the neo-liberal economy needs to be
understood for better strategic alliances. It • The perceptions of the Muslim community
is important to examine what TRIPS and in India too need to be researched,
GATS are saying on ARTs and stem cell considering it forms a large part of the
research since there are some peculiarities Muslim world.
there.
• A central message for awareness-raising
• Currently, heteronormativity, the campaign has to be developed (like
traditional family structure and the ‘Smoking Kills’ in the case of smoking)?
institution of marriage restrict some
people from accessing these technologies. • One of the differences among feminists
Possibilities of local subversions of these with respect to women who access ARTs
restrictions must be accommodated in is whether to view them as victims or
our strategies. agents. How do we critically engage
with women’s choices? The differences
• A large incidence of infertility is
of opinion among the participants at
preventable and needs to be addressed.
the consultation have to be recognised
• When drawing from the experience and understood – for instance, between
of population control, it must be regulation and banning, within regulation,
remembered that population control was and on the nature of regulation.

79
 Global Experiences: Latin America
Coordinators: Renate Klein and Marcia Inhorn

Egg Traffic in Ecuador in the Context of Another issue that has been on the forefront
Latin American Reproductive Policy of feminist activism in this region is that of
sterilisation abuse. Although not as prevalent
Elizabeth Roberts as it was in the previous decades, it still
continues to remain an issue of major concern
There has been a definitive shift of for groups working on reproductive rights
health care in Latin America towards and policy.
privatisation. Across the region, the public
health sector has been completely devalued, Abortion rights do not fall neatly in Latin
with people who have few resources paying America in terms of Left and Right wing
out of their pockets for expensive treatments politics. For instance, although the Ecuadorian
in the private sector. However, at the same president is leftist, he has had a very mixed
time there continues to exist a paradox within record on reproductive rights and abortion
the region, with robust public health systems policy. This has largely to do with the history
in countries like Brazil, Venezuela and of repressive regimes across Latin America
Colombia. in the seventies and eighties, and the support
to the Left by the Catholic Church at that
Latin America is home to some active time, forcing them to lay down restrictive
national and pan-national feminist reproductive policies.
organisations. Many groups working in these
areas generally tend to look at reproductive Over the years, there has been a simultaneous
and sexual rights as a package, and this is liberalisation and criminalisation of abortion
often reflected in their work. In terms of law in Latin America. Until four years ago,
political activism and legislative debate, Cuba was the only nation in the region where
the arena of birth control is highly volatile abortion was legal, with all the other nations
and the morning-after pill has recently having stringent laws against abortion.
become one of the flashpoints of these Interestingly, despite this, Latin America
debates. In Ecuador, for instance, different has the highest rates of abortion. Ironically,
feminist groups were actively engaged in in Ecuador, safe abortion is available in the
trying to legalise the pill, which resulted private sector, albeit illegally, for all those who
in a huge backlash because of which two can afford to pay for it. At the same time, the
varieties of the pill (thus far widely available chances of unsafe abortions among poorer
without prescription, albeit illegally) were women who cannot afford these services are
taken off the market and have now become much higher, thus raising important questions
unavailable.

80
about the effectiveness and implementation relation between the Church and the state
of policies. and the actual robustness of the state to effect
change or implement policies. In Ecuador, for
Recently, Mexico City made ‘on demand’ example, the Church has very little sway, while
abortion legal, which was considered a huge in Costa Rica it is obviously much stronger.
victory by all the groups working on policy
and reproductive rights there. However, Mexico, Brazil, Argentina, Chile and Colombia
as a huge backlash following this step, 10 - the nations with the largest economies in the
states have adopted stricter abortion laws, region - not surprisingly, also have the largest
criminalising the activity itself. Nicaragua thriving ART industries. There are absolutely
and El Salvador have the strictest laws against no laws anywhere in the region that directly
abortion globally. affect the industry. Or if they exist, they have
not been relevant in any way. For instance,
Many reproductive rights groups look at this Article 20 of The Child and Adolescent Civil
phenomenon as a paradox. However, it is Code (2003) in Ecuador that states ‘boys and
important to look at it simultaneously with girls and adolescents have the right to life from
regard to the rights discourse as well. On the their conception… Experiments and medical
one hand, there is the right to public health and genetic manipulations are prohibited from
and the right to choose for the woman, and on the fertilisation of the egg until birth’, has been
the other hand, is the right to life and rights interpreted as – embryos should not be frozen.
of the foetus that are often purported in this There have been several debates regarding this
respect. between IVF providers and policy makers,
but it has not translated to anything, and
With these issues at the forefront of feminist any form of regulation remains completely
activism, it is not surprising that ARTs have absent. ARTs thus remain legal and largely
received very little attention from groups thus unregulated in all the countries in this region,
far. Barring a few groups in Brazil, none of with only Costa Rica as an exception where
the other feminist organisations have delved IVF is banned.
into the issue. Similarly, there has been no
legislative effort to regulate ARTs in the All ART clinics are in the private sector
region either. where the practitioner or clinic has complete
discretion over the practice, costs as well as
From a religious standpoint, the Catholic the clientele of the clinic. Thus, issues such as
Church is the only major world religious body whether the clinic will provide procedures for
that absolutely condemns all forms of ARTs. single women of surrogacy and egg donation,
The condemnation of IVF relates to the fact that are decided by the practitioner. Some
in the Church’s view IVF is akin to abortion. reproductive tourism also exists in the region,
Even though the couple going through the and movement from Costa Rica to Columbia
procedure may not destroy the embryos, the is especially prominent. There are 12 private
procedure is perceived as developed through ART clinics in Ecuador (a nation of 12 million
the destruction of embryos. Moreover, there people); all of which, as in other countries, are
is the added objection of the processes not completely unregulated and see a diversity of
being ‘natural’. patients. In fact, in Ecuador, there is complete
absence of regulation of private medicine of
The effect of the Church doctrine varies any sort, let alone ART clinics, except for a
across countries depending on the specific yearly sanitation inspection. Twenty five per

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cent of the patients are generally resource Practitioners in Ecuador are largely
poor, making around US $ 300, in situations uncomfortable with surrogacy, and it is not
of massive debts, to pay US $ 4000–5000 for generally advocated to the patients. Along
an IVF cycle. with sisters and other female relatives,
many a times the patients also recruit their
Another interesting observation has been domestic servants as surrogates.
that a lot of the poorer women at the clinic
are there because of unsafe abortions in Paid egg donors in Ecuador are typically
the past. Thus, they are becoming a classic students below 28 years, from the working
example of being 'produced', in a way, for class, non-virgins and light skinned. Race
the IVF industry through the illegality of plays a very important role in gamete
abortion in the country. It is important donation, with the long-standing history
to consider this effect of abortion policies and virtue of ‘mestizaje’ (whitening). Thus,
on other similar issues that effectively
doctors assume that patients want lighter
make consumers for private reproductive
skinned children, and lighter skinned women
medicine.
are sought for anonymous, paid donation.
Many couples too prefer donors lighter than
Similarly, gamete donation in Latin Amer-
themselves and believe that using that donor
ica, like IVF, is rarely regulated and little
attention is paid to donor health and other will further contribute to the ‘whitening’ of
aspects. Certain professional organisations, the nation. Racial analysis, therefore, is a
like LA Red Latino Americana (registry for component of egg donor profile. Unlike in
various clinics around the region), have the United States, they are very clear that
developed certain guidelines in this respect they are doing it for money and do not give
but these remain non-binding. Many, but not excuses of altruism. They donate eggs for
all, IVF practitioners promote paid anony- money and receive US $ 500 per retrieval,
mous donors rather than known donors. only if they deliver eggs. Many of the egg
However, at the same time, there are several donors have also spoken about how going
instances of sisters, god-daughters, nieces or through the process of egg donation for
daughters (in case the mother remarries) do- them becomes a way to escape male control.
nating their eggs. Moreover, even in the case It is often valued for this reason as it gives
of known donors, a financial motive is not al- them the opportunity to participate in a
ways missing. Often younger women donate high-class, privatised form of medicine. It is
eggs to older women from whom they have generally kept a secret and only shared with
had a lot of financial support in the past; this female relatives.
is a way of paying them back. It portrays a
kind of financial interaction and exchange A summary of the assisted reproductive
of kinship. Children born with the help of scenario in Ecuador, thus, points to: private
egg donation are considered to belong to medicine drawing patients across the class
the entire kin and not just to the couple. spectrum; known egg donation among
Since reproduction has always been un- kinswomen involving financial exchange;
derstood to be ‘assisted’ (by god, family, paid egg donors experiencing donation as
etc.), ARTs are not seen as 'too far' from an adventure and a way to participate in
how children are generally produced. That is high-tech medicine; darker skinned women,
why, in a way, ARTs are much less problem- who can be desirable IVF patients, not being
atic in Ecuador. considered desirable egg donors.

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Assisted Reproductive Technologies in of its activities, either by the government or by
Brazil: An Overview of the Scenario and medical societies. The Assisted Reproduction
its Ethical, Legal and Social Challenges Latin American Network’s registry too works
on a voluntary basis, and they collect data only
Marilena Correa from clinics that want to give data. Therefore,
the worst results do not show up. Only 50 clinics
In the Brazilian context, the 'need' for a are present according to records, but actually
child is highly valued and it is considered there are more than 100. Though inconsistent,
unthinkable that a woman might want to this is also the first path towards a monitoring
live without a child. Along with the social mechanism. There is no control and a
medicalisation of contemporary societies, lack of political will from the public
there is a medicalisation of childlessness as health authorities.
well. A recent research in a public hospital
in Rio de Janeiro revealed that though In the direction of regulation, the Federal
infertility services are available, there is no Council of Medicine passed the first resolution
high technology. These women are exposed in 1992. This is the main document regarding
to the idea of being treated, without being ARTs in Brazil, and is widely referred to by
‘completely treated’. While the need and doctors. In the nineties, three bills were put up
desire to set up a family is presented as an in the National Congress on Assisted Human
‘unfulfilled dream’, there are also elements Reproduction. The Ministry of Health called
of embarrassment and stigmatisation that for a consultation on these bills and in 2005,
come with childlessness. This makes women the Brazilian Bio-technology Law was revised,
vulnerable, and poor women particularly want which changed matters significantly. All
access to these technologies – a small group of efforts at regulation have been in the interest
about 8 to 10 such women came together to of the medical profession, and have aimed
claim access from the state. The vulnerability at legalising what medical professionals
of women is also reinforced because of the were already doing. While the consultation
irresponsibility of doctors who frame ARTs included people from diverse backgrounds,
as a response to the ‘need’ for children. including feminists, what prevailed eventually
was the view of the medical specialists. The
ARTs were introduced in Brazil in the eighties resolution has permitted surrogacy and
and the first test-tube baby was born in 1984. insemination for single women, but it does
ARTs were then almost only found in private not talk about sexual orientation. Therefore,
clinics, but during the eighties, they organised it does not have the ‘universal eligibility’ it
a system of hands-on learning, by calling in claims to have, and in the private sector it is
and paying their foreign colleagues to teach really a way to magnify the medical market.
them IVF. This was a contradiction because at It is important here to note that in
that time Brazil also had good publicly-funded Brazil, it is a criminal offence to sell body
research programmes. Other innovations at parts, tissues and cells. The resolution repeats
the time did not enter the country in this way. this, and talks additionally of informed
ARTs have stayed in the private sector (where consent.
they came), and for public health, it is as if
they do not exist. When this bill was proposed, the doctors
wanted to repeat the same chapters, articles
There remains an inadequate monitoring of and norms, but when it entered the national
the results of ARTs, and a lack of registration Congress, the bill suffered a more restrictive

83
bias. It was very ‘liberal’ and silent about environmentalists, firms, deputies and so
many things. This has changed and now there on. The scientists were able to construct a
are two bills up for voting, both with different discourse that projected the environmentalists
points. One deals with surrogacy in the spirit as retrograde, and discredited the precaution
of the resolution, and says it is possible to principle. At the time of voting, agro-
cryopreserve gametes and transfer up to four business and genetically modified crops had
embryos. The other bill does not allow for these. less support in Congress and in society; these
The Catholic deputies and other religions like firms had committed many illegalities. Brazil
the New Protestants have actively exerted was the second largest exporter of soy and
their influence to block laws. None of these it was not clear to people why genetically
bills address the need for monitoring and modified soy would bring more wealth to
control, which goes to show the commercial the country. But the ‘progressive’ scientists
interests that they are pandering to. aligned themselves to agro-business and
The data collected by the RED network of mobilised patients and patients’ associations,
centres of assisted reproduction in Latin- in the interest of ‘curing disease’, to approve
America does not take into consideration human embryo stem cell research in the
aspects like the effects of drugs, although their country. Now, the law in Brazil allows
work does make available more information. embryonic stem cell research, and these
embryos come from IVF clinics where there
From cross-country data on IVF centres and is no regulation. In the last two years, a lot
data on ART procedures in Brazil over the of regulations have come forth regarding
years, it is evident that the number of embryo aspects related to laboratory conditions but
transfers and multiple pregnancies in Brazil no questions regarding women have been
are quite high, putting both women and featured. The doctors do not want to discuss
children at risk. these issues, and would rather perform IVF
to earn money and ‘fulfill dreams’.
Brazil faces many challenges in reproductive
health including a declining fertility rate from Some unattended areas of regulation are:
6.2 in 1960 to 1.8 in 2006. While the early How many embryos should be cryopreserved?
period of declining fertility was caused by Where and who should keep them, and
medicalisation through unsolicited pills and whose responsibility are they? What kinds
forced sterilisations, the more recent decline of contracts govern such practices, as well as
in fertility is associated with education. The others, like egg donation?
population in 2009 was 192,343,632 of which
84 per cent was urban. The life expectancy is The activities of the RED network include
72 years and the infant mortality rate is 22 per accreditation, logistical support, training and
1,000 live births. research. There is a need for more information
on results, use of drugs, pregnancies, deliveries
The 1995 bio-technology law in Brazil and newborns in Brazilian and Latin American
forbade the genetic modification of plants, clinics.
humans, seeds, etc. Genetic engineering
could only be produced in a confined space Some non-regulated and ‘hidden’ forms of
for research. In 2004 the agro-business lobby, commercialisation have been seen in Brazil,
especially Monsanto, put a lot of pressure including egg sharing or donation in return
on the government. There was a huge for subsidising fertility treatment. One such
public debate involving feminists, scientists, example is Projeto Acesso.

84
Projeto Acesso (Access Project) sponsored by • We have unwanted pregnancies leading
Merck-Serono since 2005, provides discounts women to abortions on the one hand, and
for patients who present a condition defined women who want children but are infertile
as ‘impaired conception’. The project also on the other. One of our points of activism
defines who its beneficiaries are – they cannot could be the emergence of ART as an end
be completely poor because they have to product of poor abortion, given that there
purchase their drugs. Beneficiaries are said to are thousands of unsafe abortions in
‘have access’ i.e. they can buy drugs cheaper countries where it is criminalised. Unsafe
and their ART medical fees are subsidised. practice of one kind is leading to a high
Projeto Acesso operates in association with degree of unsafe practice of another. This
IVF clinics previously accredited by the firm is a profound link, coupled with the fact
itself. This practice is new and unregulated that ‘right to life’ is probably the most
and paradoxical within Brazil’s public important issue for the Catholic Church.
health system, which functions on the two
principles of universality and justice. There • From the high prevalence of ICSI,
is also another system of private insurance it can be concluded that there is a high
for those who can afford it. However, 80 rate of male factor infertility in Latin
per cent of the population depends on the America. Practitioners are using a more
government, and the government does not expensive, more invasive procedure to
want to introduce ARTs as they are too force fertilisation to occur.
expensive, and infertility is not considered • Religion is another axis of oppression that
life threatening. needs highlighting. The Catholic Church’s
opposition to condoms, contraceptives
The practice of oocyte sharing and donation is and abortions has adverse implications
present in the country at least since 1995. It is for women.
done in private clinics by doctors who recruit
young patients with tubal problems due to • The ‘wantedness’ of and desire for
abortions or untreated sexually transmitted children is manifested in and through
infections. This practice is not paid, since the ART industry. Here, the issue of class
the sale of human tissue is a criminal offence oppression and stratified reproduction
in Brazil. Overall, it can be concluded that comes in; poor women do not get access
there is an imbalance between this picture of to technologies they need and want,
privatisation and Brazil’s public health system including ARTs.
that takes care of all patients.
• Race is another aspect that was highlighted
- IVF doctors who think it is their duty
Coordinators’ Comments
to ‘lighten’ Ecuador raise up questions of
Marcia Inhorn who is valued and who is not.
• In trying to place the issue in a broader
• Most countries have no laws and their
framework, intersectionality theory could
ART industries are unregulated with only
be useful. Multiple interlocking forms of
voluntary registries.
oppression – gender, race, class, religion –
are not just additive but also multiplicative.
Renate Klein
We also need to place ARTs in the broader
framework of women’s reproductive lives • While unsafe abortion is one of the
and their health. reasons why we have secondary infertility

85
 in women, there is a need to look into need to be vigilant about the way religion
incomplete abortions, particularly in the is mobilised, depending on particular
Global South. political formations.

• It is clear that women have not been able • ARTs are definitely signifiers of modernity
to shake off the patriarchal assumption in Bangladesh today. While India, with its
that they are available for sex. With ARTs, big technology industry, claims a place at
are we shifting women from one form of the global high table, the middle classes
oppression to another, wherein they use in Bangladesh can at least say that they
technology to stay within patriarchal have ARTs. Technologies that women
family structures? Technology cannot be need, like paternity tests, need to be given
the way out of male oppression. priority. The entry point for the women’s
movement should be to demystify
Discussion Points the relationship between technology,
modernity and women’s emancipation.
• Given that the political system is Feminists do not need to think of ARTs as
constrained by religion to the extent that the most pressing problem, but it has to be
the Left is also beholden to the dictates of placed in a certain context. For a regional
the Church because of the support they map, it would be interesting to see the
received at some point, it is important to commonalities and the disjunctures
trace how religion impacts politics and within regions on technology and ARTs,
therefore, governance. and the reasons behind them.

• Kinship is not necessarily a non-communal, • One thing that became clear in the course
pure space that is being polluted by these of the research in IVF clinics in Ecuador
technologies. Reproduction has always was the idea of ‘reproductive modernity’.
been assisted in different ways. Certainly There are long histories, beyond Ecuador
in Bangladesh, informal adoptions have and Latin America, of making racialised
been common. They are not about the bifurcations between who can reproduce
law or Islam, but really about community and who cannot. It is the poor and the
practice. As long as the public-private ‘primitive’ who are considered very
distinction is not ruptured, they are fertile, and although epidemiologically
allowed and acceptable. inaccurate, in Ecuador there is a strong
association between infertility and upper
• In discussions of religion, it is important class women. Therefore, to have an
to contextualise the politicisation of ‘unreproductive’ body, and to gather the
religion, rather than viewing religion per resources to fix it through technology,
se as the problem. Thus, it has been useful is most definitely a sign of ‘status’ and
to look at the different relationships ‘whiteness’. This is not to say that the
between the church and the state in women who are investing in this kind of
different countries of Latin America, participation are frivolous; because to be
rather than seeing the Catholic Church able to enter into private sector medicine
itself as the problem. This is significant means one is treated like a worthwhile
because there is a tendency to look at human being, in a way that entering
Islam as the explanatory framework when into public sector medicine means one is
we discuss Muslim societies today. We treated like an unworthy human being.

86
 There is a study by the London School of the one hand and lack of governance on
Hygiene and Tropical Medicine in Brazil the other comes into play. Abortion until
that shows how poorer women actively recently has not been a political issue
strategise to get caesarian sections in because so many of the feminists involved
public hospitals. The C-section rate all in these movements were wealthier or
across Latin America is very high, but middle class, with access to paid-for, safe
women in private clinics have a much abortion. Further, lawyers, IVF doctors,
higher C-section rate (90-95 per cent) etc. did not want to say anything very
while in public hospitals it is much lower specific about reproductive technologies
(20-25 per cent). These women know in the Child and Adolescent Civil
that C-sections bring greater resources Code, because that would force the
and more attention from doctors. This Catholic Church (and others) to take a
is similar to what goes on in accessing stand on the question of when life begins.
IVF. C-section literature for public Therefore, even while IVF services are
health organisations that talks about advertised publicly, there is no governance
women seeking C-sections in frivolous or movement for regulation.
ways is a mis-characterisation of women
who are seeking engagements with their • The women who undergo unsafe
bodies that make them feel like worthy
abortions are not all the women who
citizens. In this context, ‘patient’ is the
undergo IVF. The link between unsafe
word that people use as a sign of honour,
abortions and infertility needs to be
because it engages one in a patron-client
examined, particularly in terms of the
relationship.
incidence and the role of the medical
community. Further, we need to
• The voices and experiences from the
distinguish between safe and
women’s movement that are countering
unsafe abortion when talking of
the hegemony of the private medical
sector need to be highlighted. The infertility, because abortion is a
women’s movement has to work with very important safety net, and the
states which have strong governance right to safe abortion must be protected.
structures for markets, but weak state Even the overuse of menstrual regulation
structures for people. pills in the family planning programs of
Latin American and South Asia should be
• Ecuador has a feminist movement discussed as a cause of infertility.
with some organising around issues of
reproductive health and sexual rights. • Although the feminist movement in
However, most of this organising has been Brazil has an upper class character, it is
around issues like access to the morning a very strong movement, with a history
after pill. Being able to access any form of of struggle under the dictatorship,
birth control has always been incredibly together with the movement for public
easy. Yet interestingly, the discussion that health reforms. In 1988, Brazil got a
aimed to make the morning after pill legal new democratic constitution with many
is what prompted it becoming illegal, as inclusions that were important for
the Catholic Church harnessed its powers women, like the right to family planning.
to create a backlash. It is in terms of However, this was implemented only later
abortion that the lack of regulation on for surgical sterilisation in the country.

87
 Ten years after this, in 2006, 40 per pesticides, pharmaceuticals, etc., by
cent of all births in Brazil were surgical. companies like Monsanto and Syngenta.
There are many reasons for this, not only This raises the possibility of building
because of the high amount of money alliances and networking on these issues.
involved, but also because good family With GM, abortion, IVF and high finance,
planning services are not available and every failure is viewed as a new business
reproductive rights are not addressed opportunity. Today we are confronted
adequately. Moreover, the scientists with a scenario where a company is
who aligned with Monsanto were happy to put the terminator gene in a
in techno-science embryo research, seed for profit, and has a clear mandate to
including two women who worked on control 90 per cent of seeds in the world
embryo stem cells and had encountered through IPR. The National Biotechnology
problems because they had imported Regulatory Authority Act, which is in the
embryos from the US. Because of this, process of being finalised, is characterised
the Brazilian state made a law forbidding by an absence of gender and public health
this kind of import. So there is a lot of concerns.
scientific ‘progressive’ interest in doing
such research in Brazil. • The post marketing surveillance of over
the counter drugs is supposed to be done
Further, class is definitely important by companies, but this is not happening.
when we talk about vulnerability.
However, in the first research with • It is clear that big business is stoking the
rich women, it was clear that they latent desires of women. There is also a
also had their limitations with regard to certain commerce within the family that
treatment. is going on in Ecuador where women
feel they are free agents doing commerce
• There is a close connection between food, without any external influence. However,
women’s health, reproductive health there is big business in the background,
and bio-technology. Bio-technology whose reality for these women is masked
law is very important as it ties up with by the idea of transactions and networks
other issues of IPR, and the control of free of patriarchy.

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 In Pursuit of Tissues: Global Movement and the
Biogenetic Form
Chayanika Shah and Sarah Sexton

Our Bodies Ourselves: The Fertility In the US, as the demand for eggs rises in
Industry and Threats to Women’s Health: the fertility setting, it is understandable that
Creating a More Coordinated Global payment incentives are also increasing. As
Response scientists seek more eggs for SCNT research,
there is increasing pressure to allow for
Judy Norsigian payment incentives in the research arena.
This is currently a point of contention in
A summary of the challenges facing us in California, where the California Institute
ARTs are as follows: of Regenerative Medicine is seeking new
rules that would allow for payments that
• The increasing demand for women’s were previously prohibited. A US company
eggs for both IVF purposes and for use (The World Egg Bank) has signed a deal
in SCNT or ‘cloning research’, not just with fertility clinics in Spain to provide
because of infertility but for other social US consumers with ‘IVF vacations’ to
or genetic reasons that are not related to Spain. They offer the world’s largest online
fertility. registry of egg donors and specialise in egg
extraction services, and the storage and
• Increasing demand for women as
sale of cryopreserved eggs. Since the early
commercial gestational mothers. nineties, in response to the growth of IVF
• Deflection of attention and resources services globally, the international market
away from the primary prevention of for human eggs has increased substantially,
infertility (e.g. Sexually Transmitted as chronicled in Debora Spar’s book titled
Infections, toxic exposures). The Baby Business. President Diana Thomas
notes that “recipients no longer have to
• No adequate safety data for many synchronise cycles with the donor and the
infertility drugs, especially the class of donor can be anywhere in the world.”
drugs that suppresses ovulation, while
substantial anecdotal evidence of harm Newspaper reports of scandals have
grows. There is also growing evidence increased in number, and in one case, the
of harm from ovarian hyperstimulatory Romanian government prosecuted two
drugs (a class of drugs used in IVF). Israeli physicians for illegally procuring eggs
from young Romanian women. Some of these
• The proliferation of misleading women are now suing for strange physical
advertisements and marketing schemes problems they believe are related to the egg
to increase both the demand and supply. extraction procedures.

94
The combination of big capital and an effective The recent positions taken in the US, include
global marketing strategy will be difficult to those by the ASRM (American Society for
counter, especially in terms of informing Reproductive Medicine) which regards
women with a more balanced perspective infertility as a disease. Similar definitions
of the risks involved. The lure of big money are being considered by the ESHRE
will continue to draw unethical practitioners (European Society of Human Reproduction
to the field. Already a proliferation of and Embryology), and by the ICMART
advertisements seeking donors with specified (International Committee for Monitoring
physical features can be seen. Assisted Reproductive Technologies). A
US Supreme Court opinion agreed with a
The first evidence of a statistically significant lower court statement that reproduction
increase in the risk of ovarian tumours is a major life activity and confirmed
among IVF patients can also be seen now. In that conditions that interfere with
20 to 33 per cent of the cases, mild Ovarian reproduction should be regarded as
Hyperstimulation Syndrome (OHSS) is said disabilities, as defined in the Americans with
to exist, while in one per cent of the cases Disabilities Act.
severe OHSS could lead to hospitalisation,
renal failure and death, in rare cases. There is very little policy related to ARTs
in general in the US. There is no federal
There have been no long-term studies of regulation of eggs. In terms of state regulation,
Lupron which is being used off-label in Indiana prohibits the sale of human eggs and
IVF clinics. Lupron (leuprolide acetate) allows for reimbursement for expenses, lost
is the drug that is most often used to shut wages, and up to US $ 3,000 for recovery
down a woman’s ovaries, before stimulating time. Louisiana explicitly prohibits the sale of
them with other drugs to produce multiple human eggs and Virginia explicitly authorises
follicles. It has caused a range of its sale. Voluntary guidelines from American
problems reported to the Food and Drug Society for Reproductive Medicine state that
Administration, including rash, dizziness, women should not be paid more than US $
chest pain, nausea, depression, amnesia 5,000 for eggs, and anything over US $ 10,000
(disturbance in memory), hypertension
is ‘inappropriate’. Further, women should not
(high arterial blood pressure), muscular
undergo more than six cycles of egg retrieval.
pain, bone pain, liver function abnormality,
vision abnormality, anxiety, myasthenia
In ‘Gender and Justice in the Gene Age’ a
(muscle weakness) and vertigo.
feminist meeting on New Reproductive and
Genetic Technologies in May 2004, participants
Many of these Lupron-related problems are
strongly articulated their opposition to – sex
discussed at greater length on a website created
selection and disability de-selection, without
by Lynne Millican, a nurse-practitioner who
the support for a law that would make selective
herself experienced harmful consequences
abortion illegal; the ideal of perfection of
from multiple uses of Lupron. Her work
humans and children; the commercialisation
builds upon that of the National Lupron
Victims Network (NLVN), founded by two of health and commodification of human
dentist sisters, Linda and Rita Abend (Rita life, body parts or cells; practices and social
became seriously ill following Lupron use). conditions that pressure people to select
The NLVN website was mysteriously taken children based on their traits, or to select
down in 2003. traits in their children; the development

95
and proliferation of technologies that select, makers have to be approached as political
modify and commodify children. momentum grows and a public mandate for
change becomes imperative. Concepts that
The strategies and next steps identified are generally compelling and already have
included - developing more comprehensive traction in the public’s mind will have to be
approaches to advocacy on these issues, capitalised on.
organising a dialogue between disability
and feminist activists, identifying doctors Suggested first efforts:
and scientists to join the group’s advocacy
• Since there are ‘lunatic’ fringe physicians
and counter the claim that it was anti-
and researchers (e.g. Dr Panos Zavros)
science; supporting research that would
and others who are proponents of
show the impact of high-tech biomedicine
reproductive cloning, a global ban on
on communities in terms of use of resources;
human reproductive cloning can be
creating an international network for
called for, with insistence that countries
information and monitoring; developing
that have not instituted such a ban, do so
a feminist statement on these technologies
now.
that could act as a bridge to other social
movements; developing popular educational • Those who voice opposition are likely to
tools and materials to expand understanding have vested interests in perfecting and
of the issues; reaching other communities using reproductive cloning technology
and constituencies; countering media (if not for human reproductive cloning,
messages that distort the debate on these then possibly for other germline genetic
technologies; connecting with movements engineering schemes). This effort could
that have long fought eugenics; and building bring them out into the open.
new partnerships.
• Ways need to be sought to keep the Dr
Persuasive messages around SCNT have Hwang Woo Suk scandal alive in the
to be crafted saying that it is the gateway to mind of the public (Korea Women’s
genetically-enhanced or modified children Associations United and Korean
and that there is no safe way to conduct human Womenlink could take a lead role here).
germline genetic modification. Studies can
be done ad nauseum in animal models, but • The expanded use of public dollars for
it does not eliminate the huge and ethically infertility services has to be challenged
unacceptable risks of such studies in humans. when infertility prevention measures are
In other words, there is no ‘safe’ way to get not adequately funded.
‘from here to there.’
• New ways have to be sought to challenge
In generating a public discourse that can be the misleading claims and advertisements
the foundation for change, ‘opinion leaders’ of the IVF ‘industry’. These could include
or spokespersons with substantial stature to writing booklets for young women
take up one or more of the issues have to be (similar to Egg Donation: the Reasons
identified. Eventually multiple spokespersons and the Risks by Kristi Lew) to counter
have to be prepared to begin a coordinated the misleading hype. They could be
media outreach campaign that demonstrates put online and used through a range of
these concerns to be shared by more than social networking sites to market them
a few fringe activists. Appropriate policy effectively to younger women. Secondly,

96
 copies of the primer, Human Genetic of them will act to protect themselves and
Engineering by activist Pete Shanks can their loved ones).
be brought into high schools and into the
hands of biology teachers. Thirdly, more Coordinators' Comments
accurate information about what young
women are told can be collected. Sarah Sexton
• There is a need to raise awareness of While we discuss the movement across
the unique ways in which reproductive borders of tissues, embryos, companies,
tourism exploits women and why people doctors and so on, there is also an issue of the
in different countries who care about non-movement of people in today’s age of
these issues must think of policies and visa regimes.
practices outside their own countries.
Chayanika Shah
• The anti-intellectual trends among many
politicians must be responded to in Is the egg closer to blood or to an organ? This
different ways. is a confusing issue, and in our discussions,
we seem to be drawing parallels between eggs
• Possible research and study areas include and organs. This is especially significant if we
systematic surveys of women who want to be clearer about why we are opposed
pursue the idea of providing their eggs to something. What exactly is it about
for IVF; exploration of medical, psycho- embryo donation or purchase that makes
sociological and ethical implications; us so uncomfortable? We need to engage
consequences of egg donation in European with the debate on technology, including
countries, especially in Czech Republic, the differences of opinion between us on
Spain, United Kingdom, Ukraine and technology. While we may have an ideological
Romania. position against regulation and these
technologies, yet the reality of the 250 clinics
• Grants could be utilised from
in India demands some sort of regulation. At
foundations that support the use of
the pragmatic level, where do we draw the line
documentaries in bringing about
with technology? This is an issue we struggled
needed social change (e.g. The
with in 1989 also. Over the last twenty years
Fledgling Fund in NYC). One
our positions have become more difficult,
possibility is to launch a collaboration
because the line is being pushed further and
that utilises Made in India (and/or similar
further, as we had anticipated. If we resist the
films), to motivate more people to become
push, the line will shift slower. How will it be
activists in this cause. University venues
possible, if at all, in a rapidly changing world
can be excellent sites for such movement-
to make this line not shift at all?
building. Films that model attitudes and
behaviours that are considered worth
supporting (e.g. My Sister’s Keeper), could Discussion Points
be promoted.
• Is it correct to always pose technology
• There is a need to adopt different forms – as the problem? We need to be nuanced
political power (for policy changes); the about the kinds of technology that
power of information (reaching people might be problematic, and not say that
with the truth, hoping that at least some technology is itself inherently a problem.

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 We have all embraced technology in a It is not a vaccination against cervical
big way. In many ways, to be human is cancer, but against two strains of one
to be technological, because humans virus – HPV, when there are many types
use technology. Are technologies then a of cervical cancer that have nothing to do
master’s tools, and if they are, then how with this virus. In India now, 2 research
do we make these technologies ours? projects are being coordinated by PATH
There is a distinction, however, between (a US based NGO), in the states of
technologies that can be controlled and Gujarat and Andhra Pradesh, involving
those that cannot. We need to be critical
32,000 girls. We need to be critical of
of technologies that are positioned as
this vaccine at an international level. The
the ‘saviour’. Attention needs to be paid
to the human aspect of technologies. HPV vaccine has had adverse effects on
There is a question here of power, of who women, and particularly on fertility, as
controls the processes of technological it has been seen that women who took
development, and who decides which the vaccine when pregnant, suffered
technologies will be evolved. Further, do miscarriages and delivered disabled
technologies have a way of universalising foetuses.
despite differences in local contexts?
• In the US, to get opinion leaders on its
• This consultation would have been side, Merck funded groups of women
different with the presence of an legislators to promote the idea of
additional constituency – women mandatory school based vaccinations
who are interested in obtaining this for young girls. This campaign was very
technology. Are we going to engage effective, and even got some states to pass
with this constituency as a possible future laws (which have since been reversed)
strategy? After all, our formulations mandating that all school age girls be
of what it is that we are opposing will given HPV vaccines. There have been
depend on the consumers of these debates about whether parents should
services. However, this raises the issue be allowed to opt-out of HPV and other
that the consumers of these technologies
vaccine programs. There is also a strong
are not monolithic either. Do we
anti-vaccine campaign in the US that
want to bring in ten women who had
terrible experiences with ARTs, or ten opposes vaccines of any sort for any
women for whom it was a relatively reason, which is really like throwing
good experience? Further, men must be the baby out with the bathwater. In the
engaged in movement-building as well, experience of Our Bodies Ourselves
since without their participation, we will fighting against state level laws, although
not be successful in our strategies. we were up against huge machinery, the
information did eventually get through to
• We need to learn from our more recent legislators. In terms of strategy, we need
experience of the administration of the to get to opinion leaders beforehand,
HPV (Human Papilloma Virus) vaccine. with credible information that cannot be
In Australia, it is government policy discounted.
to vaccinate all young girls in schools
regularly. There is evidence of 1,200 girls • Information about the off label use of
under the age of 16 being included in the drugs is either not being collected, or
initial trials. Girls as young as 9 years were is unavailable. Off label use of drugs
pushed into this three-part vaccination. is probably at its greatest right now,

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 and needs to be researched by the • In questions of whether we are going
government. to use the language of donation, of
commerce or of exchange within families,
• In the US, the CDC is tracking the perhaps we need to pay attention to how
offspring of women who get IVF. there is not going to be one language
However, data is being collected on a given the different countries that these
small scale only and very problematic technologies are operating in. These
effects on offspring and women who issues are understood through different
have undergone IVF themselves are not frameworks, depending on what is useful
being tracked longitudinally. The Dutch to understand with in a particular context.
15-year study should be commended in A blanket framework is not going to be
this regard. A report (in draft form now) effective for all.
that came out of a CDC symposium
(with participation from ASRM and • Medical tourism operators in the US
other advocacy groups) is going to be (like Planet Hospital in California and
put out that emphasises the primary ProActive Family Solutions in Florida)
prevention of infertility, while talking are in collaboration with hospitals in
about other issues also. If this report India to promote fertility tourism. These
comes through, it will give us a very establishments have huge set-ups in
strong case for looking into the allocation Mumbai and Chennai, and bring in
of public funds so that millions are not young girls from the US to India for egg
spent on IVF, with primary prevention donation, throwing in two weeks of sight-
of infertility not receiving adequate seeing. These agencies are not transparent
funds. In 1973, Our Bodies Ourselves and do not share details like success rates.
organised a talk with the VD (Venereal We need to develop strategies to engage
Disease) division, where a physician, such agencies both in India and in the
Dr. Paul Weiser, made the point that we US.
are not going to reach the public about
VD - mainly gonorrhoea and syphilis - • Through emails, we should contribute our
unless we reach women. Basic messages ideas about the many different strategies
of prevention and protection from we can employ, and after this is collated,
exposure during sexual intercourse must we should each take up an aspect where
reach people. However, prevention in we would be best suited to work. We also
general has never gained much traction need to engage with academics. We must
in the United States because there is not share our material only with trustworthy
much money to be made in it. individuals, not through a website but
through email attachments.
• While the CDC data is reliable, it is
voluntary and not all clinics participate Even with regard to medical tourism
and provide information. Further, it practices, our best option is probably to
focuses more on success rates, rather than put together powerful information and
on data on the effects of these drugs on reach the people who are making these
women. choices.

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Challenges and Strategies: Where do we go from here?
Coordinators: Lakshmi Lingam, Marcy Darnovsky, Amit Sengupta

The coordinators reiterated that several rights; these are not ‘individual’ issues but
issues have emerged from the Consultation exist within a repressive regime where it
which needed highlighting, further is considered that all women should have
discussion or action. They put forth the children.
issues that each of them had identified.
• How do we go beyond the framework
Lakshmi Lingam of victimhood and look at the agency of
women?
• Women do not get the treatment they
deserve in the public health system. This • What are our key problems with
untreated infectious base gives rise to surrogacy? While we need to have the
infertility which earns them a red carpet global as context, we should have the local
welcome into the private sector. Is it as our focus. We cannot be immobilised
possible to consider infertility treatment by global institutions, global markets and
in the public health sector instead of being global governance structures that might
against all infertility treatments? not have spaces for us.

• The causes of infertility need to be Marcy Darnovsky

addressed immediately, from reproductive
and sexual health to those causes that we • We have some clear points of
do not know much about, like toxins, the disagreement between us (e.g. should the
environment, workplace conditions, and genie be put back in the bottle or should
so on. we make it a friendlier genie?). Given
these differences what can we agree on?
• The conceptualisation of the family and To employ the same metaphor, are there
its link with biological motherhood, genies that we want to keep in the bottle?
technological fixes to have a baby as the
• Are there global strategies that already
solution and the pressure to have a baby
exist in dealing with issues of ART?
at any cost need to be questioned. How
do we look at this entire spectrum of • International agreements have to be
issues? explored while designing a strategy for
ARTs. What are the kinds of collaborations
• The earlier strategies, for instance against
and information sharing that we can
population control, need to be sharpened.
initiate at the international level?
They were not perfect, but there are lessons
to be learnt from them especially in the • Within the question of regulation we have
area of coercive policies and reproductive to look at issues of political education

100
 through the media for the protection of from the perspective of rights and within
women. a non-patriarchal, public health model. It
is not adequate to press for it to be offered
Amit Sengupta in the public sector simply because people
will otherwise go to the private sector.
• We must remember that nomenclature Should the information available on low
is important. If we find a different name cost fertility treatments for resource poor
for ARTs that represents our ideology, countries (from ESHRE, for instance)
it would send out a strong message be explored further? Or does asking
demarcating our position from that of for cheaper infertility treatments imply
the industry. Can we call it ‘Reproductive complicity with the fertility industry?
Technology’ for now?
Before moving forward, a position must
• The industry of reproductive technology be clearly established about where we are
and its relationship with the objectives right now. Are we asking for globalisation,
of the research and pharmaceutical or in this case, commodification, with a
industries has to be established. human face? It should be remembered
that IVF has a public sector beginning in
• How do we view technology, and research India, after which it flowed into the private
itself? Do we oppose it in entirety, or sector. It was initiated under the garb
do we oppose how it is controlled and of population control, with the rhetoric
organised? that if we better understand what causes
infertility, we will be better able to control
population. In the nineties, the Ministry
Discussion Points of Health and Family Welfare decided
that infertility was a genuine reproductive
• A position vis-à-vis major religious health issue that needed addressing. In
groups needs to be carefully examined. Army Hospitals, IVF treatment is still
Some critical questions have emerged provided free of charge for those soldiers
in this context - should we engage with whose postings can cause infertility.
the interface between religion and Nonetheless, the need for quality primary
technologies, since religion cannot health care needs to be emphasised.
be escaped; shall we say ‘no’ to such
alliances, given our negative experiences, • At the heart of the entire debate on ARTs
for e.g. vis-a-vis sex selection in India. lie notions of motherhood, fertility and
eugenics, promoted by stakeholders
• ARTs have entered the public health in a patriarchal and heteronormative
sphere in India, with services being framework. It is in this context that service
offered in two public hospitals in Delhi providers are presenting commercial
–AIIMS (All India Institute of Medical surrogacy as altruistic. We need to
Sciences) and LNJP (Lok Nayak Jai create discourses and discussions that
Prakash). Does the logic used to critique normalise infertility. Further, alternative
the ART industry apply to the public possibilities of constructing families
sector too? If not, then there has to outside of blood/genetic continuity and
be clarity on why we are pressing for marriage need to be explored. There has
infertility treatment in the public sector; to be celebration of alternative families

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 and the option of not having children. In persons involved in protecting the child.
addition to the psychological and physical The effort at influencing policy has to
pain of infertile women, we need to talk involve a range of Ministries in order
about the social pain of infertility because to incorporate the range of issues –
a lot of women who do not fit within Health, Family Welfare, Law, Foreign
the social normative framework, are not Affairs, Commerce, Women and Child
allowed to have children. Glorification of Development, Human Resources, Food
motherhood needs to be challenged. and Drug, etc.

In the US, a quarter of the adults • Corporate misdemeanors must be

live in nuclear family formations documented and highlighted, for
(with husband, wife and children), instance, Monsanto’s successful lobbying
a quarter in other types of families – that repealed the law banning genetically
divorced, gay, lesbian, etc., a quarter are modified foods in Brazil. There has to
married couples living without children be some focus on players like Bayer,
and a quarter are single adults living alone. Merck, etc. and it has to be considered
So the nuclear family model of marriage whether there is a case for a minimum
with children is actually the minority; draft to regulate these technologies
and these other family formations need by harmonising laws across borders?
to be celebrated and talked about. Family Further, particularly with regard to HPV,
fostering in Egypt is one such example. the role of pharmaceuticals like Merck
must be examined and critiqued. The
• The debates with respect to disability irresponsibility of medical companies
have to be incorporated within ART- towards human body parts needs to be
related concerns; the birth of a child discussed. We need to get the message out
with disability, the added vulnerability that the players in the biotech, reprotech,
of disabled women and the reproductive finance, pharmaceutical, research and
rights of disabled women. corporate sectors, are all linked. This
could increase our allies, for instance,
• The legal and policy framework for ARTs
among the ecological, health, feminist
needs to address a number of areas;
and anti-globalisation activists.
ethical issues, family relationships,
informed choice, research, gender issues, • It is important to remember that
access to ARTs with regard to class technologies fail, and cannot be depended
and sexual orientation, embryo status, on wholly. Further, infertility treatments
commercialised reproduction, players and ARTs are not interchangeable; they
involved in ARTs, its control, sale and must not be confused as the same10.
compensation, role of industry, the Technology is not the answer, and adoption
relationship between clinics, laboratories is one option that is beyond technology.
and individuals, control and registration A more nuanced critique of technology is
of agencies, individuals, or companies required – should it be banned or should
across borders, and legal consequences it be negotiated to see how it can be used
regarding creation of rights and for the benefit of the people who really
obligations between ART clinics and need it? For some women, technology is
10
It was clarified by Sama that from the perspective of their research and activism, ARTs are not included
within the framework of ‘infertility treatment’ as they do not treat or cure infertility but merely 'assist' reproduction. Infertility
treatments must deal with the underlying causes of infertility such as genital TB, malnutrition, etc.

102
 a way of negotiating with their reality. to use social networking and new media
Since we are claiming to take a stand on (Facebook, blogs, etc.) to get messages
behalf of the women who are using these across.
technologies, it is important to bring
their voices into this debate. At no point • Adoption needs to be de-stigmatised and
must women be alienated since they are put on the agenda as an alternative to
the primary constituency. It is important ARTs. Documentation and dissemination
to view them as part victim and part of stories about adoption need to be done.
agent, and to both question and respect In traditional communities (such as
their choices. Further, it is important to Assam) adoption is an option. However,
ask who controls technology. Artificial some people are known to have resorted
insemination has been taken away to IVF because of the long waiting periods
from our hands under the guise of HIV for adoption. Overall the adoption of girls
prevention, by disallowing the use of non- has been increasing. Society is not static
frozen sperms. However, it is considered and we need to recognise that family
alright to continue to have sex with a structures are changing in some ways.
husband who may be HIV positive. This In the context of adoption laws in India,
is a contradiction. Since ARTs under while Hindu couples can have complete
the present conception include artificial parenthood over their adopted child,
insemination, they should not be rejected other religions can adopt only as legal
entirely. guardians. Any attempt to homogenise
adoption laws is viewed as Hindu-centric,
• At the international level, CEDAW could and even if this includes progressive
be approached for shadow reports and aspects, there is a risk of losing allies from
information could be sought from different non-Hindu communities. Nonetheless,
countries about their particular situation the government has set up a commission
with regard to ARTs, its regulation, to look into and harmonise adoption laws
how women’s rights are positioned, the in India. Further, of the many myths that
public health system’s response to ARTs surround women’s bodies, a common
and women’s rights, and policies of the and persistent one is that bearing children
government. Perhaps CEDAW could be is key to women’s mental and physical
approached to issue general comments fitness. This is propagated by the medical
on women’s rights, women’s health and fraternity and mainstream media, films,
ARTs with a focus on non-negotiables? etc. and must be combated.

• Engagement with the media is • Globally, more than half of all infertility
essential in the effort to generate awareness is male factor Infertility, most of which is
and public discussion. Currently, the incurable. With our focus on women, we
media bypasses all aspects of ARTs except risk losing sight of this. We need a huge
surrogacy, which is sensationalised. Catchy public education campaign so we can
and clear slogans have to be developed talk about male infertility more openly,
while reaching out in the public and so the burden of fertility does not fall
domain, just like any good political or only on women. Some common cause
marketing campaign, such as ‘Merck is needs to be made with the men who are
murky’ or ‘Are you a sub-prime embryo?’. facing infertility. A lot of male factor
There is also a need to understand how infertility is caused by Non-Gonococcal

103
 Urethritis (NGU), which is preventable use of women’s bodies by industries as a
by using condoms. The focus on men and free commons, the partitioning of bodies
preventable male factor infertility could and exploitative medicalisation, the latest
motivate men to use condoms. Further, being public private partnerships whose
50 per cent of male factor infertility is genuine outcome is profit rather than
genetic and not preventable. The use of health.
ICSI to overcome male fertility results
in the perpetuation of male infertility • We need to think in terms of the 3 Rs:
into future generations. The sons of Research questions – a lot of issues have
genetically infertile men will carry that come up that require further research;
genetic mutation and this presents a huge Regulation – which direction are we going
bioethical issue. Such information needs in at the international and national levels;
to be made available, especially given that and Re-Education – how do we get across
male infertility gets treated on the female the messages that we are clear about?
body. • A loose global network on New
Reproductive Technologies can be
• It is important to track the fate of the
established with immediate effect. Not
ART Bill; sometimes such Bills get
only strategies, but also positions have to
passed quietly amidst all the noise about
be developed, taking into consideration
more important ones like those on
variables such as the rural-urban divide.
terrorism, army budgets, etc. There is
It is important to establish an ethical
also the danger that even after comments
charter or a list of non-negotiables and
have been submitted on the Bill, the
targets in the short run, which are feasible.
state could deploy this simply as a box-
We could look at using internet laws that
ticking exercise; as evidence that public
ban the advertisement of certain things in
engagement on the Bill was carried out.
countries where they are illegal (e.g. sex
Rejecting the Bill in its current form is
selective abortion).
also an option.
• We need to minimize health risks
• The close link between ARTs and research from the market push on present
is disturbing. The fact that there is a lot technologies, and the potential risks of
of discussion and debate on the ethics new technologies. Safety issues have to
of research and the need to regulate be raised while engaging with regulation
research could provide an opportunity and policy. Off-label use of drugs
with ARTs as well. Some of the research has to be opposed strongly because it
areas that we need to look at are: causes is unscientific and absolutely at the
of infertility, hazards of ARTs and discretion of doctors.
safety issues, commercialisation – costs,
turnovers, etc. and links with research • The experiences of women need to be
and pharmaceutical industries. brought into our discussions – those
who have paid money to clinics and
• A desirable position with regard to the not got results, those who are suffering
Intellectual Property status, particularly from clinical depression resulting from
across borders, needs to be established. treatment, etc. As activists, we should
We need to be clear that we are against the begin from the community and be
theft and privatisation of knowledge, the guided by their voices. We have to be

104
 mindful about the right of people to Summary
have children, especially people who
cannot afford to have children. The Amit Sengupta summarised the areas of
context of surrogate women has to be consensus within the group:
explored further. What is the nature • The importance of public health measures
of participation and the stand of the located within developed and universally
population control committee and the accessible public health systems that
sex selection committee on ARTs? prevent and treat infertility.
• We need to make some urgent feminist • Rejection of patriarchy, family and
interventions in medical and science eugenics, and recognition that these form
education. The STS (Science, Technology the framework within which ARTs are
and Society) aspects of science need to located and where the so-called ‘need’ for
be addressed, together with ethics, such these technologies is, in fact, created.
as through engagements with feminists • Understanding of how this
within biological sciences. technology is controlled with intellectual
property rights, markets, finance
• Traditional medicine practitioners are
capitalisation and globalisation.
also advertising infertility treatments and
need to be looked at.
Lakshmi Lingam highlighted some key points
• Nomenclature is indeed an issue from the discussion:
(‘Assisted Reproductive Technology’ or • It is important to engage with
‘Reproductive Technology’?), but we need legal frameworks in different
to continue using the common parlance countries, for example, the draft ART Bill
in order to be understood. in India.
• A detailed mapping of the ART • The 'Goliath', as it were, must be taken on
business and conferences is essential, in bits and pieces, from the perspective of
also to establish its linkages with strategising.
other industries, like food and
tourism. We need to scrutinise the claims • Cross-movement conversations and
that this industry is making, such as success links with other people’s movements are
rates. For instance, Merck has started a necessary. One way would be to prepare
consumer protection outfit for fertility a note in various languages that can be
tourism. Additionally, the Tamil disseminated across the country.
Nadu State Tourism Department • Minority groups at the ground-level must
promotes ARTs as part of its medical be engaged with. There is silence on how
tourism package. Muslim women cope with infertility.

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 The Way Forward
NB Sarojini

In the previous consultation organised by on surrogacy, which reinforces patriarchal

Sama, the Bill (Draft Assisted Reproductive values, emphasises biological motherhood
Technology (Regulation) Bill and Rules - and says ‘no’ to commercial surrogacy,
2008) was discussed and a common press whereas the Bill promotes commercial
release emerged demanding that the ICMR surrogacy. Given this contradiction, it is
and the MOHFW (Ministry of Health and unclear where we stand at the moment.
Family Welfare) put up the draft Bill on In this context, this consultation was an
their websites and invite comments on it, opportunity to review the situation regarding
have a larger discussion both at regional ART policy in other countries, in an attempt
levels and at the national level with different to formulate responses and strategies at the
movements, individuals, researchers, health local, regional and global levels. Although
activists, providers, users and civil society the advancement of these technologies
organisations and bring in all the concerns and the related discourses are at different
raised, which are pro-women and protect stages in different countries, it is important
women’s rights and health concerns. to compare and learn from each other’s
experiences.
Sama tried to critique the Bill in detail and
many participants of the current consultation Several issues, as well as several differences,
did so too, independently. Everybody have emerged; even within India, there
sent their critique to the ICMR and to the are different positions on surrogacy, on
Ministry, but there is no information on technologies, on choices and on rights.
how many issues from the Bill have been There is a need for continued alertness,
looked into. A representative of the Ministry preparedness, information sharing and
said that the Bill was already with the Law strategising. Therefore, it is crucial to have
Commission, perhaps implying that it has a platform where we can continue to discuss
been finalised by the MOHFW. There is and debate the commercial, economic and
no way of knowing whether the concerns ethical aspects of Assisted Reproductive
raised have been incorporated because the Technologies. A small group has to be set
Bill, in its final form, was not shared with up to take this issue forward, and it should
anybody, including those who submitted include even those who could not be present
their comments. at this consultation. We hope that this
process of coming together and working
The concern is that the Bill has been together will yield concrete results. We
developed mainly by IVF providers and hope to continue to engage with one other,
not by the people who are engaged with the through consultations and otherwise, so
issue from the ethics movement, women’s these debates can reach out to other activists
movement or public health movement. The within the social sector, academia, as well as
Law Commission came up with its own report the medical and legal fraternity.

106
107
108
109
 Programme

Day 1: 22nd January 2010

The Consultation in Perspective
Anjali and Aastha from Sama and Pramada Menon

Context of Assisted Reproductive Technologies

Objectives of the Consultation
Key Note Address: The Gene Express: Speeding Toward What Future?
Betsy Hartmann

Session 1
Biogenetic Transactions: Politics and Economics
Coordinators: Manisha Gupte and Judy Norsigian
Technology, Markets and the Commoditisation of Life
Amit Sengupta

Biogenetic Futures: Patents and Property, Speculation and Services

Sarah Sexton

Session 2
Global Experiences: Asia Pacific
Coordinators: Mohan Rao and Shree Mulay

From the Cutting Edge to ‘Business as Usual’: What does the future hold for women in
Australia’s mainstreaming of ARTs?
Renate Klein

Assisted Reproductive Technologies at the Crossroads: Neoliberal Economy, National

Depopulation Crisis and the Politics of Reproduction in South Korea
Young-Gyung Paik

110
Session 3
Global Experiences: South Asia
Coordinators: Imrana Qadeer and Farida Akhter

Medecins Sans Frontiers. This day and This way!

Nighat Khan

Assisted Reproductive Technologies in Nepal: A Brief Picture

Pinky Singh Rana

Session 4
Emerging Perspectives and Challenges: Towards a Global Movement
Coordinators: Sandhya Srinivasan and Jyotsna Agnihotri Gupta

Day 2: 23rd January 2010

Session 5
Global Experiences: South Asia
Coordinators: Padmini Swaminathan and Betsy Hartmann
‘Doctor's Babies’: The Scenario of Unregulated Trade over Infertility in Bangladesh
Farida Akhter
Unraveling the Fertility Industry: ARTs in the Indian Context
NB Sarojini
Experimental State, State of Experiments: State, Science, Citizens and Embryonic Stem
Cell Research in India
Aditya Bharadwaj

Session 6
Global Experiences: Middle East and Israel
Coordinators: Malini Bhattacharya and Aditya Bharadwaj
Ova Donation Bill: The Israeli Case
Hedva Eyal
Globalisation and Gametes: Reproductive Tourism, Islamic Bioethics and Middle
Eastern Modernity
Marcia C Inhorn

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Session 7
Global Experiences: US, Canada and The Netherlands
Coordinators: Amar Jesani and Sarah Hodges
Commercialisation of Reproductive and Genetic Technologies: What Lessons for
Biotech Developments around the Globe?
Marcy Darnovsky
Closing the Barn Door after the Horse has Bolted: Canadian Experience with Regulating
Assisted Human Reproduction
Shree Mulay
Bio-crossings and the Global Fertility Market
Jyotsna Agnihotri Gupta

Session 8
Emerging Perspectives and Challenges: Towards a Global Movement
Coordinators: Renu Khanna and Young-Gyung Paik

Day 3: 24th January 2010

Session 9
Global Experiences: Latin America
Coordinators: Renate Klein and Marcia Inhorn
Egg Traffic in Ecuador in the Context of Latin American Reproductive Policy
Elizabeth Roberts
Assisted Reproductive Technologies in Brazil: An Overview of the Scenario and its
Ethical, Legal and Social Challenges
Marilena Correa

Session 10
In Pursuit of Tissues: Global Movement and the Biogenetic Form
Chayanika Shah and Sarah Sexton

Our Bodies Ourselves: The Fertility Industry and Threats to Women’s Health: Creating
a More Coordinated Global Response
Judy Norsigian

Session 11
Challenges and Strategies: Where do we go from here?
Coordinators: Lakshmi Lingam, Marcy Darnovsky, Amit Sengupta
The Way Forward
NB Sarojini

112
 About Sama

Sama is a resource group working on issues analysis within the wider context of other social
of women’s health and rights, which seeks to relations in order to emphasise the complexity
locate the concerns of women’s well being in of existing power relations that work towards
the larger context of socio-historical, economic exclusion and marginalisation.
and political realities. Sama considers health a
fundamental human right and believes that Sama engages with Community Based
the provision of quality and affordable health Organisations, Non Government
care to every citizen is the responsibility of the Organisations, women’s groups and
state. collectives, health networks and coalitions,
autonomous bodies like the National Human
Sama believes that equality and empowerment Rights Commission (NHRC) and National
can be ensured only when poverty, curtailment Commission for Women (NCW), youth,
of capabilities, lack of livelihood rights, lack traditional healers and birth attendants, health
of health services and access to health care, care providers, medical professionals and
illiteracy and multiple forms of discrimination the media. The word Sama means equality
based on caste, class, gender, religion, ethnicity, in Sanskrit, Hindustani and other Indian
sexual orientation and many other rubrics are languages. The logo symbolises balance and
structurally challenged. Our commitment is equality. These are an intrinsic part of Sama’s
to integrate the gender, caste, class and rights philosophy and vision.

113
 Speakers' and coordinators’ profiles

Aastha Sharma works with Sama - Resource He is also one of the founders of the Forum for
Group for Women and Health as a project Medical Ethics Society and its journal, Indian
associate. She holds a Bachelors degree in Journal of Medical Ethics and is presently
Journalism and a Masters in Social Work from on its editorial board. He was national
University of Delhi. She is currently working coordinator of the two National Bioethics
on ARTs through research, policy advocacy, Conferences (2005 and 2007) of the IJME. He
capacity building and material development is on the national faculty of the ICMR for its
and is involved with the Right to Health NIH supported research bioethics training
Campaign, as part of Sama. Previously, she programme and a visiting faculty teaching
worked as a social work trainee at AIIMS bioethics at five institutions in India.
hospital and Project Concern International/
India and did a research project with UNICEF Dr Amit Sengupta is associated with the Delhi
India on girls’ education. Science Forum, a public interest organisation
working on science and technology policy
Dr Aditya Bharadwaj is a lecturer in the School issues. He is trained in medicine, and
of Social and Political Science, University of works on issues related to public health,
Edinburgh. His principal research interest pharmaceutical policy, IPR and other science
is in the global spread of new reproductive, and technology issues. He is the secretary of
genetic, and stem cell bio-technologies. the All India People’s Science Network and is
Aditya has published extensively on these member of the international secretariat of the
subjects and has co-authored the monograph World Social Forum. He is currently the joint
Risky Relations: Family, Kinship and the New convener of Jan Swasthya Abhiyan.
Genetics (Berg, 2006). He is the lead author of
Local Cells, Global Science: The Proliferation Anjali Shenoi, a Masters graduate in
of Stem Cell Technologies in India (Routledge, International Development from the
2009) and is currently completing the research University of Bath, UK, is currently working
monograph Conceptions: Infertility and with Sama - Resource Group for Women and
Procreative Modernity in India (Berghahn Health. She has been engaged with Sama’s
Books, 2010). research on ARTs and has also actively
contributed to advocacy initiatives around
Dr Amar Jesani is managing trustee of the regulation of ARTs in India.
Anusandhan Trust, which manages three
institutions - CEHAT (Centre for Enquiry Dr Betsy Hartmann is the director of the
into Health and Allied Themes) and CSER Population and Development Program
(Centre for Studies in Ethics and Rights) in and professor of Development Studies
Mumbai and SATHI (Support for Advocacy at Hampshire College in Amherst, MA,
and Training to Health Initiatives) in Pune. USA (http://www.BetsyHartmann.

114
com). A longstanding activist in and is a member of Resistance Network, a
the international women’s health movement, network of various women’s organisations
she writes and speaks frequently on the working on issues of women’s health. She is a
intersections between reproductive rights, prolific writer in Bengali and English and has
population, immi-gration, environment a number of publications and research papers
and security concerns in activist, policy and to her credit.
scholarly venues. She is a prolific writer with
many non-fiction books and two political Hedva Eyal is the coordinator of the Women
thrillers to her name. and Medical Technologies project of Isha
L’Isha, Israel. She has worked as the general
Chayanika is an activist in the women’s coordinator of the Haifa Feminist Center from
movement and part of FAOW (Forum Against 2004 until January 2009. She holds a BA in
Oppression of Women) and LABIA (Lesbians Philosophy, an MA in the History of Art, is a
And Bisexuals In Action) in Mumbai. She graduate of the Heschell Center’s Social and
has been working on concerns pertaining to Environmental Leadership programme, and
sexuality rights and has also co-authored We a PhD candidate at the Hebrew University
and our fertility, a book looking into the entire in Jerusalem. Her research is on the issue of
range of reproductive technologies from the regulation and health in Israel at the School
point of view that there is no fundamental for Public Policy and Government.
difference between two kinds (contraceptive
and conceptive) of technologies. Dr Imrana Qadeer is currently senior fellow
at the Centre for Women’s Development
Dr Elizabeth Roberts is assistant professor, Studies in New Delhi. She has taught
Department of Anthropology, University Public Health at the Jawaharlal Nehru
of Michigan. Her work over the years has University in New Delhi for 35 years. She
focused on issues of reproduction, citizenship, is a member of the Standing Committee
IVF, governance in Latin America and the of the University Grants Commission on
Caribbean with a lot of research and scholarly Women’s Studies Centres. Her main interests
work focused on Ecuador. She has written are organisation of health services,  political
prolifically and organised conferences and economy of health, epidemiology, research
presented papers globally on these issues. She methodology, and women’s health.
has professional membership of a number She has written extensively on issues of
of Anthropological Societies and is on the women’s health.
Science, Technology, Medicine Interest Group
of the American Anthropology Association. Judy Norsigian is executive director of
Our Bodies Ourselves, co-author of Our
Farida Akhter is the executive director of Bodies, Ourselves (8th edition, May 2005)
UBINIG (Policy Research for Development and a member of the editorial teams for Our
Alternative) in Bangladesh (www.ubinig. Bodies, Ourselves: Menopause (2006) and
org). She has been active in the national Our Bodies, Ourselves: Pregnancy and Birth
level women’s movement in Bangladesh (2008). She speaks and writes frequently on
since 1985. Farida is a council member of a wide range of women’s health concerns,
Asian Women’s Human Rights Council, is including abortion and contraception,
involved actively with FINRRAGE (Feminist sexually transmissible infections, genetics
International Network for Resistance Against and reproductive technologies, body image,
Reproductive and Genetic Engineering), tobacco and women, women and health care

115
reform, and midwifery advocacy. She has and a professor in Jadavpur University in
appeared on numerous national television Kolkata. She has been a member of Parliament
and radio programs and currently serves as and a member of the National Commission
a board member for Public Responsibility in for Women. She is currently a member of
Medicine and Research. State Planning Board, West Bengal, Vice-
Chairperson of Folk and Tribal Cultural
Dr Jyotsna Agnihotri Gupta is currently Centre, West Bengal and member of West
senior lecturer in Gender and Diversity at Bengal State Commission for Women.
the University for Humanistics in Utrecht,
and affiliated fellow at the International Manisha Gupte is a veteran of the women’s
Institute of Asian Studies, Leiden University, movement in India, and has been involved
in the Netherlands. She is the author of New with issues related to health, sexuality,
Reproductive Technologies, Women’s Health reproductive rights, human rights and
and Autonomy: Freedom or Dependency? violence for over 30 years. Manisha is the
(Sage, 2000) and several articles published in founder trustee and co-convener of MASUM
books and scientific journals on population (Mahila Sarvangeen Utkarsh Mandal) and
and development issues, new reproductive managing trustee of Medico Friend Circle.
technologies, including genetics, women’s She was co-ordinator for the 10th International
health and autonomy, and bioethics, based Women and Health Meeting, held in Delhi in
on empirical research in India and the 2005, and has also been a visiting scholar at
Netherlands. Since 2007 she is a member of the Johns Hopkins University, USA and senior
board of Feminist Approaches to Bioethics. research officer at CEHAT and FRCH. She has
worked with the government of Maharashtra,
Dr Lakshmi Lingam is a professor in the Planning Commission, National Commission
Centre for Women’s Studies at the Tata for Women and NRHM on policy issues.
Institute for Social Sciences, Mumbai, India. She is the recipient of several awards and
In 2004-05, as a FullBright/New Century citations, including the ‘Diwaliben Mehta
scholar, she worked on the program titled Award’ for long-term commitment to social
‘Global Empowerment of Women’. She issues, given by the former president of India
was also a visiting scholar at the Centre R Venkatraman.
for Education of Women, University of
Michigan, Ann Arbor (2003), a resource Dr Marcia C Inhorn is the William K
person at the International Training Program Lanman Jr Professor of Anthropology and
of Uppsala University, Sweden (2000-02) and International Affairs in the Department of
the Institute of Social Studies, the Hague, Anthropology and The Whitney and Betty
Netherlands (2002). She is a curriculum MacMillan Center for International and
advisory board member of several women’s Area Studies at Yale University. A specialist
studies departments in Indian universities as on Middle Eastern gender and health issues,
well as technical and ethical advisory board Marcia has conducted research on the social
member of NGOs. She has also contributed impact of infertility and assisted reproductive
to gender and equity mainstreaming activities technologies in Egypt, Lebanon, the United
of government departments in a number of Arab Emirates, and Arab America over the
states in India. past 20 years. She has published extensively
and is the founding editor of JMEWS (Journal
Dr Malini Bhattacharya was the former of Middle East Women’s Studies) of the
director of the School of Women’s Studies Association of Middle East Women’s Studies,

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and co-editor of the Berghahn Book series on extensively on health and population policy
Fertility, Sexuality and Reproduction. and on the history and politics of health and
family planning. He is the author of From
Dr Marcy Darnovsky is associate executive Population Control to Reproductive Health:
director at the Center for Genetics and Malthusian Arithmetic (Sage, 2004) and has
Society (www.genetics-and-society. edited Disinvesting in Health: The World
org), a Berkeley, California-based public Bank’s Health Prescriptions (Sage, 1999) and
affairs organisation working to encourage The Unheard Scream: Reproductive Health
responsible uses and effective societal and Women’s Lives in India (Zubaan/Kali
governance of reproductive and genetic bio- for Women, 2004). His new volume, co-
technologies. She  speaks and writes widely edited with Sarah Sexton entitled Markets
on human bio-technologies, focusing on and Malthus: Gender, Population and Health
their social justice, human rights, health in Neoliberal Times (Sage) is forthcoming.
equity, and public interest implications. He has been a member of the National
She has appeared on national television and Population Commission and is actively
radio, and been cited in hundreds of news involved with the Jan Swasthya Abhiyan. 
and magazine articles. Her PhD is from the
History of Consciousness program at the Dr Nighat Khan runs the Fertility Advisory
University of California, Santa Cruz. Center in Karachi. She is also affiliated
with the Department of Bioethics, Aga
Dr Marilena Correa is lecturer at the Social Khan University, Karachi for many years.
Medicine Institute of the State University She received her primary medical degree
of Rio de Janeiro. She is a public health in Pakistan and completed her PhD in
specialist (National School of Public Health Reproductive Biology in England. She has
of the Oswaldo Cruz Foundation, 1985). She worked as a postdoctoral clinical scientist
holds a Masters in Public Health (1992) and in the Assisted Reproductive Unit at Kings
a PhD in Humanities and Health Sciences College, London and also at the Center for
(1997) from the State University of Rio de Human Reproduction in Chicago, USA.
Janeiro. During her doctorate she had a
scholarship from the Brazilian Council for Dr Padmini Swaminathan is professor
Scientific and Technological Development and Reserve Bank of India Chair in
for a 16-months programme on medical Regional Economics at the Madras Institute
sociology at the Ecole des Hautes Etudes en of Development Studies, Chennai, Tamil
Sciences Sociales, in Paris. She is member of Nadu, India. Padmini’s work provides a
the Brazilian Association of Public Health multi-disciplinary focus to her research
(Abrasco), Brazilian Association of Bioethics interests that now cover and explore the
(SBB); International Sociological Association linkages between the themes of industrial
(ISA); Feminist Approaches to Bioethcis organisation, labour, education and health
Network (FaB); and the International – all from a gender perspective. She actively
Association of Bioethics (IAB).  serves on the editorial boards of several
academic journals and also does work for
Dr Mohan Rao is professor at the Centre provincial and central government bodies
of Social Medicine and Community Health, such as the Tamil Nadu State Statistical
School of Social Sciences, Jawaharlal Nehru Committee, the High Court of Madras,
University, New Delhi. A medical doctor the Central Planning Commission, to name
specialised in public health, he has written a few.

117
Pinky Singh Rana did her Masters in was associate professor in Women’s Studies
Political Science, and has been involved in at Deakin University, Melbourne, Australia
the development sector since 1994, with where she developed and taught an MA course
particular focus on conceptualisation, in Reproductive Medicine and Feminist
design and implementation of development Ethics. She has also written extensively on
programmes on sexual and gender based reproductive technologies.
violence, reproductive health, malnutrition,
trafficking and women’s employment. She Renu Khanna is a feminist activist and
has worked extensively in Western Nepal, the founder trustee of SAHAJ (Society
one of the poorest regions of the country. for Health Alternatives). She has over 25
She is associated with the Safe Motherhood years of experience in gender and health
Network, and is currently with SAATHI, care management and in training various
Nepal. levels of health care and social development
professionals and para-professionals. She
Pramada Menon is a queer, feminist activist is engaged in the application of behavioural
and an independent consultant working sciences to organisations and the institutional
on issues of sexuality, sexual rights, gender, development of voluntary and more recently
violence against women, organisational public sector organisations. She is part of
development and livelihoods for more than several interdisciplinary groups working on
two decades. She is the co-founder of CREA, women’s health and rights issues and has co-
an international women’s human rights edited and co-ordinated the publication of
organisation and worked as the Director several books like Women, Healing and Plants
Programs of the organisation from 2000 by Shodhini and Towards Comprehensive
– 2008. Before co-founding CREA, she Women’s Health Programmes and Policy,
was the executive director of Dastkar, an a volume of papers written by eminent
organisation working to ensure sustainable researchers and activists.
livelihoods for craftspeople. She has been
very active in the sexual rights movement in Sandhya Srinivasan is a freelance journalist
India and internationally. She is also a stand and consultant. She writes on health and
up performance artist and does a show ‘Fat, development for various publications and
Feminist and Free’, which examines issues websites, and was a Panos Reproductive
of gender, sexuality, sexual rights and body Health Media Fellow in 1998, writing on
image through a series of humorous stories the infertility industry in India. She is
based on her life. consulting editor, public health, for the
development website www.infochangeindia.
Dr Renate Klein holds an MSc from Zürich org and commissioning editor for www.
University, a BA (Honours) in Women’s hivaidsonline.in, both managed by the Centre
Studies from the University of California at for Communication and Development
Berkeley and a PhD in Sociology of Education Studies. Sandhya is executive editor of the
from the University of London. She is a Indian Journal of Medical Ethics, member
founding member of FINRRAGE (Feminist of the editorial board of Developing World
International Network of Resistance to Bioethics, and member of the faculty of the
Reproductive and Genetic Engineering) and Centre for Studies in Ethics and Rights. In
CATWA (The Coalition against Trafficking 2002, she was awarded the Ashoka Fellowship
in Women, Australia). Until August 2006 she for her work in medical ethics.

118
Dr Sarah Hodges is associate professor in Swasthya Abhiyan, and the ex convenor of
the Department of History, University of Medico Friend Circle. She co-coordinated
Warwick, UK. She is author of Contraception, the MFC fact finding committee that studied
Colonialism and Commerce: Birth Control the health impact of the Gujarat riots of 2002
in South India, 1920-1940 (2008),  editor and contributed to the report, ‘Carnage in
of Reproductive Health in India: History, Gujarat: A Public Health Crisis’.
Politics, Controversies (2006) and co-editor of
the 2009 Women’s Studies Quarterly Special Dr Shree Mulay is the associate dean of
Issue on Technologies. She is currently the Community Health and Humanities
spending a sabbatical year in Chennai, Division in the Faculty of Medicine at
working on her current project, ‘Biotrash: Memorial University of Newfoundland,
Medical Garbage, Bodily Economies and Canada. She is the former director of the
the Making of New Chennai.’ This project McGill Centre for Research and Teaching on
investigates the commoditisation of health Women (1996-2007). Shree’s more recent
research has focused on women’s health; one
under neoliberalism by tracing the economic
such research done with Dr Navsharan Singh
afterlives of items routinely discarded in
on Informed Consent and Contraceptive
clinical encounters, such as disposable
Trials: Implications for Human Rights of
syringes and umbilical cord blood.
Women investigated the experiences of
women with non-surgical sterilisation
Sarah Sexton works with The Corner House,
method and their understanding of
a non-profit research and solidarity group
informed consent. Shree has published
based in the United Kingdom, which focuses
about 70 peer-reviewed scientific papers,
on a wide range of environmental and social
several reviews and chapters in books. She
justice issues. In the past few years, she has
has also written several op-ed pieces for
written and edited several books and articles
newspapers and magazines and on refugees
on various intersections between health,
and immigrants and women’s health and
genetic and reproductive technologies, trade, new reproductive technologies.
population thinking, foreign investment and
refugee issues. Dr Young-Gyung Paik is affiliated with
the Program in History and Philosophy of
NB Sarojini has been working on women’s Science at Seoul National University, as a post
health and rights for many years and is doctoral fellow for the research team for the
the director of Sama - Resource Group for Education of Human Resources in Science,
Women and Health. She is involved in the Technology, Society and Culture. Her PhD in
coordination of a national level research Anthropology from Johns Hopkins University,
on reproductive technologies and their Baltimore, USA was on Technologies of ‘the
implications on women. She has co-authored Korean Family’; Population Crisis and the
‘Women’s Right to Health’, published by Politics of Reproduction in Contemporary
the National Human Rights Commission, South Korea. Young-Gyung also teaches
contributed to the Political Science Textbook courses on ethics, culture and bio-technology
for class VII by the National Council of at Korea Advanced Institute of Science and
Educational Research and Training, and co- Technology (KAIST) and has served as a
authored a book, Touch me, Touch me not: coordinator of the International Forum on
Women, Plants and Healing (Kali for Women, Biotechnology and Human Rights of Women,
1997). She is also the joint convenor of Jan hosted by the Korean WomenLink in 2006.

119
 Participants

1. Aastha Sharma 6. Amit Sengupta

Sama - Resource Group for Women and Health Delhi Science Forum
B- 45 Main Road Shivalik D-158, Lower Ground Floor
Malviya Nagar Saket
New Delhi New Delhi-110017
Phone: 011 – 26692730/65637632 Phone: 011-26862716, 26524342
Email: sama.womenshealth@gmail.com Email: ctddsf@vsnl.com

2. Abha Bhaiya 7. Anchita Ghatak

Jagori Grameen Kolkata
Sidhbari Rakkar Road Mobile: +91-98303-26101
District Kangra Email: anchita.ghatak@gmail.com
Himachal Pradesh 176057
Phone: 01892-246857 8. Anjali Shenoi
Email: info@jagorigrameen.org Sama - Resource Group for Women and Health
B- 45 Main Road Shivalik
3. Aditya Bharadwaj Malviya Nagar
School of Social & Political Science New Delhi
University of Edinburgh Phone: 011 – 26692730/65637632
6.24 Chrystal Macmillan Building Email: sama.womenshealth@gmail.com
15A George Square
Edinburgh EH8 9LD 9. Antony Kurian
Scotland, United Kingdom Sama- Resource Group for Women and Health
Phone: + (0) 131 651 3861 B- 45 Main Road Shivalik
Email: adi.bharadwaj@ed.ac.uk Malviya Nagar
New Delhi
4. Ajitha S.George Phone: 011 – 26692730/65637632
Omon Mahila Sangathan Email: sama.womenshealth@gmail.com
Village - Duccasai
P.O Noamundi, Chaibasa 10. Anu Gupta
West Singhbhum-833217 Eklavya
Jharkhand 33 Saket Nagar
Phone: 06582-256416/256159 Dewas 455001
Email: ajithasg@gmail.com Madhya Pradesh
Phone: 07272 – 223496
5. Amar Jesani Email: anuarvindbali@gmail.com
Indian Journal of Medical Ethics
Trustee, Anusandhan Trust 11. Arathi P.M.
Sai Ashray, Aaram Society Road Centre for Social Medicine and Community Health
Vakola, Santacruz East School of Social Sciences
Mumbai 400055 Jawaharlal Nehru University
Phone: 022- 2666 1176 New Delhi- 110067
Email: amar.jesani@gmail.com Mobile: 91-98684-13141
Email: arathipm@gmail.com

120
12. Ashok Yadav 18. Chayanika Shah
Sama- Resource Group for Women and Health Forum Against Oppression of Women
B- 45 Main Road Shivalik 19, Bhatia Bhavan
Malviya Nagar Babrekar Marg
New Delhi Dadar (West)
Phone: 011 – 26692730/65637632 Mumbai- 400028
Email: sama.womenshealth@gmail.com Phone: 022- 24010482
Email: chayanikashah@gmail.com
13. Atul Sood
Centre for the Study of Regional Development 19. Chandana Anusha
Jawaharlal Nehru University Student
New Delhi- 110067 University of Delhi
Phone: 26704573/26704463 Mobile: 9810231995
Email: atulsood61@gmail.com, atulsood@mail.jnu. Email: chandana.anusha@gmail.com
ac.in
20. Daisy Dharmaraj
14. Beenu Rawat TEST Foundation
Sama- Resource Group for Women and Health 4 Sathalvar Street, Mugappair West
B- 45 Main Road Shivalik Chennai 600037
Malviya Nagar Tamil Nadu
New Delhi Phone: 044-26244211/26244100
Phone: 011 – 26692730/65637632 Email: daisy.dharmaraj@gmail.com
Email: sama.womenshealth@gmail.com
21. Deepa Venkatachalam
15. Betsy Hartmann Sama- Resource Group for Women and Health
CLPP, Hampshire College B- 45 Main Road Shivalik
Amherst, MA 01002. Malviya Nagar
USA New Delhi
Phone: 413-559-6046 Phone: 011 – 26692730/65637632
Email: bhartmann@hampshire.edu Email: sama.womenshealth@gmail.com

16. Bhawna Rawat 22. Dharashree Das

Sama- Resource Group for Women and Health Simon Fraser University
B- 45 Main Road Shivalik 515 West Hastings Street
Malviya Nagar Vancouver, B.C.
New Delhi Canada V6B 5K3
Phone: 011 – 26692730/65637632 Phone: 778.782.5000
Email: sama.womenshealth@gmail.com Email: dharashree30@rediffmail.com, dharashreedas@
yahoo.co.in
17. Bijoya Roy
Centre for Women and Development Studies 23. Dina Siddiqi
25, Bhai Vir Singh Marg Center For Gender, Sexuality and HIV/AIDS
Gol Market James P. Grant School of Public Health
New Delhi- 110001 BRAC University
Phone: 011- 23366930, 23345530, 23365541 66 Mohakhali
Email: bijoya@cwds.ac.in, Dhaka 1212
bijoyaroy@gmail.com Bangladesh.
Phone: +88 (02) 8824051-4 (PABX) (Information
Desk ext. 4003), +88 (02) 8853948-9
Email: dmsiddiqi@yahoo.com

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24. Elizabeth F. S. Roberts 30. Jashodhara Das Gupta
University of Michigan SAHAYOG
Department of Anthropology C-153, Golf View Apartments
The Residential College Saket
108 West Hall New Delhi-110017
1085 South University Avenue Phone: 011-2685 1101
Ann Arbor, USA Email: jashodhara@sahayogindia.org
Phone: 734-936-0642
Email: lfsrob@umich.edu 31. Jaya Sagade
ILS Law College
25. Farida Akhter Law College Road
U B I N I G, Pune- 411004
22/13 Khiljee Road, Block-B Maharashtra
Mohammedpur Mobile: +91-9890003149
Dhaka-1207 Email: sagade@gmail.com
Bangladesh.
Phone: 880-2-8111465 / 8116420 32. Jayeeta Chowdhury
Email: kachuripana@gmail.com Mumbai
Phone: 022-42155431
26. Hedva Eyal Email: jayeetachowdhury@gmail.com,
Coordinator jaye_ch9@yahoo.com
Women and Medical Technologies
Isha L'Isha- Haifa Feminist Center 33. Jennifer Liang
118 Arlozorov The Action Northeast Trust
St.Haifa 33276 Udangshri Dera
Israel Rowmari, via Bongaigaon
Phone :+972 4 865 0977 or +972 4 866 0951 Distt CHIRANG (BTAD)
Email: wmt.isha@gmail.com Assam 783380
Website: www.isha.org.il Phone: 03664 293802 / 293803
Email: jenniferliang07@gmail.com
27. Imrana Qadeer
C-4/111, Safdarjung Development Area 34. Judy Norsigian
New Delhi- 110016 Our Bodies Ourselves
Phone: 011- 26510824 5 Upland Rd, Suite 3
Email: imranaqadeer@gmail.com Cambridge, MA 02140
USA
28. Indu Agnihotri Phone: 617-245-0200 x11
Centre for Women and Development Studies Email: judy@bwhbc.org
25, Bhai Vir Singh Marg
Gol Market 35. Jyotsna Agnihotri Gupta
New Delhi- 110001 Gender and Diversity
Phone: 011-23365541, 23345530 University for Humanistics
Email: indu@cwds.ac.in Utrecht
The Netherlands
29. Janaki Email: jagupta@tiscali.nl
J 291 1st Floor
Saket 36. Kamla Bhasin
New Delhi Sangat
Phone: 011- 29551384 B-114 Shivalik, Malviya Nagar
New Delhi 110 017
Phone: 011 - 2669 1219, 2669 1220
Email: kamlabhasin@gmail.com,
kamla@sangatsouthasia.org

122
37. Kiran Ambwani 43. Marcia C. Inhorn
Ministry of Health and Family Welfare Government Yale University, Department of Anthropology
of India 10 Sachem Street
Family Planning Section P.O. Box 208277
Nirmaan Bhawan New Haven, CT 06520-8277
New Delhi USA
Telex: 231-65413 Phone: 203-432-4510
Email: marcia.inhorn@yale.edu
38. Kranti
Vasant View A wing, flat 201 44. Marcy Darnovsky
D’Monte Lane Center for Genetics and Society
Malad (West) 1936 University Avenue, Suite 350
Mumbai Berkeley, CA 94704
Phone: 022-28886237 USA
Email: krantijean@gmail.com Phone: 510-625-0819 ext 305
Email: mdarnovsky@geneticsandsociety.org
39. Lakshmi Lingam
Centre for Women's Studies 45. Marilena C. D. V. Correa
Tata Institute of Social Sciences The Social Medicine Institute
Deonar State University of Rio de Janeiro
Mumbai- 400088 Brazil
Phone: 022- 25525311 Phone: +5521 22252853, 86691957
Email: lakshmi.lingam@gmail.com Email: mcorrea@ism.com.br

40. Malini Bhattacharya 46. Mira Shiva

West Bengal Commission for Women Institute for Health Equity and Society/AIDAN/
Kolkata IPHC/Diverse Women for Diversity (South Asia)
Email: mihirmalini@gmail.com, A-60, Hauz Khas
wbcw@vsnl.net New Delhi- 100014
Phone: 011-25612385
41. Manisha Gupte Email: mirashiva@yahoo.com
MASUM
B-1, Flat No. 41-44 47. Mohan Rao
Kubera Vihar, Gadital, Centre of Social Medicine and Community Health
Hadapsar Jawaharlal Nehru University
Pune -411 028 New Delhi – 110067
Maharashtra Phone: 011-2674-2730
Phone: 020- 26995625/33 Email: mohanrao2008@gmail.com
Email: manishagupte@gmail.com
48. Mohana Chaterjee
42. Manjeer Mukherjee SAHAYOG
Lonavala Delhi
India Mobile: 91-9873719291
Mobile: +91-9637821728 Email: mohana@sahyogindia.org
Email: contactmanjeer@gmail.com
49. Morissa Zuckerman
Student
USA

123
50. Navsharan Singh 56. Pallavi Sobti-Rajpal
International Development Research Centre Utthan
208 Jorbagh 36, Chitrakut Twins
New Delhi-110003 B/h Management Enclave
Phone: 011-24619411 Nehru Park, Vastrapur
Email: rbaksh@idrc.ca, nsingh@idrc.org.in Ahmedabad
Gujarat 380015
51. Neha Madhiwalla Phone: 079 - 26751023, 26732926
Centre for Studies in Ethics and Rights Indian Journal Email: pallavisr@gmail.com, utthan.ahmedabad@
of Medical Ethics gmail.com
501, Dalkhania House, B Wing
Behind State Bank of India 57. Pinky Singh Rana
Nehru Road, Vakola Pipe Line SAATHI Nepal
Santacruz (East) Ekantakuna, Lalitpur,
Mumbai – 400 055 Kathmandu
Phone: 022 - 2668 1568 Nepal
Email: nmadhiwala@gmail.com Phone: 00977-9841-20-1897
Email: pinky_s_rana@hotmail.com
52. Nighat Khan
C/o Dr. Murad M Khan 58. Prabha Nagaraja
Dept of Psychiatry Talking About Reproductive and Sexual Health Issues
Aga Khan University A 91 Amritpuri, 1st Floor
Stadium Rd, PO box 3500 (Opposite ISKCON Temple)
Karachi-74800 East of Kailash
Pakistan New Delhi -110 065
Phone: 92-21-34934294, 92-21-34932095 Phone: 011- 26474022/ 011- 26474023
Email: nighatkhan21@hotmail.com Email: tarshi@vsnl.com,
prabha@tarshi.net
53. Nilangi
SATHI-CEHAT 59. Prabhakar Shreshtha
Flat no 3-4, Aman E Terrace Center for Research on Environment Health and
Dahanukar Colony, Kothrud Population Activities
Pune 411038 Kusunti Lalitpur
Maharashtra PO Box 9626
Phone: 020-25452325, 25451413 Kathmandu
Email: nilangi_nanal@yahoo.com Nepal
Email: prabhakar@crehpa.org.np
54. Padmini Swaminathan
Madras Institute of Development Studies 60. Pramada Menon
79, 2nd Main Road, Gandhinagar, Adyar C-81, Sushant Apartment
Chennai 600 020 Sushant Lok, Phase -1
Phone: 044-2-4412295/4412589 Gurgaon- 122001
Email: pads78@yahoo.com Haryana
Mobile: 9810215148
55. Pakhi De Email: pramadam@gmail.com
J 291 1st Floor
Saket 61. Preeti Nayak
New Delhi Sama- Resource Group for Women and Health
Phone: 011- 29551384 B- 45 Main Road Shivalik
Email: pakhi2001@gmail.com, Malviya Nagar
New Delhi
Phone: 011 – 26692730/65637632
Email: sama.womenshealth@gmail.com

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62. Priya Ranjan 68. Ramila Bisht
Centre for Social Medicine and Community Health Centre of Social Medicine and Coomunity Health
School of Social Sciences Jawaharlal Nehru University
Jawaharlal Nehru University New Delhi- 110067
New Delhi- 110067 Mobile: 91- 9868-270702
Mobile: 91-995884-3320 Email: ramila.bisht@gmail.com
Email: priyaranjanmuni@gmail.com
69. Ranjan De
63. Priya Suman Magic Lantern Foundation
Student J 1881 Basement
University of Pune Chittaranjan Park
Email: priyasuman@hotmail.com New Delhi 110019
Phone: 011 41605239, 26273244
64. Radhika Chandiramani Email: ednajnar@gmail.com
Talking About Reproductive and Sexual Health Issues
A 91 Amritpuri, 1st Floor 70. Renate Klein
(Opposite ISKCON Temple) PO BOX 920
East of Kailash North Melbourne
New Delhi -110 065 Victoria 3051
Phone: 011- 26474022/ 011- 26474023 Australia
Email: tarshi@vsnl.com Phone: +61438002979
Email: rklein@netspace.net.au
65. Rajashri Dasgupta
218 B lake Terrace Extension 71. Renu Khanna
Calcutta 700029 SAHAJ
West Bengal 1, Tejas Apartment
Phone: 033-24661759/6060 53 Haribhakti Colony
Email: rajashridasgupta@gmail.com Old Padra Road
Rajashri_dasgupta@yahoo.com Baroda- 390007
Gujarat
66. Rajesh K Phone: 0265-2340223 /2333438
Centre for Studies in Science Policy Email: sahajbrc@icenet.co.in
School of Social Sciences
Jawaharlal Nehru University 72. Renuka Mukadam
New Delhi- 110067 Sama- Resource Group for Women and Health
Mobile: +91-98999-33487 B- 45 Main Road Shivalik
Email: rajesh.wdr@gmail.com Malaviya Nagar
New Delhi
67. Ramesh Awasthi Phone: 011 – 26692730/65637632
MASUM Email: sama.womenshealth@gmail.com
B-1, Flat No. 41-44
Kubera Vihar, Gadital 73. Ritwik De
Hadapsar J 291 1st Floor
Pune -411 028 Saket
Maharashtra New Delhi
Phone: 020-26995625/33 Phone: 011- 29551384
Email: rameshawasthi@gmail.com Email: ritzokoe@hotmail.com

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74. Rukmini Datta 80. Sarah Sexton
2E 301 Great Eastern Links The Corner House
Ram Mandir Road Station Road
Goregaon (W) Sturminster Newton
Mumbai- 400104 Dorset DT101 YJ
Mobile: +91-98203 83366 United Kingdom
Email: rukmini.datta@gmail.com Phone: 44 (0) 1258 473795
Email: sarahsexton@gn.apc.org
75. Rukmini Sen
Centre for Women’s Development Studies 81. NB Sarojini
25, Bhai Vir Singh Marg Sama- Resource Group for Women and Health
Gol Market B- 45 Main Road Shivalik
New Delhi- 110001 Malviya Nagar
Mobile: 91-901350 – 3666 New Delhi
Email: senrukmini18@gmail.com Phone: 011 – 26692730/65637632
Email: sama.womenshealth@gmail.com
76. Sabala
Forum Against Oppression of Women 82. Satish Kumar Singh
Vasant View A wing, Flat 201 MASVAW, CHSJ
D’Monte Lane, Malad (West) D-63 Basement
Mumbai Saket
Phone: 022-28886237 New Delhi – 110017
Email: sabalsing@gmail.com Phone: 011 – 40517478, 26111425
Email: chsj@chsj.org,
77. Salai Selvam satish@sahayogindia.org
5/640 Bharatipuram, Karupayurani
Madurai - 20 83. Shalini Singh
Tamil Nadu CREA
Mobile: +91-944-388-1701 7 Mathura Road, 2nd Floor
Email: saalaiselvam@gmail.com Jangpura B
New Delhi – 110014
78. Sandhya Srinivasan Phone: 011 2437770724378701 (Extn. 19)
8 Seadoll Email: ssingh@creaworld.org
54, Chimbai Road
Bandra (West) 84. Shalini Yog
Mumbai-400050 Programme Coordinator
Phone: 022-26400607 Heinrich Boll Foundation
Email: sandhya@bom3.vsnl.net.in C-20, First Floor, Qutub Institutional Area
New Delhi – 110016
79. Sarah Hodges Phone: 011- 2685 4405, 2651 6695
History Department Email: shalini.yog@hbfasia.org
University of Warwick
Coventry CV4 7AL 85. Shree Mulay
United Kingdom Associate Dean and Professor
C/o MIDS, Chennai Community Health and Humanities Division
Phone: +44 2476 523451 Faculty of Medicine
Email: s.hodges@warwick.ac.uk Room 2843, Health Sciences Centre
300 Prince Philip Drive
St. John's NL A1B 3V6
Canada
Phone : 709-777-8939
Email: shree.mulay@med.mun.ca

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86. Smitha 93. Suneeta Dhar
Jawaharlal Nehru University JAGORI
New Delhi- 110067 B-114, Shivalik
Mobile: 91-97177-40701 Malviya Nagar
Email: smitha.sps@gmail.com New Delhi – 110017
Phone: 011 2669 1219/20
87. Sneha Mishra Email: jagori@jagori.org
AAINA suneeta.dhar@gmail.com
N-6/298, Jaydev Vihar
Bhubaneswar- 751015 94. Susan Hawthorne
Orissa Victoria University
Phone: 0674-2550100 PO Box 920
Email: aaina50@hotmail.com North Melbourne
Victoria- 3051
88. Sonvi Kapoor Australia
International Centre for Research on Women Phone: 61418506645
C – 139 Defence Colony Email: hawsu@spinifexpress.com.au
New Delhi – 110024
Phone: 011-2465-4216 95. Susheela D Singh
Email: info.india@icrw.org, skapoor@icrw.org Sama- Resource Group for Women and Health
B- 45 Main Road Shivalik
89. Sonya Gill Malviya Nagar
AIDWA New Delhi
Mumbai Phone: 011 – 26692730/65637632
Mobile: +91-9869250126 Email: sama.womenshealth@gmail.com
Email: gill.sonya1@gmail.com
96. Svetha Venkataram
90. Sreekala Sama- Resource Group for Women and Health
JN Borooah Lane B- 45 Main Road Shivalik
Jorpulchuli Malviya Nagar,
Guwahati -1 New Delhi
Assam Phone: 011 – 26692730/65637632
Phone: 0361- 2631582 Email: sama.womenshealth@gmail.com
Email: sreekala@northeastnetwork.org
97. Vaishali Sinha
91. S Srinivasan Independent Filmmaker
Low Cost Standard Therapeutics USA
Ist floor, Premanand Sahitya Sabha Mobile: 347 623 2076
Dandia Bazar Email: sinha.vaishali@gmail.com
Baroda- 390001
Gujarat 98. Varada Madge
Phone: 0265-2413319 Jawaharlal Nehru University
Email: sahajbrc@youtele.com New Delhi- 110067
locostbrd@satyam.net.in Mobile:9818923950
Email: v_madge@rediffmail.com
92. B Subha Sri
Reproductive Health Clinic 99. Vasudha Mohanka
Rural Women's Social Education Centre NARI
Tamil Nadu Pune
Mobile: +91-9840-260-715 Maharashtra
Email: subhasrib@gmail.com Mobile: +91-937-020-4378
Email: vasudha.mohanka@gmail.com

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100. Vineeta Bal 102. Yamini Mishra
Saheli Women's Resource Centre Centre for Budget and Governance Accountability
Above Unit 105-108 Second Floor, A-11 Niti Bagh
Defence Colony Flyover Market New Delhi-110 049
New Delhi 100 024 Phone: 011-417 412 85/86/87
Email: vineetabal@yahoo.com Email: yamini.mishra@gmail.com

101. Vrinda Marwah 103. Young Gyung Paik

Sama- Resource Group for Women and Health Korean WomenLink
B- 45 Main Road Shivalik 3F Naru, 249-10
Malviya Nagar Seongsan-dong, Mapo-gu
New Delhi Seoul 121-847
Phone: 011 – 26692730/65637632 Korea
Email: sama.womenshealth@gmail.com Phone: + 821034755624
Email: yg.paik@gmail.com

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Sama is a Delhi based resource group working on issues of women’s rights and health.
Sama seeks to locate the concerns of women’s health in the context of socio-historical,
economic and political realities, and find linkages between women’s well being and
livelihoods, food, violence and other larger issues that affect their lives. Sama has been
working closely with community based organisations, health networks, people’s
movements, women’s groups and health care providers across the country, primarily
through building capacities, action research and advocacy.

Sama
Resource Group for Women and Health