In 2018, three news stories about assisted reproductive technologies (ART) — treatments used to assist people in achieving a pregnancy — made headlines in three different parts of the world.
In Stellenbosch, a testicular sperm extraction surgery was performed on a 38-year-old man with testicular failure to achieve the first successful pregnancy of this kind in South Africa. In Barcelona, fertility experts discussed a new computer app that would allow a woman to ask for a perfectly matched egg by taking a selfie. A computer algorithm would take detailed measurements of the woman’s face and search through its memory banks to find the face of an egg donor she most resembles. In Australia, a 50-year-old woman gave birth to twins using eggs from a South African university student and sperm from a Danish sperm bank in a “process like online dating”.
These reports are startling, but what if we go beyond the sensational to open up a much-needed discussion about these new technologies?
There is limited literature that addresses assisted reproduction in Africa partly because of the assumption that such technologies are unsuitable for and unavailable in our low-resource circumstances. Fertility control through contraception, rather than assisted fertility, is assumed to be more relevant for our continent.
But the continent’s societies are pronatalist, with immense social, economic and religious imperatives to reproduce. Additionally, many African countries with high fertility rates continue to have high (secondary) infertility rates, especially because of untreated post-abortion and postpartum infections.
The burden of “failed fertility” falls almost exclusively on women, causing sociopsychological and even physical harm. In South Africa, the increasing incidence of new technologies in reproduction are linked to demand for this because of factors such as increased infertility and the social stigma of being childless.
But it is also connected to other factors, such as “medical tourism”. With the neoliberalisation of healthcare and the rise of private-sector corporate hospitals, the country has become a hot spot for patients and clients from all parts of the world.
South Africa is the continent’s top destination for medical travel and a popular destination for “egg safaris”, which bring patients from Europe and North America to be matched with South African egg and sperm providers.
Although the history of egg provision in South Africa can be traced to the 1980s, in the first two decades the egg provider was typically a family member. In 2004, this changed when an enterprising American woman establishing an agency to pair South African egg providers with clients from abroad.
In the past decade, many such agencies have emerged, which provide a database of potential egg providers to recipients both in South Africa and those from abroad.
In the past decade, a related but new phenomenon has emerged — egg providers travelling abroad to fertility clinics around the world. Medical professionals, under the professional society known as the South African Society for Reproductive Medicine and Gynecological Endoscopy (Sasreg) do not favour this, however, because young and naive South African women can be duped and end up in risky situations.
This anxiety was realised in 2009 when one provider returned from India with ovarian hyper-stimulation syndrome. Although she recovered, Sasreg went on to impose an effective ban on local agencies co-ordinating such overseas trips. But women continue to travel with exclusively global egg agencies, which have no visible local base.
In April 2016, some young South African women posted their egg travel stories on social media, with the hashtag #IwasNOTEggsploited. The women shared their stories about travelling to Thailand and India to “donate” their eggs, partly in response to a Carte Blanche television episode that had focused on the risks involved in such pursuits.
The young women claimed that they were not exploited. They echoed the sentiments of almost all egg providers I have interacted with in the past eight years of my research — that in providing eggs they make well-researched, informed decisions, and the only risk is of getting involved with a fraudulent global egg agency.
My interviews with egg agency owners, managers, egg providers and fertility professionals reveal a multitude of complex and contrasting views about these trips abroad. Although fertility (almost all male) professionals seek to protect the young female egg provider from potential harm from unsafe medical techniques and assumed unhygienic clinics abroad, agency owners reaffirmed their role and responsibility in ensuring the safety of egg providers.
The young egg providers, in turn, discussed many motivations, such as a sense of adventure, the desire for an all-expenses-paid exotic vacation, extra pocket money and the added attraction of doing good and helping a couple in need of eggs.
Many of the women are repeat donors, women who have done it several times, in several beautiful and exotic locations around the world — egg provision is their passport to see the world.
The women’s reasons are a critical counterargument to the “eggsploitation” narrative and those who advocate a ban on such travels. The “revolutionary” nature of these technologies cannot be underplayed — they challenge our heteronormative assumptions about what constitutes parenthood and allow many who would not be able to conceive, for medical or social reasons, to have genetic babies of their own.
But let us celebrate these revolutions with caution. Who are the consumers of these new technologies, and who provides the resources and bodily services? These new technologies, treatment facilities and expertise are available to a privileged few who can afford private care.
Much like the burden of infertility, the responsibility of treatment is known to fall disproportionately on women; and the burden and responsibility of providing the resources for these new technologies are also borne primarily by women.
Unlike sperm provision, egg retrieval is a relatively complicated and invasive procedure, which includes the stimulation of ovaries with hormone injections and a short surgical procedure under anaesthesia. The long-term effect of these procedures on women’s bodies is not known.
With patients travelling across borders to get cheaper treatment and access to better expertise and technology, the need to address questions about access and inequity becomes even more critical. We need to stop thinking about these technologies as “scientific” and for medical experts only, and instead start engaging with them as an everyday reality that will shape the world and that of our future generations.
Amrita Pande, author of Wombs in Labour: Transnational Commercial Surrogacy in India (Columbia University Press, 2014) teaches in the sociology department of the University of Cape Town