Colonizing the (reproductive) future: the discursive construction of arts as technologies of self.
Significant strains within feminist scholarship have debated the implications and potential of ARTS, often casting them as tools of either feminist liberation or patriarchal oppression. (5) As these technologies continue to develop and their use continues to spread, their impacts and potential continue to evolve. Much of the feminist debate on the subject of ARTS is limited by an understanding of risk that is either undertheorized or missing altogether. This article aims to contribute to a more productive theorization of ARTS by drawing on a specified concept of risk, as it has been conceptualized in the risk society and governmentality literature. (6) A longitudinal study of unfolding risk narratives in the journalistic coverage of the management of age-related fertility risks through the use of selected reproductive technologies provides a valuable new approach to the analysis of these technologies. My analysis of these narratives illuminates the discursive construction of privileged candidates for reproduction and modes of family formation. Further, I identify the central role that reflexivity plays in the journalistic construction of these technologies, which is best understood in relation to risk society literature on reflexive modernity. Finally, I identify the ways in which narratives of reproductive choice and empowerment are co-opted in relation to arts to serve neoliberal rather than feminist ends.
RISK SOCIETY AND GOVERNMENTALITY
Risk society is characterized by the disintegration of traditional value systems, which comprises an integral element of the epochal discontinuity within modernity between the classical (or "first") modernity of the industrial nineteenth and early twentieth centuries and the reflexive (or "second") modernity of the postindustrial, globalized late twentieth and early twenty-first centuries. (7) Whereas, under the conditions of first modernity, subject positioning in terms of social categories like gender, class, and occupation rendered life theoretically stable and predictable, under the conditions of second modernity these normative trajectories become increasingly flexible. (8) Although this increasing flexibility can be perceived as liberating and empowering for those privileged enough to have access to these newfound choices, it can also be disorienting and unsettling. The use of arts in relation to age-related fertility concerns is an exemplary case of the type of risk central to risk society theory as age-related infertility and its treatment both, in part, arise from and become constitutive of the detraditionalization of life course trajectories and the proliferation of reproductive choice for certain privileged groups. (9)
While these choices may be experienced as empowering, even as they remain limited by institutional and cultural constraints, they also produce uncertainty, contingency, and an awareness of risk. In risk society risk becomes inescapable and omnipresent; every choice becomes laden with the potential for gains and losses, benefits and harms. Giddens argues that the very existence of alternatives pushes all social actors--even those without privileged access to choice--to view their own life courses and self-identity in terms of life planning and risk assessment, which becomes a means of reestablishing ontological security through the colonization of the future. (10) Further, risk society theory emphasizes the shift from the natural, external risks of first modernity to the technological, reflexive risks of second modernity. These technological risks may arise as the unintended consequences of technological solutions to other risks and may only become visible through technologically enabled expert knowledge. (11) Consequently "risks" in risk society theory are not treated as empirical truths, but rather as the product of expert knowledge produced about them and thus "particularly open to social definition and construction." (12)
The issue of choice is further developed in the governmentality literature, particularly in the works of Nikolas Rose. Drawing on Foucaults theorization of governmentality as an epochal shift following the emergence of systems of discipline, as well as Colin Gordons concept of entrepreneurialism of self, Rose has developed a theory of advanced liberalism. (13) Rather than merely cultivating an absence of government, the advanced liberal state takes an active role in inciting entrepreneurism in its citizens by removing as many securities as possible and making the remaining social support dependent on demonstration of the entrepreneurial mindset. (14) Choice plays a central role in Rose's model of advanced liberal subjectivity. Individuals act as entrepreneurs of self by investing in their own human capital through choices regarding undertakings like health, education, savings, and insurance. (15) Here Rose's central contribution is that choice is a form of government, rather than the absence of government. Choice is a means by which responsibility for the management of risk is transferred to the individual. Following Rose's characterization of freedom--that is, agentive action--as "not to be defined as the absence of constraint, but as a rather diverse array of invented technologies of the self," we can move beyond the false choice as to whether arts are oppressive or liberating, to focus on the ways in which they are represented as technologies of the self and as suitable means for colonizing the future. (16)
Although risk society and governmentality take somewhat differing positions on risk in society, arts provide a case in which the shift to reflexive modernity can be seen to shape individuals' relations to their future and in which constellations of knowledge-power serve to shift greater responsibility for risk management to the individual. These reflexive risk society and governmentality frameworks productively expand the feminist analysis of arts by allowing for the critical assessment of narratives of empowerment and choice. These frameworks allow us to address the ways in which greater freedom of choice and empowerment to choose, though laudable goals, generally speaking, may not always produce unalloyed goods, but may in some cases produce new forms of oppression. This critical approach also allows for the analysis of exclusions and hierarchies embedded within narratives of freedom, empowerment, and choice. My analysis draws on these literatures to address the ways in which journalistic narratives contribute to the discursive construction of arts as cases of reflexive risk and as advanced liberal technologies of self. This provides new insight within the limited social science research on the relationship between ARTS and risk.
REPRODUCTIVE TECHNOLOGIES AND RISK
Several studies have addressed the role that powerful stakeholders play--through the media and in direct interaction with laypersons--in shaping the representation of arts in the interest of minimizing the appearance or perception of risk. (17) Responding to notable strains in the feminist analysis of arts that tend to focus on the potential of these technologies to perpetuate inequalities and consolidate patriarchal control over women's reproduction, some researchers have challenged the validity of these assumptions and promoted more fluid and contextualized means of assessing the risks posed by ARTS. (18) Others have focused more specifically on older mothers and the role they play in media representation of ARTs and the interplay between contraceptive and conceptive technologies in their experience of age-related infertility. (19) In particular Campbell focuses on the way in which older mothers challenge the stability of the discourse constructed around arts, thereby reopening journalistic engagement with technologies that have become decreasingly "newsworthy" through increased use. In contrast my purpose is to address the ways in which journalistic risk narratives linking maternal age and reproductive technologies develop over time and in relation to different technologies and how these journalistic narratives function as exemplars of a broader cultural discourse around reproduction, risk, and subjectivity, thereby constructing privileged candidates for medical intervention and privileged modes of family formation.
Data come from news articles published in newspapers and news magazines in the United States from i960 through 2012. This time period was selected based on the periods during which maternal age at first birth was increasing after the postwar low and the exemplary technologies--prenatal screening, IVF, and egg freezing--were available to the public. Popular press databases were searched using reproductive technology-related terms, like in vitro fertilization, egg freezing, and amniocentesis, as well as the combination of terms like risk, danger, older, delayed, childbearing, mothers, fathers, parents, and pregnancy, resulting in twenty-three total search terms. (20) Initial searches generated a database of 670 nonunique articles. This initial sample was culled of all duplicate citations and articles that were clearly unrelated to the research question, which yielded 351 titularly unique and related articles. (21) The sample of unique related articles was then culled of all articles published in periodicals with an average daily circulation of fewer than one hundred thousand people, in the interest of capturing the media messages receiving the widest distribution. This produced a list of 142 unique and related articles published in major periodicals. These 142 articles were retrieved, scanned for relevance, and sorted by technology. A final sample of 15 chronologically stratified and randomly selected articles was created for each of the three exemplary reproductive technologies: prenatal screening, in vitro fertilization (IVF), and egg freezing. The prenatal screening subsample spanned the years 1979 to 2007, while the IVF articles ranged from 1988 to 2012, and the egg freezing articles ran from 1985 to 2012. These articles were generally informational pieces published in the science, health, and medicine sections of the paper, rather than editorial pieces.
The 45 articles in this final sample were published in eighteen periodicals from across the United States. The periodicals represented were primarily newspapers with regional distribution but also included two newsmagazines--TIME and Newsweek--and two newspapers with national distribution--USA Today and the New York Times. (22) Although this would seem to limit the sample to narratives common in major metropolitan areas, in the original search results many of the articles published in smaller-circulation papers were merely reprints of articles published in major newspapers or Associated Press wire reports, suggesting that few of these eliminated articles represented genuine local discourse.
Original search parameters were highly inclusive, yet the articles resulting from these searches were notably limited in several ways. All indexed years, starting in i960, were included in the searches; however, popular journalistic reporting on these technologies only intensified after the widely publicized 1978 birth of Louise Brown, the worlds first "test tube baby." Even more notable is the gender imbalance of this reporting. Although I performed every search combination with feminine terms (e.g., mother*, mom*, wom*n, and egg'), masculine terms (e.g., father*, dad*, m*n, and sperm), and neutral terms (e.g., parent*, couple*, and famil*), masculine terms only yielded 15 articles, where feminine terms yielded 297 articles, and neutral or technological terms yielded the remaining 358 articles. (23) It is worth noting that many articles turned up in multiple searches, so there was considerable overlap between articles returned by gendered and nongendered search terms. Ultimately the 15 articles returned by the masculine search terms were excluded from the final sample because none of them made direct reference to the use of reproductive technologies for the management of risk. (24)
Focusing on the framing and construction of risk narratives, I conducted a multiphase analysis of the sampled articles. The first phase was a textual analysis of the articles in which the hazards for which the technology was proposed as a solution and the risks that the technologies were said to produce, as well as the problem frame and contexts within which the technologies were discursively situated and the normative stance taken by the author, were identified. The second phase involved mapping the risk narrative as it occurred in chronological, rather than literary, sequence. (25) The maps situate the technologies within the chronological unfolding of the risk narrative, providing a clear representation of the risks the technologies are said to be responding to and those they are said to create.
The discussion of my findings is organized chronologically, following the order in which these technologies were made available to the public and consequently the order in which they gained traction in the popular press. It is worth noting, however, that this will mean beginning with postconceptive technologies and working backward through the reproductive process to preconceptive interventions. Although the tendency has been neither unidirectional nor smooth, this is indicative of the way in which reproductive medicine has pushed the point of intervention further and further back in the conceptive process. Where the earliest technologies of reproductive risk management, most notably amniocentesis, could only intervene after conception had already occurred, the most recent technology under study--egg freezing--proposes to intervene months, even years, before conception will ever occur.
Within my sample the broad demographic shift in many wealthy industrialized nations toward postponement of childbearing and related phenomena--including rising maternal age at first birth, falling fertility rates, shrinking family size, and increasing rates of childlessness and age-related infertility--are presented as a critical cultural backdrop against which reproductive technologies are discussed. (26) Although I analyze each of these technologies as interventions for the management of maternal-age-related risks, none of them were specifically developed with age-related fertility concerns in mind. Prenatal screening techniques were initially used in cases where family history of sex-linked or other genetic disorders suggested high risk; it was not until some decades later that the link between "advanced" maternal age and increased risk of fetal Down syndrome was recognized and maternal-age-based indications for prenatal screening were introduced. In vitro fertilization was initially developed to overcome physiological obstructions to spontaneous conception, particularly obstruction, malformation, or absence of the fallopian tubes; medical indication would only later expand to include the treatment of age-related infertility. Finally, egg freezing was initially developed with the dual purposes of circumventing bans on the cryopreservation of embryos, as in the Italian case, and of providing an alternative to embryo storage for single women who were to undergo necessary medical procedures requiring removal of part of all of the reproductive organs or the use of gonadotoxic treatments like chemotherapy. (27) Over time, through the confluence of patient demand and medical domain expansion, the use of each of these technologies has expanded to include the treatment of age-related infertility in some way. In my findings I will address the historical and technical background of each exemplary technology briefly, to better contextualize the analysis of the risk narratives constructed around each of these technologies.
Postconception: Prenatal Screening and Cost-Benefit Analysis
Among the earliest prenatal screening techniques, amniocentesis is performed by inserting a long needle through the abdomen to draw out amniotic fluid, often with the assistance of ultrasound guidance. The fluid sample can be examined for the presence of certain compounds, and fetal cells present in fluid can be cultured and examined for chromosomal abnormality. Of the three technologies under review amniocentesis has been available longest. The technique for withdrawing amniotic fluid has been available since the 1930s and has been in use for treatment of sex-linked disorders since the 1950s and for chromosomal analysis since the 1960s. (28)
Although it was not introduced into general practice until the 1980s, chorionic villus sampling (CVS) was under development at roughly the same time. (29) This alternative prenatal screening technique involves the transabdominal or transcervical biopsy of placental tissue (rather than amniotic fluid), which is generally identical to fetal tissue. Whereas amniocentesis is usually performed in the second trimester, CVS can be performed in the first trimester, thereby allowing for early diagnosis of fetal abnormalities. Both invasive forms of prenatal screening carry a small risk of miscarriage, with fetal loss occurring in about 1 percent of patients.
Prenatal screening provides an excellent example of the reflexive risks of second modernity. First, prenatal screening redefines fetal abnormalities--which might have once been treated as a danger and a matter of fate--as risk. The site of risk, in this case chromosomal abnormalities, is not discernible to the layperson; rather it must be rendered visible through the application of technology and expert knowledge. Second, as I will illustrate, the case of prenatal screening is marked by the production of new risks (e.g., miscarriage and fetal deformity) as a result of the technical solution to preceding risk (e.g., fetal chromosomal abnormality) and the constant reassessment of these risks in light of ongoing research on these technologies and their application.
Perhaps, in part, because the clinical use of amniocentesis expanded at the same time that technical risk assessment was establishing cultural dominance--as a central element of US regulatory debates during the 1980s--the narratives constructed around prenatal screening were marked by a predominance of cost-benefit analysis. Initially this cost-benefit analysis primarily addressed the balance of the risks associated with undergoing amniocentesis and the risks associated with the correlation between "advanced" maternal age and incidence of Down syndrome in the fetus. This was later complicated by the introduction of alternative screening methods like chorionic villus sampling (CVS)--which seemed to offer earlier diagnosis at somewhat greater risk to the fetus--and noninvasive methods--which eliminated the risks associated with invasive methods but presented new challenges in terms of timing and accuracy. Additionally, the ways in which a patients risk perception may differ from that of her doctor or of impersonal cost-benefit analysis introduced additional complexity.
When the use of amniocentesis was expanded beyond cases of clear familial history of genetic disorders in the mid-twentieth century, maternal age was initially considered an adequate criterion for recommending its use. Almost every news article sampled positioned amniocentesis as initially directed primarily toward detecting Down syndrome--although screening has always captured other chromosomal abnormalities--and women over the age of thirty-five, as well as women with a family history of the disorder, were considered to be at elevated risk for carrying a fetus affected by Down syndrome and, as such, were encouraged to undergo amniocentesis. At the time pregnancy over the age of thirty-five was relatively rare. However, in the 1980s, as the age of first birth began to increase, journalistic narratives suggest that obstetricians began to question the efficacy of this age criteria, given that the majority of "older" women undergoing the procedure were carrying healthy fetuses and thus being placed unnecessarily at risk, while many younger women carrying Down syndrome-affected fetuses were excluded from screening. Subsequently some practitioners suggested extending the recommendation of amniocentesis to all pregnant women. With the potential patient population so broadly expanded, the risks involved in amniocentesis became more salient, and news articles on the subject show a trend toward technical risk assessment in the form of cost-benefit analysis. This narrative is visible in the sample beginning in 1988 but persists throughout and is most clearly articulated in a 2001 article about the promises and limitations of noninvasive screening methods:
If amniocentesis were a totally innocuous procedure, it might be universally recommended for all pregnant women despite its inherent costs, $800 or more in this country, since more than half of Down syndrome pregnancies occur in women under 35. But amniocentesis is not without risk--about one in 200 to one in 300 women miscarries as a result of the procedure--and perinatal experts hope to limit its use to women most likely to be carrying an affected fetus. Amniocentesis, however, does not miss chromosomal abnormalities. (30)
In this news article we can see the benefits of accurately identifying all Down Syndrome--affected fetuses weighed against the monetary costs and the miscarriage risks associated with the procedure. In a pattern repeated through many of the sampled articles, the expense of the procedure is deemed relatively immaterial, while the miscarriage risks are considered a compelling reason for restraint. This points to certain values in play in the assessment of the risk of amniocentesis. The weight given to miscarriage may suggest a pronatalist emphasis; however, the unquestioned desirability of identifying--and presumably usually aborting--fetuses affected by chromosomal abnormalities suggests that only certain types of babies are valued, those that will conform to culturally dominant ideals of health and who are presumed to be capable of acting as self-sufficient, independent subjects someday.
Further, many of the news articles sampled often included multiple iterations of the cost-benefit analysis, typical of the reflexive nature of the risks of second modernity. Longitudinal sampling allowed me to observe the ways in which these iterations unfolded over time, across multiple articles. In the first phase the initial costs of older motherhood--in this case primarily represented as increased risks of fetal chromosomal abnormality--are managed through the use of amniocentesis. In the next phase amniocentesis is found to pose new risks to the mother and the fetus, and these risks are in turn managed, usually through the development of new prenatal screening technologies or improved protocols for the use of amniocentesis. A third phase occurred when the new technologies or protocols produced risks of their own. There are two primary cases of this type of iteration visible in the sample: chorionic villus sampling and prescreening through noninvasive blood tests and ultrasound.
Chorionic Villus Sampling
Introduced in 1983, chorionic villus sampling was initially represented in sampled articles as a prenatal screening method that would replace amniocentesis. CVS was deemed preferable because it could be performed and produce results earlier in a pregnancy, allowing affected women to have abortions before their pregnancy became visible and before restrictions on late-term abortion began to take effect:
The prime advantages of the new chorion villus biopsy technique include the simplicity and speed with which it can be applied. Another key advantage is that it can be done as early as the 9th or 10th week of pregnancy, far earlier than amniocentesis. (31)
However, almost immediately following its clinical implementation in the mid-1980s, concerns began to surface that CVS resulted in higher rates of miscarriage and fetal limb deformities:
A technique experts had predicted would revolutionize prenatal diagnosis has faltered in recent studies, leading some doctors to turn back to an older, established procedure, amniocentesis. Last month, a large randomized European trial showed that patients who used the new technique, chorionic villus sampling, experienced almost 5 percent more fetal and neonatal deaths than women who chose amniocentesis. Weeks before, British researchers reported an unusually high number of limb deformities in the children of a small group of women who had opted for the new technique.... Studies have also suggested that the new tech nique more often yields ambiguous diagnoses, so that some women have to undergo subsequent amniocentesis to clarify their babies' health. (32)
News articles from the period suggest that these complications were judged to outweigh the benefits of earlier diagnosis, and the technique was subsequently branded too risky for widespread implementation. Although CVS has not been entirely discontinued, it is now reserved for women with very high probabilities of carrying chromosomally abnormal fetuses. Amniocentesis remains the prenatal screening technique of choice. However, the sampled articles show continued concern on the part of patients and doctors regarding the invasiveness of these procedures and the associated risk of miscarriage. As an extension of this narrative journalists covered the efforts of researchers to develop noninvasive methods of identifying high-risk pregnancies, in the interest of decreasing the rates of invasive prenatal screening.
Noninvasive Prescreening Techniques
In the late 1980s computer modeling of risk, based on maternal blood tests, entered the journalistic coverage of prenatal screening. These virtual models were designed to determine which pregnancies were high risk and should, therefore, be subject to invasive prenatal testing. These tests were intended to decrease the number of older women unnecessarily subjected to risky invasive procedures while increasing the inclusion of younger women carrying abnormal fetuses, who were excluded by the earlier age-based protocol:
The current tests for Downs syndrome, amniocentesis and chorionic villus sampling, require inserting a needle or a catheters into the uterus near the fetus, with a small risk of causing a miscarriage. The current tests are thus recommended only for women over the age of 35 and others deemed to be at special risk of carrying a fetus with Down's syndrome. However, 80 percent of babies with Downs syndrome are born to women under the age of 35.... If the new blood tests are used instead of age as a criterion for determining which women should be offered amniocentesis, they would be three times as effective in detecting Down's syndrome. (33)
In this excerpt we see a narrative emphasis on technical risk assessment in a way that maximizes accuracy while minimizing risk exposure, which is dependent on probabilistic reasoning central to the concept of risk. This narrative continued in reporting on research directed at refining these prescreening techniques and improving their accuracy in identifying at risk pregnancies:
"Using age as the sole criterion for an invasive test is not an efficient use of resources," Dr. Benn said in an interview. He added that reducing the number of invasive tests did not result in a failure to detect affected pregnancies. "We're getting at least as many, if not more," he said, at a much lower cost and with minimal trauma to the woman and her unborn child. An amniocentesis or C.V.S. costs $2,000 or more, while the blood tests and sonogram cost about $300. (34)
Given a cost-benefit frame, increasingly accurate maternal blood screening seemed to provide an optimal solution, reducing both the expenses involved in prenatal screening and the number of women and fetuses placed unnecessarily at risk, while identifying as many--or more--affected pregnancies. However, effective predictive modeling required waiting until the second trimester, which put affected women back in the realm of late-term abortion:
The new test necessitates diagnosis in the second trimester, a time when abortions are more difficult physically and emotionally. Researchers would like to extend the screening test into the first trimester, when women who are at high risk could be offered chorionic villus sampling. (35)
Efforts were made to perform blood tests in the first trimester; however, concerns were raised about the accuracy of these tests, which were said to produce both false positives and false negatives. (36) Unlike the case of cvs, wherein the narrative emphasized direct physical risk to the fetus, the shortcomings of maternal blood screening are represented as relating solely to accuracy and timing. Subsequently, in a move that is typical of technical risk assessment, the response in evidence in the articles has been to continue research to improve the timing and accuracy of maternal blood screening, rather than discontinuing or severely limiting its use.
Patient's Risk Perception
In the 2000s the popular narrative shows a shift in thinking about risk perception, with the practitioners interviewed in the sampled articles beginning to complicate prenatal cost-benefit analysis, which had previously considered Down syndrome and miscarriage equivalent risks, by taking into account patients' differential perceptions of risk. In 2001 Dr. Virginia Lupo, a Minneapolis-area perinatologist, is quoted invoking an individualistic model of risk assessment:
"I think a woman needs to quietly reflect on her level of concern," Lupo said. "Some women hear they have a one in 1,000 chance of Down's and think that's a high rate. Some hear they have a one in 50 chance and they think that's a low rate. She has to decide whether to live through the anxiety of knowing or not knowing." (37)
Rather than discounting these differing risk perceptions as irrational or unfounded, Dr. Lupo--who stands in as the embodiment of expert opinion in this article--suggests that the evaluation of risk in relation to fetal abnormalities is deeply personal and therefore should be subject to individual, rather than population-wide, evaluation. In 2004 we are presented with a similar narrative constructed in opposition to persistent age-based qualification for amniocentesis:
Until now, obstetricians rarely recommend amniocentesis to women younger than 35 because for them, the potential risks of the technique--miscarriage--outweighed the potential advantage of the technique: its ability to foresee chromosomal defects in newborns. The old wisdom was based on the assumption that a woman's fear of having a genetically defective child ... was equivalent to her fear of having a miscarriage.... In a previous study ... the researchers discovered that for most of the women surveyed in the study, the anxiety about having a child with Down syndrome outweighed the fear of a miscarriage.... The study illustrates the importance of doctors' taking into account the complexities of patients' preferences in potential medical outcomes.... This is just one example of where there's a great need to explicitly incorporate patient preferences in the formation of clinical practice guidelines. (38)
Here again we see a narrative structure in which expert knowledge is used to document and validate individual patients' differential risk assessment, which is based in part on the strength of their acceptance of an implicit societal hierarchy in which not only chromosomally "normal" babies but even childlessness is deemed more desirable than the birth of chromosomally abnormal babies. This increasingly individualized narrative is likely related to the diversification of prenatal screening techniques. As the options proliferate and the risks and benefits associated with each technique diverge, it becomes increasingly incumbent upon prospective parents to choose among them. In keeping with Gidden's discussion of the dilemmas of expertise under the conditions of second modernity, in the articles sampled there is evidence of the retreat of overarching authoritative knowledge on the superiority of any given method and, subsequently, an increasing sense that expecting parents should become informed about their choices and make a decision that both takes expert knowledge into account and reflects their own individual values and lifestyle. (39)
Conception: IVF and Reflexive Risks
In 1978 Louise Brown--the world's first "test tube baby"--was born in England, conceived in part through the pioneering fertility research of OB/GYN Patrick Steptoe and physiologist Robert Edwards. (40) Since that time the European Society of Human Reproduction and Embryology (ESHRE) estimates that over three million IVF-conceived babies have been born worldwide. (41) In vitro fertilization involves the surgical retrieval of a woman's mature eggs (oocytes) from her ovaries and their combination with sperm in a Petri dish. The fertilized eggs are allowed to develop for several days in a culture solution before being returned to a woman's body. It is common practice to use fertility drugs to stimulate a woman's ovaries to produce multiple mature eggs at the same time, a practice that increases the efficiency and efficacy of IVF but carries added health risks.
In the journalistic coverage of IVF we can see evidence of the increased public skepticism in relation to the effects of the technologies that increasingly permeate modern life. Beck argues that this simultaneous expansion of science and technology and public distrust of science and technology is typical of second modernity, in contrast to the widespread faith in techno-science that is typical of first modernity. (42) Although the coverage of IVF focuses on the reflexive unfolding of ongoing research on the derivative risks associated with ivf similar to that seen in the prenatal screening sample, cost-benefit analysis framing is notably absent.
This may be the case because both the benefits and the risks of IVF are less readily quantifiable than those associated with prenatal screening. Researchers have access to sufficiently large data sets to perform precise calculation of the increased risk of miscarriage and to causally link this risk to invasive screening methods. In the IVF case there is still insufficient data to clearly and unambiguously link increased risk of cancer to IVF treatments. Further, the medical consequences of certain chromosomal abnormalities and the costs to a family and to the state of a chromosomally abnormal child are represented as clear-cut. By contrast the costs and health risks of multiple births are represented as being somewhat ambiguous or variable in the sample, and the undesirability of multiple births is contested, with many parents and the mainstream media frequently represented as treating these births as miracles and a source of joy. From a dispassionate, financially orientated position the benefit to society of decreasing the occurrence of severe genetic illnesses in the population is clear and largely uncontested, while the benefit of permitting otherwise infertile people to conceive genetically related children is less clearly quantifiable. (43)
As was the case in the analysis of invasive prenatal screening techniques, reproductive technologies can be treated as both means of managing risk and sources of risk in and of themselves. Beginning in the late 1970s, as maternal age at first birth began to rise steadily, some reproductive medicine specialists proposed that IVF and associated reproductive technologies could be used to manage the effects of physiological and age-related infertility. However, these technologies have been associated with additional risks, like increased rates of higher-order multiple births and increased risks of cancer in both mothers and children. The risks associated with IVF are represented in a reflexive manner, often framed as the unforeseen byproducts of innovations intended to manage external risks relating to infertility, maternal health, and infant mortality. In keeping with the narratives present in my sample I will deal with the ways in which IVF is represented primarily as a source of reflexive risks, rather than a means of managing risk.
In the journalistic narratives constructed around IVF multiple births--particularly higher-order births involving quadruplets or more--were the most common risk associated with fertility medicine. These multiple births were represented as being not only the result of irresponsible or aggressive use of fertility technologies, although that certainly played a part, but also the unforeseen outcome of improved medical care, increasingly healthy populations, and individual fertility decisions. As early as 1988 journalists were situating increasing rates of multiple births in a reflexive rhetoric:
While there are several competing theories to explain this phenomenon [of increasing rates of multiple births], scientists agree that as a woman ages or bears more children, she releases more than one egg each month during ovulation. With better prenatal care and healthier mothers, more fertilized eggs are surviving. (44)
Although this news article also presented the increased use of fertility drugs and IVF technology as a source of the multiple-birth boom, the explanation also encompasses women who do not use reproductive technologies. Delayed childbearing is presented as a strategy intended to reduce the conflict between work and family, which has the unforeseen result of women attempting to conceive at a time when their body naturally releases more eggs, increasing the risk of multiple births. Further, better medical care and improved maternal health--neither of which was specific to older mothers--creates an environment in which these multiple fertilized eggs, which would have previously failed to implant or miscarried early on, have a much greater chance of successful gestation.
These narratives of the unintended consequences of medical techniques intended to assist the infertile and improve maternal and infant health continue throughout the sample:
Thanks to modern technology and new fertility drugs, thousands of older couples are having kids for the first time in their late 30s and early 40s--and in many cases getting twice what they bargained for--or more. Twins. Triplets. Even quadruplets.... In addition, medical science has dramatically improved the odds of survival for these infants, who are often born premature and underweight, with underdeveloped organs. (45)
In this excerpt we can see the development of the narrative that not only are older first-time parents driving the multiple birth boom but the availability of ARTS--and the public awareness of their promises--may be contributing to increased rates of delayed childbearing. Further we see that neonatal technologies, intended to ensure the health of infants, now increase the survival rate of premature multiples, who would have likely died shortly after birth had they been born a few decades earlier but now go on to have lifelong health complications. No journalist was so bold as to suggest that improved infant survival rates were undesirable, but there was often an implicit concern regarding the long-term health costs of keeping severely underdeveloped infants alive. A1997 Newsweek article came the closest to an outright statement of this concern when the authors suggested, "The trouble is, kids born in groups are almost always born prematurely. And though intensive-care units can often keep them alive, the medical consequences can be devastating." (46) As was the case in the assumption that the identification and abortion of chromosomally abnormal fetuses is desirable, there is an implicit assumption that the birth of medically fragile children is undesirable because these children will require the investment of greater than usual health resources, and their medical problems are likely to persist throughout their lives, the implicit concern being that these children are likely to continue to be dependent rather than growing into the liberal ideal of the fully self-sufficient individual.
By the late 1990s, with IVF in use for roughly two decades and the link to multiple births becoming increasingly well substantiated, the question of responsibility for these problematic births entered the discourse. In a narrative that would reemerge with the well-publicized 2009 live birth of octuplets to Nadya Suleman ("Octomom"), the lack of regulation regarding the number of embryos transferred was called into question in several of the sampled articles:
Britain--where fertility treatment is covered under government-funded national health insurance--limits the number of embryos that may be implanted and punishes doctors for violations. In the United States, where a couple may spend tens of thousands of dollars out of pocket to get pregnant, the sanctity of individual choice and the power of the free market are at odds with regulation. (47)
Here we can clearly see the linkages between the advanced liberal emphasis on individual choice made through market interactions and the unforeseen consequences of the uptake of IVF technology. This excerpt also points to the effects that regulatory environments can have on the site-specific development of a technology, not only in relation to the presence or absence of direct governmental regulation but also in relation to insurance coverage or the lack thereof. Where IVF is not covered by insurance and a couple must pay out of pocket for each cycle, there is increased incentive to minimize the number of cycles by maximizing the chances of conception. Coupled with a lack of formal regulation of the number of embryos that can be transferred, this incentive can lead patients to pressure their doctors to transfer more than the recommended number of embryos. As reported success rates improved and the increase in the multiple birth rate continued to be presented as a serious medical problem, the sample shows increasingly strident calls for regulation of the number of embryos transferred, reflected in more recent reporting on elective single-embryo transfer (eSET) and calls to ban the transfer of three or more embryos. (48)
Increased Cancer Risk
In the 2000s, with IVF in use for over two decades and over a million children conceived through IVF worldwide, longitudinal data on the outcomes of IVF-conceived people began to reach adequate scale for statistical analysis. In 2002 time reported that two studies published in the New England Journal of Medicine challenged the conventional wisdom that "as far as scientists knew there was no extra risk of genetic damage associated with in-vitro fertilization." (49) The first study was reported to have found an 8.6 percent risk of major birth defects among IVF-conceived infants, more than double the 4.2 percent rate among babies conceived "the old-fashioned way," and the second that ARTconceived babies were 2.6 times more likely to be born at low or very low birth weights, which carries its own health risks. (50) However, the author was quick to reassure readers that "there's no need to panic," given that the absolute levels of risk are still low and that the studies had not controlled for the risk factors associated with the preexisting condition of infertility. The author closed by pointing out:
And even if the danger is twice what doctors previously believed, 91% of ART babies would still be born perfectly healthy. Says Dr. Zev Rosenwaks, director of New York Presbyterian Hospital's infertility program: "If you ask a couple if they would rather not have a child at all or try to have a child that over 90% of the time will be normal, I think they will choose to have the child." (51)
This excerpt displays a narrative, which was repeated throughout subsequent articles addressing long-term health risks associated with IVF, that infertile people would generally decide that modest health risks associated with IVF pale in comparison to the desire to conceive and raise a genetically related child. This narrative demonstrates the way in which risk assessment is not value neutral, but rather assumes and perpetuates certain values and hierarchies. In this case the risk-assessment frame promotes pronatalist values and privileges biogenetic kinship in a way that subtly communicates the hierarchical superiority of families with genetically related children to either childfree families or families raising nonbiogenetically related children.
Although a 2005 article reassured would-be parents that IVF was not, in fact, linked to increased risks of birth defects or chromosomal abnormalities, a 2010 article again raised the specter of long-term health problems linked to IVF conception, including "an increased risk of cancer ... [and] epigenetic differences in the DNA of children conceived via IVF." (52) Following the earlier pattern, after reporting that an article published in the journal Pediatrics had found an elevated risk of cancer in IVF-conceived children, the author hastened to reassure readers that the increased risk was still very small, in absolute numbers, and might be related to the underlying condition of infertility rather than IVF, going on to say, "Even if the study had confirmed IVF as a risk factor, experts say the level of increased risk is not enough to deter parents from undergoing the treatment. While IVF may bump up a tiny risk of childhood cancer, without it, many infertile couples may not have a baby at all," echoing earlier pronatalist rhetoric, as well as the erasure of alternative family building methods. (53) Most recently, it was reported that IVF use might be linked to increased risk of ovarian cancer in mothers, but yet again the narrative emphasized the low absolute risk and the lack of a clear causal link between fertility treatment and cancer. (54)
Although they currently form a minority of the risks associated with IVF in journalistic narratives, these genetic and epigenetic risks provide an excellent example of Beck's notion of reflexive risks. (55) The effects of IVF use on both the mothers and the child's health are almost certainly irreversible and, because they are invisible, only become accessible to the population through scientific causal interpretation. Additionally, these technologies create a social risk position, one that--in a US context of market-based medicine and a lack of mandated insurance coverage for ARTS--disproportionately affects affluent working women and their children.
Preconception: Egg Freezing and Prudentialism
Similarly, oocyte cryopreservation, more commonly known as egg freezing, is also disproportionately directed at affluent working women. The process involves the retrieval and cryo-banking of human eggs. Although the first pregnancy from a frozen and thawed oocyte was reported in 1986, the technology has not attained nearly the ubiquity of sperm or embryo banking. (56) This is because human eggs, as the largest cell in the body, contain a large amount of water and therefore tend to sustain extensive damage when frozen and thawed. Egg freezing has been used as an experimental "fertility preservation" method for women undergoing life-saving medical treatments that carry the risk of inducing sterility or infertility, the most common example being chemotherapy. However, in 2005 an article in the medical journal Fertility and Sterility reported that pregnancy rates using frozen eggs were approaching those of frozen and even fresh embryos. (57) In 2006 Harvard MBA Christy Jones founded Extend Fertility to offer commercial egg banking to healthy women. Despite the fact that, at the time, the American Society for Reproductive Medicine (ASRM) guidelines maintained that egg freezing was experimental and not effective enough to offer commercially, Extend Fertility had opened centers in eight cities, and other clinics were beginning to offer egg freezing as an elective service well before the ASRM lifted the experimental label in late 2012. (58)
The confluence of increasing cultural awareness of age-related fertility decline and the expanding availability of egg freezing creates conditions in which affluent working women or young women who anticipate undertaking the extended schooling and demanding work schedules associated with higher-earning professional-class careers increasingly occupy another, new risk position, which Martin has termed "anticipated infertility." (59) Martin argues that the "elective" use of egg freezing by healthy, fertile young women is indicative of the biomedicalization of reproduction, in which "the 'normal' stage disappears" for childless women, leaving them with only two pathological options, infertility and anticipated infertility. (60) By virtue of this shift, of all of the technologies under analysis, the journalistic narratives constructed around egg freezing offer the best examples of reproductive technology deployed as a technique of advanced liberal subjectivity.
Issues of Personal Control and Choice
Central to the concept of advanced liberal subjectivity are the beliefs that subjects should be "rational, responsible, knowledgeable and calculative," and most of all "in control of the key aspects of their lives" and that subjects should invest in themselves and their own futures by choosing among a multitude of options on the basis of rational decision making. (61) These emphases on control and choice are in evidence as journalists set the stage for the introduction of egg freezing and expound its many virtues. Ovarian aging and the infertility it can produce are presented, in these narratives, as subjects of fear and anxiety for women, centering on the inability to predict or control future fertility:
"The thing that is scary to me is that as you get older, you don't know what's going to happen when you're ready to have children," Jacques said. "Anything I can do to make things a little easier is well worth it." (62) "If you ever told me I'd be having this kind of difficulty [conceiving], I would have laughed in your face," she says. "I exercise, I eat well, I keep better work hours, but I'm really not in control of what's happening with my little eggs. It's devastating. It's a terrible sense of failure." (63)
Against this "devastating" loss of control egg freezing is proposed as a means of reasserting the ability to manage one's own reproductive future. In the news articles sampled the technology is said to offer women "who plan in advance" greater "reproductive flexibility" by "giving them more control over their fertility and giving them more options." (64) These narratives are often cast in terms of increasing gender egalitarianism. Likened to sperm banking--which was pioneered in the late 1950s--egg freezing is said to move women closer to "reproductive autonomy" because it "empowers women so they're not controlled by their biological clock.'" (65) In other words, egg freezing permits women to achieve greater parity with men as rational, calculative liberal subjects and responsible colonizers of their own future.
Only on rare occasion was it suggested that egg freezing might, in fact, be a high-tech solution to the work-family conflict "that asks women to bear the cost of a socially created problem," which might be better addressed through structural changes that foster "a family-friendly work environment." (66) In both cases this position--which calls for societal rather than individual responses to the problem of work-family conflict--was ultimately rejected in favor of egg freezing. In the first case this argument is rejected on the grounds that feminist concerns are "theoretical, while the needs of individual women are immediate and real." (67) In the second case the author reasserts an individualistic mindset through her argument that egg freezing--like birth control and abortion--should be viewed as a "tool by which women are able to assert control over their bodies" and that the "decision to freeze eggs should be a matter of personal conscience." (68) In the absence of final authority on the best timing of the transition to parenthood, these narratives emphasize the acceptability of egg freezing as a responsible lifestyle choice.
Frozen Eggs as Insurance Policy
Throughout the articles sampled egg freezing was cast not only as a form of insurance against future (or anticipated) infertility but as a form of what O'Malley calls "prudentialism," which emphasizes individual responsibility and rationality, making it better suited to advanced liberal models of government than socialized actuarial models. (69) In these narratives egg freezing operates as a form of privatized actuarialism, in which individual women take responsibility for their own reproductive futures by calculating their own chances of future infertility and electing to freeze their own eggs--through market-based interactions with fertility clinics--as an insurance policy. However, it is important to recognize that, while many of the doctors and patients interviewed in these articles refer to egg freezing as an insurance policy, it is not, strictly speaking, actuarial, because the exact value of fertility lost cannot be calculated, and frozen eggs do not offer compensation, but rather the chance that infertility can be overcome and biogenetic kinship preserved.
Nevertheless, actuarialism was the dominant narrative motif, with doctors and patients in several articles referring to frozen eggs as an "insurance policy." (70) Other analogies repeated the motif of planning for the future. This included the suggestion that by banking eggs "women can hedge their reproductive bets for the future," that frozen eggs function as "fertility savings accounts," or that frozen eggs comprise an "investment in the future," a "cushion," or a "backup plan." (71) While these analogies imply the forward-thinking responsibility for ones own future that is valued in advanced liberal subjects, on rare occasion egg freezing was represented as an attempt to hit the "snooze button" or "buy more time" on the biological clock. (72) This narrative suggests that women freezing their eggs are not taking responsibility for appropriately colonizing their own reproductive futures, but are rather simply trying to put that future off. While this latter, minority, narrative is in keeping with Martin's findings on the comparison of "altruistic" cancer patients, who freeze to protect the possibility of motherhood, and "selfish" healthy young women, who freeze to put off motherhood, the majority of articles in my sample represented egg freezing as an appropriate means of managing personal future risk. (73) This preponderance suggests that this technology is well suited to advanced liberal systems of governmentality, to the extent that some journalists suggested that the technology might become so routinized that recent college graduates or even "college sophomores with big career dreams [might] freeze their still-healthy eggs, just in case." (74) These narratives point to the value-laden nature of egg freezing. As a technology of risk management egg freezing emphasizes individual responsibility for risk management, as well as presuming the importance of preserving biogenetic kinship above all else, particularly for women with markers of higher socioeconomic status: college students and graduates and career women.
RISK NARRATIVES AND REPRODUCTIVE TECHNOLOGIES
This study sheds light on the risk narratives constructed around various reproductive technologies and helps to position them in relation to both risk society and advanced liberal governmentality. While the articles on prenatal screening and IVF showed clear evidence of the reflexive risks typical of risk society, the articles on egg freezing showed a strong tendency toward prudentialism and actuarialism developed in the governmentality literature. Additionally, the articles on prenatal screening showed a preponderance of technical risk assessment in the form of cost-benefit analysis not present in the other subsamples.
These variations in risk narratives may be due, in part, to the scale and mode of dispersion of these technologies and the regulatory environments in which they are used. Amniocentesis is primarily used to detect Down syndrome-affected fetuses. Since its introduction there has been a clear, probabilistically calculable relationship between a woman's age and her chances of carrying a Down-affected fetus. Further, the rates of Down syndrome births to women of all ages and the chances of miscarriage due to invasive screening are also readily calculable, as are the comparative costs--to families, insurance companies, and society--of providing prenatal screening, as compared to the birth of a Down syndrome-affected child. This climate of clearly calculable risks, costs, and benefits makes prenatal screening fertile ground for technical risk-assessment techniques. Given that the costs incurred through screening are considered to be lower than the costs incurred by the birth of a genetically abnormal child, insurance companies have compelling reasons to cover the cost of prenatal screening, and public health agencies have compelling reasons to encourage their use. These conditions create a regulatory environment that promotes wide-scale implementation of the technologies. The population-level scale of their use, combined with the calculability discussed above, makes them further amenable to technical risk assessment.
By contrast the value to society of the birth of additional children--in this case through the treatment of infertility--is not so readily calculable, and consequently, IVF and egg freezing are not so amenable to technical risk assessment. As a result very few states mandate insurance coverage for IVF, and none require coverage of egg freezing, both of which can cost tens of thousands of dollars. Lack of coverage and expense, coupled with geographic limitations on the availability of these technologies, tend to limit their use primarily to affluent, urban, White women, a fact that formed the background of many of the articles sampled but was never directly mentioned. Beyond the absence of cost-benefit analysis, the future and present orientations of egg freezing and IVF, respectively, contribute to differences in their framing, IVF is employed when barriers to conception have already become evident and the birth of a child is an established objective in the present moment. On the other hand egg freezing is performed before barriers to conception have actually occurred or become apparent and, usually, years before the birth of a child is desired. Where egg freezing is employed, it is possible that barriers to fertility will never occur, and conception may take place spontaneously. It is also possible that a woman who freezes her eggs may never decide to have children. In either case the frozen eggs may never be used. This orientation to future misfortune that may never come to pass contributes to the framing of egg freezing as a prudential technology.
Although they differ in their risk framing, all of the reproductive technologies discussed are similarly positioned with regard to reflexive modernity and advanced liberal subjectivity. All three technologies play a role in individual risk management and life planning and can be productively understood as abstract systems of control, which, Giddens argues, incorporate the "subordination of nature to human purposes, organized via the colonizing of the future." (75) One of the essential commonalities of all reproductive technologies is their objective to bring the vagaries of natural reproductive processes under human control. Further, in advanced liberalism individuals are expected to act as entrepreneurs of self by investing in themselves through rational decision making. In this rational-choice model, for most people, earning power should be maximized by postponing childbearing until formal education is completed and career trajectories are firmly established. When this precludes the medically "ideal" timing of pregnancy, the risks of future infertility should be guarded against through the cryo-preservation of gametes and the use of IVF and other procedures, while the risk of undertaking the burdens of raising disabled children should be avoided through preimplantation genetic diagnosis or prenatal screening. Life calendars should be arranged such that children arrive only at the most opportune times, birth control is used to prevent inopportune births, and reproductive technologies are used to incite conception at the chosen time.
While the journalistic reporting on the risks of advanced maternal age and reproductive technologies should not be uncritically accepted as empirically valid representations of reality, these narratives do contribute to the discursive construction of the purposes, risks, benefits, and, more subtly, the appropriate recipients of these technologies. Through these narratives certain types of family and kinship are emphasized as desirable, and certain types of people are constructed as deserving or undeserving of these technologies. It is beyond the scope of this study to make claims about reader response; however, other studies have found that, in the absence of face-to-face interaction with parents who have used reproductive technologies, many individuals do draw on media representations and other cultural texts to construct their concept of the community and belonging, including specific notions of the community of ART users. (76)
Further, these are not neutral technologies. The risk narratives constructed around each of these technologies reproduce hierarchical rankings of babies, of family forms, and of women as both mothers and patients. Presumably healthy infants are valued above infants affected by chromosomal abnormalities or prematurity and low birth weight. Implicit in this valuation is the perception that medically fragile children will go on to be dependent consumers of limited medical resources, rather than idealized, self-sufficient advanced liberal subjects. Families raising biogenetically related children are represented as preferable to childfree families or families raising nonbiogenetically related children. Affluent, highly educated, career-focused women are held up as the presumptive recipients of reproductive technologies.
Egg freezing for the purpose of "fertility preservation," which Martin argues is a misnomer, provides an excellent example of the intersection of these hierarchies. For the affluent women presumed to be the candidates for egg freezing, "what has been preserved is not their fertility, but the genetic connection. 'Fertility' is here being redefined as not the ability to spontaneously conceive and carry a pregnancy, but the ability to transmit ones genetic material to future generations." (77) While Martin addresses the ways in which altruistic cancer patients are judged, by fertility specialists, to be more deserving of access to egg freezing technology than selfish young career women, there is another, more subtle hierarchy at play. (78)
Throughout my sample of popular press coverage of egg freezing the presumed candidates are healthy young women who are currently enrolled in college or already pursuing professional careers. Although this may be partially driven by an assumption that working-class women tend not to delay childbearing and therefore are not in need of "fertility preservation," this is not made explicit in any of the articles sampled. What we observe then is a class-based judgment about whose postponed childbearing is a matter for concern and whose genetic line is worthy of "preservation" and reproduction.
The intersection of neoliberal narratives of reproductive choice and cultural hierarchies of desirable reproduction played out most clearly in the media coverage of the birth of IVF-conceived octuplets to Nadya Suleman ("Octomom"). Initial celebration of the miraculous live birth of eight babies turned to public condemnation as it came to light that Suleman was unmarried, unemployed, receiving disability payments, and already had six children at home. Stigmatization of her family's ethnic background and of her status as a low-income single woman formed the foundation of the public assault on her fitness as a mother, her right to reproduce, and her right to access reproductive technologies. (79)
Underlying media narratives constructed around generative reproductive technologies, like IVF and egg freezing, are images of the appropriate recipients of their benefits--financially independent, professional-class women pursuing childbearing within married heterosexual unions--and those whose use of these technologies is considered illegitimate or subject to greater scrutiny and control--women of color, women with low socioeconomic status, and women pursuing childbearing outside of the confines of married heterosexual relationships. The representation of candidates for screening technologies confirms this hierarchy in the obverse. The most common subjects of these narratives were marked as potentially irresponsible parents by virtue of "advanced" maternal age, immigrant or racial minority status, low income or class status, or membership in a religious minority. In occupying the bottom of the procreative hierarchy, these groups are also subject to greater surveillance and control of their reproduction.
The advanced liberal subject is presumed to have access to a wide array of choices and to demonstrate responsible citizenship by choosing correctly among them. This is evident in the article sample, where barriers to access are rarely discussed and principled refusal to adopt technologies of reproductive control is wholly absent. However, despite the liberal mythos of pure market choice common in the US context, the opportunity to choose (and the choices available) is not evenly distributed, nor do all actors embrace the narrative of choice. In the United States access to technologies like IVF and egg freezing require substantial investment of time and money. Even access to adequate birth control and prenatal screening technologies is limited for many women marginalized on the basis of race, class, English fluency, and citizenship status. Already economically disadvantaged in many ways, these women are further disadvantaged, in the present system, by their lack of access to technologies of reproductive control. Further, even where access to technologies is available, uptake is not universal. For example, there is evidence that some parents of children with genetic conditions employ strategies of "choosing not to choose" as a means of responsible parenting, rather than embracing the promises of prenatal screening. (80) By facilitating the excavation of cultural values and hierarchies operating within the discursive construction of arts, an assessment of these technologies grounded in theories of risk allows for the development of a feminist analysis of reproductive technologies capable of accounting for the fluid, contingent, and evolving nature of their application.
The analysis of risk draws our attention to the reflexivity embedded within the development of arts and narratives about ARTS, as well as the ways in which these narratives are embedded within pronatalist, hierarchical, and neoliberal frameworks that tend to run counter to broad feminist commitments to equality and the separation of women's worth from their fulfillment of maternal "duties." Through my analysis I have demonstrated the ways in which arts, as they are currently discursively constructed, are productively understood as reflexive technologies of neoliberal entrepreneurialism of self. Reflexive narrative structure is clearly present in the journalistic discourse on arts. Incorporating this reflexivity into the analysis of arts promotes a more productive understanding of arts as fluid, contingent, and unfolding, rather than stable technological constructions that can only affect women in a singularly oppressive or liberatory way. Acknowledging this contingency allows for an analysis of arts that focuses on identifying the ways in which these technologies are and might be used to benefit women and promote feminist politics, as well as the ways in which they are or might be used to the detriment of women and in opposition to feminist politics. Identifying and acting on the ways in which the former might be promoted and the latter curbed is more productive than taking a technologically deterministic view that assumes that arts will be inherently either liberatory or oppressive.
Additionally, my analysis has identified ways in which narratives of freedom of choice and empowerment--which have been so integral to the fight for women's access to abortion, contraception, and basic knowledge of and control over their own bodies--can serve ends that run counter to many core feminist values when applied to some arts. When applied to egg freezing, for example, these narratives serve to encourage women toward extensive outlays of time and money and exposure to risks in a manner that reifies the paramount importance of childbearing and the hierarchical valuation of the genetic contributions of affluent, professional-class, White women over those of lower-income, working-class, and poor women and women of color. While in no way discounting the importance of the fight for women's reproductive choice, empowerment, and right to self-determination, my analysis underscores the ways in which these narratives are particularly amenable to cooptation by neoliberal frameworks that often run counter to central feminist values. By incorporating a theorization of arts grounded in risk society and governmentality literatures, a feminist analysis of reproductive technologies is better equipped to identify and combat this cooptation.
(1.) Anthony Giddens, The Consequences of Modernity (Cambridge: Polity Press, 1990), 92
(2.) Giddens, Consequences of Modernity, 133.
(3.) The term assisted reproductive technology technically refers only to those technologies, directed toward conception, that involve the manipulation of both egg and sperm (e.g., in vitro fertilization). However, my use follows a broader colloquial definition, which incorporates a range of technologies for intervention into the reproductive process. These include technologies that deal solely with a single gamete (e.g., egg or sperm banking or donor insemination), as well as technologies that are used after conception has been achieved (e.g., prenatal screening or sonography).
(4.) For technologies of the self see Nikolas Rose, Pat O'Malley, and Mariana Valverde, "Governmentality," Annual Review of Law and Social Science 2 (2006): 100. For expert systems see Giddens, Consequences of Modernity. For sources of reflexive risk see Giddens, Consequences of Modernity, Ulrich Beck, Risk Society: Towards a New Modernity (Thousand Oaks ca: SAGE, 1992).
(5.) For example: Shulamith Firestone, The Dialectic of Sex (New York: Bantam Books, 1970); Gina Corea, The Mother Machine: Reproductive Technologies from Artificial Insemination to Artificial Wombs (New York: Harper & Row, 1985); Patricia Spallone and Deborah Steinberg, eds., Made to Order: The Myth of Reproductive and Genetic Progress (London: Pergamon, 1987); Lori B. Andrews, "Surrogate Motherhood: The Challenge for Feminists," Law, Medicine, and Health Care 16 (1988): 72-80; Sara Ruddick, "Maternal Thinking," Feminist Studies 6, no. 2 (1980): 342-67; Martha E. Gimenez, "The Mode of Reproduction in Transition: A Marxist-Feminist Analysis of the Effects of Reproductive Technologies," Gender and Society 5 (1991): 334-50; Faye Ginsburg and Rayna Rapp, "The Politics of Reproduction," Annual Review of Anthropology 20 (1991): 311--43; Kathryn Pauly Morgan, "Of Woman Born? How OldFashioned! New Reproductive Technologies and Women's Oppression," in A Reader in Feminist Ethics, ed. D. Shogan (Toronto: Canadian Scholars' Press, 1993); Christine Sistare, "Reproductive Freedom and Women's Freedom: Surrogacy and Autonomy," in Living with Contradictions, ed. Alison Jaggar (Boulder: Westview Press, 1994); Joan Mahoney, "Adoption as a Feminist Alternative to Reproductive Technology," in Reproduction, Ethics and the Law, ed. Joan Callahan (Bloomington: Indiana University Press, 1995); Barbara Katz Rothman, Recreating Motherhood (New Brunswick nj: Rutgers University Press, 2000); B. Bennett, "Choosing a Child's Future? Reproductive Decision-Making and Preimplantation Genetic Diagnosis," in The Regulation of Assisted Reproductive Technology, ed. J. Gunning and H. Szoke (Aldershot UK: Ashgate, 2003); J. C. Ciccarelli and L. J. Beckman, "Navigating Rough Waters: An Overview of Psychological Aspects of Surrogacy," Journal of Social Issues 61 (2005): 21-43; Laura Mamo, Queering Reproduction: Achieving Pregnancy in the Age of Technoscience. (Durham: Duke University Press, 2007).
(6.) For risk society literature see U. Beck, Risk Society; Anthony Giddens, Modernity and Self-Identity: Self and Society in the Late Modern Age (Stanford: Stanford University Press, 1991); Niklas Luhmann, Risk: A Sociology Theory (Piscataway nj: Aldine Transaction,  2005); Anthony Giddens, Beyond Left and Right (Cambridge: Polity Press, 1994); Nikolas Rose, "Refiguring the Territory of Government," Economy and Society 25, no. 3 (1996): 327-56; Anthony Giddens, The Third Way (Cambridge: Polity Press, 1998); Nikolas Rose, Powers of Freedom: Reframing Political Tlwught (Cambridge: Cambridge University Press, 1999). For governmentality literature see Michel Foucault, Discipline and Punish: The Birth of the Prison (London: Allen Lane, 1977); J. Donzelot, The Policing of Families (New York: Pantheon, 1979); Nikolas Rose, Governing the Soul (London: Routledge, 1990); Michel Foucault, "Governmentality," in The Foucault Effect: Studies in Governmentality, ed. G. Burchell, C. Gordon, and P. Miller (Chicago: University of Chicago Press, 1991); Francois Ewald, "Insurance and Risk," in Burchell, Gordon, and Miller, Foucault Effect; Pat O'Malley, "Risk and Responsibility," in Foucault and Political Reason, ed. A. Barry, T. Osborne, and N. Rose (Chicago: University of Chicago Press, 1996); Pat O'Malley, "Uncertain Subjects: Risk, Liberalism and Contract," Economy and Society 29, no. 4 (2000): 460-84; Rose, Powers of Freedom-, Rose, O'Malley, and Valverde, "Governmentality."
(7.) Giddens, Consequences of Modernity, U. Beck, Risk Society.
(8.) For second modernity see U. Beck, Risk Society: Anthony Giddens, "Living in a Post-Traditional Society," in Reflexive Modernization: Politics, Tradition and Aesthetics in the Modern Social Order, ed. U. Beck, A. Giddens, and S. Lash (Cambridge: Polity Press, 1994).
(9.) H. P. Blossfeld and J. Huinink, "Human Capital Investments or Norms of Role Transition? How Women's Schooling and Career Affect the Process of Family Formation," American Journal of Sociology 97, no. 1 (1991): 143-68; R. Leete, Dynamics of Values in Fertility Change (Oxford: Clarendon Press, 1998); A. C. Liefbroer and M Corijn, "Who, What, Where, and When? Specifying the Impact of Educational Attainment and Labour Force Participation on Family Formation," European Journal of Population 15, no. 1 (1999): 45-75; K. L. Brewster and R. R. Rindfuss, "Fertility and Women's Employment in Industrialized Nations," Annual Review of Sociology 26 (2000): 271-96; S. S. Gustaffson, E. Kenjoh, and C. Wetzels, "The Role of Education on Postponement of Maternity in Britain, German, the Netherlands and Sweden," in Tl:e Gender Dimension of Social Change, ed. E. Rsupini and A. Dale (Bristol: Policy Press, 2002); T. Sobotka and M. R. Testa, "Attitudes and Intentions toward Childlessness in Europe," in People, Population Change and Policies, ed. C. Hohn, D. Avramov, and I. E. Kotowska (Dordrecht: Springer Netherlands, 2008); T. Sobotka "Shifting Parenthood to Advanced Reproductive Ages: Trends, Causes and Consequences," in A Young Generation under Pressure? ed.}. Tremmel (Berlin: Springer, 2010).
(10.) Giddens, Modernity and Self-Identity.
(11.) U. Beck, Risk Society: Giddens, Consequences of Modernity.
(12.) U. Beck, Risk Society, 23, original emphasis.
(13.) Foucault, "Governmentality"; Colin Gordon, "The Soul of the Citizen: Max Weber and Michel Foucault on Rationality and Government," in Max Weber: Rationality and Modernity, ed. S. Lash and S. Whimster (London: Allen & Unwin, 1987).
(14.) Rose, Powers of Freedom, 144.
(15.) Rose, Powers of Freedom.
(16.) Rose, O'Malley, and Valverde, "Governmentality," too; Giddens, Modernity and Self-Identity, 133.
(17.) Deborah Wilson Lowry, "Understanding Reproductive Technologies as a Surveillant Assemblage: Revisions of Power and Technoscience," Sociological Perspectives 47, no. 4 (2004): 357-70; Carolyn Michelle, "'Human Clones Talk about Their Lives': Media Representations of Assisted Reproductive and Biogenetic Technologies," Media, Culture and Society 29, no. 4 (2007): 639-63; Susana Silva and Helena Machado, "Uncertainty, Risks and Ethics in Unsuccessful In Vitro Fertilisation Treatment Cycles," Health Risk and Society 12, no. 6 (2010): 531-45.
(18.) For a thorough review of the feminist analysis of ARTS see Charis Thompson, "Fertile Ground: Feminists Theorize Reproductive Technologies" in Making Parents: The Ontological Choreography of Reproductive Technologies (Cambridge: mit Press, 2005), 55-75. For challenges to these views see Lowry, "Understanding Reproductive Technologies"; S. Markens, C. H. Browner, and H. M. Preloran, '"I'm Not the One They're Sticking the Needle Into': Latino Couples, Fetal Diagnosis, and the Discourse of Reproductive Rights," Gender and Society 17, no. 3 (2003): 462-81.
(19.) Patricia Campbell, "Boundaries and Risk: Media Framing of Assisted Reproductive Technologies and Older Mothers," Social Science and Medicine 72, no. 2 (2011): 265-72; Elizabeth Szewezuk, "Age-Related Infertility: A Tale of Two Technologies," Sociology of Health and Illness 34, no. 3 (2012): 429-43.
(20.) LexisNexis and EBSCO Academic Search Premier databases were used.
(21.) Please note that here related simply means that the article's title suggested that it was related to questions of older motherhood, delayed childbearing, falling birth rates, the risks associated with "advanced" parental age, and/or reproductive technologies. Many of these 351 articles did not make direct reference to any reproductive technologies.
(22.) The forty-five articles in the final sample were published in eighteen periodicals. These were: Chicago Sun-Times (IL), Newsweek (US), Orange County Register (CA), Palm Beach Post (FL), Pittsburgh Post-Gazette (PA), Providence Journal-Bulletin (RI), San Jose Mercury News (CA), Star Tribune (MN), Tampa Tribune (FL), Atlanta Journal and Constitution (GA), Houston Chronicle (TX), New York Post (NY), New York Times (US), Philadelphia Inquirer (PA), San Francisco Chronicle (CA), Washington Post (DC), time (US), and USA Today (US).
(23.) The asterisk (*) symbol functions as a wildcard in database searches. This allows a search like "mother*" to return all instances of mother, mothers, mothering, and motherhood, while a search like "wom*n" will return both woman and women, thereby ensuring the most comprehensive search parameters possible.
(24.) Although these searches did not return any articles directly linking men with technologies for age-related reproductive risk management, after the date of submission the New York Times ran an article on Aug. 22, 2012, entitled "Father's Age Is Linked to Risk of Autism and Schizophrenia" (http://www.nytimes.com/20r2/08/23/ health/fathers-age-is-linked-to-risk-of-autism-and-schizophrenia.html), which culminated with the suggestion that "collecting the sperm of young adult men and coldstoring it for later use could be a wise individual decision." This suggests that the elective use of reproductive technologies for "fertility preservation" as a "reproductive insurance policy" among healthy young men may begin to enter the popular media, on par with egg freezing. Certainly this warrants future research.
(25.) At times a new risk, like the risk of birth defects in fetuses born to women who have undergone CVS, might be discussed at the beginning of the article before the author goes on to discuss the reasons that maternal-age-based indications for prenatal screening were implemented in the first place. In the risk map created the reasons given for maternal-age-based indications are placed before the risk of birth defects rather than after, thus following the chronological order of the risk narrative, rather than order in the text.
(26.) See D. J. Van de kaa, "Europe's Second Demographic Transition," Population Bulletin 42, no. 1 (1987): 1-57; K. O. Mason, "Explaining Fertility Transitions," Demography 34, no. 4 (1997): 443-54; J. Bongaarts and G. Feeney, "On the Quantum and Tempo of Fertility," Population and Development Review 24, no. 2 (1998): 271; J. Bongaarts, "The Fertility Impact of Changes in the Timing of Childbearing in the Developing World," Population Studies 53, no. 3 (1999): 277-89; J. Bongaarts, "Fertility and Reproductive Preferences in Post-Transitional Societies," Population and Development Review 27 (20or): 26o-8r; H. P. Kohler, F. C. Billari, and J. A. Ortega, "The Emergence of Lowest-Low Fertility in Europe during the 1990s," Population and Development Review 28, no. 4 (2002): 641-80; F. C. Billari and H. P. Kohler, "Patterns of Low and Lowest-Low Fertility in Europe," Population Studies 58, no. 2 (2004): 161-76; T. Sobotka, "Is Lowest-Low Fertility in Europe Explained by the Postponement of Childbearing?" Population and Development Review 30, no. 2 (2004): 195-220.
(27.) For Italy see A. Boggio, "Italy Enacts New Law on Medically Assisted Reproduction," Human Reproduction 20 (2005): 1153-57; L. Parmegiani, F. Bertocci, C. Garello, M. C. Salvarani, G. Tambuscio, and R. Fabbri, "Efficiency of Human Oocyte Slow Freezing: Results from Five Assisted Reproduction Centres," Reproductive Biomedicine Online 18 (2009): 352-59. For medical procedures affecting reproductive organs see J. G. Bromer and P. Patrizio, "Preservation and Postponement of Female Fertility," Placenta 29 (2008): S200-205; H. J. Chang and C. S. Suh, "Fertility Preservation for Women with Malignancies: Current Developments of Cryopreservation," Journal of Gynecological Oncology 19 (2008): 99-107; Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology, "Ovarian Tissue and Oocyte Cryopreservation," Fertility and Sterility 90 (2008): S241-46; T. Tao and A. Del Valle, "Human Oocyte and Ovarian Tissue Cryopreservation and Its Application," Journal of Assisted Reproduction and Genetics 25 (2008): 287-96; J. A. Grifo and N. Noyes, "Delivery Rate Using Cryopreserved Oocytes Is Comparable to Conventional In Vitro Fertilization Using Fresh Oocytes: Potential Fertility Preservation for Cancer Patients," Fertility and Sterility 93 (2010): 391-96; D. De Ziegler, I. Streuli, I. Vasilopoulos, C. Decanter, P. This, and C. Chapron, "Cancer and Fecundity Issues Mandate a Multidisciplinary Approach," Fertility and Sterility 93 (2010): 691-96. Where embryo storage would require single women to select donor sperm, egg freezing was considered superior because it preserved the option to create embryos using a male partners sperm at a later date.
(28.) T. O. Menees, J. D. Millar, and L. E. Holly, "Amniography: Preliminary Report," American Journal of Roentgenology 24 (1930): 353-66; Fritz Fuchs and Povl Riis, "Antenatal Sex Determination," Nature 177 (1956): 330; H. A. Thiede, W. T. Creasman, and S. Metcalfe, "Antenatal Analysis of the Human Chromosomes," American Journal of Obstetrics and Gynecology 94 (1966): 589.
(29.) S. Smidt-Jensen, N. Hahnemann, P. K. A Jensen, et al., "Experience with Fine Needle Biopsy in the First Trimester--An Alternative to Amniocentesis," Clinical Genetics 26 (1984): 272; J. Mohr, "Foetal Genetic Diagnosis: Development of Techniques for Early Sampling of Foetal Cells," Acta Pathologica Microbiolabic Scandinavia 73 (1968): 7377.
(30.) Jane Brody, "Experts Explore Safer Tests for Down Syndrome," New York Times, Jan. 24, 2001.
(31.) Harold M. Schmeck, "New Prenatal Test Raises Concern for Fetus," New York Times, May 27,1984. See also G. Kolata, "Health: Fetal Testing; New Tests to Provide Safer Screening for Down's Syndrome," New York Times, Oct. 13, 1988.
(32.) Elisabeth Rosenthal, "Technique for Early Prenatal Test Comes under Question in Studies," New York Times, July 10,1991.
(33.) Kolata, "Health: Fetal Testing."
(34.) Jane Brody, "Prenatal Tests: More Information, Less Risk," New York Times, July 27, 2004.
(35.) Kolata, "Health: Fetal Testing."
(36.) Brody, "Experts Explore Safer Tests."
(37.) Maria Elena Baca, "Journey to Birth; 2nd Trimester; Weighing the Risks, Benefits, of Testing," Star Tribune, June 11, 2001.
(38.) Keay Davidson, "Study Argues for More Amniocentesis; Testing Moms-to-be Can Find Abnormality in Fetuses' Genes," San Francisco Chronicle, Jan. 23, 2004.
(39.) Giddens, Consequences of Modernity, 141.
(40.) See Patrick Steptoe and Robert Edwards, "Pregnancy in an Infertile Patient after Transfer of an Embryo Fertilized In Vitro," British Medical Journal 268, no. 6374 (1983): 1351
(41.) Kristy Horsey, "Three Million IVF Babies Born Worldwide." BioNews, June 26, 2006, http://www.bionews.org.uk/page_12772.asp.
(42.) U. Beck, Risk Society.
(43.) Some patient advocacy and disability rights groups, as well as some bioethicists, have in fact contested the benefit of diminishing the number of people affected by genetic disorders, likening it to a form of genocide against the disabled or the genetically "abnormal" fetus. However, these views were not present in any of the sampled articles and thus will not be addressed in my analysis.
(44.) Jillian Mincer, "Baby Baby Boom Boom: Later Pregnancies Mean More Twins," New York Times, Nov. 30,1988, emphasis added.
(45.) Bill Hendrick, "Health Watch; Baby Boom Women, Fertility Drugs Increasing Rate of Multiple Births," Atlanta Journal and Constitution, Feb. 21, 1996.
(46.) Geoffrey Cowley and Karen Springen, "Multiplying the Risks," Newsweek, Dec. 1.1997
(47.) Marie McCullough, "Increase in Multiple Births Rattles the Experts/High-Tech Conception Can Raise Health Risks," Philadelphia Inquirer, May 10, 1998.
(48.) Nicholas Bakalar, "Regimens: Use of 3 or More Embryos Is Called Too Risky," New York Times, Jan. 24, 2012; Rita Rubin, "A Singular Approach to ivf; Newer 'eSET' Procedure Reduces Risk of Multiples," USA Today, Mar. 5, 2009.
(49.) Michael D. Lemonick, "Risky Business?" Time, Mar. 19, 2002.
(50.) Lemonick, "Risky Business?"
(51.) Lemonick, "Risky Business?"
(52.) David Beck and Julie Severns Lynos, "Reproductive Therapies Don't Pose Risk to Babies, Research Finds," San Jose Mercury News, Oct. 31, 2005; Catherine Elton, "Why IVF Is Linked with Cancer Risk," Time, July 19, 2010.
(53.) Elton, "Why ivf Is Linked with Cancer Risk."
(54.) Meredith Melnick, "IVF Linked to Ovarian Tumors. Should Women Worry?" Time, Oct. 27, 2011.
(55.) U. Beck, Risk Society.
(56.) C. Chen, "Pregnancy after Human Oocyte Cryopreservation," Lancet 1, no. 8486 (1986): 884-86.
(57.) J. Jain et al., "Oocyte Cryopreservation," Fertility and Sterility 86, no. 4 (2005): 1037-46.
(58.) Although the ASRM did lift the experimental label, in an announcement preceding its 2012 annual meeting, the statement maintained that the safety and efficacy data were as yet insufficient to recommend the universal implementation of banking of donor eggs or the marketing or provision of elective egg freezing for the purpose of postponing childbearing.
(59.) Lauren Jade Martin, "Anticipating Infertility: Egg Freezing, Genetic Preservation, and Risk," Gender and Society 24, no. 4 (2010): 526-45.
(60.) Martin, "Anticipating Infertility."
(61.) O'Malley, "Risk and Responsibility," 203.
(62.) Tony Saavedra, "A Genesis of Conflict; Fertility: Experts Say Freezing Eggs Is Too Experimental for the Public, Though Some Women Are Willing to Take the Chance," Orange County Register, Apr. 30, 2000.
(63.) Claudia Kalb, "Should You Have Your Baby Now?" Newsweek, Aug. 13, 2001.
(64.) Rebecca Dana, "Ice Queens; They Save Their Eggs and Thrive at Work. Diane Sawyers Secret to Resetting the Biological Clock," Newsweek, Jan. 30,2012; Rick Weiss, "New Ways May Let Women Put Family Plans on Ice," Washington Post, Oct. 12,1998; Rob Stein, "Women Hedge Bets by Banking Their Eggs; As More Freeze, Debate Expands," Washington Post, May 13,2007.
(65.) Dana, "Ice Queens"; Susan Edelman, "Eggs on the Side: nyu to Debut Ova-Freeze Clinic," New York Post, Oct. 26, 2003.
(66.) Stein, "Women Hedge Bets." See also Rachel Lehmann-Haupt, "Why I Froze My Eggs," Newsweek, May 18, 2009.
(67.) Stein, "Women Hedge Bets."
(68.) Lehmann-Haupt, "Why I Froze My Eggs."
(69.) O'Malley, "Risk and Responsibility."
(70.) Anita Hamilton, "Eggs on Ice," Time, July 2, 2002; Sally Wadyka, "For Women Worried about Fertility, Egg Bank Is a New Option," New York Times, Sept. 21, 2004; Stein, "Women Hedge Bets."
(71.) Maureen Downey, "New Moms; New Choices; Frozen Egg Technology Gives Women New Hope for Their Chances of Childbearing," Atlanta Journal and Constitution, Oct. 19, 1997; Wadyka, "For Women Worried about Fertility"; Pohla Smith, "Investment in the Future; Preservation Program's 'Egg Freezing' Keeps Expand Fertility Options," Pittsburgh Post-Gazette, Oct. 24, 2011; Blythe Bernhard, "Focus: Fertility; Is Egg Freezing Coming into Its Own?; Technique Called A Way to Break the Reproductive Logjam,' and yet Caution Is Urged," Houston Chronicle, Sept. 1, 2005; Smith, "Investment in the Future."
(72.) Daren Briscoe, "Put Those Eggs on Ice; Most Couples without Children Wait Too Long to Have Them. But Technology May Have an Answer," Newsweek, Sept. 4, 2006; Stein, "Women Hedge Bets."
(73.) Martin, "Anticipating Infertility," 536-37.
(74.) Kalb, "Should You Have Your Baby Now?"; Dana, "Ice Queens."
(75.) Giddens, Modernity and Self-Identity, 144.
(76.) Marit Melhuus, "Conflicting Notions of Continuity and Belonging: Assisted Reproduction, Law, and Practices in Norway," Social Analysis 53, no. 3 (2009): 148-62; Carles Salazar, and Gemma Orobitg, "The Making of an Imagined Community: The Press as a Mediator in Ethnographic Research into Assisted Reproductive Technologies (ART)," Ethnography 13, no. 2 (2012): 236-55.
(77.) Martin, "Anticipating Infertility," 533.
(78.) Martin, "Anticipating Infertility," 536-47.
(79.) Dana-Ain Davis, "The Politics of Reproduction: The Troubling Case of Nadya Suleman and Assisted Reproductive Technology," Transforming Anthropology 17, no. 2 (2009): 105-16.
(80.) Susan E. Kelly, "Choosing Not to Choose: Reproductive Responses of Parents of Children with Genetic Conditions or Impairments," Sociology of Health and Illness 31, no. 1 (2009): 81-97.
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|Author:||Myers, Caitlin E.C.|
|Publication:||Frontiers: A Journal of Women's Studies|
|Date:||Jan 1, 2014|
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