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In Search of Parenthood: Coping with Infertility and High-Tech Conception.

In Search of Parenthood: Coping with Infertility and Hi-Tech Conception.

In In Search of Parenthood, Lasker and Borg seek to give those considering using new productive technologies "a clearer picture of what they are likely to face." They do this more effectively than most books for the infertile because they do consider some of the risks and negative experiences involved.

They raise the issue of why people go through these physically and emotionally painful experiences to have children, pointing out the strong socialization pressures, particularly on women. The authors explore the grief and strong emotions involved, and question why infertility is so painful, particularly when it "is not life-threatening." They find, as have others, that it indicates a lack of control in a person's life, particularly among middle-class heterosexual couple. Technologies such as artificial insemination (AID), in vitro fertilization (IVF), surrogate motherhood and ovum transfer are seen, misleadingly, as a way of regaining control.

This perspective on infertility sets discussion remains at the level of the individual, backed up by interviews with professionals in the field and with infertile couples. They indicate that they "find it impossible to join those who take positions that are clearly for or against" the technologies, yet their book results in advocacy of them.

The chapter on AID is a useful introduction to the technique, addressing the anxieties involved for women using an unknown donor's sperm. IVF is also represented with its pros and cons, and the authors stress the lies told about so-called success rates--something that feminists have argued for a long time. Lasker and Borg point out that women are dropped from IVF programs at various stages along the way, which influences the success rates quoted by doctors. The correctly point out that "The most crucial question, the best measure of success, is how many couples that entered the program actually ended up with babies." Their own survey of hospitals in 1985-1986 showed that most were below 10 percent on this rating and many had no births, while claiming a 50 percent success rate. The authors cover the risks involved, including financial strain, disruption to work and marriage, anxiety, depression, high rates of ectopic pregnancy, miscarriage, premature birth, unknown side-effects of the drugs given, and the risks of general anesthesia.

Unfortunately, the issues involved in surrogate motherhood and ovum transfer are not given the same critical attention. We are misleadingly told that surrogacy is used mainly by fertile men with infertile wives, and surrogacy is represented as a real alternative for infertile couples. The process is described as "a difficult job" for the surrogate mother, already establishing it in a workplace role.

The authors' case studies of the experience of surrogate mothers offer no analysis of the overwhelming self-debasement and desire for love and approval evidenced by many of these women. Yet this phenomenon is obviously part of the emotional exploitation of women, fitting the stereotype of women as caring for others more than they care for themselves and belying the appalling lack of love and attention that women receive in their everyday lives.

The chapter on ovum transfer, the flushing of a five-day embryo from a fertile donor followed by its implantation in an infertile woman, gives details on an unsuccessful technology backed by commercial enterprise. The authors give statistics showing the failure rate, danger to the donor of infection, ectopic pregnancy and retained pregnancy, as well as the possibilities of miscarriage for the receiving woman.

They comment on the uses of ovum transfer for prenatal screening, raising the possibility of eugenics. Yet they do not so much query this in itself as who will have access to it. They pose the important question, "When only poor and uneducated women have children with serious problems, how much influence will they have over the allocation of resources to help such children?" But Lasker and Borg fail to stress that ovum transfer, advertised as donation of an egg, actually involves taking potent drugs whose side-effects are not known, as well as other risks.

This book essentially remains an advocacy for the technologies. The authors do present many of the associated problems, but ultimately cannot step outside the experiences of the individual. Their discussion of public responses to the technologies would have been best left out. It can only be superficial, linking quite wrongly the positions of the religious right and feminist left.

Lasker and Borg raise many important questions, but do not answer them in any analytic way. They look at some sex-role differentiation between women and men in infertility programs, but lack a power analysis. They fail to examine the role a commercialization in this field. And language itself is sloppily used in an area in which language is critically important in defining public response to technology. Having relayed some quite damning and outrageous experiences and information to the reader, the authors tend to undermine it, always finishing on a positive note. The stories of infertile couples are used to make the technologies seem more human and acceptable. Finally, In Search of Parenthood does not extend its analysis to the social implications of the research. Reading this, one might believe that only scientists and a few infertile couples are involved, when the implications of genetic engineering and prenatal screening, intimately related to IVF for example, affect everyone.

In contrast to Lasker and Borg's sample, Emily Martin deals with a wide cross-section of women from the middle and working classes, black and white, and from three stages of life. She takes what women are saying and looks beyond the representations of their language to a more sophisticated analysis of the development of the social reproduction of knowledge and how women's experience fits or does not fit with it. In this particular instance, she considers scientific medical knowledge concerning menopause, birth, and menstruation.

The aim of Martin's book is first to consider contemporary ideas in medical practice concerning these three primary experiences in women's lives, using current medical texts. In the process, she constructs an interesting history of the ideology behind the construction of medicine itself, and in particular its attitudes to and relationship with women.

Martin shows that many elements in modern science have contributed to "the fragmentation of the unity of the person." Science, for example, construes women as raw material and babies as products, and treats the person as a machine. Images of the body as machine also allow for images of the doctor as mechanic, opening the way for the use of technology. This is particularly apparent in women's labor before birth. The uterus is described as a machine out of control, and so doctors "manage" labor. The result is that cesarian section is seen to be the best kind of birth from a doctor's point of view. Martin includes powerful descriptions from women who experienced a cesarian as a rape and an assault. Yet she also deals with the statistics on cesarians indicating that the need for them is questionable, and that their use is related to both class and race, though often in a contradictory way.

In examining premenstrual syndrome (PMS), Martin deals with the dilemma faced by most feminists in giving credibility to women's negative experiences during menstruation while questioning the political use of cyclic changes. She argues that PMS can be a socially sanctioned way for women to express anger: It would be the "rebellion and resistance" of the oppressed.

But the notion of resistance has its strongest impact in Martin's sections on birth. Here she shows, following the factory imagery again, that clocks are watched by doctors and women are ordered to fulfill an hourly schedule with respect to their stage of labor. She uses Barbara Katz Rothman's work to show that time allowed for both first and second stage labor has been reduced steadily by the medical profession since the 1940s! Martin lists actions of resistance by women to the medical "management" of labor and birth, but she points out ominously that the ability to resist is becoming more and more difficult as the technology becomes more and more complex and as women are forced to conform to its use.

Martin never slides from her determination to look at class and race differences in her analysis. At times this is confusing, but at other points it is horrifyingly clear. For example, between 1959 and 1961 the total maternal mortality rate for nonwhite women was four times that of white women. Poverty, inadequate health care, stress, unemployment, and all of the experiences that go along with these have an important impact on women's experience of birth. Martin points out that women's ability to resist medical treatment during birth is also obviously affected by their race and their class.
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Author:Rowland, Robyn
Publication:The Hastings Center Report
Article Type:Book Review
Date:May 1, 1989
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