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The politics of assisted reproduction, explained


This Mother’s Day, many women (and men) around the globe are struggling to have children, turning to a variety of approaches to overcome infertility. Meanwhile, lawmakers, medical professionals and activists have been in a heated public debate about the complex morals and politics of abortion and assisted reproductive technologies, also called ART.

Here are five things to know about the politics of such technologies, including how they are viewed and regulated.

1. Use of ART, and IVF in particular, is booming in the U.S. and abroad.

Since the 1978 birth of Louise Brown, the first “test tube baby,” nearly 7 million babies have been born using ART, defined as fertility treatments in which eggs or embryos are handled outside the body.

The most commonly used technology is in vitro fertilization (IVF), where a woman’s eggs are removed, fertilized in a laboratory and then reimplanted into her body. IVF can also involve a constellation of other technologies, including the use of donor eggs and/or sperm.

In recent years, U.S. use of these technologies has skyrocketed. In 2015, 464 fertility clinics reported the birth of more than 72,000 infants via ART procedures, a 30 percent increase since 2006.

ART is in use globally, with people traveling across the world, including to and from the U.S., for treatment. Women in Israel undergo the most IVF cycles per capita; globally, Israel has the highest per capita rate of fertility clinics.

2. Debates over personhood may threaten assisted parenthood.

When assisted reproduction emerged in the late 1970s, some religious and political forces attacked its use. Some politicians feared IVF would be linked to the debate over abortion.

That hasn’t happened. The Catholic Church continues to formally oppose ART because of concerns about the use of technology in the creation of human life, as well as possible destruction of embryos in IVF.

But most people in the U.S. see abortion and ART as disconnected. As one of us, Heather Silber Mohamed, explores in a new article, the 2013 Pew Survey on Aging and Longevity revealed that while 53.9 percent of respondents in a nationally representative survey described abortion as morally wrong, only 11.7 percent viewed IVF this way. And among those who consider abortion morally wrong, only 19.5 percent described IVF in similar terms; one-third described IVF as morally acceptable and nearly half did not consider IVF a moral issue.

In the U.S., modern debates over abortion emphasize the point at which an embryo becomes a person. Abortion opponents typically argue that “personhood” occurs at the moment of conception; others argue that personhood should be measured in other ways. Fetal personhood proposals, like the bill rejected by South Carolina’s Senate last week, typically state that human life begins upon fertilization.

Infertility activists fear that, if passed, such proposals would threaten IVF. During this procedure, in many cases, more embryos are fertilized than are reimplanted. For many people, that leaves difficult questions about what to do with remaining embryos: donating them to science, destroying them, keeping them frozen indefinitely, or donating them to other families.

Fertility treatments can also result in a multiple pregnancy, which may threaten the health of the mother and the pregnancy — leading to debates over the controversial practice of what’s called selective reduction, or terminating one or more of the embryos.

3. What do Americans think about ART?

Silber Mohamed finds that compared to mainline Protestants, evangelical Protestants are more likely to hold “constrained,” or consistent, views opposing a group of policies related to human embryos, including abortion, embryonic stem cell research and IVF. And despite the Catholic Church’s official position, Catholics were not more likely than mainline Protestants to oppose IVF.

Religious beliefs are also more closely linked to attitudes about abortion than other procedures involving embryos. Individuals who say religion is very important in their lives are much more likely to say abortion is morally wrong (by 30 points) than those who say religion is not very important. For IVF, it’s just 10 points. The difference appears to relate to the end result: ending life vs. creating life.

Beyond religious beliefs, many perceive ART as being for upper-class white women. Despite higher rates of infertility in many communities of color, stigma surrounding treatment persists within African American, Latino and Arab American communities. The high costs of IVF, and the fact that it is not covered by most private insurance plans or Medicaid, leaves it financially out of reach for many.

 4. How are these technologies regulated?

European countries generally regulate ART fairly strictly — and many see the U.S. as the “wild West” of ART. As Erin Heidt-Forsythe’s research shows, the U.S. system is often seen as governed only by morals — religious beliefs and practices — or financial interests, overseen by the courts.

Nationally, patients and politicians have begun to seek solutions to some of the complex moral, ethical and technical problems involved with ART. For instance, last year, Congress overturned a 30-year-old ban on IVF within Veterans Affairs.

5. Abortion opponents are ART policy leaders

Heidt-Forsythe finds that Republican, not Democratic, women are leaders in advocating for ART at the state level. Between 1995 and 2010, Republican women in state legislatures were more likely to introduce and co-sponsor bills to regulate certain aspects of egg donation than Democratic women. The presence of Republican women in state legislatures increases the chances that legal protections around compensation of egg donors, informed consent and donors’ legal responsibilities will be passed.


Erin Heidt-Forsythe is an assistant professor of political science and women’s, gender, and sexuality studies at Penn State University, and author of the forthcoming book, “Between Families and Frankenstein: The Politics of Egg Donation in the United States” (University of California Press).

Heather Silber Mohamed is an assistant professor of political science at Clark University, and author of “The New Americans?: Immigration, Protest, and the Politics of Latino Identity” (University Press of Kansas, 2017).