Put yourself in Kylie Jenner’s shoes for two minutes. And, before you start counting how much money you could be making from the ‘gram, ponder this: If you could have a baby, or multiple babies, and your wealth could be used to eliminate all the risks pregnancy poses to your health, body, and career, while introducing no dangers to your child, would you?
Assuming the answer is yes, would your response be the same if that meant growing your baby in an artificial womb?
Ectogenesis, the process of gestating a fetus outside the womb, sounds like the stuff of science fiction. But at some point, this technology could cross the border from The Matrix into medical reality. Last year, researchers at the Children’s Hospital of Philadelphia kept premature lamb fetuses alive in fluid-filled biobags for four weeks and, in 2016, scientists at the University of Cambridge sustained an embryo in a petri dish for 13 days (one day shy of the legal limit).
Eventually these two technologies could progress to a point where they meet in the middle, says Scott Gelfand, professor of philosophy and director of the Ethics Center at Oklahoma State University. This would mean a baby could be gestated from fertilization to viability outside the body. “We could end up with the technology by kind of stumbling on it,” Gelfand tells me. “We could find ourselves in a situation where these two technologies actually meet.”
Carlo Bulletti, associate professor at Yale University’s department of obstetrics, gynecology, and reproductive science, believes a fully functioning artificial womb could be created within a decade with the right investment. Bulletti, a fertility specialist, tells me the proposed system would be a “glass cabinet with UV protection” containing a gelatinous protein substance. The fetus would be sustained by a maternal blood supply, which is oxygenated by an artificial lung, circulated by an artificial heart, and filtered by artificial kidneys. The machine would need to undergo testing on animals with similar-sized fetuses to humans first, he adds.
Bulletti’s vision of a world where ectogenesis is mainstream is one where it's easier for male same-sex couples to have biologically related children, for women with uterine abnormalities or no uterus at all to have their own children, and where gender equality is advanced by a “new parenthood balance where men and women will no longer have primary and secondary roles,” he says.
However, as with any new technology, ectogenesis is likely to start out as an expensive luxury. And when almost one in 11 people have no health insurance coverage, it seems likely that—at least at first—it would only be wealthy couples who could outsource the job of gestation.
Will the artificial womb just be like a mechanical version of surrogacy? And could pregnancy become a class signifier in the same vein as claiming welfare, or living in public housing?
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“There is a risk that ectogenesis would only be accessible to the wealthy unless a system of public access is established at the outset,” says Evie Kendal, bioethics and health humanities lecturer at Deakin University in Australia and author of Equal Opportunity and the Case for State Sponsored Ectogenesis. “Most other reproductive biotechnologies, like IVF, were initially accessible only to wealthy clients but as the technology improved became affordable for many more citizens.”
Gelfand fears, though, that ectogenesis existing at all, and then becoming more affordable, could pose its own dangers. He posits that artificial womb technology may become more cost-effective with time, and that it would also rule out expenses like hospital stays for pregnancy complications, treatment for fetal alcohol syndrome, or the massive expenses of premature births. While he emphasizes that this is all hypothetical, he questions whether, if insurers deem pregnancy an expensive non-necessity, they could they stop covering it altogether.
“In the political culture of the United States right now, I would find it difficult to believe that there would be national legislation that would prohibit insurance companies from coercing patients to utilize ectogenesis—assuming, of course, that it's safe and efficacious,” he explains. “Think about it, if there is a generic medicine that costs less than a name-brand medicine, an insurance company's not going to cover [the name-brand drug].”
Of course, not having to deal with health issues arising from pregnancy could be a desirable outcome in itself. Kendal points out that “women would no longer need to take time off work for pregnancy-related illness and childbirth,” which could leave them better off financially. She adds, “This has substantial implications for career advancement, as women are often overlooked for promotion simply because they are not present at the time discussions arise.”
But insurance companies’ treatment of those who want to have a child naturally isn’t the only thing that concerns Gelfand about ectogenesis entering the current political landscape. Bioethicists have frequently pointed out that the abortion rights established by Roe v. Wade were borne out of the mother’s right to privacy, not her right to terminate the fetus. Roe and ensuing rulings say states can’t impose limits on abortion before fetal viability. But if the fetus could survive outside the mother’s womb at any point during gestation, where does that leave a woman’s ability to terminate a pregnancy?
Gelfand warns that legislators could feasibly decide that “women who want an abortion can terminate their pregnancies but that they have to put the fetus in an artificial womb.” In this event, choosing a termination because having a child is not an option (for financial or other reasons) would be made even less straightforward. In this event, anti-choice lawmakers could try to use the wombs as a tool to convince women to parent the child once it's born.
“If you want an abortion in certain states now they want to do an ultrasound and you have to look at [the fetus],” Gelfand adds. “You can imagine in the United States that you [might] have to come in every month and look at the kid developing in the artificial womb with the idea that they could coerce parents to develop feelings that they don’t want to develop and then they’d keep the child.”
Francesca Minerva, postdoctoral fellow in the University of Ghent’s department of philosophy and moral sciences, believes that while the artificial womb should be “regulated carefully,” its risks don’t outweigh its potential to bring joy to those who can’t have children naturally.
“It would be a mistake to prevent the development of a technology that has huge potential to allow people to have children and to have families and happy lives because we fear that in some states, in some cases, it could be used in the wrong way,” she tells me. “This is the history of any progress. With every technology, there is always that risk.”
Kendal proposes that ectogenesis could eradicate the sometimes exploitative practice of surrogacy, where a “power imbalance” can lead to wealthy parents taking advantage of poorer women who take on this role. “One of the potential benefits of ectogenesis is it could outsource contract pregnancy to a machine, rather than a person,” Kendal explains. “As it is not possible to exploit or dehumanize a machine, this can be seen to be preferable to commercial surrogacy.”
To ensure the artificial womb doesn't diminish women’s reproductive autonomy and expands, rather than contracts, their range of options, Gelfand says we need to have ethical discussions about it before it arrives.
“We're in a unique position, whereby we see this technology on the frontier but yet we can talk about it and maybe understand it more,” he says. “There are things that we as a society need to, in my opinion, think through, talk about, before we wake up and read in the newspaper 'Scientist delivered baby in an artificial womb' and then we're like ‘oh, what now?’”
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