Although Merve Emre does not use the term “neoliberal” in her essay, she vividly brings to life the effects of neoliberalism on our reproductive choices. When I speak of neoliberalism, I mean the “small-government” ideology of deregulation, laissez-faire economics, low taxation, elimination of social programs, socioeconomic inequality, the privatization of public resources, and a lack of collective social organization directed by government. Among the worst way that neoliberalism can affect our reproductive choices is by ingratiating its political and economic imperatives into the reproductive options that are available to us, in the process subverting our most considered values.

The technologization of reproduction encourages a norm of ableist perfectionism that is consistent with the neoliberal worldview.

One of the most obvious ways that neoliberal politics can influence reproductive choices is by denying parents paid leave when they have children, and job security when they return to work. In the United States, unlike in other affluent nations, paid parental leave is privatized—a benefit available only to those who work for employers willing to provide it. Without parental leave and job protection, workers might be motivated to put off having children until they are established in their career, or until they have saved enough money to take time off to raise a child through the first months or years of life. 

The Silicon Valley version of social justice, exemplified by Emre’s story of S, enables this deferral of parenthood by technologizing reproduction: ovarian stimulation, egg retrieval, egg freezing, preimplantation genetic diagnosis (PGD), and in vitro fertilization (IVF). Assisted reproduction interventions and employer-provided coverage for egg freezing and parental leave can transform getting pregnant and giving birth into a set of consumer transactions with reproductive health technicians and HR wonks.

Emre focuses on the stories of women utilizing and contracting for assisted reproduction, and does not discuss the more disadvantaged contributors to assisted reproduction. The whole enterprise of technologized reproduction feeds off of inequality created by neoliberal politics. For example, egg donors are usually young women who are paid to undergo ovarian stimulation and egg harvesting so that their eggs can be used by others in IVF interventions when they experience infertility. The donors tend to have financial needs sufficient to motivate them to undergo these unpleasant and dangerous procedures. In other words, a sufficient level of economic inequality is necessary for the existence of a market for donating ova. Feminist bioethics scholars such as Françoise Baylis have warned against the exploitation of egg donors for assisted reproduction. The risks posed to these women are often ignored in debates about the ethics of IVF. Because of the health risks, underpayment for egg donors is a problem, due to worries about exploiting the desperation of poor women. But overpayment would also be a problem because of concerns about undue inducement.

Economic inequality is also necessary for the participation of pregnancy surrogates, who are involved in some assisted reproduction arrangements. One U.S. surrogacy agency advertises reimbursement fees for surrogates in the range of $35,000 to $40,000 (alongside other fees for undergoing embryo transfer and for costs such as maternity clothing). The costs ultimately paid by intended parents are much higher, due to agency fees, legal fees, and other costs. Aspiring parents from Western countries looking for lower-cost surrogacy have created a commercial surrogacy industry in places such as India and Thailand. In such countries, there is a clear likelihood of exploiting the precarious economic circumstances of women for whom surrogacy fees might seem appealing.

At a deeper level, the technologization of reproduction encourages a norm of ableist perfectionism that is consistent with the neoliberal worldview. For example, intended parents often seek out egg donors who exemplify certain cultural ideals of perfection. Agencies place ads seeking donors who are Ivy League students. Potential donors with desirable traits that are thought to be heritable—intelligence, athleticism, musical talent—are promised a premium payout, sometimes in the range of $100,000. The message conveyed by such practices is that intended parents want their children to join the elite—to be high achievers according to the conventional standards that are set by our current economic system. Within this system, being a student at Harvard or Yale is at the top of a hierarchy, showing a high degree of promise for economic success. The hope is that the child resulting from elite gametes can replicate this success.

Ableism is a concern even when using one’s own gametes, though. Emre tells the story of N and K, a couple who have their embryos genetically tested prior to implantation, though they are distressed by the ableism inherent in genetic testing. Such genetic testing is widespread now even in non-ART pregnancies, and most prospective parents choose to terminate when told that the test indicates a high likelihood of, for example, Down syndrome. I have argued in my book Choosing Down Syndrome that one prominent motive for seeking to identify and eliminate fetuses with Down syndrome is the belief that children with Down syndrome will have reduced economic opportunity as compared to children without disabilities. Other reasons for prenatal testing and selective termination do not add up. People living with Down syndrome enjoy their lives and their families tend to be as stable and functional as other families. Nonetheless, people with Down syndrome may have difficulty fitting in to the job market without certain forms of public support. The perfectionism we impose on our children arises, in my opinion, from a deep-seated need to have children that replicate the conventional set of values in which we live our lives, and our economic system exerts a profound influence on these values.

Now in Emre’s article, N and K do not undertake genetic testing of their embryos for these economic reasons. They undergo testing because it provides information about which embryos have the best chance of a live birth. For this reason, no one undergoing IVF can be faulted for having their embryos genetically tested. But notice how the logic of assisted reproduction is stacked against giving birth to a child with a disability. Once a test like PGD exists to enable one to avoid the birth of a child with a condition such as Down syndrome, it becomes imperative to do so. IVF as a technology of control over reproduction requires control of even the genome of the child.

The fact that a disabling condition reduces the chances of live birth is a very sensible justification for genetic testing, yet the very sensibility of this justification contributes to the veneer of necessity. When people get pregnant without ARTs, and refuse prenatal testing, they welcome the chance that the child will have a genetically-caused disability, and take on the possibility of miscarriage. Such choices are totally contrary to the intended outcomes of pregnancy technologized through IVF, and are thus unlikely to even be contemplated.

The view that assisted reproduction contributes to feminist goals tout court requires a facile understanding of feminism that does not take into account the intersectionality of gender with race, class, sexuality, disability, and other targets of oppression. Emre’s article is striking because she shows the potential suffering that awaits anybody who seeks assisted reproduction.