Thursday, September 20, 2007

Brave New World XXXVIII: Designer Babies and the Pro-Choice Movement

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This article by Rebecca Tuhus-Dubrow in the Summer 2007 issue of DISSENT magazine deals with Margaret Sanger, birth control, the eugenics movement, in vitro fertilization, gene selection and all the hot button issues that the Pro-Life movement has been fighting. They are becoming hot button issues for the pro-abortion movement also. The unique part of this article is that Dissent is a journal of the near and far left and few of its readers would be on Pro-Life mailing lists.

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VER THE LAST century, the link between sex and reproduction has weakened. Feminist activism, aided by technological advances, has given middle-class women in the United States widespread access to effective contraception and safe, legal abortion. Although far too many exceptions persist, for large numbers of women, sex today has no necessary relationship to childbearing. Meanwhile, a burgeoning fertility industry has, for thousands, taken baby-making from the bedroom to the laboratory.

In vitro fertilization (IVF) does not merely help the infertile to procreate; increasingly, it allows parents to determine the genetic makeup of their offspring. Initially, preimplantation genetic diagnosis (PGD) targeted severe childhood diseases, such as Tay-Sachs and sickle cell anemia. Now, more parents use it to screen out genes for late-onset, treatable diseases, such as colon cancer; sex selection is also popular. According to a 2006 survey conducted by the Genetics and Public Policy Center at Johns Hopkins University, 42 percent of 137 IVF-PGD clinics allowed parents to select for gender. Scientists predict that parents will be able to choose such characteristics as blue eyes or curly hair. Less certain, but plausible, is that scientists will be able to identify genes for more complex traits, such as intelligence and homosexuality. Genetic engineering, which will enable not merely the selection but the insertion of desired genes, is on the horizon. In the United States, this rapidly advancing technology is unchecked by any regulatory mechanism.

It will emerge as an important political issue, complicated by competing values, such as individual liberty and social equality. Nowhere will this tension be more conspicuous than in the reproductive rights movement. There is a lot of messy overlap between reproductive rights and what could emerge as a neo-eugenics: both benefit from the separation of sex and reproduction and both entail increased “choice.” Pro-choice advocates already find themselves associated with advocates of this “reprogenetic” technology, who often appropriate pro-choice language. “It’s about Reproductive Rights, Stupid,” reads the title of an article on the Web site betterhumans.com, which promotes the use of biotechnologies to improve the human species.

Even without the borrowed buzzwords, the pro-choice movement would be uneasily close to the issue. Historically, pro-choice arguments have focused on the right to privacy and freedom from government interference. Legally, those are the terms that define reproductive rights. The landmark Supreme Court cases Connecticut v. Griswold (1965) and Roe v. Wade (1973) recognized the right of individuals to control their reproductive destinies. Legal scholars predict that when the question of selecting the traits of offspring inevitably arrives in court, it will be considered in this framework.

Like it or not, pro-choice groups, then, will be compelled to take a stand. They will have to distinguish their concept of reproductive rights from that advanced by neo-eugenicists and to decide whether and how to endorse regulation of reproductive technologies without jeopardizing already tenuous rights. But along with these challenges come opportunities. By incorporating concerns about the abuse of reproductive technologies into a pro-choice platform, the movement can shift away from an individual-liberties paradigm toward a social justice orientation; move away from a single-issue focus on abortion toward a more comprehensive agenda; and form coalitions with other segments of the left.

The Twentieth Century

The link between reproductive rights and eugenics is not new; in fact, it has dogged the movement since its early days. Margaret Sanger, the tireless pioneer of birth control in the United States, started out in the early twentieth century as a radical socialist and feminist. A nurse with working-class origins, she saw firsthand the travails of poor women drained physically and financially by endless births. Sanger believed that birth control—legally restricted at the time—was all but a panacea for society’s ills. She launched a crusade, even subordinating other values to the cause: during World War I, for example, she kept quiet about her pacifist beliefs out of fear that her unpopular opinion would undermine support for birth control.

By 1919, Sanger’s far-left political background was a liability in a climate hostile to radicalism. At the same time, the eugenics movement was seen as socially responsible and forward-thinking by the public and many intellectuals. Eugenicists argued that society would benefit if families with “good genes” reproduced prolifically, while the “unfit” refrained from procreating.

To advance the latter goal, some eugenicists advocated sterilization, by force, if necessary. This option was presented as a humane alternative: the “dysgenic” would not have to be permanently institutionalized or even remain celibate to avoid propagating their undesirable genes. Forced sterilization received Supreme Court approval in Buck v. Bell (1927). Justice Oliver Wendell Holmes, Jr., famously wrote, “It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind . . . . Three generations of imbeciles are enough.” Numerous state laws were enacted to authorize forced sterilization.

In an attempt to gain the imprimatur of science, and in a move that has since haunted her legacy, Sanger became associated with the eugenics movement. She had promoted birth control for the poor because she saw that they suffered most for the lack of it. The well-off always managed to procure means for controlling their fertility; Sanger’s poor patients begged her for the secrets of the rich. When she embraced eugenics, her rhetoric adapted easily to the values of the movement. “While I personally believe in the sterilization of the feeble-minded, the insane and the syphiletic [sic],” she wrote in 1919, “I have not been able to discover that these measures are more than superficial deterrents when applied to the constantly growing stream of the unfit. . . . Birth control, on the other hand, not only opens the way to the eugenist [sic], but it preserves his work.”

This early association, along with certain government policies, helped to taint birth control and abortion in the eyes of many minorities. Plenty of poor white people suffered under eugenic policies, but black, Hispanic, and indigenous women were targeted disproportionately. (In the rural South, sterilizations of black women—often performed without their knowledge following childbirth, abortion, or other operations—were known as the “Mississippi appendectomy,” a term coined by Fannie Lou Hamer to describe her own.) In the 1960s and 1970s, the Black Panther Party and the Nation of Islam both denounced birth control as genocidal. Other groups, such as the National Association for the Advancement of Colored People and the Student Non-violent Coordinating Committee, also harbored suspicions. When the government funded birth control rather than health care or child care in poor communities, some activists angrily pointed out that reducing the number of poor people was not the same as reducing poverty. Fears ran deep that contraception and abortion, as well as sterilization, were means of controlling, if not eliminating, these communities.

Meanwhile, the mainstream pro-choice movement was operating from a vastly different perspective. Mainstream feminists wanted the choice not to have children, to be emancipated from the constraints of the traditional female role. Rarely did white women have to fight to have children; the struggle was to avoid having them. In the 1960s and 1970s, abortion rights activists framed the debate in terms of feminism and sexual liberation. The movement triumphed with Roe v. Wade.

In the following decades, some strands of the mainstream pro-choice movement, notably NARAL (then known as the National Abortion Rights Action League), modified their approach in the face of changing political realities. In the aftermath of the Webster v. Reproductive Health Services Supreme Court decision (1989), which upheld a Missouri statute prohibiting the use of public facilities for abortions, NARAL launched its successful “Who Decides?” campaign, which toned down the women’s liberation language and focused on the right to freedom from government intervention. As Kate Michelman, until recently NARAL’s president, recalls in her 2005 book, With Liberty and Justice for All, “The issue was not whether abortion was morally right or wrong; that was a matter of individual conscience. The question was, who had the right to decide—women or the government?” On the defensive against a passionately committed (and sometimes murderous) anti-abortion movement, many feminists focused more intensively on abortion, shifting energy away from other goals, such as child care, maternity leave, and support for alternative sexual lifestyles. All of these had once been integral parts of the feminist pro-choice agenda, as Carole Joffe discussed in these pages (“It’s Not Just Abortion, Stupid,” Winter 2005).

Although arguably a political necessity at the time, focusing on abortion and adopting an individual liberties paradigm had its costs. (William Saletan has analyzed the campaign in his book Bearing Right: How Conservatives Won the Abortion War.) One was the loss of a compelling moral narrative, which left a vacuum for the anti-abortion side to fill. Another was the alienation of poor minority women. Abortion was less of a priority for women struggling with multiple reproductive challenges: environmental hazards, lack of health care and child care, the fear of coerced sterilization. Some of those who wanted abortions couldn’t afford to pay for them, so the freedom from government intervention was inadequate. The racial component of reproductive politics has been analyzed by scholars such as Dorothy Roberts in Killing the Black Body and Jennifer Nelson in Women of Color and the Reproductive Rights Movement.

Currently, the pro-choice movement is under siege to a greater degree than any time since 1973, a situation that has led it to reassess its strategy. Now, some supporters of abortion rights want to move beyond the stagnant terms of the debate. Efforts to rethink the conventional approach are evident in the work of Frances Kissling, former president of Catholics for a Free Choice; “reproductive justice” advocates, including Loretta Ross; mainstream players in the Democratic Party, such as George Lakoff, a linguist and consultant; and would-be presidential nominee Hillary Clinton; as well as many other feminists and activists. The term “choice” itself has come under scrutiny, often criticized as a problematic concept and a weak and morally flaccid competitor with “life.” Recent documents, such as Beyond Choice, a 2004 book by Alexander Sanger, grandson of Margaret and chair of the International Planned Parenthood Council, and More than a Choice, a 2006 paper by the Center for American Progress, reflect this attitude.

Choice rhetoric has seeped into other aspects of feminism as well, with mixed results. Linda Hirschman caused a stir in 2005 with an article in the American Prospect decrying “choice feminism”—the notion that staying home with the kids is as feminist as working, provided that it’s the woman’s “choice.” Her article focused on the “mommy wars” debate, but the same rationale can apply to other aspects of female life. Some women assert that anything from wearing lipstick to topless dancing can be a feminist act, because a woman is empowered by her choice to perform it. (Ariel Levy discusses this phenomenon in her book Female Chauvinist Pigs.) Hirschman argued that women, with the goal of collective advancement in mind, ought to aggressively pursue high-power, high-paying positions.

Although I don’t agree with everything Hirschman wrote—for instance, that we should eschew low-paying, socially beneficial work in favor of cutthroat corporate success—I think she was onto something. “Choice feminism” is uncomfortably close to the ethos of consumer culture. A feminism that consecrates individual choices, endorsing them all as equally valid, has lost its mission and its soul. (Indeed, “choice feminism” is Hirschman’s term, not a movement with an agenda; but some women do subscribe to the idea.)

And here is where the reprogenetic technologies fit in. What is a “designer baby” but a new consumer choice? When a vague, distorted feminism is conflated with enthusiastic consumerism, when “choice” is the catchword of both, designer babies can easily emerge as the natural, if not inevitable, next step in the evolution of our liberated, capitalist society, in which choices will continue to multiply for consumers—especially for those consumers par excellence, women.

Assessing the “New Eugenics”

Eugenics is a bad word, and “designer baby” is a term the media use to conjure science fiction dystopias, but is it really wrong to use new technologies to improve the human species?

There’s no easy answer. Many people instinctively react against the idea of tinkering with genetics. It evokes fears of playing God, of technological experimentation gone horribly awry, even of the end of humanity as we know it. If only, or primarily, out of pure nostalgia, a lot of us bristle at the prospect.

Approached on the level of specifics, however, the questions appear more complicated. A couple profiled in the New York Times underwent elective in vitro fertilization—even though they could likely have conceived without it—in order to choose an embryo without a gene that would predispose their child to colon cancer. There are several possible criticisms of their decision. Colon cancer is a late-onset, treatable disease. By the time the child is an adult, a cure may be found. The gene is not even certain to cause the disease. How can they justify the expenditure and the godlike control they’ve assumed? On the other hand, their family has suffered immensely from this disease, and they want to ensure that their child avoids that suffering. If the technology is available, and they choose to spend their money on it, how can we deprive them of that option?

This example leads us down the slippery slope. Where, and how, do we draw the line between acceptable and unacceptable? Many people condone health-related genetic tinkering, but not a cosmetic kind. Or, we may feel comfortable with treatment, but not enhancement. Yet, in a culture in which health and beauty are increasingly conflated, as are treatments and enhancements (as more natural variation is pathologized), these distinctions are exceedingly difficult to make. It is even more difficult to imagine how they would be regulated.

The “new eugenics” is in many ways the opposite of its predecessor. The original eugenics was largely “negative”: its goal was to curtail the population growth of the “unfit,” often through involuntary, state-sanctioned, sometimes state-funded sterilization. Today’s version is “positive”: it allows for the creation of more desirable babies. (Granted, it could be interpreted as negative because, at this stage, it involves discarding “unfit” embryos. And the original eugenics also included a “positive” element: encouraging “fit families” to breed.) The more meaningful distinction is that the original eugenics involved coercion, depriving people of their rights and liberties. Today’s variety technically does the opposite: the technologies offer more choices. Indeed, some proponents of their use accuse “bio-Luddites” of being the true descendants of eugenicists—for proposing state interference in the arena, for seeking to circumscribe the full range of available “reproductive choices.”

But individual choices can have larger social consequences. Princeton professor Lee Silver has outlined a nightmarish scenario in which an essentially new species evolves: “The GenRich class and the Natural class will become entirely separate species with no ability to crossbreed, and with as much romantic interest in each other as a current human would have for a chimpanzee.” Others, such as bioethicist George Annas, have worried that such a scenario could undermine the notion of human rights, which is based on a concept of our shared humanity. On a less existentially threatening but disturbing note, Annas and others have also predicted an “arms race” among relatively affluent parents: added to pressure to enroll kids in the most prestigious preschools will be pressure to provide them with the best genes. The result could be an increased tendency to see children as commodities and status markers; on the other hand, parents who choose to forgo these measures could be seen as negligent.

Clearly, there is great potential for good as well as harm in these technologies. They shouldn’t be left, as they currently are, entirely to the market. It’s time for a society-wide conversation about their use and abuse. The United States is lagging in this regard. Many countries, mostly in Europe, but also Canada, Australia, and Trinidad and Tobago have passed laws or regulations restricting or proscribing various kinds of genetic modifications. The United Kingdom has the Human Fertilization and Embryology Authority (HFEA), which licenses and monitors all fertility clinics.

Responses and Political Possibilities
This issue creates strange bedmates. The common political assumption is that conservatives would oppose the potentially radical change promised by reprogenetic technologies, while liberals would embrace the scientific progress they represent. And indeed, the religious right, concerned about the embryo and the blasphemy of playing God, condemns them, while some liberals are more inclined to welcome them on the grounds of “progress”—and, perhaps, in opposition to “culture of life” priorities. At the same time, economic libertarians oppose regulation of this three-billion-dollar-a-year industry, and a fringe of neo-eugenicists wants to create a super race. Qualms on the left include the potential exacerbation of inequalities, the eugenic overtones, and the environmental implications of meddling with nature.

Other progressive contingents have their worries. Disability activists are wary of technologies that essentially aim to eliminate their community. Gay and lesbian people have an especially complex relationship to assisted reproductive technology. I spoke to staff at the GLBT (Gay, Lesbian, Bisexual and Trans-gendered) Community Center in New York, who said that to the extent that it helps them have genetically related families, they welcome the technology. But if a “gay gene” is ever identified, their communities, too, could be threatened. Many feminists are troubled by sex selection, but fear that regulating any aspect of reproduction could jeopardize abortion rights.

The relevant legal infrastructure adds another complication. The court decisions that uphold rights valued by progressives could also afford protection to the right to design babies. This applies to all of the major cases affirming the right to contraception and abortion: Griswold and Roe, but also Eisenstadt v. Baird (1972), which recognized the right of unmarried people to use contraception, and even Planned Parenthood v. Casey (1992), which allowed some restrictions on abortion but reiterated the essential right of people to make decisions regarding reproduction. Further, Lawrence v. Texas (2003), hailed by the left for striking down sodomy laws, dramatically limits the ability of government to restrict personal decisions “absent injury to a person or abuse of an institution the law protects.” Although progressives welcome these freedoms, the implications for the unfettered use of reprogenetic technologies are disturbing. (Of course, the recent decision in Gonzalez v. Carhart raises questions about the durability of these liberties under the current Supreme Court.)

Legal issues aside, in the court of public opinion reproductive rights may be conflated with a libertarian view on genetic technologies. University of Texas law professor John Robertson has defended the use of reprogenetic technologies on the grounds of “procreative liberty.” His argument goes like this: people have the right to procreate; sometimes the choice whether to procreate depends on the qualities of the prospective offspring; therefore, enhancement must be permitted (although he endorses limited restrictions). British author Nicholas Agar, in his recent book Liberal Eugenics, writes, “The eugenics defended here [is] primarily concerned with the protection and extension of reproductive freedom.” Thus can the concept of reproductive choice be appropriated and abused.

The first and least controversial task for pro-choice activists, then, is to make it very clear that the rights for which they have fought are fundamentally different from the right to determine the genetic makeup of offspring. Whether the latter right is legitimate or not, it is not the same as or an extension of the former. Pro-choice activists have struggled for women’s freedom to control their own lives and bodies, not to control the lives and bodies of their children.

Drawing this distinction could lead to another step: emphasizing the morality of abortion rights. Abortion should be legal because women should have the same rights as men to shape their lives; because sometimes bringing a child into the world is the wrong thing to do; because without legal abortion, women suffer and die. Abortion-rights advocates can frame abortion as a matter of social justice, not just of freedom from government interference.

As an alternative to “choice,” women of color have created the concept of “reproductive justice.” In the literature of SisterSong Women of Color Reproductive Health Collective, the national coordinator, Loretta Ross, defines the term, coined in 1994, as “(1) the right to have a child; (2) the right not to have a child; (3) the right to parent the children we have . . . . We also fight for the necessary enabling conditions to realize these rights.” This more comprehensive notion of reproductive justice can be useful in confronting the issue of designer babies. Although not currently one of the main items on the reproductive justice agenda, a position on reprogenetic technologies can easily be added to the list of concerns, which include environmental hazards and health care. In fact, of the reproductive rights activists I’ve spoken to, Ross was the most sympathetic to the prospect of regulating these technologies.

As Joffe pointed out in the Dissent article mentioned earlier, “the logic of seeing abortion as just one part of the mosaic of reproductive and sexual rights and services is not simply that it is persuasive to others. It is also the most authentic position of the reproductive freedom movement itself.” Reproductive technologies did not factor into the original movement, because they didn’t yet exist. But now that they do, promoting sensible policies on their use should fit into a broader platform. Such a platform could appeal to other factions of the left as well as moderates, who might be turned off by the focus on abortion but who share concerns about related issues, including the abuse of reprogenetic technologies.

The concept of reproductive justice has already made inroads into the mainstream movement. The pro-choice movement eludes generalization, because different organizations have different priorities and approaches, but many parts of it have already begun to shift toward a social justice focus and a broader platform. The literature of Choice USA, a fifteen-year-old organization founded by Gloria Steinem, uses the term reproductive justice, and Planned Parenthood sponsored a conference in 2005 at Smith College titled “Reproductive Justice for All.”

Concerns about reprogenetics have also surfaced. The Planned Parenthood conference devoted a quarter of the agenda to reproductive technologies. The Center for Genetics and Society, billed as “a pro-choice organization working for sensible policies on genetic engineering technology,” aims to initiate and facilitate conversations about the subject. One effort was a retreat in October 2006 with representatives from various progressive organizations, including Planned Parenthood, Choice USA, the ACLU, the disability rights group Not Dead Yet, and the LGBT Community Center of New York.

According to Sujatha Jesudason of the Center for Genetics and Society, the groups that attended that retreat were enthusiastic about continuing the conversations within their own organizations and forming coalitions to address the issue. The pro-choice advocates in particular started a process of reflection on the tensions—between individual liberties and social justice—that are especially prominent in their movement.

In contemplating regulation, an example from the past might prove illuminating. In 1975, in New York, a multiracial coalition called the Advisory Committee on Sterilization helped implement guidelines for regulating sterilization, including a mandatory waiting period. The aim was to ensure informed consent, because so many poor minority women had been sterilized without it, in haste. Planned Parenthood and NARAL opposed the restrictions, arguing that they infringed on reproductive freedom. (White women, who frequently could not persuade doctors to sterilize them, did not want to make the process more cumbersome.) This conflict was perhaps the clearest manifestation of the discordant outlooks of different feminists.

The opposition of the mainstream groups was understandable, but it also reflected a degree of myopia. Likewise, Margaret Sanger was so single-minded in the promotion of her cause that she endorsed wrongheaded ideas that she believed would serve it. Now, we who support abortion rights may fear that regulating reproductive technologies could endanger our cause. There is no doubt that maintaining the legality of abortion—and fighting to reverse harmful restrictions of it—is paramount. But it is also important for us to sustain a larger moral vision. We have to find a way to advance that multifaceted program, including views on reproductive technologies, while protecting the right to abortion.

It appears inevitable that genetic technologies of all kinds will become one of the major issues of this century. It appears equally inevitable that the pro-choice movement will become entangled in the debate. In this new challenge, Margaret Sanger provides an instructive example—today’s reproductive-rights advocates should emulate her passionate advocacy and avoid repeating her mistakes.

Thoughts and Dreams of "Brave New World" by Aldous Huxley
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