Egg donation and surrogacy - an altruistic gift or work?

A central theme of the Care Revolution network is to draw attention to the all too often overlooked and devalued unpaid care work and to support those who do it. In the following article, Viola Schubert-Lehnhardt draws attention to areas that are marginalised even more than others.

At a symposium organised by the Arbeitskreis Frauengesundheit (AKF) in Medizin, Psychotherapie und Gesellschaft e.V. on 3 November 2013 entitled "Unwanted childlessness - the myth of limitless feasibility and the dark side of reproductive medicine", the topic of egg donation and surrogacy was examined from a legal, medical, socio-political and philosophical-ethical perspective. The AKF felt that this symposium was necessary because the public debate to date has mainly focussed on the needs, wishes, claims and supposed rights of so-called intended parents and less on the other inevitably involved parties: the egg donors, the women carrying the eggs and the children resulting or already resulting from the treatments. The economic interests of the reproductive medicine centres, the agencies and the already internationally active medical corporations have been analysed even less in the current debates. Their interests are sometimes quite different from those of the women or couples involved. Also up for debate are the questions repeatedly asked elsewhere about the tasks of the healthcare system and the mission of medicine.

From the point of view of the Care Revolution approach and goals - the approach emphasises that unpaid care work is socially necessary work - the question of whether egg donation and surrogacy are "gifts of love" or altruistic "gifts" - or "clinical work", according to the proposed legal term - is particularly interesting. The authors of the anthology "They call it life, we call it work"[1] have already taken a clear position on this. After all, not only are contracts concluded abroad[2] for the donation of eggs or children, but also rules of behaviour are formulated, certain examinations are prescribed, etc. However, it is not only these requirements that refer to the concept of work - the classification of these activities as work would above all mean an improvement in the living situation of women, including insurance cover and clearly regulated financial remuneration. Why should everyone else (mediators, lawyers, reproduction clinics etc.) be able to earn huge sums of money from this procedure, but not the women involved? Reproductive techniques do not take place in a vacuum, but within capitalist structures.[3] These activities must be seen as work and integrated into the care discourse (on unpaid or underpaid female-marked activities) in order to prevent exploitation and to place a value on the work performed.

As with a possible application of the term "self-determination"[4], the use of the term "altruism" is controversial. In particular, there are doubts as to how the role of women should be viewed in this context and whether the concept of voluntarism can be applied here at all. It must be asked whether the concept of altruism is not being functionalised in this context: "child as a gift". This is based on an ideal of femininity that assumes that women are fundamentally more altruistic than men and serves outdated role models. These services are sometimes framed as "motherliness". In this context, it was also pointed out that by not legalising these techniques, Germany is only shifting the problem abroad in order to maintain its image of motherhood ("if a surrogate mother, then out of love"). It was questioned in principle whether it was even possible to speak of altruism in such a commercialised market. Laura Perler, among others, has dealt extensively with the "utilisation" of the concept of self-determination in her book "Selektioniertes Leben. A feminist perspective on egg donation" (Münster 2022). However, the use of these technologies can and must be seen as instrumental access to non-privileged women for the wishes of privileged women.

The public debate on the unfulfilled desire to have children focuses on the possibilities of technical medicine. Other possibilities, such as other forms of parenthood, which many people already desire and live, as well as the possibility of accepting biological childlessness, must be given a natural place in this debate and in social reality in the future and lead to corresponding social legislation. In addition, global injustices must be increasingly included in the debates - in many countries, for example, it is not possible for LGBTQ people to start a family. However, it is absolutely necessary to adapt parentage law to the realities that already exist (use of surrogacy and egg donation abroad).

Even after a potential legalisation of egg donation or surrogacy in Germany, it is to be expected that the demand stimulated by this cannot be met in Germany and that intended parents will continue to choose to go to other countries with less regulated framework conditions in order to circumvent possible restrictions, such as the ban on anonymity.

Although the various options for moving abroad can no longer be reversed, they do lead us to global issues of reproductive justice. This concept emerged at a pro-choice conference in Chicago in 1994, where black women criticised the predominantly white mainstream feminist movement. At this event, the main focus was on the right to abortion and its decriminalisation. Other forms of reproductive oppression, which primarily affect people of colour or people in marginalised communities, were not considered.

Twelve black women criticised this one-sided perspective and the prioritisation of the right to abortion - without denying the need to fight for this right. They first developed three central principles:

1. The right to choose to have children and to be able to choose the forms of pregnancy care and obstetric care in a self-determined way.
2. The right not to have children and to have safe access to contraception and abortion.
3. The right to raise children in circumstances of their own choosing - free from institutional, structural and interpersonal violence and in good social, health and environmental conditions.

In 2012, younger activists added another principle:

4. The human right to sexual autonomy, gender self-determination and sexual pleasure.

The concept of reproductive justice is rooted in the belief that systemic inequality has always shaped people's decisions about childbearing and parenthood, particularly those of disadvantaged women. It is a tool for systematically analysing white supremacy - embedded in the existing social conditions.

However, it is not only people biologically defined as women who experience reproductive oppression, but also trans men and women and non-gender conforming people.

The concept goes beyond the demand for individual rights and represents an amalgamation of reproductive rights and social justice, as it is based on intersectionality.

• is orientated towards intersectionality,
• connects the local with the global,
• is based on the principles of human rights,
• connects the individual with their community,
• addresses the responsibility of governments and companies,
• combats all forms of population control and eugenics,
• aims to strengthen communal forms of self-organisation,
• places marginalised communities at the centre of the analysis,
• aims to achieve policy change, as this is necessary in order to achieve reproductive justice,
• develops its own intersectional approaches, and
• applies to all people.

The aspects of reproductive justice presented here as part of the struggles of Care Revolution are relatively new and perhaps unfamiliar to some, but they show the ever-increasing importance of the debate on care work in all its forms and the broad commitment of all those involved.

[1] Kitchen politics, edition assamblage, Münster 2015

[2] Both egg donation and surrogacy are prohibited by law in Germany. However, the current debates on updating the Embryo Protection Act, which is over 30 years old, very often include calls to legalise this. The regulations abroad currently vary. A factsheet from the Gunda Werner Institute provides a good overview https://www.gwi-boell.de/sites/default/files/importedFiles/2022/05/04/Factsheet-Reproduktionstechnologien.pdf

[3] Irina Herb explained that transnational corporations, "which shape the fertility market, are increasingly making their profits not only through treatments, but also through financial transactions such as IPOs or participation in investment funds" (https://calendar.boell.de/de/event/feminist-lunch (accessed on 14/10/2023)

[4] Originally developed as a right of defence against state norms of reproduction, this term is now increasingly understood in the sense of patient autonomy as the right to make one's own decisions about the time, manner and method of conception and birth. Those in favour of egg donation and surrogacy are primarily concerned with individual self-determination over one's own body, while critics primarily raise moral and religious objections.