“Bold and gripping, God’s Laboratory is ethnography at its best. The book’s unforgettable characters and their desperate travails to reproduce via global medicine are the very fabric of a highly-original and much-needed social theory for our twenty-first century technological societies.”–João Biehl, author of Vita: Life in a Zone of Social Abandonment

“God’s Laboratory is the perfect anthropological antidote to the fetishization of reproductive materials as ‘life itself.’ Roberts shows in meticulous detail and in luminous prose how Catholic scientists and technicians in Ecuador invite God into private IVF labs to ‘bless the work’ of producing embryos. Kinship, care, and cultivation–not embryonic life–define reproduction in this uncertain world.” – Nancy Scheper-Hughes, author of Death Without Weeping: The Violence of Everyday Life in Brazil

“Written with clarity, compassion, and self-reflection, God’s Laboratory is a beautiful book which puts the ethnographic method to excellent use. Roberts’s painstaking fieldwork unearthed the many layers through which the aspirations for fertility and use of infertility technologies instantiate not only gender and kinship in Ecuador, but ethnicity, race and region in the national project of modernity. The book is a stunning instance of the benefits which accrue when the study of reproduction is used as an optic for understanding social life.”–Rayna Rapp, author of Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America

“God’s Laboratory is a strong, intriguing and careful look at the daily connections between faith and science that underpin the process of human assisted reproduction in urban Ecuador.”–Marisol de la Cadena, author of Indigenous Mestizos: The Politics of Race and Culture in Cuzco, Peru, 1910-1991

Elizabeth Roberts is Assistant Professor of Anthropology at University of Michigan.

God’s Laboratory

Assisted Reproduction in the Andes

By Elizabeth F.S. Roberts

UNIVERSITY OF CALIFORNIA PRESS

Copyright © 2012 The Regents of the University of California
All rights reserved.
ISBN: 978-0-520-27082-4

Contents

List of Illustrations, ix,
Acknowledgments, xi,
Cast of Characters, xvii,
Preface, xxi,
Introduction: Reproductive Assistance, 1,
1. Private Medicine and the Law of Life, 36,
2. Assisted Whiteness, 75,
3. White Beauty: Gamete Donation in a Mestizo Nation, 112,
4. Egg Economies and the Traffic between Women, 148,
5. On Ice: Embryo Destinies, 186,
Conclusion: Care-Worthy, 211,
Notes, 217,
References, 231,
Index, 255,

CHAPTER 1

Private Medicine and the Law of Life

OF POPES AND PRESIDENTS

On April 19, 2005, Cardinal Joseph Ratzinger was elected to succeed John Paul II as pope. Pope Benedict, as he is now known, was, in the decades before his ordination, the theologian primarily responsible for framing the Church’s position on reproduction and the dignity of human life. In his address on behalf of the Congregation for the Doctrine of the Faith, titled Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation (Ratzinger 1987), Ratzinger reinforced the Vatican’s position against abortion and birth control and laid out objections to new reproductive technologies like IVF. This document provided Catholic theologians with the framework to oppose the oncoming tide of embryonic stem-cell research and cloning made possible by assisted reproductive technologies.

The day after Pope Benedict’s election, Lucio Gutiérrez, the beleaguered president of Ecuador (and one of only two elected presidents in a decade), was ousted after months of protests. Widespread dissatisfaction with the incompetence of his administration, along with outrage over his capitulation to IMF–mandated austerity measures, had plagued his presidency since his election two years before. During his administration, Ecuador’s congress ratified a new civil code that prohibited “the manipulation of human life after conception,” which in theory could have restricted some practices within Ecuador’s expanding IVF industry. The civil code, along with the 1998 constitution, which declared that “life begins at conception,” were shaped within the emergence of evangelical Christianity as a powerful force in Ecuador and throughout Latin America.

The near-simultaneous election of Pope Benedict and the toppling of Gutiérrez can inform our understanding of individual reproductive histories like Sandra’s (see “Corporeal Punishment”). Both the procedures Sandra underwent, abortion and IVF, are of intense interest to church and state actors in sustaining the demographics of the faithful and of the nation-state. In Ecuador, the officially distinct but intertwined institutions of church and state impose restrictions that claim to protect unborn human life. The law against abortion is flouted by women of all classes (and by men, as partners and practitioners) but it is significantly more difficult for women without recursos (resources) to access safe clinical abortion. Sandra’s misfortune was to be young, a recent migrant to the city, and lacking in familial assistance or monetary resources. She probably didn’t feel able to “manage” her sexual encounters. Sandra didn’t have the resources to seek out private clinical gynecological care for an abortion. She didn’t think of herself as an individual with rights. She was a client with a patron—God—who didn’t agree to her bargain. And when she entered the IVF clinic, she wasn’t a consumer with rights either.

Surgical abortion can be an extremely safe procedure with few side effects. In Ecuador, despite the law, women with money can undergo safe abortions in clinical settings. The women I met who had had clinical abortions or who had the money to leave the country suffered no complications. But the devastating effects of unsafe abortions on poorer women can have repercussions for decades. Sandra’s abortion history, ectopic pregnancy, and poor hospital care made her infertile. Years later she sought out IVF in an expensive private clinic that theoretically should have been governed by the same church and state politics that outlaw abortion. But although Catholic doctrines and state policies scarred Sandra internally, they did not follow her into the private IVF clinic.

As Cardinal Ratzinger, Pope Benedict was a famous hard-liner on the question of the protection of nascent human life. Vatican condemnation of IVF, as dictated by Ratzinger, is based on two main arguments. First, the research, development, and practice of IVF involves the destruction of embryos. The Church regards this practice as “destruction of human life,” equivalent to abortion. Second, by engaging in assisted reproduction, humans are interfering with a process that should remain under God’s dominion (Ratzinger 1987). Globally, much of the controversy surrounding assisted-reproduction technologies has come from religious institutions; but within Islam, Judaism, Confucianism, Hinduism, and most forms of Christianity, adjustments have been made to facilitate the fertility procedures of their adherents (Bharadwaj 2002; Handwerker 1995; Inhorn 2003; Kahn 2000). Catholicism remains the only major world faith that unequivocally condemns the use of IVF. Although the Vatican has influenced many of the debates over IVF in different parts of the world, this has not meant that all or even most Catholics heed its denunciation of this technology. In Ecuador, for so-called traditional and religiously conservative Catholics, an ongoing relationship with God has taken precedence over Church doctrine.

In Ecuador, despite the 2003 legal code that bans the manipulation of life after conception, the law has had no impact on private reproductive medicine. It remains to be seen whether or how the views of the current president, Rafael Correa, an anti-abortion leftist who is implementing health-sector reform, will affect Ecuador’s IVF industry. So far, IVF practitioners have ignored the strictures that might limit their practice. They see state regulations as largely irrelevant to their private medical practices and don’t see the Church as speaking for God in its condemnation of IVF. Church and state institutions in Ecuador rarely interfere with the business of the elite men who tend to be the directors of private IVF clinics. These clinics appear to exist outside or above state and church oversight or regulation.

REPRODUCTIVE GOVERNANCE

In this chapter I explore how IVF clinics are situated relative to Ecuador’s church and state institutions. Both are seen as impersonal bureaucracies that can be evaded by elite male clinic directors and patients with adequate resources within paternalistic private clinics. Church condemnation of assisted reproduction means little when patients and doctors invoke God’s help in the undertaking. Both patients and practitioners turn to God to arbitrate questions of life, and practitioners literally place responsibility for IVF in God’s hands. Likewise, state governance means little when patients turn to private clinics, largely outside state control.

Sandra’s trajectory through illegal abortion and into an IVF clinic was embedded in various forms of what Lynn Morgan and I call reproductive governance: the mechanisms through which different historical configurations of actors (such as state institutions, churches, hacienda owners, private doctors, corporate actors, donor agencies, and NGOs) use legislative controls, personal interactions, economic inducements, moral injunctions, and ethical incitements to produce and control reproductive behaviors and practices (Morgan and Roberts, forthcoming). As several commentators have noted, Cold War–era population programs have been quite effective in bringing birth rates down across Latin America (Leite 2004). I had imagined that studying the arrival of assisted-reproductive technologies in a developing nation would offer a means to examine the lasting effects of population-control efforts in Ecuador, along with the effects of abortion politics. Like most developing nations, Ecuador has been the target of international family planning programs for half a century, even if by no one’s account has it ever been “overpopulated.” Private organizations began conducting family planning programs in Ecuador in 1966. State programs partially funded by the United Nations Fund for Population Activities began in 1975 (Ruilova 1974). And indeed, family-planning campaigns appear to have been successful in Ecuador: more than 66 percent of women with male partners use some form of birth control (CEPAR 2000). As of 2007 the total fertility rate (TFR) in Ecuador was 2.71; the U.S. rate was 2.07. It’s debatable, though, whether this lowered birth rate is an effect of these campaigns or of shifting economic realities.

Currently, reproductive governance in Ecuador tends to center on rights and the sanctity of life; however, assisted reproduction and the urban experience of childbearing is also enmeshed in the midcentury modernity of fertility control, small families, changing gender roles and shifting consumption habits. Almost all reproductive-aged Ecuadorian urbanites I met, across class lines, felt that they could afford no more than two children, although they usually longed for more. Economic conditions make large families untenable. One young woman undergoing IVF told me that her husband had nine brothers and sisters. Her mother, on the other hand, had only three children. “My mother is maybe more modern,” she observed. Her husband added, “My mother is from an older time, more traditional. In this time they were accustomed to have nine, ten, twelve, fourteen [children].” Although government policies on population have shaped reproductive practices in Ecuador, IVF patients rarely mentioned them. The necessity for small families, which, among other advantages, allow parents to invest more in their children’s education, is now normalized.

Abortion politics came up more than population politics in Ecuadorian IVF practice. The Catholic focus on the idea that life begins at conception took shape in the nineteenth century, in conjunction with the development of the biological sciences and the rise of nation-states—developments that could not (and still cannot) be divorced from a eugenic agenda. As in Western Europe and the United States, abortion became illegal in most Latin American countries only in the late nineteenth and early twentieth centuries (Mohr 1978). Despite the continued illegality of on-demand abortion in Latin America, except in Cuba and now Mexico City, it is the region with the world’s highest abortion rates (Browner 1979; Htun 2003; Scrimshaw 1985). But until recently, there has been no move to decriminalize abortion. In her survey of reproductive and family law in Latin America, Mala Htun argues that because clandestine abortion is available and relatively safe for those with money, there has been little impetus for legalization (Htun 2003; see also Mooney 2009, 51). Recently abortion was legalized in Mexico City, and in Colombia, feminist activists and lawyers have succeeded in decriminalizing abortion to varying degrees. Their arguments for decriminalization center on a right to public health rather than the North American concept of the right to choose (Morgan and Roberts 2009, forthcoming).

In Ecuador the legislature and the judiciary are intensely engaged in abortion politics, as exemplified by their positions against legal abortion and for the protection of life from conception. Clandestine abortion is nevertheless ubiquitous and relatively easy to obtain. The WHO estimates that 95,000 abortions take place in Ecuador every year, a rate of 30 per 1,000 women of fertile age. Each year 20,000 to 30,000 women are admitted to clinics and emergency rooms with complications arising from botched abortions, and abortions cause 18 percent of maternal fatalities in Ecuador. This rate might start to fall as the use of misoprostol, a medication officially used for the treatment of peptic ulcers but also effective as an abortifacient, becomes more common throughout the region.

Like several researchers, I found that most urban Ecuadorians I surveyed had ambivalent attitudes toward abortion (Morgan 1998). Most thought it was wrong but deemed it acceptable in individual situations, especially for young women, in cases involving rape or a damaged fetus. In these cases, my informants believed, women could negotiate with God for pardon. One IVF patient told me that when she developed toxoplasmosis in an earlier pregnancy she had an abortion because of the possibility of birth defects. Her priest told her that God forgave her. Another IVF patient reasoned with me, “If a woman has an abortion, she is in debt to God.” These were not rights-based arguments that assume discrete, rational individuals but a rationale embedded in relational exchanges (the kinds of exchanges that were encouraged in private IVF clinics). Most women knew at least one friend or relative who had undergone an abortion. Only a few women and men involved with IVF thought abortion was always wrong: a few told me it was “assassination” in all cases. In general, urban Ecuadorians didn’t want to appear extreme on the issue.

During my year of resident fieldwork in 2002–3, I scanned the newspaper every day for articles related to assisted reproductive technologies, population issues, abortion, and family planning. I found several every week. On a return trip in 2007, I discovered an explosion of articles in response to a legislative battle about the morning-after pill. At the same time, graffiti about abortion, condoms, and the morning-after pill appeared on street walls throughout Quito. Various groups, including local and transnational right-to-life and feminist organizations, were gearing up for a fight about the new constitution, which was ratified in the fall of 2008. The final draft of the constitution guaranteed the right to “take free, responsible, and informed decisions about one’s health and reproductive life and to decide how many children to have” but continued to outlaw abortion (in Article 66, Number 10). No one was happy with this outcome. The Catholic Church denounced the constitution as anti-life, while feminist groups denounced it as a threat to reproductive health. President Rafael Correa, who backed the constitution, remained on record as opposing legal abortion.

Throughout the 1990s several Latin American legal codes were revised to define life as beginning at the moment of conception, not at birth. Ecuadorian state and church institutions participated in a newly energized mandate to protect human life promulgated by the globalized right-to life-movement, through rights-based arguments. In recent legislative battles, the reproductive rights of individual women have been pitted against the right to life of the unborn. As in other Latin American nations, laws and policies on abortion have become more restrictive at the same time that laws providing free maternity care have been enacted under the banner of the right to reproductive health (Hermida et al. 2004). In Andean nations, the resources for free maternity care tend to be channeled into public-sector health care, not social security, which provides for the employed middle class—once again making poor and indigenous women the targets of intervention and reproductive governance (Ewig 2010).

The shift in the discourse of reproductive governance, from issues of population and race to those of rights and life, was manifested through a host of complex material and political forces in Latin America. Internationally, rights-based discourses have flourished in the context of economic policies that promote the expansion of private-sector medicine, and they have pitted citizens against states in the legal arena, where rights can be debated. Under these political and juridical conditions, rights have been allotted to previously unrecognized groups: the landless, women, indigenous people, and, increasingly, the unborn. Although granting rights to the unborn is a hotly debated issue, the idea that embryos and fetuses might have rights is fostered by medical technologies that make it possible to see inside, measure, and manage human bodies, especially women’s. Through this visualization of women’s insides, fetuses and embryos have become increasingly personified (J. Taylor 2008a).

U.S.–based right-to-life groups are working in Latin America to shape the debate. These groups are finding fertile ground in many nations where the Cold War legacy of the Left’s alignment with the Church has created alliances between newly elected leftist administrations and the local Catholic episcopal conferences. At the same time, international feminist health organizations are working to promote women’s rights. In Latin America they frame their arguments in terms of the right to health, rather than the right to autonomy or reproductive freedom: they thus cast illegal abortion as a public health problem (Morgan 1998). The language of rights that currently frames reproductive practice in relation to the rights of women and the rights of the unborn also produces consumers with rights for the flourishing, privatized medical sector throughout Latin America (Radcliffe and Westwood 1996; Rose 1999).

THE CODE OF LIFE

The Child and Adolescent Civil Code enacted while Lucio Gutiérrez was president states: “Boys and girls and adolescents have the right to life from their conception…. Experiments and medical and genetic manipulations are prohibited from the fertilization of the egg until birth” (Congreso Nacional, Función Ejecutiva, Ecuador 2003). Some of the techniques used in IVF, particularly embryo cryopreservation, could be interpreted as medical manipulation after fertilization. In this process, embryos are mixed with a cryoprotectant fluid, allowing them to be stored at very low temperatures without damage. Below I describe how three lawyers with different agendas and positions—Marco Andrade, Ricardo Rabinovich-Berkman, and Sonia Merlyn Sacoto—responded to this code.

(Continues…)Excerpted from God’s Laboratory by Elizabeth F.S. Roberts. Copyright © 2012 The Regents of the University of California. Excerpted by permission of UNIVERSITY OF CALIFORNIA PRESS.
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