The Governance gap in assisted human reproduction

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Publication Date: 
Mon, 2013-12-02

By Alana Cattapan, Margrit Eichler & Lorna Weir

Eighteen feminist scholars and activists met on Friday, April 26, 2013 in Toronto to discuss the governance of assisted human reproduction (AHR) in Canada. Alana Cattapan, Margrit Eichler & Lorna Weir (the authors of this article) co-organized and participated in the interdisciplinary workshop which provided a forum for discussions about the state of Canadian public policy on assisted reproduction and an opportunity to consider strategies for change. The intent was not to produce consensus, but to engage in a frank and free discussion of issues that were identified as important by all. The following article describes the issues addressed and the recommendations for change.

Assisted human reproduction (AHR) refers to a wide range of approaches to helping people conceive children without sexual intercourse. Practices range from relatively simple techniques like artificial insemination to more technically complicated ones, like in vitro fertilization. Assisted human reproduction is a controversial subject due to the social and ethical issues raised by these techniques, which also include surrogacy, egg and sperm donation and prenatal genetic diagnosis.  

When a public dialogue on assisted human reproduction first emerged in Canada in the 1980s, it was informed by a strong feminist presence. Workshop participants agreed that feminist perspectives in this area have been marginalized, if not eliminated, from the policy discussion, which is now turning from the federal to provincial arenas after the Supreme Court of Canada, responding to a legal challenge by the government of Quebec, suspended parts of the federal Assisted Human Reproduction Act. Many workshop participants felt that the governance situation is now worse than it was prior to the report of the Royal Commission on New Reproductive Technologies (1993). After decades of women’s health advocacy there is little to show, and what remains in terms of public governance is a widely contested federal criminal law. In contrast, a thriving private, for-profit fertility industry that lacks adequate public oversight has come into existence.

Four panelists provided an overview of selected aspects of AHR in Canada today (see summaries below), identifying areas of mutual concern as well as other issues where there was less agreement. Participants agreed that the governance of assisted human reproduction in Canada is currently insufficient in a number of ways and that action is sorely needed.

Areas of mutual concern

From the outset, workshop participants agreed that more coordinated, sustained and diverse feminist interventions in the governance of assisted human reproduction are needed. If this does not occur provincial policies on this topic will develop without the necessary commitments to inclusive feminist input and strong advocacy for women’s health needs.

An inclusive and diverse feminist presence is needed in all areas of policy, and assisted human reproduction is no exception. AHR policy needs to take seriously the impact of class, race, ability, sexual orientation and gender identity in terms of access to and experience of AHR services. However, during the workshop a full analysis of AHR governance and the issues that intersect with it was not possible given the limits of a relatively small group during a single-day event.

Participants were concerned with the lack of data tracing the long-term effects of assisted human reproduction. There is a dearth of available information about the health outcomes of people using and born from assisted human reproduction, and while some research has been done in recent years, much more is needed. For example, participants agreed that more research on egg providers is essential, including the collection of clear data about the number of egg retrievals women undergo, their fertility in subsequent years, the number of eggs retrieved, and both short-term and long-term illness, mortality and other harms. This information is not available now.

Although there was no consensus on the role of provincial governments in the regulation of assisted reproductive technologies, participants agreed on the need for coordinated oversight from the provinces, at least with respect to data collection. Clinics, governments, and researchers need to collect data and ensure the independent and publicly available analysis of information to answer the many questions that remain about the current uses and future outcomes of assisted human reproduction.  

The lack of independent research is closely tied to participants' concerns about women’s health. The current focus on assisted human reproduction, and particularly the Assisted Human Reproduction Act, has eclipsed a focus on primary prevention of infertility, and women’s health is no longer a central priority in the policies related to assisted human reproduction. Women’s health needs, including primary prevention policies, must be made more central to continuing discussions of assisted human reproduction and must include health issues related to social status (e.g., workplace exposures with negative effects on fertility and child health) within and outside of Canada.