‘Normalizing’ IVF: Reproductive Rights and the Nuclear Family

Edwards’s emphasis on reproductive rights was a major component of what Charis Thompson calls the ‘normalization’ of IVF.69 Focusing on the rights and needs of infertile couples, who were ‘just like millions of others except for their inability to have children’, encouraged media portrayals of IVF as an important medical procedure and countered the predictions of cloned armies that were rife in the 1960s.70 But the invocation of rights was not the only factor that contributed to this normalization during the 1970s. Edwards and Steptoe also located IVF within traditional norms surrounding marriage, kinship, and the family. In talks and publications throughout the 1970s they presented the beneficiaries of IVF as ‘married couples’ who could not conceive because ‘the wife has blocked oviducts’ or ‘the husband [... ] has too few spermatozoa for normal conception’.71 Against a backdrop of concern at increasing divorce rates following the 1969 Divorce Reform Act, Edwards and Steptoe even claimed that using IVF to produce ‘desperately wanted’ children would prevent the ‘breakdown of marriage’ among infertile couples.72

Edwards and Steptoe also used concerns about marriage to portray IVF as less problematic than existing infertility treatments such as AID. Edwards noted that many doctors - as discussed more fully in Gayle Davis’s chapter in this volume - were ‘dissuaded’ from AID because the use of donor sperm undermined marriage and raised troubling questions about adultery, paternity, and illegitimacy.73 In a paper at a 1973 conference on the ethics of assisted reproduction, Edwards and Steptoe noted that IVF, by contrast, posed fewer problems as ‘it will be used almost exclusively for many years to come to alleviate infertility within a marriage, by giving husbands and wives a chance to have their own children’.74 Participants at the conference agreed that IVF differed from AID because it did not ‘undermine the integrity of the marital relation’.75 Its presentation as critical to a successful marriage also ensured that IVF received support from seemingly unexpected quarters. While the Catholic Church maintained its opposition to all ‘unnatural’ interference in human reproduction - that is, where children were not directly conceived through intercourse between a husband and wife - the Catholic MP and former lawyer Norman St John Stevas publicly supported IVF provided it was used by married couples and a woman’s ovum was fertilized by her husband’s sperm in vitro.76

The incorporation of IVF within traditional social norms and kinship patterns also underpinned an episode of the TV Eye documentary series that was screened in September 1978. John and Lesley Brown proudly introduced their new daughter Louise and recalled how failure to conceive had placed strain on their marriage. Several other infertile couples were filmed during appointments with Patrick Steptoe, who claimed that he and Edwards hoped to provide them with ‘something they couldn’t have without our help’. The narrator was clear that this ‘something’ was not simply a child. By providing couples with their own children, he noted, Steptoe and Edwards ‘treat a marriage’.77

The extent to which IVF was embedded within normalized expectations about marriage and family life further explains the lack of ‘moral and ethical outrage’ in the late 1970s.78 But this positive attitude did not last long, and in a 1982 report on IVF the New Scientist noted that ‘controversy in England is starting anew - as though people are suddenly seeing the matter in a new light’.79 This change can be partly explained by the renewed emphasis on ‘traditional’ morals that followed the 1979 election of Margaret Thatcher’s Conservative Party. Members of the new Government were keen for a ‘return to Victorian values’ and spoke regularly about the need to reaffirm the social principles undermined by ‘permissive’ bills on homosexuality, divorce, and abortion that were passed in the 1960s.80 Politicians, lobby groups and commentators who were marginal when the Conservatives were in opposition now had the chance to alter ‘the rhetoric of British political life’, and IVF was soon among their targets.81

While Steptoe and Edwards had presented the recipients of IVF as married couples throughout the 1970s, supporters of ‘traditional’ morals now framed the procedure as a threat to the nuclear family. They claimed there was nothing to prevent unmarried women from using donor sperm and having multiple embryos implanted in one cycle, producing a generation of fatherless children, or even to prevent the birth of ‘orphaned test tube embryos’ that had been stored in freezers and implanted into surrogates after both their natural parents died.82 Some even warned of an ‘Oedipus tragedy’ in which a fertilized embryo was implanted into a surrogate and, years later, grew into an adult who unwittingly married his biological mother.83 The Conservative peer Lord Campbell struck a chord with many when he argued that IVF would ‘threaten the welfare of children and destroy the sanctity of family life’, and the Daily Mail, which had greeted Louise Brown as a ‘miracle’, withdrew the money it had pledged for the private IVF clinic that Steptoe and Edwards were building at Bourn Hall, near Cambridge.84 Newspapers criticized Steptoe and Edwards for seemingly disregarding public concerns and joined politicians in urging the Prime Minister to set up a public inquiry to establish ‘which of the strange possibilities opening up are acceptable, which need controls, and which are unacceptable’.85

IVF also came under fire amidst growing criticism of the laissez-faire approach to professional regulation that Edwards had endorsed throughout the 1970s. In a series of academic papers, newspaper columns, radio documentaries, and his 1980 BBC Reith Lectures, provocatively titled ‘Unmasking Medicine’, the academic lawyer Ian Kennedy argued that medicine was ‘pursued in ways that do not always serve the best needs of society’.86 Like the bioethicists he encountered while teaching in the USA, Kennedy argued that external oversight involving lawyers, philosophers and others, acting on behalf of patients and the public, was vital to ensuring that ‘doctors conform to standards set down by all of us’.87 The rising disquiet over IVF proved to Kennedy that ‘decisions cannot be left to one professional group, whether doctors, lawyers or whatever’.88 Writing for the Observer, the lawyer Geoffrey Robertson agreed that an inquiry into IVF was urgently needed and that guidelines should ‘not be developed behind a closed door marked “Medical Ethics - laymen and lawyers keep out”’.89

These proposals for the approach that Kennedy called ‘bioethics’ echoed Gould and Pappworth’s earlier calls for oversight, but were far more influential thanks to the changing political climate of the 1980s. Whereas politicians in the 1960s and 1970s were reluctant to interfere with the freedom of scientists and doctors, members of Thatcher’s Government believed that professions should be exposed to outside scrutiny in order to remodel them ‘on market lines’ and make them more accountable to end-users.90 Norman Fowler, Secretary of State for Health and Social Services, viewed patients and the public as ‘consumers’, and believed that non-doctors should play a major role in developing policies that rendered medical research more publicly accountable. This belief was evident when civil servants prioritized an ‘outside chair’ and ‘four or five non-experts’ for the government inquiry into human fertilization and embryology that was formally announced in July 1982.91 The committee was chaired by the philosopher Mary Warnock (b. 1924) and, in an unprecedented move for an inquiry into science or medicine, included more ‘non-expert’ members than doctors or scientists.92

The Warnock Committee was scheduled to consider written or oral evidence from over 300 individuals and organizations before they issued their recommendations.93 As they heard evidence and considered the issues themselves, committee members soon realized that embryo experimentation was ‘the most significant of the moral problems raised by in vitro fertilization techniques’.94 Although experiments on ‘spare’ in vitro embryos were largely considered unproblematic in the 1970s, they became increasingly contentious in the 1980s thanks to the efforts of anti-abortion groups such as LIFE and the Society for the Protection of Unborn Children (SPUC), which used their growing political influence to demand the prosecution of researchers such as Robert Edwards for ‘manipulation of life on a horrifying scale’.95 Deciding whether or not to permit research raised fundamental questions about when in development human embryos should be accorded legal protection; and although the majority of committee members believed research should proceed, they disagreed about the developmental stage at which it should be prohibited. As Warnock conceded in 1985, ‘all the other issues we had to consider seemed relatively trivial compared with this one, concerned as it is with a matter which nobody could deny is of central moral significance’.96 When the Committee’s report was published, in July 1984, attention centred on its proposal to allow research up to 14 days after fertilization, which corresponds to the formation of the ‘primitive streak’ in the early embryo. Opponents of research criticized the proposal as ‘amoral’ and persuaded the MP Enoch Powell to introduce a Private Member’s Bill that would prohibit all research, while supporters of research, including Robert Edwards, warned that ‘many fundamental studies of differentiation, human anomalies and other advances may require more days in vitro' 9

But while it was generally overlooked in the furore over embryo experiments, the Warnock Committee did address questions about who had the right to access IVF. At the start of their report they noted that Articles 8 and 12 of the European Convention on Human Rights, which guaranteed a respect for family life and the right to found a family, might ‘create a right to take full advantage of the techniques which are available to alleviate infertility’.98 The Committee noted that some groups who submitted evidence believed that this right should include ‘the fertile single woman and lesbian couple', but also noted that many others who submitted evidence believed ‘that the interests of the child dictate that it should be born into a home where there is a loving, stable, heterosexual relationship and that, therefore, the deliberate creation of a child for a woman who is not a partner in such a relationship is morally

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wrong'.

In contrast to its firm rules on embryo research, the Warnock Committee adopted a more laissez-faire attitude when they considered these questions about eligibility and access, arguing that ‘hard and fast rules are not applicable’ at a time ‘when at the present services for the treatment of infertility are at short supply’.100 Although the establishment of this ‘broad-based’ committee was presented as a key moment in bioethics, with Ian Kennedy citing it as ‘progress along the lines I advocate’, its members nevertheless believed that the solution here was to let doctors decide what constituted an eligible patient.101 Their report argued that ‘everyone should be entitled to seek expert advice about their infertility’, but supported the continuing arrangement ‘where the consultant may, after discussion with professional health and social work colleagues, consider that there are valid reasons why infertility treatment would not be in the best interests of the patient, the child that may be born following treatment, or the patient’s immediate family’.102 The Committee also gave a strong indication of those patients they believed would be prioritized, by defining the recipients of infertility treatments as ‘a heterosexual couple living together in a stable relationship, whether married or not’, and expressing their belief that ‘as a general rule it is better for children to be born into a two-parent family, with both father and mother’.103

This part of the report also prompted criticism, though it was not as concerted or high-profile as that which greeted the proposals for embryo research. One correspondent to the Guardian claimed that many women would be dismayed by the Committee’s preference for ‘a traditional and sentimental stereotype of motherhood’. They argued that the report had failed to provide any evidence to support its assumption that ‘single women and lesbians make inadequate mothers’, and wondered ‘why this cost-conscious government did not just pick 20 people off the street to write it, since it embodies every kind of irrationality and popular prejudice scientists and philosophers are supposed to be above’.104 An article in the feminist journal Trouble and Strife noted that participants at a conference on new reproductive technologies had also ‘firmly rejected’ the proposal that doctors should be allowed to continue ‘dividing women into fit and unfit mothers’.105 And the sociologist Hilary Rose argued that the Committee had overlooked ‘a major cause of political and feminist concern’ by leaving a male-dominated profession free to ‘determine who shall mother and on what grounds’.106

It soon became clear that doctors were indeed determining who counted as an eligible patient for IVF. Trouble and Strife claimed that Edwards and Steptoe only treated married couples at Bourn Hall, while the anthropologist Sarah Franklin noted that although marriage was not a requirement for treatment in the IVF clinic she studied during the late 1980s, ‘the medical director had strong views about the naturalness of the reproductive drive, and it is likely unmarried or non-heterosexual women would not have felt welcome’.107 These attitudes were written into law by the 1990 Human Fertilisation and Embryology Act, which stated that a condition of licences issued by the new Human Fertilisation and Embryology Authority (HFEA) was that clinics should not undertake IVF ‘unless account has been taken of the welfare of any child who may be born as a result of the treatment (including the need of that child for a father)’.108 As a consequence of this ruling, many NHS and private clinics excluded single women and lesbian couples from treatment altogether, and others created a requirement for minimum length of relationship before they treated unmarried heterosexual couples.109

The ability to pay also determined access to IVF for many couples. NHS provision throughout the 1980s was uneven, with some health authorities offering no free treatment. NHS clinics, moreover, were generally subsumed within obstetrics and gynaecology departments, had long waiting lists, and refused to see patients from outside the region. Many infertile couples therefore had to seek treatment at private IVF clinics, which often charged ?2,000 for inpatient treatment. This was roughly a third of the average household income in the 1980s, though some clinics reduced costs by having the necessary hormone drugs prescribed through a woman’s general practitioner.110

By 1990, the Warnock Committee, directors of IVF clinics and government legislation had largely quelled unease surrounding the ‘aberrations of the baby revolution’ by ensuring that access to IVF was restricted to heterosexual couples.111 This meant that the ‘right to have children’ was restricted to those who were deemed ‘suitable’ when judged against social rather than purely clinical criteria. But this should come as no surprise. Here, as elsewhere in the history of infertility, the debate about who got to reproduce was ‘in essence a debate about values and priorities rather than a debate about what works’.112 As Robert Edwards, Patrick Steptoe, and members of the Warnock Committee realized, IVF would only ever become fully normalized if it conformed to, rather than fundamentally challenged, existing norms surrounding kinship, parenthood, and reproduction.

 
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