Author: Danielle Collett

Good afternoon esteemed congressmen and congresswomen,

As an infertility specialist who has spent much time working at various clinics across the world, I am extremely honored to have the opportunity to present my testimony on one of the most important issues of our time: assisted reproductive technology. As biotechnology continues to advance at a rapid pace, it is only fitting that we discuss the role that we must play in deciding the funding of such technology. I have spent the majority of my time working at clinics in Israel as well as studying the infertility treatment options and funding made available to patients in other countries. Because I specialize in IVF, or in-vitro fertilization, I have spent a great amount of time interviewing with patients who are interested in pursuing this course of treatment if they are unable to become pregnant. I have spoken with women across the United States, both those can afford the treatment and those who cannot. I continue to conduct research on the subject and am excited to share my findings with the Congress today and ultimately explain why the United States must continue to support this practice, and even consider increasing its funding for it. I will begin by discussing what in-vitro fertilization entails and the benefits of providing such technology to women across the world. I will bring to light some arguments against IVF that the Congress has previously mentioned, and will discuss why these no longer need to be concerns. I will then explain how in-vitro fertilization in the United States avoids kinship issues and is thus, an uncomplicated process with respect to the parent of the conceived child. I will conclude my testimony by discussing the current funding situation and how the United States is currently failing to provide adequate funding for such technology and most importantly, its need to increase such funding.

As an IVF specialist at the Atlanta Center for Reproductive Medicine, I have undergone significant training for practicing this form of assisted reproductive technology. In-vitro fertilization entails a process by which fertilization occurs outside of the body, hence “in vitro”. IVF may involve any combination of a mother’s own eggs and a husband’s sperm or donor eggs and sperm. Once the egg and sperm cells have been obtained, they are brought together in a laboratory for fertilization. The fertilized egg is then taken and “placed in a catheter, which is inserted into the woman’s uterus and released in the location that will maximize the possibility of conception” (Kahn 39). In previous discussions, the Congress brought up its concern that the remaining fertilized eggs “will be destroyed after the success of one fertilization” and it must recognize the ethical considerations for this (Haimowitz, “Made in India”). However, as technology continues to progress, scientists and researchers are using the remaining fertilized eggs to be cyropreserved for future use, rather than merely destroying them. The countless stories of successful IVF procedures strengthens my argument that IVF should not merely be permitted in the United States, but rather, should be an event that is celebrated and made available to women from all socioeconomic backgrounds.

In Susan Kahn’s ethnographic work, Reproducing Jews, she describes a number of women’s experience with IVF, particularly those in Jerusalem. Most importantly, she makes it clear that the process is safe and continues to make pregnancy a possibility for women with a range of infertility issues. She shares an account with one of the women she interviewed who partook in the IVF process that felt much less clinical and more like that of a family atmosphere. Kahn shares the story of Etti who describes how “it was so un-clinical. It [felt] like an extended family that really [wanted] me to get pregnant. [She] found it warm (hamama) and pleasant” (Kahn 26). This should be the type of treatment and experience clinics in the United States models and provides for patients looking to engage in IVF treatments. In my experience as an IVF specialist, many of the women who come to me have accepted that they will become single mothers, and I recognize that this is not an easy decision to make. These intimate and intense relationships that Kahn describes in her book are quite similar to the relationships I have fostered with my patients in Israel. As technology continues to progress, the idea of the “nuclear family” is continuing to dissolve and as a country, it is imperative that we support this change. In Israel, reproductive clinics believe that, “every baby is a blessing and that every woman deserves to be a mother” (Kahn 27). This most likely stems from the Jewish interpretation of the first two chapters of Genesis. While these chapters tell a cosmology of how God created the universe, they also introduce ideas of kinship, marriage, and reproduction. In line 28, Genesis reads, “God blessed [male and female] and said to them, ‘Be fruitful and increase in number; fill the earth and subdue it” (Gen. 1:28). It is clear that the text supports God’s idea that humankind should reproduce. Because the Israeli Supreme Court believes that chapter one in Genesis makes it clear that God commands His people to reproduce, this support for reproductive practices despite marital status is found throughout Israel. Kahn notes that the Israeli government plays an extremely unique role in the lives of potential mothers– there is no separation of Church and state. It is important to note that I am not advocating for a separation of Church and state, but rather merely pointing out the importance of supporting of IVF practices for potential mothers.

In order to further understand the benefits of IVF, it is imperative to understand that “reproduction, in its biological and social senses, is inextricably bound up with the production of culture” (Rapp 88). It is therefore necessary to examine reproduction via IVF cross-culturally. If we examine the assisted reproductive technology practices in India, it is clear that the cost is significantly more affordable than in the United States. India recognizes the importance of IVF and the benefits it brings to women. In Bhattacharyyas’s Magical Progeny, Modern Technology: A Hindu Bioethics of Assisted Reproductive Technology, she delves into her interpretation of how the Mahabharata, the longest epic ever written, can be used to explain various bioethical issues in India. She outlines the “six key elements” of Hinduism: centrality of societal good, belief in the unity of all life, dharma, the multivalent nature of Hindu traditions, karma, and ahisma or commitment to do no harm (Bhattacharyya 49). IVF would most likely fall under the elements of dharma and karma. The decision to engage in IVF would follow the action of dharma, while the decision to take responsibility for that action would fall under the element of karma. Essentially, the decision for a mother to partake in IVF would not be dictated by a Hindu law, but would be left to the individual to decide and take responsibility for that action. Because the United States prides itself on individual freedom, it aligns similarly with these two Hindu principles when discussing the continuation of IVF. Women should have the freedom to decide whether or not they would like to partake in this form of reproductive technology, not the United States government.

As we continue to discuss IVF across various cultures, it is important to recognize Japan. In Japan, there are now over 600 fertility clinics and hospitals in operation nationwide. Similar to Israel, Japan is becoming known as a “superpower of fertility treatment” (Ivry 113). In Japan, women who are pregnant become labeled and redefined as an “important body” (Ivry 128) and they equate bearing children to “being blessed with treasure” or kodakara ni megumareru. Although this extreme is not the current culture in the United States, women across the country do “feel that having a child is a blessing” (Seeman 4), both those who have planned and unplanned pregnancies. As a result, when a woman in the United States faces infertility issues, she is presented with an option, such as IVF, to help circumvent such issues. Women who have ovulation disorders, genetic disorders, damaged fallopian tubes, or even have husbands whose sperm motility has been compromised, have the option to still bear children. IVF must be continued in order to provide women in the United States with the opportunity to, like women in Japan, be blessed with such “treasure”.

On the same vein, another benefit IVF can provide is the ability to provide gay and lesbian couples with the option to bear children. In her book, Kahn describes how, “Israeli lesbians often receive financial, emotional, and childcare support” (Kahn 53) and shares the interview she had with one lesbian woman who partook in IVF. The woman Kahn interviews describes how she was ostracized by her family for being both a lesbian and for wanting to have a child. However, after she engaged in IVF, “[her] mother changed completely and now comes by all the time, baby-sits, and even brings presents for her [partner’s] biological son” (Kahn 53). This is just one of the myriad of successful stories of reproduction that IVF makes possible for gay and lesbian couples. With the legalization of gay marriage in the United States three years ago, it is logical to continue to provide such technology for these couples. Times are progressing and changing. As a country, it is imperative that our laws and funding reflect these changing times, especially with respect to biotechnology and reproductive assistance.

Another angle in which to examine IVF practices is through the lens of kinship. In countries such as Israel, IVF can create kinship issues because as Broyde states, “genetic relationship does not establish legal relationship” (Broyde 328). In his work, Broyde describes how some assisted reproductive technology practices can create kinship issues because the gestational mother is considered to be the “real” mother. In this case, if a woman tries to use IVF and uses a surrogate mother, the Jewish law would deduce that the surrogate is the mother of the child. Thus, the child of the surrogate mother would not be permitted to marry any relatives of the surrogate. Broyde asserts that, “unlike the common law tradition and Jewish law, modern American law views status issues such as parenthood as something that law determines, rather than something that the law discovers” (Broyde 5). Congressmen and women, I urge you to understand the importance of Broyde’s statement: the American law can change the natural order of relationships in this view. As a society, we can avoid the kinship issues brought up in many, other countries because we have collectively decided to use court rulings and contracts in order to determine who the parents of children can be.

Although the United States has deemed IVF “acceptable,” it continues to hardly engage or provide funding for the practice. Unlike the United States, the Israeli government “heavily subsidizes all forms of technological treatment” (Kahn 16). The state policies set forth by the Israeli government not only help subsidize the treatment, they make it possible for unmarried women and single-mothers to have the option to reproduce. The Israeli state policies “subsidize the pursuit of single parenthood, contributing to the growing social acceptance of unmarried mothers” (Kahn 16). The United States should adopt similar principles, encouraging women who want to bear children, to do so. Unlike the United States, the Israeli government makes it possible for women from all socioeconomic classes to reproduce, not just those in the wealthy upper-class. It begs the question: why should money be the determinant of whether a woman  in the United States can reproduce? It shouldn’t be. The United States must consider funding IVF more sufficiently in order to assist women who struggle to bear children.

As Dr. Seeman describes in his work, Ethnography, Exegesis, and Jewish Ethical Reflection, whether it is “in Israel, India, or Japan, each of these contexts shapes the ways in which ostensibly universal technologies like IVF or surrogacy are practiced and understood” (Seeman 5). IVF is being practiced, improved, and increasingly funded in countries across the world. In fact, it is important to understand how other countries view and use IVF in order to help the United States determine the benefits of continuing such technology. Because “when we learn to think of this diversity as a resource for comparative deliberation, it will become clear that what happens in Israel should be of concern to North Americans at least as much as North American paradigms” (Seeman 5). The benefits of IVF are immeasurable and are of paramount interest. This assisted reproductive technology makes it possible for women to have children despite any crippling infertility issues. This practice allows for gay and lesbian couples to bear children despite their sexual orientation. Most importantly, this form of biotechnology is not only one that needs to be continued, it must be more sufficiently funded in order to help future parents across the country have the reproductive freedom they deserve.

 

Bhattacharyya, Swasti. A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.

Book of Genesis, chapters 1-2 <www.webpages.uidaho.edu/PDF/166/20Genesis.pdf)>.

Broyde, Michael J. Marriage, Sex, and the Family in Judaism. Rowman & Littlefield, 2005.

Ivry, Tispy. Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).   

Seeman, Don, et al. “Blessing Unintended Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine Anthropology Theory, vol. 3, no. 1, pp. 29–54.

Seeman, Don. “Ethnography, Exegesis and Jewish Ethical Reflection: The New Reproductive Technologies in Israel.” In Daphna Birenbaum-Carmeli and Yoram S. Carmeli editors, Kin, Gene, Community: Reproductive Technologies Among Jewish Israelis (Berghahn Books, 2010), pp. 340-362.

Kahn, Susan. Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000).

Rayna, Rapp. Testing Women, Testing the Fetus (Routledge, 2000).

As reproductive technology continues to rapidly grow and develop across the globe, an increasing number of anthropologists seek to understand the role these technologies play within different cultures, societies, and civilizations. In order to understand the importance and permissibility of reproductive practices cross-culturally, anthropologists turn to religious texts to form the foundations of such bioethical conversations. In this paper, I will explore the work of Swasti Bhattacharyya in her book, Magical Progeny, Modern Technology: A Hindu Bioethics of Assisted Reproductive Technology, which delves into her interpretation of how the Mahabharata can be used to explain various bioethical issues in India. I will also look at Michael J. Broyde’s Marriage, Sex, and Family in Judaism, in which he forms a preliminary analysis of reproductive technologies, specifically cloning, from a Jewish normative law perspective. Through a careful analysis of both works, I will characterize some of the main differences found between Bhattacharyya’s and Broyde’s works, and draw conclusions about their perspectives on the cultural implications of reproductive technology found in two, different countries.

Bhattacharyya uses the Mahabharata, the longest epic ever written, as her primary source to analyze and draw bioethical conclusions from a Hindu perspective regarding reproductive technologies. She begins her book by establishing that because Hinduism has no formal law regarding reproductive technology, she will use her interpretation of three stories from the Mahabharata describing three women and their efforts to bear children, to create a Hindu perspective of bioethics. She uses the Mahabharata because its “paradigmatic narratives are mines that upon excavation will reveal the jewels that reflect India’s past, its present, and Hinduism’s ethical ideology” (Bhattacharyya 32). Ostensibly, the book seems to emphasize the stories which are told in great detail; however, it becomes increasingly clear by the end of the book, that the level of detail in these stories is not as important as her overall message and goal: religion and culture play a large role in bioethics and it is thus extremely important to establish and understand cultural competency. Bhattacharyya’s description of the stories in the Mahabharata serve as a cosmology and foundation for her formation of different bioethical principles from a Hindu perspective. She describes Hinduism as a religion, “overflowing with options, alternatives, and divergent beliefs” (Bhattacharyya 49) and that it is for this reason that Hindus welcome pluralism, embracing a variety of different voices, and are bothered by any “attempt to eliminate alternative views” (Bhattacharyya 50). It is important to recognize that Bhattacharyya does not claim to represent the Hindu voice of reproductive technology and morals, but rather seeks to take many, different voices into consideration in attempt to draw more broad and abstract conclusions about such technology usage in India.

With a significantly different methodology, Broyde uses various sets of Jewish laws emphasized by rabbinic authorities in attempt to draw conclusions about cloning. Broyde uses these concrete laws and morals to guide his thoughts throughout the article, leaving little room for interpretation. Unlike Bhattacharyya’s attempt to draw analogies between the stories in the Mahabharata and bioethics, Broyde focuses on how specific Jewish laws and beliefs about reproductive technology affect kinship rules and situations while simultaneously interweaving the scientific process of cloning. Broyde’s goal is “not to advance a rule that represents itself as definitive normative Jewish law” (Broyde 304), but rather, to “attempt to outline some of the issues in the hope that others will focus on the same problems.” This goal lends itself to his preliminary analysis regarding the effect of cloning on marriage, parental status, and other related kinship issues. Through a series of examples regarding other reproductive technologies, Broyde’s article argues that fundamentally, cloning is a form of assisted reproduction. He suggests that cloning is “no different from artificial insemination or surrogate motherhood” and that this form of assisted reproduction should be made available those who need it (Broyde 305). Rather than drawing on analytic philosophy like Bhattacharyya, Broyde uses the American legal system to help compare his ideas for Jewish perspectives on reproductive technology. He describes that, unlike the American court system, “genetic relationship does not establish legal relationship” (Broyde 328). According to Jewish law, the gestational mother is almost always considered to be the “real” mother of the child. From here, he establishes that because the surrogate mother or gestational mother is considered to be the real mother, this directly creates a kinship issue as it then prohibits the surrogate mother from marrying any relatives of the surrogate mother. Broyde’s scientific methodology can be characterized as one that uses current Jewish laws regarding reproductive technology to address the questions of cloning and public policy.

Bhattacharyya’s methodology leads her to use comparative works from specific texts that have “significantly influenced modern ‘Western American’ thinking, namely the Hebrew Bible and the New Testament” (Bhattacharyya 56). She uses texts from the Hebrew Bible and Roman Catholicism to serve as guidelines for comparison in order to drive her own opinions regarding Hindu perspectives on reproductive technology in India. Most notably, she asserts that “in the Hebrew bible and New Testament, though humans are involved, God is ultimately in control of human procreation” (Bhattacharyya 58), immediately comparing this to the notion that in the Mahabharata, gods and humans are often co-equals in the procreative process. She uses the Church’s belief that “the soul is infused into the embryo at the moment of conception” (Bhattacharyya 62) to assert that the Church views IVF, ZIFT, and other reproductive technologies as “destroyed ensouled zygotes”. She ultimately uses the official teachings of the Roman Catholic Church to draw a sharp contrast of how these beliefs do not find their equivalent within Hinduism. Instead, she uses what she refers to as the “six key elements of Hindu thought” to underline the construction of Hindu ethic with respect to reproductive technology.

Although Broyde and Bhattacharyya take vastly different approaches to the exploration of reproductive technologies, I believe they would share similar perspectives with respect to the dilemmas of prenatal testing. Because Broyde explains that “reproductive technologies are neither prohibited nor permissible in the eyes of Jewish law, but rather subject to a case-by-case analysis” (Broyde 295), I believe he would advocate for the same mentality with respect to prenatal testing. Throughout his work, Broyde revisits the Jewish obligation for man “to be fruitful and multiply” and because possible consequences of prenatal testing may include termination of the pregnancy, Broyde might be hesitant to assert that rabbinical authorities would be accepting of such technology. However, Broyde may also add that “moral conservatism is an objective morality and not everything that humanity wants or can do is proper,” ultimately arguing that God is the only power that can dictate such decisions regarding the state or health of the child (Broyde 303). Similarly, because Bhattacharyya describes Hinduism as a collection of different voices and ideas, I believe she would subscribe to a comparable perspective regarding prenatal testing. She would most likely suggest that prenatal testing is an example of a “case-by-case” situation that must take into account the different “Hindu voices” as well as resonate with the six key elements of Hinduism she outlines: centrality of societal good, belief in the unity of all life, dharma, the multivalent nature of Hindu traditions, karma, and commitment to do no harm (ahimsa). Prenatal testing would most likely fall under the elements of dharma and karma. The decision to engage in prenatal testing would follow the action of dharma, while the decision to take responsibility for that action would fall under the element of karma. Essentially, the decision for a mother to partake in prenatal testing would not be dictated by a Hindu law, but would be left to the individual to decide and take responsibility for that action.

Both texts are clearly intended for different audiences and thus, take vastly different approaches to the subject of reproductive technology. While Bhattacharyya draws on analogies she makes from the Mahabharata as the foundation for her creation of the Hindu principles regarding bioethics and reproductive technologies, Broyde uses the normative Jewish laws that help frame his discussion for reproductive cloning. Ultimately, with the rise of reproductive technology and its increasing usage, it is important to recognize and characterize such differences in order to gain cultural competence in order to understand its effect on kinship and society as a whole.

 

Swasti Bhattacharya, Magical Progeny, Modern Technology: A Hindu Bioethics of Reproductive Technology (Suny University Press, 2006).

Michael J. Broyde, “Modern Reproductive Technologies and Jewish Law,” In Michael J. Broyde and Michael Ausubel editors, Marriage, Sex and the Family in Judaism. (Rowman and Littlefield, 2005), pp. 295-328

The first two chapters of Genesis have sparked much conversation and debate among different religions since their creation. While these chapters tell a cosmology of how God created the universe, they also introduce ideas of kinship, marriage, and reproduction. When these same ideas are applied to analyzing and understanding the place of medical technologies in today’s society, different religions take different stances on the issue, only contributing to the larger conversation about such biblical interpretations. Through Genesis, I will explore the beliefs and moral values of Jewish and Christian faith with respect to reproduction and more specifically, in vitro fertilization.

Speech plays an important role when reading and interpreting the chapters of Genesis. Although the Jewish and Christian communities use the same lines from the biblical text, their interpretations sharply contrast one another. In line 28, Genesis reads, “God blessed [male and female] and said to them, ‘Be fruitful and increase in number; fill the earth and subdue it” (Gen. 1:28). It is clear that the text supports God’s idea that humankind should reproduce. The Christian community interprets this textual line as God encouraging mankind to reproduce, and to do so in a fashion that respects the child, treating the child as a blessing or “gift” (Vitae 147). The Catholic church views the reproduction and creation of children as God’s gift to man, something to be treasured and enjoyed if it is God’s plan for a woman to bear that child. By contrast, the Jewish faith subscribes more to the idea that it is a woman’s moral right, and perhaps even obligation, to follow God’s words in Genesis line 28 to “be fruitful” and reproduce.  

These two interpretations of a single line in the Old Testament have served as the foundation for the vastly different beliefs regarding assisted reproductive technologies in both Christian and Jewish moral values and laws. Donum Vitae’s “Instruction for Human Life in its Origin and on the Dignity of Reproduction” presents an official position, speaking on behalf of the Catholic church; he ultimately argues that the Church does not permit any form of assisted reproductive technology apart from homologous IVF, or IVF taking place between that of a married man and woman. The Catholic church’s beliefs regarding IVF closely align with its interpretations of the first two chapters of Genesis. The Church believes anything “unnatural” (such as IVF, or more specifically heterologous artificial fertilization ) “violates the rights of the child; it deprives him of his filial relationship with his parental origins and can hinder the maturing of his personal identity” (Vitae 159). The Church also deeply subscribes to the investment and sacred bond that forms between man and woman through marriage, a belief that most likely stems from a second chapter in Genesis where “God made a woman from [man’s] rib” (Gen. 2:23). This coveted bond between man and woman further illustrates the reasoning behind the lack of support the Catholic church expresses toward any assisting reproductive technology that may comprise such a sacred bond. 

In sharp contrast, Susan Kahn takes an enthnographic approach to the very same subject regarding in vitro fertilization. Kahn presents a reflective and comprehensive look at women’s experience with IVF in Israel, especially in Jerusalem, the Holy city. With the presentation of a myriad of stories from women and their medical and social experience with IVF in Israel, it becomes increasingly clear that the Jewish community views reproduction as an integral fabric to its society. Kahn notes that the Israeli government plays an extremely unique role in the lives of potential mothers– there is no separation of Church and state. The Israeli state encourages women to partake in the unlimited and subsidized IVF offerings, especially if they are left with no other option for reproduction. Providing these reproductive technologies consequently contributes to removing the stigma of such practices and alleviates the pressure of having a nuclear family (unlike the Catholic church that seeks to preserve the foundation and values of the nuclear family). Because Jewish faith believes that chapter one in Genesis makes it clear that God commands His people to reproduce, this support for reproductive practices despite marital status is found throughout Israel.

Although the first two chapters of Genesis ostensibly seem to describe the creation of the universe, earth, and beings that walk among it, these chapters have paved the way for many different religious interpretations and understandings. Most importantly, it is crucial to understand the different beliefs and moral stances various religions take on these biblical chapters in order to gain better insight into their views of modern medical technological advances.

Book of Genesis, chapters 1-2 <www.webpages.uidaho.edu/PDF/166/20Genesis.pdf)>.

Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: An Inquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.” (Crossroad, 1988).

Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000).