Debora Spar is a professor at the Harvard Business School who has studied the evolution of Internet technology from early, anarchic beginnings into a more mature and consolidated industry. In her new book, The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception, she turns to reproductive technology. The science of baby making-in vitro fertilization, surrogacy, genetic engineering-has given rise to a global trade in sperm, eggs, embryos, wombs-for-rent, and in the services of a cadre of suppliers, technicians, middlemen, researchers, lawyers, third-party payers, and consultants.
Spar provides a revealing portrait of the size, scope, and rapid growth of the business. Take the most low-tech and profitable segment of the U.S. market: the fertility trade. The number of fertility clinics has increased from 100 in 1986 to 428 in 2002. Revenues from fertility treatment jumped from $41 million in 1986 to nearly $3 billion in 2002. Specialization and consolidation, either in the direction of high-end niche markets or high-volume mass markets, has also occurred. The fertility industry has spawned subsidiary businesses such as premium egg freezing and egg banking for the masses.
If the fertility business represents the mature and lucrative segment of the market, other segments-the screening of embryos for genetic defects or therapeutic cloning-are still limited to a relatively small group of parents. But Spar predicts this infant market will follow the same trajectory as the market for infertility treatment. As the technology is perfected, supply will grow. As the society changes, demand will increase. Already, demography points to a huge potential global market for baby-making parts and services. Couples in the United States and Europe are marrying at older ages, and late-marriage couples are at higher risk for infertility. Gay couples and single women are seeking babies. More people are limiting their families to one or two children, creating demand for a “perfect child.” And state-mandated insurance coverage for fertility treatments, now in existence in fourteen states, will further “grow” the market.
For Spar, babies are good; markets are good; and happy parents are good. Notably, though, she fails to consider whether this market is good for the babies. What about the children who have been created through assisted reproduction? Does it matter to them that they may have multiple parents, some of whom will remain forever anonymous? Is it a good thing to deliberately produce, for profit, a population of children who will never know their full parentage? Is a business that creates satisfied customers but less secure children a good thing? Spar is silent on these questions.
Not so the Commission on Parenthood’s Future. This newly formed group of scholars is encouraging public debate on the social, moral, and legal implications of the baby business. Its first report is written by Elizabeth Marquardt, a member of the commission and a scholar at the Institute for American Values. She has done something that few others have bothered to do. She has asked some of the first donor-conceived children, now in their late teens and early twenties, how they feel about their origins. (Estimates suggest that somewhere between thirty thousand and seventy thousand children are born each year as the result of sperm donation, and that about three thousand each year are conceived using donor eggs.) Marquardt reports that these young people struggle with unresolved questions of identity. They feel they have been deprived of their birthright and their full selfhood. Some desperately long to meet their donor dad or to find their half-siblings. And many wonder how the purveyors of sperms and eggs could be so attentive to adult desires for a child and so indifferent to children’s need to know their parentage.
To be sure, these interviewees come from a small, self-selected sample. As Marquardt notes, it will take more time and further studies before we have a representative portrait. Perhaps the number of struggling donor-conceived children will be relatively small. But if it turns out otherwise, it may be too late. By then, the baby business will be entrenched.
We have seen this happen before. In the l970s, when no-fault divorce swept the nation, the legal and social-science community favored the reform. They were little concerned about its impact on children. It was not until the 1990s, when large-scale studies demonstrated significant harms to the roughly one million children per year who experienced parental divorce, that the scholars changed their minds. By then, however, it was too late to reverse course. A high-divorce-rate society had taken root.
In the case of the baby business, however, it’s not too late to hit the brakes. The commission report issues a call to do so. It seeks to foster a broader consideration of the consequences of this new form of commerce and time to reflect on a crucial but neglected question: Do adults’ desires for a baby trump the needs of that child to achieve a secure identity?