1995]
A. LIPPMAN – “NEVER Too LATE”
“Never Too Late”: Biotechnology,
Women and Reproduction
Abby Lippman
reproductive
technology claims
Postmenopausal pregnancy is an example of how
“new”
to “rescue”
women by seemingly offering them choice, control over
their bodies and equity with men. The author suggests,
however, that the biomedical procedures associated with
postmenopausal pregnancy may be more consistent with
the oppression of women than with their liberation. Seen
in context, this technology is not neutral, and these in-
terventions are part of a larger socio-political ideology:
“successful” women are those who are freed of their
own biology and situated in a male biomedical model
which makes childbearing possible at virtually any age.
As such, postmenopausal pregnancy reflects and rein-
forces sexist and ageist attitudes in our culture. Some
may argue that postmenopausal pregnancy is a means to
eliminate the reproductive differences between men and
women. However, these differences are integral to a
woman’s identity. What is more troublesome are the
consequences that flow from these differences. Rather
than adopting the quick fix that postmenopausal preg-
nancy offers to deal with these differences, it is safer,
cheaper and more appropriate to address the conse-
quences through social policies.
Les grossesses post-indnopausiques sont un des
moyens par lesquels les nouvelles techniques de re-
production prdtendent “sauver” les femmes: elles
semblent leur offrir un choix, le contr6le de leur
corps et l’quit avec les hommes. Uauteure sugg~re
qu’en rdalit6, les procddds biomddicaux associds aux
grossesses post-mdnopausiques relvent davantage
de l’oppression de la femme que de sa libdration.
Cette technologie n’est pas neutre car ces interven-
tions font partie d’une iddologie socio-politique plus
vaste: les femmes qui “rdussissent” sont celles qui
sont libdrdes de leur propre biologie et situdes dans le
mod le biomddical masculin qui rend possible la
gestation A n’importe quel Age. Par consdquent, les
grossesses post-mdnopausiques sont une fagon de
supprimer les diffdrences reproductives entre homn-
mes et femmes, alors qu’elles sont en fait partie int6-
grante de l’identit d’une femme. Au lieu d’adopter
la solution rapide offerte par les grossesses post-
mdnopausiques pour rdsoudre les consdquences de
telles diffdrences, it est plus stir, plus appropri6 et
moins ondreux d’avoir recours a. des politiques socia-
les.
PhD; Professor, Department of Epidemiology & Biostatistics (McGill). I am grateful to the Social
Sciences and Humanities Research Council for its support of the research on which this paper is
based. I thank Anne Beaulieu, who worked on this project in its earliest stages, for her careful review
of the stories in the popular press about postmenopausal pregnancy. Thanks also to Gwynne Basen
for her editorial advice and to Vanessa Hill for help with the preparation of the manuscript. As well, I
cannot fail to thank the many other authors in this area who have contributed compelling and impor-
tant insights into the issues I address and whose work stimulates my own. I have likely failed to cite
everyone who deserves credit: even with the best of intentions, I am a sponge and sometimes absorb
the ideas of others without even realizing it –
or citing them. I hope these authors will forgive my
lapses and will, themselves, feel free to use anything I say as part of the public domain. Given the si-
lence (other than critical ill-tempered dismissal) that usually greets feminists’ verbal or written contri-
butions, the more we speak together (in both senses of the term), the harder it will be to ignore or tum
us off. This paper is based on an earlier and much shorter chapter in G. Basen, M. Eichler & A.
Lippman, eds., Misconceptions. The Social Construction of Choice and the New Reproductive and
Genetic Technologies, vol. 2 (Hull, Que.: Voyageur, 1994) 137.
McGill Law Joumal 1995
Revue de droit de McGill
To be cited as: (1995) 40 McGill L.J. 875
Mode de rdfdrence: (1995) 40 R.D. McGill 875
876
MCGILLLAWJOURNAL/REVUEDEDROITDEMCGILL
[Vol. 40
Synopsis
Introduction
I. Pregnancy after Menopause
II. Oppression and Postmenopausal Pregnancy
III. Postmenopausal Pregnancy and the Production of Children
IV. The Pregnancy Business and Body Management
V. Rescue Marketing
Conclusion
1995]
A. LIPPMAN – “NEVER Too LATE”
Introduction
“Biotechnology, women and reproduction”: the phrase combines in one breath
a dangerous trio. This paper focuses on but one area where these words intersect
and where the dangers to women emerge clearly: postmenopausal pregnancy.’ This
area is representative of many others where reproductive technology claims to have
“rescued” women by offering us body management, control and choice. In this
case, the lauded “rescue” is said to be from age limitations on fertility; postmeno-
pausal obstetrics, by managing our aging bodies, will now offer women not only
2
pregnancy at any age but, in the process, “equity” with men.
In this paper, I want to begin to uncover how postmenopausal obstetrics is more
likely to oppress than to “rescue” or provide equity for women. Further, I want to
suggest that this oppression results directly from the ideology of postmenopausal
obstetrics that uses technology to adapt women to men’s biographies and reinforces
negative stereotypes of the aging female. The way in which this intervention facili-
tates an evergrowing trend towards eugenics will also be addressed briefly.
1. Pregnancy after Menopause
The spontaneous cessation of ovulation and the resulting termination of repro-
ductive capacity in women are what we generally label menopause. For the average
healthy North American woman who has not been surgically sterilized, this process
‘ In themselves, postmenopausal pregnancies may not be of greatest interest. They do, however,
provide a point of entry to consider such things as what is biomedical versus what is biopolitical, or
what is liberating versus what is oppressive. As well, they provide a rich context in which to assess
the general meanings of new reproductive and genetic technologies, and will thus receive attention
here.
2 Some examples from the popular press are illustrative here: “It’s hypocrisy to say a woman of 59
is not fit to bring up a child but a father of 59 is a splendid instance of British virility” (B. Rudolph,
“Miracles Postmenopause” Thne (10 January 1994) 31); “It would be a negative thing if, because of
the clamor of the media and the knee-jerk reaction of the authorities, they fixed an upper age limit for
women when there is no age limit for men” (“Over-50 Motherhood Issue Divides British Doctors”
The Vancouver Sun (28 December 1993) A1-A2 [hereinafter “Over-50 Motherhood”]).
I think it is telling that when I first drafted this sentence I wrote “…equal with respect to” and
then found I could not finish the phrase; the flow of words was blocked. I initially wanted to say
“with respect to becoming a parent,” but this did not work. People become parents through adoption
and fostering, not only by giving birth to a baby, and if giving birth were the definitive experience,
then all men would be out of the running for now. Then I began, “with respect to conceiving a child.”
Here, most men would fit in, so long as their sperm were used, but the postmenopausal woman would
not, since the egg(s) from another woman would be used for in vitro fertilization. Thus, this formula-
tion didn’t work either. To get out of my aphasic state, I finally decided to end the sentence without
the “with respect to …” qualification. I think my problem is worth noting insofar as it demonstrates
how so many of the new genetic and reproductive technologies and practices cannot even be encom-
passed in our current language.
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[Vol. 40
usually occurs sometime between the ages of forty-eight and fifty-one, with most
women’s experiences falling within a range of forty-five to fifty-five years of age.’
About 0.3 per cent of women under this age have non-surgically induced lack of
ovaries or of ovulation,4 usually called ovarian “failure”,5 so that, with respect to
reproduction, they are functionally menopausal.
Biomedical researchers are now offering to create pregnancies for these women
who have experienced menopause or are functionally menopausal.6 This is done
through: the purchase of eggs from younger women;8 laboratory or in vitro fertili-
zation (IVF) and transfer of a woman’s eggs; and the hormonal manipulation of
women carrying the fertilized eggs. For simplicity, I shall refer to all of these gen-
erically as postmenopausal pregnancies.
I intend to concentrate on women over forty-five years of age and to demon-
strate how these procedures reinforce the ageism and patriarchism that underlie so-
cietal attitudes to women, reinforce gendered stereotypes about women and even
diminish possibilities for progressive social change. I will briefly relate the concept
of postmenopausal pregnancies to the eugenic practice of preimplantation diagno-
sis, another of the newer reproductive and genetic technologies. I will, however,
temporarily ignore how these technologies reduce parenthood to biological repro-
duction, privileging but one component, that of physiological gestation, in the proc-
3D. Brambilla & S. McKinlay, “A Prospective Study of Factors Affecting Age at Menopause”
(1989) 42 J. Clinical Epidemiology 1031 at 1031-39.
4 The number of women who have been rendered infertile surgically through hysterectomy is many
times greater, with estimates suggesting that as many as one third of North American women under
60 may have had this operation (M. Lock, Encounters with Aging (Berkeley: University of California
Press, 1993) at table 10, p. 260).
5I will not here unpack the term “failure” when applied to ovarian function in women in their fif-
ties, because others have done it quite eloquently already (see e.g. M. Lock, “Models and Practice in
Medicine: Menopause as Syndrome or Life Transition?” in A.D. Gaines & R.A. Hatin, eds., Physi-
cians of Western Medicine (Dordrecht: Reidel, 1985) 115; E. Martin, “Science and Women’s Bodies:
Forms of Anthropological Knowledge” in M. Jacobus, E. Fox Keller & S. Shuttleworth, eds.,
Body/Politics: Women and the Discourses of Science (New York: Routledge, 1990) 47). I cannot re-
sist noting, however, that while the language of “failure” is evident in the professional and popular lit-
erature (see e.g. “Over-50 Motherhood”, supra note 2), it is hardly a term to describe a natural life
experience such as the age-related cessation of menstruation and ovulation.
6An important distinction, considered in further detail below, is that biomedicine is not needed to
make these women into “mothers” even if it is needed to create pregnancies for them.
7 Professionals working in these programs almost invariably refer to egg “donation” as the source of
oocytes. This would hardly seem appropriate when most offer payment to those from whom the eggs
will be obtained, and it is not uncommon for these services to advertise for sales. Thus, the Depart-
ment of Obstetrics and Gynecology at Columbia Presbyterian Medical Center in New York City
placed notices on elevators to announce: “Division of Assisted Reproduction Seeking Healthy
Women to Donate Eggs – Between 21-35 Years of Age – Who are Empathetic and Wish to Assist
our Infertile Patients. Compensation for Time and Efforts will be $2,200. If interested, please call …”
8 In the future, it could result from frozen ovarian tissue taken from a woman when she was
younger, from the ovaries of aborted fetuses or from cadavers (see M.M. Seibel, “Cadaveric Ovary
Donation” (1994) 330 New England J. Medicine 796).
1995]
A. LiPPMAN – “NEVER Too LATE”
ess of becoming a parent, and but one demographic group (likely wealthy, hetero-
sexual and white).9
In clarifying these claims, I will put aside two of the most obvious problems
with postmenopausal pregnancy, namely how this is but one more manifestation of
the previously well-described medicalization of women’s health,’ and how the ex-
perimental procedures involved have an abysmal failure rate” and pose consider-
able and serious risks to the woman and to the fetus. Instead, I will focus on how,
despite the biomedical rhetoric of “liberating” women from their life cycles, the
possibilities and practice of postmenopausal obstetrics are actually quite oppres-
sive.
II. Oppression and Postmenopausal Pregnancy
I take as given that there is no such thing as “natural” old – or middle –
age.
All of us, women and men, age within a sociopolitical and cultural context that
gives meaning to personal chronology. Stripped of its accompanying context, aging
is but a decrease in the numerical probability of continuing to live. ‘ 2 It is a universal
experience of all living organisms. All who are born do age, with some merely in-
volved in the process for longer than others.
But age is never isolated to this extent other than, perhaps, in actuarial tables
from insurance companies. Rather, as with gender, race, ability and other
“signifiers”, it is a notion of difference that comes clothed in various socially con-
stituted presumptions and attitudes. Moreover, in North America, because it is a dif-
ference that matters, age is both socially constituted and politically invented.
9 1 will not be able to touch on all, or even many, of the other very troublesome aspects of these in-
terventions. We may note, however, the extent to which, beyond their race- and class-based assump-
tions, they allow the perpetuation of workplace hazards that make pregnancy harder to achieve for
certain women, maintain the development of forms of contraception that impair women’s “natural”
biological fertility and fail to challenge the North American political and economic systems that en-
courage later childbearing for some groups of women.
10 See A. Oakley, The Captured Womb: A History of the Medical Care of Pregnant Women (Oxford:
Basil Blackwell, 1984). Redefining natural body rhythms as barriers or deficiencies is not new in
modem obstetrics. Think merely of all the women entering menopause whose hormones are seen as
in need of a “fix”.-Will we one day think of premenstrual young women as hormonally deficient,
needing a “fix” to enable them to become pregnant? (see E. Kluge, “Reproductive Technology and
Postmenopausal Motherhood” (1994) 151 Can. Medical Association J. 353 at 355, for a recent rele-
vant commentary).
IINo more than 15 per cent of women in the “better” IVF programs actually take home a healthy
baby.
12 See S. De Beauvoir, OldAge, trans. A. Deutsch (London: Weidenfeld & Nicholson, 1972).
MCGILL LAW JOURNAL/REVUE DE DROITDE MCGILL
[Vol. 40
Oppression thus first emerges in the ageism and sexism of this technology.”L
Postmenopausal pregnancy fits into the sexist and capitalist definition of women as
producers of children: only because (certain) women are expected to be mothers re-
gardless of age could the inability to be pregnant at, for example, forty-eight years
or older, possibly be seen as “infertility”. Assuming childbearing is a necessary and
sufficient source of fulfilment for the older woman, postmenopausal pregnancy
perpetuates the ageist image of the woman in middle and older age who is no
longer productive by offering to “treat” this condition. 4
Postmenopausal pregnancy is also oppressive because it inverts –
and other-
wise plays with –
notions of choice. If nothing else, women cannot “choose” to
become pregnant after age fifty so much as physicians can choose (along the usual
lines of discrimination such as class, ability, sexual orientation, etc.) those to whom
to offer this technology. More troubling, however, is how not being pregnant after
menopause can no longer be seen, because of the technological advances, as an in-
evitable stage in a biological cycle; rather, it too has become a “choice”.
Granted, for some women this “choice” to become pregnant after menopause,
to carry out women’s traditional role in a conventional way, is an active response to
societal sexism and ageism that has limited their other options for self-fulfilment
and recognition and is not merely a passive submission to these forces. 5 After all,
we do embody social and cultural norms. Nevertheless, it remains the case that the
mere availability of this technology means that a woman who does not undergo it
can be presented as having “chosen” to forgo bearing a child, as having “chosen”
not to do all she can for her partner who wants a child, as having “chosen” not to
assume the womanly role expected of her or as having “chosen” not to control her
biology.
The technology thereby puts additional pressure on women to conform to exist-
ing gendered norms. Those who might have found release from pressures to be
pregnant with the welcome arrival of menopause now have an indeterminate sen-
tence and become at risk for “victim-blaming” –
it is now her fault if she is not
pregnant. 6 Who will have sympathy for one who has “chosen” not to control her
13 Some of these issues are addressed in E. Bettenhausen, “Ethical Issues in Post-menopausal Preg-
nancy and Birth” (1994) 3 IN/FIRE [International Network of Feminists Interested in Reproductive
Health] Ethics 1.
14 See Martin, supra note 5.
15 A similar point pertains to motherhood in general. All women do not need to be mothers, but
given prevailing myths about this status in the Western world, as well as the cultural conditioning ex-
perienced by women in these countries, (some) women may “choose” to have a child to actively re-
sist being labelled abnormal or selfish (see A. Oakley, Women’s Work: The Housewife, Past and Pres-
ent (New York: Pantheon, 1974)).
16 Similar questions are asked about “treatment” for infertility: when, if ever, can a woman stop the
process without being seen as giving up her “choice” to bear children? In the new world that technol-
ogy has created, the responsible woman is the mother-to-be who takes advantage of all technology of-
fered to her.
1995]
A. LIPPMAN – “NEVER Too LATE”
body when she could? After all, surrounded by media-generated images that depict
the aging woman in a battle with time, fighting against wrinkles or increased
weight or her “biological clock”,’ 7 why would a financially comfortable white
North American woman not want to enter combat and welcome the opportunity to
become an alleged “winner”? With a cult of “eternal youth” generating additional
pressures on us to control our bodies, it seems consistent for a woman to assent to
“rescue” from her biology and release from its constraints –
especially if other
“escapes” from becoming devalued are foreclosed. Thus, it might be more appro-
priate to see having, or not having, a postmenopausal pregnancy as an individual,
yet socially conditioned action. However, as a response to a social context that
promotes this activity, it is not necessarily an individual choice.
Further, we might ask if it is liberating to circumvent a process that has been
among those defining us as women, for the chance to “succeed” on men’s terms.”
Is it liberating to be “rescued” from women’s biology so as to be situated, for pur-
poses of fertility, in men’s biology and thus to be re-housed in the male-defined
institute called “family”,’ 9 with this transfer camouflaged by the language of
choice? 0
In general, it is useful to recall that any biomedical option made available is of-
fered strictly on the terms of those – most often men –
developing the technol-
ogy. Therefore, whenever any new genetic or reproductive technology is offered by
practitioners as a “choice”, we must ask ourselves whose interests are advanced by
this discourse and by this framing of the matter. For most women, especially those
of colour, those who are poor and those who have disabilities, “choice” of this
technological nature is not equally accessible. More fundamentally, “choice” ap-
pears to be a too easily manipulated notion when constructed by someone other
than the women with the greatest stake in having the freedom to select among a full
range of options. For these women, indeed for all of us, “free lives” need to precede
“free choices” if individual autonomy is to be more than a mere abstract model, un-
able to accommodate and reflect the realities of women’s lives. These realities,
which include “choice diminishing pressures”2′ on women to strive for perfection in
themselves and in their offspring, suggest that what is called “choice” by the ex-
perts offering interventions may actually be experienced as “coerced voluntarism”
17A. Beaulieu & A. Lippman, “‘Everything You Need to Know’: How Women’s Magazines
Structure Prenatal Diagnosis for Women over 35” (1995) Women & Health (forthcoming).
,8See R.E. Davis-Floyd, “The Technocratic Body: American Childbirth as Cultural Expression”
(1994) 38 Social Science & Medicine 1125.
,9 The “family”, true to the Latin origin of the word, refers to the servants of a household, and has
historically been a means for men to control women.
20 For a gender-sensitive consideration of these and related issues, see T. Joffe, “Life Begins at
21 K. Morgan, Speech delivered as part of Annie Macdonald Langstaff Workshops (Faculty of Law,
Sixty: Babies for the Older Woman” (1994) 98 Bulletin of Medical Ethics 19.
McGill University, 28 March 1994).
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[Vol. 40
by the majority of women who undergo these procedures.22 Certainly this is
“action”, but it is clearly not a “choice”.
Oppression also results because postmenopausal pregnancies blur important
distinctions between childlessness, a social situation remedied simply by the pres-
ence of a child, and “infertility”, the medical condition of a woman who is physio-
logically or anatomically unable to conceive. This conceptual confusion again per-
petuates the institutionalized idea of a family based on male definitions.” This op-
pression extends to all women because it distracts us from adopting the necessary
measures to prevent infertility and to provide social support for childlessness. If
one can take eggs from a woman when she is young and freeze them for her or an-
other woman’s later use, we should question whether there would be any impetus to
remove those workplace hazards that jeopardize fertility and themselves create the
window of opportunity for high-tech “rescues”. Here, as elsewhere when new ge-
netic and reproductive technologies are involved, what seem to be “private” deci-
sions actually affect us all and can easily result in public consequences, if not in
collective harm. Even if the public and private realms were not sociocultural con-
structs with a constantly changing frontier, all of us would be affected by the devel-
opment and use of these interventions.
IH. Postmenopausal Pregnancy and the Production of Children
The technologies used in postmenopausal obstetrics (egg retrieval and pur-
chase, in vitro fertilization, etc.) are not applied just to make a woman pregnant
(and not so successfully at that), but to produce a child.24 Except with respect to the
physical ability of an older woman to mother, both the supporters and the critics of
this technology generally ignore the ramifications to the children being created. Yet,
22 Empiric support for these speculations comes from the words of the many women we have in-
terviewed about their use or non-use of prenatal diagnosis. Women who are tested do use the word
“choice”, but often qualify it by saying that once a procedure was offered, they had “no choice” but to
use it. A similar expression of coerced voluntarism was echoed in the comments of women who did
not get tested during their pregnancies, when they described the pressures on them to have prenatal
diagnosis. Outsiders may see women freely “choosing” to have testing. From the inside, however,
constraints and pressures play a crucial role.
2- See B. Katz Rothman, Recreating Motherhood: Ideology and Technology in a Patriarchal Soci-
ety (New York: W.W. Norton & Co., 1989); see also supra note 19 and accompanying text.
24 Some permutations of the words “want[ing]”, “child” and “create” allow us to distinguish how
these technologies alter attitudes and approaches to human procreation. Where reproductive tech-
nologies are not implicated in procreation, women generally want to create a child. With contract
pregnancies, often referred to inappropriately as “surrogate” pregnancies (see S. Sherwin, “Some Re-
in G. Basen, M. Eichler & A. Lippman, eds., Misconceptions: The Social
flections on ‘Surrogacy.’
Construction of Choice and the New Reproductive and Genetic Technologies, vol. 2 (Hull, Que.:
Voyageur, 1994) 183; M. Eichler, “Reflections on the ‘Temporary Use of Normally Functioning
Uteri”‘ in Basen, Eichler & Lippman, ibid, 193), women want a created child. And with postmeno-
pausal pregnancy and the attendant genetic testing of the embryo before its placement in a woman’s
uterus, an individual creates a child I want. These grammatical arrangements are telling of the values
underlying these biomedical arrangements.
1995]
A. LIPPMAN – “NEVER Too LATE”
if we were to give the child who may be born at least as much attention as we do
the woman who hopes to give birth to her, we might discover some other features
that dampen the allure of these pregnancies.
Postmenopausal pregnancy is a social/psychological experiment, perhaps more
than a biomedical one, on the children who are born. It must be of consequence not
just to have parents of older than usual age taking care of you,”, but to have been
produced from the egg of, for example, a deacd woman or an aborted fetus.” If
nothing else, we know that adopted children often seek their roots. How will the
origins of postmenopausal babies affect them? Moreover, most children probably at
some time harbour fears of being abandoned, of not belonging. If these feelings oc-
cur in .low-tech situations, the advent of new reproductive technologies can only in-
crease their incidence. If the egg from which the child developed was from an
abortus, what does “belonging” mean? Finally, is it justice –
to
experiment with children who will be born without their “consent”? Is postmeno-
pausal pregnancy in their best interest? Even though parents can give consent for
experimentation on their “minor” children, a parallel likely to be invoked by pro-
ponents of postmenopausal pregnancy, such an analogy may not apply. Not only
must the benefits greatly outweigh the risks in such cases, but such consent is, al-
most always, separate from any consent a woman might give for having something
done to herself. This is clearly not the situation here. Is “consent” for herself neces-
sarily consent for the child to be born? Is the woman’s sole consent sufficient or is
there a more nuanced interpretation required which would address the deeper and
more complex legal ramifications of consent in these situations?
or arrogance –
These questions are especially in need of answers when we note the social re-
lations permutated to produce many postmenopausal pregnancies. Who is who
when a fifty-three-year-old woman gives birth to a baby that developed from an
embryo implanted in her following in vitro fertilization with the sperm of her thirty-
one-year-old son and an egg from an unidentified “donor” –
a baby that was then
given to this son and his thirty-three-year-old wifef Is the baby her child, her
2.5 See Joffe, supra note 20, for an especially interesting discussion of this matter. However, this is
really not the fundamental issue at all. In fact, we should be troubled by the time spent wondering
about a woman’s energy and resources to take care of a child born after she has ceased spontaneously
ovulating, while we generally ignore the many hundreds or thousands of older women around the
world caring for grandchildren whose parents have died or are dying because of AIDS.
26 For an opposing view, see G. Kolata, “Fetal Ovary Transplant Is Envisioned” The Ndw York
Thnes (6 January 1994) A16, quoting Dr. John Fletcher, an ethicist at the University of Virginia in
Charlottesville:
[E]ven though a child might be troubled to learn that its genetic mother was an aborted
fetus, the child would almost certainly rather have been born from a fetus’s eggs than
not to have been born at all.
Dismissive comments such as this one, however, hardly offer reassurance about the outcome of
these experiments.
27 L. Gruson, “When ‘Mom’ and ‘Grandma’ Are One and the Same” The New York Thies (16 Feb-
ruary 1993) B1.
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[Vol. 40
grandchild or both? And should the egg be from her own daughter, notions of fam-
ily “togetherness” take on especially disquieting proportions.
Although we lack formal studies to document what has been relayed anecdo-
tally by women who had prenatal diagnosis over fifteen years ago, it appears that
something about even this procedure continues to make some women sufficiently
uncomfortable that they often do not discuss it with their adult daughters with
whom they share all other details about pregnancy and birth. If this is the case for
many women years after testing, perhaps we should attend to the manifest squeam-
ishness we feel with regard to “selecting” our children. Given the possibility that
something as routine for so many thousands of North American women as prenatal
diagnosis is still a discomforting subject to discuss, we may not want to assume it
will be easy or inconsequential to tell a child: “your genetic mother was never
born” or “your grandmother is also your mother, but your mother is not known to
US.”
28
This is but part of the story and perhaps not the most troubling. Selecting
among embryos should also keep us wary about this newest step into the unknown.
Postmenopausal pregnancies are symbiotically linked to in vitro fertilization and to
preimplantation diagnosis. It is unlikely that the sophisticated, expensive and risky
procedures employed for egg retrieval, in vitro fertilization and implantation would
not be accompanied by examination of the resulting embryos to identify those “fit”
for implantation. Even the crude genetic analysis of embryos available today, in
which little other than the chromosomes will be assessed in most cases, is essen-
tially eugenic, even more so than is midtrimester amniocentesis.29 In this regard, the
technology warrants far closer attention than it has so far received. In whose inter-
est is such early diagnosis when it is under the control of practitioners? Who will be
deciding what is a “quality” embryo that warrants a chance at developing in a
woman’s uterus, and what “qualities” need it have to make the grade?
Over two years ago, Andrea Bonnicksen suggested that regulations and policies
could likely prevent the “unethical” use of preimplantation diagnosis.0 I think we
should be far less sanguine. Control is a “second order” concern. It presumes accep-
tance of the technology, albeit within limits. But should acceptance be presumed
when there has been no public discussion of whether this is a technology we want
at all? Thus, rather than regulate its use, perhaps we might first legislate a morato-
rium or a ban on its use until such discussion has occurred.3′
28 See text accompanying note 27, above.
29 See A. Lippman, “Women’s ‘Childbearing Age’ as Biomedical [Re]Creation: Prenatal Testing
and Postmenopausal Pregnancy” in Basen, Eichler & Lippman, supra note 24, vol. 2, 137.
A. Bonnicksen, “Genetic Diagnosis of Human Embryos” (1992) 22:4 Hastings Center Report
(Special Supplement) 55.
3! The bases for this position include: the inescapable eugenic nature of the procedure; the lack of
justification for expending funds for its development; the availability of other, if more stressful, op-
tions for the woman; the problematic commercial possibilities accompanying the creation of a market
1995]
A. LIPPMAN – “NEVER Too LATE”
IV. The Pregnancy Business and Body Management
Biomedical –
and some media –
enthusiasm for postmenopausal pregnancies
rests primarily on the implicit assumption that if women, like men, can indefinitely
retain their biological capacity to produce a child, the equity between the sexes,
now impossible because women’s physiology is a “natural” barrier to it, will be
fostered:
When men have children in their old age, it’s looked on as a kind of crowning
achievement in their lives … To say that simply because these women are post-
menopausal and above the age of 50 they can’t provide adequate child care to a
baby, that is patently ridiculous.'”
Another assumption is that menopause is always and necessarily unwelcome al-
though many women may, in fact, look forward to the relief it provides from such
things as menstrual symptoms, worry about accidental pregnancies, and, for those
who have for many years been unable or unwilling to become pregnant, from pry-
ing questions about why they are not yet pregnant.3 Freedom from the ability to
become pregnant may be, for some, even more valuable than being “free” to be-
come pregnant at any age.
As postmenopausal obstetrics emerges, it is being promoted as a humane re-
sponse to the needs of women who “chose” to postpone childbearing while they
pursued education and careers.M Unfortunately, this view completely ignores how
only some women may have the luxury to complete their educations or to establish
their careers and to postpone pregnancy. It overlooks how postmenopausal obstet-
rics is but another franchise of the “business that caters to those who will make a
in eggs and embryos; the way in which it facilitates human germ line manipulation and a number of
other equally serious concerns.
S. Chira, “Of a Certain Age, and in a Family Way” The New York Tmes (2 January 1994) E5,
quoting Dr. Mark Siegler, Director of the Center for Medical Clinical Ethics at the University of Chi-
cago. Popular and professional criticism of postmenopausal pregnancy, however, generally takes a
contrary position when it suggests, for example, that it is “shocking that a child be 18 when his
mother is 80” (Reuter, “France wants to ban ‘retirement pregnancies’ The [Montreal] Gazette (4
January 1994) A5, quoting Philippe Douste-Blazy, France’s Health Minister) and that “we cannot ig-
nore the social consequences [when age is “no bar” to pregnancy]. Is it wise for women in middle and
old age to rear young children through to adulthood?” (Editorial, “Declining Fertility: Eggs or
Uterus” (1991) 338 Lancet 285).
33It should also be emphasized that in some societies menopause is welcomed because of the con-
sequent freedom from cultural taboos associated with childbearing ability (Y. Beyene, “Menopause:
A Biocultural Event” in A.J. Dan & L.L. Lewis, eds., Menstrual Health in Women’s Lives (Chicago:
University of Illinois Press, 1992) 169).
.4 See e.g. this quote from Dr. Severino Antinori: “I would not want to condemn either the woman
or the doctor … I can fully understand a woman being desperate for a child, even if she has left it
rather late (“Twins Born to 59-year-old Woman Stir Ethics Controversy” The [Toronto] Globe and
Mail (28 December 1993) A8.
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business out of being a family.”3
In this business, women’s eggs are a kind of
“therapeutic” merchandise and children become luxury items to be purchased from
the best suppliers, with women’s bodies the “cultural plastic” out of which they are
fashioned.36 This industry ignores how postponing or delaying pregnancy is not
necessarily a real choice when the privileged white man’s traditional unbroken, lin-
ear career path is imposed as the norm to which women are expected to adapt. To
the extent that “delay” is constructed by societal norms, postmenopausal pregnancy
only offers to “resolve” what should not have even been a problem. Were there
flexibility in the workplace/workpace for all, the rescheduling of working women
would not be an issue. Similarly, if women were not continually defined by their
biological fulfilment of the mother role, childless relations in midlife might be pre-
cious advantages of adult independence.
When first described in the biomedical literature in the mid 1980s,37 postmeno-
pausal pregnancy technologies were applied to women who were under the age of
thirty-five who did not ovulate. These women were said to have “premature ovarian
failure”. When the technologies were found to “work” –
in this
group,
they were next attempted in women in their early forties who were not
ovulating. Within only four to five years, they were applied to “perimenopausal”
women, and now their principal use is geared to women well past this stage.’
albeit modestly –
35M. Strathem, Reproducing the Future: Essays on Anthropology, Kinship and the New Reproduc-
tive Technologies (New York: Routledge, 1992) at 35.
36 See S. Bordo, “Reading the Slender Body” in Jacobus, Fox Keller & Shuttleworth, supra note 5,
83. In this way, postmenopausal pregnancy joins the constructing-the-body industry along with other
interventions such as cosmetic surgery and genetic engineering. Thus, postmenopausal obstetrics also
makes the supposedly “natural” condition of pregnancy a luxury item to be bought from technology.
Interestingly, too, other items, such as water or soap, are also now repackaged as “natural” and come
with luxury price tags.
37M. Bustillo et al., “Nonsurgical Ovum Transfer as a Treatment in Infertile Women” (1984) 251
LA.M.A. 1171; P. Lutjen et aL, “The Establishment and Maintenance of Pregnancy Using hit Vitro
Fertilization and Embryo Donation in a Patient with Primary Ovarian Failure” (1984) 307 Nature
174.
38Some women subjected to these technologies did become pregnant, and some among this small
group gave birth to children.
39 See M.N. Sauer & R.J. Paulson, “Human Oocyte and Preembryo Donation: An Evolving Method
for the Treatment of Infertility”(1990) 163 American J. Obstetrics & Gynecology 1421; M.V. Sauer,
R.J. Paulson & R.A. Lobo, “A Preliminary Report on Oocyte Donation Extending Reproductive Po-
tential to Women Over 40” (1990) 323 New England J. Medicine 1157; M.V. Sauer, R.J. Paulson &
R.A. Lobo, “Reversing the Natural Decline in Human Fertility: An Extended Clinical Trial of Oocyte
Donation to Women of Advanced Reproductive Age” (1992) 268 J.A.M.A. 1275; M.V. Sauer, B.R.
Ary & R.J. Paulson, “The Demographic Characterization of Women Participating in Oocyte Dona-
tion: A Review of 300 Consecutively Performed Cycles” (1994) 45 Int’l J. Gynecology & Obstetrics
147; M.V. Sauer et al., “Three Hundred Cycles of Oocyte Donation at the University of Southern
California: Assessing the Effect of Age and Infertility Diagnosis on Pregnancy and Implantation
Rates” (1994) 11:2 J. Assisted Reproduction & Genetics 92.
19951
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Thus, what was initially described less than a decade ago as an intervention for
a very limited number of women 4 has become something for which all women are
potential candidates.4′ In the words of the most active practitioners in this area,
[a]pproximately 19% of all women living in the United States are between 45
and 64 years of age. Many women within this age group are still very inter-
ested in having a child. Couples of advanced reproductive age … may in fact be
ideal candidates for oocyte donation!
The numerical data Sauer and his colleagues present in the most recent summaries
of their work suggest that couples of advanced reproductive age are indeed the
group they are targetting: two-thirds of the women in their egg “donation” program
were forty years of age or older. Moreover, the participation of these women would
seem to be more for “social” than for “medical” reasons: 50.4 per cent of those
forty to forty-nine, and 66.6 per cent of those fifty to fifty-nine were remarried and
appear to have already had a child –
hardly a sign of infertility.43
The authors’ incidental comment further suggests that postmenopausal preg-
nancy has come a long way from its putative origin as “treatment” for infertility.
Compared to the younger women, those over forty
were more likely to have undergone cosmetic surgery, most commonly silicone
breast implants. This latter phenomenon further underscores the perceived in-
terest of many patients to appear young and vital. Their desire to reproduce
may be a further attempt at challenging their chronologic age.”
Clearly, Sauer, Ary and Paulson, and even the American Medical Association’s
Council on Ethical and Judicial Affairs,45 are here to help these women with this
40 It could even be argued, although weakly and not by me, that the intervention might be
“therapeutic” for the 26-year-old who does not ovulate. However, this is surely not its role for the
women over 50 years of age where it is instead, if anything, manipulation of their “normal” physiol-
ogy.
4 M.V. Sauer, RJ. Paulson & R.A. Lobo, “Pregnancy After Age 50: Application of Oocyte Dona-
tion to Women After Natural Menopause” (1993) 341 Lancet 321. A similar expansion in the use of
sex hormones is tellingly traced by N. Oudshoom, “United We Stand: The Pharmaceutical Industry,
Laboratory and Clinic in the Development of Sex Hormones into Scientific Drug” (1993) 18:1 Sci-
ence, Technology & Human Values 5. These pharmacologic agents, which were first used for a lim-
ited number of specific conditions, quickly became drugs appropriate for treating enough “problems”
so as to make all women eligible for their prescription.
42 Sauer, Paulson & Lobo (1992), supra note 39 at 1276 [references omitted; emphasis added].
Further, it is now claimed that eggs from another woman are even “bettere’ than one’s own for women
participating in in vitro fertilization programs. Those women who “fail” in standard IVF programs
(i.e. women of advanced reproductive age) should be encouraged
to participate in IVF with
“borrowed” oocytes because they stand a better chance at becoming pregnant.
43 Sauer, Ary & Paulson, supra note 39; Sauer et al., supra note 39.
44 Sauer, Ary & Paulson, ibid. at 150.
45 The Council issued the following statement:
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challenge and to rescue them from age. They are bolstered by the enthusiastic sup-
port, it would appear, of some bioethicists: “The history of medicine has been de-
voted to overcoming the natural lottery, the hand fate has dealt each one of us …
Why draw the line at reproduction? 46
Even without these commentaries, it is apparent that a component of this new
pregnancy business centres on body management. This new industry apparently
gives women options to change their bodies, to “improve” on what time and biol-
ogy make possible. This “choice”, as with others promoted by practitioners of
postmenopausal obstetrics, primarily lets us choose homogeneity and conformity
according to their designs.
To expose some of the subtle ageist oppression associated with postmenopausal
pregnancy, it helps to think of postmenopausal pregnancy as a method for
“passing”. 47 This strategy to present/preserve an image of oneself as youthful, to
pass (and therefore be valued), does not only buy into the reification of the youthful
woman, but actually threatens a woman’s true identity.48 The woman with a post-
menopausal pregnancy may seem to pass as “not that old, after all”. But she really
is; at best, her passing is illusory. Postmenopausal pregnancy may circumvent
menopause, but it does nothing about aging. Sadder, however, is that passing is also
oppressive because a woman distances herself from the solidarity that affiliation
with other women her age can provide, and she thus becomes isolated in her indi-
viduality.
49
It is the fundamental right of all women, including post-menopausal and older women,
to bear children, whether artificially or naturally. The average life-span of American
Women [their caps] is nearly 79 years. Fears that, while still young, children born to
older women will lose their mothers are unfounded. Moreover, our experience with
grandparenting demonstrates that older adults can provide excellent care for children …
[E]ven if there were parenting abilities according to age, there would not be a reason to
deny parenthood to older persons. Neither their government nor the medical profession
should decide who is entitled to have children. It is the right of older persons, who are
fully informed about all the medical risks, to make these decisions (American Medical
Association, “AMA Opinion on Older Women’s Decision to Bear Children” (1994) 7:2
Professional Ethics Report 3).
If only the government and the medical profession were not already deciding who is “entitled” to
have children by their various practices and policies, this very problematic statement might at least
have some credibility.
46Chira, supra note 32, quoting Siegler.
47B. Macdonald & C. Rich, Look Me in the Eye: Old Women, Aging and Ageism (San Francisco:
Spinsters/Aunt Lute, 1983) at 55-56.
48 A similar criticism would apply to cosmetic surgery to remove well-eamed facial lines and
creases.
49 Macdonald & Rich, supra note 47 at 55-56.
1995]
A. LIPPMAN – “NEVER Too LATE”
V. Rescue Marketing
The “rescue” potential of today’s biomedicine for the individual woman with a
tragically told story and the usual public delight when the individual is “spared” the
misery of her unassisted body are powerful selling points. 0 High-tech devices and
strategies, however, are not developed only for “rare” cases, that is, women in their
twenties who do not ovulate; the return on the investment of time, money or other
resources is insufficient unless the technology can create a substantial niche. Creat-
ing that niche requires little effort, however, when using the “rescue” model.
Moreover, when offered with the authority attributed to biomedicine and its practi-
tioners in North America, the sales pitch is quite compelling. Marketing is easy and
opportunities for expansion endless, as was likely apparent to the Italian physician,
Severino Antinori, whose intervention put postmenopausal pregnancy on the front
pages of newspapers in the winter of 1994: “Every woman has the right to have a
child. These women come to me when they have nowhere else to go and I help
where I can.”‘”
Even if this particular in vitro fertilization-based technology did not fail much
more often than it succeeded and, in the process, expose mother and child to serious
risks which remained unmentioned in the media reports we located, we must be
suspicious about interventions sold to “rescue” individuals. What is available to
“rescue” the really quite rare woman born without ovaries or whose ovaries do not
produce eggs, can also be used to “rescue” anyone. Moreover, to justify the invest-
ment in this technology, it must be used. The application of this technology for
(mostly white, wealthy) women has just begun 52 and the potential market is im-
pressive when we consider that all women who live long enough will one day reach
menopause. Postmenopausal pregnancies privilege a high-tech attempt to “rescue’
women by removing their differences from men; but, the differences from which
rescue may be offered are less problematic than the unequal consequences which
flow from them. These consequences can be removed or managed by low-tech (and
less hazardous) social policies. If women’s physiology is at all an “impairment” to
equity between the sexes –
is it because
our bodies’ natural rhythms prevent us from spontaneously participating in the con-
ception of a child after the age of fifty, as biomedical researchers suggest, or is it
because women’s “physiology” is used to maintain us in an inequitable social posi-
tion and to make it impossible for us to interrupt paid-working lives to have chil-
dren at earlier ages? There are differences between men and women, yet these dif-
ferences should neither be ignored, denied nor exaggerated. Rather, the unequal
consequences which stem from these differences should be eliminated. What we
should look for is a social “fix” which would be far more effective, and certainly
and this can and should be questioned –
50 Equally powerful is the appeal to compassion and altruism in the advertisements for egg sellers
(see e.g. supra note 7).
5, “Over-50 Motherhood”, supra note 2 at A2.
52 Gruson, supra note 27 at B5, quoting Dr. Ida M. Campagna.
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much safer than a medical “fix”, and would also be relevant to the lives of women
other than those who are wealthy and white.3
Conclusion
Technology is never neutral; when applied to women it is necessarily gendered
in ways that reflect and support prevailing attitudes and customs. Postmenopausal
pregnancy mirrors and reinforces the “production of baby” metaphor that domi-
nates much of the recent biomedical literature about pregnancy. It is advanced as a
tool to reverse, or to “rescue” us from, age-based cessation of egg production –
in
essence, to rejuvenate us. It partakes of a view of female aging as a disease-causing
agent, a view with great potential to constrain needed social changes.
There is nothing obviously “natural” about age. Age in a broader sense, how-
ever, is a complex socially defined construct: cultural, social and political contexts
influence how and when we age. Some of this complexity is revealed in the way we
generally assume the existence of such things as chronological age, mental age and
social ages (for example, driving-age, voting-age, drinking-age, retirement-age,
golden-age). Yet, it is important to remember that all these are tied to what society
allows us to do as well as to available technologies.4 As such, ages are flexible,
with boundaries that vary according to political decisions, technological develop-
ments and so on. Childbearing-age has joined this list as a category that rests on
biopolitical, perhaps even more than on biomedical decisions.
Postmenopausal pregnancy is a costly way –
financially, physically and emo-
tionally –
for women to conform to male biography. Oppression is more likely
than liberation to result from its practice. We must learn to value the older woman
and her own trajectory. This requires us to remove the real constraints to graceful
aging for most women, those that stem from poverty, abuse and discriminatory so-
cial and economic policies that damage our health. The problems experienced by
aging women are not created by the fact of living many years, but they do result
from the lack of resources and the abuse and denigration that await us. Privileging
postmenopausal pregnancy and other cosmetic fixes is more likely to exacerbate
women’s aging-related problems. If we instead focused on these broader social
problems, we might begin to reclaim our right to define ourselves on our own terms
and reject the male biomedical model on which the marketing of postmenopausal
pregnancy is based.
When I stop releasing eggs, it will not be because I have “failed” biologically;
rather, I will have reached a perfectly expected, albeit new, stage in my life. At this
53See Lippman, supra note 29. Social and political changes would also go far towards removing
the unequal consequences that attach to meaningful differences between women instead of the bio-
medical, postmenopausal pregnancy approach that obliterates these differences in favor of some ho-
mogeneous, conforming, ready-to-be-pregnant standard for well-to-do women.
54 E.L. Barbec, “Worries, Aging and Desires to be Younger in a Sample of American Middle-Aged
Women” (1989) 12 Medical Anthropology 117.
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A. LIPPMAN – “NEVER Too LATE”
stage, I want to be free to act my age, both unconstrained and not passing as some-
one else. It should be liberating to accept this new limit on my body and, perhaps,
even see it as an advantage.55 Did I really enjoy menstrual cramps? Invariably
searching for a tampon in unfriendly places? Has not menopause itself actually
“rescued” me from these? I might even enjoy this stage if policies and their accom-
panying interventions eliminate poverty, abuse and isolation, and provide safety,
security, value and equity –
to women fifty years and
older.
rather than pregnancy –
Feminists have generally been critical of environmentally unfriendly behaviour
towards women. We recognize threats to our health as resulting from the ideologies
of patriarchy, capitalism and technological reductionism. In our response to these
most recent technologies, which are imbued with the same ideologies, we must
keep these threats in mind.
Menopause is not about disability, deficiency or disease. Why not reimagine
this rhythm in the lives of women and refuse attempts to pass over the aging
process (if for no other reason than it is probably too hard to do)? Do I really want
to lop off old(er) age as if it were a bothersome skinfold? Do I want to be seen as a
“perambulatory anomaly”?56 Shall I be a “lavendar rose” or a “grey panther”; a
senior citizen or a Raging Grannie? Do I want to guard an empty nest, re-stock it
with fledgling dillings57 or fly the coop? If I become a “Methusaleh mom” follow-
ing a “retirement pregnancy” will I not be cheated of the wonderful things my age
should allow me to do? When I am too old to work, should I not also be too old to
work at staying young, as biomedicine would encourage me to do?
Perhaps there are some things which we, as individuals and as a society, are
better off accepting and yielding to than struggling against or seeking to fix through
biomedicine and reproductive technologies. Age seems to be one experience we
might consider in this light.
55A now outmoded term, climacteric, was once applied to the life processes surrounding meno-
pause. The term evokes a rung of a ladder from which women can climb upwards, which in turn sug-
gests that a semantic return to its use might be beneficial and liberating.
56 M. Lock, “The Politics of Mid-Life and Menopause: Ideologies for the Second Sex in North
America and Japan” in S. Lindenbaum & M. Lock, eds., Knowledge, Pover, and Practice: The An-
thropology of Medicine and Everyday Life (Berkeley: University of California Press, 1993) 330.
57
,”Dilling” is a now obsolete word for a child born when parents are old.
