Fertile Markets: Governing Cross-Border Reproductive Care

This paper explores how market governance develops in an institutional vacuum. It does so by focusing on cross-border reproductive care, a recent but growing phenomenon enabled by developments in assisted reproductive technology (ART) services. This care raises questions of who regulatory environments recognise as a potential parent, and what risks patients are willing to endure to their rights, and their bodies, to receive treatment. The paper proposes a political economy approach to understand this emerging market, and the regulatory and governance dimensions of cross-border reproductive care. It first outlines demand and supply side factors, such as national welfare provision (including public funding for ART), and cross-border regulatory variation on reproductive rights and ART methods. It proceeds to explore (i) how for-profit and not-for-profit actors create and govern this market; and (ii) the institutional challenge posed by cross-border services and how professional, market and regulatory governance mechanisms are involved in providing structures and legitimacy to such care provision. These markets have emerged in an institutional vacuum where regulatory authorities have ignored developments because of lack of capacity or due to the services in question tackling local religious and cultural taboos, or are still in the process of seeking information on what is happening. In this vacuum, specialist clinics and patient care organisations emerge as providers and facilitators, while communities, virtual and personal, enable the market, with formal governance mechanisms playing regulatory catch-up.  

Sociologists have long worked on some of the broader issues underpinning this paper, especially with contributions on market emergence in unspecified legal and ethical contexts. Pioneering work in this field developed with an empirical focus on markets of human organs (Titmuss 1971; Healy 2006), but recent work has also focused on ‘baby markets’, covering adoption, sperm and egg donations and surrogacy (Spar 2006; Almeling 2009; Goodwin 2010).

The paper aims to address these issues by developing a unique framework that blends three sets of conceptual insights from political economy concerning: (i) gender and social rights; (ii) commodification; and (iii) expert governance. In short, the paper assesses who has access, at what cost to the patient and society, and what actors are important in deciding what is permissible where. These three elements – rights, costs and best practices – determine the governance of cross-border reproductive care.

On rights, the analysis employs concepts developed in work on the ‘reproductive economy’ about the body in/and markets within Gender Studies (Seabrooke and Tsingou 2016), and considers economic and social constraints to access. It makes an important contribution to feminist literature, which suggests that ART reinforces biological understandings of parenthood (Neyer and Bernardi 2011), as well as the opposite claim that the use of ART by new types of patients is transforming gendered treatment (cf. Mamo 2007).

On commodification and costs, the paper speaks directly to Welfare Studies research on the intersection of reproductive care and welfare regimes, including the role of commodification in family policies (Esping-Andersen 2009). It also contributes to studies of commodification in new markets and the negotiation of boundaries between legal and illegal markets (Jeffreys 2008). The paper provides an analysis of how the interplay between for-profit and not-for-profit actors results in identifiable market mechanisms and how these ‘fertile markets’ are valued; of relevance is work in economic sociology that examines the interrelation of economic and non-economic factors in market formation (Zelizer 2005) and processes of economic valuation (Fourcade 2011). This facet of the work also directly addresses assessments of cross-border patients as consumers (Culley and Hudson 2010) or tourists (Bergmann 2011).

On best practices among experts, the study informs work in International Relations on how experts govern markets within ambiguous transnational institutional arrangements, especially when these are composed by hybrid for-profit and not-for-profit actors, and how professional practice and patient experiences inform cross-border regulatory possibilities (Seabrooke and Tsingou 2015).

While cross-border reproductive care is a global phenomenon, the paper focuses on ‘fertile markets’ for patients based in the European Union and travelling to other European countries or the United States. The research uses a mixed qualitative methods approach. The paper relies on interviews, participant observation and focus groups, data from which is to be analysed through content analysis.

References

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Bergmann, S. (2011) ‘Fertility Tourism: Circumventive Routes That Enable Access to Reproductive Technologies and Substances’, Signs, 36(2): 280-289.

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