Assisted Reproduction Technologies and Practices: Advancing Health and Reproductive Justice in Family Formation

A new era in human reproduction is here. Assisted reproductive technologies (ARTs) present unprecedented opportunities in family formation for people with infertility, unmarried and single individuals, and the LGBTQ+ community. At the same time, they pose major risks for others – especially women who provide their services in contractual third-party reproduction.

ARTs and related commercial arrangements have given rise to a multi-billion dollar, largely unregulated global fertility industry and amplified global inequities. Despite the magnitude of their implications, they are, so far, largely under the radar of public awareness and absent from civil society discourse. When they garner attention, the complex issues embedded in these technologies, practices, and social arrangements are discussed as seemingly separate and niche issues that have little to do with the broader revolution that is underway and out of sight.

Take, for example:

  • The availability of employee benefits like egg freezing, which were initially offered by trend-setting companies like Facebook, Intel, and Apple and are now available at many large companies
  • The courting of young women at prestigious universities in the United States for their “Ivy league” eggs
  • The recruitment of women drawn by poverty to become “surrogate” mothers in countries like Cambodia, Ukraine, and Mexico
  • The practice of “assembling the global baby,” as it was dubbed by the Wall Street Journal
  • The tacit acceptance of eugenically driven options, including sex and trait selection, offered to intended parents during fertility treatment

Any one of these developments, examined separately, might seem inconsequential or too peripheral to warrant sustained attention, social action, or new public policy. Yet, taken together, this 21st century landscape of childbearing poses urgent societal questions: How can we make use of the enormous benefits of ARTs and related arrangements while ensuring we do not do so at the risk of our own and others’ health and human rights? How can we ensure expanded options for family formation for everyone and, at the same time, avoid new forms of marginalization and health risks for those who make these options possible?

Since the early 2000s, Our Bodies Ourselves (OBOS) has collaborated with a broad coalition of groups working to engage and educate the public and advocate for responsible practice and governance of assisted reproduction. In 2016, OBOS created, an educational website that serves as a clearinghouse for information on commercial international surrogacy and the effects on all parties: intended parents, gamete donors, gestational mothers and children. The site promotes transparency and best medical practices by documenting the health, legal, and ethical aspects of surrogacy arrangements. Our close collaborator, the Center for Genetics & Society, is now overseeing

Our Bodies Ourselves’ current work in assisted reproduction includes:

  • Raising awareness and educating people about ARTs and the potential rise of a market driven eugenics. This includes young women who increasingly assume their future childbearing will necessitate IVF or other expensive technologies and social arrangements.
  • Engaging with allies on key surrogacy bills as they arise across the country and encouraging regulations that protect surrogates, egg providers and the children born through these arrangements.
  • Participating in global organizing efforts on human gene modification (HGM) As scientific institutions in the U.S. and U.K. convene to discuss whether to proceed with altering the genes of future children and generations – in essence a new eugenics – OBOS joins a coalition of groups insisting that the voices and perspectives of those in the disability and reproductive rights and racial justice movements be included.
  • Developing public education materials on surrogacy and human gene modification as these issues converge with the growth of the global fertility industry.
  • Highlighting the work of our colleagues at Center for Genetics & Society, We Are Egg Donors, and the Donor Sibling Registry.

Together with our long-standing networks – both domestic and global – we are working to ensure that biotechnologies hold promise rather than harm for the human future.

To learn more, see:

  • Connecting the Dots and Drawing a Line
    This at-a-glance infographic shows the full range of technologies and practices in assisted reproduction and the connections between them. It also visually depicts the bright line between those ARTs that are currently in use and those whose potential future use would be highly problematic.
  • International Commercial Surrogacy: Defining Risks, Driving Change
    This infographic visually introduces the various participants in a surrogacy arrangement and identifies the challenges and risks that can arise if the health and rights of all participants are not prioritized.
  • Principles to Inform Practice and Policy on Contractual Surrogacy 
    These principles are intended as an aid to public understanding of contractual surrogacy, as well as a primer for legislators across the U.S. considering surrogacy bills. They aim to inform surrogacy practice and policy by emphasizing the complexity of a surrogacy arrangement and the contribution of each participant, thus helping to ensure that the health and rights of all participants are respected and protected.
  • A Call to Improve Practice in International Surrogacy Arrangements
    This 2023 statement from Our Bodies Ourselves calls on public health advocates, medical practitioners, fertility clinics, and reproductive justice activists to improve international surrogacy arrangements. It outlines common contractual and clinical practices that are detrimental and urges changes to better protect the health and rights of surrogates, egg providers, intended parents and future children born through surrogacy.
  • Letters and statements in support of legislation to regulate surrogacy in New York, 2019- 2022 
    As legislators work state by state to regulate commercial surrogacy, public health advocates and practitioners weigh in on the importance of protecting all participants in surrogacy arrangements – surrogates, egg providers, and the children born. OBOS frequently works with colleagues in other states to assist in making recommendations to legislators, as we have in New York State.