Everyone wants women to have more babies, is technology the solution?

Imagine what it is like to be a 60-year-old grandmother in today's China.

"With many having experienced being hounded, chased, and at times forcibly sterilised or having forced abortions under the One-Child policy", says Ayo Wahlberg, anthropologist and author of "Good Quality-The Routinization of Sperm Banking in China", "you now have the government explicitly encouraging women to have more babies". Seemingly overnight, the country's abortion centres have been converted to fertility centres under the Two, now Three-Child Policy. "One can only imagine how this feels”, says the professor at University of Copenhagen and visiting professor at the University of Vienna. 

As births drop, global pronatalism is on the rise

China’s dramatic U-turn is a response to what has been dubbed a “low-fertility future”. "Population fertility is dropping globally and not just in the Western world or East Asia, with South Korea's famously low birth rate. Also, in Latin America and sub-Saharan Africa, childbirth rates are falling," notes Wahlberg.

According to the 2024 UN World Population Prospects report, global fertility rate has dropped more than half since the 1960s, now 2.3 children per woman instead of 5. Across Africa, the current number is 4 per woman instead of 7 in the 1970s. The latest OECD social indicators found that among member countries, the numbers are at merely 1.5 children per woman in 2022.

Many countries see fertility decline as a national and economic crisis (calling it a "baby crisis", "fertility crisis", or sometimes, a “population collapse"). The reasoning is that a shrinking labour force simply cannot continue to support an aging society. Industries and schools built for a younger or growing society will start to fail. 

Pronatalism is thus on the rise, pushing for restrictions, regulations, or welfare to promote a higher national birth rate. Countries after countries are messaging the need for more babies, swinging from the Danish government’s promise to solve the "involuntary childlessness" problem by covering fertility treatment under their public health system to Russia's omnipresent discourse of a "demographic crisis" and Putin’s current legal push to ban so-called "child-free propaganda". In the recent US elections, extreme pronatalist claims about population extinctions and race wars peppered the discourse over reproductive control. The previous scare of global overpopulation has somehow ceded into the background.

IVF, surrogacy, egg and sperm banks to the rescue?

A sprawling "baby making" market is growing to meet fertility demands. The reproductive industry, which is mostly private, often makes use of medically assisted reproductive technologies such as IVF (in vitro fertilisation), surrogacy and egg and sperm banks. Furthermore, the reproduction trade has gone global. Hopeful parents are flying to foreign nations to locate donors and surrogates or to escape from restrictions in their own countries (for instance, many countries ban single women or gay couples from receiving IVF treatment). 

Can increased access to reproductive technologies offer a direct solution to fertility decline? Anthropologist Veronika Siegl, who dove deep into the commercial surrogacy market in Russia and Ukraine to understand the moral realities of surrogates, and anthropologist Ayo Wahlberg, who for over a decade tracked family policies and engaged with actors in state-controlled fertility clinics of China, are concerned.

A narrow focus on technocratic solutions may miss the underlying complex causes of global low fertility. It also tends to put the blame on individual women and their infertility.

Every country has a fertility scene

"Going to fertility treatment as the solution is like trying to put a Band-Aid on a much larger issue." To understand issues of fertility, explains Wahlberg, we need to first take a step back and recognise that "every nation has a fertility scene, a national reproductive complex". These are the regulatory and legal setups, the policies and moral codes that authorise and legitimise reproduction. They frame what is allowed to take place and why.

The goals of assisted reproductive technologies are fit into the rules and constraints of each nation’s reproductive complex. For instance, the fertility scene during China’s One-Child Policy era was set up to prevent population overgrowth. "Yet even then, in the 1980s, the world’s largest fertility clinic managed to convince the family planning officials that fertility treatments to make more babies are necessary not only to help infertile families but also for the state to allow all couples to have their one child," says Wahlberg, drawing on his interviews with the director of China’s oldest clinic, which is in Hunan. 

In Russia, commercial actors in the field of surrogacy have also framed assisted reproduction as a crucial element in tackling national population decline, states Siegl, who is the author of a new book "Intimate Strangers: Commercial Surrogacy in Russia and Ukraine and the Making of Truth". "Russia’s recent ban of surrogacy for foreigners underlines that only the Russian state and its (heterosexual) citizens shall profit from these effects", continues the senior researcher at the Health Matters research group of the University of Vienna. "Some time ago, the director of one of Russia’s biggest surrogacy agencies even argued that surrogacy, due to its high price, supports the 'reproduction of the elite'". 

While the existence of a national fertility scene might be obvious in China, "even in the market capitalism of the US, the hyper-commercialised fertility sector shapes the very intimate experiences of American individuals", states Wahlberg. They decide who has access, who is discriminated. "Every country has a scene".

Navigating fertility markets requires constant ethical labour

Within the national reproductive complex, a whirlwind of routines, practices, and decisions govern the selective abortion, surrogate matches, or donations to a sperm bank. These structures, argues Wahlberg, shape the intimate experiences of individuals as they seek to navigate the process.

These processes are steeped in moral grey zones. Siegl examines the "intimate labour" Russian and Ukrainian surrogates sign up for when enter the commercial market, a practice deeply associated with moral taboos, illegitimacy, and secrecy. 

The highly commercial context provides a distant, "sanitised" trading experience. Siegl recalls an interview with a woman from Russia, who "was just happy that she would get paid and that the clinic took over all the communications. She didn’t have any contact with the parents and didn’t want to." This corresponds with the overall understanding of surrogacy as business relationship, which clearly sets Russia and Ukraine apart from countries such as the US, where altruism and love are common narratives around surrogacy. “While intimate and affective entanglements are deemed dangerous and unethical in the former, financial and economic aspects are considered tainting in the latter," says Siegl. 

Different socio-historical contexts impact the way we think about what’s right or wrong about surrogacy. As a result, birthing surrogates and the intended parents invest in what Siegl calls "ethical labour" as they grapple with and counter the moral critiques around them. Battling over the "true" meanings of surrogacy, which are often simplified and shifting, "helps surrogate participants navigate their roles in the reproductive market", explains Siegl, "while on a bigger scale, they ‘lubricate’ the market’s expansion". For instance, in Russia, framing surrogacy as paid work facilitates a neat exchange of money and baby that can then be casted and defended as saving the so-called "traditional family".

Women are simply exhausted

Wahlberg is working on a new concept. The discourse on dropped fertility often centres on women and the choices they make, e.g. more and more women are entering labour forces, have higher education levels, and are acquiring more personal control over their fertility and marriage. Yet such explanations put significant weight on the individual without considering the larger fertility scenes they’re situated in. 

To better capture the multiple factors that are at stake, he proposes using the concept of "fertility exhaustion" to instead focus on the draining nature of a capitalist society that demands intensified working hours, intensified parenting, but also a misogynistic society that demands more domestic work and caring obligations from women—but with less pay and less pension. It highlights how fertility is impacted by the structural and everyday discrimination of women, but also by their concerns of a future plagued by climate change, economic uncertainty and conflict.  

Even in welfare states, Wahlberg talks about an implicit social contract women are asked to engage in: "you must pay your taxes, of course, but you must also reproduce, as very soon there will be a lot of old people who need to be looked after."  After a pause, he continues, "but who would sign such a contract? We need to push back on pronatalist tropes that try to blame the woman". 

"Fertility exhaustion is deeply gendered", agrees Siegl, "this exhaustion will not improve as long as men are not willing to become more involved in childcare or reproductive work more broadly". Among European countries, Austria now ranks last in terms of paternity leave uptake.

Surrogacy and IVF are part of a package of technologies that will not solve the social problem of fertility decline without looking at the shortcomings of our current society and the unequal treatment of women. "Whatever your view on fertility decline might be, perhaps global low fertility is a symptom, a signal, a canary in the coal mine of something much more problematic about our societies", Wahlberg concludes. (lc)