The baby industrial complex

A Harvard economist reveals that the booming fertility industry is shockingly unregulated -- and says it's time for the U.S. government to step in.

By Lynn Harris

Read more: Parenting, Pregnancy, Motherhood, Infertility, Life

Feb. 9, 2006 | Last week, I had three phone calls with my insurance company to find out whether my plan covers in-vitro fertilization (IVF). First they said yes, then they said, "What's IVF?" and third, they said no. Long story short, my husband and I are probably looking at least $15,000 for one round. That's including drugs, anesthesia and, when I'm feeling put-upon, car service to the fertility clinic with by far the best success rates in New York City -- why shop anywhere else? -- and, naturally, the least convenient coordinates (so far east it's practically in the river).

Fifteen thousand dollars. Sure would be nice to spend it on food, shelter and a Louis Vuitton diaper bag for an actual child, not the 30 percent likelihood of one. Should I "relocate" to, God help me, my parents' house in Massachusetts, where -- Gov. Mitt Romney's evolving anti-choice views notwithstanding - IVF is universally covered? Should we travel as "fertility tourists" to Israel, which covers all treatments and offers low out-of-foreign-pocket rates? Down the road, will we wish we'd saved the cash for adoption fees?

Whatever we decide, one thing is already clear: For us -- along with at least 10 percent of American couples -- fertility is not a miracle, it's a market. "Advances in reproductive medicine have indeed created a market for babies, a market in which parents choose traits, clinics woo clients, and specialized providers earn millions of dollars a year," writes Harvard economist Debora L. Spar in her provocative new book, "Baby Business: How Money, Science, and Politics Drive the Commerce of Conception." "Eggs are being sold; sperm is being sold; wombs and genes and orphans are being sold; and many individuals are profiting handsomely in the process."

And she's not saying that's wrong. The problem, Spar argues, is that -- because "it is difficult to conceive of a child as commerce" -- no one is willing to call the baby business what it is: an industry. And as long as it's not truly considered an industry, it will continue to fly under the regulatory radar, she says. Indeed, fertility is one of the extremely few U.S. industries that "operate with virtually no rules" -- not much more beyond a requirement that clinics report their success rates to the CDC (which has no means of actually enforcing that requirement). Spar's contention: "Governments need to play a more active role in regulating the baby trade."

Yeah, but ... this government? "The debate will not be cordial," Spar concedes in her book. In his recent State of the Union address, President Bush did take up certain bioethical matters, saying: "Tonight I ask you to pass legislation to prohibit the most egregious abuses of medical research, human cloning in all its forms, creating or implanting embryos for experiments, creating human-animal hybrids, and buying, selling or patenting human embryos." "Human-animal hybrids"? Yes. But the types of regulations Spar proposes would affect real people, not goat people, now -- without the not-so-hidden agenda of defining embryos as people."We need to acknowledge the market that reproductive technologies have created and then figure out how to channel this market toward our own best interests," she writes. "It's no use being coy about the baby market or cloaking it in fairy-tale prose. We are making babies now, for better or worse, in a very high-tech way ... We can moralize about these developments ... or we can plunge into the market that desire has created, imagining how we can shape our children and secure our children without destroying ourselves."

Salon recently spoke by phone with Spar, the Spangler Family Professor of Business Administration at Harvard Business School, about the economics of the baby trade and how reasonable regulation could democratize, rather than politicize, the fertility industry.

What drew you to this topic?

I wrote my last book on the politics of the Internet, and inevitably people would ask me: What is the next cycle of technology that will have the same effect? A technology so radical that it creates a market that didn't exist before, and people jump into it and do all kinds of wacky things because there are no rules -- though people will eventually want them? It hit me that the answer was reproductive medicine. What scientists are now able to do in terms of high-tech reproduction was going to create -- has created -- a market for conception that never existed before.

Give us some historical perspective. Don't we have a history of reacting to certain innovations -- say, birth control, IVF - like they're signs of the apocalypse, but then adjusting to and absorbing them into our culture?

As people know, there was major opposition to contraception for hundreds of years. If you go back to the witch trials of the 15th century, most of the witches were midwives. The argument, and it was partially true, was that midwives knew how to birth babies, but they also knew rudimentary forms of contraception -- and that was considered witchcraft. So this is an ancient prohibition against mucking around with Mother Nature.

Then in the late 19th century it began to be possible to get better forms of contraception. There was major moral opposition to the use of contraception, particularly the use of condoms. But it turned out that contraception was a really good business. So as the manufacturers continued to make the stuff, they started doing so well that they became a lobbying force in their own right. Then Margaret Sanger came along. She got the American Medical Association to come out in support of contraception. They supported contraception only when it was prescribed by a doctor. Now think about that: Maybe they had a change of heart, but they also created a whole new area of business for themselves. That's the market trumping morality for you.

Fast forward once again: The science behind the pill was known for some time. But none of the corporations wanted to touch it because the moral outrage was so high. The work that finally brought the pill out of the laboratory was entirely funded by one woman who was the heiress to the McCormick reaper fortune, whose husband was schizophrenic and she didn't want to risk having a schizophrenic child. Once the pill was actually out, companies were very nervous about getting behind it. But when they did, the sales were so big that it just trumped the opposition because there was so much money in it -- and there still is.

So the first IVF is performed in 1978, and people go wild. There's massive opposition. There's marching in the streets. There are people declaring that the end of the world is nigh. And you know what? It turns out there's an awful lot of people who want to use this service. Literally within a year or two all of the public opposition goes away. Because the people for whom this technology works, they want it to work so badly, they're willing to do anything, pay anything, and they really drown out the critics -- even though it's not a public, politically organized fight. And so the market, the combination of supply finally emerging to meet this long-standing demand for reproductive options, just trumps the opposition. I'm predicting we're going to see the same thing with stem cells. The science just isn't good enough yet.

Next page: "There is still a puritan element among many people who really want to believe that reproduction is a private, intimate process"