Parks describes five common arguments against AMA, namely: the scarcity of resources; fairness arguments; the inappropriateness of older mothers; the concern for orphaned children; and the feminist autonomy argument. To date, these arguments continue to play a part in academic and popular media discussions concerning AMA and upper age limits on women’s access to assisted reproduction. Parks describes the first four arguments against AMA as “non-feminist” arguments and the fifth argument as “feminist”.
Although feminists might argue against AMA for any of these reasons, the fifth argument is explicitly feminist because it is committed to the ideas that women are oppressed within patriarchy and that oppression can impede women’s reproductive autonomy and well-being (Parks, 1999, p. 92-3, footnote 1). The non-feminist arguments need not be committed to these feminist insights. I shall explain each of these five arguments against AMA in more detail.
a) Scarcity of Resources Argument
First, Parks considers the scarcity of resources argument (1999, p. 79). This argument is premised on the idea that donor oocytes are a limited (i.e. scarce) resource. Most cases of AMA involve donor oocytes. Donor eggs are in high demand, but can be very difficult to obtain. This is especially true in places such as Canada, where the sale of reproductive material is prohibited. As such, the demand for donor eggs exceeds the supply. Some individuals and governing bodies appeal to the fact that donor eggs are a scarce resource in order to justify restrictions on older women’s access to donor oocytes (Parks, 1999, p. 79-80). For example, Parks cites the Canadian Royal Commission (1993), which
maintains that the use by IVF and donor oocytes by older women is an “inappropriate use of resources” (1999, p. 79). So, some critics of AMA argue that donor oocytes should be given to younger women, as opposed to older women, because they assume that these oocytes will be used most efficiently and/ or successfully by younger women. These critics maintain that IVF is safer for younger women, than for older women. Furthermore, they claim that younger women have a better chance of pregnancy and live birth than do older women. Here, the ‘effective use of resources’ is measured by both safety and the chances of achieving a successful pregnancy. The scarcity of resources argument maintains that older women should be denied access to IVF and donor oocytes because these ‘valuable’ resources will be ‘wasted’ on (old) women who are not likely to achieve pregnancy and birth.
b) Fairness Arguments
The second argument considered by Parks is the argument from fairness (Parks, 1999, p. 80- 81). This argument stems from a type of fair-innings argument, which is invoked to justify the restriction of some healthcare resources to older adults, more generally. Fair- innings arguments hold that older individuals have already had their fair chance or “fair innings” to access healthcare services (Williams & Evans, 1997, p. 822). The fairness argument concerning AMA holds that older women have already had their chance to be mothers, so a concern for fairness dictates that donor eggs (or other scarce or expensive resources, such as IVF) should be allocated to younger women who have not yet had this opportunity. The argument from fairness assumes that there is a limited (and appropriate) window of opportunity for women to become mothers. Critics maintain that it is unfair to deny younger women priority access because they have not yet had their chance to become mothers. Older women who choose to delay motherhood are effectively out of luck if they miss the (appropriate) reproductive window.
The third argument against AMA concerns the inappropriateness of older mothers. According to Parks, arguments against advanced maternal age that appeal to the
‘inappropriateness’ of postmenopausal motherhood argue that older women do not make good mothers because they have less energy and are less able to deal with toddlers or troublesome teenagers (Parks, 1999, p. 82-83). This type of argument rests on the
premise that children have a “right” (or at least a strong interest) to a “normal childhood” (Parks, 1999, p. 81). Arguably, this type of argument is deeply rooted in cultural norms concerning ideals of parenthood and parental responsibilities. AMA has also been
described as ‘unnatural’ by some critics who believe that a woman’s body is not meant to bear children after menopause (Blickstein, 2003). It is believed that the cessation of the menses supports this claim. As such, IVF use for younger women is generally seen as a way to restore younger women to ‘normalcy’ because most young women are fertile. In contrast, IVF use by older women is viewed as going ‘against nature’ because
postmenopausal women (and many perimenopausal women) are incapable of achieving an unassisted pregnancy. According to this view, infertility is statistically normal for older women and therefore it should not be viewed as a disease that requires medical intervention in older women.
d) Concern for Orphaned Children
The fourth argument against AMA involves a concern for orphaned children (Parks, 1999, p. 84-5). This argument is premised on the following claims: first, that older women are more likely to die sooner than younger women; and second, children have a “right” to have a mother (or parents, more generally) who can care for them through to adulthood. Older women who are unlikely to survive long enough to raise their children into adulthood will not be able to fulfil their parental responsibilities. So, older women who use assisted reproductive technologies, can increase the likelihood that their resulting children will become orphans (or a partial orphan) before these children reach adulthood. The concern for orphaned children is often a central concern for critics of AMA.
e) Feminist Argument
The final argument against AMA that Parks describes rests on the feminist autonomy debate (Parks, 1999, p. 85-88). According to some feminists, most older women’s choices concerning IVF and donor oocytes fail to be autonomous, so allowing them access to reproductive technologies is morally problematic. These feminist critics maintain, as most feminists do, that within patriarchy, women can internalize pronatalist ideologies (Morgan, 1989). As I describe in chapter one of this dissertation, patriarchal pronatalism ties women’s identities, qua women, to the ability to bear children. Within a patriarchal society, some women may internalize oppressive social norms around
reproduction and come to uncritically adopt pronatalist values. As such, the reproductive autonomy of women at any age can be impeded by pronatalism. However, ageism is a social bias that can also coerce some women’s reproductive decisions within patriarchy. This bias involves the systematic social valuing of youth and the devaluing of old age. Ageism, like pronatalism, is an oppressive social bias that can impede autonomous choices, actions and desires.
In the context of reproduction, ‘youth’ is marked by a woman’s ability to bear a child. IVF (with donor oocytes) can be used by older women to regain or retain their ‘youth’, while also fulfilling the pronatalist mandate to bear children. The problem, according to feminist critics of AMA is that (most) older women’s reproductive decision making will fail to be autonomous, because older women are coerced by both pronatalism and ageism. Feminist critics of AMA worry that when pronatalism is coupled with ageism, or the valuing of youth, older women can suffer from “double oppression” (Parks, 1999, p. 85- 6). These feminists construe (most) older women who use IVF technologies as mere “dupes of patriarchy”, who fall victim to both pronatalist and ageist social ideologies (Parks, 1999, p. 91). Younger women do not suffer from ageist oppression. So, according to this feminist argument against AMA, it is morally permissible to deny older women access to assisted reproductive technologies because their reproductive decisions will likely be less autonomous that the reproductive decisions of their younger counter parts.
Each of the five arguments against AMA, described above, aims to show that older women’s uses of assisted reproductive technologies are more morally problematic than younger women’s uses of these technologies. In the next section I describe how FP can complicate discussions concerning the moral permissibility of AMA and upper age limits on access to assisted reproductive technologies.