I think I should begin with an apology to regular readers/commenters. Somehow this past week (first week of classes) I lost control of the comments. I’ve tried to play catch-up this AM but I let too much pile up and it is hard to follow the threads. So I’ve done my best. I think I’m now in a place where I can respond to comments relatively promptly and that should make it better from here on out. But I really do appreciate the time and effort people put into the comments they add here and so I wanted to let you know that I’m aware I dropped the ball.
All that said, this post is in part prompted by a comment/question from Kisarita on an earlier post–the one about raising the price paid to egg providers in the UK. This is part of an effort to increase the number of women willing to provide eggs, and she asked why the HFEA wanted to do that.
To back up a bit, stories have reported shortages of gamete donors in the UK for some time. (I think mostly I’ve written about this as a sperm shortage, but I could have made the point more generally.) So on the most simplistic (and unsatisfying) level, raising the payments is an attempt to alleviate the shortage of eggs. (There’s also a proposal to allow the use of sperm from each provider to create a larger number of children, which is a different approach to dealing with the sperm shortage. Perhaps that’s worthy of separate discussion.)
Really, though, I think what Kisarita is asking is why is the government responding to the shortage by seeking to increase the supply? I think the answer is that if you don’t increase the supply you increase reproductive tourism. In other words, people will travel to obtain what they cannot get in the UK.
Of course, not everyone will travel. It costs money and takes time (although I wonder if you can get eggs shipped to the UK, which would negate the time point.) Added costs will surely deter some people. But this hardly seems a sound policy basis for allotting a scarce resource. (Okay–so we use the “who can afford it” method all the time. But still, I don’t think I’d pick to say that anyone who can afford an egg gets one and those who cannot don’t.)
You see the same thing happening with surrogacy–that’s the reason there is out-sourced surrogacy, which I’ve written about in the past. There’s a new story from last week’s Slate that discusses this. Where people cannot afford or do not have access to surrogacy in their own countries, they travel to others–India and the US being major destinations.
Whether you travel for gametes or travel for surrogates, the problem, I think, is that the destination country is almost assuredly one with weaker safeguards. That’s why the items or services are available to you there when they are not available at home.
To be more concrete, I’m going to discuss surrogacy first. Surrogacy in India is less regulated than it is in the UK or even the US. To my mind, the lack of regulation in India is quite problematic. I worry a great deal about what’s happening to the surrogates there. If I ban surrogacy here (or saddle it with too many restrictions) I’ll end up pushing more people there. So while I might have made a nice statement about morality and law and surrogacy and all that, I may also have contributed to the exploitation of women in India.
Now I’m not opposed to the purchase/sale of eggs generally. But I recognize that providing eggs is not without risk and pain. I think some measure of government regulation is probably appropriate. Beyond that, I think it important that the price offered to women is somewhat commensurate with the risk and pain.
If there aren’t enough eggs available in the UK, some people will travel to where they can get them and those may be places where the women providing the eggs are far worse off than in the UK. This being the case, the concerns that might lead me to be wary of markets for eggs generally might also lead me to want to ensure that most people stay in my controlled market in the UK. Hence, I’d like to have more eggs available in the UK. Hence, I’d like to raise payments.
I can see that on some level this seems counter-intuitive and it is deeply pragmatic. A purer approach wouldn’t raise the price. But there are always trade-offs between pragmatism and principle–this may be a place to make them. In any event, this is what I think is going on here.