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The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception

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Despite legislation that claims to prohibit it, there is a thriving market for babies spreading across the globe. Fueled by rapid advances in reproductive medicine and the desperate desires of millions of would-be parents, the acquisition of children—whether through donated eggs, rented wombs, or cross-border adoption—has become a multibillion dollar industry that has left Despite legislation that claims to prohibit it, there is a thriving market for babies spreading across the globe. Fueled by rapid advances in reproductive medicine and the desperate desires of millions of would-be parents, the acquisition of children—whether through donated eggs, rented wombs, or cross-border adoption—has become a multibillion dollar industry that has left science, law, ethics, and commerce deeply at odds. In The Baby Business, Debora Spar argues that it is time to acknowledge the commercial truth about reproduction and to establish a standard that governs its transactions. In this fascinating behind-the-scenes account, she combines pioneering research and interviews with the industry’s top reproductive scientists and trailblazers to provide a first glimpse at how the industry works: who the baby-makers are, who makes money, how prices are set, and what defines the clientele. Fascinating stories illustrate the inner workings of market segments--including stem cell research, surrogacy, egg swapping, “designer babies,” adoption, and human cloning--as Spar explores the moral and legal challenges that industry players must address. The first purely commercial look at an industry that deals in humanity’s most intimate issues, this book challenges us to consider the financial promise and ethical perils we’ll face as the baby business moves inevitably forward.


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Despite legislation that claims to prohibit it, there is a thriving market for babies spreading across the globe. Fueled by rapid advances in reproductive medicine and the desperate desires of millions of would-be parents, the acquisition of children—whether through donated eggs, rented wombs, or cross-border adoption—has become a multibillion dollar industry that has left Despite legislation that claims to prohibit it, there is a thriving market for babies spreading across the globe. Fueled by rapid advances in reproductive medicine and the desperate desires of millions of would-be parents, the acquisition of children—whether through donated eggs, rented wombs, or cross-border adoption—has become a multibillion dollar industry that has left science, law, ethics, and commerce deeply at odds. In The Baby Business, Debora Spar argues that it is time to acknowledge the commercial truth about reproduction and to establish a standard that governs its transactions. In this fascinating behind-the-scenes account, she combines pioneering research and interviews with the industry’s top reproductive scientists and trailblazers to provide a first glimpse at how the industry works: who the baby-makers are, who makes money, how prices are set, and what defines the clientele. Fascinating stories illustrate the inner workings of market segments--including stem cell research, surrogacy, egg swapping, “designer babies,” adoption, and human cloning--as Spar explores the moral and legal challenges that industry players must address. The first purely commercial look at an industry that deals in humanity’s most intimate issues, this book challenges us to consider the financial promise and ethical perils we’ll face as the baby business moves inevitably forward.

30 review for The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception

  1. 4 out of 5

    Lightreads

    There was a sign in the waiting room of a fertility clinic I was in a while ago that said, "One of our babies is born every X hours." I don't actually remember what the X was, but I remember sitting there, trying to stay calm, multiplying it out in my head and coming up with thousands and thousands of babies a year, and being just stunned. When I first heard that about 1% of American babies born these days are the product of IVF conceptions, I thought that was extraordinarily high. Oh, those naiv There was a sign in the waiting room of a fertility clinic I was in a while ago that said, "One of our babies is born every X hours." I don't actually remember what the X was, but I remember sitting there, trying to stay calm, multiplying it out in my head and coming up with thousands and thousands of babies a year, and being just stunned. When I first heard that about 1% of American babies born these days are the product of IVF conceptions, I thought that was extraordinarily high. Oh, those naive days. Now that I know so much more about infertility – how one in six heterosexual couples will meet the clinical definition, to say nothing of the hundreds of thousands of queer and single people who will have to participate in the fertility market out of practicality, not medical need. Yeah, now that I know a lot more, that 1% is shockingly low. It says to me that many people find noncommercial ways to acquire the children they want, even when banging a heterosexual partner won't get the job done. But more to the point, the 1% says millions and millions of people simply can't afford to play at all. I get pretty angry about that. How making a baby for some people takes a bottle of wine and some jazz. And for others it takes $120,000 and years of anguish and depression and loss. And obviously there's a lot of selection bias, and obviously worthiness has nothing to do with it, but sometimes I swear there's a direct correlation between how awesome someone is and what a great parent they will be, and just how tortuously difficult it will be for them to get there. And let's not even start on the way access to the fertility market is stratified by class and race and sexuality. Anyway. This book is ostensibly about babymaking economics: IVF, gamete donation, PGD and genetic screening, surrogacy, adoption, cloning. How supply and demand interact with the political and social and legal milieu to create functional – or not functional – markets. It's pretty interesting, but the book is already outdated in less than a decade, and I object to many of her premises. For example, she leans heavily on this notion that demand for certain fertility services is nearly limitless, because enough people will spend past the point of rationality to get what they want. Which is just flatly incorrect – there are people like that, but if you spend as much time in infertility communities as I have, you'll discover that the first thing everyone talks about is, obviously, infertility. But the second thing is money, and just how many chances the money will buy, and how once X dollars are spent, that's it, game over. She also dwells more on moral alarmists and scare stories than I felt was necessary. The surrogacy chapter was particularly egregious on this front. And I blinked a lot at all the times she talked about "wrenching moral dilemmas for society" where I was like, "eh, no, I have no problem with that reproductive choice, what's your damage?" E.g. apparently people think that reproductive cloning will mean the end of humanity? Because, like, reproducing a new human without a genetic partner is so fundamentally different that it will rewrite our species identity, and we should not let anyone do it ever? And I'm like yeah, it's a big deal, and there will be abuses (the Bujoldian force-grown clones for medical cannibalism, for example) and it will be the playground of the uber wealthy, but come on. Get some fucking perspective, and also, your sciencephobia is showing. Anyway. I have a much longer list of intellectual quibbles with this book, but it was interesting and well put together and really very useful to me. But I think that's partly because we're not TTC right now, and it's been months since I had to deal with fertility industry bullshit, or asinine government regulations. If I read this when we're back in the trenches, my reaction to this somewhat judgey outsider perspective might be different. So there's that.

  2. 4 out of 5

    Ngee Poo

    Pretty good summary of the economics behind the baby business, a taboo topic. A topic rarely discussed but which displays clear characteristics of a market.

  3. 5 out of 5

    Candice

    At times reading this book, I considered the author jaded and skewed. I’m qualifying the judgment with “at times” because I felt she became fairer in the very last chapter. My, perhaps unpopular, opinion is that babies are a luxury item, not an entitlement. You can have a baby either through the luxury of being fertile or the luxury of trying to buy one or more aspects of fertility. Having a baby isn’t a “right” nor is it even a responsibility considering our current state of overpopulation. So i At times reading this book, I considered the author jaded and skewed. I’m qualifying the judgment with “at times” because I felt she became fairer in the very last chapter. My, perhaps unpopular, opinion is that babies are a luxury item, not an entitlement. You can have a baby either through the luxury of being fertile or the luxury of trying to buy one or more aspects of fertility. Having a baby isn’t a “right” nor is it even a responsibility considering our current state of overpopulation. So if people can afford to leverage science to achieve the most positive results, why shouldn’t they? It is a bridge too far to compare PGD to Nazi eugenics. What is so wrong with wanting the healthiest baby possible? Nazis took away LIVES in order to create their vision of a perfect race. Opting for PGD isn’t at all the same thing. It is ADDING potential success to a specific embryo, not taking it away from all embryos everywhere. The fear-whipping in this book reminds me of “Well, if we let GAY people get married, what’s next? Marrying HAMSTERS???” The author cites a critic who says, “What began as an attempt to ease or prevent a genetic disorder would rapidly escalate into an instrument of improvement and consumer choice”. Well god forbid we IMPROVE anything... that would be disastrous! And if you feel smug about opting for adoption in lieu of IVF, not so fast. Apparently even adoption isn’t allowed to be considered generous or win-win for the child and childless. It’s all one big greedy Machiavellian scheme, as suggested by the author’s presentation. I rather resent that she refers to adoption as part of the “baby trade”. It seems to be that you’re between a rock and a hard place if you’re childless. If you want a white baby, you’re racist. But if you want to adopt a minority baby or an international adoption you’re exploitative and “trafficking in lies”. She gives space to the critique that “adoption encourages throw-away women who are discarded after fulfilling their breeding roles”. As if the women themselves have no agency or say in the matter! And this quote is by a feminist! How dehumanizing is THAT? Adoption is a court-sanctioned process undertaken by women who cannot or choose not to raise the child they created. This book touched a lot of nerves for me. I was more compelled by the current and real ramifications regarding IVF and its potentials (multiple births, low weight births, babies more likely to be born with chromosomal abnormalities, aging parents who don’t have the resources or energy to care for late-life children) and how these ramifications affect all of society through increased insurance premiums. I was less compelled by the suppositions suggested that IVF and other scientific reproductive advancements may create another Nazi Germany or a real-life Huxleyan Brave New World.

  4. 4 out of 5

    Christine Gould

    This review has been hidden because it contains spoilers. To view it, click here. A bit out dated by now (10 years post publication), but the author provides a comprehensive overview of the history of IVF and surrogacy, which is interesting. My favorite line in the book was definitely in the conclusion on p. 213: "it's because we have decided that healthy pregnancies, like lighthouses, are a public good." The author writes this book from a business standpoint but to me it points to the need to lobby for states to mandate coverage for fertility treatments. I don't know if the A bit out dated by now (10 years post publication), but the author provides a comprehensive overview of the history of IVF and surrogacy, which is interesting. My favorite line in the book was definitely in the conclusion on p. 213: "it's because we have decided that healthy pregnancies, like lighthouses, are a public good." The author writes this book from a business standpoint but to me it points to the need to lobby for states to mandate coverage for fertility treatments. I don't know if the market will ever reduce prices enough to make it possible for those couples who don't have coverage and don't have the means to pay for treatment. As an aside, I did find the author's discussion of PGD to be a bit lacking. She states that it isn't directly connected to IVF and doesn't consider the role that PGD may have in increasing live birth rates by screening to make sure that the cells have the correct number of chromosomes (beyond turners and Down's syndrome). Many early miscarriages are due chromosome abnormalities that may have happened in the reproduction/meiosis process not just genetically linked disorders.

  5. 5 out of 5

    Natalia

    Debora Spar aporta una panorámica general de las diferentes técnicas de reproducción asistida desde una perspectiva casi estrictamente mercantil y a través de un lenguaje referido a transacciones comerciales. Me ha resultado interesante leerlo en la medida en que aporta un esquema general pero ha sido decepcionando la neutralidad moral con la que se abordan estas cuestiones: pretende una identificación de todos los procesos de reproducción asistida (desde la donación de esperma hasta los vientre Debora Spar aporta una panorámica general de las diferentes técnicas de reproducción asistida desde una perspectiva casi estrictamente mercantil y a través de un lenguaje referido a transacciones comerciales. Me ha resultado interesante leerlo en la medida en que aporta un esquema general pero ha sido decepcionando la neutralidad moral con la que se abordan estas cuestiones: pretende una identificación de todos los procesos de reproducción asistida (desde la donación de esperma hasta los vientres de alquiler, pasando por el diagnóstico genético por preimplantación y la clonación) a nivel político y los entiende como técnicas. Se maravilla ante los progresos científicos y me ha abrumado la centralidad en la coloca al aspecto tecnocientífico (hay algunos apuntes históricos, es cierto), ¿dónde estás las otras dimensiones de la vida humana desde las cuales también puede pensarse el problema? Además, hay unas escasas líneas dedicadas a la desigualdad como tal consecuente de este tipo de cuestiones: hay reduccionismo en tanto que solo se valora la relevancia del dinero. A lo largo de la lectura he tenido la sensación de que los avances en materia de reproducción asistida son producto del derecho adulto a la instrumentalización de la infancia. No obstante, y a pesar de estas críticas, considero provechosa esta lectura teniendo presente el reduccionismo tecnocientífico en el que cae.

  6. 4 out of 5

    Ashley

    A fascinating read about the reproductive industry that comes into play when couples can't conceive via the normal route. Spar is a Harvard professor and while she stays decidely on topic throughout, the book moved along nicely and wasn't overly dry. She explored everything from fertility drugs to IVF to egg donors, surrogacy, and adoption. She kept emotion to a minimum, while still acknowledging that the consumers of these services were dealing with one of the most difficult periods of their li A fascinating read about the reproductive industry that comes into play when couples can't conceive via the normal route. Spar is a Harvard professor and while she stays decidely on topic throughout, the book moved along nicely and wasn't overly dry. She explored everything from fertility drugs to IVF to egg donors, surrogacy, and adoption. She kept emotion to a minimum, while still acknowledging that the consumers of these services were dealing with one of the most difficult periods of their life. She continually tied everything back to free markets, which I really liked because of its practicality. One interesting subtlety that Spar pointed out was that all these services are essentially substitutes, though no IVF doctor or adoption coordinator would ever admit it. Throughout, Spar draws interesting conlusions and parallels and relentlessly asks the difficult questions. One such difficult question revolves around the current disconnect between the science of making babies and the social, ethical, and medical issues that emerge from that science: should a 63-year old woman be allowed to undergo IVF although she will not likely be able or even around care for her child(ren) [IVF often results in mulitples]? Who is at fault if the baby is born severely deformed or with severe health problems - the mother or the fertility clinic? Shold hospitals and insurance companies be forced to pay for multiples who are often born premature and with significant health needs? And the basic question underlying all others: is reproduction a right or privilege? Spar seems to believe - and I tend to agree - that the answer to this question is the key to all other questions. That is, if it's a right, infertility should be treated like any other disease and covered by health insurance. If not, the unfortunate couples afflicted by it are on their own to explore their medical options. Spar also touches on the topic of cloning, which I admittedly knew very little about. I found it interesting that - medically speaking - cloning isn't that different than other reproductive technologies like IVF. Essentially, one cell has its genetic info "deleted" and then replaced with DNA from another cell. Scientists then "trick" the egg cell into believing it was fertilized, setting off the growth process. I also found it interesting that the two scientists who cloned Dolly the sheep sort of stumbled upon the procedure while trying to create insulin for a pharmaceutiacal company, using sheep. They never intended to use the technology to clone humans, as many critics claimed. I also didn't know that Dolly aged prematurely and had to be put to sleep at age 6.5 years. The author hit the nail on the head when she said (of stem cell research) that the US can continue its current bans and watch the technology move to other parts of the globe or decide to regulate the industry and reap some of the benefits at home. Another factoid is that adoption levels declined dramatically after Roe v. Wade and made foreign adoption more common, since the supply of babies for adoption in the US was so sharply curtailed. Before 1973, 20% of white, unwed mothers placed their children for adoption. By 1982, only 12% of those women made the same choice. The adoption industry has faced many of the same challenges as the reproductive side of the house has, struggling between independence and regulation. Spar also wasn't afraid to lay out her own thoughts on how the market can better regulated. Rather than brush it off as a Sisyphean task, she dives in and has some excellent solutions. A market for babies - via IVF, egg donors, surrogacy, and adoption - exists. We should acknowledge the market and try to make it better through regulation. Overall, an excellent read that I thoroughly enjoyed.

  7. 4 out of 5

    Kirk

    A well-researched overview of the different global markets (and potential markets) for reproduction: fertility clinics, IVF, cloning, designer babies, and adoption. Spar points out that many of us are reluctant to admit to ourselves that these markets exist because they deal with sensitive subjects (parents trying to have a child) and seem to commodify human life. She argues that whatever our feelings about the market, exist it does. Yet the sensitivity has left each of these industries largely A well-researched overview of the different global markets (and potential markets) for reproduction: fertility clinics, IVF, cloning, designer babies, and adoption. Spar points out that many of us are reluctant to admit to ourselves that these markets exist because they deal with sensitive subjects (parents trying to have a child) and seem to commodify human life. She argues that whatever our feelings about the market, exist it does. Yet the sensitivity has left each of these industries largely unregulated in the US. The result is that the emerging market has grown without consideration of the best landscape to protect parents, children and equality of access. How should we do this? One approach is to be mostly permissive (as we are today), another is to ban these activities completely, which may only push them underground. Legal treatment of these cases frequently use family law and examine the best interest of the resulting child. She instead argues for application of property law to the outputs (eggs, sperm, babies) as a legal framework, but in a way that does not commodify the process. Whatever the outcome, she argues that more regulation is needed. Each of the markets should be viewed as substitutes for one another - e.g. limiting IVF will increase demand for adoption - and so she advocates for a holistic model. I found the book to be interesting. She does a great job in digging up data in an industry where data is notoriously hard to come by. The technology has evolved rapidly in the last decade, so it's a little out of date (the book is 8 years old). I'm not ultimately convinced that an unified federal policy is better than a state by state approach, especially since there is so much uncertainty with where this market will go.

  8. 5 out of 5

    Stephanie

    Pubisher's Description: "Despite legislation that claims to prohibit it, there is a thriving market for babies spreading across the globe. Fueled by rapid advances in reproductive medicine and the desperate desires of millions of would-be parents, the acquisition of children--whether through donated eggs, rented wombs, or cross-border adoption--has become a multibillion dollar industry that has left science, law, ethics, and commerce deeply at odds. In The Baby Business, Debora Spar argues that i Pubisher's Description: "Despite legislation that claims to prohibit it, there is a thriving market for babies spreading across the globe. Fueled by rapid advances in reproductive medicine and the desperate desires of millions of would-be parents, the acquisition of children--whether through donated eggs, rented wombs, or cross-border adoption--has become a multibillion dollar industry that has left science, law, ethics, and commerce deeply at odds. In The Baby Business, Debora Spar argues that it is time to acknowledge the commercial truth about reproduction and to establish a standard that governs its transactions. In this fascinating behind-the-scenes account, she combines pioneering research and interviews with the industry's top reproductive scientists and trailblazers to provide a first glimpse at how the industry works: who the baby makers are, who makes money, how prices are set, and what defines the clientele. Fascinating stories illustrate the inner workings of market segments--including stem cell research, surrogacy, egg swapping, "designer babies," adoption, and human cloning--as Spar explores the moral and legal challenges that industry players must address. The first purely commercial look at an industry that deals in humanity's most intimate issues, this book challenges us to consider the financial promise and ethical perils we'll face as the baby business moves inevitably forward."

  9. 4 out of 5

    Xing Chen

    Very lucid, realistic look at the mechanisms underlying the generation and exchange of babies and the ingredients that go into their creation. Extensively researched and concepts soundly tied together, detailing the roles of policy-makers, NGOs and governments, international bodies, consumers, sellers, and end products. Dives in at the boundaries and murky areas of legislation, teasing out conflicting issues, financial conundrums, and ethical constraints, highlighting the fact that fields such a Very lucid, realistic look at the mechanisms underlying the generation and exchange of babies and the ingredients that go into their creation. Extensively researched and concepts soundly tied together, detailing the roles of policy-makers, NGOs and governments, international bodies, consumers, sellers, and end products. Dives in at the boundaries and murky areas of legislation, teasing out conflicting issues, financial conundrums, and ethical constraints, highlighting the fact that fields such as these, that have emerged relatively recently, are evolving rather faster than our current systems and traditional ways of thinking, as a species, can comfortably keep up with. These technologies might appear futuristic to those who are not quite familiar with the advances in embryology that've been reached, but this book is a sharp reminder that they exist, are increasingly widely used (at least by those who can afford them), and that research will continue to push hard at the edges of what is possible, or even only vaguely achievable. Refreshing in its directness, and pinpoints key issues that societies need to recognise, grapple with, and come to some sort of consensus over- as rapidly as possible.

  10. 4 out of 5

    Jim

    amazing, the book is only four years old and the preface is out of date. "In 1996, a fifty-year-old law professor was impregnated..." (p. xi) now (2010) there are seventy-year-old women giving birth. this year, (or was it last?) a woman in LA gave bith to eight in one pregnancy. "Will people protest when two lesbian mothers use cutting-edge techniques to conceive a child that is biologically "theirs"? Yes." (p. xviii) no, no one cares. the book's preface barely had time for the ink to dry before i amazing, the book is only four years old and the preface is out of date. "In 1996, a fifty-year-old law professor was impregnated..." (p. xi) now (2010) there are seventy-year-old women giving birth. this year, (or was it last?) a woman in LA gave bith to eight in one pregnancy. "Will people protest when two lesbian mothers use cutting-edge techniques to conceive a child that is biologically "theirs"? Yes." (p. xviii) no, no one cares. the book's preface barely had time for the ink to dry before it was outdated. will someone in five years stumble across this little review on their Kindle/electronic book device and think seventy years old? women in their nineties give birth all the time. and only eight kids? was the woman on birth control?

  11. 4 out of 5

    Chrystal

    This book was pretty fascinating. It read a lot like a textbook or scientific article - full of information about the baby business in America. The topics range from cloning to adoption to IVF. It discussed the need for legislation to manage these businesses and discusses the moral and political implication of them all.

  12. 4 out of 5

    Johanna

    This was a well-researched, well-written examination of the baby business. I found many parts of it very interesting - particularly the historical view of topics such as infertility, surrogacy, and adoption. Must admit to skipping the chapter on cloning in its entirety and only skimming the author's wrap-up chapter, but all in all, I enjoyed this book.

  13. 5 out of 5

    Kennedy

    Wow. Fascinating look into the business of babies (In-Vitro, surrogacy, choosing genetic qualities of your child,adoption). Very very interesting. Its amazing to see what lengths people will go to have a child.

  14. 5 out of 5

    Sue

    No pictures or illustrations, which makes it a huge term paper. Well-researched and well-documented, not too hard to read, which makes it informative and credible.

  15. 4 out of 5

    Nikki

    Just started, but find it extremely interesting so far. It's all about traditional commerce and how those rules don't apply to the business of making babies and what that means.

  16. 4 out of 5

    Kristen

    I've given up on trying to read this book - every time I return to it, I just get bored again. I think the topic would be interesting, but this particular book is just so dry.

  17. 5 out of 5

    Uzie

    read

  18. 5 out of 5

    Suzanne Lang

    Nice primer on the social and moral concerns brought up by reproductive technologies but a lot of the rest of the content is outdated. Could use a second edition.

  19. 4 out of 5

    margotreynolds

  20. 5 out of 5

    Emily

  21. 4 out of 5

    Mimi Phillips

  22. 5 out of 5

    Cherisse Wilkins

  23. 5 out of 5

    Jose Felipe Obiols

  24. 5 out of 5

    Nate

  25. 5 out of 5

    Nina Resler-myklebust

  26. 5 out of 5

    Heather

  27. 4 out of 5

    April

  28. 5 out of 5

    Sarah Bolivar

  29. 4 out of 5

    Vince

  30. 5 out of 5

    Anna

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