Reprotech in France and the United States: Comparisons, reproductive technology and migrapolitics

The title of this symposium volume of Reproductive Biomedicine and Society Online, ‘Reprotech in France and the United States: differences and similarities’, is deceptively modest. At their best, comparative studies do far more than highlight what is the same and what is different between two or more foci. They also yield clues as to what is important in general to each of the times and places being compared (France and USA today), and what is important in general to the phenomenon that is being compared [current trends in human assisted reproductive technology (ART)]. Comparative studies lead us to this sense of ‘in general’ via empirical and archival specifics, by painstakingly researching what happens – and just as importantly, what does not happen – in one place rather than another, and what is contested and what is taken for granted in each case. Comparisons are particularly productive when the places being compared have strong similarities and yet differ in characteristic ways. It is difficult to see these things from ‘inside’ a single perspective.

Perhaps most significantly, the capacity of comparisons to highlight core dynamics of a field within different polities opens up two important avenues for action. Differences between broadly similar settings help us to understand which aspects of the field are contingent from one setting to another and so can be imagined otherwise. This is especially important for a field such as human ART that has ethical, economic, access and stratifying stakes wherever deployed. Differences also allow researchers to understand the parameters in each place – the social, political and technical repertoires of each national setting – within which any efforts to effect change must make sense if they are to have any chance of legitimacy and success.

Not surprisingly, the introduction and papers in this symposium volume identified plenty of similarities between ART in France and the USA, despite the limits discussed when comparing nations and when comparing two countries of such different sizes and governance structures (Mathieu and Rapp, 2020). Both countries developed ART early, in the 1980s. Both are broadly pronatalist and remain organized in ways that centre the heterosexual reproductive marital family, which is reflected directly in ART. Both have codified ethical review and robust forums for public debate, although these are very different. Both are capitalist, nationalist, liberal democracies with advanced biomedical and life science research infrastructures. Both countries have ongoing imperial legacies which mean they concentrate global wealth, and they are receiving countries for migration, including medical and family migration.

Among the differences noted between the two countries, there is national social solidarity for the infertile in France which is not found in the USA. It should be noted, however, that legal battles for insurance coverage for ART in the USA, for example, have drawn on deep bipartisan support for the desires of intended parents for family-building. French national solidarity relates to its different size and political structure, but also directly to a difference in kinship between the two countries that can be found in the role of state, citizenship and patriarchal laws. France has a tradition of anonymity where the state can stand in for the parent, evident in 'accouchement sous X' (a long-established legal right for a woman to choose to give birth anonymously, immediately relinquishing the newborn to the state for adoption) and a greater tolerance of physician-selected donor gametes and gamete–donor anonymity than is found in the more individual, marketized choice-based and biomedicalized kinship of ART in the USA. This works in tandem with the ways in which France presumes the fatherhood and patrimony of the legal husband more readily than the USA. In both countries, kinship and the state interact vigorously in migratory patterns and in ART, opening up research avenues into what I refer to as the 'migrapolitics' of ART. In the USA, ‘jus solis’ without the need for a citizen parent has generated a vocabulary of ‘anchor babies’ in which surrogates and medical tourism for ART have come to play a part. In France, unless you are born stateless, you do not qualify for ‘jus solis’ without a French citizen parent. In other words, kinship in France already combines citizen and state, whereas an ART-conceived baby, as other births, can be a bid to access citizenship in the USA.

This issue also focuses on stark regulatory differences in the two national contexts. In the USA, the Federal Government regulates laboratory safety and clinical standards, and limits the availability of federal funds for anything with proximity to abortion, including the human embryo surplus that is common in ART (Thompson, 2016). Most regulations are at state level; in some states, many ART procedures are prohibited and many types of intended parents are not served. In other more liberal states, insurance coverage and legal contracts with third-party reproducers are the main forms of regulation. In these states, family-building is an individual biomedical set of practices, access to which is severely restricted in reality by cost for any procedures and anyone not covered by health insurance. This regulatory picture opens up more room for alternative family forms based on marital and health status, age, third-party involvement and sexual orientation, but stratifies intended users in terms of ability to pay.

This too opens lines for further research in migrapolitics. The US states where many ART procedures are available to those with the ability to pay or those with good insurance also attract wealthy overseas reproductive tourists from more restrictive countries. This adds to the migratory and receiving/sending contrasts between the USA and France. Access and payment are governed by national regulation in France, and bioethical processes centre on a presumed shared set of religious and cultural norms in debates about new types of families. Wealthy French intended parents with means are among those who follow regulatory gradients to find places where procedures are less restricted; French intended parents concerned with both price and regulation make calculations about which overseas markets to try to access. From the USA, intended parents often travel across state lines for fewer restrictions and travel overseas to access cheaper services, while trying to keep biomedical infrastructure, language and other aspects constant. France and the USA host diverse diasporas with correspondingly different concepts of race and ethnicity, and citizenship that play a role in reducing or increasing access to ART domestically, and making one or another overseas ART destination more accessible.

When we examine the body of work in this symposium volume and in the wider field of ART studies, we see history in the present, including recalcitrant patterns of privilege in both national contexts. In the USA, ART allows us to trace the afterlives of settler and slave-holding regimes and subsequent waves of migration through who lives where and what ART services can be accessed by different people. Regulation occurs between the private sector and State and Federal Governments to make a characteristically stratified reproductive marketplace. In France, ART is an excellent way to understand state paternalism evident in a tighter and more juridical, not only biological, elision between parentage, citizenship and the state. Public debate around ART in France allows us to witness the current and afterlives of Catholicism and too-little-discussed post-coloniality on kinship and public culture. A comparative exercise such as this symposium opens up ways to see who is encouraged to reproduce, and for whom it is much more difficult in both nations. It also reminds us again that a population is made up of birth, death and migration; where one is at stake, the others will be too. Policy changes can be imagined by thinking about the advantages of one jurisdiction over another, but can only be implemented if they can be relativized to the history and present of the setting in question. A comparison such as this allows us to begin this work.

Declaration

The author reports no financial or commercial conflicts of interest.