By Dr Laura O’Donovan

In November 2022, The Future of Human Reproduction programme held the first in a series of scoping workshops on disruptive reproductive technologies. ‘Envisaging Reproductive Futures: Extra Corporeal Gestation (ExCG)’, aimed to facilitate in depth discussion and interdisciplinary collaboration between academics with an interest in ExCG.

ExCG is also known as ectogenesis, ectogestation or artificial womb technology and is the partial or complete gestation of a fetus wholly outside of the human body. A partial form of ExCG is currently being pursued by clinical researchers as a potential treatment for extremely premature babies to reduce the risk of infant mortality and morbidity. Attendees at the workshop included academics working in Bioethics, Creative Writing, English Literature, History, Law, Linguistics and English Language, Philosophy, Psychology, Sociology and Speculative Design.

Session 1: Perspectives on ExCG

The first session provided an opportunity to hear about the work of academics researching both ExCG and human reproduction more broadly. First to present was Victoria Adkins (Greenwich University) who gave an overview of her PhD research on partial ectogestation. Victoria’s research explores the views of healthcare professionals in relation to the prospect of partial ectogestation and, at the workshop, she summarised some of her findings from a series of interviews conducted with midwives, neonatologists, and obstetricians. A number of concerns about the technology emerged as a result of these interviews. These included the idea that ExCG must be approached with caution and there were concerns about the social messaging surrounding the technology. The interviewees expressed the view that partial ectogestation should not be used merely to expand and accommodate reproductive choice, but could be acceptable as an intervention in cases of extreme prematurity. They also expressed concerns about the status of the externally gestating entity.

Next, Dr Giulia Cavaliere (King’s College London) explored what it means to liberate women in the context of ExCG and what kind of strategies are needed to achieve freedom and equality. She noted that liberal defences of ExCG too quickly dismiss important structural constraints associated with gender-based oppression, such as constraints relating to race, class, sexuality and age. Giulia suggested that three issues require further discussion: the kind of freedom that is being promoted; how this can be promoted in a way that is inclusive and serves gender justice; and that levelling the playing field between men and women requires changing background socio-political conditions. Following the workshop, Giulia published a blog on the Journal of Medical Ethics’ website which further explores some of these issues.

Giulia was followed by Dr Duncan Wilson (University of Manchester) who went back to the early 20th century to explore the cultural history of, and some of the ethical issues raised by, developments in medical science at this critical juncture. A key question Duncan has considered is how issues that are framed as controversial arise at the interplay of science and medicine. In this context, he made the point that behind grand and relevant claims that ExCG is dystopian and degrades what is it to be human lie historically specific critiques about gender and culture. Further, he suggested that we cannot truly begin to understand what is at stake for different groups in the face of ExCG without attending to these specificities and why they emerge over time.

Next up was Professor Elselijn Kingma (King’s College London) whose research explores the metaphysics of pregnancy. She suggested that in order to understand what ectogestation is, we first need to understand what pregnancy is. After explaining some of the important differences between neonatal intensive care and ExCG, Elselijn argued that the ‘fetal container’ model of pregnancy is wrong; being pregnant is more than a matter of merely ‘containing’ the fetus. Instead, she suggested that we ought to prefer the ‘parthood model’ – the view that the developing in utero fetus is part of the woman gestating it. This, she claimed, is key to understanding what the externally gestating entity is, and has important consequences for law and regulation.

Professor Maureen McNeil (Lancaster University) followed with a discussion about the empirical research she has undertaken in the US, Canada and the UK looking specifically at the stories being told by women about the possibilities linked to reproduction, and how women’s dreams were being shaped and denied. Tracing “I can’t have a baby” narratives, proliferated in popular media in the early 21st century, and drawing on data from interviews with participants led her to conclude that new reproductive technologies involved both the extension and the intensification of motherhood and procreative responsibilities for women. Maureen also noted the role of the media in the proliferation of reproductive technologies as well as the circular relationship between the use of technology and forms of technology. She concluded by speculating that anxieties about reproduction and how this operates at different levels – individual, couple, state and society – which can be both generated and contained by reproductive technologies, will also apply to future technologies like ExCG. Future research, she suggested, ought to focus on these anxieties at different levels and the interaction between them.

Finally, Stefanie Weigold (Kiel University) discussed her PhD research looking at perceptions of technology and views of the body to understand how different biomaterials are viewed as living, valuable, and worthy of protection versus capable of being split off and circulated. She suggested that the concept of comparison, for example comparing uterine transplantation and ExCG, could be fruitful in exploring how the people involved in reproductive change and how the goals and choices of infertile people are shaped and fulfilled. Uterine transplantation and ExCG represent two diametric conceptions of what it means to be pregnant or a mother considering the obvious contrast of bodily involvement.

Session 2: Future research agendas
The second session focused on exploring future research agendas through a round table discussion. The aim was to identify and begin to unpick some of the most important questions raised by ExCG from a variety of perspectives (conceptual, cultural, economic, ethical, legal, linguistic, political, social) and to identify what is missing from the current debate.

There was a lively exchange with most participants agreeing that research needs to focus not just on futuristic conceptions of ectogestation, but on the more immediate impact it might have in the Neonatal Intensive Care Unit (NICU) setting. Other issues raised included:

• The legal and moral status of the externally gestating entity. Is it a baby, a fetus or an entirely new kind of entity? Depending on its status, what legal and regulatory reforms will be required to legislate for it?
• Value sensitive design. What human values will inform the design of future ExCG processes and technologies? How will these be identified and accounted for in a comprehensive and principled manner?
• Questions about research ethics and how the end users of this technology will be determined. What are the potential benefits and harms to the fetus and the parents? What authority will parents have in terms of the medical care of the fetus? Who will have access to this technology, how will that be determined and will it be equitable?
• Social questions about equality between the sexes and biological necessity. Will ExCG enable reproductive labour to be redistributed more fairly in society? Will it be liberating for women or will it lead to greater oppression of certain groups of women on the basis of race, class, age or sexuality?

In terms of what participants felt was missing from the literature, one major theme that emerged was that of empirical research whether that be speaking to parents who have had children in NICU, regulatory bodies who might be required to licence and approve use of the technology, and the public whose understanding and response to the technology may impact its acceptance and use. Other under-explored themes were suggested to include the concept of death in the context of ExCG and how we might explore and understand the experience of the gestating entity.

Session 3: Interdisciplinary methods
The third and final session of the workshop involved breakout group discussions about interdisciplinary research methods. Each group discussed their own personal experiences of interdisciplinary working before coming back together to share what worked well and the challenges of this type of research collaboration.

There was particular enthusiasm for using creative writing and the arts to explore ExCG and also an acknowledgement that digital gaming is currently an underexplored area where there are representations of these technologies. Attendees also recognised the importance of examining shorter-term policy issues and of engaging scientists, who are at the cutting edge of developing these technologies, in dialogue. It was agreed that incorporating evidence from those with clinical or psychology backgrounds would be invaluable. Considerations were also given to more radical experimentation, for example using innovative methods to consider ExCG in highly futuristic settings, such as outer space, where there are currently no legal or regulatory restrictions and where societies are yet to be established with particular cultural norms.

A number of broader ideas also emerged from the discussion. It was recognised that, for interdisciplinarity to work effectively, there needs to be early and continuous dialogue across disciplines and that establishing a shared language and a clear rationale for an interdisciplinary approach is essential before embarking on substantive research. The importance of narrowing the research topic, having a clear aim, and the benefits of embracing ambiguity and messiness, successes and failures were also discussed.

The Future of Reproduction team would like to thank all of the presenters and attendees at the workshop for making it such a stimulating and thought-provoking event.

The full event programme can be found here: ExCG Workshop Programme.

If you are a researcher, academic, clinician or policymaker with an interest in presenting at, or attending, future events please contact futureofhumanreproduction@lancaster.ac.uk.