An Interview with Debora Spar

Sarah Werthan Buttenwieser: How did you become interested in the subject matter for The Baby Business?

Debora Spar: I came to this book in a somewhat odd way. My last book, Ruling the Waves: Cycles of Discovery, Chaos, and Wealth from the Compass to the Internet, was about the emergence of the Internet. It discussed that when breakthrough technologies crop up, then new markets are created around them. Because they are so new, two things are often true: they make tons of money — no price structure exists for something that has never existed before — and there are no rules. Political responses, rules, or would-be rules come next. The inevitable question I’d get after I completed that book was “What’s the next technology to set off a storm?” I thought it might be biotech. Much of biotech hasn’t yet happened except in the lab, but reproductive technology was already being applied, and there was indeed a market. No one had yet looked closely at reproductive technology from an economic perspective. It’s an academic’s dream to stumble onto a topic no one has done before.

SWB: This book delves squarely into women’s lives. How has the topic of reproductive technology been regarded by your economist peers?

DS: This was a very different kind of project for me, my first with a women’s flavor to it. I hadn’t thought much about feminist theory since I studied it but found myself thinking about it again. And while I was looking at this subject as an economist, it wasn’t a topic my colleagues were all that comfortable with. Many were aghast, even vaguely disgusted.

We have a communal printer in my department, and they’d remark, “Oh, that must be yours; it’s about sperm.” More interesting though, is how this book draws different people than have read my other books. I’m meeting more women with this book.

SWB: I’m curious about the responses to your book. Have you had much feedback from women who have utilized these more extreme and costly forms of reproductive technology?

DS: Women, especially those who have been through infertility treatments, were very glad to see this viewed as a market. Some said they wished they’d been better consumers. Even those who had a positive outcome see it as a market. The harshest responses were from the adoption community. They are much more nervous to see what they do as a market.

People presume, because I’m a certain age and a mother, that my personal struggles are the book’s roots. In fact, I didn’t stumble onto this subject because I was dealing with infertility. However, it did turn out that after having had two biological children — two healthy boys I had very easily — my husband and I did decide on international adoption to adopt an older girl.

SWB: Do you think that this country is right to stay out of creating parameters the way other countries have done? Is there a tipping point that might compel legislators to decide to become involved in decision-making over time?

DS: Maybe there’s not a particular tipping point. Egg donation is most likely to generate a response because it’s connected to stem cell research, and so those that are against anything having to do with embryonic research are concerned that women don’t give eggs for those purposes. There’s also some controversy about “making sure women aren’t exploited,” which probably has the same roots. Why shouldn’t women be compensated if men are for donating sperm? What is more reasonable to worry about is making sure that women are protected medically. Donating eggs is a medically involved procedure whereas sperm donation has no potential medical risks.

SWB: What do you think we’ll learn if we look further at costs related to reproductive technology, such as the economics of multiple births or IVF for older mothers? Will there be a move to make these treatments affordable or more equitable, or will they remain under the purview of the wealthy?

A key question is how far we believe we can go in exercising free choice: do we believe there’s such a thing as being too old to be a biological mother? Do we feel comfortable with free choice including implanting multiple embryos, even though the medical risks for multiples, especially three or more are well documented? With multiples come more intervention and more care and increased costs; we can also document that older mothers’ pregnancies cost more. So, there’s a health issue and a monetary issue, but who gets to decide? There is a question about how to handle the fact that many women become so obsessed about getting pregnant they cease to focus upon health.

Obviously, it’s unfair that only wealthy people can afford to be parents if they struggle with infertility, grossly inequitable. Whether our society chooses to see becoming parents as a right for all and makes that happen is something that’s yet to be resolved. To do so, we’d have to place some restrictions upon these technologies, yet we’d also drive the cost down. If this happens, it will happen slowly and painfully.

Fourteen states have insurance coverage for infertility. The exact parameters vary state by state, but insurance is pushing the price for certain treatments down.

SWB: With the current frailty of abortion rights in this country, if abortion were declared illegal would reproductive technology suffer?

DS: I don’t know what will happen if abortion becomes illegal. You can construct a way to imagine doing IVF, so it’s not at odds with being anti-abortion, much as this is not ideal, since seeking infertility treatments is a reproductive rights issue just as abortion is. But in Europe (for health reasons, not having anything to do with abortion) they are already moving away from hyperstimulating a woman’s ovaries (which is how you get a large yield of eggs in one cycle). Instead, they collect one or two eggs a month from a woman naturally, and this way there are no excess embryos. The excess embryos are what the fundamentalist right struggles with, and they’d pretty much be a thing of the past. Catholics would still disagree. I hope the states move away from hyperstimulating, too, simply because it’s a health risk.

SWB: It sounds like there’s much more to explore on this topic. Are you continuing your work in this field?

DS: I’m definitely fascinated by this topic. I am working on a few related projects. Along with a colleague more schooled in statistics, we’re studying sperm banking and what genetic aspects people choose. There are three categories of people that buy sperm: heterosexual couples, lesbians, and single women. We want to see whether these three different groups behave differently. One thing we’re looking at is whether most people choose genetic aspects of themselves — trying to match characteristics that would replicate themselves — or do they choose genetic traits coveted in society? If they take the route of choosing to replicate themselves, it probably means something different for society than if they choose something other than themselves. For example, what if the short, brown-haired people all chose tall, blond donors?

Then, there’s egg donation, which is an even more complicated subject because it gets into issues of medical safety, and it gets into stem cell research, and it has sparked a debate about payment. But on the parallel to sperm bank experience of how people choose eggs, it’s possible that people behave differently. For one thing, eggs, I suspect, are being sold on how women look. While sperm donors’ information profiles describe the man, the egg donors’ profiles include photographs. That says to me that how women look is more important to buyers than how the men look. It’s a little more like online dating, although of course, you’re not getting the donor, just her egg. You can’t look at that fact and not wonder about the objectification of women.

SWB: These issues surrounding reproduction and how families are created, as you point out in your book, are highly charged emotionally, yet your focus — the economics of baby making — keeps your observations quite cool. Was this difficult to do? Did you learn things that pushed you or surprised you?

DS: What I brought to this debate was my ability to step back, and while it was hard to do that, it was important to keep my perspective — the economist’s one — to write a strong book. Having said that, although this book was fascinating to research, it was also emotionally exhausting, something that wasn’t true of my other books.

I found that researching PGD (preimplantation genetic diagnosis) was especially hard. There were real people dealing with dying children, and as a mother, that’s especially hard to think about. There were also some points in the adoption chapter when I just had to take a break because it was so emotionally draining.

SWB: Did you form any personal conclusions from all you learned?

DS: When I start a research project, I always try to be open-ended in my thinking, although the idea of regarding reproductive technology as a market remained unchanged. I did become more accepting of the ambiguity, though; what’s right and wrong with how we approach creating our families isn’t black and white. It’s all shades of gray. There is no right way to make these decisions. I was humbled by what I learned. There were some remarkable doctors. For example, I met a woman doctor — she died last year — she came out of retirement to do IVF in this country, the first to offer the service. She was obviously gratified by what she did, but she certainly gave a great deal. We don’t want experts, philosophers or Solomon to make these decisions; expertise doesn’t buy you that much.

SWB: You note that your family experienced international adoption. Did that personal experience affect how you looked at the research on adoption?

DS: My view didn’t change to the extent that I saw adoption as a market. I didn’t believe it was a fairy tale. Having said that, we were extremely lucky, both with our biological children and our adoption experience. But an interesting thing did happen: In the midst of what I’d call a “bad” adoption day, a lightbulb went off, and I realized that I’d spent a year researching what is essentially the flip side of reproductive technology, and that’s how I decided to include international adoption in the book.

SWB: One of the things Literary Mama readers are interested in is how authors balance the work and parenting in their own lives. You have three children and a busy career. Do you have a sense of choices you made in order to pursue work and family life as fully as you do?

DS: I’ve been able to do the mom thing and the job and survive, but of course, it’s hard to do. What gives when you are giving at home and at work is yourself. Having said that, I’m extremely lucky: I like my work. I have the luxury to choose whether to work. I have resources to have help and some control over my time, which is easier to get as an academic. [Spar’s son brings her a cup of tea.] And it helps to have good children!