Artificial wombs and the future of pregnancy

The idea of growing babies in pods has long been limited to dystopian science fiction such as the Matrix movies. But recent scientific developments could mean that this fiction will become reality within our lifetimes.

In 2017, a research group reported that they’d successfully removed a premature lamb from its mother’s womb and grown it in a plastic bag until it was ready to be born. The so-called “Biobag” has two main components. One of these is the fluid environment, a bag filled with warm, sterile fluid, which mimics the womb with its amniotic fluid. The other component is the circulatory system, which involves connecting vessels from the lamb’s umbilical cord to an oxygen-supplying device. This part of the system also removes carbon dioxide from the lamb’s blood and delivers nutrients, thereby acting as a replacement placenta.

The lambs were removed from their mothers’ wombs at an age equivalent to about 24 weeks’ gestation in humans. This is the age at which a baby may just be able to survive with a lot of medical help. Even with doctors doing everything in their power to help babies this premature to survive, only around 50% of them live. Of those that do survive, 90% have severe complications such as blindness, brain damage, or lung disease. Improving medical care for these babies is therefore a priority, especially in higher-income countries where preterm birth is the leading cause of death and disability in children under five.

Artificial wombs like the Biobag may in future provide a way to improve survival and long-term health of babies born at around 24 weeks. Despite this being good new to anyone who has suffered the loss of a prematurely born child, the potential uses of such technology have implications for women’s rights and reproductive equality.

The age at which a baby is able to survive outside its mother’s womb is called the threshold of viability. Humans are typically born at about 37-42 weeks’ gestation, and the threshold of viability used to be around 36 weeks. But as our technology to keep babies alive improves, the viability threshold is coming down, and is currently around the 24-week mark. Although the threshold of viability sounds like a medical term, it is also a legal one: current laws around abortion are centred around it. In many places, a foetus’ right to survive supersedes a woman’s right to bodily autonomy when it becomes viable. This means that if technology such as the Biobag started to be used for babies younger than 24 weeks, bringing down the abortion threshold, legal abortion limits could drop. So far, the viability threshold of 24 weeks has meant that both a woman’s right to bodily autonomy and the foetus’ right to life have been somewhat balanced. The concern is that if the threshold is pushed lower and lower, continuing to use foetal viability as a criterion for allowing abortion could impinge on a woman’s ability to choose what happens to her body. Advocates of abortion rights have pointed out that if artificial wombs become used in humans, abortion law could be restructured to be centred around reproductive autonomy in order to protect access.

The potential uses of such technology have implications for women’s rights and reproductive equality.

Besides having implications for abortion rights, ectogenesis (the growth of babies outside the mother’s body) would also affect reproductive equality. Many effects could be positive: the option to have a baby grow outside their own body could allow women with epilepsy or other conditions that make pregnancy very risky to still have biological children. For women with infertility or same-sex couples, artificial wombs would enable having children without the difficulties associated with surrogacy. Even for healthy women, the technology has the potential to reduce the risks associated with pregnancy, which are still significant. However, ectogenesis could also reduce reproductive equality if it becomes privatised. People with fewer financial means would be less able to afford it, meaning they would be excluded from the benefits listed above.

All these thoughts are very hypothetical. Realistically, any use of artificial wombs in humans, even for research purposes, faces huge regulatory hurdles and will take years, if not decades. But past experiences have taught us that it is worth addressing such ethical and regulatory issues earlier rather than later. In vitro fertilisation was once hailed as a technology that would improve reproductive equality; instead, unequal commissioning has limited access for those living in more deprived areas. In the area of trans rights, reproductive law has also not caught up with reality, with trans men still having to be listed as “mother” on the birth certificate. If we want to have discussions about how ectogenesis would be used, we should start before it is too late to make the changes to the legal and political system that enable their being used in an equitable manner. Artificial wombs have the potential to improve the lives of thousands of babies and their families. We need to ensure that whenever they arrive, we’re ready to use this potential in a positive way.

Photo credit: Aditsya Romansa on Unsplash