Wednesday 18 March 2020

Corona bucket list #1: PDF of my PhD thesis on reproductive politics in Israel

I submitted my PhD thesis to the University of Oxford in 2011. At the time, I planned to turn it into a book. But life had other plans for me - campaigning for equal civil partnerships, a career switch from academia to policy, and two beautiful babies. I wish I'd uploaded a PDF years ago, but it seems there's no time like the (uncertain) present.  

No doubt some of the later chapters are out of date, and the policy debates have shifted. And I'm sure I'd have framed and phrased things differently if I'd written it now or turned it into a book. But that hasn't happened yet, perfection is the enemy of the good, and there's some useful material in here -- about covert discrimination in child allowances to encourage Jewish fertility, and on the flip side, the lack of data to back up the claim that Palestinian citizens of Israel were the only population group given free contraceptives. 

My goal in sharing this now is to prevent any future researchers similarly intrigued by these questions of reproductive politics in Israel having to start from scratch. Hope it helps someone, somewhere, sometime.

Here it is. 

Monday 13 January 2020

Surrogacy – wish fulfilment or exploitation? Read my blog for Sprogcast

Whether surrogacy is wish fulfilment for those facing infertility or unethical exploitation of women's wombs is not an abstract question -- the Law Commission is in the process of a review of existing surrogacy laws in the UK, the aim of which is to reform them for the first time since 1985. 

So, if you'd like to know more about some of the serious issues in this debate, please read my blog for Sprogcast via this link or copied below. As always, please let me know what you think. 

Surrogacy – wish fulfilment or exploitation? A guest blog by Dr Rebecca Steinfeld, Senior Policy Officer for Health, Maternity Action

Surrogacy is a polarising issue. For some, it embodies true altruism – a woman realising the dreams of others by birthing their baby, with all the medical risks, and physical and emotional toll, that can come with pregnancy, birth and, ultimately, handing over a baby. Sprogcast’s interview with David Gregory-Kumar is a touching example of how surrogacy can help gay couples to become parents, as is the heart-warming story recently aired on BBC 2’s series The Baby Has Landed of Paul and Craig Saunders, whose work friend Mel carries their twins.

But that is not the whole the story. For others, surrogacy is inherently exploitative and unethical. They say it makes children commodities, and disadvantaged women “breeders.” Some even compare surrogacy to prostitution, and argue “womb rental” be the term used.

This debate is not abstract.  

The Law Commission is in the process of a review of existing surrogacy laws in the UK entitled "Building Families Through Surrogacy: A New Law." Their proposals include a new pre-conception agreement and related pathway, as well as changes to the types and level of payments for surrogate mothers. The goal is to bring forward a Surrogacy Bill in 2021 that will constitute the first legal reform to surrogacy law in the UK since the Surrogacy Arrangements Act 1985.  

We at Maternity Action, along with a number of feminist organisations, submitted responses expressing our concerns about law reform in this area. Our concerns focus on the process of the consultation, barriers to accessing it (the consultation document was 502 pages long and had 118 questions!), and the extent to which surrogate mothers' rights and experiences are being taken into account.  

But beyond the specifics of the consultation, there are several other serious issues at stake in this debate. These include potential power imbalances between surrogate mothers and intended parents, the risks of pregnancy and birth taken on by the surrogate mother, and human rights concerns that may crop up during a surrogate mother’s antenatal, intrapartum and/or postnatal care. It is crucial to acknowledge and reflect on these difficult areas in any discussion of surrogacy.  

Surrogates may be vulnerable to exploitation as there is often socioeconomic inequality between surrogate mothers and intended parents. Intended parents tend to be older, wealthier, better educated and employed in higher status jobs than surrogate mothers. Though there does not appear to be any research exclusively considering the demographic characteristics of surrogates in the UK, evidence from other studies indicates that the majority of women who act as surrogate mothers are substantially less well-off, less powerful and less endowed with status than the majority of intended parents.

Though there may be some exceptions to this pattern in what are known as “traditional” or “altruistic” surrogacy arrangements – such as a sister carrying a baby for her brother/sister – these arrangements account for the minority of surrogacy arrangements. Plus, there may be other power imbalances in these familial arrangements, and economic inequalities may still exist.  

There are inherent risks involved in pregnancy and birth for the surrogate. Emeritus Professor Susan Bewley, a retired consultant obstetrician with direct, first-hand experience of many UK surrogates contends that there are documented medical and psychosocial risks to surrogacy. All pregnancies carry physical and mental health risks to pregnant women, ranging from trivial to very severe (sepsis, pre-eclampsia, haemorrhage and maternal death for the woman; abnormality, prematurity, stillbirth, brain damage, infant death for the baby). For untested first-time mothers, or primigravidae, these risks are entirely unknown, and the Law Commission rightly asked whether primigravidae should be allowed to be surrogates.  

Risks for the surrogate may be higher if she, or another woman, are involved as egg donor, which involves undergoing ovarian stimulation, egg extractions and a small risk of the serious complication of ovarian hyperstimulation syndrome. The surrogate may have many appointments, drug treatments, invasive procedures and timed embryo transfer. More importantly, she is at a significantly increased risk of developing pre-eclampsia. If it is a twin pregnancy, she is at increased risk of every complication barring postmaturity. Pre-eclampsia and multiple pregnancy, which remain high in the UK IVF sector, both increase the risk of prematurity, with possible lifelong health consequences for the child. 

On a perinatal mental health level, although many surrogates are keen to hand over the baby, there are a lot of dramatic hormonal events in the first days and weeks after birth, and some find that handover triggers or exacerbates perinatal mental ill-health conditions, like postnatal depression or postpartum psychosis.  

Finally, surrogates may experience coercion from intended parents during their antenatal care or birth. In their consultation response, the Woman’s Place UK said “it is not difficult to imagine a scenario where the mother may find it difficult to make choices which prioritise her own health and wellbeing if the intended parents are in the room with her, even if they do not actively put pressure on her to prioritise the welfare of the foetus. Or in a scenario where a scan reveals a foetal anomaly, the pregnant woman may feel unduly pressured to conform to the intended parents’ wishes regarding continuing or terminating the pregnancy if they are present in the room when the scan takes place.” As these scenarios suggest, the surrogate mother’s rights to dignity and bodily autonomy may be subtly undermined by the known wishes or momentary reactions of the intended parents.  

Given the current policy climate and controversy around surrogacy, it’s crucial that public discussion of this issue includes the fullest range of perspectives. As well as hearing moving stories from intended parents about how surrogacy enabled them to overcome biological or social infertility to realise their dreams of becoming parents, we also need to hear from a range of surrogate mothers. That includes those whose experiences have not been so rosy, and who instead encountered challenging power imbalances between themselves and the intended parents, or who felt that their human rights were subtly or overtly undermined during their pregnancy or birth, or who suffered unexpected physical or emotional repercussions. There are two sides to this story, and both must be told.  

Friday 6 December 2019

The radical feminist potential of civil partnerships

Civil partnerships have enormous feminist potential: They avoid the special-day sexism of many weddings, formalise a relationship of equals, and give the parties rhetorical leverage whenever there's creeping gender inequality. 
But they've also kick-started a public conversation about the need for cohabitation law reform to ensure social policy keeps up with the reality of modern families. And, perhaps most importantly, by ending the unrivalled position of marriage, they widen the space for deeper discussions about giving legal recognition to other types of personal and caring relationships, such as those between friends, siblings and co-parents, as well as alternative sexual relationships.
Read my op-ed in iNews if you want to know more!

Friday 8 November 2019

I've joined the Expert Panel of the Wrisk Project

I'm excited to announce that I've joined the Expert Panel of the Wrisk Project. For those who don't know, Wrisk is a collaboration between the British Pregnancy Advisory Service (bpas) and Heather Trickey at the School of Social Sciences at Cardiff University.

Working with stakeholders from a wide range of disciplines, the project draws on women’s experiences to understand and improve the development and communication of risk messages in pregnancy.

The project runs for two years from November 2018 to November 2020. In the first year, Wrisk conducted an extensive survey and interviews to gather women’s experiences of risk messaging. From January 2020, the Expert Panel will discuss the results, using a consensus methodology, and consider what lessons to draw from women’s experiences.

Stakeholders on the Expert Panel include scientists, public health and risk communication specialists, women’s advocacy groups, and specialists in women’s sexual and reproductive health - and me! This work will lead to the development of recommendations for respectful risk communication in pregnancy.

The project is funded by the Wellcome Trust.

Friday 8 March 2019

Speaking about civil partnerships at "Beyond Marriage" conference at the University of Cambridge in May

I'm really looking forward to contributing to the discussion at this forthcoming conference "Beyond Marriage" at the University of Cambridge at the end of May. I'll be discussing my experiences as co-claimant in Charlie Keidan's and my successful Judicial Review challenge of the ongoing ban on mixed-sex civil partnerships in the UK.  

Here are the details: 

"Beyond Marriage: Philosophy, Politics Law" conference
24-25 May 2019, University of Cambridge
Convenor: Clare Chambers, University of Cambridge

There have been significant changes to the institution of marriage in recent years, with many countries introducing same-sex marriage, civil partnerships, and other forms of non-traditional union. For some, marriage is a central institution that must be protected, for others it is inevitably unjust and should be abolished. This conference will bring together academics and practitioners from philosophy, politics, and law to debate what lies beyond marriage.

-Samia Bano, Law, SOAS
-Elizabeth Brake, Philosophy, Arizona State University
-Clare Chambers, Philosophy, University of Cambridge
-Baroness Lynne Featherstone (Lib Dem), former Minister of State
-Andrew Harrop, General Secretary, Fabian Society 
-Tim Loughton MP (Con)
-Jo Miles, Law, University of Cambridge
-Rebecca Steinfeld, Claimant in Steinfeld and Keidan v. Secretary of State
-Lori Watson, Philosophy, University of San Diego
-Robert Wintemute, Law, KCL

Chairs: Jude Browne, Clare Chambers, Tom Dougherty, Findlay Stark, Ralph Wedgwood

Bookings are now open here:

Thursday 21 February 2019

'Campaigning for (circumcision) change: some ideas for the UK' - upcoming talk at the University of Leeds

I'm excited to be speaking at this conference on genital cutting at the University of Leeds at the end of April. 

My talk - 'Campaigning for (circumcision) change: some ideas for the UK' - draws on my experiences and insights campaigning for equal civil partnerships. In it, I will suggest what I consider to be the most attainable and measurable objective for change; consider the feasibility, and potential advantages, of running a Judicial Review case aimed at challenging the unequal legal treatment of girls’ and boys’ genitals; explore how such a case could complement a broader political campaign; consider the limitations of legal challenges and changes; identify the merits of differing campaign messages (equality and human rights versus child protection, for example); and suggest some avenues for fundraising. 

If you'd like to hear more from me and from an incredible group of academics, lawyers, doctors and activists about why a commitment to child's rights means extending protections to the genitals of male and intersex children too, please do come along. Hope to see you there.

Here is a link to eventbrite to book tickets. 

Thursday 25 May 2017

How different are female, male and intersex genital cutting? Brian Earp's and my article in last week's The Conversation

Last week, my bioethicist colleague Brian Earp and I published an article in The Conversation asking how different are female, male and intersex genital cutting.

We frame our article around the recent indictment of three members of the Dawoodi Bohra sect of Islam on charges of “female genital mutilation” (FGM) in the US state of Michigan, and the decision by one of Norway's major political parties to back a measure to ban childhood male circumcision.

In Western countries, popular attitudes towards these procedures differ sharply depending on the child’s sex. But in our article we ask whether the supposedly clear distinction between these different forms of genital cutting stand up to scrutiny. 

Having concluded that they do not, we argue that moral considerations should instead centre around medical necessity, autonomy, and respect for the bodily integrity of all children – regardless of their sex or gender. 

We outline three practical advantages to this approach: 

1) It deflects accusations of sexism by recognising that boys and intersex children – just like girls – are vulnerable to genital alterations that they may later come to seriously resent.

2) It reduces the moral confusion that stems from Western-led efforts to eliminate only the female “half” of genital cutting rites in communities that practice both male and female forms in parallel.

3) It neutralises accusations of cultural imperialism and anti-Muslim bias by avoiding racially tinged double standards

This is because the same moral concern would apply to medically unnecessary genital cutting practices that primarily affect white children in North America, Australasia and Europe, as to those affecting children of colour (and immigrants) from Africa, the Middle East and Southeast Asia.

As we explain in our article, adopting such an approach does not necessarily mean “banning” all pre-consensual forms of non-therapeutic genital alteration. History shows that attempting to pass strict legal prohibitions before cultural readiness can backfire, creating intense resistance among those who are dedicated to modifying children’s genitals for whatever reason, and often driving such practices further underground. 

Rather, there are many levers that societies can pull to discourage unethical practices: the law is only one among them, and not necessarily the most desirable or effective. Some authors have proposed step-wise regulation of medically unnecessary childhood genital cutting, along with community engagement and education, as alternatives and/or supplements to formal prohibition. 

As Brian and I conclude, whatever specific policies are implemented, it is clear that fundamentally different treatment of female, male and intersex children, in terms of their protection from non-therapeutic genital alteration, will become increasingly difficult to justify in the years to come.

To read our article in full, please click here. We welcome your comments. 

Reproductive injustice in Europe - my contribution to UCL's School of Slavonic & East European Studies' ongoing work in this area

Confronting reproductive injustice in Europe is urgent. I'm glad that I can be part of an ongoing conversation amongst academics and activists about the most pressing reproductive injustices in Europe, and how best to combat these. 

At a panel discussion for International Women's Day on 8th March 2017, I contributed to a panel discussion convened by Dr. Rory Archer and Cara Spelman to broaden choice-related questions. As Dr Nevila Pahjumi recently wrote on UCL's School of Slavonic & East European Studies (SSEES) blog, during my introductory remarks I:

"exposed the limitations of pro-choice debates, and introduced some of the often-difficult questions that reproductive justice that Europe faces at the moment. Part of what the focus from ‘choice’ to ‘reproductive justice’ aims to achieve is, to expand the sometimes theoretical definition of ‘choice’ and ‘rights’ to include the dignified upbringing of children. Notably this switch in research, and hopefully also activism, seems promising in that pro-life activists offer no alternatives to childcare, which is an important concern for would-be parents, and indeed, a consideration that can lead to abortions. Some of the pressing concerns for reproductive justice that Rebecca has identified are: refugee access, general lack of access, as well as birth injustice."

With thanks to my colleagues at SSEES for organising such important and timely events to air these important issues. 

For more, please read Dr Nevila Pehjumi's blog on behalf of SSEES here

Monday 24 April 2017

“Gender and Genital Cutting: A New Paradigm” – bioethicist Brian Earp’s and my recent paper for the European Parliament

My bioethicist colleague, Brian Earp, and I have recently published a paper for the European Parliament on the non-therapeutic cutting of children’s genitals.

In it, we explain that though moral and legal opposition to the non-therapeutic cutting of children’s genitals has traditionally focused on female children, a growing movement of scholars, activists, and individuals affected by childhood genital cutting have argued that all children, regardless of sex or gender, should be protected from such intimate violations.

In our paper, we argue, first, that the conventional distinctions based on sex or gender do not reliably reflect the actual harms that are entailed by various forms of NGC; and secondly that distinctions based on autonomy and informed consent do provide coherent grounds for an empirically justifiable analysis of the moral permissibility of NGC.

These conclusions have significant implications for policy. At a recent WHO-sponsored conference on female NGC held at Geneva University Hospitals, we argued that a gender-inclusive approach, based on an individual’s capacity to provide informed consent to NGC, is not only better supported by the available evidence, but also offers several practical advantages:

  1. It deflects accusations of sexism by recognizing that boys and intersex children are also vulnerable to non-therapeutic genital alterations that they may later come to seriously resent. 
  1. It clarifies the moral confusion that stems from Western-led efforts to eliminate only the female “half” of childhood NGC practices in communities that practice both male and female NGC in parallel. 
  1. It neutralizes accusations of cultural imperialism by applying the same standards to medically unnecessary genital cutting practices primarily affecting white minors in North America, Australasia, and Europe (i.e., medicalized routine or religious male circumcision, and intersex genital normalization surgery) as it does to such practices primarily affecting minors of color in Africa, the Middle East, and Southeast Asia (i.e., male and female peripubertal initiation ceremonies and other customary forms of childhood NGC). 
Adopting such an approach does not necessarily mean seeking to prohibit all pre-consensual forms of NGC. Experience shows that the enactment of strict legal prohibitions prior to cultural readiness can backfire, creating intense resistance among those who are dedicated to the practice, and often driving it further underground. Prohibition of childhood female NGC, for example, has been largely unsuccessful in many countries where it is customary and deeply embedded, and recent attempts to criminalise circumcision of boys have been blocked, ignored or overturned.

There are, however, many “levers” society that can pull to discourage harmful practices: the law is only one among many, and not necessarily the most desirable or effective. Some authors have proposed step-wise regulation of childhood NGCs, along with community engagement and education, as alternatives and/or supplements to formal prohibition.

Whatever specific policies are implemented, it is clear that fundamentally different treatment of female, male, and intersex children, in terms of their protection from nontherapeutic genital cutting, will become increasingly difficult to justify, morally, legally or medically, in years to come.


Our thanks go to Eduardo Zugasti, assisting MEP Teresa Giménez Barbat, for inviting us to prepare this essay, and to Professor Elizabeth Reis and Dr. Robert Darby for feedback on an earlier draft.

Wednesday 15 March 2017

FGM/C Geneva conference presentation: Could efforts to eliminate female genital cutting be strengthened by extending protections to male and intersex children?

Over the last two days, I participated in an inspiring and enriching conference on Female Genital Mutilation/Cutting at the Geneva University Hospitals. There, I met so many incredible people working so hard on such complex issues. 

I also shared some of my bioethicist colleague Brian Earp's and my research on whether efforts to eliminate female genital cutting could be strengthened by extending protections to male and intersex children. We created and displayed this eposter to summarise our analysis and arguments: 

In my presentation, I recognised that comparing female genital cutting with male and intersex genital alteration is controversial. At the same time, I emphasised that there are significant areas of overlap between these practices that necessitate reconsideration of their divergent ethical statuses and policy treatments.

I explained that some argue that efforts to reduce FGC are undermined by failing to apply principles of bodily integrity to children of all sexes. While a sex-based approach is incompatible with equality principles, it could also backfire because some defenders of male circumcision call for 'nicking' of females' genitalia for intellectual consistency. Essentially they're seeking to 'equalise down' by rolling back existing protections for females. 

By contrast, Brian and I have identified three advantages of a gender-inclusive approach:
  1. It negates accusations of cultural imperialism by applying the same standards to white children in the USA as to children of colour in Africa.
  2. It weakens accusations of sexism by recognising that boys and intersex children are also vulnerable to non-therapeutic genital alteration.
  3. It clarifies the moral confusion caused by applying a gendered-double standard to communities that modify both sexes' genitals. 
We quoted the Swiss lawyer Sami Abu-Sahlieh, who said: “Female circumcision will never stop as long as male circumcision is going on. How do you expect to convince an African father to leave his daughter uncircumcised as long as you let him do it to his son?”

Finally, we made two arguments for extending protections to male and intersex children. The first was an ethical argument, namely that consent, not sex, should form the basis of policy: All children should be protected from non-consensual, non-therapeutic cutting of their genitalia. 

The second was an effectiveness argument: That efforts to eliminate FGC will only be successful if they expand to include vulnerable persons of all genders.

Participants' reactions to our analysis were very encouraging. Everyone was enthusiastically and vocally supportive of the need to apply principles of bodily integrity consistently to children of all genders. 

Thank you to the organisers for providing the space for this important conversation. Here's to many more discussions like this!