Access to Assisted Reproductive Technologies: The Case of France and Belgium. Jennifer Merchant, ed., 2020, New York: Berghahn Books, 2020, 242 pp.
Vérité en deçà des Pyrénées, erreur au-delà (Truth on one side of the Pyrenees, error on the other). This maxim from Pascal, a French philosopher and mathematician, cannot be more pertinent to contextualize Access to Assisted Reproductive Technologies: The Case of France and Belgium. Like the Pyrenees in Pascal’s aphorism, the border between France and Belgium delineates conflicting views of assisted reproductive technologies. France and Belgium are two neighboring countries that share many cultural traits but have distinctive ways of regulating and practicing assisted reproductive technologies (ARTs). In this volume, scholars from France, Belgium, England, and the United States, representing anthropology, sociology, political science, philosophy, and law, contribute to the flourishing scholarship on ARTs. Their contributions offer a comparative and transnational portrait of a restrictive ART landscape in France and a liberal and pragmatic one in Belgium.
Many French patients cross the border in pursuit of their parental project, especially single women and lesbian couples as well as gay men needing surrogacy. Refusing to abide by a therapeutic, heteronormative, and exclusionary model, they conceive “Thalys Babies,” named for the train that connects Paris to Brussels. Yet much of the literature on ARTs in France and Belgium has not reached English readership. This book is thus a rich addition to the field because it sheds light on ARTs and reproductive national politics in these two countries.
A major focus of the volume is the international governance of ARTs between porous nation states.The book focuses on reproductive technologies involving gamete or embryo donation and surrogacy, highlighting the stark differences between Belgian and French law, where the latter is based on a therapeutic model of assisted reproduction. French law bans surrogacy as well as gamete or embryo donation for heterosexual couples suffering from medical infertility, and only recently allowed access to ARTs for single people and same-sex couples. Belgian infertility centers, on the other hand, welcome many French patients and provide them with the care they seek thanks to a lenient regulatory environment. Indeed, in Belgium, all that is not forbidden by law is implicitly allowed. This context nurtures a welcoming biomedical environment for all kinds of parental projects.
The flow of patients to Belgium illuminates tensions within the French model, considered hypocritical by many contributors of this book since treatments provided abroad are reimbursed by the French social security apparatus. The book provides an insightful critique of the French nationalist reproductive culture, just as Parliament voted to extend ARTs to all women. But as liberal as it is, Belgian ARTs are not without tensions. As lawmakers debate the compulsory anonymity of donors and the regulation of surrogacy (which is currently unregulated but may change in the future), sociologists Cathy Herbrand and Nicky Hudson delineate how family formations constantly challenge the compulsory anonymity implemented by Belgian law (p. 97). Ultimately, sociologist Dominic Mehl argues that “the plea for European harmonization carries some risks” (p. 187), as it is difficult to know which model would be designed: the restrictive one, the permissive one, or a compromise between the two.
A second major theme of interest is the use of “reproduction” and “procreation” as analytical categories. The book opens with a foreword from sociologist Irène Théry, whose work is little known outside of French-based scholarship yet is very influential in France both in academia and in the public sphere. Théry shows how France views gamete and embryo donation by analyzing how French scholars and medical practitioners use the term procreation far more than reproduction. Indeed, ARTs are commonly referred to as “medically assisted procreation.” Furthermore, French scholarship distinguishes procreation from “filiation,” as exemplified by anthropologist Jérôme Courduriès’ work on same-sex families doing surrogacy. When surrogates belong to the realm of procreation, they forgo any ties of filiation, participating in kinship making practices without any rights to legal parentage. While procreation emphasizes relationality through the circulation of bodily substances and interpersonal subjectivities, reproduction focuses more on the classical distinction between social and biological aspects of conception. These two terms also illustrate different approaches to biotechnologies and the role of the biosciences. Belgian infertility practitioners take a pragmatic approach to biotechnologies, while French practitioners work in a national environment that associates science and technology with the objectification of bodies and persons.
But what about the colonial and race dynamics of France and Belgium? Three points call for critique, especially from the point of view of a U.S.-based readership attuned to identifying racial disparities and racism in reproduction.
First, gamete and embryo donations as well as surrogacy are highly racialized practices (see for example Deomampo 2016). Yet while France-based scholarship has devoted much analysis to class and gender, historically it has not offered equal attention to race. When nationalism, xenophobia, or racism are studied and analyzed, race remains a contested notion in a national context where the law forbids its use to categorize people (the trauma of the Holocaust based on a supposed Jewish race is one important reason for this). The absence of racial analyses throughout the chapters indicates that there is much work to be done.
Second, the overseas territories of France—Guadeloupe, Guyana, Martinique, Reunion, Mayotte, New-Caledonia, French Polynesia, Saint-Barthélemy, Saint-Martin, Saint-Pierre-et-Miquelon, French Southern, and Antarctic lands as well as Wallis-et-Futuna islands—welcome 2.6 million inhabitants, including 1.2 million youth (see http://www.outre-mer.gouv.fr/les-territoires). Yet the book focuses on “the hexagon” only and does not mention overseas territories. To my knowledge, there is no work published on ARTs in these territories, but I would have liked this topic raised and not erased.
Finally, writing about access, it would have been helpful to mention patients who, within Belgian and French borders, do not have access to ARTs because of their status as migrant workers, undocumented, or homeless people. Within states, too, national and economic borders bar access to many people who might wish to make families and who need the services of fertility specialists. Again, with the exception of two chapters on the experience of sub-Saharan families seeking ARTs in France (Bonnet and Duchesnes 2016), this type of scholarship is cruelly scarce.
It is not a coincidence that I started this review with a French quote from a French male philosopher. This ironic start speaks directly to a French style of framing reproductive bioethics through philosophical principles (Emmanuel Kant is popular in French bioethics), while Belgium has a more pragmatic and liberal approach to ARTs regulation. But, as views on either side of the border may change, philosophy can morph, too. Philosopher Marie Gaille concludes the book by advocating for empirically based philosophy. “The most difficult border to cross is one’s frame of thought,” she writes.
As this volume shows, social scientists continue to address the stiffness of some social norms and cultural symbols through teaching, publications, and public engagement. This book is certainly one more tool to soften, cross, transform, overlap, and queer mental barriers.
Bonnet, D., and V. Duchesnes. 2016. Procréation Médicale et Mondialisation. Expériences Africaines. Paris: L’Harmattan.
Deomampo, D. 2016. Transnational Reproduction. Race, Kinship and Commercial Surrogacy in India. New York: NYU Press.