Shifting surrogacies: Comparative ethnographies

Gestational surrogacy is a reproductive arrangement where a woman gestates a child for others—the “intended parents”—in order to be handed over to them after birth. Since the turn of the millennium, demands for surrogacy have continuously increased due to social and demographic changes, rising rates of infertility, and the normalization of new, non-heteronormative, family forms. Many countries prohibit surrogacy, and others that previously permitted this reproductive arrangement closed down as a result of political decisions or surrogacy scandals. Moreover, surrogacy is offered at greatly varying costs, ranging from approximately US$50,000 in countries like the Republic of Georgia to US$200,000 in fertility clinics in California. Accordingly, many of these arrangements are transnational, with intended parents who cannot access surrogacy or afford surrogacy in their home country commissioning it in countries such as the United States, until recently Ukraine, and today increasingly in the Republic of Georgia. Existing research has focused on surrogacy from different angles, such as practices of kinning and de-kinning, inequality and stratification, the political economy of the fertility industry, and its gender dimensions. We engage in, but further these debates by drawing attention to settings, accounts, experiences, and new theoretical notions that diverge from “mainstream” presentations of surrogacy. Moreover, in this Special Issue, we experimented with writing joint papers with a deliberative aim to provide comparative analyses and emphasize the links between and diversity of different cases of surrogacy. Therefore, all papers have an explicit comparative character and are all based on empirical studies from more than one field site. They provide nuanced understandings of surrogacy arrangements, grounded in empirical data rather than ideological, political, or moral assessments

Assisted reproductive technologies in Ghana: transnational undertakings, local practices and ‘more affordable’ IVF

The article sketches the origins and development of IVF in Ghana as a highly transnational undertaking. Movements are from and to Africa, involving human beings (providers and users), and also refer to other entities such as technologies, skills and knowledge. None of these movements are paid for using public money, neither are they subsidized by international health organizations. Currently, ‘more affordable’ IVF is being introduced into Ghana, on initiative of the first Association of Childless Couples of Ghana (ACCOG), in collaboration with the Belgium based non-profit organization the Walking Egg (tWE), representing another form of transnational networking. The article underlines the scarcity of well-trained embryologists in Ghana, which turns the embryologists’ expertise and skills into a scarce and precious commodity and guarantees this expertise becomes a major challenge for the directors of the private clinics. Next to local Ghanaian couples, the clinics also attend to transnational reproductive travellers, including women and men from neighbouring countries and Ghanaians in the diaspora returning to their country of origin. Their manifold motivations to cross borders and visit the IVF clinics in Ghana provide insight into the structural conditions impeding or facilitating the use of assisted reproductive technologies at different local sites. Transnational movements also include the flow of new procreation practices (such as surrogacy and the use of donor material), which (re-)shape existing cultural and societal notions regarding kinship and the importance of blood/genetic ties. Finally, the article lists a number of thematic and theoretical issues which require further exploration and studies

Shifting surrogacies: Comparative ethnographies

Gestational surrogacy is a reproductive arrangement where a woman gestates a child for others—the “intended parents”—in order to be handed over to them after birth. Since the turn of the millennium, demands for surrogacy have continuously increased due to social and demographic changes, rising rates of infertility, and the normalization of new, non-heteronormative, family forms. Many countries prohibit surrogacy, and others that previously permitted this reproductive arrangement closed down as a result of political decisions or surrogacy scandals. Moreover, surrogacy is offered at greatly varying costs, ranging from approximately US$50,000 in countries like the Republic of Georgia to US$200,000 in fertility clinics in California. Accordingly, many of these arrangements are transnational, with intended parents who cannot access surrogacy or afford surrogacy in their home country commissioning it in countries such as the United States, until recently Ukraine, and today increasingly in the Republic of Georgia. Existing research has focused on surrogacy from different angles, such as practices of kinning and de-kinning, inequality and stratification, the political economy of the fertility industry, and its gender dimensions. We engage in, but further these debates by drawing attention to settings, accounts, experiences, and new theoretical notions that diverge from “mainstream” presentations of surrogacy. Moreover, in this Special Issue, we experimented with writing joint papers with a deliberative aim to provide comparative analyses and emphasize the links between and diversity of different cases of surrogacy. Therefore, all papers have an explicit comparative character and are all based on empirical studies from more than one field site. They provide nuanced understandings of surrogacy arrangements, grounded in empirical data rather than ideological, political, or moral assessments

Counsellors’ practices in donor sperm treatment

When intended parents choose to have donor sperm treatment (DST), this may entail wide-ranging and long-lasting psychosocial implications related to the social parent not having a genetic tie with the child, how to disclose donor-conception and future donor contact. Counselling by qualified professionals is recommended to help intended parents cope with these implications. The objective of this study is to present findings and insights about how counsellors execute their counselling practices. We performed a qualitative study that included 13 counsellors working in the 11 clinics offering DST in the Netherlands. We held a focus group discussion and individual face-to-face semi-structured interviews, which were fully transcribed and analysed using thematic analysis. The counsellors combined screening for eligibility and guidance within one session. They acted according to their individual knowledge and clinical experience and had different opinions on the issues they discussed with intended parents, which resulted in large practice variations. The counsellors were dependent on the admission policies of the clinics, which were mainly limited to regulating access to psychosocial counselling, which also lead to a variety of counselling practices. This means that evidence-based guidelines on counselling in DST need to be developed to provide consistent counselling with less practice variation

Reproductive travel to, from and within sub-Saharan Africa:A scoping review

Reproductive travel to, from and within sub-Saharan Africa: A scoping revie

Mothers’ reproductive and medical history misinformation practices as strategies against healthcare providers’ domination and humiliation in maternal care decision-making interactions: an ethnographic study in Southern Ghana

Abstract Background Pregnant women can misinform or withhold their reproductive and medical information from providers when they interact with them during care decision-making interactions, although, the information clients reveal or withhold while seeking care plays a critical role in the quality of care provided. This study explored ‘how’ and ‘why’ pregnant women in Ghana control their past obstetric and reproductive information as they interact with providers at their first antenatal visit, and how this influences providers’ decision-making at the time and in subsequent care encounters. Methods This research was a case-study of two public hospitals in southern Ghana, using participant observation, conversations, interviews and focus group discussions with antenatal, delivery, and post-natal clients and providers over a 22-month period. The Ghana Health Service Ethical Review Committee gave ethical approval for the study (Ethical approval number: GHS-ERC: 03/01/12). Data analysis was conducted according to grounded theory. Results Many of the women in this study selectively controlled the reproductive, obstetric and social history information they shared with their provider at their first visit. They believed that telling a complete history might cause providers to verbally abuse them and they would be regarded in a negative light. Examples of the information controlled included concealing the actual number of children or self-induced abortions. The women adopted this behaviour as a resistance strategy to mitigate providers’ disrespectful treatment through verbal abuses and questioning women’s practices that contradicted providers’ biomedical ideologies. Secondly, they utilised this strategy to evade public humiliation because of inadequate privacy in the hospitals. The withheld information affected quality of care decision-making and care provision processes and outcomes, since misinformed providers were unaware of particular women’s risk profile. Conclusion Many mothers in this study withhold or misinform providers about their obstetric, reproductive and social information as a way to avoid receiving disrespectful maternal care and protect their privacy. Improving provider client relationship skills, empowering clients and providing adequate infrastructure to ensure privacy and confidentiality in hospitals, are critical to the provision of respectful maternal care

Knowing what the patient wants:a hospital ethnography studying physician culture in shared decision making in the Netherlands

OBJECTIVES: To study physician culture in relation to shared decision making (SDM) practice. DESIGN: Execution of a hospital ethnography, combined with interviews and a study of clinical guidelines. Ten-week observations by an insider (physician) and an outsider (student medical anthropology) observer. The use of French sociologist Bourdieu's 'Theory of Practice' and its description of habitus, field and capital, as a lens for analysing physician culture. SETTING: The gynaecological oncology department of a university hospital in the Netherlands. Observations were executed at meetings, as well as individual patient contacts. PARTICIPANTS: Six gynaecological oncologists, three registrars and two specialised nurses. Nine of these professionals were also interviewed. MAIN OUTCOME MEASURES: Common elements in physician habitus that influence the way SDM is being implemented. RESULTS: Three main elements of physician habitus were identified. First of all, the 'emphasis on medical evidence' in group meetings as well as in patient encounters. Second 'acting as a team', which confronts the patient with the recommendations of a whole team of professionals. And lastly 'knowing what the patient wants', which describes how doctors act on what they think is best for patients instead of checking what patients actually want. Results were viewed in the light of how physicians deal with uncertainty by turning to medical evidence, as well as how the educational system stresses evidence-based medicine. Observations also highlighted the positive attitude doctors actually have towards SDM. CONCLUSIONS: Certain features of physician culture hinder the correct implementation of SDM. Medical training and guidelines should put more emphasis on how to elicit patient perspective. Patient preferences should be addressed better in the patient workup, for example by giving them explicit attention first. This eventually could create a physician culture that is more helpful for SDM