Few studies explore in-depth accounts of women's and men's experiences with, and transitions between, obstetrician/gynaecologists (OB/GYNs) and reproductive endocrinologists during infertility diagnostic and treatment processes. This study examined this subject matter with data from qualitative, in-depth, semi-structured interviews. Between April 2007 and March 2008, the first author interviewed 20 women and eight men from a large midwestern metropolitan area in the USA who had used, or were in the process of using, any fertility treatment in the 5 years preceding the interview. Six couples and 16 individuals were interviewed, resulting in narratives of 22 distinct infertility journeys. The main complaints made by respondents about OB/GYNs were that they were insufficiently concerned with providing timely treatment and that they paid insufficient attention to male partners. Women felt that their concerns were taken more seriously by reproductive endocrinologists, but complained of insensitivity, depersonalization and misinformation, and were suspicious of a profit orientation.
Childbearing takes place at increasingly older ages, and fertility is continuing to decrease across female birth cohorts. This study investigated whether the proportion of women who unintentionally forwent childbearing increased over time, and linked this to the age profile of fertility intentions and realization among men and women. This study was based on the Austrian Micro-Censuses (1986–2016) and on the Austrian Generations and Gender Surveys (panel data 2008/09 and 2012/13). Across the birth cohorts 1950–1979, an increasing proportion of women wanted to have children after 40 years of age, but more women failed to meet their fertility intentions expressed at 34–36 years of age. At the individual level, from 30 years of age, more than one-third of women and men with a strong fertility intention were found to persist with this intention within four years even at less fertile ages. In addition, women and men with a strong fertility intention became less likely to have a child with age: <10% of women and approximately 20% of men who had expressed a certain and short-term intention to have a child at 39–41 years of age in 2008/09 had a child by 2012/13. In particular, childless women and men, and those with only one child, persisted in certain and short-term positive intentions from 30 years of age, but parity was not a significant factor in their realization. The sharp increase in ‘unrealized fertility’ over time draws attention to the importance that personal circumstances and context encountered at older ages may have for fertility, and augurs a continued increase in the use of assisted reproduction.
Conceptualizations of the 'biological clock' in popular imaginary in the USA centre on the temporal limits of fertility, with assisted reproductive technology (ART) an increasingly proposed answer to these constraints (at least in the public imaginary). In this study, I analyse how surrogates in the USA understand their own bioavailability for others' reproductive needs in the commercial ART market vis-à-vis their own reproductive trajectories. Based on interview data with gestational surrogates, I propose a new concept of the 'ART clock' to capture how time shapes the experiences of reproductive workers in the US fertility clinic. My findings point to four important ART time-related issues: (i) women desiring to extend their own 'biological clocks' via surrogacy; (ii) significant time being needed to achieve and sustain third-party pregnancy; (iii) women extending their total reproductive time via repeat surrogacy 'journeys'; and (iv) temporal constraints to surrogacy reproduction regarding time of year, the day-to-day time effort, the number of surrogacy journeys, the total number of pregnancies, and surrogates' age and the ages of their children. Each of these aspects point to important ways that reproductive desire and time shape the labour of reproductive workers, highlighting temporal constraints to assisted reproduction and limits to ART as a solution to delayed reproduction and the biological clock.
The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented measures across all health services around the globe, including the large-scale cessation of assisted reproductive technology treatment in Europe as clinics closed, causing disruption and delay to the fertility treatment of thousands of patients in the UK alone. This research explores how patients were impacted by the delay and disruption, and their feelings, concerns and reactions. A mixed-methods, anonymous, online questionnaire, live between 19 May and 30 June 2020, was used to target all fertility patients aged >18 years whose treatment had been impacted by COVID-19. In total, 709 people began the questionnaire and 501 completed it in the time available (70.7% completion rate). Patients reported feeling ‘powerless/helpless’ (78.3%), ‘frustrated’ (59.3%) and ‘anxious’ (54.7%) in response to the closure of fertility clinics. The majority were ‘very concerned’ about time passing and not knowing when they could start treatment again (79.0%), and the length of waiting lists when clinics reopened (70.9%). While 76.8% of respondents had some concerns around contracting COVID-19, 42.9% were ‘not at all concerned’ about undergoing in-vitro fertilization treatment during a pandemic. Variables such as funding source, duration of infertility, previous experience of fertility treatment, treatment stage and the presence of children were correlated with significant intragroup differences in the types of concerns reported. The large majority (72.7%) of respondents stated their eagerness to start treatment as soon as possible, and 9.4% said that they had already resumed treatment; only 6.0% of respondents wanted to wait due to concerns related to COVID-19.
From 1941, the synthetic oestrogen diethylstilbestrol (DES) was administered to millions of women around the world to prevent miscarriages. In 1971, a clear and direct link was shown between taking DES during pregnancy and its subsequent long-term morbid effects on offspring. In the last 50 years, the list of side effects of in-utero exposure to DES has grown to include cancer, infertility, significant prematurity and urogenital malformation, amongst others. Based on qualitative sociological research conducted between 2010 and 2013, compiling archives, judicial documents and 108 interviews, this article illustrates a continuous production of ignorance in France. By focusing on DES as a reproductive health technology, three aspects are stressed. First, in terms of recognition of adverse effects, despite DES being identified as a prototype for other technologies such as the contraceptive pill or hormone replacement therapy, there remained a strong reluctance to import knowledge from the USA on its dangers and risks. Second, there was indifference to transgenerational side effects: even when the most visible effects of DES were finally acknowledged, there was a lack of consideration of the health of descendants; an inability to deem the knowledge of these repercussions as emancipatory or potentially empowering for the offspring. Third, regarding the health care of DES daughters, an important propensity to undone science is highlighted, with notable indifference to the risks of hormonalization of the female body, even on the part of activists. Thus, decades after it was last given to pregnant women, the shadow of DES still lingers as a failed reproductive health technology.
If parents have used donated gametes, it is a personal choice whether they disclose to their children. For those that do, there is, however, little advice on how to tell their children. The Donor Conception Network (DCN) has made a series of books to help parents disclose. This study evaluated parents' experience of using these books. An online survey with both quantitative and qualitative questions was used. The DCN membership and social media were used to publicize the survey, and 108 responses were analysed. At the time of conception, the parents' family types were mainly mother and father (56.5%) and solo mothers (36.1%). The method of conception was mainly donor spermatozoa (55.6%) followed by donor egg (38.0%), double donation (8.3%) and one case of surrogacy. Most parents had read the book to their children before 2 years of age (76.9%). Before reading the books, some of the parents had some confidence in telling (43.5%) or were very confident in telling (30.6%). After reading the books, 60.2% reported having much more confidence in telling. Most parents felt their children had no understanding (76.8%) or only some understanding (22.3%) of donor conception before reading the books. After reading the books most parents felt their children's understanding had increased (71.3%). Most parents felt that reading the books had given them more confidence in using donor conception language (90.7%). The use of books to tell children about their conception may be a useful resource for parents wishing to be open with their children.
Most studies of the psychosocial consequences of infertility have focused on those who seek medical treatment, leaving a research gap regarding the psychosocial consequences of perceived inability to procreate in the general population. Moreover, most studies are cross-sectional and the results are thus likely affected by omitted variable bias. Inspired by aspects of the Theory of Conjunctural Action, this study analysed 10 waves of data from the German Family Panel (pairfam) for women and men using fixed effects panel regression and including time-varying control variables suggested by theory and research. This study found that both women and men experienced lower life satisfaction in years when they perceived an inability to procreate. This association was not affected by the inclusion of relevant time-varying control variables. Furthermore, the association between perceived barriers to procreation and life satisfaction was found to differ depending on life circumstances and gender. Women with partners and men without partners had lower life satisfaction when they perceived an inability to procreate compared with when they did not. Women and men who intended to have a(nother) child had lower life satisfaction when they perceived an inability to procreate compared with when they did not. The association, however, was only significant for men. Somewhat surprisingly, women who perceived an inability to procreate also had lower life satisfaction when they were not intending to have a(nother) child. This study makes an important contribution to research on the psychosocial consequences of perceived infertility, and provides insights into why some people may pursue assisted reproductive technology for family creation.
New Zealand and Australia are countries which currently prohibit donor payment and require open-identity forms of donation. This study explored the concerns of fertility stakeholders regarding payment which would constitute financial reward for gamete donation, and factors predicting such concerns. A total of 434 participants from across New Zealand and Australia completed an online survey anonymously. Participants included those with infertility and treatment experience, donors, recipients, donor-conceived people and clinic professionals. Results indicated that participants’ concerns related to their assumptions about the type of donor motivated by financial reward, and the possibility that, if paid, donors might conceal information relevant to treatment and the donor-conceived person. Furthermore, participants were concerned about increasing recipient costs. Participants with personal experience of infertility held stronger concerns overall. Professionals expressed concerns of clinical relevance, such as the withholding of donor information relevant to treatment outcomes. The lowest levels of concern were expressed in relation to payment devaluing the meaning of human life. Qualitatively, themes highlighted concerns regarding payment enticing the ‘wrong’ type of donor, increased cost to recipients, and concern about the wellbeing of donor-offspring. Collectively, such concerns must be understood against the New Zealand and Australia open-identity donation context which enables the possibility of contact between donors and offspring. These findings indicate that donor recruitment campaigns need to account for different stakeholder concerns, and consider ways to address donor shortages effectively while remaining compliant with legislative requirements.
Scholarly interest in reproductive travel has increased in recent years, but travel within, to and from the African continent has received much less attention. We reviewed the literature on cross-border reproductive travel to and from countries of sub-Saharan Africa in order to understand the local forms of this trade. Access to fertility care remains deeply stratified, which is an ongoing concern in a region with some of the highest rates of infertility. We found a wide variety of reasons for reproductive travel, including a lack of trusted local clinics. Destinations were chosen for reasons including historical movements for medical treatment broadly, diasporic circulations, pragmatic language reasons, and ties of former colonial relations. We describe the unique tempos of treatment in the region, ranging from some intended parents staying in receiving countries for some years to the short-term contingent support networks that reprotravellers develop during their treatment and travel. Unique to the region is the movement of medical professionals, such as the 'fly-in, fly-out' clinic staff to deliver fertility care. Future research should include practices and movements to presently neglected 'reprohubs', particularly Kenya and Nigeria; the impact of pandemic-related lockdowns and border closures on the movements of intended parents, reproductive assistors and reproductive material; and the impact of low-cost protocols on treatment access within the region. This scoping review provides insight into the relevant work on cross-border reproductive care in sub-Saharan Africa, where a unique combination of access factors, affordability, and sociocultural and geopolitical issues fashion individuals' and couples' cross-border reproductive travel within, to and from Africa.
This article examines the West German controversy over Duogynon, a ‘hormone pregnancy test’ and the drug at the centre of the first major, international debate over iatrogenic birth defects in the post-thalidomide era. It recovers an asymmetrical power struggle over the uneven distribution of biomedical knowledge and ignorance (about teratogenic risk) that pitted parent-activists, whistleblowers and investigative journalists against industrialists, scientific experts and government officials. It sheds new light on the nexus of reproduction, disability, epidemiology and health activism in West Germany. In addition, it begins to recover an internationally influential discourse that, in the post-thalidomide world, seems to have resuscitated antenatal drug use as safe until proven harmful.
Most women and men want and expect to have children. Parental age and some health behaviours affect fertility and the chance of conception. The aim of this study was to gauge people’s parenthood aspirations and knowledge about the factors that affect their chance of achieving them. Members of an Australian probability-based online panel aged 18–45 years were invited to complete a survey with questions about parenthood goals and knowledge about factors known to affect fertility. Of the 965 eligible people, 716 (74.2%) completed the survey. Only 6% stated that they did not want biological children. Around one in 10 respondents had experienced infertility. Amongst respondents aged 35–45 years, almost one in five (18%) had experienced infertility. Overall, respondents reported high levels of confidence about their understanding of preventative measures associated with safe sex and avoiding unwanted pregnancies. However, confidence in understanding of factors affecting ability to conceive was lower. Almost one-third of respondents believed that female fertility starts to decline between the ages of 35 and 39 years, and another one-third of respondents believed that the decline starts at 40 years of age or later. One in four respondents believed that male fertility starts to decline at 50 years of age or later. Findings suggest that people of reproductive age in Australia have inadequate knowledge about the factors that affect the chance of achieving their parenthood goals. Fertility health education initiatives are needed to allow people to make informed decisions about childbearing, and reduce the risk of unfulfilled parenthood aspirations.
Like other assisted reproductive technology (ART) procedures, the cost of egg freezing (EF) is significant, presenting a potential barrier to access. Given recent technological advancements and rising demand for EF, it is timely to reassess how EF is funded. An online cross-sectional survey was conducted in Victoria, Australia and was completed by 656 female individuals. Participants were asked their views on funding for both medical and non-medical EF. The median age of participants was 28 years (interquartile range 23–37 years) and most participants were employed (44% full-time, 28% part-time, 33% students). There was very high support for public funding for medical EF (n = 574, 87%), with 302 (46%) participants indicating support for the complete funding of medical EF through the public system. Views about funding for non-medical EF were more divided; 43 (6%) participants supported full public funding, 235 (36%) supported partial public funding, 150 (23%) supported coverage through private health insurance, and 204 (31%) indicated that non-medical EF should be self-funded. If faced with the decision of what to do with surplus eggs, a high proportion of participants indicated that they would consider donation (71% to research, 59% to a known recipient, 52% to a donor programme), indicating that eggs surplus to requirements could be a potential source of donor eggs. This study provides insights that could inform policy review, and suggests revisiting whether the medical/non-medical distinction is a fair criterion to allocate funding to ART.
This study examined awareness about fertility among immigrant women and non-migrants in Germany. The social relevance of infertility and fertility treatment is increasing in Western countries due to continually low overall birth rates, a high rate of childlessness, and a gap between the desired and actual numbers of children. While there is growing interest in infertility and reproductive medicine in general, previous studies have rarely included immigrant or ethnic minorities in Europe. This study investigated whether knowledge on the age-related fertility decline (ARFD) varies between migrant groups and the majority group, and the role of education. Working hypotheses were drawn from theoretical considerations on frameworks of migrant assimilation. The analysis was based on data collected in a social science pilot study on reproductive medicine, representative of the general population (‘NeWiRe’ 2014–2015). The sample included 962 women aged 18–50 years living in Germany. Approximately 81% of the sample were immigrants who originated from Turkey, Poland, the Balkan countries or countries of the (post-Soviet) Commonwealth of Independent States. While rather poor overall, knowledge on ARFD was found to be significantly lower in the migrant groups compared with the majority group. This minority-group disadvantage cannot be explained by sociodemographic or cultural variables. Future research should include minority groups in empirical studies on awareness about fertility in order to better understand the causes of this disadvantage, and the potential reproductive needs of migrants.
Zsuzsa Berend is a sociology professor at the University of California, Los Angeles, and her 2016 book, The Online World of Surrogacy is an ethnographic study of surrogacy in the United States. Berend explores the cultural and emotional work American surrogates actively engage in with one another on Surrogate Mothers Online (SMO, http://surromomsonline.com), the largest online (and public) surrogacy support website. Specifically, this book focuses on the meanings that surrogates collectively make in relation to ideas of relatedness, surrogacy contracts, money, and the concept of 'the gift' that is pervasive in discourses about and academic analyses of surrogacy. More broadly, Berend's analysis is situated within the larger sociocultural context, including kinship practices, parenthood, money, reproductive labour, and assisted reproduction in the USA. The Online World of Surrogacy builds on and offers an extended analysis of some of the themes already introduced elsewhere (see Berend, 2012Berend Z. The romance of surrogacy 1.Sociological Forum. 2012; 27: 913-936Crossref Scopus (40) Google Scholar). Through the book, the author carefully steers the reader through the myriad complexities of surrogacy and the issues that can arise. These include the more contentious topics related to surrogacy, such as monetary compensation and legal contracts. This book will be of particular interest to the multi-disciplinary field of reproduction studies, medical and sociological anthropology, and kinship studies. For over a decade, Berend immersed herself in the virtual community and world of SMO, the original surrogacy support forum that had grown from 800 members in 2002 to 30,000 in 2013. She also had email correspondence with 35 surrogates and face to face conversations with one person. As a public forum, SMO is easier to access than closed and private online spaces where surrogates and intended parents interact. Berend is not the only outsider to be interested in reading what surrogates discuss on SMO (p. 1). Yet, her data gathering spans over 10 years, and has resulted in the only ethnography or book based on a virtual surrogacy community. Her meticulous approach to analysing and interpreting the complexities of surrogacy are evident throughout. Although this makes the ethnography valuable in itself, some of the overarching discussion points provide fresh contributions and nuance. During the dissertation writing phase of my PhD on surrogacy in New Zealand, The Online World of Surrogacy sat on my desk in a pile of the 'key' ethnographic texts on surrogacy within reproduction studies. The array of rainbow-coloured tabs peeking out from its pages and sticky notes on my 'things to think about' wall from the book demonstrate the significance of this ethnography. More than once, I silently thanked Berend (and admittedly told her at a conference and via email) for writing it. In this review, I will explore some of the key themes that emerge from each of the chapters. In Chapter One, 'The Virtual Meeting Ground for Real People', Berend introduces the reader to the SMO forum, describing her field-site and the various threads and sub-threads where members can ask questions, share news, and discuss the topic of surrogacy and beyond. Here, we also learn about the forum culture and how more experienced members define and maintain the rules of engagement. Forum moderation is underpinned by certain shared expectations of what a good surrogate 'is' and how she behaves. These expectations ultimately shape the behaviour of new members. For example, 'newcomers were expected to not complain about both the responses they received; they were expected to 'take it' and learn to conform to group norms' (p. 22). At the same time, more seasoned surrogates are not immune to these unwritten rules, particularly if they are seen to be complaining about being treated badly by the intended parents. We see later in the book that they would be more likely to receive sympathy if the intended parents had breached a contract or broke promises they had made, but if the surrogates shared distress that was borne out of personal expectations, then they would be chastised. At the same time, according to Berend, these norms around what is deemed appropriate grief or distress are reflective of surrogates' desire to avoid the practice of surrogacy being seen in an unfavourable light:As I came to realize, surrogates did not want me to take their side; rather they wanted me to be pro-surrogacy. In the context of much media attention to bad stories, any criticism could potentially turn into a critique of surrogacy itself. If IPs could be so unfair or ungrateful, can it still be true that they are wonderful people who deserve a baby? (pp. 43–44). Policing of the website and discussions by members is influenced by the desire to represent a particular image of surrogacy to those who read the conversations. In the introduction, Berend calls it a 'new kind of social control', with discussions revealing joint efforts to 'negotiate and define the balance between selflessness and self-protection, between giving and receiving' (p. 6). Surrogates, particularly newbies, were encouraged to protect themselves and negotiate adequate financial and legal provisions. Chapter One also spotlights the need for a community to foster connection, create shared meanings and assert agency. Whether that is to do research before choosing a surrogacy agency (in the US context), or successfully matching without any intermediatory at all, both reflect the shift to self-determination. Online matching in particular shows a de-centring of the monopoly that clinics and agencies have traditionally had over the surrogacy process. In contrast to Ragoné, 1996Ragoné H. Surrogate Motherhood: Conception in the Heart. Routledge, 1996Google Scholar much earlier ethnography on US surrogacy, Berend found that surrogates were taking more control over their journeys. Over the 10 years of research, Berend identifies the increasingly savvier and better-informed discussions, particularly on contracts and grasp of legal logic (p. 106). Within the strictly altruistic context in New Zealand, where there are no agencies or intermediaries, surrogates must find their own matches, unless they offer to be a surrogate for family or friends. I vividly recall conversations with some of my research participants, when they said that perhaps if there was an agency, they would have felt less lost when they started out. Of course, they have their online support forums, which is where many surrogates and intended parents seeking a match ultimately find a community of like-minded people that have been through the journey on which they are embarking on. At the same time, not everyone I spoke with felt comfortable using this forum. For some, places like California were seen as 'the easier option if you have money'. Chapter Two, 'Journey', explores the relational aspects of surrogacy, between surrogates and their intended parents, and between surrogates and the foetus that they carry. Surrogates use the rhetoric of love to 'reframe commercial surrogacy as an intimate relationship with the intended parents' (p. 12). The giving becomes part of the romance and journey, even when surrogates have disappointing experiences. The 'romance of surrogacy' often reignites their desire to do another surrogacy. This was consistent with some of my participants in New Zealand who felt they could (and should) replace one 'bad journey' with a 'good one'. We learn that the hope of connection and 'shared love' is part of the narrative of altruistic giving within a commercial context. It is not void of altruistic motivations or intentions, blurring the lines between commodification and altruism. Berend's framing of surrogates' feelings, thoughts, and experiences as relational, emotional, and intimate reveals one of several continuums between the commercial (US) and altruistic contexts (New Zealand). In New Zealand, where only altruistic surrogacy is legal, and advertising for surrogacy arrangements is prohibited (as is the case in the UK), many intended parents and surrogates find one another on a closed forum. Similarly, the use of romantic metaphors is also part of the narrative in New Zealand, alongside a pragmatic approach to finding a match (Gibson, 2021aGibson, Hannah, 2021a. The Search for the Right Match: Finding a Surrogate in Aotearoa New Zealand. In Assisted Reproduction and New Family Formation, edited by Rhonda ShawGoogle Scholar, Gibson, 2021Gibson H. 'Doing it our way': Participation and resistance in traditional surrogacy.Medical Anthropology Theory. 2021; (in press)Crossref Google Scholar). According to Berend (p. 66), American surrogates prioritise spending time getting to know their potential intended parents, while at the same time more experienced community members encourage 'newbies' to trust their own intuition and to take a 'leap of faith'. In Chapter Three, 'Contract', Berend explores the way that surrogates negotiate some of the tangible and intangible aspects of surrogacy and the surrogacy arrangement. We learn that within the US, the surrogacy contract is more than a legal document. It is laden with affective meanings linked to concepts such as reciprocity, respect, and recognition of the various sacrifices required by surrogates. As such, the contract is the means through which 'relationships are negotiated' (p. 105) between surrogates and intended parents and provides an opportunity to think through complex moral questions, including the number of embryos to be implanted, under what conditions termination is acceptable, and selective reduction. Actors focus on self-protections because surrogacy is understood and approached as an intimate journey that may not always work out as hoped or expected. Chapter three also highlights that the contract, often pitted by critics of surrogacy, alongside the topic of money, as the proof that surrogacy commodifies babies, is a way to protect everyone involved in the surrogacy arrangement. One of the interesting things to emerge from the altruistic New Zealand surrogacy context is how the lack of legal parental rights for the intended parents makes all parties feel vulnerable1There can be no enforceable contract, and legally, regardless of who is genetically related to the baby born of surrogacy, the law identifies the 'birth mother' as the legal mother and her parent, if she has one, as the legal father. The intended parents become the legal guardians of the baby once they have applied for adoption. While the surrogate can choose to keep the baby, the intended parents can also choose to not adopt the child, leaving both vulnerable. 1There can be no enforceable contract, and legally, regardless of who is genetically related to the baby born of surrogacy, the law identifies the 'birth mother' as the legal mother and her parent, if she has one, as the legal father. The intended parents become the legal guardians of the baby once they have applied for adoption. While the surrogate can choose to keep the baby, the intended parents can also choose to not adopt the child, leaving both vulnerable.. Any contract would thus be meaningless, and yet some in the surrogacy community find that writing a 'letter of intent' symbolically helps to mitigate risks by providing a formal (if not legally enforceable) agreement. In Chapter Four, 'Money', Berend reveals how surrogates conceptualise the role of money in surrogacy arrangements. Similar to Ragoné, 1996Ragoné H. Surrogate Motherhood: Conception in the Heart. Routledge, 1996Google Scholar findings, surrogates are not primarily motivated by money, and remuneration is seen as the necessary compensation for the physical and emotional hardships of pregnancy and labour (p.151). Surrogates are quick to argue that babies themselves are priceless (p. 147), and the rhetoric of money is often combined with 'altruism, reciprocity, emotional benefits, and rewards for the surrogate's family' (p. 152). Monetary compensation is thus complementary to altruistic intentions and motivations, having both symbolic and practical significance. Berend highlights the centrality of the forum in helping surrogates to make sense of this topic: 'SMO discussions enable surrogates to collectively respond to criticism without denying the importance of money and allow them to make sense of their complex motivations and to situate money in the relational rather than in the business context of money' (p. 151). Some surrogates emphasise the role of empathy and altruistic intentions by calling attention to how much money they actually receive in comparison to what they give (p. 163). Berend also captures the shifting of priorities, and how, for those surrogates who were initially incentivised by money, it took on less meaning over time. This is similar to Elly Teman's findings in the Israeli context, although carrying a baby for money is less stigmatised in Israel (Teman, 2010Teman E. Birthing a Mother: The Surrogate Body and the Pregnant Self. University of California Press, 2010Crossref Google Scholar). Chapter Five, 'Gift' deals with the metaphor of 'the gift' as it relates to the surrogates' collective identity and in relation to the topics discussed in the previous chapters. As defined by the surrogates in this book, the 'gift of life' is irreducible to the child or baby they have conceived and gestated. Rather, it is the process of conceiving and giving birth that culminates in parenthood and thus this capacity, in combination with other factors, makes surrogates a special kind of resource (p. 193). This conceptualisation challenges critiques of surrogacy as an exploitative practice that commodifies the baby, who cannot be a 'gift' when money is involved. Berend's analysis underlines the importance of not applying a simplistic lens to the practice. Rather, multiple processes are involved in surrogates helping their intended parents fulfil their dream of having a family. As touched on in other chapters, surrogacy is redefined by surrogates as 'a gift relationship' (p. 193), one that ideally involves bonds of reciprocity and affective ties of (non-sexual or romantic) intimacy and relationships. Here, we read about the rhetoric of the 'gift of trust', and sacrifice involved. Overall, The Online World of Surrogacy is an excellent ethnography of the virtual surrogacy community. The overarching arguments Berend makes highlight the relevance of focusing entirely on how surrogates collectively create meanings. Berend finds Viviana Zelizer, 2009Zelizer V.A. The Purchase of Intimacy. Princeton University Press, 2009Crossref Google Scholar 'relational work' concept useful to frame her analysis, choosing to focus on the 'interactions that create shared understandings, ideas, and desires among the women who assist reproduction…..[rather than] on reproductive technologies or the politics or reproduction' (p. 5). At the same time, although Berend describes the enormous amounts of data she was left with after logging onto the site several times a week for over a decade, I think that she could have elaborated more on her methods. Given the depth and length of her engagement, it would have been good to see more about how she conducted this research. Virtual ethnographies are less understood than more 'traditional' approaches to ethnography and I felt like the entry to the field, and her presence in it, was mostly absent. One of the most valuable contributions Berend makes with this book is spotlighting the surrogates' narratives rather than the practice of surrogacy itself. Berend's decision to centralise the surrogates' voices in each chapter, whilst weaving in some main themes and her own analysis throughout, paints a vivid image of the topics that are important to surrogatres. Unsurprisingly, their perspectives and experiences differ from the common perceptions of surrogacy within the media and wider society. Surrogacy threatens the very foundations of the institution of 'the family', particularly the cultural myths about motherhood and relatedness (Gibson, 2021Gibson H. 'Doing it our way': Participation and resistance in traditional surrogacy.Medical Anthropology Theory. 2021; (in press)Crossref Google Scholar, Teman and Berend, 2021Teman E. Berend Z. Surrogacy as a family project: How surrogates articulate familial identity and belonging.J. Family Issues. 2021; 42: 1143-1165Crossref Scopus (0) Google Scholar) Berend rightly argues that critics have not taken surrogates' own perspectives into consideration (p. 2), and I ponder whether it is in part because their narratives challenge, or at the least add nuance to, pervasive critiques which purport that surrogacy leads to exploitation of women and the commodification of babies and reproduction.
