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Speaker 1: social media ads for egg Freezing IVF clinics boasting about
Speaker 1: success rates, surrogacy contracts approaching the length of a book,
Speaker 1: websites where breast milk can be bought and sold. These days,
Speaker 1: the maternal body is increasingly seen in terms of monetary value.
Speaker 1: Does this leave people more vulnerable to exploitation or might
Speaker 1: it actually be empowering? As this week's book shows, there
Speaker 1: is no right answer. Journalist Alev Scott joins me to
Speaker 1: discuss her latest book, Cash Cow, How the maternal body
Speaker 1: became a global commodity and the hidden costs for women.
Speaker 1: Scott takes readers through her personal and compassionate exploration of
Speaker 1: the fascinating and at times deeply disturbing underbelly of the
Speaker 1: global fertility industry. She explores the three main elements that
Speaker 1: have undergone this commodification breast milk, eggs, and womb and
Speaker 1: delves into how each has been turned into a business
Speaker 1: opportunity with little to know public scrutiny the breast milk market,
Speaker 1: who's buying and who's selling in this completely unregulated space.
Speaker 1: Future fertility fairs promoting cutting edge technology alongside shamanic nutritionists
Speaker 1: are claims of success required to have support. The wide
Speaker 1: range of surrogacy legality across the globe, which countries allow
Speaker 1: for profit surrogacy versus altruistic only surrogacy versus surrogacy being
Speaker 1: labeled a crime against women. The regulation of sperm donation.
Speaker 1: Should a donor's identity be visible or should they remain anonymous?
Speaker 1: To say the ethics are complicated is quite the understatement,
Speaker 1: but that is where the power of cash Cow truly lies.
Speaker 1: Readers are forced to confront their feelings and have their
Speaker 1: assumptions questioned. Where does the line between exploitation and empowerment lie?
Speaker 1: Sitting in that moral gray zone is not a comfortable
Speaker 1: thing to do, but it is crucial, especially since the
Speaker 1: global fertility market will only continue to grow in the
Speaker 1: coming decades. I found this book to be a revelation,
Speaker 1: one of those books where for weeks after you're telling
Speaker 1: your friends about what you learned. I do want to
Speaker 1: mention that this conversation features discussions of pregnancy, loss, abuse,
Speaker 1: and overall exploitation. So please listen with discretion. Let's take
Speaker 1: a short break and get started. Alev, thanks so much
Speaker 1: for joining me today. Thank you for having me in
Speaker 1: the prologue of your book, cash Cow. You drop readers
Speaker 1: right into this strange world really of the breast milk market,
Speaker 1: which you later explained, you know, kind of planted the
Speaker 1: seed for this idea of this book. How did that
Speaker 1: seed grow?
Speaker 2: Like?
Speaker 1: When did you go from the breast milk market to
Speaker 1: kind of seeing the commodification of fertility everywhere you looked.
Speaker 3: I really didn't set out to write about the fertility
Speaker 3: industry or the breast milk market, but it kind of
Speaker 3: came about serendipitously when I had my first child a
Speaker 3: few years ago. It sort of did come from that
Speaker 3: initial encounter I had with the online breast milk market,
Speaker 3: and I suppose it was natural for my curiosity to
Speaker 3: go from there to other parts of the maternal body
Speaker 3: that are commodified. I was extremely lucky. I had a
Speaker 3: very easy, heteronormative route to motherhood. I didn't go through IVF,
Speaker 3: but many of my friends have either gone through IVF
Speaker 3: or are considering doing so, or they're having their eggs frozen,
Speaker 3: or they're looking at surrogacy. And so when I'd encountered
Speaker 3: that world before, i'd seen it through their eyes, but
Speaker 3: I began to see it a bit more from this perspective,
Speaker 3: I suppose of like, what are we actually doing here?
Speaker 3: Like what does the industry entail? How is it that
Speaker 3: there are such different laws and regulations in one country
Speaker 3: from the other, And how much does cultural attitude play
Speaker 3: into that? To be totally honest, I felt quite protective
Speaker 3: of some of my friends when they were embarking on
Speaker 3: these IVF journeys, because I could see that they were well,
Speaker 3: they were obviously desperate to have children, but they were
Speaker 3: they were very, very vulnerable as consumers as well. So
Speaker 3: I was looking at it from a kind of mark lens.
Speaker 3: I suppose. I don't know how better to explain it, really,
Speaker 3: other than my very personal, very visceral encounter with the
Speaker 3: breast milk industry online sort of matched up with my
Speaker 3: curiosity about the IVF market in other ways, and they
Speaker 3: kind of came together in this.
Speaker 1: Book, and you arrange this book in three main big chapters.
Speaker 1: Can you tell me a little bit about that structure
Speaker 1: and how you landed on that structure.
Speaker 3: I forced myself to be quite literal about what I
Speaker 3: was doing, which was really kind of breaking the maternal
Speaker 3: body down into its composite parts, the sort of byproducts
Speaker 3: of fertility in a way, or the stepping stones to
Speaker 3: having a child. And it made me think of a
Speaker 3: Dutch book I'd encountered, which was written by a Dutch
Speaker 3: artist about the uses of one commercially raised pig, and
Speaker 3: she detailed hundreds of uses of its body parts, everything
Speaker 3: from cigarettes to body like to pay to bullets, like
Speaker 3: crazy stuff. Anyway, that made me think about how the
Speaker 3: bits of the maternal body are commodified. And it is
Speaker 3: a bit of a start comparison perhaps, but I thought, actually,
Speaker 3: it's effective, and those are the three main parts of
Speaker 3: the maternal body that we do commoditize. So that's how
Speaker 3: I kind of landed on that structure.
Speaker 1: I really love how throughout the entire book you are
Speaker 1: constantly probing the question of exploitation and empowerment and where
Speaker 1: does it lie, and does it lie in a different
Speaker 1: place for different people, or different countries, or different experiences
Speaker 1: or different practices, And just so much of these questions
Speaker 1: that I think that many of us don't really consider
Speaker 1: that deeply or like unless we are confronted with it.
Speaker 1: And throughout the course of reading your book, I found
Speaker 1: myself confronted a lot by these ethical questions that I
Speaker 1: did know the answer to and I still don't know
Speaker 1: the answer to. And you discussed this as well, how
Speaker 1: some of your preconceptions about parenthood and fertility were overturned
Speaker 1: throughout the course of writing this. What were some of those?
Speaker 3: I think the subject I knew least about well. I mean,
Speaker 3: I knew very little about lots of things when I
Speaker 3: started this research. Sarrogacy was something that I didn't know
Speaker 3: very much about. I didn't actually know how I felt
Speaker 3: about it, because, like you, I'd never forced myself to
Speaker 3: confront any of the ethical questions that it brings up.
Speaker 3: I have to say that when I set out looking
Speaker 3: at the American model, I sort of expected to find
Speaker 3: it a bit in your face, a bit crass, like
Speaker 3: the commercial aspects of it, because I live in a
Speaker 3: country where only altruistic surrogacy is allowed, and in Europe
Speaker 3: sarrogacy is either banned in certain countries like Spain for example,
Speaker 3: or Italy, or it's allowed in a strictly altruistic sense,
Speaker 3: like in the UK or the nether So I was thinking, Okay,
Speaker 3: this is going to be a bit weird looking into
Speaker 3: the US market, and it was a bit weird. And
Speaker 3: the first time I read a surrogacy contract, I was
Speaker 3: very taken aback by some of the clauses in that contract.
Speaker 3: Having said that, by the time I finished my research,
Speaker 3: and by the time I'd looked into surrogacy markets in
Speaker 3: other parts of the world where surrogacy is not strictly illegal,
Speaker 3: but it's not really legal either.
Speaker 2: It's this gray.
Speaker 3: Area and there's a lack of regulation and no one
Speaker 3: really knows how the surrogates involved are treated. It depends
Speaker 3: from agency to agency. Those markets worried me so much
Speaker 3: more that I came round to the view that the
Speaker 3: US market is probably the safest in terms of well
Speaker 3: in terms of safeguards expectations from both sides.
Speaker 2: It doesn't mean it's perfect at all. There've been a
Speaker 2: couple of viral articles recently I don't know if you've read.
Speaker 2: There was one in Wired recently in New Yorker.
Speaker 3: For me, I was really glad those articles are written,
Speaker 3: not because I am critical of surrogacin and I want
Speaker 3: there to bad press about surrogacy out there, which, by
Speaker 3: the way, some people assume.
Speaker 2: Some people assume my book is anti sarrogacy. It's not.
Speaker 3: I just want to open up the conversations about the
Speaker 3: pitfalls and the weaknesses in the system, even in the US,
Speaker 3: which is held up as like you know, the post
Speaker 3: a child of a sorrogcy industry. It's it's much better
Speaker 3: than many other markets. It's not perfect, and we need
Speaker 3: to talk about why it's not perfect.
Speaker 1: Yeah, showing the full range of there is no one
Speaker 1: answer necessarily or one way to feel. And you do
Speaker 1: this right away in your chapter on breast milk and
Speaker 1: how you know you talk about that your first exposure
Speaker 1: to the fertility industry for this book was through the
Speaker 1: breast milk market. Can you tell me about this market?
Speaker 1: You know, who's on the market selling, who's on the
Speaker 1: market buying. Are there laws or regulations surrounding this, What's
Speaker 1: what's going on with the breast milk market?
Speaker 2: Great question, so I knew very little.
Speaker 3: I didn't know there was a breast milk market until
Speaker 3: I had my child, and I hadn't supply of milk.
Speaker 3: So I had all this frozen breast milk in the
Speaker 3: freezer and it was going to go to waste, and
Speaker 3: I wanted to donate it. I knew that was possible,
Speaker 3: although it isn't widely known. Actually, I happened to have
Speaker 3: a friend in Amsterdam who donated her breast milk to
Speaker 3: the hospital. So that's what I set out to do.
Speaker 3: And what I discovered while I was researching that was
Speaker 3: the online market, which took me by surprise. I decided
Speaker 3: to post an ad in this spirit of research.
Speaker 2: I was never.
Speaker 3: Intending to sell my milk because morally, I personally didn't
Speaker 3: want to do that. I've tried to be very open
Speaker 3: minded in my research and non judgmental about women who
Speaker 3: do sell their milk, but I personally didn't want to.
Speaker 3: I didn't feel comfortable, but I wanted to see who
Speaker 3: would approach me, and I also wanted to kind of
Speaker 3: just get a sense of the market and talk to
Speaker 3: other women selling their milk online. So I posted an
Speaker 3: ad and I made it very kind of clinical almost.
Speaker 3: It was just a photo of some milk that I'd pumped,
Speaker 3: and some details about the fact that I had an
Speaker 3: oversupply and that I donated to hospital previously, So in
Speaker 3: other words, it was not phishing for attention. But most
Speaker 3: of the replies I got, most of the requests I
Speaker 3: got were from men within hours of posting that ad.
Speaker 3: They were predominantly men.
Speaker 2: Which I think.
Speaker 3: I'd had an idea that maybe there might be a
Speaker 3: few men approaching me, but I hadn't expected it to
Speaker 3: be the vast majority. I thought the majority would be
Speaker 3: other parents, maybe mothers with milk supply, or gay or
Speaker 3: adopted parents looking for breast milk, so that was a
Speaker 3: huge surprise. Some of them didn't come straight away with
Speaker 3: sexual requests. They said they were bodybuilders it's very big
Speaker 3: in the bodybuilding industry. Or they said they had a
Speaker 3: health concern like IBS, or they were cancer survivors or.
Speaker 2: Something like that.
Speaker 3: But often when we got into a correspondence, the sexual
Speaker 3: element would come out.
Speaker 1: Let's take a quick break, and when we get back,
Speaker 1: there's still so much to discuss. Welcome back everyone. I've
Speaker 1: been chatting with elev Scott about her book cash cow,
Speaker 1: how the maternal body became a global commodity, and the
Speaker 1: hidden costs for women. Let's get back into things with
Speaker 1: this market. Is their regulation, for instance, like when you
Speaker 1: were looking into the breast milk market and selling milk online,
Speaker 1: what are the different places where people can do this
Speaker 1: and what are their regulations surrounding these websites.
Speaker 3: So in very few countries are there regulations. In a
Speaker 3: few countries it's banned altogether for reasons I go into
Speaker 3: in the book. There's often been a scandal and the
Speaker 3: government ends up saying, you know what, sales of breast
Speaker 3: milk at night banned now. But that's only happened in
Speaker 3: like two three countries. By and large, it's not It's
Speaker 3: not regulated in the UK and the US, it's actually
Speaker 3: classed as a food, So breast milk is the only
Speaker 3: bodily fluid substance that's classes as of food. The FDA
Speaker 3: and the FSA both advise against sales of breast milk,
Speaker 3: but it's not illegal. And honestly, I don't know who
Speaker 3: would trust breast milk that is sourced online because the
Speaker 3: dangers for the consumer are like obvious. Right, So when
Speaker 3: I donated to a hospital. I had to go through
Speaker 3: so many hoops. I had to have my blood tested
Speaker 3: for STDs, for all sorts of things like I had
Speaker 3: to promise. I had to sign forms promising not to
Speaker 3: have ibuprofen avil. I can't remember it. It was a
Speaker 3: big kind of saga to get through before they even
Speaker 3: agreed to accept my milk, which was then screened for pathogens.
Speaker 2: It was pasteurized.
Speaker 3: You know, it's being given to premature babies in hospitals,
Speaker 3: so the protocol is very strict. There's obviously none of
Speaker 3: that for something you're buying online. That kind of goes
Speaker 3: without saying. I don't think a lot of the men
Speaker 3: buying breast milk online care about that.
Speaker 2: I don't.
Speaker 3: They probably wouldn't care if it was actually cow's milk
Speaker 3: that some random person is, you know, putting into bottles
Speaker 3: and shipping to them. It's the idea of buying it
Speaker 3: that they like. So I'm less concerned about them about
Speaker 3: those particular consumers being defrauded. I'm more concerned about parents
Speaker 3: and babies being defrauded. But yeah, it's interesting. It's not
Speaker 3: regulated because it's not really legal, but it's not really illegal.
Speaker 2: It's just sort of there.
Speaker 3: It's just out there. It's just one of these things
Speaker 3: you can sell your used knickers online if you want to,
Speaker 3: Like there's it's just kind of the market's there if
Speaker 3: you want it.
Speaker 1: There is so much discourse today surrounding breast milk, and
Speaker 1: there's shame and judgment surrounding breastfeeding or not breastfeeding, whether
Speaker 1: that's a choice, whether that's something that you want to
Speaker 1: breastfeed but you cannot. And I couldn't help, but think of,
Speaker 1: you know, as reading your chapters, how technology has really
Speaker 1: transformed the way that we approach breastfeeding. Where there are
Speaker 1: pumps available, there'sctation consultants, there's formula available, and so there
Speaker 1: kind of then leads to the stigma surrounding breast milk
Speaker 1: that is not something that you produce directly that you
Speaker 1: either purchase or you know, formula or wet nursing for instance.
Speaker 1: And it's like technology has kind of in a way
Speaker 1: further the stigma and narrowed the acceptable range for if
Speaker 1: you do not breastfeed. Is that something that you kind
Speaker 1: of encountered throughout this I.
Speaker 3: Think there's a lot of kind of not just social stigma,
Speaker 3: but political stigma that surrounds breast milk because, as you say,
Speaker 3: breastfeeding is now this hot potato where I don't know
Speaker 3: about in the US, but in the UK certainly we
Speaker 3: used to have this slogan and breast is best that
Speaker 3: I think was used by the NHS, our National Health Service,
Speaker 3: and it was seen to be the best thing to
Speaker 3: give your child, but it came under this backlash because
Speaker 3: it was seemed to also shame women who chose not
Speaker 3: to or struggled to breastfeed and needed or chose to
Speaker 3: use infant formula instead. So I've now visited the milk
Speaker 3: bank where I donated my milk, and for premature babies,
Speaker 3: certain premature babies, they actually do need breast milk like
Speaker 3: they cannot digest infant formula right, So it's not a
Speaker 3: matter of like, oh, ideally they would have this or that,
Speaker 3: or it doesn't matter. They just they need it. So
Speaker 3: donations are absolutely crucial for saving the lives of premature
Speaker 3: babies in some instances, which is why I feel conflicted
Speaker 3: about the kind of open market which treats breast milk
Speaker 3: as it commodity which could go.
Speaker 2: To a baby in need, or it could go to a.
Speaker 3: Man because I on the one hand, I feel like, look,
Speaker 3: as long as a baby isn't being deprived, if mother,
Speaker 3: if a lactating mother at home, has got enough for
Speaker 3: her baby and she's got this excess, who am I
Speaker 3: to say where she sells it or who she sells
Speaker 3: it to, or whether she donates it. You know, I
Speaker 3: think we expect a lot more altruism of women than
Speaker 3: we do of men. And I think that's another stigma
Speaker 3: that kind of plays into all of this, is that
Speaker 3: we were like, what kind of mother sells her milk? Like,
Speaker 3: surely she would want to donate it to a hospital,
Speaker 3: and actually, like, you know, that woman is probably excluded
Speaker 3: from the labor market. It's a way for her to
Speaker 3: remain at home with her baby and make some money
Speaker 3: on the side to support her family. Who am I
Speaker 3: to say shouldn't be doing that? And if that means
Speaker 3: selling to men, maybe that just means selling to men.
Speaker 3: On the other hand, I have seen how important from
Speaker 3: a health perspective donated breast milk is and how dependent
Speaker 3: on donations hospital milk banks are, So it's difficult for
Speaker 3: me to keep that entirely out of my mind. If
Speaker 3: I thought that the private online market was so big
Speaker 3: that it was seriously threatening donations to the nonprofit sector,
Speaker 3: I'd be more worried, I think, even though it's much
Speaker 3: bigger than I expected, this online market, I instinctively I
Speaker 3: don't feel like it's leaching those nonprofit donations personally, but
Speaker 3: I might be wrong. I'm not an expert, That's the thing.
Speaker 3: I'm not an expert in any of these fields. All
Speaker 3: I'm saying as a journalist is what I've found in
Speaker 3: my research. But that's where the interesting kind of ethical
Speaker 3: conundrums come from. Is like we don't really know actually
Speaker 3: m hm.
Speaker 1: Again, this question of empowerment versus exploitation, and who gets
Speaker 1: to decide that whether something is exploited and versus empowering.
Speaker 1: Is it the individual, is it society? Yeah, I feel
Speaker 1: like there are so many dimensions.
Speaker 3: Definitely, And I think also at this part of the
Speaker 3: book where I talk about the Cambodian example, where very
Speaker 3: poor women in Cambodia were being paid by an American
Speaker 3: company to I mean they call it compensation. Essentially, they
Speaker 3: were being paid for their milk. And women's rights groups
Speaker 3: got to know about this and there was this big
Speaker 3: backlash in Cambodia ended up being one of the first
Speaker 3: governments to say when banning exports of breast milk, and
Speaker 3: the company shut down its operations in Cambodia, and so
Speaker 3: these women no longer sold their milk, and this was
Speaker 3: hailed as a great victory by these women's rights groups
Speaker 3: who rights groups. Actually, if you read the local media
Speaker 3: stories where they interview the women and ask them what
Speaker 3: they feel about it, they're upset, they're angry. They didn't
Speaker 3: want that income to be shut off. And so for me,
Speaker 3: that's a really good example of the empowerment versus exploitation debate,
Speaker 3: because are we just being patronizing with these Western ideas
Speaker 3: of coming in and being like, oh, these poor Cambodian women,
Speaker 3: they shouldn't be allowed to sell their milk. Really, like,
Speaker 3: what's it like to be in their shoes?
Speaker 1: Right?
Speaker 2: Right?
Speaker 1: I feel like you do such an amazing job of
Speaker 1: for the reader to kind of go, well, wait a second, now,
Speaker 1: like think about this in this way and from this perspective.
Speaker 1: And the flip side of the corner is that, of
Speaker 1: course there are companies that do prey on people's intense
Speaker 1: desire to have a baby, a biological child as part
Speaker 1: of your research. You went to the Future Fertility Show,
Speaker 1: which features this dizzying range of clinics and services from
Speaker 1: I think you described a consultation from a shamanic nutritionist
Speaker 1: to legal representation sperm analysis. I mean that seems like
Speaker 1: such an eye opening experience, Like what was it like
Speaker 1: to wander around this show and what do you think
Speaker 1: it says about the global fertility industry or the fertility
Speaker 1: industry you know where this show was held.
Speaker 3: Yeah, it was a really really interesting experience and I
Speaker 3: definitely felt.
Speaker 2: Like a consumer walking around that show. And that is.
Speaker 3: Another kind of interesting point for me about the whole
Speaker 3: fertility industry, is to what extent are people consumers versus patients.
Speaker 3: So obviously a lot of fertility treatment is elective. There
Speaker 3: are certain cases where I don't know. For example, the
Speaker 3: woman who's been diagnosed with cancer has to freeze her
Speaker 3: eggs if she wants any chance of having children after treatment.
Speaker 3: But usually it's women electing to do that because they're
Speaker 3: worried that at some point they'll want a child and
Speaker 3: they'll no longer be fertile, and that worry, that anxiety
Speaker 3: is something that's very much monetized, arguably exploited I had
Speaker 3: so many kind of philosophical conversations during my research with
Speaker 3: people outside and inside the industry about what that line is.
Speaker 3: I had a really interesting conversation with a surrogacy lawyer
Speaker 3: in California where I kind of said, look, it seems
Speaker 3: to me there is an exploitative nature sometimes in the
Speaker 3: promises that are made to these people who are desperate
Speaker 3: for children. Is it to you is there an element
Speaker 3: of exploitation? And he was like, absolutely not, It's just
Speaker 3: taking advantage of a need that exists. And we had
Speaker 3: this sort of weird semantic discussion about what the difference
Speaker 3: is between taking advantage and exploitation, and then I realized
Speaker 3: that he was coming at it from quite a kind
Speaker 3: of well obviously a very capitalist, but a kind of
Speaker 3: business perspective of taking advantage as a positive thing, like
Speaker 3: there's a market that exists, let's take advantage of it,
Speaker 3: as opposed to like, is there a vulnerability about this
Speaker 3: particular patient stroke consumer demographic that we should be more
Speaker 3: careful of exploiting. So that's what came out to me
Speaker 3: from well, from that conversation and other conversations, I thought
Speaker 3: it was very interesting that the Future Fertility Fair was
Speaker 3: actually part of a bigger fair that was the Future
Speaker 3: Beauty Fair or something show trade show. There were so
Speaker 3: many women kind of wandering between the two, and in
Speaker 3: one hall they were being offered the chance to look
Speaker 3: younger and more beautiful and if you're being cynical, more
Speaker 3: capable of attracting a mate perhaps, and then in the
Speaker 3: other hall, they were being offered the chance to either
Speaker 3: fix or kind of stave off invitility. And it just
Speaker 3: seemed to me two sides of the same coin. And
Speaker 3: I'm not saying, by the way, that these shows shouldn't
Speaker 3: exist or that the market shouldn't exist. And obviously I
Speaker 3: think IVF is a wonderful innovation and it's helped so
Speaker 3: many people. I do think that the way the industry
Speaker 3: markets itself can be problematic, and I do think there
Speaker 3: is an exploitative nature that is not just limited to
Speaker 3: a few bad actors. Which is what a lot of
Speaker 3: people have suggested to me, is just like, oh, yeah,
Speaker 3: some clinics overpromise or overtreat, Because a lot of clinics
Speaker 3: do overtreat. They offer sort of almost endless rounds of
Speaker 3: IVF when it's probably obvious that they're not going to work,
Speaker 3: for one example, or they target egg freezing at women
Speaker 3: in their forties, which I was told by several gynecologists
Speaker 3: is like pretty much a waste of money. And I
Speaker 3: was told, you know, well, yeah, of course there are
Speaker 3: a few bad actors. There are a few bad clinics.
Speaker 3: There always are in every industry. I'm not sure about that.
Speaker 3: I think it's more pervasive than.
Speaker 1: That, and I think it makes it so much more
Speaker 1: difficult to know what is an ethical clinic, what's a
Speaker 1: good clinic? How how are they measuring success? You know,
Speaker 1: if you have a choice, then the one clinic is
Speaker 1: going to want to stand out in some way, whether
Speaker 1: that's for egg freezing or IVF or anything like that.
Speaker 1: How do you sift through as a consumer patient? How
Speaker 1: do you sift through what is a good or ethical
Speaker 1: clinic from a bad one? And is it ever that obvious? Yeah?
Speaker 3: I don't think it is that obvious. I think most
Speaker 3: patients probably don't actually come at it initially from a
Speaker 3: perspective like is this ethical or.
Speaker 2: Is this not? Am I going to be taken for
Speaker 2: a ride?
Speaker 3: They just want a baby, So they're looking at success
Speaker 3: rates and that's all important to clinics. Like their success rates,
Speaker 3: that they're everything. That's what makes like high profile fatility
Speaker 3: docs is extremely competitive with each other, and that is
Speaker 3: something I go into in the book, like what has
Speaker 3: that actually led to in practice?
Speaker 2: I don't know.
Speaker 3: I have talked to fertility doctors who admit that the
Speaker 3: competitive element is a problem, and they sort of accuse
Speaker 3: their rivals of acting in unethical ways and they say, look,
Speaker 3: I'd never do that. You know, obviously this isn't a charity.
Speaker 3: A clinic is a profit making enterprise. But I would
Speaker 3: never put the needs of my patients behind you know,
Speaker 3: financial gain.
Speaker 2: So they are aware of it. They're definitely aware of it.
Speaker 3: And I'm not a doctor, so I don't I can't
Speaker 3: judge what they're doing with sort of clinical eye. What
Speaker 3: I do know is that, for example, in London, there
Speaker 3: are some clinics who are like big clinics, and they
Speaker 3: have they have good reputations, but they're known for pushing
Speaker 3: treatments on patients when they're probably not needed. Add Ons
Speaker 3: for example, all these things that you can pay extra
Speaker 3: for or you know, hidden costs, like they'll advertise as
Speaker 3: price on their website, but then they won't include the
Speaker 3: medication or some of the testing that has to be done,
Speaker 3: certainly not the storage cost. So you go in thinking
Speaker 3: you're going to pay a certain amount and then it's
Speaker 3: like three times that amount in some cases. So I
Speaker 3: think it's very difficult to judge which clinics are ethical
Speaker 3: or not. And I don't even think most people care
Speaker 3: that much as long as they get a baby, right.
Speaker 1: It's so hard because you have people who might have
Speaker 1: vastly different experiences, like you talk about between you know,
Speaker 1: within one clinic, one person goes, they love their experience,
Speaker 1: they everything worked out for them, and another person who
Speaker 1: really had the opposite experience, and so again shows how
Speaker 1: personal this journey can be.
Speaker 2: Yeah.
Speaker 3: Absolutely, And it's really interesting actually looking at Google reviews
Speaker 3: of fertility clinics because I don't know if you're familiar
Speaker 3: with the Jacob phenomenon of most online Google reviews are
Speaker 3: generally like very bad or very good, because it's only
Speaker 3: people who are kind of really motivated to write them,
Speaker 3: of you who are going to do that. But it's
Speaker 3: particularly acute in fertility clinics, I think, because you either
Speaker 3: get a baby at the end or you don't, and
Speaker 3: often if you don't, you feel like it's been denied
Speaker 3: to you in some way, or you've been treated badly,
Speaker 3: or there's been a mistake, there's been a kind of
Speaker 3: human error, or the doctor's been really unkind when you've
Speaker 3: miscarried or whatever. It is like you feel strongly about
Speaker 3: the fact that it went wrong, or you feel very
Speaker 3: strongly about the fact that it went well and you've
Speaker 3: got a baby, so you're incredibly grateful. Very few people
Speaker 3: seem to have a mediocre experience freezing their eggs ort
Speaker 3: like some people do. Some are like, eh, it wasn't great,
Speaker 3: but it was fine. But that's particularly the case with
Speaker 3: egg freezing, obviously, because most people never use their frozen eggs,
Speaker 3: so you don't actually know how that process is going
Speaker 3: to pan out in the long term. But in terms
Speaker 3: of IVF and actually trying for a baby, it feels
Speaker 3: like there are two extremes of the experience.
Speaker 1: Let's take a quick break here, we'll be back before
Speaker 1: you know it. Welcome back, everyone, I'm here chatting with
Speaker 1: the wonderful I Love Scott about her book cash Cow.
Speaker 1: Let's get into some more questions. We've mostly I feel like,
Speaker 1: been talking about IVF within either the UK or a
Speaker 1: little bit in the US, but there's also the swath
Speaker 1: of international IVF clinics where people may elect to go
Speaker 1: to another country to go through this IVF experience, and
Speaker 1: your book explores some of the gray market kind of
Speaker 1: place where these agencies live. Can you tell me more
Speaker 1: about the legal landscape that these clinics operate within and
Speaker 1: what has driven their growth.
Speaker 2: Well, I wish I could tell you more about the
Speaker 2: legal landscape. It's very opaque.
Speaker 3: I don't think even the clinics themselves are entirely clear
Speaker 3: about the legal landscape.
Speaker 2: But yeah, I focused a.
Speaker 3: Lot of my research on Northern Cyprus, which happens to
Speaker 3: be where my mother is from and where I spend
Speaker 3: a lot of time as a child. And it's not
Speaker 3: an internationally recognized country. It's actually viewed as occupied territories.
Speaker 3: So the reason that's significant is that it operates in
Speaker 3: many ways, and not just in the fertility sector, but
Speaker 3: in other ways where regulation is just not really a
Speaker 3: thing and they don't have to sign up to like,
Speaker 3: you know, EU regulations or anything like that. I should
Speaker 3: say that clinics in Northern Cyprus generally have a very
Speaker 3: good word of mouth reputation and they're cheap. The IVF
Speaker 3: sector is part of their tourism industry, which is huge.
Speaker 3: It's like, by far the biggest economy within that country,
Speaker 3: and so it's hard for me to say, look, it's
Speaker 3: you know, a dodgy place to go and freeze your
Speaker 3: eggs or have IVF, because actually I was quite impressed
Speaker 3: by the clinics I went to, and I have heard
Speaker 3: many good stories there, but I did encounter practices that
Speaker 3: I well thurrogacy.
Speaker 2: Aside, if we're keeping.
Speaker 3: With IVF strictly IVF and egg freezing, there are things
Speaker 3: that are done there that just aren't legal in many
Speaker 3: other countries. So for example, women up to the age
Speaker 3: of fifty five are treated that you can undergo IVF
Speaker 3: in Northern Cypress. And I spoke to a gynecologist in
Speaker 3: the National Health Service here in the UK who was
Speaker 3: complaining about the number of women she treats who go
Speaker 3: and get pregnant and then have these extremely dangerous, high
Speaker 3: risk pregnancies where they're often you know, they're often pregnant
Speaker 3: with like twins or triplets, because that obviously in IVF,
Speaker 3: the more embryos you implant, the higher your chance of
Speaker 3: achieving pregnancy.
Speaker 2: But that can lead to multiples.
Speaker 3: So you know, a woman in her fifties coming back
Speaker 3: from Cypress to the UK pregnant with twins, and you
Speaker 3: know that's that's a big burden on the NHS. So
Speaker 3: that's a bigger conversation about like kind of picking up
Speaker 3: the slack of people choosing their treatments abroad and coming
Speaker 3: back and needing treatment for high risk pregnancies. But also
Speaker 3: I'm not sure. I'm not sure what I think about
Speaker 3: the availability of that and other things like gender selection
Speaker 3: of embryos that's legal in the US, it's really really
Speaker 3: frowned upon in other countries, including the Ugay and most
Speaker 3: of Europe. Like I said before, I'm not you know,
Speaker 3: I'm not a specialist in these in bioethics.
Speaker 2: I'm not.
Speaker 3: I don't have a degree in that. I don't have
Speaker 3: ready answers here. All I'm saying is that some of
Speaker 3: these things made me feel like, oh, this is this okay,
Speaker 3: I don't know, Like it's a really extreme example of
Speaker 3: a totally open market where if you want it, it's
Speaker 3: there and it's cheap.
Speaker 1: You bring up this great question of like why does
Speaker 1: the ethics or the laws regulation, why do they differ
Speaker 1: so drastically in different countries. You know, you use surrogacy
Speaker 1: as an example, where in the US it's a it's
Speaker 1: a thriving industry and in some ways, and and you
Speaker 1: more about that industry in your book, But in Spain
Speaker 1: it's completely illegal. And what do you think contributes to
Speaker 1: some of the regulations or just the general sense of
Speaker 1: ethics varying across the landscape.
Speaker 3: Okay, starting with Europe, I think that a really interesting
Speaker 3: commonality I noticed was Catholic Southern European countries like Spain
Speaker 3: and Italy, they both have a real aversion to surrogacy.
Speaker 3: In both countries. It's not just not allowed, it's a crime.
Speaker 3: In Spain, it's class as a crime against women. In Italy,
Speaker 3: a politician described it recently as worse than pedophilia. And
Speaker 3: not only is it illegal in the country in Italy,
Speaker 3: for example, but they're now beginning to prosecute parents who've
Speaker 3: gone abroad for surrogacy and come back, which has really
Speaker 3: spooked a lot of people obviously, and they're kind of
Speaker 3: striking off parents from birth certificates retrospectively.
Speaker 2: So that's a pretty extreme example.
Speaker 3: And if we look at Spain, Spain is so interesting
Speaker 3: because it's the country in which most egg donations are
Speaker 3: performed in Europe.
Speaker 2: It has an.
Speaker 3: Incredibly high number of like lots of people go to
Speaker 3: Spain to have their eggs frozen or to donate, and
Speaker 3: it's a big IVF center in general. But all donations
Speaker 3: have to be strictly anonymous, and so there's this dual
Speaker 3: thing where like they never have a shortage of eggs,
Speaker 3: unlike for example, the UK, where you're not allowed to
Speaker 3: be an anonymous donors. So unsurprisingly, not that many people
Speaker 3: want to donate, so they're always having to import import
Speaker 3: eggs and sperm from other countries like the US and Denmark.
Speaker 3: Spain doesn't have that problem, and it has plenty of eggs,
Speaker 3: plenty of sperm, loads of anonymous donations, so that side
Speaker 3: of things is like thriving. But then the surrogacy is
Speaker 3: completely illegal. And I have a vague theory about like
Speaker 3: Protestant versus Catholic countries and their different atgues, because if
Speaker 3: you look at say the UK and the Netherlands, it's
Speaker 3: non anonymous donations, which means it's that doesn't mean by
Speaker 3: the way that as a parent stroke client, you know
Speaker 3: or you can choose a lot of detail about your donor.
Speaker 3: The donor is anonymous by name to the people using
Speaker 3: those sperms or X, but the child, any resulting child
Speaker 3: from this donation, when they turn eighteen, they're allowed to
Speaker 3: contact and find out who they're biological parents. So but
Speaker 3: on the other hand, out surrogacy, altruistic surrogacy is allowed
Speaker 3: in the UK and the Netherlands. So that was just
Speaker 3: a weird sort of divide that I found, And I
Speaker 3: don't really know. I would have to talk to sort
Speaker 3: of sociologists or anthropologists. I don't exactly know what's going
Speaker 3: on there, but there does seem to be a link
Speaker 3: between anonymous donation and a negative attitude towards surrogacy in
Speaker 3: these Catholic countries, which I don't know, if it's like you,
Speaker 3: they want to sort of eliminate any tie between a
Speaker 3: child and a parent that isn't sort of present in
Speaker 3: their life or I don't know. It's a strange thing.
Speaker 3: But the US is obviously a whole different landscape.
Speaker 1: Yeah, the US, and the commerciality within the US I
Speaker 1: think is highlighted so well, especially in the surrogacy aspect
Speaker 1: of it, where you talk about the surrogacy contracts where
Speaker 1: you can start to see evidence of like the different
Speaker 1: things that can go wrong or have gone wrong wrong
Speaker 1: in the past, and then lead to these like clauses
Speaker 1: upon clauses upon clauses, like what does a surrogacy contract.
Speaker 2: In the US?
Speaker 1: What does it look like?
Speaker 2: Like?
Speaker 1: What are the expectations for the surrogate and the intended parents.
Speaker 2: It's very long. Most contracts I read. Most contracts I
Speaker 2: read and U s.
Speaker 3: Were maybe fifty to sixty pages, and one parent described
Speaker 3: it to me as this very sort of sad experience
Speaker 3: reading it because all the clauses that prohibit certain behaviors
Speaker 3: will kind of worn against certain scenarios. Are basically saying
Speaker 3: this went wrong this one time, or you know this
Speaker 3: has gone wrong in the past, therefore we have to
Speaker 3: guard against it in this particular contract.
Speaker 2: So in a way, it's good that those clauses are there.
Speaker 3: It's also very sad to read them because you kind
Speaker 3: of imagine, like, oh, my god, that happened to someone.
Speaker 3: One clause I found very upsetting was one in which
Speaker 3: the surrogate's husband, So if a saragut is married or
Speaker 3: possibly even in a partnership, but that partner O husband
Speaker 3: has to be a cosignatory on the contract, so they
Speaker 3: agree to certain things, and this clause prohibited or said
Speaker 3: that if the sarrogut's husband hit, punched, kit, you know,
Speaker 3: abused in some way hurt the surrogate, he would be
Speaker 3: liable for the financial damages that would result in terms
Speaker 3: of like hospital bills for her, or if there was
Speaker 3: any damage done to the fetus or fetuses. And it
Speaker 3: was written in such a way that it wasn't at
Speaker 3: all about the fact that that was a criminal offense
Speaker 3: or that that.
Speaker 2: Would just be an abhorrent thing to do. Obviously, I
Speaker 2: mean it's legal, legal document.
Speaker 3: It's not going to go into like all of the
Speaker 3: ins and outs of how terrible that situation would be.
Speaker 3: But just the coldness with which it kind of focused
Speaker 3: on the financial damages that would imclude from that really
Speaker 3: upset me and I was thinking about it for many
Speaker 3: many weeks afterwards. Other quite upsetting examples like more to
Speaker 3: do with money, like if you're if a sarrogut's carrying
Speaker 3: multiples and one of them dies in the womb and
Speaker 3: the other survives, like how does that affect her pay?
Speaker 3: It's kind of pro rated and how much money would
Speaker 3: she get from the day of the sonographer, just like
Speaker 3: you know, finding there's only one heartbeat until delivery, and
Speaker 3: like all that really kind of detail oriented stuff which
Speaker 3: happens in contracts, Like it is about the details, it
Speaker 3: is about the money, but somehow there's an added emotional
Speaker 3: element to it in this in something like a surrogcy contract,
Speaker 3: because it's like, that's just really unpleasant to think about.
Speaker 3: And by the way, I should say that, like I
Speaker 3: think in the US, like you said, because it is
Speaker 3: so normalized and accepted, it feels like if you say
Speaker 3: anything negative about the industry, you're seen as a critic.
Speaker 3: So I feel like there will probably be people who
Speaker 3: read the book and read those things. For example, when
Speaker 3: I discuss how unpleasant the contract is in these ways,
Speaker 3: who will think, oh, she's just anti surrogacy and this
Speaker 3: is out this is like a skewering of this surrogacy industry.
Speaker 3: Because broadly speaking, if surrogacy is a choice, it's about choice.
Speaker 3: It's a positive thing, it's a progressive thing, and in
Speaker 3: some cases rightly so. But it feels like if you
Speaker 3: ever point out that there are maybe some aspects that
Speaker 3: should be modified or regulated or changed. It's assumed that
Speaker 3: you're kind of against the whole industry, but.
Speaker 1: There needs to be room for nuance in these discussions
Speaker 1: about it. And this is what I loved so much
Speaker 1: about your book is that how much nuance you explored
Speaker 1: in each aspect of the global fertility industry. You also
Speaker 1: touched on some ethical examples too that will like, Okay,
Speaker 1: here is something that seems to be working well, that
Speaker 1: seems to be in agreement. What were some of the
Speaker 1: examples of ethical practices that you encountered.
Speaker 3: Personally, I'm a big fan of the legal changes that
Speaker 3: happened here in the UK. For example, back in two
Speaker 3: thousand and five. Previously donors could choose to be anonymous,
Speaker 3: as I mentioned, and in two thousand and five a
Speaker 3: law came in to change that so that any donor
Speaker 3: signing up for any clinic or bank would have to
Speaker 3: agree to be contacted by any resulting biological children when
Speaker 3: those children turn eighteen. And the reason that the regulatory
Speaker 3: body here in the UK gave for that decision was
Speaker 3: they said that the rights of a child to know
Speaker 3: their biological parent trumps the right of a donor to
Speaker 3: remain anonymous. They thought it was more important for a
Speaker 3: child to know about their biological origins, and this has
Speaker 3: come up in a lot of research that it's really
Speaker 3: beneficial for children to have answers to the questions they
Speaker 3: may have if they know their donor conceived or suspect
Speaker 3: their donor conceived or born from a whatever it is. Basically,
Speaker 3: secrets are bad and not being totally transparent with children
Speaker 3: within a family about how it came into the world
Speaker 3: is generally not a good thing. So I personally think
Speaker 3: that's a really good change. Having said that, I can
Speaker 3: see that there's an issue with a shortage of donated
Speaker 3: eggs and sperm in this country. As I said before,
Speaker 3: like we have to import a lot from the US
Speaker 3: from Denmark, So is it feasible you know, if every
Speaker 3: country did that, we wouldn't have enough donated sperm or eggs,
Speaker 3: certainly in the future as the industry grows at the
Speaker 3: dizzying rate that it's currently growing. So sometimes what's ethically
Speaker 3: the right choice might not be workable, And then you
Speaker 3: have to look at the bigger picture and you have
Speaker 3: to say, Okay, do we say do we just say
Speaker 3: that this is the way it is, or do we say, actually, no,
Speaker 3: we need to promote more donation. This is what we need.
Speaker 3: Infertility is rising, more people need donated eggs and sperms,
Speaker 3: so we can't restrict it in this way. A pu maker,
Speaker 3: I don't know, but personally I think that anonymous donations
Speaker 3: are problematic. The US is a good example of someone
Speaker 3: where both are possible. You can have anonymous and non
Speaker 3: anonymous donation. You usually pay more for a known donor.
Speaker 3: You pay for all the information you receive really about
Speaker 3: donors in one way or the other. So that's one
Speaker 3: thing that I have I suppose a relatively firm opinion
Speaker 3: on with caveats. I think similarly, we have to be
Speaker 3: realistic about surrogacy and the fact that it's absolutely exploding.
Speaker 3: There are many people who would say altruistic surrogacy is
Speaker 3: the only acceptable form. There are some people, of course,
Speaker 3: who don't think that even altruistics surrogacy acceptable. But if
Speaker 3: you think that altruistic is superior to commercial, fine, But
Speaker 3: is it realistic in a world where surrogacy demand for
Speaker 3: surrogates is booming and there just won't be enough to
Speaker 3: go round, And if you can't afford the prices in
Speaker 3: the US, you go to places like northern Cyprus, you
Speaker 3: go to places like Georgia Columbia where it's not really
Speaker 3: an established industry yet, and there are unfortunately unethical agencies
Speaker 3: that do operate as I discovered. I don't think that's
Speaker 3: an acceptable situation. I think broadly speaking, it should be
Speaker 3: legal and it should be regulated, because that's the way
Speaker 3: it's going, That is the way the industry is headed.
Speaker 3: Is just like more demand, huge demand, not enough supply.
Speaker 3: How do we make sure that sarahgets are treated well
Speaker 3: and also that parents are treated well? We don't want
Speaker 3: we don't want parents in situations like some of the
Speaker 3: nightmare situations you discover where they've been left without their child,
Speaker 3: having spent all this money, and also the rights of
Speaker 3: the child. You know, those are so often overlooked. It's
Speaker 3: all about kind of the customer and the provider, but
Speaker 3: what about.
Speaker 2: The babies as well.
Speaker 3: It's just such a legal, ethical, cultural minefield the entire industry.
Speaker 1: It really is, and it's an uncomfortable one to think about.
Speaker 1: But all of this just speaks to how important it
Speaker 1: is to think about this these situations deeply, and maybe
Speaker 1: not like personally. If this is something you don't want to,
Speaker 1: but just like at least for policymakers for regulation, because
Speaker 1: it's not going anywhere, and it's only going to become
Speaker 1: more abundant, it's only growing, and so these questions, these
Speaker 1: ethical considerations are also growing along with the fertility industry overall.
Speaker 3: Yeah, exactly. I mean, in a totally utopian future, there
Speaker 3: would be some kind of international treaty, there would be
Speaker 3: some kind of form of international regulation where countries would
Speaker 3: have to sign on to certain ethical standards, and there
Speaker 3: would be more sort of oversight and cohesion between the
Speaker 3: different disparate markets in the global space. I really don't
Speaker 3: think that's coming anytime soon, unfortunately, so it's kind of
Speaker 3: up to individual governments to make those decisions. But yeah,
Speaker 3: I've spoken to several surrogacy lawyers in the UK and
Speaker 3: Europe who are slightly sort of in despair at the
Speaker 3: lack of regulation in this country. For example, there was
Speaker 3: meant to be a sort of a government body that
Speaker 3: was going to look at reforming surrogacy law here. It's
Speaker 3: just it's just not deemed to be a priority, particularly
Speaker 3: because it's such a hot potato politically, right, No one
Speaker 3: really wants to go there. No government wants to be
Speaker 3: responsible for looking really pro anti cerebracy, really, especially if
Speaker 3: it's a vaguely centrist government like we have currently in
Speaker 3: the UK, Like they just don't want to touch that.
Speaker 2: It's too it's not worth it for.
Speaker 1: Them, too politically dangerous. Ah well, this I mean, this
Speaker 1: is I again just thank you so much for it,
Speaker 1: for writing this book, but also for taking the time
Speaker 1: to chat with me today today. I really enjoyed our
Speaker 1: conversation me.
Speaker 2: Too, Thank you very much.
Speaker 3: I still have so much to think about with relation
Speaker 3: to the book and all's well, it's nooks and crannies,
Speaker 3: so it's nice to nice to discuss them.
Speaker 2: Thank you.
Speaker 1: A big thank you again to Alev Scott for taking
Speaker 1: the time to chat with me. If you enjoyed today's
Speaker 1: episode and would like to learn more, check out our
Speaker 1: website this podcast will kill You dot com. We're I'll
Speaker 1: post a link to where you can find cash Cow,
Speaker 1: how the maternal body became a global commodity and the
Speaker 1: hidden costs for women, as well as a link to
Speaker 1: a Lev's website where you can find her other work.
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