The Abolition of Mother

Based on the cover, readers might think that Claire Horn’s debut book is about the miraculous event that is pregnancy and birth. Although it does touch upon these subjects, Eve: The Disobedient Future of Birth is rather about artificial gestation and the ways in which this technology could be used to advance progressive ideals or, conversely, used to reinforce regressive ends.^[1] The author, Claire Horn, is a feminist scholar and legal researcher who studies law and policy surrounding pregnancy, abortion, and reproductive rights. While researching her Ph.D. topic over a decade ago, Horn came across numerous headlines claiming that artificial wombs would end the abortion debate and went on to write her dissertation as a rebuttal of this claim. Stemming from that research, this book is aimed at a general audience and intends to bring the conversation about artificial womb technology out of academic journals and into the public square. As Horn writes, “The question is no longer: Is this innovation possible? [but] Are we ready?” and her answer is a resounding “No”—but not for the reasons you might think. She ultimately argues that artificial wombs can serve the good of children and “pregnant people,” as she puts it, but only if current inequalities in society are rectified and regressive uses of the technology are barred.

For readers who have not heard of artificial gestation, it refers to the growth and life-support of pre-term babies ex-vivo, that is, outside the womb in a technological platform that mimics the warm, liquid environment of the womb. Eve begins by chronicling how artificial womb technology has already been developed by four different research groups and successfully trialed on animals.^[2] The technology’s purpose is to bridge the gap in life-saving care for extremely pre-term babies (between 22–24 weeks gestation) by enabling the fetus to continue to grow in womb-like conditions “as though it had not yet been born,” something which modern incubators and other neonatal life-support measures cannot do. If successful, this so-called “partial artificial womb” treatment will revolutionize neonatal care.^[3]

The implementation of this technology, however, is not so straightforward. Horn points out that voluntary and informed consent for first-ever human clinical trials will be very difficult if not impossible to obtain from prospective parents, as circumstances surrounding premature birth can be extremely stressful and even traumatic. Moreover, she wonders about the ethics of experimenting on infants under emergency circumstances, pointing out that historically, patient interests (including health and life itself) have been regrettably overlooked for the sake of the advancement of science and society.^[4]

How would the absence of birth affect the child?

Notwithstanding the obstacles facing human clinical trials, Horn is optimistic about the benefits of partial artificial womb technology—but only if it is equally accessible to all “pregnant people” in need of it. This includes women who experience higher rates of pre-term birth and maternal injury or death (such as in low-income countries like India or Bangladesh), and women who are racial minorities living in wealthier nations, who already experience diminished access to healthcare. But in Horn’s estimation, equal access must also include “pregnant people” of “all genders,” because “cis women are not the only people who can become pregnant and require antenatal care[.]” Since the technology will likely end up being available only to the privileged few, Horn argues that it will ultimately widen the existing gap in equitable access to healthcare, both nationally and internationally.

Besides equitable access, Horn’s other concern with artificial wombs is the way in which this technology could be “co-opted” for ends that undermine the rights of “pregnant people.” For example, she points out a trend among bioethicists and contemporary legal scholars to think that artificial wombs may be “safer” than human wombs in certain circumstances (whether due to maternal drug or alcohol abuse, illnesses such as uterine cancer, or adverse social conditions such as poverty). Horn argues that whether presented as an alternative to gestation or mandated by law, such a use of artificial wombs would wrongfully take away control from “pregnant people” and undermine their “reproductive autonomy,” continuing the eugenic legacy initiated by J.B.S. Haldane in 1923 when he coined the term “ectogenesis” as a future means of controlling reproduction.

Yet the most sinister consequence of artificial womb technology, according to Horn, is the threat it could pose to abortion rights in jurisdictions where abortion remains criminally sanctioned. Although she takes issue with the claim made by bioethicists that artificial wombs will “solve” the abortion debate (rightly pointing out that this superficial line of thinking overlooks the matter of responsibility for the ectogenetic fetus, and of who would adopt it once it was “born”), her main concern centers on how anti-abortion states could use artificial wombs as a way of restricting access to abortion, whether by banning abortions past a certain point of viability, or by presenting artificial wombs as a welcome alternative to termination. This would be egregious for Horn, since she repeatedly advocates for universal and unrestricted access to abortion, “without exceptions or gestational limits.”

As for how artificial wombs might affect the child therein contained, Horn’s consideration does not extend much beyond a few rhetorical questions. For instance, although she acknowledges that there is a relationship and “reciprocal exchange” between the fetus and “the person who gestates it” that may not be so easily replicated, there is no discussion of the significance of being gestated and born—let alone any consideration of the morality of ex-vivo gestation^[5] (unsurprising, given Horn’s inability to fathom that abortion is a moral issue). A baby gestated in a machine would simply have a different experience than one in a human pregnancy, she posits. “We don’t really know what the possible consequences of extending gestation outside the body (even for a few weeks) may be, because no one has tried it yet.” There is zero consideration of the intricacies of the relationship between mother and child-in-the-womb, from the ontological^[6] to the physiological^[7] to the emotional and psychological aspects,^[8] other than Horn’s musings about her own experience of being pregnant while writing the book. There is not a single mention of the implications of the fact that ectogenetic children—whether gestated only partially as the recipient of neonatal care, or fully as the experiment of complete ectogenesis—will never experience birth as we know it.^[9]

At its core, Horn’s exploration of artificial womb technology is her way of advocating for “reproductive justice,” including universal access to abortion, contraception, prenatal support, and respectful birth and postpartum care for people of “all genders.” Her overall concern with artificial womb technology is that it is a tool which can be used by the wrong people for the wrong ends—that is, ends which undermine the choices and self-determination of “pregnant people.” Horn admits that, in the final analysis, gestating may be a human activity and not something that could simply be automated by a machine, but this objection is not made for the sake of the child. Rather, it is because pregnancy is a work performed by human bodies—not incubators—with real “desires, needs, and interests” (and not solely female human bodies, as Horn does not believe in the sexual difference nor in maternal bodies).

One reason for Horn’s lack of concern about the meaning of pregnancy and birth is because she sees these as a process that can be done (or undone) by any person. For Horn, pregnancy is a choice, not the innate capacity to bear life that belongs to women. “We should reject the false idea that only women gestate,” writes Horn, because it is “a fact” that “trans men, non-binary people and gender-queer people [have already been] gestational parents.” Horn’s concern with artificial womb technology begins and ends with protecting the rights of “pregnant people” and expanding their “reproductive choices.” This theme makes her book terribly repetitive—but also irresponsible, for she fails to consider the needs and interests of the child in the womb. Although she raises some questions about the ethics of ectogenesis (growing embryos entirely outside the womb), she fails to consider any of the profound ethical and philosophical issues involved with artificial gestation, especially regarding the child. Granted, she doesn’t claim to consider these facets in her book, but this major omission renders her analysis of the implications of this new technology wholly one-dimensional and ultimately insufficient. If readers are looking for an examination of the ethics of artificial wombs, or of the significance of natural pregnancy and birth, this book will surely disappoint.

^[1] The “Eve” in the title is an acronym for “Ex-vivo Uterine Environment Therapy,” the name given by researchers in Japan and Australia to describe technology intended to support the extra-uterine growth of pre-term babies.

^[2] 1) A team at the Children’s Hospital of Philadelphia who created a “bio-bag” for animal trials with extremely premature lamb fetuses in 2017 (this project is now titled “EXTrauterine Environment for Neonatal Development,” or EXTEND for short); 2) a team in Japan and Australia who created what they call “Ex-vivo Uterine Environment Therapy” (EVE for short) as of 2022; 3) a group in the Netherlands who used 3D-printed neonates as prototypes for their platform in 2019; and 4) a team at the Weizmann Institute of Science in Israel who grew mice entirely ex-vivo from embryos into fully formed fetuses in 2021.

^[3] The physician Phillip Wozniak offers an excellent overview of what exactly partial artificial womb technology entails, as well as one of the major ethical and legal challenges it may pose (which Horn never mentions in her book), namely, whether the technology requires a re-definition of birth and “a new category of human being between fetus and child … dubbed the ‘gestateling.’” Wozniak, “What is an ‘Artificial Womb’? A Response to Katy Faust and Samantha Stephenson,” Public Discourse, 28 July 2024.

^[4] The philosopher Hans Jonas wrote about the consequences of the phenomenon of human experimentation in modern medicine and science, warning that it would put human life and dignity at risk.

^[5] For an excellent presentation of the morality of artificial wombs, see Irene Alexander, “Frozen Embryos, Unwanted Pregnancies, and Artificial Wombs: Which Options Are Morally Licit?” Nova et vetera 19, no. 4 (2021): 111–145.

^[6] Cardinal Ratzinger explains how although the child and mother are related in a literal “physical unity,” both remain distinct persons: the child is described as a “being-from” and “being-with,” and the mother as a “being-for.” This condition of being-from and -with describes not only the child in utero, but is rather “a very graphic depiction of the essence of human existence in general” in which every person remains a being-from, with, and for another. See Ratzinger, “Truth and Freedom,” trans. Adrian Walker, Communio: International Catholic Review 23 (Spring 1996): 26–29. John Paul II’s writing is also a rich source of reflection on the theological-ontological significance of conception and gestation. See, for instance, Letter to Families, 16.

^[7] For instance, how would artificial womb technology replicate the placenta, which is a living organ created entirely anew by the mother’s body in response to the growing fetus, and which transmits the nutrients and hormones necessary for the child’s growth? The significance of maternal nutrition during pregnancy is astounding when one considers that it affects not only the child’s growth in utero, but also the child’s future metabolic health, known as “fetal programming” (see Lily Nichols, Real Food for Pregnancy, 2018). What about the significance of maternal amniotic fluid and its connection to colostrum and breastfeeding (both contain the same scent so that the newborn child is aided in latching and feeding)? Furthermore, what about labor and vaginal birth, which is a process involving a cascade of hormones, particularly oxytocin, between mother and baby? In short, how would the absence of birth affect the child? See Mary Haseltine, Made for This: The Catholic Mom’s Guide to Birth (2018) for an incredible overview of what takes place physically, emotionally, and spiritually during the phenomenon of birth.

^[8] How would a child be affected at the neurological level, as related to language development or level of attachment, from being gestated in an artificial womb?

^[9] For starters, see Christine Rosen’s thoughtful article “Why Not Artificial Wombs?” as well as her review of Horn’s book, “Born of Woman,” National Review vol. 75, Issue 18, October 2023.