The World Health Organization (WHO) gives a clinical definition of infertility as a disease of the reproductive system deined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.[1] This definition dates from 2009; however, in 2016, some information about the change in this definition came about.
WHO web page states clearly: WHO has not changed its use of this definition. It is important to note that this definition provides a clinical description of infertility. It does not make any recommendations about the provision of fertility care services. WHO is not planning to make any changes to the definition of infertility. WHO is currently developing guidelines on the diagnosis and management of infertility.
Interestingly, the current information points out some changes (proposal of) in the definition that, considering the number of web pages holding the same information, may appear sooner or later. For instance, Herjeet Marway and Gulzaar Barn, both lecturers at the University of Birmingham, state that the World Health Organization proposal is to change the definition of infertility. This would move it away from a clinical disease-based definition where it is viewed as a disability to a view that includes a more social definition, recognizing it as a right to reproduce. Moreover, they state that infertility would not be the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Rather, it would also be considered to include cases when single men and women without medical issues do not have children but want to become a parent.[3]
A recent article sustains that David Adamson, MD, one of the authors of the new guidelines, told The Telegraph the change is designed to reflect “the rights of all individuals to have a family, and that includes single men, single women, gay men, gay women.[4] David Adamson works as a Reproductive Medicine Expert to WHO. In the same article, this new definition of infertility has the potential to become a great equalizer of reproductive rights: It fundamentally alters who should be [classified as infertile] and who should have access to healthcare, said Dr. Adamson it sets an international legal standard.[5]
All this has a direct relation with the topic of study since surrogacy can be the means more suitable for these single men, single women, gay men, and gay women who, without medical issues, do not have children but want to become parents.
The society is a dynamic system, changing in all spheres of knowledge; the Church is part of this dynamic system; therefore it is interesting to give an account of the position of the Church regarding paternity, surrogacy and this probable change in the definition of infertility provided by the World Health Organization.
This research/reflection paper deals with de definition of infertility and its relation to surrogacy. Before going forward, it is interesting to trace, more or less, the usage of the word sterility. For this purpose, the author will quote some insights found in Infertility: Tracing the History of a Transformative Term written by Robin E. Jensen (2016). Choosing this work is because of its historical view and the use of the term mechanical regarding the human body. According to the text, there is a similarity between the human body and a piece of machinery, in moments of malfunction, it needs repairing. Even though this comparison seems to be metaphorically correct (and nave), the acceptance of comparing the human body with an engine, for instance, will lead to approach the woman womb, and therefore surrogacy, in a materialistic way, manipulable at the person will.
Early twentieth-century medical experts routinely described married women without children as fruitless and in need of repair barren and broken, thereby framing women inability to bear children through the conflicting lenses of the natural organic world and the world of machines.[6] With this affirmation, it is understandable that the condition of fertility/infertility has become an excellent mechanical process or one in need of repairing.
According to Jensen, in the context of contemporary women reproductive health, the term (in) fertility is as ubiquitous as it is fraught with seemingly endless uses and connotations. But it was not until 1868 that the obstetrician James Matthews Duncan first used the word fertile to reference women who gave birth (or had the potential to give birth) to numerous children.[7] As time goes on, Duncan metaphor had moved into the realm of the literal, as physicians routinely enlisted the term fertile to describe women with many spring (or the potential for many spring), just as they enlisted the term infertile to describe married women who remained childless (or who bore few children).[8]
Here in these definitions, both of fertile and infertile women, there is a common framework: married women; the author considers that, even in the field of medical research, the value of marriage is present while regarding the conception and birth of a child, putting out of the definition single persons.
The history of civilizations has documented the word infertility several times. Being Christianity an essential part of human history, it is not strange to find references to this condition in the Bible the story of Sarah, Abraham wife, for instance which will give a direct link with the divine. Extensive discourse about women reproductive problems and capabilities can be traced back as far as the writings of ancient Egyptians, Hebrews, and pre- Hippocratic Greeks. Over the past few centuries, the terms barren and then sterile have functioned as metaphorical predecessors to infertile serving as common denotations for women inability to become pregnant or bear healthy children.[9]
Jensen writes regarding fertility: Nineteenth-century rhetoric referred to sterile female bodies as machines in need of repair by a surgeon and, in this way, constituted women as somewhat outside the realm of culpability for their childlessness. This rhetoric, in contrast to earlier rhetoric that referred to women as barren and therefore unbalanced, unnatural, cored them few opportunities for self- help but much in the way of surgical hope (despite the relatively bleak success rates of surgical interventions at the time). Sterile bodies could be fixed by medical intervention.[10]
In this sense, the question about the right of having a child shows up in the ethical scenario. If the logic relation 1:1 is made upon the basis of the human body: machine, the idea of surrogacy is valid and fosterable, accepting the surrogated womb/mother just as a factory of babies; consequently, any person will be able to claim his/her right to have a child. This worldly way of thinking cannot be the answer to the question about surrogacy and its implications in society.
Moreover, if the case is to take the aforesaid idea literally, homosexual couples have to be discarded out of the possibility of making use of surrogacy, because it is the female body that needs to be repaired so as to function correctly. The union of male and female continues to be the conceptive way. It takes away the idea of the rights of all individuals to have a family, and that includes single men, single women, gay men, gay women, which is the implication of a future change in the definition of infertility given by WHO.
Jensen work ends with an interesting statement: The mixing of perceptual lenses from centuries past lenses with divergent assumptions about blame and responsibility, morality and science foretold an era in which articulating infertility involved a complicated, fraught balance of divergent appeals, as well as one in which the meaning of infertility was constantly reinvented according to the circulation and percolation of scientia coincindings, medical technologies, media depictions, and lay discourses.[11]
One of the scientific findings is that of infertility in men. The history of the word infertility has a female connotation, both in the scientific and religious fields. Jensen work is clear evidence of this, and for all those who are familiar with the Bible, they know that there is no even one account of male sterility/infertility. At knowing this, the author considers that there is a double disrespect towards women, namely, to have found only women unable to have a child because of countless reasons; and to consider now the surrogacy as an alternative for becoming parents.
As a final point, the author reflects on the so-called right to have a child which is a controversial issue if the definition of infertility changes. For this purpose, it is necessary to consider the United Nations Universal Declaration of Human Rights and the insights of Robert Spaedmann on Human dignity.
Now, the second main feature of the human being is his/her dignity. According to the United Nations (UN) all human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.[12] This statement is taken from The Universal Declaration of Human Rights emphasizes two main concepts for this research, namely: dignity and rights. Reading the UN Declaration on Human Rights there is no mention at all of the right of having a child.
According to Spaedmann, quoted by Zaborowski, person is not the name of a species, but a general proper name for each member of a species this name says who we are, and this is evidently not simply identical with what we are.[13] If this definition can be applied to the topic in this research, it is clear that Marie, Anna, Laura, Peter, John, any person who may be infertile continue to be a human being, this is who she/he is therefore her/his dignity is not conferred by the fact of being parents.
Furthermore, Spaedmann writes that persons are in an unparalleled sense individuals, because of their freedom and their capacity to transcend themselves no longer mere parts, but a whole, which cannot be accounted for as a means to an end.[14] This statement is very important here because taking into account Duncan/Jensen metaphor of the body as a piece of machinery in need to be repaired, the human person/body is treated as parts instead of as a whole; moreover, this part in need of reparation is regarded as a means to have a child, to have a child is not the real transcendence of a person.
To complete this idea, Pope Francis in Amoris Laetitia (178) writes some couples are unable to have children. We know that this can be a cause of real suffering for them.[15] He acknowledges that there is an element of suffering within the condition of infertility, but he does not say that this is a cause for no transcendence. He continues: We know that marriage was not instituted solely for the procreation of children.[16] To consider infertility as a failure in the way towards transcendence is not to understand the definitions of human being given by UN and Spaedmann. In this same number, the Pope takes the concept of wholeness: even in cases where, despite the intense desire of the spouses, there are no children, marriage still retains its character of being a whole manner and communion of life.[17]
Finally, Spaedmann points out that to speak of person is to take cognizance of the fact that human nature as nature realizes itself only when it awakens when it transcends its centrality when it consciously grasps the self-transcendence which is essential to it and does not turn it back into an instrument of merely natural self-preservation.[18] Surrogacy and an eventual change in the definition of Infertility may put human beings and procreation into the role of instruments: the surrogate mother as a baby factory and the institution of marriage as self-preservation of the human species in the planet. To have a child will never be a right, it is a gift from God, and therefore the changes in definitions and policies regarding this controversial issue will never change this appreciation.
Bibliography
Francis Pope, Amoris Laetitia. 2016.
Jensen, Robin E. Infertility: Tracing the History of a Transformative Term. USA: Penn State University Press, 2016.
Marway, Herjeet, and Barn, Gulzaar. Surrogacy Laws: Why a Global Approach is Needed to Stop Exploitation of Women, The Conversation (2018), https://theconversation.com/surrogacy-laws-why-a-global-approach-is-needed-to-stop-exploitation-of-women-98966
Naftulin, Julia. The Definition of Infertility Is Changing. Here Why That Matters (2019), https://www.health.com/condition/infertility/infertility-definition-change
The World Health Organization (2020) https://www.who.int/reproductivehealth/topics/infertility/multiple-definitions/en/
United Nations, The Universal Declaration of Human Rights. Paris 1948. https://www.un.org/en/universal-declaration-human-rights/
Zaboroski, Holger. Robert Spaedmann Philosophy of the Human Person: Nature, Freedom, and the Critique of Modernity. New York, USA: Oxford University Press, 2010.
Zegers-Hochschild, F., et al, The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009, Human Reproduction 24, No.11 (2009): 2683 2687.
References
[1] F. Zegers-Hochschild et al, The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009, Human Reproduction 24, No.11 (2009): 2683 2687, here 2686.
[2] The World Health Organization (2020) https://www.who.int/reproductivehealth/topics/infertility/multiple-definitions/en/
[3] Herjeet Marway and Gulzaar Barn, Surrogacy laws: why a global approach is needed to stop the exploitation of women, (Australia: The Conversation, 2018), https://theconversation.com/surrogacy-laws-why-a-global-approach-is-needed-to-stop-exploitation-of-women-98966
[4] Julia Naftulin, The Definition of Infertility Is Changing. Here Why That Matters, (2019) https://www.health.com/condition/infertility/infertility-definition-change
[5] Ibid.
[6] Robin E. Jensen, Infertility: Tracing the History of a Transformative Term (USA: Penn State University Press, 2016), 17.
[7] Ibid., 18
[8] Ibid.
[9] Robin E. Jensen, Infertility: Tracing the History of a Transformative Term (USA: Penn State University Press, 2016), 18.
[10] Ibid. 19.
[11] Robin E. Jensen, Infertility: Tracing the History of a Transformative Term (USA: Penn State University Press, 2016), 37.
[12] United Nations, The Universal Declaration of Human Rights, article 1, Paris on 10 December 1948, https://www.un.org/en/universal-declaration-human-rights/
[13] Holger Zaboroski, Robert Spaedmann Philosophy of the Human Person: Nature, Freedom, and the Critique of Modernity (New York, USA: Oxford University Press, 2010), 222.
[14] Ibid.
[15] Francis Pope, Amoris Laetitia (2016). 178
[16] Ibid.
[17] Ibid.
[18]Holger Zaboroski, Robert Spaedmann Philosophy of the Human Person: Nature, Freedom, and the Critique of Modernity (New York, USA: Oxford University Press, 2010), 222.
By Br. Reynaldo Rafael Chang, OP.