“Are you my mummy?”*: Diverse notions of “motherhood” in the IVF era

Back in autumn 2017, I was asked to be a contributor at the Edinburgh Biomedical Ethics Film Festival on the Ethics of Surrogacy. As part of the weekend we watched the 2016 documentary Future Baby, and the 1990 film version of The Handmaid’s Tale.

It was during my preparation for that event that I found myself ruminating on the diverse tasks that constitute being a mother. The anniversary of IVF brings this back into my thoughts.

There are, in essence, three contributions that a mother would naturally make:

  • producing the egg which provides half of the chromosomes for the resulting child (plus nutrients and some other genetic material via the mitochondria),
  • offering the womb in which the baby will develop (whilst receiving both nutrition and epigenetic influence on gene expression), and
  • caring for the infant after birth, and as they grow on to eventually attain their own independence.
motherhood too

Motherhood can now be subdivided into different roles (cartoon inspired by Morparia original)

These phases could be summarised as the genetic, the gestational and the nurturing dimensions of motherhood (the term “social” is sometimes used in the literature to cover this third category, but I prefer to the notion of nurture).

Of course, there have been deviations from this pattern right from the earliest days of human development. The process of giving birth has been (and in some parts of the world, continues to be) a significant risk to the life of the mother – the World Health Organisation estimates that about 830 women per day die from preventable complications associated with childbirth. Alternatively the child might have been adopted, or there may have been some other reason why the biological mother was not subsequently the primary care giver (divorce, imprisonment, geographical separation from the child, e.g. sent back to the UK for education). In some cultures, conception via a concubine or some other surrogate, may have been an acceptable mechanism to produce a child that would be cared for by an apparently infertile wife. So the model where one woman is responsible for being the genetic, gestational and nurturing mother was never universal.

Having said that, however, the past forty years have seen unprecedented variations from the traditional, unified model of motherhood. The advent of in vitro fertilisation, beginning with the birth of Louise Brown on 25th July 1978, have introduced a potential schism between the previously inviolable stages of genetic and gestational motherhood. This already opens up combinations of the three “mother” roles that were not possible prior to IVF, and others will inevitably follow as other developments in assisted reproduction occur.

In the table below, I have sought to summarise both the historical and IVF-era variations. Of course IVF using the mother’s egg and husband’s sperm can fulfil the same pattern of mother roles as a natural conception, but it offers scope for alternatives.

An overview of this kind is inevitably simplified and fails to capture the full range of human experience. For clarity, theoretical combinations (e.g. death of a mother following an IVF conception) have been omitted. The precise mechanisms by which a gestational & genetic surrogate (providing both the egg and the uterus) becomes pregnant have no bearing on the argument being presented re the definition of “mother”, and have therefore not been elaborated. Similarly, variation in the male contribution (genetic and/or nurturing) are also outside the remit of the current discussion.

Where the various mother roles are divided across more than one person, I have defined “woman 1” as the intended long-term care giver, and/or purchaser of services in donor egg/surrogacy cases. In the context of same-sex female partners where one provides the egg (fertilised with donor sperm) and the other carries the baby (a process known as reciprocal IVF or Co-IVF), I have designated the genetic mother as number 1, though these numbers could be reversed if care is going to be shared. Three parent IVF, in which a donor provides the egg into which the long-term mother’s chromosomal DNA is transplanted, is included since this procedure has now been conducted.

Reflection on the fragmented nature of motherhood is not new (see, for example, Helena Ragone on Surrogate Motherhood and American Kinship) but I am not aware of any attempt to systematise and catalogue emerging models of “motherhood” in exactly the way presented. This grid, below (and here) represents my first attempt to do so.

What additional combinations have I missed?

* The refrain “Are you my mummy?” is integral to The Empty Child, an episode of the first season of Doctor Who following relaunch in 2005.

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