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Saturday, April 13, 2024

Science Is Redefining Motherhood. If Only Society Would Let It

Karl, a PhD and lecturer at MIT, gave birth to both of his children—and despite being the one with the baby bump, he was routinely asked to wait outside while the nurses attended to his (not pregnant) wife. People were unable, he says, to see both a man and a pregnant body; as a result, Karl became a “fat man” rather than a pregnant person. Despite being assigned female at birth (AFAB) and possessing a uterus and glands for lactating, Karl was not—in the eyes of even the medical staff—the mother. Karl considered himself a PaPa; other transgender parents choose more androgynous terms, largely because of the way motherhood has been construed. At best, says Karl, unconventional pregnant parents cause “total gender confusion” even among medical practitioners, but at worst it results in trauma, violence, and harm, in trans men failing to get emergency care during miscarriages, in trans women being treated as pedophiles, and in nonbinary identities being entirely erased.

And yet woman and mother are not, nor have they ever been, synonymous. In fact, neither term has any objective reality at all.

Motherhood, like gender, is a social construct; “it exists because humans agree that it exists.” We create constructs as a means of ordering the world and attempting to control it. They are useful for organizing our thoughts; they become extremely dangerous when we mistake them for reality. Some commentators go so far as to suggest that a trans woman’s pregnancy “inverts” and warps “immutable biological realities.” But motherhood is not immutable, and it is not (necessarily or entirely) biological. In recent decades, scientific technology has come closer than ever to providing fertility to all, from those who struggle with infertility due to conditions like endometriosis or low gamete count to those born with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a rare disorder wherein AFAB women are born without a womb or upper two-thirds of the birth canal.

The concept of “motherhood” must be actively decoupled from its exclusive connection to “womanhood” or we risk devolving into a society that penalizes, imprisons, or commits violence against would-be parents or their children. We built this term and imbued it with meaning, and we can likewise change it, and perhaps divest it of its divinity and its demons.

Adrienne Rich, a poet and essayist, once described “two strands” of motherhood. One is an experience, and the other is a political institution in which “all women are seen primarily as mothers; all mothers are expected to experience motherhood unambivalently and in accordance with patriarchal values; and the ‘nonmothering’ woman is seen as deviant.” These restrictive assumptions do more than limit the opportunities for women; they limit access to health care for those who would become mothers but who do not fit the traditional concept of motherhood. (The recent Supreme Court decision draft concerning Roe vs. Wade makes these ommissions even more glaring, as transgender people with uteruses are continually left out of discussions about reproductive rights.)

Today’s gender-biased assumptions about motherhood have been largely inherited from the rise of the middle class. Among the poorer classes, men, women, and sometimes children worked to sustain the family; among wealthy or aristocratic women, nurses and governesses frequently took on the childcare. But affluent 19-century families, who could afford leisure, needed to have only one parent leave the house for work, and it became a mark of pride if a man could keep his wife at home. The new middle class fused the woman, wife, and mother into a single social category. The image of the submissive housewife and mother was reinforced in the June Cleaver tropes of the 1950s and '60s. According to Pew time-use studies, in 1965 dads spent only 2.5 hours a week taking care of their children. That was a woman's work, even if “motherhood” as a social role for women was a recent invention.

The social constructs surrounding motherhood have always limited the experience to very specific and patriarchally sanctioned groups. Class, education level, and race have all been used at different times to deny the right to mother. In the 20th century, more than 60,000 people (largely women of color, disabled persons, and those with lower incomes) were sterilized against their will in the United States. In California, female prisoners were forcibly sterilized as late as 2010. And Immigration and Customs Enforcement teams have been accused of coercive sterilization of detainees in the past five years. All of these procedures were performed on people who possessed the reproductive organs for giving birth and were considered “women” by those who took their organs away. For all the emphasis on motherhood belonging only to people who have two X chromosomes and were assigned female at birth, there are those ready to forcibly take that right away when it suits political ends. It’s clear, therefore, that no term is immutable.

Similarly, trans women are often excluded from the category of motherhood in a variety of ways. Some have been denied the term “mother” by their children and even by court systems, but the threats to transgender parenthood don’t stop there. As Mya Byrne, an American singer-songwriter, actor, and trans activist, explains, trans women are thought of as “problematic” parents by heteronormative society. They have been presented as “unsafe” around children through deeply sexist and genderist rhetoric [Trigger warning: Linked transcript contains abusive language toward transgender persons]. “If a child came to my door, I would take it in and raise it,” Mya tells me; “If you adopt, they are your own kids. [Queer people] create family. We create parenting. And whether or not we reproduce through gestation, we can be parents.”

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Trans women spend their lives resisting the errant conditioning that someone is unfit for motherhood based on superficial characteristics.

Where the social construct limits, science expands. The definition of who could be considered a potential mother, in terms of fertility and reproductive capability, was already being challenged by medical technology as early as 1969. British developmental biologist Robert Geoffrey Edwards and gynecologist Patrick Steptoe laparoscopically removed mature human eggs, mixed them with prepared sperm, and incubated them for fertilization. They had created the first “test-tube” embryos. On July 25, 1978, the world's first baby conceived via in vitro fertilization (IVF) was born, followed by countless others—more than 8 million globally, in fact. The concerted scientific efforts to aid fertilization have continued unabated ever since. Two years ago, a new mother welcomed the first baby ever born from a transplanted uterus. This took place in my hometown of Cleveland, Ohio. The mother, in her thirties, took part in a trial to treat women who were born without a uterus or had theirs removed surgically. She received a transplant from a deceased donor and gave birth to a healthy baby.

In 2021, researchers in Australia and Japan built artificial wombs that could support lambs. Scientists in the Netherlands claim they are “within 10 years” of developing such wombs for premature infants, allowing them to complete gestation outside a human body. Meanwhile, Conception, a commercial venture, is working to turn adult cells into gametes—or sperm or egg cells—repudiating the usual rules of conception. It would “break the rules of reproduction as we know them,” writes the MIT Technology Review. Another recent research breakthrough means eggs can be grown from the ovaries of transgender men, even after years of testosterone–and new possibilities for uterine transplant pave the way for transgender women, too. Becoming pregnant is easier now than it has been at any point in history, even in the face of infertility, hysterectomy, nonexistence of a uterus—and the absence of human-made eggs.

Scientific breakthroughs have allowed us to overcome many obstacles, but even science cannot easily overturn social constructs and gender expectations. When the team behind the first test-tube embryo announced their findings and prepared to implant these embryos into a woman’s womb, they faced lawsuits and defamation. The Medical Research Council called it unethical and refused to fund their work; fellow scientists dismissed it as an amoral meddling with nature, akin to playing God. Since the first uterine transplant at the Cleveland Clinic, specialists there have received increasing requests from transgender patients. But when Richard Paulson, an obstetrician-gynecologist and president of the American Society for Reproductive Medicine, announced that trans women could be giving birth “tomorrow,” a severe backlash followed. Julie Bindel, who has clashed with trans activists in the past, argues that trans women have no right to the procedure, calling their desires a “twisted notion” [Trigger warning: The article uses blatant misgendering]. Following Bindel, Women’s Forum in Australia attacks the idea as “bad for children.”

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Through each advancement, society has remained wedded to social constructs, refusing to see that those too must change as experiences change. As a result, every scientific development has been viewed as a threat to motherhood, rather than an opportunity to provide reproductive support to all who seek it.

It isn’t the state of science that holds us back from supporting non-normative mothers, but stagnant notions and stigma. The way forward is inclusivity. “There has been growing awareness of alternative reproductive options in the queer and trans communities,” says Karl, who’s also an activist. This has been fostered almost entirely by increased access to peer support groups on the internet. When Karl was pregnant, he joined a Facebook group with a handful of others, looking to share information about conception, pregnancy, gestation, birth, and lactation across groups of people who are gender nonconforming, or transgender. Birthing and Breast or Chestfeeding Trans People and Allies now has more than 7,200 people subscribed. “I think this, like so much in the trans community, is changing very, very rapidly,” Karl tells me. The younger generation is pushing it forward, bypassing traditional routes and creating birth and motherhood networks of inclusion.

Mya tells a similar story. Support—emotional, fiscal, and interpersonal—has most often come from other trans people, elders in the LGBTQ community who can offer connection and a safety net. There are Kickstarter campaigns to help pay for gender confirmation surgeries; there’s no reason to suppose similar kinds of communal support wouldn’t make up part of the costs of new technologies (those for aiding mothers without female reproductive organs, in particular) when they become available. It’s true that there are still hurdles to overcome, including understanding the exact hormone levels required. But every transplant “first,” from kidneys to hearts and lungs, began as an almost unimaginable possibility; uterine transplants will be much the same.

Patriarchal culture once rendered motherhood sacred to the point of sexless divinity—of which the Virgin Mary and the Victorian “angel of the house” are both emblematic. As we have challenged those norms, through working mothers, stay-at-home fathers, same-sex parenting, and technologies that make science central to human reproductivity, a more balanced understanding of what it means to “mother” has gained acceptance. While we still have battles to fight for reproductive justice (and some to fight again), progress is possible when we continue to evolve our understanding: The intimate, gentle, nurturing, generative properties long associated with motherhood could be equally the province of women, men, trans men, and trans women. To do away with the artificial boundaries and false distances between children and their carers, regardless of gender, would be the greatest achievement. It would simultaneously create new safe spaces for children and new outlets for those who love them to express emotional care.

Through scientific and medical advances, “non-normatively gendered” and queer families are challenging and expanding the definition of “mother” in just these ways. Parent groups are calling practitioners to account and advocating for inclusive language; physicians themselves are increasingly speaking about how to improve care for transgender patients and would-be parents. We must resist, again and again, the notion that words make realities and be led instead to investigate experience. We have the technology nearly within our grasp; what we must do next is create safe spaces to nurture new mothers—whatever their gender—and welcome families into the world.

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