Sex Cells: The Medical Market for Eggs and Sperm (26 page)

Nor are the particulars of the exchange determined by biology or technology. Theoretically, sperm banks could sell all of a donor’s samples to “his” recipient (and indeed some banks do offer such “exclusivity” for a price), and there is no technological barrier to splitting eggs from one donor among several recipients. Sperm banks could emphasize the deep significance of the gift that men are giving, sharing details about recipients’ lives with sperm donors, and passing on thank-you notes. Egg agencies could treat women like employees, paying them based on the number of eggs they produce and refraining from mentioning any details about the program’s customers. But this is not how it works in the market for sex cells, where a woman’s donation is considered a precious gift and a man’s donation a job well done.

More than just influencing program protocols, these gendered understandings affect women’s and men’s experiences of paid donation, because organizing it as a gift or a job simultaneously encourages and discourages particular conceptualizations of the monetary exchange. Most women are drawn by the prospect of making money, but as they
interact with staff and sometimes with recipients, they begin to define donation in terms of being compensated to help people have children. Egg donors are paid to undergo the shots and surgery associated with IVF, and as they are not attempting a long-awaited pregnancy, they have a less intense bodily experience of this technology than would be expected. Moreover, they are paid for completing the
process
of donation, not on the basis of its outcome (number of eggs), so when they talk about “giving enough,” it is about making sure the recipients have a good chance at becoming pregnant. At the same time, egg donors downplay the significance of their genetic contribution. When a woman calls her donation “just an egg,” she is removing herself from any suspicion of being a bad mother, the kind who would sell her baby, and underscoring her contribution to the recipient’s motherhood project, a contribution that she defines as a “huge gift.”

Most sperm donors, too, are attracted by the idea of making money, but their interactions with staff are more closely aligned to those of employees in a workplace. Clocking in at the bank on a regular basis, men must produce high-count samples, and they hear little about recipients. As a result, sperm donors conceptualize donation as a job, and the fact that payment is based on bodily performance leaves them feeling like “assets” or “resources” for the sperm bank. Drawing on broader cultural understandings of paternity, they offer straightforward definitions of themselves as fathers to offspring, a view that is only reinforced by the banks’ identity-release programs, which mark as significant the
donor’s
contribution, not what he is doing for the recipient.

In this market, gendered cultural norms of maternal femininity and paternal masculinity operate in complicated ways, some of which seem almost contradictory. Relying on such norms, egg agencies recruit women who express altruistic motivations that are consistent with nurturing caregiving, but staffers expect donors to stop short of actually seeing themselves as mothers. Sperm banks frame donation as a job, reflecting cultural expectations that men be productive breadwinners, but they, too, do not want sperm donors defining themselves as fathers who will be responsible for offspring. These organizational practices result from the
selective
mobilization of gendered ideals, with egg agencies and
sperm banks drawing on some elements of maternal femininity and paternal masculinity to manage donors. And it is the confluence of those organizational practices with the broader cultural norms that lead sperm donors to simultaneously see themselves as fathers and feel like “assets,” while egg donors can simultaneously consider their donation to be “just an egg” and a “huge gift.”

This sociological rendering of the market for eggs and sperm contrasts with the traditional vision of a market offered by commodification scholars, a vision in which the monetary exchange is all that matters. It is the “underlying activity,” and all the other factors that go into making a market—who is doing the buying and selling, what is being bought and sold, how the exchange is organized, and how the participants experience it—are dismissed as irrelevant.
¹
But these factors
do
matter. The market for sex cells reveals that the gendered framing of donation as a gift or a job is enormously powerful in shaping the social process of bodily commodification, both in terms of how it is organized and experienced.

WHY?

The question that remains is why sperm donation is considered a job and egg donation a gift. To answer this question, I return to some of the themes from the Introduction regarding the relationship between economy and society and how the social relations within and between them are suffused with gendered norms. Specifically, I contend that a powerful cultural distinction between the market and the family generates underlying mechanisms that drive much of the organization and experience of the market for sex cells.

Traditionally, markets have been associated with paid work, and the family has been associated with private life. The prevailing image has been one of “separate spheres,” in which there is a bright line between the public sphere of the market and the private sphere of the home. According to the traditional division of labor, men dominated the public sphere, leaving the home each day to go to work, where they earned money to provide for the family. Women reigned over the private sphere,
bearing and nurturing children while maintaining the home and family ties. Even as these gender norms became less hegemonic—more and more women are joining the workforce, and more and more men are performing household duties—the association of men with the market and women with the family has persisted.

More than these gendered associations, though, the idea that market and family
should
be separate has survived enormous social changes during the course of the last century. In different times and places, the line between these spheres has been drawn in different ways, and the actual lines are rarely as distinct as they appear in the abstract.
²
However, the dichotomies that undergird this cultural distinction—/files/02/13/03/f021303/public/private, work/home, and male/female—remain incredibly powerful in structuring social practices.

In effect, the market for sex cells collapses the distinction between the public sphere of the market and the private sphere of the home, because it is
family
that is
for sale
. Certainly, the staff in donation programs would never put it so bluntly, and economists might identify the actual product as eggs or sperm or the donors who provide them. But what those cells and donors make possible is families. Consequently, there is a deep tension between what is for sale and what is culturally appropriate, tension that both egg agencies and sperm banks manage by deploying the altruistic rhetoric of donation.

Furthermore, given that women are more closely associated with the home and family life, paid egg donation is a more direct violation of the cultural distinction between market and family than is paid sperm donation. Historically, men’s relationship to the home has been defined in terms of being a breadwinner, of providing financially for the family, so the connection between monetary exchange and family life that exists in sperm banks does not pose the same “threat” that it does in egg agencies. As Sharon Hays puts it, the relationship between mother and child is “understood as more distant and more protected from market relationships than any other.”
³
As a result, it is not only the language of donation that appears in egg agencies, but also the language of the gift, which serves to manage the cultural tension of women being paid for eggs that become children and create families.

The historical data suggest that the language of donation and, for women, the language of the gift, were present from the inception of the market. From the first physician–researchers experimenting with IVF to egg agencies in different parts of the country, egg donation is a gift, a compensated gift, but a gift. The paid provision of sperm has consistently been referenced as donation, but sperm banks do not put much effort into defining this donation as altruistic. I do not wish to suggest that these are conscious strategies, that such language was adopted at some staff meeting somewhere and then became systematic policy. It was present from the beginning and has appeared throughout the history of the market because it
makes sense
, culturally speaking.

Until now, the working assumption has been that biological differences between women and men fully account for the differences in the market for eggs and sperm. In contrast, the explanation offered here takes into account biology but draws on the cultural meanings associated with sex differences to contend that gendered expectations of women and men, particularly those around reproduction and the family, also contribute to creating a market where sperm donors are paid piecework wages on the basis of bodily production and egg donors are compensated for giving a priceless gift.

BODILY COMMODIFICATION AS SOCIAL PROCESS

This book serves as an extended call to refine the concept of bodily commodification. In this section, I draw on insights from the medical market for sex cells to propose a sociological approach to thinking about what happens when people are paid for bodily goods and services.

First, it is crucial to view commodification of the body as an interactive social process, one that occurs over time between people who occupy particular social locations. This contrasts with the prevailing view of commodification in bioethical writings, which is essentially that of a light switch: if money is exchanged, then there is commodification, and the author does not need to know much more than that to speculate about its objectifying, alienating, and dehumanizing effects. I argue that identifying the monetary exchange is just the first step in a rigorous analysis.

Second, given that bodily commodification is a social process, scholars should expect to find variation in how that process unfolds. The potential causes and effects of this variation are numerous and are likely to be related to the good or service being exchanged. At a minimum, researchers should be attuned to:

• the broader social context, including the historical time in which the exchange occurs, the space in which it is managed, and the cultural norms that influence it;

• the social and biological characteristics of those participating as buyers, brokers, and sellers;

• the extent to which each participant has access to different forms of social power and social control;

• the supply of and demand for the good and any regulations that govern its exchange; and

• the characteristics of the good itself, including whether it is present in all kinds of bodies, if it is renewable, if it is separable from the rest of the body, and if its provision entails risk.

Third, it is important to attend to at least two levels of analysis when examining variation in bodily commodification: the organization of the market and the experiences of those participating in the market. Given the dominant assumption that commodification is commodification is commodification, scholars have paid little attention to variation in how markets for bodily goods and services are organized. Social scientists have begun some of the detailed, empirical work to trace this variation, but it is still rare to find comparative, qualitative data from buyers, brokers, and sellers about their experiences in different kinds of markets. As a result, the primary question asked in this book suggests a new angle on bodily commodification: how does variation in the organization of markets shape the experiences of participants in those markets?

Answering this question reveals one of the significant findings from this study: the way in which payment happens (i.e.,
how
the money is handed over) is surprisingly important in shaping egg and sperm donors’ experiences of being paid for bodily goods. Thus, the fourth and final suggestion for refining the concept of bodily commodification is to pay extremely close attention to the monetary exchange itself, both in
terms of what the money is called and how it is doled out. Is the money referred to as a gift or compensation, as income or wages, or something else? Who refers to it that way? Do those who organize the market and those who participate in it call the money the same thing? When and how is the money paid? Is it all at once, or is it based on the provision of particular goods or the completion of particular acts? Each detail is not necessarily significant on its own, but together they reveal underlying assumptions about what kind of market it is and what kinds of social relationships are appropriate.

Each of the four elements in this proposal stresses the necessity of systematic, empirical research on markets for bodily goods rather than relying on abstract distinctions between gifts and commodities or between the family and the market. Learning more about how markets for bodily goods and services work in practice will offer a way out of interminable debates about whether commodification is objectifying or liberating, dehumanizing or empowering, because normative questions such as these cannot be answered
a priori
. Commodification is not a generic or uniform process, and it can result in different kinds of outcomes for different kinds of people in different kinds of situations.

In sum, debates about bodily commodification need to be infused with a more detailed understanding of what actually happens when people are paid for parts of their bodies. Much remains to be learned about the interactional dynamics in such markets, of how subtle and not so subtle differences in framing the exchange influence how each party responds to the transaction. Moreover, comparative research is also necessary to examine how the setting of such exchanges—in medical clinics, on the black market, and in countries with more and less regulation—matters. Social scientists working in this arena need to analyze precisely how it is that the structure and experience of bodily commodification is shaped by social categories and social inequalities, as economic valuations intertwine with cultural norms in specific organizational contexts.