The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception (Hardcover)

by Debora L. Spar (Author)

Editorial Reviews

From Publishers Weekly
Among the troubling aspects of new reproductive technologies is the takeover of reproduction by the marketplace. This probing study accepts the free market process while casting a discerning and skeptical eye at its pitfalls. Harvard business prof Spar (The Cooperative Edge: The Internal Politics of International Cartels) explores many aspects of the high-tech commodification of procreation: the fabulous revenues commercial fertility clinics earn from couples' desperate desire for children and the ensuing conflicts between medical ethics and the profit motive; the premiums paid for sperm and eggs from genetically desirable donors; the possible exploitation of poor, nonwhite and Third World surrogate mothers paid to gestate the spawn of wealthy Westerners; the fine line between modern adoption practices and outright baby selling; and the new entrepreneurial paradigm of maternity, in which the official "mother" simply finances the assemblage of sperm, purchased egg and hired womb and lays contractual claim to the finished infant. Spar considers most of these developments inevitable and not undesirable (they provide kids to parents who want them), but calls for government regulation to curb excesses and protect the interests of all involved. Her sanguinity will not satisfy all critics, but she offers a lucid, nuanced guide to this brave new world. (Feb. 14)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From The Washington Post
Infertility in America has become a string of titillating anecdotes, one long episode of "Oprah": "The surrogate took our baby." "Our baby has three mothers: Which is the real one?" "I used my dead son's frozen sperm to make a grandchild." "My ex-wife stole our IVF embryos and had a baby." Heartwarming, heartbreaking -- these stories are all heart. We are so busy emoting that we never stop for a moment to think: What on Earth is going on here? Fortunately, the very sharp-eyed, clear-headed and unsentimental Debora L. Spar is not so easily distracted by these inconceivable tales. She has chiseled through the encrusted anecdotes, hardened her heart against the saccharine language of "miracle babies" and "angels," cast a skeptical eye at the doctors trying to cloak all infertility in medical necessity and recognized what no one involved in infertility wants to acknowledge (or wants their customers to know): that it is a business. In fact, it is more than a business: It is an industry. It is the fertility-industrial complex, and its product is babies. The Baby Business is as smart and sensible a book as you could hope to find about such a charged subject. Spar is not the first professor or writer to recognize that there is money in infertility, but she is the first to capture and explain the whole market clearly. She leads readers step by step through the fertility industry, from the relative simplicity of sperm donation, to the greater complexity of egg donation and surrogacy, to the cutting-edge medicine of in vitro fertilization (IVF) and Pre-Implantation Genetic Diagnosis, to the oldest infertility treatment of them all, adoption. The principal point of The Baby Business is that making babies these days doesn't always involve the old-fashioned method. There are 8 million infertile women in the United States alone, and they are spending around $3 billion a year to try to help themselves conceive. There is not a market for babies -- propriety restrains all but the most desperate and demented from actually buying children -- but there is a market for everything else: sperm ($275 a vial), eggs (up to $50,000 apiece), nine months use of a womb ($20,000), the creation of an embryo ($12,000 per cycle). The fertility-industrial complex is a stunning array of businesses -- practically a microcosm of the entire global economy. It includes the manufacturing of fertility hormones, harvesting of renewable natural resources (sperm and egg collection), international trade (foreign adoptions), expert services (IVF and other high-tech medicine), and even rental real estate (surrogate mothers) and long-term storage (embryo banks). What is perhaps most interesting about The Baby Business is what it's not obsessed with. Unlike almost every writer who touches the subject, Spar doesn't fixate on ethics. She writes about cloning but doesn't spin utopian or dystopian scenarios involving cloned and enhanced superkids. Her concerns are much more mundane. Fertility treatments are troubling not because they could lead to a genetic elite or clone armies or other horrors, but because people are getting ripped off. Not enough people are getting fertility treatments, and those who do are paying too much. Spar asks why our infertility markets don't work as well as they should. The first and most important problem is that the customers -- usually infertile women -- are too desperate. "The clients' demand for the 'product' is exceedingly strong. They are willing to try anything -- repeated rounds of hormones, multiple surgeries, pregnancy right after cancer -- and they are essentially unwilling to give up." The result is that the normal restraints on a market are absent. Women will drop $100,000 on round after round of failed IVF treatments. Their doctors, who profit from every new attempt, are put in an awkward position, one financially rewarding but ethically unsound. The second major problem with the fertility market, Spar says, is that no one who works in it wants to acknowledge it exists. The brokers who recruit egg donors and surrogates tend to portray themselves and the women they recruit as good Samaritans, committing acts of kindness for needy strangers. Fertility doctors duck behind the shield of Hippocrates. They deny that what they are doing is commercial: They insist they are just trying their latest new, risky treatment to help their suffering patients, and don't point out that each of these new techniques makes them a fortune. This pretense of noncommercial activity makes infertility very opaque for customers: They don't know whether they ought to be paying what they are paying, or if they are getting a good service, because the usual market checks -- information, competition, transparency -- are absent. And finally, Spar writes, the American approach to infertility has left it particularly chaotic. Almost every other developed nation regulates fertility treatments more systematically than the United States does; some, such as Israel, have extensive state subsidies for certain treatments, while others, such as Germany, ban practices that are common here, such as surrogacy or anonymous sperm donation. The American left has not wanted to regulate fertility because it intrudes on women's reproductive choices, which disturbs pro-choicers. The American right, by contrast, has not wanted to regulate fertility because it appears to be a functioning and free market. The result is a Wild West. As USC law professor Alexander Capron once told me, in most U.S. states until recently, nothing would stop you from opening "Sam's Sperm Bank and Delicatessen." The result of the desperation of the customers, refusal of providers to acknowledge they are in business and the lack of government regulation, Spar says, is an ugly chaos. People make contracts that can't be legally enforced. They travel across the country to states that permit practices that their state might ban. Those who live in states where insurers have to cover infertility avail themselves of the latest techniques to get babies, while those elsewhere bankrupt themselves for much worse treatment. Would-be parents contract with one woman for an egg and another for a womb, leaving the law baffled about which of the three mothers is actually the legal one. This baby business can't be eliminated, but it can be made to work better. Spar, with the pragmatic streak that runs through the book, rejects various foreign models that would never work here. In many European nations, a massive state apparatus decides who can and can't get which kind of treatment. Americans would bristle at such government control of their reproductive rights. What American fertility needs instead, Spar concludes, is a modicum of regulation: a system of property rights, more consistency from state to state about insurance and laws, and more transparency. The result will be lower prices and more customers. The Baby Business looks forward to an America where fertility treatments are less miraculous and more ordinary, less Oprah and more Wal-Mart. David Plotz is deputy editor of Slate and author of "The Genius Factory: The Curious History of the Nobel Prize Sperm Bank."

Reviewed by David Plotz
Copyright 2006, The Washington Post. All Rights Reserved.

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Product Details

• Hardcover: 302 pages
• Publisher: Harvard Business School Press; 1 edition (February 14, 2006)
• Language: English
• ISBN-10: 1591396204
• ISBN-13: 978-1591396208
• Product Dimensions: 9.1 x 6.1 x 1.1 inches
• Shipping Weight: 1.4 pounds (View shipping rates and policies)
• Average Customer Review: 4.3 out of 5 stars See all reviews (7 customer reviews)
• Amazon.com Sales Rank: #89,337 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

9 of 11 people found the following review helpful:

5.0 out of 5 stars Insightful treatise on a difficult and emotional topic, February 28, 2006

By	G. Ross - See all my reviews (REAL NAME)

A very insightful treatise on a very difficult and necessarily emotional topic. For anyone involved in the business of fertility or interested in using non-traditional methods of conception or the adoption of children, a must read. Ms. Spar's book is a frank, detailed plunge into the practices, economies and ethics of the "Baby Business" with conclusions that propose a gentle regulation of reproduction practices.

8 of 10 people found the following review helpful:

5.0 out of 5 stars The Birth of the Scholarly Page Turner, March 30, 2006

By	R. Schmon (New York, NY. USA) - See all my reviews (REAL NAME)

This is good stuff-if not juicy, and Spar casts a wide net that doesn't miss a thing: conception techniques, fertility markets, surrogacy, designer babies, human cloning, and adoption. The writer also has the guts to have a lucid, constructive point of view-never backing away from the controversial subjects many would balk about discussing. This book is a must read for anyone who might, is, or has gone through any of the processes above, and for the rest of us like me, just a great eye-opening read. In fact, I kept thinking as the pages turned: "I had no idea..." As a piece of scholarly writing it is immaculate (check out the pages of footnotes!), but more impressive is the fact that Spar's writing style is trenchant, entertaining and unwavering in it's ability to present a point of view to the reader. I wasn't expecting it, but Spar continually challenges and provokes as she weaves her riveting tale of the dynamics of a topic-both moral and technical-that is dear to the hearts of us all: babies. Wow. A scholarly page-turner!? Shouldn't there be an award for that? It's great read, and I highly recommend it.

2 of 2 people found the following review helpful:

5.0 out of 5 stars Fabulously Informative and Unemotional, April 12, 2008

By	Taina Brack "Taina" (Cincinnati, OH, USA) - See all my reviews (REAL NAME)

I love this book for what it is. Some other reviers commented on the Stoic nature of the work. They are accurate about that. However, that is why I like it. The book isn't meant to say what's right or wrong or make judgements. The author does raise some ethical and moral questions but makes no attempt to answer them. As someone who has spent some time on the infertility hamster wheel and also has a background in Economics, I found this book fabulous. It is very dense, containing a very informative mix of economics, history and science. It is all about the market for babies.