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14. The “Local” Confronts the “Global”: Infertile Bodies and New Reproductive Technologies in Egypt
- University of California Press
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263 FOURTEEN The “Local” Confronts the “Global” Infertile Bodies and New Reproductive Technologies in Egypt Marcia C. Inhorn Since the birth in 1978 of Louise Brown, the world’s first test-tube baby, new reproductive technologies (NRTs) have spread around the globe, reaching countries far from the “producing” nations of the West. Perhaps nowhere is this globalization process more evident than in the nearly twenty nations of the Muslim Middle East, where in vitro fertilization (IVF) centers have opened in small, petro-rich Arab countries such as Bahrain and Qatar and in much larger but less prosperous North African nations such as Morocco and Egypt. Egypt provides a fascinating locus for investigation of this global transfer of NRTs because of its ironic position as one of the poor, “overpopulated” Middle Eastern nations. With nearly 70 million citizens and an annual per capita GNP of $3,460 (Population Reference Bureau, 2001), Egypt has pursued population reduction goals through family planning since the 1960s, the first Muslim Middle Eastern nation to do so (Stycos , Said, Avery, & Fridman, 1988). Yet, as in the vast majority of the world’s societies, infertility has never been included in Egypt’s population program as a population problem, a more general public health concern, or an issue of human suffering for Egyptian citizens, especially women. This is despite the fact that a recent World Health Organization–sponsored survey placed the total infertility prevalence rate among married Egyptian couples at 12 percent (4.3% primary infertility and 7.7% secondary infertility) (Egyptian Fertility Care Society, 1995). Given the size of this infertile population and the strong culturally embedded desire for children expressed by virtually all Egyptian men and women, it is not surprising that Egypt provides a ready market for NRTs. Despite its regionally underprivileged position, Egypt has been on the forefront of NRT development in the Middle East—a legacy, perhaps, of its long history with colonially inspired biomedicine (Inhorn, 1994). In 1986 Egypt was one of two nations in the region to 264 GLOBALIZING TECHNOLOGIES open an IVF center. By 1996, when the research for this chapter was carried out, there were ten Egyptian IVF centers in full operation or development . By the end of the decade, there were more than thirty-five IVF centers in Egypt—a greater than threefold expansion in only three years, placing Egypt ahead of even Israel, which alone boasts twenty-four IVF centers (Kahn, 2000). This explosion of IVF services in Egypt is perhaps surprising when one considers that a single trial of IVF can cost more than£E 10,000, or U.S. $3,000. This represents several times the annual income of a poor Egyptian and is an admittedly large sum for even the most affluent Egyptian patients. In other words, the new reproductive technologies would seem to be out of reach for most ordinary Egyptians; yet infertile Egyptian patients are inundating IVF centers, which face such great demand for their services that they are chronically short of the powerful drugs, supplies, and even competent technical staff necessary to carry out IVF procedures. A critical question thus becomes: What factors explain the consumption of high-cost, high-tech reproductive technologies in a Third World country such as Egypt? Or, put another way, why are Egyptian consumers so powerfully motivated to try these costly, potentially risky, and often unsuccessful technologies? Certainly, to understand this demand for NRTs requires an analysis of pronatalism, or child desire, and the accompanying dread, severe stigmatization, and suffering that infertility brings for most Egyptian couples. These are subjects that I have taken up at length elsewhere (see Inhorn, 1994, 1996) and that provide the implicit background to this chapter . But my primary goal here is to ask, not what motivates Egyptians to use these technologies, but rather what might prevent them from doing so. Namely, my research in Egypt shows that would-be Egyptian IVF consumers confront numerous “arenas of constraint,” or various structural, socialcultural , ideological, and practical obstacles and apprehensions that may detract or deter them altogether from using NRTs. During two periods of research in Egypt, I have identified eight major arenas of constraint, ranging from local formulations of patriarchy, which privilege infertile Egyptian men in their marital relationships, to local versions of Islam and Coptic Christianity, which legislate the “appropriate” use of new reproductive technologies , thereby restricting who may benefit from them (Inhorn, 2001). I would argue that examining such arenas of constraint facing the infertile wherever these...