Lessons from Latin America: A commentary of Florencia Luna, “Challenges for assisted reproduction and secondary infertility in Latin America”

Florencia Luna begins her essay, “Challenges for Assisted Reproduction and Secondary Infertility in Latin America,” by saying: “I want to explore a new way to think about Assisted Reproductive Technologies (ARTs) in the Latin American context.” I think she clearly achieves that objective. I want to suggest that she does more than this, however. In addition to revealing how traditional depictions of infertility in the United States and Europe are anachronistic for Latin America, her analysis offers feminist bioethicists in the United States the opportunity to revisit our own assumptions about infertility and improve our work as a result.

Anachronistic photographs of infertility that create a “relatively” invisible problem

Luna states early in her essay that her analysis will center on secondary infertility, which she defines as infertility “caused by inadequately treated sexually transmitted diseases (STDs) and infections or injuries resulting from unsafe or illegal abortions” (4). In the first part of her essay, she details the way in which the traditional conception of infertility renders secondary infertility a “‘relatively’ invisible problem” by utilizing what she refers to as “a logic of historical photography.” Luna explains:

The logic of historical photography refers to the idea that solutions to the problem of infertility still appear to be designed and implemented according to a picture of infertility and reproductive technologies taken when these treatments were first introduced. That is, we model our ideas about ARTs today on images of how infertility has been addressed in industrialized nations.

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According to Luna, this logic depicts and treats infertility as it is understood in industrialized nations—a problem that results from individual choices to delay procreation, that fundamentally afflicts accomplished, educated women who delayed procreation, and that is best addressed by assisted reproductive technologies (ARTs).

When we center secondary infertility in our analysis, though, it becomes clear that this vision of infertility is anachronistic for Latin America. Far from resulting from personal choices to delay procreation intentionally, secondary infertility is caused by the inadequacy of women’s reproductive health-care and social policies that make it difficult to obtain key women’s care services, such as safe abortions. Despite the fact that secondary infertility affects a large percentage of women in the developing world (Luna cites a statistic, e.g., that 38 percent of infertility can be attributed globally to inadequately treated STDs), she argues that the condition is unacknowledged, ignored, and rendered invisible by the logic of historical photography most commonly assumed in feminist bioethical analyses of infertility. As a result, Luna suggests that we may want to consider rejecting the historical photograph in order to design solutions that would better capture and alleviate infertility in Latin America.

Luna’s new infertility agenda

Because secondary infertility results from poor sexual and reproductive women’s health care as well as from various policies that prevent needed improvements in that care (such as those prohibiting abortion and valuing embryos), Luna wonders whether it makes sense to center an approach to infertility in Latin America around ARTs. After all, it appears that prevention, rather than technology, would better address infertility in Latin America. And, thus, she proposes a more holistic approach to infertility, one that emphasizes the connections among fertility, women’s overall health, and larger feminist goals.

Luna characterizes her proposal as, at least, a short- to medium-term solution that distances itself from “the U.S. model of private practice and the European model of public health that is centered around ARTs. The main difference is that, in order for this vision to make sense, at least for Latin America, ARTs should not be the point of departure or the center of attention. Instead, prevention and integrated sexual and reproductive health care for women should take center stage” (17). This approach, for example, would involve creating new types of infertility clinics that focus on preventing secondary infertility by offering a wide range of services, including treatment for STDs, expanded access to safe abortions and birth control, and education about prenatal care and what is necessary...