Elizabeth Chloe Romanis is an Associate Professor in Biolaw at Durham Law School, University of Durham in the U.K. Chloe does research in healthcare law and bioethics with a particular interest in reproduction and the body (abortion, gestation, pregnancy, and birth). Chloe’s principal publications concern artificial placenta/womb technology. While writing this book, Chloe was a Fellow-in-Residence at the Edmond and Lily Safra Center for Ethics and Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law (2022–2023). In this Recently Published Book Spotlight, Chloe talks about the relationship between sex and gestation, the metaphysics of pregnancy, and how one needs to read to write well.

We all result from gestation—the generative process supporting the creation and development of new human babies. It begins at conception and ends with an entity being born that can (most of the time) adapt to the external environment to begin a new kind of development. In humans, gestation is a process that has always been sustained by pregnancy; bodily work sustained by a person with biotypical physiology assigned female at birth. However, developments on the horizon offer some critical alternative possibilities with wide-reaching ramifications. Uterus transplants could “unsex” gestation by, in theory, enabling gestation to be sustained by pregnancy as part of bodies assigned male at birth. Artificial placenta technologies could introduce the possibility of gestation beyond bodies at all; of gestation facilitated partially or completely by machine.

My book is about the process of gestation—what it is, how the nature of gestation may be shifted by unsexing and disembodying technologies, and the social, ethical, and legal implications of gestation and future gestations. The first three chapters explore what gestation is and how we should classify technologies that enable gestation, while the final five chapters consider the impact of these technologies on key practical issues: access to technologies, sex and gender equality, parenthood, and abortion. While I think I raise more questions than answers, my key takeaway is that biological essentialism undergirds our existing thinking in these areas. Technologies enabling gestation have the capacity to challenge these ideas, but only if we really take up the critical challenges they raise to consider different kinds of futures.

The first three chapters of my book—establishing my theoretical framework—draw heavily from bodies of work in metaphysics, phenomenology, and feminist theory exploring pregnancy.

I became interested in the metaphysics of pregnancy due to the work of friends and colleagues like Suki Finn and Elselijn Kingma. I felt that I could build upon their work and contribute to our understanding of pregnancy—raising and defending the distinction between gestation and pregnancy (which are often conflated) and examining how the law relates to models of pregnancy being discussed among philosophers.

Something I really learned from writing this book was the importance of taking a step back from what jumped to mind as the immediate legal and philosophical issues surrounding novel procreative technologies to grapple with the mechanics (the metaphysics) of what I was thinking about. I spent much of the first chapter of the book thinking about what English law says about the ontologies of pregnancy (rather than what it says about things that can happen during a pregnancy). This is an investigation that I now think was critical to an account of everything that follows about the ethical and legal issues around, for example, abortion, parenthood, and gender equality, but it seems to be a step in interrogating the law/social values that are readily missed.

The importance of thinking about procreative futures is a hill I will die on. What often is missed about the exercise, however, is that speculation is not just an (important) form of anticipatory work to consider the social, ethical, and legal implications of technologies or new uses of technologies that we may one day have. It is also a critical lens through which we can interrogate the values that underpin our thinking about and regulation of procreation in the present.

Thinking about a future in which gestation can be facilitated in bodies beyond those sexed female, whether we are talking about cis male pregnancy or ectogestation, is a useful exercise to expose what we take for granted in the present and how this is reflected in societal values around procreation that are embedded in legal frameworks. One example is that in English law (and many other jurisdictions), gestation is used as a sole determinant of who a mother is. While this may have made sense and indeed have been important for the rights of people who can become pregnant in the past, this is now a very constraining condition. While the reasons that gestation might be thought of as the only criterion on which to attribute motherhood (in the legal sense) may have changed over time, it is important to examine whether the reasons people place stock in right now still make sense if the nature of gestation changes—the who or what of the work involved. This reveals something about how contingent contemporary reasoning is or isn’t and what it is contingent on. It opens up space for a fuller discussion of what we should value in how we attribute parental status. 

Writing a book takes much longer than you think it will, but this isn’t a bad thing. I had initially planned to write this book over the period of a year in which I had a research fellowship in the US (generously supported by the Edmond and Lily Safra Center and the Petrie Flom Center in the Law School at Harvard). As the period of research time went on, progress was slower than I thought. It wasn’t because I wasn’t making progress; it was because progress was not what I imagined it to be. I was taking the time to think and read as much as I was to write. I was very lucky that on my return to the UK, I had a research sabbatical from my department and support from another visiting researcher scheme (with the Future of Human Reproduction project at Lancaster).

The additional time that I took to complete the manuscript was because I chose not to compromise on the research time (reading and reading as much as writing). I chose to write this book because I had a lot to say that I was worried would feel too “bitty” if it were published as a series of articles. A book meant it could be in one place—together as it should be. The joy of writing this book became not so much the writing and the collation of my thoughts but the time I gave myself to sit with the thoughts of others. I’m really grateful to my publisher for their patience, and I learned to ask for more time when drawing up timelines.

The TL;DR of that—it is better to take longer to write the book you really want than to write it quickly, and research fellowships were a great way to support time.

For my sins, I already have another book contract. My colleague, Dr. Victoria Hooton, and I are working on a title called Pregnancy, Parenting, and Work, which explores the distinction between procreative work and parenting work that are often inappropriately conflated. When this occurs, there are serious consequences for individuals and families, particularly concerning employment protections. For example, some people raising children may find themselves without access to entitlements like parental leave (or feeling unable to use them) because they were not themselves pregnant. This can sometimes place a disproportionate burden on people socially branded as mothers to the exclusion of others, often fathers, who may want to be more involved in parenting work.

We are also interested in how assisted procreation has intensified these problems—it enables people to build their families, but sometimes, people using it are especially vulnerable to a lack of recognition of their parenting work (e.g., in cases like surrogacy). Without appropriate employment protections, we aren’t affording appropriate recognition to either pregnancy work or parenting work, and people may not feel able to make procreative and parenting choices for themselves.

If you’re interested, we’ve published a piece on ectogestation and employment rights that gives a glimpse into what we’re up to.