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Canada has recently emerged as a hotspot in a burgeoning global surrogacy bio‐economy. On the grounds that any commercial trade in reproductive capabilities would result in the exploitation of marginalised women willing to sell their eggs and wombs, Canada's Assisted Human Reproduction Act (AHRA) bans commercial surrogacy, allowing only for altruistic arrangements. Drawing together analysis of the AHRA and related legal, regulatory, and policy documents, feminist political economic theory, and a growing body of critical social scientific scholarship on surrogacy, this paper troubles altruism as a means of insulating surrogacy from market‐based exploitation. It contributes to the extant literature an explicit focus on the law as a key site in the reproduction of the gendered division of labour. Acknowledging the serious concerns that dog commercial markets in reproductive biology, it argues that the legal constitution of gestational work as altruistic is part of a broader juridico‐economic apparatus that has systematically devalued reproductive labour under capitalism. Efforts to insulate surrogacy from the market by legally designating it as a gift freely given facilitate the ongoing appropriation of reproductive labour, which is assigned, once again, to the realm of non‐value. A feminist political‐economic critique of altruism, this paper does not forward an argument in favour of commercialisation. Rather, its aim is to upend the commercial/altruistic binary that has circumscribed so much of the thinking and legislating around surrogacy. This paper explores the role of the law in devaluing reproductive labour under capitalism. It does so via an examination of Canada's burgeoning surrogacy bio‐economy and the legislation – the Assisted Human Reproduction Act – designed to regulate it. [ABSTRACT FROM AUTHOR]

In January 2017, the 'abortion pill' was finally used legally in Canada. This paper provides a sociotechnical analysis of the controversy surrounding RU486 in Canada, focusing on its entry into public discourse, 1990-1995. The case study draws primarily on statements made about the pill, both in Canadian media and in various actors' print communications. Using approaches from science and technology studies, the analysis identifies the multiple human and nonhuman actors, their discursive mobilizations of RU486 and each other, and their contingent alliances, illustrating how RU486 mediates and shapes the communication that attempts to define it. Unpacking the network's complexity illuminates how these sense-making practices established the early setting of the technology's path, a first step in understanding why Canada has been a laggard in making the pill available. The discussion illustrates the tensions, instabilities, and reversals in the network that have hindered RU486's movement from development to diffusion. Finally, the paper suggests a framework for future sociological research on controversial reproductive technologies in their shift from discursive to material diffusion, one that recognises the integral role of women as users. [ABSTRACT FROM AUTHOR]

Background: This study investigated the surrogates' birth experiences, their levels of emotional struggle at relinquishment, how often they thought about the surrogacy children, and the surrogate–parent relationship dynamics during pregnancy and post‐birth. Methods: Data were collected from 06/2016 to 02/2017 using an anonymous questionnaire. Participants were Canadian gestational surrogates who had completed the process with or without a successful live birth, and who were at various stages of an ongoing surrogacy. For this paper, only a subgroup of cases with a successful live birth was selected for analysis. Results: The data set included 131 births involving 90 surrogates who delivered 157 babies (105 singletons and 26 sets of twins). Their mean age at the time of surrogacy was 31.7 ± 5 years (range: 21‐47y). More than one‐third (37.4%) of the cases were for intended parents who were same‐sex male couples and single men. Surrogates assisting Canadian‐resident intended parents had an overall better birthing experience compared with those assisting nonresidents. There was none or very little struggle with the relinquishment of the baby in 96.9% of cases. Continued contact with parents after the births was reported in 93.0% of cases. Surrogates were significantly more likely to have frequent post‐birth contact with same‐sex and single fathers compared with heterosexual parents and single mothers (76.6% vs 54.3%). Conclusions: Same‐sex male couples and single men can develop a long‐lasting relationship with their surrogates even when no intended female partners are involved. The development of institutional practice guidelines in standardizing surrogacy birth practice is paramount in optimizing surrogates' care. [ABSTRACT FROM AUTHOR]

This paper raises some troubling questions about the fertility treatments provided to Canadian gestational surrogates, women not genetically related to the child that they carry. Using information published between 2003 and 2012 by Canada’s Assisted Reproduction Registry, the paper traces the growing incidence of births to gestational surrogates. The transfer of more than one embryo increases the chance of pregnancy and the incidence of multiple births, and while the incidence of multiple births has declined overall since 2010, gestational surrogates consistently experience a higher proportion of multiple births and experienced higher levels of multiple embryo transfers. In 2012, just 26% of gestational surrogates received a single embryo transfer compared to 47% of other in vitro fertilisation (IVF) patients. The paper suggests that renewed attention needs to be paid to the counselling provided to gestational surrogates and treatment consenting mechanisms used by IVF clinics and that review of the 2007 Canadian Medical Association surrogate treatment guidelines is warranted. Finally, the paper describes the difficulties in obtaining accurate data about Canadian assisted reproductive medicine. Without good data, it becomes far more difficult to identify the possibility of potentially harmful practices. [ABSTRACT FROM AUTHOR]

Background Surrogacy is growing worldwide. Although recently some countries have sought to ban it, between 2010 and 2014 the number of babies born to gestational surrogates having in vitro fertilization treatment in California doubled, and in Canada it grew by 35%. This work seeks to fill identified knowledge gaps about the similarities and differences in the practices and outcomes of gestational surrogacy, which in California operates on a commercial basis, whereas in Canada it is illegal to pay a surrogate. The paper focusses on the period from 2010 to 2014, for which comparable American and Canadian national assisted reproduction technology information exist. Study Design A retrospective data analysis was performed using information on gestational surrogate multiple births obtained from the Centers for Disease Control and Prevention National Assisted Reproductive Technology Surveillance System (NASS) and Canada's Assisted Reproduction Registry-Better Outcomes Registry and Network (CARTR-BORN). Multiple birth rates and transfers of multiple embryos were compared using relative risk analysis. Adherence to voluntary American Society for Reproductive Medicine–Society for Assisted Reproductive Technology and Canadian Fertility and Andrology Society embryo transfer guidelines was modelled. Findings Among gestational surrogates, when donor ova embryos obtained from women aged less than 35 years were used, embryo transfer guideline adherence was 42% in California and 48% in Canada. Conclusions Regardless of where on the commercial/noncommercial boundary North American surrogates reside, they are more likely to receive more donor ova embryos per in vitro fertilization transfer than other in vitro fertilization patients. An altruistic desire to assist childless couples and individuals create families along with clinic practices seem to play major roles in treatment decisions privileging the transfer two or more embryos. [ABSTRACT FROM AUTHOR]

Amidst a barrage of policy documents, bio-medical research, and press items concerned with the “crisis” of obesity, a growing scholarship is concerned with what has come to be known as “obesity stigma.” This scholarship hails from a range of sources including critical obesity scholars who problematize the idea of obesity as a health concern, as well as from “mainstream” organizations and researchers who, while maintaining obesity is a world-wide health problem, also argue that “obese” people are the targets of discrimination. In this paper, we analyze both interpretations of obesity stigma, particularly as that stigma applies to obese women's experiences of accessing and receiving reproductive care. We describe a qualitative study conducted with 24 overweight and obese women in 2 Canadian cities. Participants related overt and covert experiences of stigma when accessing reproductive care founded in healthcare practitioners' focus on fetal risk and “mother-blame” which, though partially evidence-based, was interpreted by participants as discriminatory. As such, we maintain that any true interruption of obesity stigma in the reproductive healthcare interaction requires a bridge between critical and mainstream scholarship, and careful attention to the risk-based foci in clinical settings which can be interpreted by clients as moralizing. [ABSTRACT FROM AUTHOR]

Study Question: Do publicly funded fertility treatment and single embryo transfer (SET) result in lower hospitalization rates of children of parents with infertility?Summary Answer: Following the 2010 Quebec law introducing free fertility treatment and SET, neonatal intensive care unit (NICU) admissions decreased among all children born to parents with infertility, but not among singletons, whose risk remained slightly higher than that of children of parents without infertility, even accounting for treatment and maternal age.What Is Known Already: Previous studies reported lower NICU admission rates among children conceived with ART after the 2010 law; however, children conceived without ART by parents with infertility were not considered.Study Design, Size, Duration: Cohort study of children born in 1997-2017 to patients evaluated for infertility ('exposed') at an academic fertility center in Montreal (Canada) in 1996-2015. A random sample of births to Montreal residents served as comparison. Outcomes were identified from Quebec administrative databases.Participants/materials, Setting, Methods: We compared children's healthcare utilization before and after the 2010 law in 6273 exposed and 12 583 randomly sampled births (6846 and 12 775 children, respectively). We repeated the analysis among children conceived in the 63 months before and after the law ('restricted period'), and examined whether differences in twinning, fertility treatment, and maternal age explained the higher risk of NICU admission among children of parents with infertility.Main Results and the Role Of Chance: In the exposed cohort, the proportion of twin births and of several adverse outcomes declined after the law. NICU admission and duration of NICU stay decreased overall, but not in singletons. Both measures remained higher in exposed children. Except for NICU admission, hospitalization rates were similar in exposed and random sample children. After accounting for fertility treatment and maternal age, exposed singletons were 17% more likely to be admitted to the NICU than children of parents with no medical history of infertility.Limitations, Reasons For Caution: Sample size was relatively small; infertile patients were from a single center and the random sample from one city. Despite some limitations, administrative databases are likely to accurately reflect healthcare utilization.Wider Implications Of the Findings: Universal access to treatment and, particularly, SET results in an overall reduction of adverse outcomes among children conceived with treatment; however, children of parents with infertility are at a slightly higher risk, regardless of treatment.Study Funding/competing Interest(s): This study was funded by the Canadian Institutes for Health Research (CIHR, grant no. 123362). No competing interests.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

The Assisted Human Reproduction Act seeks to protect egg donors' health and well-being and prevent trade in their reproductive capabilities. In order to fulfill these objectives, the Act prohibits the buying and selling of ova, and only allows for egg donors to be reimbursed for their expenses. However, no regulations setting out what expenses can be reimbursed were promulgated. Sixteen years later, these long-awaited regulations finally came into force in June 2020. In this study, I rely on data from interviews with sixteen egg donors in order to assess how the new regulations might help or hinder concerns that egg donors have with how egg transactions are regulated in Canada. I argue that the new regulations might hinder, more than help with, addressing current concerns related to egg transactions in Canada. The most likely result is that they will not change the current state of affairs. [ABSTRACT FROM AUTHOR]

Despite their low and inconsistent rates of success, assisted reproductive technologies (ARTs) are presented by fertility clinics and constructed in media and popular culture as an effective treatment for infertility. The ways in which such technologies medicalize women's health and bodies have been well documented by social scientists and feminist health researchers. However, little is known about the struggles women face in cases of "failure"; that is, when ART does not achieve its purported potential to assist women in their attempts to conceive and have the desired outcomes of conception and birth. Using a post-structural feminist interpretive framework combined with a narrative methodology, this paper critically examines the ways in which social and cultural narratives about gender and biotechnology shape women's accounts of discontinuing ART. Thirty-six interviews were conducted with twenty-two women across Canada who were at various stages of discontinuation and who utilized a variety of treatment types. Three inter-related narrative themes were developed to categorize the stories of struggle: (i) a growing desperation to be pregnant; (ii) confronting paternalistic medical expectations; and (iii) internalizing and resisting blame for treatment failures. These themes highlight both the explicit and subtle ways in which restrictive social and cultural narratives about womanhood and motherhood were perpetuated in clinical interactions, which ultimately made ending treatment more difficult. Our analysis illustrates how women navigated and resisted such narratives, through pausing or ending treatment despite provider recommendations and clinical messages. We suggest that fertility providers critically reflect on the potentially harmful language used during interactions with patients and recommend that discontinuation discussions become a recurring, normalized component of treatment protocols and patient-provider conversations so that women feel better supported to end treatment when they believe it is financially, emotionally, and physically beneficial for them to do so. • To discontinue (pause/end) fertility treatment is difficult, fraught with ambiguity. • Social and cultural values and clinical priorities shape women's experiences. • Careful clinical attention and support for discontinuation is needed. [ABSTRACT FROM AUTHOR]

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Objective: To compare stress levels throughout pregnancy in women who had conceived using assisted reproductive technology (ART) and women who had conceived naturally and somatometric values for infants. Background: Pregnant women who have received ART are exposed to high levels of stress. Methods: Ninety-one women attending a prenatal appointment at a Health Centre (Granada, Spain), and their 91 newborns participated in this study: 69 women conceiving naturally and 22 conceiving using ART. Assessment consisted of measuring hair cortisol levels, the Prenatal Distress Questionnaire, the Perceived Stress Scale and the Symptom Checklist-90-Revised. Results: Women conceiving using ART had higher cortisol levels in the first trimester than women who conceived naturally. In the third trimester, women who used ART reported higher levels of perceived stress than those who had conceived naturally. Maternal cortisol levels in the first trimester explained 32% of the variance in neonatal head circumference in the group of women who had conceived using ART. Conclusions: Women who had conceived using ART showed higher levels of cortisol in the first trimester and higher levels of perceived stress in the third trimester than women who had conceived naturally, rendering them more vulnerable to adverse outcomes. Maternal cortisol predicted the infants' development. [ABSTRACT FROM AUTHOR]

In the last decade, transnational surrogacy has attracted world-wide attention for making babies and pregnancies exchangeable with money. Involuntarily childless couples and individuals travel abroad and pay to have the desired child and to become parents. Acknowledging the importance of asking into the consequences of this monetization of reproduction, the author takes issue with universalistic assumptions about money and markets, and their presumed universal effects on social relations. Instead, it is argued that we need to explore how money works, and, by extension, how transnational surrogacy works out and becomes viable to people as a way to become parents. Putting together insights from economic sociology, and the assisted reproductive technology and parenting culture literature, the author employs the notion of accounting to grasp how people make sense of the money involved in making them parents. Based on a study involving 21 interviews with Norwegian gay and straight couples and single men and women seeking surrogacy abroad, the author explores how money is accounted for in three cases, set in three different countries; India, the United States and Canada. The analysis shows how money is accounted for in particular ways to confirm parenthood. These ways differ depending on the local context and transnational relations; ultimately making differentiated monetized parenthood. This is of significance when we try to conceptualize contemporary parenthood and how money seemingly sustains parenthood in ever more radical ways. [ABSTRACT FROM AUTHOR]

In the modern era of HIV care, a multitude of clinical needs have emerged; one such need is the growing sub-specialty of HIV and reproductive health. In 2007, a study surveying Canadian fertility clinics found limited access to fertility services for HIV-positive patients. Given the extensive efforts made to address this lack of services, a follow-up assessment was warranted. This study aimed to compare the access to Canadian fertility clinics and services for HIV-positive individuals and couples in 2014 and 2007. Surveys were sent to medical or laboratory directors of assisted reproductive technology (ART) clinics in 2014 and results were compared to those sent in 2007. Main outcome measures included: the proportion of fertility clinics willing to provide ART to people with HIV, the specific services offered, and whether the 2012 Canadian HIV Pregnancy Planning Guidelines were implemented to inform practice. Across Canadian provinces, 20/34 (59%) clinics completed the survey. Ninety-five percent (19/20) of clinics accepted HIV-positive patients for consultation. Only 50% (10/20) of clinics in four provinces offered a full range of ART (defined as including in vitro fertilization [IVF]). Ten clinics (50%) in five provinces were aware that guidelines exist; half (n = 5) having read them and four reporting implementation of all the guidelines' recommendations in their practice. Compared to 2007, more clinics had implemented separate facilities (p = 0.028) to treat HIV-positive individuals, offered IVF (p = 0.013) for HIV-positive female partners, sperm washing (p = 0.033) for HIV-positive male partners, and risk reduction techniques to couples with HIV-positive men and women (p = 0.006). Access to fertility clinics for people with HIV has improved over time but is still regionally dependent and access to full ART remains limited. These findings suggest the need for advocacy targeted towards geographical-specific areas and optimizing access to comprehensive services. [ABSTRACT FROM AUTHOR]

Grounded in face theory (see Brown & Levinson, 1987; Cupach & Metts, 1994; Goffman, 1967) and exploratory in nature, the present study sought to understand the face-related experiences o f parents whose children were conceived with an anonymous donor. The sample included 19 parents from the United States, United Kingdom, and Canada, who experienced infertility, were in a lesbian relationship, or identified as solo parents. The researchers identified face-related concerns parents have for themselves and their children and preventative facework strategies they enact to avoid or minimize face loss. Findings showcase parents' desire for social approval, autonomy, respect, and preventing rejection. Also discussed are a variety o f facework strategies, namely, disclosure, avoidance, closedness, humor, deception, and strategic donor choice. The findings support and extend previous research on donor-assisted families and showcase the complexity o f face for members o f these families by highlighting instances where communication simultaneously preserves and threatens face. [ABSTRACT FROM AUTHOR]

This article examines how medical and scientific professionals experience and engage with the governance of embryo research in Canada. Drawing on the history of embryo regulation in Canada and the findings of a survey conducted with lab directors in Canadian fertility clinics, we identify a disjuncture between the rules established by legislation, regulations, and research ethics guidelines and the real-life experiences of professionals in the field. This disjuncture, we argue, is the result of both the absence of implementation mechanisms that would give substance to the governing framework, as well as an inability on the part of medical and scientific professionals to engage in robust self-regulation. Overall, we demonstrate that in an ethically charged and highly technical area of policy-making like embryonic research, clarity about the roles and responsibilities of government and professionals in policy-making and implementation is critical to effective governance. [ABSTRACT FROM PUBLISHER]

The article highlights the Canadian Fertility & Andrology Society's support for amendments to the Assisted Human Reproduction Act to permit reasonable compensation for surrogates as well as gamete donors. Issues and concerns discussed are the viability of a system of compensation for third-party reproduction, clarity of rules pertaining to the financial reimbursement of gamete donors and surrogates, and grounds for banning surrogate compensation in the country.