Cross‐Border Reproductive Care: Two Lenses in Political Science

Published date01 December 2018
AuthorPatricia Stapleton,Daniel Skinner
DOIhttp://doi.org/10.1002/wmh3.287
Date01 December 2018
Cross-Border Reproductive Care: Two Lenses in Political
Science
Patricia Stapleton and Daniel Skinner
Cross-border reproductive care (CBRC)—when patients travel outside their country to seek assisted
reproductive services—is a booming industry. Globalization facilitates the increase in CBRC by
reducing transportation costs, removing language barriers, and liberalizing the reproductive services
market. Yet global and domestic regulatory responses are failing to keep pace, raising ethical,
economic, political, and social issues. Political science has been slow to contribute to our
understanding of CBRC politics and policies. This article f‌irst establishes the gap in existing CBRC
research, before presenting how political scientists can respond in two specif‌ic areas: 1) the role of
globalization health governance in relation to CBRC and 2) the political implications and potentials
of “medical necessity” in shaping patient motivations for seeking—as well as their ultimate access
to—CBRC. New research in these areas will aid policymakers in recognizing the context in which
they must develop CBRC regulations.
KEY WORDS: cross-border reproductive care, medical necessity, reproductive health policy
Introduction
Cross-border medical care has become a growing global phenomenon. The
Centers for Disease Control and Prevention (CDC, 2015) estimate that up to
750,000 Americans travel abroad for medical care each year. Although patients
travel to seek a range of procedures, they are generally motivated by the same
reasons: privacy, cost, access, and the circumvention of legal restrictions. Within
cross-border medical care, cross-border reproductive care (CBRC)—when patients
travel outside of their home country to seek assisted reproductive services—has
developed into a booming industry: 5 percent of all European fertility care and 4
percent of all American fertility care involves cross-border travel (Ethics Commit-
tee of ASRM, 2016).
In addition to travel within a region, such as North America or Europe, less-
developed countries have become popular for patients from more developed
areas, making them among the top destinations worldwide. Globalization has
facilitated this upward trend in CBRC by reducing transportation costs, removing
World Medical & Health Policy, Vol. 10, No. 4, 2018
331
doi: 10.1002/wmh3.287
#2018 Policy Studies Organization
language barriers, and liberalizing the reproductive services market. Globalization
thus provides expanded access to reproductive care for women, yet it has also led
to the commodif‌ication of wombs and ova. Regulatory responses—both global
and domestic—have been slow to keep up with the increase in CBRC, which has
raised a number of economic and ethical issues.
Despite the recognition of CBRC as a growing practice, research has been
minimal. Several reviews have examined the state of academic research on CBRC
(Hudson et al., 2011; Inhorn & G
urtin, 2011; Inhorn & Patrizio, 2012; Salama et al.,
2018), revealing that clinicians, bioethicists, and anthropologists have engaged
most predominantly with CBRC (Inhorn & G
urtin, 2011; Salama et al., 2018).
While all of these reviews highlight the interest in CBRC, they also acknowledge
that the dearth of existing data and obstacles to data collection regarding patient
motivations and outcomes have challenged social scientists’ ability to perform
empirical work. As such, Marcia Inhorn and Zeynep G
urtin have proposed an
agenda to help guide research in this issue area. They outline the need for
economists, psychologists, and gender studies and legal scholars to join in this
research effort (Inhorn & G
urtin, 2011).
Although each of these f‌ields has an important perspective to offer, we argue
that political science can—and should—contribute to this effort too, particularly
in two areas. First, political scientists are well positioned to contribute to
scholarship examining globalization and the role it plays in the increase of CBRC.
While several disciplines are engaged in this area, political scientists’ expertise in
addressing questions of institutional legitimacy and capacity in global governance
make them well suited for this work. Second, political science offers tools for
understanding the implications of the role of “medical necessity” and similar
discourses of need as a means of legitimizing reproductive care and underpinning
patient motivations for seeking CBRC. Here again, though medical necessity and
related discourses have gained the attention of sociologists and anthropologists,
among others, approaching them as specif‌ically political discourses with political
interactions with the institutions that control cross-border f‌lows, is something that
political science is uniquely situated to do. Accordingly, in this article we explain
how political scientists, drawing on their particular skill set and vantage point,
should contribute to research on CBRC.
To do so, we f‌irst ascertain the scope of the disciplinary gap in the literature
through a search of academic publications, as well as a brief overview of existing
political science research on CBRC. We then offer two lenses with which political
scientists can work to f‌ill that gap. The f‌irst lens is rooted in the international
relations (IR) subf‌ield, with emphasis on what globalization and global gover-
nance studies within political science can contribute to CBRC research. The
second lens relies on the intersection of political theory and public policy frames,
by engaging with the function of “medical necessity” decision making within
domestic politics and how states might use medical necessity in their approaches
toward people seeking entry for medical purposes. We focus on the United States,
both in looking at how globalization facilitates patient travel to and from the
United States and how the exclusion of fertility treatments and abortion access
332 World Medical & Health Policy, 10:4

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