Birds and the biz

A new book explores the controversial subject of the economics of fertility.

Babies are born every minute. These days, in particular, it seems there are pregnant bellies everywhere (although that may be my own skewed perception). But as ample as the supply of babies may be in the world, the demand to keep having them is profoundly strong — and therein, for better or worse, lies a market opportunity.

Few topics are more contentious. These are, after all, matters of life and death: bringing a child into the world strikes to the core of humans' own sense of mortality, our innate biological urges to reproduce, and our spiritual desires to leave a legacy. The paths we take as individuals, families and societies to achieve those ends say much about our values, and our future. Weighty stuff.

So exploring something as intimate as fertility in the context of economics, markets and commerce is bound to be controversial. But The Baby Business: How Money, Science and Politics Drive the Commerce of Conception, (Harvard Business School Press; $36.95), despite its grim cover image of an in utero child with a bar code on its cheek, is far from a sensationalistic book. Debora L. Spar, a professor of business administration at the Harvard Business School, soberly lays bare the markets that exist to service those who want a child but cannot have one through traditional procreation.

As personal a topic as this is, however, Spar goes to great lengths to objectively examine the series of approaches would-be parents pursue: fertility treatments, genetic engineering, surrogacy, adoption and even the potential for cloning. In each case, she explores the history of how the markets have developed, and the issues that are currently shaping them. Spar's description of the scientific advances of assisted reproduction — in vitro fertilization, intracytoplasmic sperm injection (in which a single sperm is injected directly into an egg), preimplantation genetic diagnosis — are as clear as how she details the hodge-podge of regulatory frameworks that exist and the underlying politics.

Spar's approach is not academic, however. The book builds a cogent case that as fragmented and unstructured as it may be, making babies is an industry — by her calculations, the U.S. fertility market alone in 2004 pulled in revenue of nearly US$3 billion — and that economic forces of supply and demand are at work, with science helping fuel them. But, she argues, because of society's reticence to confront the complex issues that arise from acknowledging the connection between conception and money, there is no coherent approach to regulation in the United States. All the while, science around the world continues to rush ahead, offering would-be parents greater control over the creation of life — and the moral issues only grow larger.

To her credit, Spar acknowledges the politics without politicizing. She is plainly passionate about the subject, but it is unclear where she personally draws lines of right and wrong. Instead, what concerns her most is that leaving such essential questions to an ad hoc collection of state laws, high-profile court cases, federal research funding rules and private industry will not result in a rational answer; it will not set a certain path forward for science, would-be parents or society.

In fact, the book's last chapter features something rare in non-fiction: a plot twist. Instead of setting out the policies that she would like to see established, Spar defines the arenas of debate: how principles of equality ought to apply to infertility treatment; the legal limits of scientific pursuit; the potential societal costs of reproductive technology; and finally, the extent of parental choice. It is, as Spar acknowledges, messy. But then, so is child birth. That's just life.