Do transwomen have a ‘right’ to be pregnant?

Do transwomen have a ‘right’ to be pregnant?

Do transwomen (i.e. biological males) have a right to become pregnant? This somewhat dystopic question continues to be explored, most recently in a Letter to the Editor published in peer reviewed journal Acta Biomedica. Its authors are two Italian academics from the Sapienza University of Rome, who say that the speed of scientific innovation requires us to address this question.

To exercise such a ‘right’, a transwoman would need to undergo a uterus transplant (UTx), a temporary transplant that is removed after childbearing in order to avoid the need for ongoing immunosuppressive drugs. As an elective procedure, carrying high risks of physical and psychological complications for the recipient, child and donor (if alive), and costing upwards of USD $200,000, UTx is already an ethically fraught practice. Successful UTx in biological women are still rare and often unsuccessful, but as technology develops, it is predicted that a transwoman could in theory undergo a successful UTx, become pregnant, and give birth (likely via caesarean section). 

The authors of the letter point out that UTx is not a “life-saving” transplantation, but rather a “life-giving” or “life-enhancing” one, which came about because of its “potential to allay dissatisfaction and unhappiness stemming from the discrepancy between procreative ability and reproductive aspirations”. They argue that this “life-enhancing” motivation is the same for both transwomen and biological women. 

“Research has clarified the primary motivation for which transgender women would opt for UTx. Findings from a recent survey unequivocally reflect the ‘life-enhancing’ purpose: an overwhelming 90% majority of respondents expressed the belief that having a transplanted, functioning uterus and vagina would benefit their sex life and perceived sense of femininity, improving quality of life overall.

“Such findings are rather similar to those regarding the perceptions of biological women with AUFI (absolute uterine factor infertility): 95% of respondents in a UK study exploring the attitudes of women toward uterus transplant stated that, despite the additional risks posed, they would choose uterus transplant over surrogacy and adoption.”

The authors also consider that UTx in transgender women may help alleviate their dysphoric symptoms, in the same way that other “gender affirming” surgeries are touted to do.

With that in mind, the authors maintain that:

“The fundamental ethical question that needs an answer is: if UTx becomes mainstream, safe and effective for biological women with AUFI, would there be any morally tenable grounds as to why transgender women should be denied such an opportunity for gestation? In countries where transgendered women who have transitioned are granted the same legal rights as their female counterparts, this will become a relevant question if UTx is offered as clinical treatment in women.

“Ultimately, we feel it may all go down to whether procreative liberty ought to be deemed as entailing an absolute right to gestate, and whether transgender women can be denied such a right without infringing upon ethical precepts of equality and non-discrimination.” 

An “absolute right to gestate”? There is no such right. 

Feminist campaigner Julie Bindel has said that "[T]rans-women pushing for womb transplants…are driven by a desire to experience childbirth, because it is considered to be an authentic female experience. But this is not about transgender rights – it’s about a twisted notion as to what constitutes a ‘real woman’". 

Yet, the reality of being a woman is that biological, lifestyle, environmental and other factors can both positively or negatively affect our fertility. Not every woman will be able to conceive (whether due to fertility issues or life’s circumstances) and not every woman will be able to carry a baby to term (with some pregnancies tragically resulting in stillbirth or miscarriage). Yes, there are both natural and technological ways to either facilitate or manipulate a woman’s fertility, but becoming pregnant as a result of such means can hardly be called a right when life and health are not dependent on them (indeed, they may jeopardise them) and they depend on expensive, third party interventions. Just because we want something and perceive some benefit from it, does not make it a right. 

And as one commentator notes, the authors in this case give no consideration at all to the best interests of a future child, in their contemplation of adult 'rights'.

“We already know that children created through IVF have greater health risks. Imagine the potential problems of having a biological male gestate, with the requirements of necessary hormones and other essential mother contributions to healthy gestation mostly provided artificially. Why, it’s as if the issue does not exist.”

Children are not a feminising accessory nor a treatment for the dissatisfaction in adult lives - trans or otherwise. To treat them as such, with seemingly little regard for their welfare, is just one more instance of the increasing commodification of children in our society.

But even if pregnancy is not a right (nor the technologies that may be employed to this end), if UTx does become “mainstream, safe and effective” for biological women, could transwomen be denied the same chance to access such a procedure without this amounting to discrimination?

The greater risks posed to the child could be one reason why UTx should not be offered to transwomen. There could also conceivably be greater risks to the trans individual and greater costs incurred due to the particularly unnatural condition of implanting a woman’s womb inside a male’s body. But in places where transwomen are treated as “women” in every other sense and “gender affirming” surgeries are considered as critical medical treatments, it may otherwise be difficult to justify denying UTx to transwomen when it is readily available to biological women. 

However, rather than this being a cogent argument for why transwomen have a right to receive uterus transplants, following this train of thought through to its troubling logical conclusion should prompt us to take a step back and reconsider these starting assumptions. When implanting a womb into a man’s body is no longer a question of science fiction, but part of genuine academic and medical inquiry, it is long past time we became reacquainted with immutable biological realities and took a long hard look at the warped and damaging impacts of attempting to invert these.