University of California Press, 2012, 273 pp.
In God’s Laboratory: Assisted Reproduction in the Andes, Elizabeth Roberts examines how science and spirituality are connected in the practice of in vitro fertilization (IVF) in Ecuador. This alone is a significant contribution to the anthropology of assisted reproduction, but in reading this book we come to understand how race, class, kinship, gender, and labor histories shape IVF in this setting as well. In this engaging ethnography, Roberts, shows us how Ecuadorians make up people, in both a literal sense—by means of IVF—and in a conceptual one.
Central to making up people in Ecuador are local understandings of the malleability of the body and the degree to which reproduction is perceived as always already “assisted” by others. Roberts shows how a long history of “Andean racial malleability” (p. 114) profoundly shapes reproductive practices, allowing some patients opportunities to “whiten” themselves and their families through donor eggs and sperm as well as through certain acts of care and cultivation. Roberts demonstrates that IVF does not pose the same conceptual problems that it does in a place like the United States because Ecuadorians do not view assisted reproduction as an artificial intrusion on a normatively bounded and dyadic experience of human reproduction. Instead, she notes, “it was assumed by Ecuadorians that relations between larger family groups, as well as relations between God and money, always assisted in producing children” (p. 6).
Roberts conducted ethnographic research between 1999 and 2007 in most of Ecuador’s nine IVF clinics and with people involved at all levels of IVF procedures: patients (most of whom self-identified as middle class), their families, doctors, biologists, other medical professionals, egg and sperm donors, and legal experts. The fact that her fieldwork spanned Quito and Guayaquil adds depth and nuance to the ethnographic story, since IVF is perceived and practiced differently in each region. The book’s vivid ethnographic narratives begin in the introduction with a description of how IVF practitioners make God “real” in their clinical practice. Each chapter is prefaced by a stand-alone narrative focusing on one patient’s or family’s experience of IVF, ethnographically anchoring the arguments that follow.
Chapter 1 explains how Catholic church doctrines and Ecuadorian state laws do not restrict IVF practices as much as we might expect. Practitioners and patients invoked God’s assistance constantly during IVF procedures, but disavowed official church sanctions against assisted reproduction, reasoning that God, not the church, was in charge of reproduction and that God not only supported IVF but was “the main actor in determining IVF outcomes” (p. 56). Also in this chapter Roberts explores the “gray areas of Ecuador’s legal landscape” (p. 49), in which a 2003 civil code theoretically limits IVF but in practice has no effect on what elite doctors and their patients do with eggs and embryos in private clinics.
The next two chapters explore how IVF practices are both shaped by and further entrench aspirational practices of whitening in Ecuador. In Chapter 2, Roberts shows how female patients, who often go into debt for expensive private medical treatments like IVF, are not merely accessing medical care but are obtaining care in the same way that wealthy, white women do. Thus, IVF in this setting is not only about assisted reproduction—it is also about “assisted whiteness” (p. 76). Roberts situates this claim in the history of race and racial malleability in the Andes, where a person’s perceived race can change depending on upbringing, use of language, education, and use of private health care. She argues that historically, public health services have been associated with the substandard treatment of poor people of color, while private health services were associated with highly valued, personalistic care practices of and for white elites.
Chapter 3 focuses on the cultivation of whiteness through anonymous egg and sperm donation. Ecuadorian IVF participants commonly associate whiteness with both beauty and better life chances in a racist society. Roberts shows how practitioners, anonymous donors, and patients navigate the racial politics of assisted reproduction in ways that reinforce older national projects of blancamiento (whitening) through mestizaje or racial mixture (e.g., by choosing eggs or sperm from a “whiter” donor than the prospective parent). Roberts brings nuance to this argument by showing how whitening does not just occur at the biological level but also gets cultivated by IVF patients in the ways they seek to raise their children.
The final chapters deal with the movements and meanings of eggs and embryos. In Chapter 4, Roberts explains how “egg economies” (p. 148) work in this setting. Women often choose female relatives as egg donors. This exchange of eggs between kin becomes part of ongoing exchange relationships between these women, while men are commonly on the sidelines, playing a minor role in egg economies. Unlike other settings where egg exchanges have been studied, these exchanges between female relatives did not usually bring about anxieties over the intertwining of love, blood, and money (p. 153). Chapter 5 explores how IVF participants deal with “extra embryos,” which are donated to other patients, placed in cryopreservation for different periods of time, or discarded. What people do with extra embryos is a matter of debate and anxiety and varies regionally. Participants in Guayaquil often embraced anonymous embryo donation, whereas Quiteños would rather eggs were wasted than circulate outside the family. Roberts argues that these divergent views are shaped by differing conceptions of kinship, individual autonomy, and the sanctity of life (p. 208).
Roberts provides excellent concrete examples to explain how assisted reproduction in Ecuador is always in dialog with regional forms of race, class, religion, gender, labor, and kinship. In addition, many readers will appreciate that Roberts’s analysis is explicitly comparative, outlining the similarities and differences between IVF in Ecuador and in other settings (particularly in the United States, where Roberts has also done fieldwork). The book is an important contribution to the anthropology of reproduction and Latin American studies, among other fields. With its skillful integration of ethnographic narratives and theoretical arguments, her book would be a thought-provoking and lively addition to both undergraduate and graduate courses in medical anthropology, science studies, and Latin American studies.
Amy Cooper is an Assistant Professor of Anthropology at Muhlenberg College. Her research interests include medicine, the body, mental health and psychiatry, homelessness, and aging; the anthropological study of citizenship and political activism; and Latin American and Caribbean studies. Her research focuses on the relationships between political ideologies, public health systems, and local formulations of bodies, medicine, and subjectivity. She has conducted ethnographic research on these topics in urban Venezuela, Cuba, and the United States. Amy received her Ph.D. from the University of Chicago’s Department of Comparative Human Development in 2012.