Imagine, for a minute, that you haven't been born yet (a bit of a stretch, I know, but stay with me).
You don't know whether you're going to come out male or female, and you can choose to enter one of two worlds. First you're offered Society A, in which one biological sex carries and births babies, taking on the risks of becoming ill or dying in childbirth. Or you can opt for Society B, where all embryos grow safely in artificial wombs. What would you do?
That's the question Anna Smajdor, associate professor of philosophy at the University of Oslo, wants us to ask ourselves. She's calling for more research into something called ectogenesis, an umbrella term for technology that allows babies to be grown artificially outside the womb.
'Being pregnant and giving birth are still significantly risky for women's health and, in other contexts, similar levels of risk are treated as very serious problems,' Smajdor tells me. 'A woman is more likely to die in pregnancy or childbirth than from measles, if she catches it. And yet we have big public health campaigns against measles.'
At the moment, it is not possible to grow a baby outside the womb for the full 40 weeks of pregnancy. But Dr Carlo Bulletti, a fertility specialist with more than 40 years' experience researching reproductive medicine, believes it could be in a decade's time.
'If there was adequate financial support, I think 10 years would be reasonable,' he says. 'The benefits of ectogenesis from a scientific point of view are enormous.'
He points to research that has seen fertilised embryos kept alive for almost a fortnight using a 'co-culture system' designed to mimic the uterine environment. At the other end of the spectrum, premature lambs born at an age equivalent to a 23-24-week human foetus have been sustained for four weeks in fluid-filled 'biobags' by researchers at the Children's Hospital of Philadelphia.
Bulletti believes it is possible to create a system that allows babies to develop for 'the entire period from implantation to delivery' but, right now, laws prohibit researchers from keeping an embryo alive outside the uterus for longer than 14 days (the most scientists have managed so far is one day shy of this). Bulletti thinks these regulations could be relaxed in future, just as past rules surrounding IVF treatments have changed to accommodate new technologies.
'Ectogenesis could be the solution for the one in 500 women with anatomical uterine abnormalities and women who have undergone a hysterectomy,' he says. 'Think about the women that have had their uteruses removed after having cancer. Or the women that want to have a baby and can't because of some chronic disease.'
It's not only mothers who might be spared the risks of pregnancy and birth but foetuses too, adds Smajdor. 'The most common time to die if you're a foetus that isn't aborted is during childbirth,' she says. 'The advantage of the foetus not being in a woman's body is that we can absolutely control what it gets exposed to and, if we need to operate on it, we don't have to go through a woman's body to do that.'
Evie Kendal, a lecturer of bioethics and health humanities at Deakin University in Victoria, and author of Equal Opportunity and the Case for State Sponsored Ectogenesis, believes an optional replacement for pregnancy could also have enormous social benefits for women.
'Access to ectogenesis would prevent career interruptions caused by pregnancy-related illness and giving birth,' she tells me. 'Beginning a discussion of childcare responsibilities where neither partner has already had to alter their work routine due to pregnancy or birth avoids some of the disadvantage that may lead women to assume primary carer responsibilities by default.'
Kendal predicts that artificial womb technology could also revise our view of femininity more generally. 'There are a lot of assumptions made about women as a result of their reproductive potential,' she says. 'Considering a method of having children that does not require a woman's body has the potential to radically alter some of these assumptions, including that women are not a good investment for professional development'.
Anna Smadjor adds: 'As a woman in societies like the UK, your body is regarded as a potentially pregnant thing, which gives you very particular duties in relation to it but also imposes very significant risks on you.'
'The data that shows that, in countries where women have access to contraception, careers and financial independence, birth rates go down and the age at which women have their first child goes up,' she adds.
It's easy to see the theoretical benefits of a Matrix-style reproductive future but, in reality, there are currently very few medical researchers pushing for full ectogenesis.
Dr Matthew Kemp, principal obstetrics and gynaecology research fellow at the University of Western Australia, is part of a team that successfully kept premature lamb foetuses alive in an artificial womb. The animals lived for two weeks in medical grade plastic bags containing saline solution, while hooked up to a device that oxygenated their blood. The team hopes to secure FDA approval to trial this technology with human foetuses in around 2023 or 2024, with the aim of improving survival rates for extremely premature infants (born between 21 and 24 weeks).
When I ask Kemp whether this system could ever be used for an entire pregnancy, he says this is 'extremely unlikely' and that it is not an avenue his team is 'at all interested in'.
'This particular technology requires some surgical intervention and obviously a fertilised embryo is not going to be amenable to that,' he explains. 'It's very much designed to be a treatment platform for babies that are born pre-term.'
While full ectogenesis is not on the radar for many reproductive scientists, director of Oklahoma State University's ethics centre, Professor Scott Gelfand, thinks it could develop more quickly than researchers anticipate.
'It's going to happen unintentionally,' he says. 'We're going to get better at saving babies that are born prematurely at an earlier stage of development – imagine you could get that down to let's say 16 weeks – and, meanwhile, we're going to have developments which will extend the period that a fertilised embryo can live. At some point in time, the two are going to connect - possibly without us even intending for them to.'
Gelfand is concerned that artificial wombs may become viable before we've had a chance to consider how to regulate the technology. He fears that companies could use the availability of ectogenesis to reduce maternity leave or even to discriminate against women who choose natural gestation by regarding it as a self-indulgent 'lifestyle choice'.
Perhaps even more concerning is the questions that new technology could raise around abortion rights. The right to end a pregnancy is rooted in women's bodily autonomy - so what would happen if unwanted foetuses could survive without our bodies? Could a couple who changed their minds about wanting an artificially-gestated baby ask for it to be terminated? What would happen if one parent wanted the child and the other didn't?
Gelfand asks: 'Can states force women to utilise ectogenesis if they want to terminate their pregnancy? And if they can do so, can the woman give up all rights to the foetus? Does she have to support it? Pay for it?'
These are the questions that 'society needs to address before ectogenesis becomes a reality,' he says.
In order for widespread artificial womb technology to reduce women's reproductive burdens, rather than add to them, Anna Smajdor says people need to have already re-evaluated their view of motherhood before it arrives. 'I don't want to present a future utopia that is brought to us purely by virtue of ectogenesis being developed,' she says. 'What really is going to make the difference is how enlightened our societies are - and we're definitely not there yet.'
'My hope is that the research goes slowly until we have some serious societal discussions,' agrees Gelfand. 'We have to talk about these things a lot more – we're like children playing with matches'
