Abstract
This thesis examines the history of infertility (involuntary childlessness) in New Zealand from 1950 to 2004. This period was dominated by scientific developments in assisted reproductive technologies (‘ART’), initially developed to help infertile married couples to conceive a baby. Of these techniques, in vitro fertilisation (‘IVF’) generated a great deal of international media attention and stimulated medico-legal debates around the world.
I argue that the specific backdrop of the Baby Boom and widespread promotion of motherhood ideals is essential to the emergence of infertility medicine in New Zealand. New Zealand had a reputation as a ‘model’ welfare state and as an ideal place to raise a child. My study considers how infertility was defined and discussed from this time, so as to trace how and why understandings towards infertility changed by the start of the new millennium. Doctors were reframing infertility as a ‘couple’s issue’, in response to scientific developments showing that infertility could originate from men’s bodies as frequently as it could from women’s bodies. Medical developments in infertility treatment enabled a greater variety of people to form families, sometimes involving the assistance of a third party gamete donor. Over time questions were raised over who should be allowed to access these treatments and who should pay for them. These developments in turn posed problems for the law and challenged traditional legal definitions of families.
My focus is primarily upon medico-legal responses to infertility and its treatment. By ‘medico-legal responses’ I am referring to how medical and legal professionals approached the topic of infertility in their professional lives, in their published discussions. I adopt a broad approach in my categories of ‘medical and legal professionals’, and include general practitioners, specialists, psychologists, nurses, counsellors, and social workers as well as lawyers, government health officials, judges and members of parliament (lawmakers). While my focus is primarily on the New Zealand context, I draw on international developments in ART, and analyse the introduction to New Zealand of donor insemination, fertility drugs, IVF, egg donation, the intracytoplasmic injection, IVF surrogacy and other forms of ART. I examine related legal developments in adoption, divorce, ART and other family law contexts, including the Adoption Act 1955 and Human Assisted Reproductive Technologies Act 2004.
Infertility is a burgeoning area of academic inquiry. Melbourne, Australia was the site of world-leading developments in ART and I examine the flow of medico-legal ideas, technologies and people between Australia and New Zealand. New Zealand’s relatively small population enables me to draw further insights about infertility, secrecy and donor conception in small communities; the concentration and development of medical specialities; and specific cultural perspectives on infertility, especially those of Māori. This study contributes to the scholarship of reproductive medicine, parenthood, marriage and families in New Zealand. I build upon legal scholarship in ART law by locating developments within their broader socio-historical context.
While I focus primarily on medico-legal discussions about infertility, I bring patient perspectives into my discussion, drawing on a wide range of sources, including magazines and case law, to show how infertility affected individuals and how doctors, judges, social workers and others responded in those situations. I consider responses to both male and female infertility.
Doctors, as part of treating infertility, were able to assess the suitability of their patients for their future parenting roles, assuming a ‘gatekeeper role’. I argue that medicolegal developments in infertility treatment and regulation challenged doctors’ gatekeeper roles. A wider range of adults began seeking access to fertility services, as a result of broader social reform movements from the 1970s, culminating in changes to New Zealand’s human rights legislation in the early 1990s. I suggest that these developments – as well as women’s health activism – represented the first significant challenges to doctors’ roles as ‘gatekeepers’ of infertility services.
I argue that infertility, once considered primarily a ‘woman’s problem’ and then an issue for married heterosexual couples, assumed new understandings as a result of developments in IVF and donor conception. Depicted as a physical disease with psycho-social dimensions in the early 1980s, by the 1990s, infertility was commonly called a disability, with ‘biopsychosocial’ dimensions. The new concept of ‘social infertility’ was recognised in medico-legal discussions as a result of developments in human rights law, and the ability of lesbian and single women to access ART. Social workers made a significant contribution to these changing medico-legal perspectives on infertility.