Médiation procréative et maternités assistées : vers une approche relationnelle et pragmatique de la gestation pour autrui et du don d’ovules au Canada

CONTEXT. Although the different components of maternity and motherhood coincide and are embodied in one woman in the vast majority of cases, surrogacy and egg donation disrupt this unified vision of “the” mother, calling for up to three women in an unprecedented birthing triad: an intended mother, a surrogate and an egg donor. The thesis aims to better understand how these women relate to maternity, in a context where their voice is hidden from the debate surrounding the regulation of these practices. Three objectives guide the research process: 1) to understand how women perceive their respective contributions in the parental project; 2) to identify the strategies deployed by these women to appropriate or distance themselves from maternity, as well as the personal, social and normative factors that promote or inhibit their emergence and 3) to highlight the relational dynamics of the birthing process.  CONCEPTUAL FRAMEWORK. The three components of assisted maternity (intention, genetics and gestation) constitute the base of a conceptual framework built to feed the analysis, to which are added three axes of social structuring. The first component refers to the formulation of the parental project of origin and the care of the child after birth, the second refers to the gamete and the transmission of genes, while the third symbolizes pregnancy and childbirth. The kinship norms of western culture and the pressures exerted by the institution of motherhood influence the definition and management of relationships by raising several concerns, including the quest for the “real” mother as a unique and exclusive figure, and the idealized image of the “good” mother with valued female qualities. Reproductive stratification reveals the power relations that are based on the hierarchy of social positions occupied by the women concerned.  METHODS. Constructivist grounded theory methodology has been retained for the research. Qualitative data were collected in two waves of recruitment with a theoretical sampling aim, in order to favor the emergence of conceptual categories through abductive reasoning. Forty-five individual and semi-structured interviews were conducted in Canada with thirty-eight participants (n = 38), including thirteen intended mothers, fifteen surrogates, and ten egg donors. The interviews were transcribed and coded according to a continuous process of theorization.  RESULTS. The birthing process is a relationship that is built through four movements: engaging, negotiating, putting into practice, and telling. The first movement (engaging) evokes the trajectories of the women who converge toward a common project. The trajectory of sterile or infertile women is motivated by the desire to access maternity or to allow their spouse to become a father, while that of surrogates and egg donors is derived from a mosaic of motives. Their depictions of what “makes” or “doesn’t make” a mother influence the discursive logic of women and subsequently guide their behavior and practices.    The second movement (negotiating) represents the meeting point between the intended mothers and third-party reproducers in one of the three channels of access to assisted human reproduction: family and friends, private intermediaries or social media networks. Women navigate through the normative frameworks of law, medicine and the state, each generating regulations that taint the outcome of negotiations and inhibit their ability to make informed decisions.  The third movement (putting into practice) correspond to the practice of surrogacy and egg donation. On the one hand, the women involved ritualize pregnancy and childbirth to cope with the current legal uncertainty regarding surrogacy. On the other hand, the egg donation corresponds to a “relay” body experience which causes the permutation of the female gamete into embodied maternity: the preparation and the extraction of the eggs from the donor’s body, then the implantation of the embryo and gestation of the fetus in that of the recipient.  The fourth movement (telling) testifies the narrative of the origins, where each protagonist finds its place in the history of the family’s genesis. This narrative construction is rooted in three conceptions of assisted maternities (exclusive maternity, sequential maternities, and honorary maternity), which guide the announcement to the child of the circumstances surrounding his/her conception, as well as the type of bonds established between all the individuals involved, including life partners, children and grandparents.  IMPACTS. Bringing together the four movements of the birthing process into an integrative model, “reproductive mediation” is a measure that rests on four theoretical foundations. First, it involves a division into sequences, which structure the birthing process over time and events. Secondly, it corresponds to a proximity approach, since the process takes place in Canada and is characterized by similarity, not distance and difference. This particularity allows women to create a relational framework that consolidates the assisted reproduction agreement. Nevertheless, between the contractualization of relations and the medicalization of childbirth, reproductive mediation is at a crossroads of regulations that hinders one’s ability to consent. Finally, the plurality of women’s experiences shows tensions between their desire to conform to family and gender norms to escape stigmatization, but also their willingness to resist and change these same norms, thus making their marginalized paths a part of an acknowledged and respected family diversity.

Keyphrases: Recherche qualitative, Maternity, Motherhood, Infertility, Assisted human reproduction, Surrogacy, Egg donation, Childbirth, Grounded theory, Qualitative research