The South African Economy of Egg Donation: Looking at the BioEconomic Side of Normalization

Field: Social Sciences (Social Sciences)

Business Ideas Travel as well as Technologies I want to start by briefly narrating the story of egg donation in South Africa – or rather one version of the story, which is dependent on my subjective perspective and access to the field as a white, female PhD student from Germany. The country's infrastructure around egg donation has undergone rapid development over the last ten years, from egg donation being very rarely practiced in the early 2000s to its becoming a routine medical procedure and a professionalized and booming industry today. So what has happened during the last decade? What has made this remarkable development possible? These questions were in my head as I flew to Cape Town, eager to understand the everyday realities of a practice that has sparked so many feminist debates, which continue until this day. I was surprised to discover that in the South African case normalization began with an outright scandal. In 2002, Robin Newman, a woman from the United States who had experienced infertility herself and was looking for a promising business idea, opened the first egg donation agency in South Africa, offering "egg safaris" to infertile American couples.6 She was entering unknown legal territory, and quickly sparked a public outcry about the "online sale of eggs" and "Bargain Babies in the Mother City" (Peters 2005). A major reason for this indignation amongst the medical community was that "the American" was copying the US model of agencies and "overpaying" the donors, offering compensation rates that were considered inappropriately high in the local context, or even "perverse," as one interviewee called them off the record. The Ministry of Health, fertility clinics, and IVF specialists, organized within the South African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG),were alarmed and in April 2004 the agency was closed down, albeit re-opening shortly afterwards.7 Yet, this brief episode had profoundly changed the field. Clinics recognized the immense demand for IVF using donated eggs and the value of agencies in terms of donor supply, a time-consuming service that they could not offer themselves.8 New agencies quickly copied the idea, "seeing that there is a business to be done"9 – with the difference that they acted more carefully, especially with regard to compensation rates and the wording of advertisements. In addition, the broad media coverage gave the topic a degree of publicity that it had not had before, even though the headlines were predominantly negative. A self-perpetuating process had begun: More and more agencies were striving to find donors via advertisements or informational events (often on university campuses), which led to growing donor databases and a rising number of mostly international "fertility travelers" making use of donor eggs. With the increasing experience of egg donation cycles, medical procedures improved and became more standardized, and complications became quite rare, which in turn made it easier to find donors and foster public and governmental acceptance. Ethics played a decisive part in this process. Due to the lack of detailed legislation and the commercialization of the field being perceived as inappropriate, in 2008 SASREG published guidelines for gamete donation and additional ones for agencies four years later. Even though these SASREG guidelines are not mandatory but only a code of conduct by which clinics and agencies are expected to abide, they are an integral part of the professionalization and new image of the industry. The recommendations include the ideal age of donors (between 18 and 36), context-sensitive advertising and recruiting (which basically means avoiding statements about financial gain), screening of donors, anonymity of donation, disapproval of donors traveling abroad justified by medical concerns about disrupting the continuity of care, and the proposal to keep monetary compensation no higher than R700010 (R6000 until November 2014). Today, the field of egg donation is structured around private IVF clinics and competing agencies as non-medical service providers. Between 60 and 80 percent of patients come from overseas (figures vary from clinic to clinic), the majority from Australia. South Africa is among the top destinations for so-called reproductive tourism, advertising its "large pool of racially diverse donors" immediately available, its "Western culture" and "first-world" medical facilities, favorable exchange rates and tourist attractions.11 The cooperation between clinics and SASREG-listed agencies seems to run quite smoothly despite critique and discontent on both sides, mainly rooted in the different spheres to which the two actors belong: the world of medicine on one side and business and marketing on the other. All in all, we can speak of a well-established, ethically regulated and quite professional egg donation market. What should have become clear, however, is that its development does not correspond to an understanding of normalization as a slow process of changing norms and discourse that may go widely unnoticed and is only visible in the long run. Rather, it was the sudden confrontation with the "abnormality" of the US agency model that laid the foundations for the later success story of egg donation in South Africa. It wasnot legal, social, or scientific factors but rather accidental developments, an imported business idea, and the discovery of the new profitable business field it entailed that triggered the normalization of egg donation in South Africa.