Johnson Simon Biomedical Technology Infertility

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Gender & Society
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DOI: 10.1177/0891243211434615
2012 26: 261 originally published online 21 February 2012 Gender & Society
Katherine M. Johnson and Richard M. Simon
for Technological Salience
Women's Attitudes Toward Biomedical Technology for Infertility : The Case
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WOMENS ATTITUDES TOWARD
BIOMEDICAL TECHNOLOGY FOR
INFERTILITY:
The Case for Technological Salience
KATHERINE M. JOHNSON
The Pennsylvania State University
RICHARD M. SIMON
Rice University at Houston
Research has consistently revealed gender differences in attitudes toward science and
technology. One explanation is that women are more personally affected by particular
technologies (e.g., biomedical interventions), so they consider them differently. However,
not all women universally experience biomedical technologies. We use the concept of
technological salience to address how differences in subjective implications of a
technology might explain differences in womens attitudes toward biotechnology. In a
sample of U.S. women from the National Survey of Fertility Barriers, we examine how
women with and without a biomedical barrier to fertility evaluate biotechnology for
infertility, which, we argue, reflects differences in technological salience. For women with
a biomedical barrier, various experiences, beliefs, and values impacted their attitudes; yet,
most of these did not affect attitudes if women had not experienced a fertility barrier.
Results suggest that technological salience contextualizes womens attitudes toward these
biotechnologies and may also have broader implications for other biotechnologies.
Keywords: health/medical; knowledge/science; reproduction
INTRODUCTION
Research has consistently revealed gender differences in public attitudes
toward science and technology. Women are typically more skeptical than
men across a wide range of issues, including reproductive interventions
(Napolitano and Ogunseitan 1999). One explanation is that women are
AUTHORS NOTE: We would like to thank Pat Rafail and the anonymous reviewers for their
comments on earlier versions of this manuscript.
GENDER & SOCIETY, Vol. 26 No. 2, April 2012 261-289
DOI: 10.1177/0891243211434615
2012 by The Author(s)
261
262 GENDER & SOCIETY / April 2012
more likely to be personally affected by particular technologies (Bryant
and Pini 2006; Nelkin 1981). Yet most studies fail to link attitudes to
experiences (except see Simon 2011). Feminist theory has provided some
basis for understanding the gendertechnology relationship, although
feminists have disagreed as to whether technology liberates or oppresses
women (Lublin 1998; Wacjman 1991). Recent theorizing, however, is
more ambivalentemphasizing that differences among women
contextualize their relationships to technology: Experiences are not
universal (Thompson 2002). Yet such insights have not been integrated
into studies of attitudes toward technology: Most still treat gender
categories as homogenous (e.g., Hayes and Tariq 2000).
In this article, we contribute to a theoretical framework of gender and
attitudes toward technology that is based on experiences, focusing on
biotechnology for infertility. Drawing on insights from feminist and other
scholarship on technology, as well as social-psychological literature on
attitudes, we address how differences in womens fertility status affect
how they may differentially use personal experiences, beliefs, and values
to evaluate this technology. For fertility status, we distinguish between
women who have and have not experienced a biomedical barrier to
fertility. This is a broader definition of fertility problems that includes
medically defined infertility (12 months of unprotected [hetero]sex
without conception), miscarriage, and other problems conceiving or
carrying a pregnancy to term (e.g., chronic illness). We argue that having
or not having a biomedical barrier to fertility is a major category of
difference shaping womens attitudes about these technologies: We expect
that women who have experienced a barrier will use different criteria
when assessing the technology because it has greater subjective
implications for them. We develop these ideas more generally with the
concept of technological salience and test this on a sample of U.S. women
from the National Survey of Fertility Barriers.
BACKGROUND: GENDER AND TECHNOLOGY
Feminist scholarship has increasingly theorized the gendertechnology
relationship, and studies of public attitudes toward science have addressed
gender differences in appraisals of science and technology. Yet these do
not often come together in the same research. In theorizing technology,
feminist scholarship has historically been deeply divided over viewing it
as inherently oppressive or liberating for women (Lublin 1998). For
instance, some view reproductive technologies as a form of patriarchal
Johnson and Simon / WOMENS ATTITUDES TOWARD BIOMEDICAL TECHNOLOGY 263
medical control over womens bodies (e.g., ORiordan and Haran 2009),
while others have emphasized how technology can give women more
control over reproduction (Wacjman 1991). More recent turns in feminist
theorizing, however, have become more ambivalent, focusing on how
womens relationships to technology may vary across different social
groups and even for one woman across her life course (Lublin 1998;
Thompson 2002). For example, Thompson (2005) observed how some
women simultaneously experienced infertility treatment as objectifying
and liberatinga phenomenon she described as agency through
objectification.
Other, often nonfeminist, research has focused on differences in mens
and womens attitudes toward science and technology. Women are
typically more pessimistic than men across a range of issues, including the
environment (McCright 2010), nuclear power (Freudenburg and Davidson
2007), and biotechnologies (Napolitano and Ogunseitan 1999; Simon
2010). Some point to gender socialization: Women are socialized to be
less interested in and less informed about science and technology
(Tenenbaum and Leaper 2003). This deficit model explanation posits
that when people know more about science and technology, they will have
more favorable attitudes (Allum et al. 2008). A recent study, however,
found that womens increasing knowledge of technology actually
contributed to their greater pessimism; for men this relationship was in the
opposite direction (Simon 2010). In other words, men and women may
evaluate science and technology through divergent processes.
One explanation is that women approach science and technology
through a unique process, reflecting gender-specific consequences.
Because womens bodies are more often involved in childbearing, they
are more likely to be exposed to the consequences of science and
technology (Bryant and Pini 2006; Mallory 2006). For example, Many
of the applications [of biotechnologies] towards human health issues will
likely affect fetuses, mothers, and young children more than [other]
members of society (Napolitano and Ogunseitan 1999, 202). This
suggests that certain technologies may have greater personal implications
for women than for men.
Two key insights from feminist science and technology studies are
relevant here. First, women are overrepresented as users rather than
producers of technology, which reinforces gender inequality: Women are
often defined as passive beneficiaries, whereas men are the bearers of
technological knowledge (Bray 2007). Second, womens bodies are
viewed differently than mens in relation to technology. As Martin (2001,
197) observed, science and medicine use models [of womens bodies]
implying failed production, waste, decay, and breakdown. Therefore,
when technology becomes personally relevant, it may also define
womens bodies as problematic.
Yet these various insights and explanations still ignore how womens
experiences with and relationships to technology differ: Not all women
relate to reproductive technologies in the same way simply because they
are women. Although womens bodies may be defined as problematic
(Martin 2001), for some women this becomes inherently more personal.
In the next section, we develop technological salience as an explanatory
concept describing how womens evaluations of technology may differ
vis--vis their personal history and experiences.
CONCEPTUAL FRAMEWORK
Technological Salience and Attitude Formation
We draw on social-psychological insights about attitude formation to
begin filling in some conceptual gaps. Research on attitudes suggests that
personal relevance of an attitude-object (i.e., the topic about which an
attitude is being formed) may affect how an individual processes
information and makes a social judgment (Liberman and Chaiken 1996;
Sorrentino et al. 1988). When an attitude-object has high personal
relevance, individuals process information about it in a more thoughtful,
holistic way; when an object is of low relevance, individuals tend to rely
on simple rules or heuristics to create judgments (Sorrentino et al. 1988).
Personal relevance therefore may activate a different set of information to
create ones attitude. Regarding attitudes toward technology, this implies
that when the technology is more personally relevant (e.g., biotechnology
for womens health), an individual will form judgments in different ways
than when it is of low relevance (e.g., space technology).
Yet, it is not simply that a technology is perceived as more or less
personally relevant; when a technology has further subjective implications for
someone as a potential user, we expect they might be more thorough in their
evaluations, drawing on various types of information in creating judgments.
We describe this as technological saliencethe subjective implications of a
specific technology for ones lived experience. When a technology becomes
more salient, it likely sensitizes individuals to consider the implications of a
technology from a wider range of perspectives (e.g., scientific, religious, or
ethical), thinking about how the technology can affect their lives.
Biotechnology for infertility arguably becomes salient when a woman
has experienced a biomedical barrier to fertility. This makes the technology
more personally relevant because she might actually use it. We would
expect, then, that women who have ever had a biomedical barrier to
fertility would use different criteria in forming their attitudes compared to
other women. Strickler made a similar observation, addressing how
clinicians versus infertility patients evaluated treatments in fundamentally
different ways: Clinicians viewed infertility in terms of diseases, which
lend themselves to medical cures (1992, 113), while patients considered
psychological and emotional consequences of treatments. Here, differences
in personal histories with and relationships to this technology gave rise to
different criteria by which it was evaluated. Women for whom reproductive
technologies had greater personal implications drew on a more extensive
set of subjective evaluative criteria than the clinicians who administered
but did not directly experience them.
It is important to note here that the salience of infertility technologies
is itself deeply gendered, shaped by gendered assumptions within
medicine as an institution: Historically there has been a greater emphasis
on infertility as a womens issue and much less focus on male infertility
(Sandelowski 1993). Women become patients not only by being infertile
but also by belonging to an infertile couple: Treatments for male infertility
are overwhelmingly applied to womens bodies (Greil 2002). Therefore,
technological salience is not gender-neutral: Medical conditions and
technological solutions are socially produced and gender norms greatly
influence whose bodies are subject to treatment (Bray 2007).
Experience, Beliefs, and Values
What are the different evaluative criteria that technological salience might
activate? Research on attitudes points to personal experience with the
attitude-object (both direct and indirect) as an important factor in attitude
formation (Fazio, Eiser, and Shook 2004). Additionally, attitudes do not
exist in isolation, but are typically built on other belief and value
orientations (Stern et al. 1995). For our study, we suggest that three main
constructs tap into these: reproductive experience and values, technological
experience, and contextual beliefs and values.
Reproductive experience and values. Womens reproductive histories
and values are likely to be highly relevant in shaping their attitudes about
reproductive technologies. Women differently contemplate pregnancy;
have/have not experienced pregnancy; and place different levels of
importance on motherhood. Because there is a general consciousness that
fertility technologies are becoming more available and more widely used
(Broekmans et al. 2007; Jade Martin 2010), we might expect that any
women who are currently pregnant, have been pregnant, or are
contemplating pregnancy may be more aware of these technologies.
However, reproductive experiences and values may be more impactful for
women with a biomedical barrier to fertility. If women have been or are
planning to become pregnant and also have a biomedical barrier, then
infertility technologies become more relevant compared to women who
can conceive without intervention. We consider reproductive experiences
and values as distinct from technological experiences (see following)
because women may not have experience with infertility and related
technologies, but their personal situations make reproductive technology
in general more relevant to their lives.
Technological experience. Having personal experience with a particular
technology or knowing others who have can be important forms of
knowledge shaping attitudes about medical technology (Gabe and Calnan
1989). Women who have had a biomedical barrier to fertility can draw on
personal experience if they have sought any medical help. Women can
also draw on indirect knowledge from social networks. In addition,
women may have more confidence in the technology if they know a friend
or family member who has successfully conceived from it; on the other
hand, they may evaluate it more negatively if they know someone who
has had unsuccessful treatment. When technological salience is high, we
expect that both direct and indirect technological experiences will predict
attitudes because women might be more likely to draw on that information.
In contrast, when technological salience is low, women might be less
likely to use (indirect) experiences because the experiences and the
technology have a weaker connection. Rather, we would expect them to
rely more on dominant cultural interpretations of the technology (i.e.,
simple rules for forming attitudes; Sorrentino et al. 1988).
Contextual beliefs and values. Reproductive processes are heavily
influenced by broader belief systems and values that individuals hold.
These might be important predictors of attitudes when technological
salience is high because we expect that women would be more likely to
consider how the technology might be assimilated into their lives. Assisted
reproduction raises many ethical concerns, which may make women
cautious, especially if scientists are perceived as playing God (Kalfoglou
et al. 2005). These are often rooted in religious beliefs, which are
frequently at odds with science and technology, including reproductive
interventions (Roudsari, Allan, and Smith 2007). Because most religions
oppose some form of reproductive intervention, religiosity may be more
important in shaping womens attitudes. Womens personal locus of
control may also factor in: Women who have a greater sense of personal
control over their health and wellness may be less likely to place
confidence in (external) medical authorities (Kornelson 2005; Nelson
1983). Finally, reproduction and family are highly gendered institutions
that call on broader belief systems about men and women. Given the
male-dominated character of science, technology, and medicine (Hayes
2001), we expect that women who espouse more traditional gender
attitudes may also be more inclined to accept traditionally construed
patriarchal medical authority.
Social Location
A final element to consider is how social structural location affects
attitudes (Kiecolt 1988). While we do not necessarily suspect that the
importance of social location varies by level of technological salience, it
is still essential to consider this for attitudes toward fertility technologies.
The concept of stratified reproduction relates womens social location to
experiences of reproduction (Colen 1986; Rapp 2001). Depending on
social class, race, age, and marital status, among other factors, women are
differentially empowered and encouraged to have/not have children,
which likely affects their attitudes about reproductive technologies. Both
imagined and actual U.S. fertility patients tend to be middle-class, white,
heterosexual, married women. Infertility services are concentrated in a
private medical market, so resources such as (private) insurance and
income are key to access (Bell 2009; King and Meyer 1997). White
women are much more likely to seek infertility help than Black and
Hispanic women (Greil et al., 2011; Stephen and Chandra 2000); this is
often interpreted via the history of distrust between Black and Hispanic
groups and the U.S. medical system (Dovidio et al. 2008). Asian women
are more similar to white women in their attitudes; however, recent
research (Greil et al., 2011) indicates they may have greater ethical
concerns about treatments. Age is both biologically and culturally
significant because of the natural decline in womens fecundity (Broekmans
et al. 2007; Friese, Becker, and Nachtigall 2006). Infertility technologies
may resonate more with older women. However, they may also be more
doubtful about the technologys efficacy compared to younger women,
who might take fertility technologies for granted. Finally, infertility has
historically been defined and treated as a medical problem within a
married couple (Sandelowski 1993)typically excluding single and
lesbian women; however, more recent technology for egg freezing targets
single, career-driven women to protect their future fertility (Jade Martin
2010). Therefore, while being married or in a heterosexual relationship
may prime women to be more aware of these technologies, single women
are also increasingly targeted for particular procedures.
To summarize, prior research has found gender differences in attitudes
toward science and technology but has tended to assume within-gender
experiences are similar (e.g., gender socialization produces womens
pessimism or viewing all womens bodies as implicated in childbearing).
Drawing on feminist insights that women do not universally experience
and relate to technology and on social-psychological literature on
attitudes, we argue that technological salience may be a key, overlooked
concept in theorizing womens attitudes about technology. When a
technology becomes salient, we expect this will activate a wide range of
individual experiences, beliefs, and values as criteria to evaluate the
technology: These same factors might be less likely to affect attitudes
when technological salience is low.
Reproductive interventions are an ideal subject with which to test the
technological salience hypothesis because they are potentially applicable
to all women, yet only some women require these interventions.
Biotechnologies for infertility have more direct implications for women
with a biomedical barrier to fertility than for other women. We expect that
reproductive experiences and values, direct and indirect experiences with
the technology, and other contextual beliefs and values will be associated
with attitudes toward biotechnology for women who have had a
biomedical barrier to fertility but not for other women.
METHOD
Data
Data came from wave one of the National Survey of Fertility Barriers
(NSFB)a random-digit-dialing telephone survey that addresses social
and psychological aspects of childbearing and fertility problems among a
nationally representative sample of U.S. women and a subset of partners
(see Johnson and White 2009 for methodology report). Interviews were
completed with 4,712 women between September 2004 and December
2006. There was a 53% percent response rate to the initial screener and
37.2% percent response rate to the final survey. Although this is relatively
low, a comparison of key demographic and reproductive measures with
two other national surveys with high response rates (National Survey of
Family Growth and Current Population Survey) showed similar
distributions of race/ethnicity, age, marital status, SES, and several
fertility variables, including ever pregnant, ever infertile, and ever sought
infertility treatment. To be interviewed, women had to be ages 25 to 45
and respond to introductory questions about wanting additional children,
having ever been pregnant, and having ever experienced fertility problems.
Women who had already had one child, did not want any more children,
and had never experienced fertility problems were undersampled (20
percent randomly selected for full interview). Census tracts with 40%
percent or more racial/ethnic minorities were oversampled to facilitate
analyses by race/ethnicity.
For this study, we divided the sample into two groups for comparison:
women who have ever had a biomedical barrier to fertility and women
who have never had a barrier. This was constructed from self-reports in
response to several questions. There were three main barrier pathways: (1)
reporting a pregnancy (intended or unintended) that took more than one
year to conceive, while not using birth control; (2) reporting one or more
miscarriages; and (3) reporting another type of medical problem, such as
sterilization prior to having desired children. Because of the diversity of
womens experiences, we controlled for type of barrier in models for
those women (described below). Because objective or medically defined
measures of infertility do not necessarily address subjective experiences,
we also included a subjective measure of fertility problems (described
below). Lesbian women can also be defined as having a fertility barrier
and are likely to use assisted reproductive technologies when desiring
biological children (Agigian 2004); however, because only 45 respondents
self-identified as lesbian, controlling for this was not feasible.
After listwise deletion, the samples contained 2,887 (89.6% percent of
the original sample) and 1,367 (87% percent of the original sample)
women for those with and without a biomedical barrier to fertility,
respectively. We compared characteristics for which there were complete
data for both the original and analytic samples. There were similar
distributions for age, race, parental status, most reproductive characteristics,
and most technological experience characteristics. This suggested that the
analytic sample did not dramatically differ from the original NSFB
sample. In analyses, we weighted to adjust for nonresponse and sampling
design.
Measures
Outcome. The main outcome was womens confidence in biotechnology
for infertility. This was constructed from two ordinal items: (1) Medical
science can be a big help to women having trouble getting pregnant and
(2) Women who have trouble getting pregnant would benefit from
consulting a doctor (polychoric correlation = .43 for women with a
biomedical barrier and .57 for women without). Items had four response
categories (strongly agree to strongly disagree). These were initially part
of a three-item scale with a planned missing design. Respondents were
randomly asked two-thirds of the items to reduce respondent burden
without compromising concept validity (Johnson and White 2009). Items
were missing completely at random, so they do not bias the results
(Allison 2002). We used singly imputed versions of items (from the NSFB
public data) to construct our measure. We used the two-item scale because
the third item was substantively different: It measured the extent to which
respondents believed women could have children in their late thirties and
beyond, with the help of modern medicine. Because the topic of
advanced maternal age is associated with numerous ethical and medical
concerns (e.g., increased risk of birth defects and complications), we
excluded this in favor of addressing more general attitudes about medical
intervention for infertility.
Social location control variables. While our analyses focus on
differences in experiences, values, and beliefs, these are likely to be
correlated with social location. We controlled for age in years. We
indicated marital status comparing married (= 1) to all other statuses (=
0). We used a dichotomous measure of race (white = 1; nonwhite = 0).
Because women could report multiple racial categories, anyone who
reported at least one nonwhite category was coded as nonwhite. In
preliminary analyses, we analyzed four categories (Black, Hispanic,
Asian, and white) but found no significant differences, so we present the
simplified measure here.
We used five variables for socioeconomic status: health insurance
(private = 1; else = 0), state-mandated insurance (living in state with
mandated infertility coverage = 1; else = 0), family income (12 categories,
<$5,000 to $100,000+), employment (full time = 1; else = 0), and
education (years). We compare private health insurance to all other
options because in the United States, infertility treatment is concentrated
in a private medical market and private insurance is key to access (King
and Meyer 1997). We included state-mandated insurance because, though
not a personal characteristic, it potentially mediates between personal
insurance and access.
Reproductive experiences and values. We included five measures to
address womens reproductive experiences and values. We gauged
parental status (= 1 if biological or social parent; = 0 if neither). Social
parenting included adoption, stepchildren, and formal/informal fostering.
An exclusive measure of biological parenthood showed no substantive
difference in preliminary analyses. We indicated whether women were
currently pregnant or trying to get pregnant (= 1) compared to women
who were not trying or ambivalent (= 0). We indicated whether a woman
had ever been pregnant (= 1) or not (= 0). We indicated whether women
would like a(nother) baby in the future (= 1 if probably or definitely
yes; = 0 if probably or definitely no). We also included the Importance
of Parenthood Scale, which was composed of the following: (1) Having
children is important to feeling complete as a woman; (2) I always thought
I would be a parent; (3) Life . . . more fulfilling with children; and (4) It
is important for me to have children. Items had four response categories
(strongly disagree to strongly agree). A high score reflected a greater
value of parenthood ( = .72 for women with a biomedical barrier, .78 for
women without).
For women with a biomedical barrier, we included additional measures
of their experiences in an extended model. We coded a respondent as self-
identifying as having fertility problems (= 1) if they answered yes or
maybe to the following: (1) Do you think you have/have had/might
have trouble getting pregnant? (2) Do you think you have/have had a
fertility problem? We indicated whether problems occurred with a first
pregnancy (= 1) versus subsequent pregnancies (= 0). We controlled for
type of fertility barrier: 12-month infertility and trying to conceive
(infertile with intent), 12-month infertility but not trying to conceive
(infertile no intent), miscarriage only, other medical issues (e.g., surgery,
illness, sterilization of self/partner, and desire to have a child). We
separated infertility into the intent/no intent groups because these women
often have very different reactions (Greil and McQuillan 2004).
Technological experience. Several variables measured womens
technological experiences. We indicated whether they knew any friends or
family who had used medical help to conceive: (1) Have family or friends
pursued medical help to get pregnant? (2) Did any have a baby as a result
of [medical] help? We recoded these into three dichotomous variables: (1)
did not know anyone; (2) know someone, they were unsuccessful; (3)
know someone, they had a baby.
In an extended model only for women with a biomedical barrier, we
included a measure assessing the level of medical help seeking: no help
seeking (= 0), considered only (= 1), talked to a doctor (= 2), had
evaluation/diagnosis (= 3), and had treatment for the problem (e.g.,
artificial insemination) (= 4). If women had treatment, we further
indicated whether it was successful, meaning it resulted in a current
pregnancy or live birth (= 1); or unsuccessful, meaning no pregnancy,
miscarriage, or stillbirth (= 0).
Contextual beliefs and values. The final set of variables included
various beliefs and values relevant to family and reproduction. We
indicated womens ethical concern about infertility treatments via a three-
item scale asking about artificial insemination, donor insemination, and in
vitro fertilization. Three response categories ranged from no ethical
problem to serious ethical problems ( = .72 for women with a
biomedical barrier, .77 for women without). We included a six-item scale
for medical locus of control. This assessed a womans perception of self-
control over her health and well-being with statements such as If I am
sick, my own behavior determines how soon I get well again. Each item
had four response categories ranging from strongly disagree to strongly
agree ( = .72 for women with a biomedical barrier, .68 for women
without). We included a four-item scale measuring religiosity. This
assessed frequency of religious behaviors, and how close they felt to God
( = .52 for women with a biomedical barrier, .57 for women without).
Each item had different response categories; these were standardized
before scaling. Finally, we included a measure of gender beliefs that
assessed attitudes about men and women having separate spheres of
responsibility for work and family life. The item had four response
categories, ranging from strongly agree to strongly disagree: a high
score indicated more traditional attitudes.
Analytic Strategy
Our main hypothesis is that because biotechnology for infertility has more
personal implications for women who have had a biomedical barrier to
fertility, they will use different criteria for appraising it than other women.
To test this, we split our sample by biomedical barrier status because we
suspect not just that the coefficients between these two groups will be
unequal (i.e., interaction effects) but that entirely different factors may be
at work in terms of what is shaping their attitudes about infertility
technologies. We estimated both linear and ordinal logistic regression
models because our outcome of interest was ordinal with seven categories.
Results were substantively similar, so we present linear results for ease of
interpretation.
RESULTS
Table 1 displays descriptive statistics by biomedical barrier status.
Bivariate associations show significant differences across each construct
for these two groups of women. Notably, women who have never had a
biomedical barrier have significantly more confidence in biotechnology
for infertility on average than women who have ever had a biomedical
barrier. This supports suggestions in prior research that women may be
more skeptical of science and technology when their bodies are the focus
of intervention (Bryant and Pini 2006; Nelkin 1981). These groups are
similar across only three characteristics: percentage who know someone
that sought medical help for pregnancy and did not have a baby;
percentage who know someone that sought medical help and had a baby;
and average medical locus of control score. The series of differences here
further justify splitting our analytic sample. These differences also suggest
that biomedical barrier status is potentially associated with different life
course trajectories: Women with a biomedical barrier are more likely to be
mothers, more likely to have experienced pregnancy or are trying to
become pregnant, rate motherhood as more important, are more religious,
and have more traditional attitudes. They also rate lower across all of the
SES variables on average. It is possible that these characteristics place
women in a position to test their fertility earlier on and discover problems.
Table 2 shows linear regression results only for women with a
biomedical barrier. Each successive model adds variables measuring the
contributions of each construct in our framework. Model 1 controls for
social location. Race, education, and income are all positively associated
with womens confidence in biotechnology in model 1, but in model 5
only the effects for race and education hold. White women express greater
confidence in this biotechnology than non-white women, and more
educated women express greater confidence than less educated women.
These are both in the expected direction, based on prior research finding
a link between higher education levels and greater acceptance of science
and technology (e.g., Hayes 2001; Simon 2010), and research suggesting
that non-white women may be less trusting of the medical system or have
274
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greater ethical concerns about treatments (Dovidio et al. 2008; Greil et al.,
2011).
Model 2 adds several variables capturing womens reproductive
experiences and values. On average, women who had ever been pregnant
were less confident in biotechnology for infertility. Many of these women
may have achieved pregnancy without medical help, which may have
lessened their need for and commitment to reproductive interventions.
Women who placed greater value on motherhood as a desired social role
tended to express greater confidence in this technology; this suggests that
when being a parent is important, women may be more accepting of
medical intervention to alleviate fertility problems. This latter result was
the only finding from this set of variables that held in model 5.
Model 3 adds indirect technological experience: womens knowledge
of the technology through the experiences of friends and family members
(Gabe and Calnan 1989). Compared to women who had no indirect
experience, women who knew someone that sought medical help and
successfully had a baby were more confident in the technology. However,
contrary to our expectations, knowing someone who had unsuccessful
treatment did not affect womens confidence in the technology.
Model 4 adds in a series of beliefs and values that are important in
contextualizing reproduction and family issues. As was expected, ethical
concern was negatively associated with womens confidence in the
technology; however, there was no effect of religiosity on womens
attitudes. Counter to our expectations, women with higher personal locus
of control about their health expressed greater confidence on average than
women with lower locus of control scores. In addition, although we
expected women with more traditional gender attitudes to be more likely
to put confidence in external, traditionally patriarchal medical authority,
we found the opposite result here: On average, these women expressed
lower confidence in biotechnology for infertility. This pattern of results
holds in model 5 as well.
Model 5 adds biomedical barrier-specific variables to the constructs of
reproductive experiences and values and technological experience to
account for additional experiences of these women. The type of fertility
barrier and the level of help seeking were the only additional factors
related to womens attitudes. Women who had experienced other medical
problems as opposed to infertility while intending to conceive had more
confidence in the technology on average; however, women who were
infertile without intending to conceive and women who had miscarried
were not significantly different from those who were infertile with
intent. Women in the other problems category have diverse issues,
including sterilization regret, and desiring but not attempting pregnancy
because of surgery or illness; these situations may put them in a position
to more positively evaluate the possibilities of this biotechnology than
women who are unable to conceive or who miscarry. Finally, women who
moved further along the different medical help-seeking levels had greater
confidence in the technology. To some extent, this contradicts the
explanation that women are more critical of science and technology if
their bodies are the focus of interventions (Bryant and Pini 2006; Nelkin
1981): If this explanation were to hold, we would expect to see women
have decreased confidence as they become more involved in medical
interventions. Without longitudinal data, however, we cannot tell if
confidence enables women to continue with medical help or if continued
interaction with fertility technologies increases womens confidence. For
instance, women who have negative experiences with medical help-
seeking may drop out at lower levels, or womens commitment to and
confidence in reproductive interventions may increase the further they
become involved. We suggest that this finding deserves significant
exploration in future research.
Incremental F tests for each of the different models provide evidence
for the successive contributions of each set of variables in explaining
womens attitudes. Notably, each set of variables in models 1 to 4
significantly contributed to the explanatory power of the model. This
supports our conceptual framework in that each of these main constructs
is both theoretically and empirically important in explaining variation in
womens attitudes about biotechnology for infertilityat least, for
women with a biomedical barrier.
Table 3 provides linear regression results for women who have not had
a biomedical barrier to fertility. To compare the patterns of effects, these
contain identical variables as those in models 1 to 4 for women who have
had a biomedical barrier. Model 1 includes the social location variables.
On average, women who are older and have higher education levels tend
to have greater confidence in biotechnology for infertility; however, only
the effect for education holds in model 4. This is, again, in the expected
direction based on prior research. One additional variable shows an effect
only in model 4: White women are less likely to express confidence in the
technology than nonwhite women. This is both counterintuitive, given
prior research findings on race, infertility treatment, and medicine in
general (Dovidio et al. 2008; Greil et al., 2011), and counter to the findings
mentioned earlier for the women who have had a biomedical barrier. One
280
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explanation is that white, middle-class women are used to being in control
of their fertility (e.g., through contraception)and therefore often
experience the failure of infertility more acutely (Greil 1991)so they
may be less supportive of this technology until they actually experience
infertility.
Model 2 includes womens reproductive experiences and values.
Women who want a(nother) baby express less confidence in this
technology; however, those who place a greater importance on motherhood
reported greater confidence in the technology. It is possible that these
reflect differences in ideal versus real circumstances for women: Ideally
they desire parenthood and would possibly use technology to become a
parent, but the reality of specifically wanting a(nother) child may make
them more considerate of the risks and benefits of the technology.
Models 3 and 4 include the variables measuring (indirect) technological
experiences and contextual beliefs and values. Unlike the previous models
for women who have had a biomedical barrier, none of these variables
were associated with womens attitudes about biotechnology for infertility
if they had not experienced a biomedical barrier. The incremental F tests
for each of the different models provide evidence that variables introduced
in models 1 and 2 significantly contributed to the explanatory power of
the model, but those introduced in models 3 and 4 did not. In other words,
social location and reproductive experiences and values helped to explain
variation in womens attitudes, but technological experience, and
contextual beliefs and values, did not.
Comparing the results by biomedical barrier status reveals a number of
differences between these groups. For women who had a barrier, measures
from each of the major set of variables were associated with their attitudes
toward biotechnology for infertility: race, education, importance of
parenthood, and technological experience, as well as a range of personal
beliefs and values. Many of these same findings were not relevant for
women who had not had a biomedical barrier to fertility. Additionally,
although each set of variables significantly contributed to the explanatory
power of the model for women who had experienced a biomedical barrier
(except for the variables added in model 5), only social location and
reproductive experiences and values provided significant contributions
for women who had not experienced any barriers. This pattern of results
generally supports our technological salience framework: The greater
subjective implications for women with a biomedical barrier activate
different sets of evaluative criteria for judging the technology.
DISCUSSION AND CONCLUSION
A review of the existing research on gender differences in attitudes toward
science and technology suggests that the more personal implications of
technologies might explain why women evaluate them differently than
men (Bryant and Pini 2006; Napolitano and Ogunseitan 1999; Nelkin
1981). However, feminist theorizing on gender and technology has argued
that not all women universally experience technology simply because
they are women (Lublin 1998; Thompson 2002). We know that technology
(particularly reproductive technology) is not gender-neutral because
gender norms deeply affect how technology is produced and consumed
(Bray 2007) and because medico-technological solutions typically use a
model that views womens bodies as inherently prone to failure (Martin
2001). However, this should not universally impact all women. Rather, for
some women we might expect biotechnologies to become inherently more
personal. Drawing on these insights, as well as on social-psychological
literature on attitudes, we developed the explanation of technological
salience: When a technology has subjective implications, a different set of
evaluative criteria will be used that draws more on experiences, values,
and beliefs than when personal implications are low. When a technology
is salient, it is something that could be done to you. Therefore, we would
expect the evaluation to be based more on personalized criteria rather than
on more abstract knowledge (Sorrentino et al. 1988).
To test this hypothesis, we examined womens attitudes toward
biotechnology for infertility. Some of the women in our sample have had
a biomedical barrier to fertility so the biotechnology in question has more
personal relevance. For other women, however, it does not have the same
implications. Based on our framework, we expected that experiences and
values related to reproduction, experiences with reproductive technologies,
and beliefs and values that contextualize reproduction would be
significantly correlated with attitudes for women who have had a
biomedical barrier to fertility, but that these would not necessarily factor
in for other women.
The results presented here do support our expectations regarding how
technological salience may shape attitudes toward technology. Using
regression analysis, we found that measures from each of our constructs
social location, reproductive experiences and values, technological
experience, and contextual beliefs and valueswere associated with
womens attitudes toward biotechnology for infertility if they had
experienced a biomedical barrier to fertility, but only a few measures from
the first two constructs were associated with attitudes for women who had
not experienced a barrier. This different pattern of results supports the
conceptual utility of technological salience: Relevant experiences, beliefs,
and values are important criteria for determining attitudes when these
interventions could have direct personal relevance for women but not for
the women who would not be directly implicated in such interventions.
Notably, although there was no significant difference between these
groups of women in the proportion who knew someone that had sought
infertility treatment and successfully had a baby, this affected attitudes
only for women with a biomedical barrier. When women are potential
users of biotechnologies, it is intuitive that they would consider these
indirect experiences as part of their evaluative criteria, but that these
would not have the same impact for other women. That is, when a
technology is particularly salient to a woman, she becomes more attuned
to others experiences because they have the potential to be her own; when
the technology is not particularly relevant, it may be easier to overlook
how it has affected others.
Three other relevant beliefs and values variables significantly predicted
attitudes for women with barriers and not for women without barriers:
ethical concerns about infertility treatments, medical locus of control, and
gender attitudes. While it is reasonable to expect those with ethical
objections to have more negative attitudes toward medicine, it is
noteworthy that this did not predict attitudes for women without a
biomedical barrier. It appears that ethical concern comes into play only for
women who would be (or have been) the subjects of such interventions,
as they are called on to potentially assess how a technology might be
assimilated into their personal belief and value systems. For women with
a biomedical barrier, those who feel more in control of their own health
and well-being actually have more confidence in medicine to help achieve
pregnancy than women who feel less in control. It may be that women
who feel more in control of their health outcomes view medical technology
as a tool to be used when needed instead of viewing it as an external
authority that must be conceded to: Medical interventions may become an
extension of their own agency in getting pregnant. This supports Greils
(1991) finding that infertile couples may turn to medical treatments to
regain a sense of control that is lost when they experience infertility.
Finally, having more traditional gender attitudes about separate spheres
for men and women was negatively associated with confidence in
biotechnology for infertility for women with a biomedical barrier, but had
no effect for the other women. We initially expected this relationship
would be positive: Women with traditional gender attitudes might be more
likely to accept external medical authority, and women with more
progressive gender attitudes might be more critical of medical interventions
that underscore the inadequacies of their bodies. We would expect this to
be true especially of medical interventions to pregnancy and birth, in
which women have traditionally been excluded from decision-making
processes by their husbands and male physicians (Leavitt 2010). Yet, for
women with a biomedical barrier, more progressive gender attitudes were
associated with more confidence in the technology. An alternative
interpretation is to view it in terms of the link between the increasing
number of reproductive interventions and womens reproductive
autonomyeven if it is only a discursive link for some reproductive
technologies, for example, egg freezing (Jade Martin 2010)rather than
as forfeiting control of ones body to traditionally construed patriarchal
medical authority.
Overall, these findings supported our technological salience framework
because we would expect ethical concerns, locus of control, and gender
attitudes to be important considerations for evaluating fertility technologies
for women with a biomedical barrier to fertility. When a woman is in a
position to be subjected to infertility technologies (i.e., high salience), she
becomes more likely to consider how to incorporate them into her own
relevant beliefs and values; when salience is low, these same beliefs and
values are not necessarily activated because these women would be much
less likely to consider how to incorporate a technology into their lives.
In an expanded model in Table 2, we added several variables that
applied only to women with a biomedical barrier to fertility: self-
identification as having a fertility problem, having problems with a first
pregnancy attempt (vs. subsequent pregnancies), type of fertility barrier,
extent of medical help seeking, and whether any treatment sought was
successful or unsuccessful. Type of fertility barrier and extent of help
seeking further predicted womens attitudes. Women who had experienced
other medical problems as opposed to infertility while trying to conceive
had more confidence in the technology on average. These women have
more diverse medical issues that do not necessarily affect their ability to
conceiveeven though they affect their ability to have children. We
suggested that this might cause them to more positively evaluate the
possibilities of medical technologies than women who are specifically
unable to conceive (medically defined infertility) or who miscarry.
Women who moved further along the different medical help-seeking
levels had more positive attitudes toward medical technology for helping
infertile women achieve pregnancy, but we cannot disentangle this
relationship without longitudinal data: We cannot tell if confidence in
technology enables these women to pursue medical help or if continued
interaction with medical help seeking increases womens confidence in
this technology. How womens broader health beliefs and use of medical
care play a role in their biotechnology attitudes deserves exploration in
future research.
This study does have some limitations. First, we used cross-sectional
data. Longitudinal data would provide a more comprehensive analysis of
how experiences shape attitudes about technology; in particular, it is
crucial to be able to disentangle the timing of attitude formation in relation
to technological experience. Second, we focused on only one type of
technology here, so it is an open question whether technological salience
can be transferred to other technologies. We suspect that it may work for
other reproductive technologies and food technologies, but perhaps not
for technologies that are rarely accessed directly by the public (e.g., space
exploration) or that do not have bodily implications. Another limitation
that urges caution in interpretation is the relatively small amount of
variance explained. The full model accounts for only about 10 percent of
the variation in the dependent variable for those with a biomedical barrier,
and about 8 percent for those without barriers. Future research should
build on our conceptual framework to further flesh out this model.
Another limitation is the relatively small sample size (n = 1,367 for
women with a biomedical barrier). Because significance tests are a
function of sample size, it is possible that we have rejected the possibility
that there are correlations between the experiences, beliefs, and values
variables and confidence in infertility technologies for this group of
women when, in fact, there may be. Ideally, further research would
perform similar analyses, but with a larger sample. A related sample issue
is that NSFB respondents may not represent all U.S. women, even though
many characteristics matched other surveys with much higher response
rates. For example, women who have had particularly distressing
experiences with infertility may have refused to participate because of the
psychological toll it might take to relive past experiences. Thus, the
findings here should be interpreted with caution. Finally, we have focused
here only on women in order to isolate specific, relevant experiences and
to critique prior research for its homogenous interpretation of gender
categories. Future research should also address differences in how couples
experience various reproductive processes, in order to assess how
asymmetric personal involvement may differentially shape partners
attitudes.
Despite limitations, this study has made several contributions to
theories of gender and technology. First, it supports arguments made by
scholars who have suggested that (gender) differences in attitude about
science and technology may stem from different personal implications of
the technologies in question (e.g., Hayes 2001; Simon 2010, 2011). Our
work strengthens this explanation because we find technological salience
to be an important contextualizing factor among women: We add to this
literature further by acknowledging that gendered processes, including
relationships to technology, cannot be conceptualized as universal among
women (or men). Our work also has implications for feminist theories of
reproduction (e.g., Strickler 1992; Wikler 1986) because it provides
insight into how women approach reproductive technologies differently
when reproduction becomes problematic (Rapp 2001, 466). Feminist
theory has tended to focus on the implications of reproductive technologies
for the women who might use them, but has paid less attention to how
fertile and infertile women evaluate these technologies differently. Our
research suggests that feminist theorizing should incorporate differences
in technological salience among women into analyses of reproductive
technologies. This line of inquiry should be particularly fruitful for
exploring intragender differences in technology attitudes and experiences.
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Katherine M. Johnson is a Ph.D. candidate in sociology, demography, and
womens studies at The Pennsylvania State University. Her research centers
on human reproduction, gender, and family issues, specifically reproductive
technologies, reproductive rights, and alternative family creation. She is
also interested in exploring linkages between social science and bioethics.
Richard M. Simon earned his Ph.D. at The Pennsylvania State University
and joined the Rice University staff as a temporary lecturer in the fall of
2011. The two major research projects he is involved in include the study of
how gendered experiences shape attitudes toward science and technology,
and stratification processes among scientific specialties.

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