Extended essay
J Med Ethics: first published as 10.1136/jme-2023-109716 on 2 April 2024. Downloaded from http://jme.bmj.com/ on April 5, 2024 at The Hong Kong Polytechnic University. Protected by
Correspondence to
Andrea Bidoli, Public Health,
University of Copenhagen,
København, Denmark;
​andrea.​bidoli@​sund.​ku.d​ k
Received 5 November 2023
Accepted 9 March 2024
© Author(s) (or their
employer(s)) 2024. No
commercial re-­use. See rights
and permissions. Published
by BMJ.
To cite: Bidoli A.
J Med Ethics Epub ahead of
print: [please include Day
Month Year]. doi:10.1136/
jme-2023-109716
More than an idea: why ectogestation should become
a concrete option
Andrea Bidoli ‍ ‍
ABSTRACT
This paper calls for the development of a method of
ectogestation as an emancipatory intervention for
women. I argue that ectogestation would have a dual
social benefit: first, by providing a gestational alternative
to pregnancy, it would create unique conditions to
reevaluate one’s reproductive preferences—which, for
women, always include gestational considerations—
and to satisfy a potential preference not to gestate.
Enabling the satisfaction of such a preference is
particularly valuable due to the pressures women
face to embrace pregnancy as central to their identity,
while at the same time being penalised by it. Second,
ectogestation would address certain specific negative
social implications of gestation and childbirth, which
cannot be avoided through social measures as they are
caused by the corporeal nature of these phenomena.
Finally, I argue that it is unfair to hold ectogestation to a
higher standard than other innovations such as modern
contraceptives and non-­medical egg freezing.
INTRODUCTION
Complete ectogestationi—a process of extracorpo-
real gestation able to replace pregnancy entirely—
has been widely discussed within the bioethics
literature. Arguments in favour generally focus on
the promotion of gender equality, the increase in
reproductive autonomy for people of all genders
and the prevention of physical harm,1–3 while
concerns relate to inequality in access, the rein-
forcement of existing oppressive norms and the
potential creation of new ones.4 5 In particular,
some scholars claim that, within our current social
environment, ectogestation would have a limited
equality-­promoting and freedom-­promoting poten-
tial and that supporting it would frame female
physiology—rather than the social response to it—
as the source of gender inequality.6 Moreover, it
has been claimed that focusing on complete rather
than partial ectogestation overstates the ‘scientific
realities’ and ‘accords undue priority to imagined
gender parity in heteronormative reproduction
at the expense of other issues of reproductive
freedom’, ‘reducing existing imbalances in the way
the work of parenting is distributed in heterosexual
relationships to the period of gestation’.7
This paper aims to join the body of literature
supporting the prospect of an ectogestative future.
I will argue that ectogestation would have a unique
emancipatory potential through its impact on the
formation process of reproductive preferences and
the opportunity it would offer to avoid certain
i
Hereinafter, ‘ectogestation’ (and ‘ectogenesis’, when
quoted) always refers to ‘complete ectogestation’.
Bidoli A. J Med Ethics 2024;0:1–7. doi:10.1136/jme-2023-109716
social implications of pregnancy. A brief overview
of the context in which women come to form
their attitudes towards reproduction may help our
discussion later. Therefore, in the next section, I
present and criticise some of the norms and pres-
sures related to pregnancy, which affect all women,
without aiming to provide a comprehensive analysis
of such a vast and complex topic.
Social norms on pregnancy: an overview
Whether we adhere to a containment or parthood
view of pregnancy, which respectively define fetuses
as merely contained within/surrounded by the
gestating person or as a part of them,8 fetuses are
inside the gestating persons. Such a unique dynamic
imposes certain limitations, which I discuss later,
and is at the basis of the social expectation for preg-
nant people to prioritise fetal interests over their
own needs and desires. For instance, during preg-
nancy, eating is under such a strict scrutiny that it
becomes a ‘significant social act charged with moral
meaning’.9 Gestating persons are expected to adhere
to the highest standards of nutrition, both by them-
copyright.
selves and by society, as they are considered morally
responsible for the well-­ being of the fetuses (and
later, of the children). ‘Healthy eating’, in line with
dietary guidelines, is associated with ‘good moth-
ering’, causing pressures to justify any infringement
of nutritional norms.9 This attitude is not limited
to the realm of food: regulations on the use and
consumption of drugs, alcohol and tobacco by preg-
nant people have implications that go well beyond
judgement. It can be argued that the criminalisation
of pregnancy—‘(t)he process of attaching punish-
ments or penalties to women for actions that are
interpreted as harmful to their own pregnancies’ii
10
—is a social control policy hidden behind the
‘best interest of the (future) child’ principle. In this
context, the management of substances’ misuse is
positioned ‘at the nexus of public health and criminal
justice intervention’.11 This can affect illegal drugs’
users as well as people taking prescription drugs as
part of their medical treatment. Moreover, persons
planning to gestate, actively pregnant or breast
feeding are often pressured to pause, or even denied,
certain medications. Such a resistance can affect both
drugs known to be teratogenic, as well as substances
only potentially harmful to fetuses. In fact, there is a
ii
According to Amnesty International, ‘(t)his includes
laws that punish actions during pregnancy that would
not otherwise be made criminal or punishable. It also
refers to other laws not specific to pregnancy but which
are either applied in a discriminatory way against preg-
nant women and/or have a disproportionate impact on
pregnant women which can in practice work as de facto
criminalisation’.10
   1
 Extended essay
significant lack of data on whether medications are safe for fetuses
due to the historical exclusion of pregnant subjects from clinical
trials,12 and it is (mostly) women who pay the price of this exclu-
sion. The social expectation for mothers to prioritise fetal and
child health regardless of the consequences on their own well-­
being is widespread; as stated by Susan Chase and Mary Rogers,
a good mother should be, ‘above all, (…) selfless. Her children
come before herself and any other need or person or commit-
ment’.13 This narrative goes well beyond gestation. For instance,
the choice of a method of delivery (which, in any case, will involve
some pain and discomfort) is often influenced by interests others’
than the birthing person’s. While a preference for vaginal deliv-
eries can reflect social pressures towards what are (questionably)
deemed ‘natural births’,14 several investigations have found that
labouring patients are pressured into having—or not having—
caesarean sections15–17 and epidurals,18 as well as being subject to
other ‘minor’ procedures without their consent.19
Pregnancy does not only affect gestating individuals but has
a much wider social impact. Historically, pregnancy has been
the most evident single-­sex feature, which led gestation, partu-
rition, and lactation—which are, in themselves, biological
processes—to be framed as the foundation of the social concepts
of womanhood and motherhood. Since a very early age, children
are exposed to motherhood—and, in particular, motherhood
through pregnancy—being depicted as ‘normal’ and central to
a woman’s identity. Their gender socialisation will inevitably be
shaped by the depiction of a woman’s ‘childbearing capacity’20 as
her main function, resulting in girls and, later on, women being
pressured ‘to pursue self-­actualisation through procreation’,21
regardless of whether they eventually choose to have children
and ‘of any social benefit they may receive if they do’.21 This can
be particularly challenging for women who cannot be pregnant,
including transgender women; at the same time, people who
gestate but are not women might have difficulties dealing with
such a strongly gendered process.
Moreover, pregnancy is a corporeal process requiring certain
sacrifices that has no equivalent in male physiology; as such, it is
used to associate women’s ‘nature’ with ‘passivity, unconditional
giving, sacrificing, suffering’.20 As claimed by Janice Raymond,
‘(a)ltruism has been one of the most effective blocks to women’s
self-­
awareness and demand for self-­ determination’22 causing
women’s bodies to be ‘the raw material for other’s needs, desires
and purposes’.22 In this view, ‘(t)he cultural norm of the altruistic
woman (…) derives from a social context in which women give
and are given away, and from a moral tradition that celebrates
women’s duty to meet and satisfy the needs of others. The cultural
expectation of altruism has fallen most heavily on pregnant
women, so that one could say they are imaged as the archetypal
altruists’.22 Claims that women are meant to be the primary care-
takers are grounded in the physical vicinity and the responsibilities
and dependence involved in the gestational relation, in childbirth,
and nursing.23 This narrative positions women as physically and
conceptually closer to children than men, and it has been used
to construct the concept of a ‘sacred’ mother–child connection
that should not be severed. Such a connection is often claimed
to be different not only from the father–child one, but also from
the relation between a mother and a child she did not gestate. In
fact, the gestational tie has been framed as morally superior, with
philosophers claiming that birth parents have stronger parental
rights,24 and judicial bodies stating that, at birth, ‘every child
should have a mother’,25 defined as the person who bore them.iii
iii
This proves particularly harmful for trans men who gestate and birth
their own children, as in most countries they are registered as ‘mothers’
2 Bidoli A. J Med Ethics 2024;0:1–7. doi:10.1136/jme-2023-109716
J Med Ethics: first published as 10.1136/jme-2023-109716 on 2 April 2024. Downloaded from http://jme.bmj.com/ on April 5, 2024 at The Hong Kong Polytechnic University. Protected by
Such a statement is detrimental to both mothers, who are assigned
disproportionate responsibilities, and fathers, whose parental role
is depicted as important at best, but not essential like mothers’.
Furthermore, political measures and socioeconomic policies,
such as those differentiating parental leaves by gender, can rein-
force the expectations for mothers to be the primary caretakers
and maintain an unequal gender division of labour.26 The soci-
etal interest in supporting a preference for reproduction via
pregnancy is also reflected, for example, in social praise as well
as financial incentives from the State, such as ‘baby bonuses’
or publicly funded methods of medically assisted reproduc-
tion. Policies, laws and regulations, together with technological
opportunities and cultural norms, do shape people’s preferences.
They are often ‘explicitly designed to produce certain prefer-
ences’,27 which can be problematic per se but even more when
the preference they encourage is harmful.
The role of pregnancy within the patriarchy, therefore, proves
to be extremely complex: it is used both as a pretext to discrim-
inate women and as an oppressive tool that relegates them to
certain roles, praising those who embrace such roles and ostra-
cise those who do not. This is what Evie Kendal refers to as
the twofold ‘social burden of pregnancy’: ‘social expectation
demands women become pregnant, and then pregnancy serves
to materially damage women’s social lives and limit their future
opportunities’.21
REPRODUCTIVE OPTIONS AND ADAPTIVE PREFERENCES
With this context in mind, it can be argued that ‘complex socio-­
political factors’ (…) make it unlikely’7 for ectogestation to be
possible in the near future, especially since there is no technolog-
copyright.
ical breakthrough in sight. Chloe Romanis and Claire Horn refer
to this last point to claim that the ‘technological possibilities to
claim legitimacy for a future of (ectogestation)’7 have been over-
stated, and that focusing on such uncertain and distant future
possibilities is damaging. On the contrary, I consider the limited
research on it as a reason to discuss complete ectogestation even
more. For those ‘future possibilities’ to become real, they need to
be a research priority, which results from being on top of or, at
least, included in the political agenda. Ectogestation is neither. It
is hard to believe it is simply a coincidence that the research and
market on new reproductive technologies enabling pregnancy
is constantly expanding, while there is none on replacing preg-
nancy.iv The lack of gestational alternatives could be explained
by the instrumental role that maintaining female-­only pregnancy
as the sole gestational method plays in preserving patriarchal
social structures. Acknowledging this role allows to address the
tension that may derive by presenting ectogestation as emancipa-
tory when many of those who could benefit from avoiding gesta-
tion and childbirth—women, mostly—seem to yearn for them.
Given how ‘efficient exploitation requires that those exploited
be relatively (…) self-­maintaining’,28 it is essential that women
keep choosing—without being explicitly forced—to engage in a
method of gestation (and, more generally, of reproduction) that
harms them.3 29 It serves patriarchy that women find value in
against their will and, at times, even against their legally recognised
gender. See, for instance, Alaattinoğlu, D. & Margaria, A. (2023). Trans
parents and the gendered law: Critical reflections on the Swedish regula-
tion, International Journal of Constitutional Law, 21(2), 603–624.
iv
See Bidoli and Di Nucci3 for a discussion on whether ectogestation
is a case of undone science, which is research that is not done because
those with resources do not have an interest in it, or have an interest in
it staying ‘undone’.

pregnancy or, even better, that they perceive it as natural and
therefore do not question the origin of their desire for it.
In light of this, I suggest that a preference for pregnancy might
be the result of oppressive norms and of the historical lack of
gestational options. Let me start by outlining women’s possible
reproductive preferences at present:
A. Some women do not desire a child nor a pregnancy. This
preference does not generally match social norms, there-
fore, often resulting in stigma and disproportionate judge-
ment.30 31 Nonetheless, with the notable exclusion of forced
pregnancies, this preference can be satisfied. These women
may simply not want to be parents, or they might have taken
a more contingent decision, related for instance to the spe-
cific environment in which they would have to raise their
children, or to the current inevitability of pregnancy.
B. Some women want a childv and a pregnancy. This preference,
if physically possible, can be satisfied, and it matches pro-
natalist social norms. This latter aspect is likely part of why
such a preference is broadly respected and supportedvi, espe-
cially when it fits the heteronormative version of a nuclear
family. As mentioned, in addition to the lack of gestational
alternatives, several factors may influence the formation of
this preference. To some women, ‘the experience of preg-
nancy might fit the conception of a project’32 and can be con-
sidered a ‘not easily substitutable’32 component of their own
identity. Pregnancy can also be perceived as a valuable part
of the childrearing process, as one of the various ways to be
involved in the (future) child’s life (e.g., by nurturing the fe-
tus through your body, or having a privileged access to their
first movementsvii). Therefore, a desire for motherhood via
pregnancy can derive from the combination of one’s values,
personal situation, and social context. However, a prefer-
ence for pregnancy cannot be assessed without reflecting on
two key factors. First, the pronatalist narrative girls grow up
in, which presents pregnancy as a natural part of reproduc-
tion, a ‘normal’ experience that all women, and women only,
should desire. Kendal claims that ‘pronatalistic enculturation
may diminish women’s autonomy in their reproductive deci-
sions, leaving them subject to overwhelming social pressures
and ‘unconscious desires’.21 Second, even if we accept the
formation of reproductive preferences as autonomous, we
must consider the other factor, i.e., the available choices. As
argued by Claire Chambers, ‘(e)ven a perfectly rational, free-
ly choosing individual is constrained by the fact that she must
choose from the options that are available to her, and that
are cast as appropriate for her’.33 Therefore, in the context
of patriarchy, and ‘in the struggle against patriarchal practic-
es, women should see their own present attitudes towards re-
production as contingent’.34 Anna Smajdor emphasises how,
with pregnancy being the only way to have children, women
‘have no reason to question the value or importance of preg-
v
The desire for children can be due to a natural instinct, socialisation or
a combination of both and more. For the purpose of this paper, I will not
discuss whether the desire to reproduce and the desire to have biological/
genetical offspring are ethical.
vi
Racism, classism, ableism and other forms of discrimination may
result in women from different social groups being judged differently
for comparable reproductive choices. See, for instance, Kallianes, V.
and Rubenfeld, P. (1997) Disabled Women and Reproductive Rights,
Disability & Society, 12:2, 203–222 and Masters, N.T., Lindhorst, T.
P., Meyers, M. K. (2014) Jezebel at the Welfare Office: How Racialized
Stereotypes of Poor Women’s Reproductive Decisions and Relationships
Shape Policy Implementation, Journal of Poverty. 18(2), 109–129.
vii
I thank Fiona Woollard for this comment.
Bidoli A. J Med Ethics 2024;0:1–7. doi:10.1136/jme-2023-109716
Extended essay
J Med Ethics: first published as 10.1136/jme-2023-109716 on 2 April 2024. Downloaded from http://jme.bmj.com/ on April 5, 2024 at The Hong Kong Polytechnic University. Protected by
nancy and childbirth independently of the arrival of their
child.’35 viii Even more, Smajdor claims that ‘(t)he necessity
of women for gestating and nurturing society’s children is so
entrenched in our consciousness that we fail to recognise that
we could change the situation’.35
C. Some women want a child but not a pregnancy. A clarifica-
tion is due here: some might simply not want to be preg-
nant themselves and would be satisfied by adopting a baby
or having one through a gestational carrier. My focus here,
however, are those women who desire to avoid pregnancy
altogether. This preference may be driven by a number of
reasons, including but not limited to ethical concerns about
exposing someone to the risks of gestation (regardless of
compensation), not wanting to be subject of the social and/
or legal implications of surrogacy, or a desire to weaken the
above-­mentioned connection between mothers/women and
pregnancy. In its latter version, this preference cannot be sat-
isfied.
Being able to choose not to bear children, as in preference
(A), has been crucial to distance women from the motherhood
mandate.ix Catharine MacKinnon states that ‘once a woman
can choose not to bear children, to do so would constitute a
project, suggesting that childbearing is ‘natural’ only so long as
it is ‘fate’.36 With significant differences as well as similarities to
the impact of adoption practices, surrogacy has disrupted the
interdependence of motherhood and pregnancy, by allowing to
sever such connection at an individual level. Despite these steps
forward, though, women are not yet collectively able to choose
to have children and not bear them. Pregnancy still affects their
fate, as they are still—as a category—in charge of/responsible
for/burdened by gestation.
copyright.
This reflects on my claim that a desire for pregnancy can be a
preference adapted ‘to and for oppression’,37 and more precisely
a preference ‘formed in oppressively limited circumstances’.38
Women can already try to imagine whether they would choose
ectogestation should it be a possibility; among those who do,
some believe they would opt for it, some do not, and others
prefer not taking a stance until it can be more than specula-
tion. However, coming to terms with a potential desire to avoid
pregnancy could be extremely difficult when faced with the
lack of an alternative as well as the complete absence of polit-
ical will to satisfy such a desire. Moreover, in a scenario where
there is no institutional effort to expand one’s ‘limited circum-
stances’ (as shown by the lack of practical research promoted
on the matter), becoming aware of the constrained origin of
one’s preference would not only not be enough to potentially
change it, but it could also prove particularly challenging to deal
with. This might hinder a full, open reconsideration of one’s
desires. For this reason, the development of an ectogestational
method is particularly important: by concretely expanding the
choice architecture, it would encourage a collective reevaluation
of reproductive preferences in a non-­coercive way. Differently
from now, such an assessment would go beyond speculation,
since ectogestation would finally offer the possibility to choose
between gestational methods and enable a practical (and not
only conceptual) separation of gestation from the human body,
and especially from female bodies.
viii
In the case of surrogacy, the benefit considered greater than the risks
could be, for example, ‘gratification’ or financial compensation; as this
is not the focus of my paper, however, I will not elaborate further on
this point.
ix
Sadly, the right to abortion is far from being globally guaranteed.
3
 Extended essay
This argument allows me to object to Giulia Cavaliere’s claim
that ‘the value of ectogenesis (…) lies in the political perspec-
tive that it can advance’.6 Cavaliere insists on how gender
justice requires fair reproductive opportunities for all, including
those pregnant now and those who would choose pregnancy
in a hypothetical future society with more than one gestational
option. She supports ectogestation as a ‘provocation’, as a
radical proposal aiming at putting existent reproductive issues
under the spotlight, rather than at its own realisation. In fact,
to serve her point, such a technology does not need to actually
exist: the idea of it is enough to ask ‘Why do we want to replace
pregnancy? Which issues are ectogestation expected to solve?’
By posing these questions, Cavaliere argues that the core of the
issues is social, not biological and that action is missing due to a
lack of political will, rather than the limits of current technology.
For instance, a meticulous deconstruction of sexist, classist, and
racist biases in medical professionals would improve the quality
of care, and a stronger commitment to invest in healthcare
would result in better infrastructure, facilities and equipment, as
well as better trained and less overworked staff. As proven by the
significant differences in between high-­income and low-­income
settings, maternal morbidity and mortality can be significantly
reduced (although, not completely prevented) through acces-
sible quality care.3
I praise and share Cavaliere’s commitment not to dismiss
these current issues as ‘impossible to solve’ unless a cutting-­edge
technology comes to the rescue, and I support her call for polit-
ical action on these matters. Indeed, even if ectogestation were
possible, all those who would still get pregnant would deserve to
be treated fairly and effectively. However, my aim here is to show
that women have been harmed both by having their reproduc-
tive preferences driven by oppressive social norms, stigmatising
preference (A), and by the lack of gestational options, keeping
preference (C) impossible to be satisfied. While Cavaliere limits
ectogestation’s social contribution to political provocation, I
argue that that is only part of its potential. Sometimes, asking
the question is not enough; an answer is required for change
to happen. Ectogestation would provide a unique contribution,
first by encouraging a collective reevaluation of the value given
to pregnancy and then, should this preference come to be, by
actually enabling reproduction without pregnancy. This would
allow women and, eventually, all people to rethink reproduction
completely and do it differently.
Questioning a preference for pregnancy, which has historically
been not only in line with an oppressive system but foundational
for it, can arguably weaken such system; the call for ectogesta-
tion is therefore not limited to the intention of offering a safe
alternative to a burdensome process, but it includes its socially
disruptive potential. As most preferences derive from what is, or
is not, available (including objective and perceived availability),
‘the mere fact that they are adaptive is not what makes them
problematic’.27 A preference for pregnancy is to be questioned
as it is in line with the needs and interest of an oppressive social
structure, resulting, for example, in different socioeconomic
prospects across and within sexes. A common objection to this
argument is that it refers to a social problem requiring social
measures. However, a preference for pregnancy goes beyond
that, as it brings a specific population group to engage with
serious risks for a reward, with many of those risks being physio-
logical and not social. For this reason, even if it may seem coun-
terintuitive to promote something that seemingly goes against
the most common preference (i.e., to promote a method to
avoid pregnancy—for women’s sake—when most women want
to be pregnant), the implications of such a gendered adaptive
4 Bidoli A. J Med Ethics 2024;0:1–7. doi:10.1136/jme-2023-109716
J Med Ethics: first published as 10.1136/jme-2023-109716 on 2 April 2024. Downloaded from http://jme.bmj.com/ on April 5, 2024 at The Hong Kong Polytechnic University. Protected by
preference might require to ‘advocate policies that go against
the express preferences and values of existing women’.27 This
does not mean I am calling for a ban pregnancy; rather, I simply
support making pregnancy one of multiple gestational options.
MORE THAN SOCIAL OPPRESSION
In this section, I discuss how the corporeal nature of pregnancy
can harm gestating persons beyond their health, by having a
negative impact at a social level.
Cavaliere warns about framing ectogestation as ‘liberatory’,
claiming it identifies the source of oppression in female physi-
ology and overlooks the ‘broader systemic issues that contribute
to the upholding of oppressive norms’.39 Along the same lines,
Lisa Campo-­ Engelstein states that disembodying gestation
cannot solve women’s inequality since its ‘root cause’ is not preg-
nancy, but ‘a systemic social structure of oppression’.40 Romanis
emphasises ‘the importance of good reproductive healthcare to
better guarantee equality and freedom’,41 and Claire Horner
calls for a society where ‘women (are) no longer economically,
socially or physically disadvantaged due to pregnancy and birth,
despite still becoming pregnant’.42
While I share those hopes, I believe that social change cannot
completely eliminate pregnancy’s social and physical risks. It
can improve healthcare services and tackle discrimination, but
not prevent all the negative effects pregnancy can cause. For
example, many people highly value activities such as work,
hobbies and sports; however, despite their best intentions not to
abandon such activities, some may have a physiological need to
do so caused by their pregnant state or by certain consequences
of gestation or childbirth. Usually, this concern is minimised, if
copyright.
at all considered, under two assumptions: first, women should
not value activities such as work or exercise more than having a
child. Some would claim that women should not value anything
more, except maybe taking care of their partners and family;
if they do, they are likely considered mean, heartless women
unwilling to make a sacrifice for their children and therefore
undeserving of becoming mothers. Since this narrative is related
to the expectation of selflessness previously addressed, here I
focus on the other assumption, namely that only few exceptional
career paths can truly be hindered by pregnancy. First, that is
not true—one does not need to be a professional athlete, actor,
or model for pregnancy to interfere with their profession in a
significant way. More importantly, though, a person's social life
is (generally) not limited to their jobs. Conditions like hyper-
emesis gravidarum, depression and anxiety, pre-­ eclampsia or
any complication resulting in bed rest would negatively affect
most persons' professional and social life. Even ‘minor’ common
consequences like fatigue, constipation, frequent urination or
perineal laceration can influence one’s ability to perform well
at work, have sexual relations, enjoy social outings and activi-
ties they might otherwise want to do. While all types of harm
pregnancy can cause are expected to be forgotten once the baby
is born,3 these ‘minor’ effects on one’s lifestyle are particularly
disregarded and trivialised, and those concerned with them are
encouraged to ‘toughen up’ when not guilted into feeling selfish,
leaving many women to deal with their worries in silence
Emily Jackson concedes that ‘being relieved of the burdens
of pregnancy might enable women to compete more equally in
the workplace during their children’s gestation’,43 but without
equality in care work after birth, ‘eliminating pregnancy
would not necessarily eliminate gender inequality’.43 Romanis
and Horn agree, claiming that pregnancy is ‘just one 9-­month
passage in raising a child’.44 Moreover, Cavaliere warns about

defending perspectives seemingly freeing women from ‘the
‘tyranny of pregnancy’ and childbirth’ only to deliver them
‘into the tyrannical hands of a precarious, unfair and potentially
exploitative labour market’.6 On this view, free of patriarchal
constraints, pregnancy could be a different, maybe easier and
generally better experience,45 as its oppressiveness could be
determined by its happening ‘under conditions of male domi-
nation’.46 Capitalistic demands can indeed play a negative
role, since a system of production that requires consistent—if
not relentlessly increasing—efficiency poorly coexists with any
form of perceived weakness. In such a system, which penalises
any ‘less-­than-­optimal’ performance, ‘(c)hild-­bearing threatens
to diminish the contribution a woman in the subordinate class
can make as a direct producer and as a participant in necessary
labour’.47
I support these scholars’ commitment to pointing out that a
disproportionate amount of parenting labour falls on mothers
regardless of whether they gestated, as this is socially assigned
and occurs after pregnancy. After birth, any parenting task can
theoretically be performed by parents regardless of their sex and
gender. When this is not the case, it is likely due to social norms
and gender roles; moreover, a study suggests non-­ gestating
expectant parents can affect the fetus and can perform parenting
tasks even during the gestational period.23 My claim, however, is
that pregnancy itself cannot be shared. The physical and some-
times psychological consequences of gestation and childbirth can
affect the person’s well-­being in ways that would not be solved,
for instance, by equal treatment policy in the workplace or equal
parental leave, because they do not originate there.x
To address the concerns about capitalist pressures, I want to
point out how these objections are not exclusive to ectogesta-
tion. For instance, non-­medical egg freezing (NMEF) encoun-
ters similar opposition, with claims that its use to postpone
pregnancy for career purposes means adapting—instead of
fighting—the unfair labour market. According to Thomas Søbirk
Petersen,48 while the system is to blame when people who need
time off cannot get it, we should not assume that the desire
not to be pregnant at a certain point of one’s career—there-
fore resorting to NMEF to maximise one’s chances to become
a (genetic) parent later on—is due to structural constraints. In
addition, one could resort to NMEF at a certain time of their
life for reasons not related to work, such as the lack of a partner
to parent with, which cannot be solved by social measures such
as improving childcare services and parental leave. In the same
way, even though it would not automatically improve women’s
career prospects or gender parity in care labour, ectogestation
would allow people to avoid the physical harm and the lifestyle
limitations related to pregnancy and childbirth. Being able to
work could also benefit their well-­being, not by aligning to the
demands of an unfair economic system, but simply because they
may genuinely care and enjoy their profession.
My aim is to emphasise that pregnancy can cause physical
harm with potential negative social repercussions and that those
limitations are not caused by negative externalities but by preg-
nancy being a corporeal experience. Therefore, until gestation
is tied to one’s body, avoiding them entirely is just not possible.
x
It is also relevant to notice how women not only undertake more
parental tasks, but they often do so while still recovering from the toll
of pregnancy and childbirth, which—to stress the point—is caused by
the physicality of the process. It should also be highlighted that such toll
varies from person to person, due to both individual physical differences
and social factors, such as racism and classism; see Birthrights. (2022).
Systemic Racism, Not Broken Bodies. An inquiry into racial injustice and
human rights in UK maternity care. 1–100.
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Stating this does not mean doubting that the oppressive social
framework women live in has a negative impact on their expe-
riences as pregnant beings, nor implying that pregnancy is still
the sole, or main, determining cause of current male oppres-
sive dominance.49 For these reasons, ectogestation would indeed
not be a solution to social issues due to structural injustices, nor
the only measure needed for women’s liberation. What I claim,
though, is that it is the only way to avoid certain social implica-
tions caused by pregnancy.
A REASONABLE BET
Finally, I want to address the objection that, even if we accept
female-­only pregnancy was an essential factor in the creation
of oppressive social norms, those have developed in such a way
throughout history that they no longer necessitate that biological
basis. To Cavaliere, this makes ectogestation’s chances of success
in dismantling oppressive gender norms dependent on a ‘bet’,
since ‘(o)nly introducing a new reproductive technology or prac-
tice (even one that so radically changes biological reproduction)
does not determine how and whether such a technology or prac-
tice will go about shaping current arrangements, and social values
and norms’.6 Similarly, Jackson claims that ‘without equality in
the distribution of household labour after birth, most notably
in relation to childcare, (…) eliminating pregnancy would not
necessarily eliminate gender inequality’.43
It is possible to accept that women’s oppression would not be
solved by ectogestation (therefore supporting the parallel need
for social interventions), while arguing that it could make such
a contribution that it is worth ‘betting’ on it, especially given
its potential unique benefits. We can commit to tackling the
copyright.
social phenomenon of women’s oppression from both sides:
while we implement social measures aimed to erode oppressive
norms and oppose those using biology as an oppressive tool,
we can take power away from them by making this ‘tool’ no
longer necessary, by transforming pregnancy from being the only
reproductive option to simply one of two gestational methods.
As famously stated by De Beauvoir, ‘human society is never left
to nature. And in particular, (…) the reproductive function has
no longer been controlled by biological chance alone but by
design’.50 In this context, redesigning biological processes such
as gestation can be ‘a potential space of emancipatory gender
political interventions’.51
Moreover, it is true that supporting ectogestation as an
emancipatory measure might be a bet, even a ‘high risk-­high
reward’ one. Given the high stakes of the case, though, it
can be argued that valid reasons in favour of it, not certain-
ties, should be enough to consider the risk ‘reasonable’. Let’s
take the case of modern contraceptives as an example of
an innovation that has had major health and social impli-
cations, by preventing sexually transmissible diseases and
undesired pregnancies. At the moment of their introduction
on the market, expecting the strong social change contra-
ceptives eventually brought was indeed a bet: there was
no guarantee against the risk of a low or no uptake, which
would have significantly limited their impact. As contracep-
tives’ cost may not be affordable to everyone, there is a risk
of exacerbating class inequalities, since those more likely
to get unwillingly pregnant earlier and more often are also
those with less access, conceptually and practically, to abor-
tion services. This is where State action is most needed, by
subsidising contraception for all, or at least for those most
with less means. Even serious issues such as cases of poor or
mentally ill people coerced or forced to use contraception, 52
5
 Extended essay
which certainly must be addressed, do not undermine the
revolutionary benefits contraception has brought in terms of
health, reproductive autonomy, and sexual liberation.
This shows how it should not be such a concern that the
introduction of ectogestation might not guarantee an equal
redistribution of responsibilities and expectations among
parents, nor automatically change the norms defining
women’s ‘role in social reproduction and the effects of
having such role on their lives at home and in the work-
place’.6 As long as there are valid reasons to believe certain
benefits could derive from it (including but not limited to
those discussed in this paper), ectogestation should not be
held to a higher standard than contraception was, or than
any other innovation. Very few policies or products, if any,
are promoted expecting a guaranteed outcome, since even
the best evidence-­b ased models cannot account for all unex-
pected variables.
CONCLUSION
This paper supports ectogestation as a means of emancipa-
tion for women. I argued that ectogestation would have a
dual social benefit: first, by providing a gestational alterna-
tive to pregnancy, ectogestation would create unique condi-
tions to reevaluate one’s reproductive preferences—which,
for women, always include gestational considerations—and
to satisfy a potential preference for reproduction without
pregnancy. Enabling the satisfaction of such a preference
is particularly valuable due to the pressures women face to
embrace pregnancy as central to their identity, while at the
same time being penalised by it. Second, I emphasise how
certain social negative implications of gestation and child-
birth are caused by these being corporeal phenomena, and
would therefore not be solved by social measures. Finally,
I consider how some objections to ectogestation resemble
those to other innovations, such as modern contraceptives
and non-­ m edical egg freezing. I argue that ectogestation
should not be treated differently than comparable technol-
ogies without a valid reason and that, given its potential
unique contribution to women’s emancipation, it is worth
the bet.
Twitter Andrea Bidoli @andreabidoli
Acknowledgements I want to thank Giulia Cavaliere and Ezio Di Nucci for their
comments on an earlier draft of this paper.
Contributors AB is the sole author of this article and guarantor.
Funding This study was funded by Velux Fonden (00026589).
Competing interests None declared.
Patient consent for publication Not applicable.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data sharing not applicable as no datasets
generated and/or analysed for this study. No data are available.
ORCID iD
Andrea Bidoli http://orcid.org/0000-0003-3835-9513
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