Humanities Blog

Polina Vlasenko: Ukraine and Georgia have developed into the most popular hubs for surrogacy with egg donation

Since September, the Tallinn University School of Humanities (TÜHI) has a new postdoctoral fellow, Polina Vlasenko, who received a research grant from the Estonian Research Council. Humanities Blog asked what Polina Vlasenko's research directions have been so far and what she will focus on in the future.

Polina Vlasenko

What has your academic activity been so far?

I received my BA degree in political science from the National University of "Kyiv-Mohyla Academy" in Ukraine and my MSc degree in gender studies from Lund University in Sweden. I have completed my PhD in The Department of Anthropology at Indiana University (Bloomington, US) with the dissertation, “Global Circuits of Fertility: The Political Economy of the Ukrainian Ova Market.” My PhD concentration was in medical anthropology with a minor in gender studies. In my research, I focus on reproductive justice, health disparities, globalization of assisted reproductive technologies (ARTs), the commodification of human biomaterials, social reproduction and medicalization of marginalized women’s bodies in post-socialist Eastern Europe. My master’s thesis scrutinized the discourses of the state, medical professionals, and patients about ARTs to reveal the experiences of infertile women who undergo in vitro fertilization (IVF) in Ukraine. To gather the data, I conducted interviews with directors of infertility clinics and women who completed IVF in Ukraine. Responding to the current debates about the politics, economies, and technologies of reproduction within medical anthropology and feminist science studies, my dissertation analyzed transnational practices associated with the commodification of donor eggs and Ukraine’s emergence as their leading supplier within the burgeoning egg donation industry in Europe. My fieldwork took place between 2015 and 2018 and included more than 100 interviews with egg donors, surrogates, medical professionals, and fertility brokers, and 15 months of participant observation in a Ukrainian egg bank, that delivers frozen eggs to any destination worldwide.

My dissertation project explored the organization of the reproductive bioeconomy at the intersection of gender, race, and class inequalities, and brought Ukraine front and centre in global debates over the commodification of eggs. I examined how the success of the export-oriented donor egg market in Ukraine was engendered by the shift from a state socialist to a market economy, the absence of state intervention, and the established sexual division of labour that discriminates against women in the labour market. Using archival materials and oral histories of the most influential reproductive specialists who spearheaded the first IVF in Ukraine, I described how ARTs transformed from a narrow scientific experimental field during Soviet time to flourishing private businesses in the 2000s. My work sheds light on a little-known history of assisted reproductive technologies in the Soviet Union and after its collapse, and its connections to population control and reproductive politics. By examining the processes of valuation inside the egg bank and following international trajectories of Ukrainian eggs, I investigated how varying and often conflicting regulatory systems and policies across Europe and North America affect cross-border infertility treatments, egg banking and shipping. By discussing the impact of transnational egg banking on the well-being of egg donors, my research provided a more robust understanding of how egg donation becomes racialized, gendered, and stigmatizing work, and an informal economic strategy for women’s survival in the context of shrinking welfare support during the capitalist transformation of state socialism. My study pushed back against women’s economic and social marginalization (i.e. lack of access to employment, the unbalanced share of household and care responsibilities, lack of support infrastructure and access to health care, dispossession and displacement due to the ongoing war in Ukraine). To increase control over and improve egg donors’ health, I suggested policy recommendations that consider egg donors’ experiences and develop actionable change processes to address health disparities and alleviate adverse health outcomes in egg donors. My work is a pioneer in bringing new insights to discussions on the crisis of social reproduction, the political economy of ARTs, and the social implications of the emerging markets in biomaterials in post-socialist states. 

My interest in social, scientific, and medical power over women’s reproductive bodies is reflected in my publications. In “Governing through Precarity: The Experience of Infertile Bodies in IVF Treatment in Ukraine” for The Journal of Social Policy Studies, I depict the ways women undergoing IVF procedures in Ukraine are made compliant with the expectations of motherhood. In the book chapter “From Precarity to Self-governance: Performing Motherhood in IVF Treatment in Ukraine” for the Assisted Reproduction Across Borders: Feminist Perspectives on Normalizations, Disruptions and Transmissions, published with Routledge, I examine how the medical discourses define infertile bodies as unlivable and in need of enhancement in accordance with the biomedical terms and social definitions of normalcy. In the chapter “Desirable Bodies/Precarious Laborers: Ukrainian Egg Donors in Context of Transnational Fertility” for the book (In)Fertile Citizens: Anthropological and Legal Challenges of ART, I explore how the commodity exchange of eggs reinforces the invisibility of egg donors’ experiences and disposability of their bodies.

I have refined my teaching approach throughout my teaching experiences at Indiana University since 2014 and as a Visiting Assistant Professor at the University of Akron since 2021. I have been an instructor of record for 10 courses, 6 of which were stand-alone courses with self-designed curricula on Anthropology of Science and Technology, Medical Anthropology, Anthropology of Sex and Gender, and Cultural Anthropology. I have also taught a range of undergraduate multi-section courses and have rich experience collaborating on teaching teams, teaching internationally, and using different methods (online, in-person and field study).

At TÜHI, you start researching the topic "Ethnography of the ova donation and surrogacy markets in Ukraine and Georgia: The supply side of the global reproductive bioeconomy". What determined the choice of this topic?

Thanks to the permissive state legislation of assisted reproductive technologies, low costs of medical treatment, and plentiful availability of willing young “Caucasian” donors and surrogate mothers, Ukraine and Georgia have developed into the most popular hubs for surrogacy with egg donation. Although both Ukraine and Georgia occupy peripheral positions in the global economy, which makes local women available to the global reproductive industry, different gender and kinship norms and experiences of privatization and class after the collapse of state socialism have shaped the development of the ARTs markets, experiences of local egg donors and surrogate mothers, and changes in understandings of work, family, and reproduction differently in the two countries. I will explore how the political economy of post-socialist Ukraine and Georgia determines their place as supply sides in the global reproductive bioeconomy. This comparative ethnographic research will bring new insights to discussions on the sexual division of labour, informal economies, and changing gender and class relations in the context of shrinking welfare support during the capitalist transformation of state socialism.

This matter is intimately tied to the development of Ukrainian and Georgian reproductive industries' reliance on the appropriation of cheap waged and unwaged reproductive labour of local women who have the phenotype and reproductive capacities demanded by couples from abroad. During Soviet times, the state assumed significant costs of certain aspects of childcare, housework, medical caregiving, and care of the elderly, but reproduction was still seen overwhelmingly as women's responsibility (Verdery 1996). Economic liberalization has precipitated the commercialization of reproductive tasks in both Ukraine and Georgia and the withering of state support, yet women were still held solely responsible for mothering and unpaid household labour--which remains invisible and devalued—while also commonly serving as their family's economic breadwinner (Verdery 1996, Gal and Kligman 2000, Bridger and Pine 1998, Zdravomyslova and Temkina 2013; Kay 2007). While with the collapse of the Soviet Union, Georgia experienced almost complete privatization of state-provided healthcare and child support services, Ukraine remains a welfare state (Weinberger 2015). However, existing economic incentives to increase fertility are not accompanied by appropriate policies that could improve women's status in the labour market and provide wide access to kindergartens, nor with men's willingness to share responsibility for domestic work and childcare. This study will reveal how exactly different experiences of privatization and sexual division of labour in Ukraine and Georgia affected the development of egg donation and surrogacy as informal economic activities. In the face of the paucity of employment opportunities, lack of support from their children’s fathers, and shrinking state support, women in both countries often see surrogacy/egg donation as an effective way to support their families financially, while also performing their childcare duties. This double burden continues a long history of the Soviet worker-mother identity, which justified women’s active economic role as parallel to fulfilling their motherly duties (Berdahl 1999). While surrogacy/egg donation is ethically framed as a form of gifting in Georgia, it is framed as a form of labour in Ukraine. I will discuss whether the continuities of the socialist worker-mother identity legitimize egg donation and surrogacy as informal work, and what are the different rationales that egg donors and surrogate mothers in two countries come up with when they are trying to reconcile the framework of labour with the framework of altruism.

Furthermore, the war in Ukraine will inevitably affect the markets of surrogacy and egg donation in the region. While Georgia remains a safe and stable destination for fertility tourism, Ukraine is under constant fire. Due to the war, Ukraine might face a decline in the number of foreign couples seeking treatments, while Georgia might receive larger flows of patients redirected from Ukraine. Currently, fertility clinics in Ukraine are either shut down or only provide consultations (no treatments), although medical professionals are hopeful that they will either recuperate their businesses after the war or shift them elsewhere. News outlets often emphasize how Ukrainian fertility clinics and egg banks transport embryos and gametes outside of the country to preserve biomaterial and facilitate exchanges with their international partners. Moreover, news report how babies born to surrogates are stranded in Ukraine and are unable to be picked up by their foreign genetic parents. The war also precipitated the dispossession and migration of a vast number of people. According to UNHCR, over 7 million refugees from Ukraine are recorded across Europe, predominantly young women with children and without work or other financial support, who might find surrogacy and egg donation an attractive source of income. Some of these precarious populations of women might also join the reproductive labour force in Georgia. To mitigate safety risks, the industry in Ukraine might further shift to the transportation of frozen ova and become more transnational in nature. This study will document how the markets for surrogacy and egg donation will change due to the war both in Ukraine and in Georgia. Scholars often emphasize how borders seem to disappear in the global ARTs that are constantly shifting, expanding, and governing diverse localities at a distance. Conducted in the conditions of ongoing military conflict, this research will reflect on the shifting nature of reproductive markets and their functioning across borders. At the same time, it will demonstrate how national borders keep playing a crucial role in determining the success of a national reproductive industry despite all the “fluidity”.

How is your research topic positioned against the background of various studies on surrogacy and egg donation?

Numerous articles and books have been written about globalization and the commercialization of assisted reproductive technologies, emphasizing how egg donation and surrogacy become new forms of embodied labour outsourced to economically disadvantaged women within less regulated markets (Cattapan 2016; Deomampo 2016; Gupta 2012; Marre et al. 2018; Nahman 2013; 2018; Pande 2014; Rudrappa 2015; Schurr 2017; Vertommen and Barbagallo 2021; Whittaker and Speier 2010). Yet few ethnographies have centred on the countries of the former Soviet Union that have become global hubs for egg donation and gestational surrogacy treatments over the past decade (Weis 2021; Vertommen and Barbagallo 2021; Siegl 2018). While most of the literature focuses on the experiences and desires of couples engaging in cross-border reproductive travel (Shenfield et al 2010; Blyth and Farrand 2005; Storrow 2006; Speier 2016; Inhorn and Patrizio 2009; Zanini 2011), the identities and precarious conditions of ova donors and surrogates remain understudied.  In examining the little-known organization of the egg donation/surrogacy markets in Ukraine and Georgia, this study relies on the robust body of literature on the commoditization of the female reproductive bodies, intimacies and labours (Sassen 2002; Bakker 2007; Wright 2006; Ehrenreich and Hochschild 2002). I see women’s role in the reproduction of the workforce, including domestic, emotional, and sexual activities, as foundational for the accumulation of capital, yet rendered invisible (Federici 2004; 2012; James and Dalla Costa 1972). Drawing on social reproduction theory that rejects the separation between the domains of production and reproduction (Barbagallo 2016; Bhattacharya 2017; Crozier, Johnson, and Hajzler 2014; Ferguson 2020; Gimenez 2019; Mezzadri 2017), this study will show how the structural position of women as providers of devalued care work pushes them to perform the commodified reproductive work of egg donation/surrogacy (Vertommen and Barbagallo 2021).

On the other hand, reproduction also becomes repositioned within the capitalist mode of production when biomedical technologies are developed to transform reproductive tissues and cells into commodities. Many scholars within medical anthropology, STS, and feminist science studies have discussed how biological materials become the source of “value” (Waldby 2002: 310; Rose 2007; Sunder Rajan 2006; Franklin and Lock 2003). According to Birch and Tyfield (2013), the proliferation of “bio-concepts” does not actually explain how the bioeconomy is shaped by transformations of financial and economic processes in modern capitalism. Using world system and dependency theories (Wallerstein 1974; Wallerstein and Hopkins 1994), this study will provide a more robust understanding of how the creation of value of reproductive commodities depends on a combination of women's unrecognized reproductive labour and a country's peripheral position in the global economy. This study will explore how women in Ukraine and Georgia are pushed into “circuits of fertility” within the global reproductive bioeconomy, which for them become “survival circuits” (Sassen 2002). In these circuits, they provide cheap labour and flexibility to produce biological resources and services, fulfilling what once were unpaid domestic responsibilities of women in the core countries and survive through informal work in the context of shrinking welfare support during the so-called “transition” to a “free” market economy (Burawoy and Verdery 1999, Williams and Round, 2007, Smith and Stenning 2006, Davis and Polese 2014; Bridger and Pine 2013; Aliyev 2015).