 All right, looks like we are ready to go. So good afternoon, everyone. It's my pleasure to welcome you to Dalhousie's Health Law seminar. My name is Professor Joanna Erdman, and I would like to begin by acknowledging that I am hosting our seminar today from McMoggy, the traditional and ancestral territory of the McMough people. And I'd like to give this acknowledgement in the recognition that Canadian Health Law and policy has had and continues to have a direct impact on Indigenous communities as part of our colonial history, and that therefore our work on reproductive justice, which I share with our guests today, is inseparable from our commitment to reconciliation. Our guest today is Dr. Claire Horne, Killham Postdoctoral Fellow at the Schulich School of Law Dalhousie University. Dr. Horne completed her PhD in law at Birkbeck University of London. She also holds degrees from NYU and McGill and a fellowship from the Welcome Trust. Dr. Horne has published extensively on the subject she'll present today, Artificial Wounds, and her work is critical, caring, and engaging. And I very much invite you to read further into her scholarship. We are so very lucky that Claire has joined us this year as a fellow, and you are very lucky today to hear about her work on foregrounding justice in the use of novel artificial wound technologies. We'll have time for questions and conversation. Please use the question and answer function to ask your questions, as well, closed captioning is available for this seminar. So Claire, please welcome. Thank you so much for that introduction, Joanna. I'm just gonna, I'm gonna pull up my slide, so I'll go into screen sharing. Okay, so thank you to Adalina and Ashley and everyone involved in organizing this event. I started my postdoc, as you can imagine during a rather tumultuous time. So it's really exciting to be able to share a bit about what I'm what I'm now working on. As Joanna mentioned, my previous work during my PhD, and my postdoc position with the Welcome Trust in the UK was on artificial wound technology specifically focusing on the impact of this technology on abortion rights and abortion law. And I'm currently finalizing my book project, which explores a number of aspects of the social, legal and ethical implications of artificial wounds. But today I'm going to talk about the work that I'm initiating in my postdoc thorough research, which is very much a project in process. So just to give you an idea of where we're going to go, I'm going to start with talking you through a bit of a speculative rendering of artificial wounds. And then we're going to look at the scientific and social realities of this technology. And finally, I want to look at how we might reframe discussions of artificial wounds and their development by taking an approach to this technology that is informed by justice. This is very much the nature of my project. So how a justice informed approach to the design implementation and regulation of artificial wounds might alter the technology's use and impact, and how artificial wounds and reproductive technologies more broadly might be reshaped if they were disentangled from the spheres of both health care regulation and the commercial market. And before we set off, I want to emphasize that this isn't a normative project. It's a speculative one. So what I'm really hoping to do is open discussion about what alternative paths might be possible for artificial wounds. And this means that this is much more of a question finding process than an answer finding one. So when I speak about my work, I often lead with the scientific research that is happening right now. And we will get to that. But this time, I'd like to start us out with a bit of speculation. So I hope you'll bear with me. Artificial wounds are technologies that would allow part or all of gestation to occur externally. So another word that you'll hear is ectogenesis, which literally means external gestation. And to gestate means to carry. This is a term among all the euphemisms for pregnancy that I think is actually quite fitting because you're carrying a baby, but you're also carrying social and cultural expectations. You're carrying the weight of social ideals and ideas about how a pregnant person should and should not behave and who is a worthy parent. These are not experienced in the same way by all pregnant people. These are racialized, classed and gendered judgments. And although law and medical regulation, they're often talked about as abstract concepts. These are the things that bound the pregnant person's experience, whether their pregnancy begins with fertility treatments, whether the pregnancy ends in abortion, in miscarriage, or in birth. Regulation shapes whether and where a person receives prenatal care, where and how they undergo the processes of terminating, continuing the pregnancy, or of experiencing delivery and aftercare. So these experiences are all produced and delineated by law and regulation. So going back to that term to carry, when you're pregnant, when you're gestating, you're also carrying all of these realities with you inscribed on your body. Not every person gestates, but so far, everyone has been gestated by a person. So what artificial wombs invite us to ask is what happens if gestation could occur outside the human body? How does this change, if at all, how both babies and social and legal norms are carried? So on this slide are two images of speculative designs that imagine artificial womb technology, a means of gestating without pregnancy. At the bottom here, this image that kind of looks like giant red balloons, is an artificial womb created by designer Lisa Mandemaker. And she was in fact commissioned alongside her collaborators to do this work by an obstetrician in the Netherlands who's currently conducting very real scientific research toward a partial artificial womb that will be used in the neonatal intensive care unit. And I am going to get to that in a minute. Mandemaker, who I've spoken to on a number of occasions, she wanted to create something to prompt a public discussion. And she was inspired by the image of a pumpkin patch, which I think you can really see here in this picture. She was following this idea of babies sprouting in a garden of balloons, a tree nursery, if you will, for communal care. The other image that you see at the top here that's kind of this glowing pod is of a speculative project called the Perturient Pod, which designed students from Arthez University of the Arts in the Netherlands created as a way of imagining ectogenesis. Both of these projects are intended to invite debate. So speculation on what a future with gestation outside the human body might hold. And alongside these speculative designs, feminist thinkers have been speculating on artificial wombs for decades. So in the 1920s, socialist feminist Dora Russell imagined that ectogenesis could allow parents to better share the work of gestating and of mothering. And indeed she imagined that mothering could be something that could be better practiced by all with the use of ectogenesis. In the 1970s, the radical feminist Shula Myth Firestone speculates on artificial wombs in the hands of progressive feminist researchers. And she imagines that this technology could be a release from what she called the tyranny of social norms around pregnancy and motherhood. More recently in 2019, Sophie Lewis writes about artificial wombs to allow pregnant people to quote pause, share, transfer, redistribute and walk away from pregnancies. And the invitation from these speculative projects and from this feminist literature is to ask, what if we imagined artificial wombs as a tool of collective care? So what could or should artificial wombs mean or do then? Pregnancy and gestating demand so much of the person who does it, not just their physical body. So what if you wanted to have a child but you didn't want to gestate it? Could you decide to use an artificial womb instead? Could you transfer the responsibility for your pregnancy to someone else, to a partner or to a friend? Or could you donate it to someone who wanted to have a child but couldn't? In our contemporary world, people whose lives are threatened by their own pregnancies can have a therapeutic termination and some jurisdictions. So in this future, could you transfer gestation to an artificial womb instead? And this is really a project of speculating that emerges out of a very specific feminist discourse and tradition. One that imagines artificial wombs to redistribute the labor of care and as a means of caring for both the pregnant person and the neonate. Firestone and Lewis are both imagining the speculative possibilities of the artificial womb from within an affirmation of collective community care. And while ectogenesis is speculative, reproductive care occurring within communities and collectives where they root this project of speculation is neither speculative nor futuristic. It's very old practice. In both settings where access to abortion infertility treatments and control over one's birth have been the most and the least heavily regulated. It's always been the case that networks of care practitioners, so often midwives, communities and activists, have shared knowledge techniques and technologies to allow people to facilitate these practices on their own terms and in their own spaces. So what I'm really interested in in my project is engaging the speculative potential of the artificial womb to imagine a justice-oriented path for reproductive practices, technologies and policies and to orient toward a future for abortion, pregnancy, care and birth outside of restrictive regulatory frameworks. So there's an important caveat here. Despite often getting interpreted as a techno-positivist, Shula Ms. Firestone was very much awake to the fact that her dreams of how ectogenesis might be used in collective care were limited by the realities of the very unequal present. She specified in the hands of progressive feminist researchers, maybe then this technology could be empowering. But outside of this context, there is much better reason to believe that it would replicate existing inequity and injustice. And this brings me to the place where my work really starts, that the precondition for a world in which artificial wombs might mean and do something different is a world grounded in reproductive justice. So what might be possible for the uses of artificial wombs if justice was foregrounded in each stage of their design, development and implementation? And I'm going to get to how I understand and use justice. This is very much informed by a reproductive justice framework. And I'm also going to get to exploring some of the questions that this approach could foreground. But first I want to look at the realities of the present. So currently, research toward artificial wombs is in fact occurring and it is not led by collective care paradigms, nor is it informed by reproductive justice. So what's the reality of both the scientific research toward external gestation and the world in which it's arriving? So the reality is that scientists have achieved what we could call partial ectogenesis. So they've managed to reproduce part of gestation outside the body. In a well-resourced hospital today, the point when an extremely preterm baby has a chance of survival sits around 23 to 24 weeks. But before 28 weeks, morbidity remains extremely high because the organs of these neonates are not yet sufficiently developed to survive in the outside worlds. In 2017 though, research groups working in the United States and Australia and Japan separately created platforms in which they gestated lamb fetuses from the equivalent of around 23 weeks in a human for four weeks. So they managed to bridge this really important developmental period. And you see one of these technologies at the top of this slide. So these technologies replicate the environment of the uterus by submerging the fetus in continually circulated artificial amniotic fluid that's pumped by the fetus's own heartbeat. And they're paired with an artificial placenta that delivers nutrients and flushes toxins. There is differences between these platforms, which have been respectively named extend and eve, but they do share a similar approach. And there's now also a team in the Netherlands engaged in this work. So this is the obstetrician who collaborated the speculative designer, at least Amanda Maker. And what really makes these technologies different or distinct from existing neonatal care is that rather than acting as emergency interventions to redress the complications of preterm birth, they're intended to prevent these complications from arising to begin with by extending the period of gestation. So they allow the fetus to continue to develop as though it had not yet been born. And one of these groups, the group that's based across Australia and Japan, they aim to target neonates born as early as 21 weeks, which is quite remarkable. This is around the halfway point of an average full term human pregnancy. And while the extend team, so the image you see there is the extend platform, they have said that they don't intend to lower the point at which a fetus can survive outside the womb. However, in a patent they filed in 2014, they referenced that their target group may go as early as 20 weeks. So the immediate goal here is emergency life support and extending development into the point with a better chance of survival for extreme neonates. Concurrently with this work, research in embryology over the last several years has also occurred toward the further cultivation of embryos outside the body. So in 2016, research teams based at Rockefeller and Cambridge universities successfully grew embryos up to 13 days. And this was a pretty significant development because before this point, it had been believed that embryos would need maternal input to continue to develop. So this showed that they could actually self organize in the absence of maternal tissue. And it also showed that the implantation of embryos could occur outside of the uterus. These groups only stopped their work due to the 14 day limit, which is a law or a strict scientific guideline in a number of countries. But this is actually in the process of revision in some jurisdictions. So in 2021, the International Society for Stem Cell Research released new guidance, advising extending the 14 day limit on a case by case basis. And this now applies where the 14 day limit is not in legislation. So for instance, in the United States, where some of this work is occurring. More recently, also in 2021, scientists at the Weissman Institute of Science in Israel announced that they had successfully grown mice from embryos into fetuses with fully formed organs using an artificial womb. And this was the first time that mammals have been externally gestated in this way. They're now hoping to take mice to full term, and eventually to replicate this experiment with human embryos if ethics approval permits. Just a few weeks ago, as well, researchers in China released data on an experiment that was very similar to the Israeli experiment, where they created a platform to grow embryos long term in culture. And they've now completed this work using mice. With the addition of an online monitoring system, or what has been dubbed an AI nanny, with a view towards future use with humans. So while research toward artificial wombs to treat neonates, maybe embraces an intervention to save wanted preterm babies, research to study the development of embryos, and perhaps quickly fetuses outside the body, is likely to be met with a lot more controversy. And this has already proven to be the case. But what's significant is that research regulations differ across jurisdictions, and this work is now happening globally at either end of gestation. There's been much discussion about whether these achievements will effectively one day meet in the middle and will have achieved full ectogenesis. And I think there's significant scientific barriers to this. But right now, what is important for the purposes of this talk, is that artificial wombs are both real, as in something that's really happening and really being developed, and something that can be engaged as a provocation for thought. So my main interest is in external gestation that's occurring in the realm of neonatal technology. But when I use the terms artificial womb and ectogenesis, I also mean the possibilities for this technology occurring broadly speaking. So there's different ways in which this could move forward. But contemporary research speaks to the fact that progress toward some form of external gestation is ongoing. And there's absolutely many social implications regarding the embryo research that I've noted above. So for instance, how far will researchers be prone to go and who owns or is responsible for a fetus that's just stated from an embryo in a laboratory setting? With regard to both the embryo, embryological and the neonatal research, there is a plethora of ethical and legal concerns. But for just one example, I do want to think here specifically about the neonatal technologies like even extend, which are intended as forms of life support for extremely preterm fetuses. So the scientists who research these technologies intend them to alleviate the very real harms of extremely preterm birth. And as I noted, they could prevent complications from arising as early as 21 weeks if they work. They also have uses in care for pregnant people. So in situations where the later stages of gestation become life-threatening or dangerous to the pregnant person. And they might also be used to deliver treatments to the fetus without exposing the pregnant person to harmful substances. So to deliver things like stem cell or gene therapy. From well before the current developments, social scientists have extoll artificial wounds as revolutionary for their potential to ease the dangers of pregnancy. But the reality of these platforms is that they're costly. They're labor intensive. They require expert training and they're designed for very limited use in neonatal intensive care units. So as one of the EVE researchers, Matthew Kemp put it in a recent interview, quote, assuming for a moment that we're going to get this to work, it will be eye wateringly expensive and require an extraordinarily skilled team of people. So this is not the stuff of Lee Samantha maker's design. Each patented piece of this biotechnology is going to be very costly. And they're stakeholders from numerous private companies that that are involved in producing each of these parts. And the social conditions into which this technology arrives are also starkly inequitable. And they are that way for the groups that external gestation is intended to benefit. So for pregnant people and for neonates. Neonatal mortality and morbidity and both neonatal and perinatal death and serious complications are subject to vast global class and racialized inequity. So according to the World Health Organization, 94% of perinatal deaths globally occur in lower and lower to medium income countries. And infants in these regions are significantly more likely to be born preterm. 90% of extremely preterm babies that are born in low income countries die in the first few days of life compared to 10% in high income countries. And we know that these disparities are not down to a lack of highly advanced technology. They're down to an inequitable distribution of low cost resources, including antibiotics, steroids, and safe culturally sensitive and appropriate midwifery care. At the same time in wealthy nations, despite the broader availability of these resources, racialized inequity in care remains. So in Canada, care throughout pregnancy is publicly funded and yet black and indigenous women are more at risk of having preterm and stillborn babies. And indigenous women are more at risk of death and complications during the perinatal period. The limited data that we have suggests this is also true for black mothers in Canada. And these disparities are down to issues including racism, bias and insufficient care and inequitable distribution of birth centers and resources. We see similar racialized inequities in perinatal and neonatal outcomes mapped across other wealthy nations like Australia, the US, and the UK. So while artificial wombs are celebrated as a game changer, it's necessary that we ask for who. There's no current reason to believe that the technologies and development are likely to do anything other than increase existing stratification or leave it where it is. And I think there's very real questions to ask here about whether we should be creating these technologies at all. The physician and founder of the US-based National Birth Equity Collaborative, Dr. Joya Crew Perry, has noted that a consistent problem that perpetuates inequity in reproductive health is investments in biotechnologies rather than in people. So for instance, investing in programming to train and support midwives, opening birth centers in places with little access, support for traditional birth practices, and measures to understand the causes of and reduce preterm birth in the first instance. And these are extremely crucial questions to ask, but for the purposes of this talk and end of my work, research toward highly costly artificial womb platforms is occurring, right? It's already been granted substantive long-term funding, and it's taking place in the context of these striking inequities. So these are the realities of the contemporary limitations in which this technology is happening. And I think that they demand us to ask whether, with reference to this platform that does not yet exist, but is in development, it's possible for artificial looms to exist otherwise. So another aspect of the realities in which artificial looms are being developed, and which is a contributing factor to inequity of care and unstable quality of care, is the way in which reproductive care and technologies are shaped, limited, and delineated by their travel through commercial markets and through healthcare frameworks. So here I'm interested in what reproductive technologies are actually for, and I think it's fair to say that while it may not reflect the intent of creators, we might say that the current orientation of new reproductive technologies can be loosely understood as oriented towards commercial uses, so economic interests in creating and maintaining patients, or towards healthcare uses, towards interest in innovating new treatments to improve and manage health. And I say manage here, because I don't think that this healthcare orientation necessarily equates with care and practice, but rather with management of risk. And to the extent that contemporary projects or projects of reproductive technologies are oriented towards ends of commercial gain and towards the management of health and codification of risks, I think we should ask whether and how it might be possible to orient these technologies towards care. So some of the technologies that I'm looking at as parallels to kind of understand the possible trajectory of artificial wounds are medication abortion and fertility technologies. Medication abortion, this is the two pill abortion protocol, and many fertility treatments are technologies that have been limited within commercial and healthcare frameworks, but that also travel within networks of mutual aid and community care. So to give an example with regard to fertility treatments, in the United Kingdom, in vitro fertilization, and intrauterine insemination, are technologies that can be covered under the National Health Service, which allows broader access and creates legal protections for parents. But then under the Human Fertilization and Embryology Act, there's a very strict regulations that create substantive limitations on use. So for instance, there are age limits for women accessing the service and restrictions that limit receiving services to very particular clinics. And in contrast in the United States, IVF is set to become a $36 billion industry by 2026. So fertility treatments are available to those who can pay and people are often encouraged to proceed with IVF where lower cost options might be just as effective. With regard to medication abortion, in some parts of the states, these pills are commercially available to people without medical insurance, but under those circumstances, they're often prohibitively expensive so they can run up to $600 per pill. And in places where medication abortion is available under a healthcare framework, like many provinces in Canada and some U.S. states, there are significant restrictions under this framework on things like timing and location of use. So in 15 U.S. states, for instance, the pills need to be taken in the presence of a physician at a clinic. And in the United Kingdom, pandemic regulations that allowed people to take both pills in the two-pill cycle at home have now been revoked and they must be, the second pill must be taken at a clinic. And these have a very real impact on people. So they create challenges of getting to an approved clinic, particularly affecting those without resources. And they can also lead to situations where people experience their termination in transit. So I'm interested in what happens to use to access and to quality of access and experience when a technology is brought into a regulatory framework. I think we can also think about how birth practices are regulated in many jurisdictions. So for instance, insurance restrictions on home births and regulations regarding where and how midwives are allowed to assist in care and in labor. There's a centering of hospitals and clinical spaces in commercial and health care regulation as the safe and appropriate location for reproductive technologies to be administered and for care to be practiced. So in each circumstance, technologies and practices that may initially be imagined to shift the status quo of access to use of and spaces of reproductive care, whether abortion, conception or birth, become mired in systems that might offer legal protection, but that often don't allow care to occur in a way that shifts experience. But also in each circumstance, so regarding abortion, fertility practices and birth, as I noted in the opening of this talk, it's always been the case that networks of care practitioners have shared knowledge techniques and technologies to allow people to facilitate these practices on their own terms and in their own spaces. So here I want to circle back to the content raised at the beginning of the presentation. Collective practices of care have always existed and they've always used technologies. So I'm looking for example at organizations like Women on Waves where abortion medication and information on safe use are provided to people in places where abortion is restricted. I'm also interested in activism in the United States where the cost of fertility treatment is prohibitive, where communities share information, materials and techniques for safe home use. So there was a recent story, for instance, of nurse practitioners who worked at a feminist clinic who taught groups of home birth midwives in their communities to wash sperm and practice intrauterine insemination safely at home. And to be clear, these processes of abortion, fertility and in future artificial or automated gestation, they differ in terms of the materials and skills required. But what I want to emphasize is that the construction of hospital spaces as the safe and appropriate locations for care are not neutral and care and practice outside these spaces does not mean unskilled care. So what lessons can be garnered from these practices that might inform our approach to artificial wombs? And how might the impact of artificial wombs and the projects toward which this technology is oriented be altered if they were created to be affordable, adaptable to numerous environments and designed for use within and outside hospital spaces? So what would it look like to center justice in exploring this question? My approach and understanding of justice is informed by a reproductive justice framework. Reproductive justice is a grassroots initiative founded by Black women in the United States. And the Sister Song Women of Color Reproductive Justice Collective defines the framework as quote, the complete physical, mental, spiritual, political, social and economic well-being of women and girls based on the full achievement and protection of women's human rights. And this framework emphasizes the importance of fighting equally for the right to have a child, the right not to have a child, the right to parent the children we have as well as to control our birthing options and the necessary conditions to realize these rights. As Kamala Price writes, the reproductive justice framework recognizes the importance of linking reproductive health and rights to other social justice issues. So for reproductive care to be granted to meet those necessary and enabling conditions, people must be provided with the resources to experience care in a way that is safe, affordable, accessible and acceptable to them on their own terms. To me, being informed by this framework means situating reproductive practices, care and technologies within their social contexts and understanding the way that race, class, gender, immigration status, sexuality, among other aspects of people's identities and experiences shape access to and quality of reproductive care. And understanding how a person's ability to act on reproductive choices is shaped by the conditions in their community and by social, structural and institutional factors. And it also means centering individuals and communities and understanding what it really means to enable access to all forms of reproductive care. So I'm thinking through how this praxis and an approach that emphasizes traditions of community care could inform the questions we ask of what artificial wombs should do and how they should be used. And at this stage I want to again reiterate that this is not intended as a normative project. I want to open questions and to reframe the conversation about artificial wombs. Because when we're thinking about this technology, we're thinking about something that does not yet exist, although it is in the process of development. So that gives us an opportunity to ask how could it exist? In seizing the means of reproduction, Michelle Murphy writes of technologies that were developed for early stage abortion, menstrual attraction in the 1960s, that the same bit of technology could, by being animated in different assemblages of technique, discourses and subject positions, be meaningfully said to be two different things. So how might an artificial womb, animated by attention to adaptability to different spaces and users, meaningfully differ from a technology constructed with the sole focus on functionality and would it? What happens if questions of accessibility, adaptable use in non-hospital environments by for instance midwives, doulas, pregnant people themselves are centralized at each stage of the technology's introduction? What if the focus is on capacity for use in low resource environments? And I'm interested in a broad range of issues here. So materials where they're sourced, what they cost to assemble them, what infrastructure is required, as well as stakeholders. So who is included as someone that has an essential perspective on how this technology should be used? And the purpose here is to show that by asking different questions of what this technology could mean and do and reexamining whose perspectives and skills are at the center of its design, we might remain open to alternative paths. So a platform that exists outside of the status quo of commercial and healthcare frameworks, it's importantly not inherently good. It would have its own contestations, limitations and challenges. And prompting discussion and investigation into what other forms the artificial womb might take from the materials to the environments it could be used in to the people that are trained in its use. That doesn't mean negating safety or functionality as a legitimate concern, but it does demand that we ask why safety has become so closely amalgamated with the hospital setting. So I think it allows us to reframe and ask what does safety actually require. Even where states undergo public consultation practices to assess concerns arising around the use of new reproductive technologies, it's not generally the case that frameworks are created in response to the actual ways in which the people most impacted by lack of access to the form of care that technology could facilitate wish to use them. And while a framework might be responsive to the interest of patients as consumers, so for instance, as in the design and marketing of contraceptives to young women, this attention is not interchangeable with engagement in community use and care. So what would a framework for artificial looms created in response to how people actually wish to use them on their own terms look like? If research toward an artificial loom is animated through questions of adaptability to safe use and under-resourced environments to use by midwiser community care practitioners, what kind of policy could be written to respond to these projects rather than inhibit undermine or monitor them? So such a framework might, for instance, regulate against costs that would direct the project of the technology toward economic gain rather than toward care. In contrast to contemporary regulations in some jurisdictions which strictly regulate the activities that may be performed by midwives, could a framework to facilitate training and safe practice with artificial looms be written in web by midwives and lay users? In analyzing the Dell M device for menstrual extraction, Michelle Murphy cautions that precisely the characteristics that made this technology an effective tool for feminist collective. So the fact that it was easily sourced and assembled and easily learned also made it a compelling tool for state-led projects of population control. And I think it's important to emphasize that characteristics that could make artificial looms usable in any environment or with limited infrastructure, they are what could make them communal and accessible. And they're also what could allow them to be co-optable for harm or unsafe use. So when we think about the role of regulation, there are uses of this technology that a workable framework might protect against. But I think what I want to sort of emphasize is that reimagining other paths for artificial looms and for reproductive technologies more broadly is as much a project of speculating on law as it is a project of speculating on care. So what are the questions that are responsive legal framework would ask? These are deliberately open questions. And I think it may be possible that no such project can be done with a tool, meaning law here, not technology, that's created quite literally to regulate and control. And it may also be the case that no consensus could occur in community-driven care as to by movement what ends external gestation should be used. But I think we can chart what paths forward might be found for ectogenesis if questions of how it could or should be used were driven not by bioethicists and scientists, but by pregnant people intending parents of all genders, nurses, stoolers, and midwives. So I'm going to wrap up there. I do have a references slide, but I'll leave it up for a moment in case anyone wants to screenshot it. Just in conclusion, I do want to say that scientific research towards some form of ectogenesis is happening. I myself remain skeptical about the possibility of a full platform for external gestation because I think that we know pregnancy is a relational process. So there's a real question here about whether we can actually fully replicate this. But I think we need to think seriously about directions for the work that is occurring. And I think with regard to the idea of full ectogenesis and promissory reproductive technologies in general, if we can imagine alternative futures for gestation, where part of this process could occur outside the human body, let's also imagine a future beyond the status quo of social norms around pregnancy and how reproductive bodies are regulated. So I am aware that I've posed a lot of questions here, and that's a reflection of where I am with the project, but also of the intention of the project as an opening for discussion, as opposed to a prescriptive document. So I will finish up there, and then hopefully we can move into any questions. Thanks so much. Excellent. Thanks so much, Claire, to you for a great presentation and a wonderful set of questions for us to think with. So I'm taking a look at the question and answer panel here, and not seeing any at the moment, wondering if maybe I'll start us off and give people a little bit of time to just throw their questions into that panel. So I think this is a wonderful project, and it really is a project sitting at the intersection of reproductive justice and design justice, because there's an entire field that asks these questions of technology, especially, and it is termed design justice and wonderful scholarship in that area. And so what holds these two fields together is the word justice, and you said that you have been thinking hard about what justice means as you use it in this work. So two ways that I was thinking about justice in listening to your talk. One is the sense of being able to survive unjust worlds. And I think you have a lot in there to try and think about it, and maybe it's the way in which the technology in its best form to date is meeting a justice framework, right, is trying to help people with difficult pregnancies or pregnancies in which there is the potential for loss, and that's one sense of justice. But another sense of justice is the justice of changing that unjust world. And how do you protect against the technology in some way becoming a bandaid for injustice? And I'll give you just an example. You talk about the artificial womb potentially as a part of collective care, so redistributing the burdens of reproductive labor. And it's interesting because that would mean we could potentially change the nature of pregnancy, right? But what we've been doing a lot of work on is trying to change the nature of work such that you can actually be pregnant, yeah, and not have such injustice in your working life. And so to what extent would this technology allow us to keep everything the same in the world? Especially the world around work life, around productive labor by indeed addressing and changing reproductive labor. So we are accommodating reproductive labor to the productive world, and we're making no change in that economic injustice. Little question to start. I love the little question. Yeah, this is so crucial because I think this is often a wall I come up against because, yes, how can we possibly, how is there a formulation for this in the contemporary world that we live in, where it does not further these existing problems? And that's such a great example that you raise because we've already seen that with things like egg freezing technologies, you have companies like Google offering to pay for women to use those technologies in order to continue working for longer, rather than having to develop better parental leave, or indeed any form of acknowledgement of the fact that being pregnant and working or being a parent and working is a challenge. So I don't think that there's an easy answer to that question. And I think, again, there is this kind of like back and forth pull to me between one part of me that says, well, there is no, there's no possibility for this technology to do anything different in the context that we live in. And then the other part of me that says, well, we should at least be having the conversations about how it could, how it could do something different. That's great. Thanks. Others, I see a great participant list here, some really smart, engaged people joining us today. Yeah, great. Thanks. I have a question here from Aris. I'll ask. So Aris asks, can you comment on the practitioners of this technology? Would they be part of existing medical training institutions or some new form of engineering? Could we predict that the relationships would be care provider and or indeed technician and client? So who operates these technologies? Yeah, great question. Thanks. That's such a great question. I mean, right now. So it's interesting. I've been looking at what each of the groups that is creating the neonatal external gestation, what their kinds of publicly announced plans are in terms of who they're going to engage in conversations about use. And the one group in the Netherlands is actually consulting with midwives and has begun or appears to have begun some conversations with parents as well. The other groups are very, very, very careful about what they publicly share. And so far seem to only be working with engineers and neonatologists. So I think in terms of the existing technology, the people that would be operating these platforms would be neonatologists in intensive care units. And then in terms of my kind of speculative question or nudge, the idea is that there could be some form of the technology or there could be a point with the technology where the person that was interfacing between the technology and the birthing person or the parents could be a midwife or another care practitioner. But this again is speculative at the moment. Excellent. So Alicia asks another little question. And this question is about affordability. So again, the affordability of the artificial womb will surely be a concern, especially upon the first release of the technology. With competing interests in mind, is there hope that this technology will become affordable over time, if at all? Is this something that can be speculated upon at this point? Yeah, great. I love all these little questions. So yeah, so right now, certainly with both the platform being developed in Australia and the one being developed in the Netherlands, there are these networks of multi-billion dollar biotech companies that are creating patent and parts. So they are going to be very costly. There are examples of neonatal technologies. So incubators, I'm thinking of an incubator technology that I think is called the embrace that were created in collaboration with nurses and midwives in low-income countries to be affordable. So they were designed so that each of the parts could be easily sourced and they could be used in the absence of infrastructure. That's not happening right now with these artificial wombs. But one thing that suggests the hope of the possibility that it could is that the biobag team, so the group that's making the technology now called Extend, they started their work without any significant grant funding. And so the very first prototype of their technology, they were using leftover pieces of tech from elsewhere in the hospital and they were also sourcing pieces from craft stores and from Home Depot. So this was in fact like a very low-cost prototype that they then built up once they received funding, which suggests that it is possible that there could be a lower-cost option. Excellent. And actually, Alicia's question leads me to think maybe in a larger way. Again, that great set of what if questions that you had, you know, what if we could shape the design process this way? What if we could regulate design development this way? And I wondered if the next stage of this project is the how. Do you know, so setting forward that idea as something to strive for and then asking, okay, what levers could you use to actually make that happen? And the reason I asked this question is I wonder if it is helpful of thinking of these as separate spheres. So as you said, the development in health systems versus the development in commercial markets versus the development in a justice or collective care practice. And maybe one of the difficulties is that we have these as separated spheres. You know, maybe it is a question of how do you introduce justice into what are inevitably going to be commercial markets because there is a commercial interest here? You know, I wonder because I think this was a big sense we can think most recently around vaccine development. Do you know of having this really strong justice narrative in the context of a clearly set up regulatory framework and a clearly set up commercial market oriented towards different values? And the idea that you could really jump spheres seemed unlikely. So instead you needed to try to in some way interrogate or move and intervene on spheres. And so I wondered if you had examples of where that's happened. You know, commercial actors that are alive to the justice concerns or justice actors who have become commercially active in some ways. But I think maybe some sense of the hybrid might be ways forward. Yeah, what do you think? Yeah, I love that kind of provocation because I think, yeah, the discussion around vaccines is such an excellent example, I think here, because and much of what has been going on during the pandemic in general, where you have action within the commercial sphere, action within sort of the healthcare and regulatory frameworks. And then you also have all of this mutual aid on the ground that was oriented by these concepts of justice and care, I think. And these kinds of contradictory places where each of those spheres came into contact with one another. And I do think that with fertility technologies, that is an interesting place to kind of look at those, the places where those spheres sometimes intersect and overlap. And then also how the very kind of like ideology that is that is the basis of each makes it really difficult for there to be meaningful collaboration. Great, so we have a few more comments and questions here. So I'll just note we have a comment, not a question, just a comment. I love that DIY approach, do it yourself. And yeah, maybe invite if you do have reflections about what would that mean? How did those technologies that moved from an expert to lay space, how did that happen? And was there something in the design of the technology at its outset that allowed for that transition? And let me share with you the other questions so you can pick them up too. So first question is, how do you think the artificial womb technology might interact with advances in genetics and the ability to test embryos genetically before implant implantation in a womb, as can already be done with IVF. So I won't, I won't put too many questions on you at the beginning and let you focus on that one first. Sure. So yeah, great question. I, I think that there should be a close watch on how that how partial ectogenesis starting from the growth of embryos outside the body and the testing of embryos for various genetic conditions, how those two situations are overlapping, because certainly I think that there are there are processes of genetic selection that some people would be very interested in whilst using artificial womb technology. And another point regarding genetics is that on the, on the other end with the, with the neonatal technologies, one of the things that the group in the States has spoken about is development of a platform to genetically track risk of, of both preterm birth and of which preterm babies from which pregnant people might be the most likely of dying if they were born early. So I think, and I, and there is a substantive body of literature around justice and genetic testing and how social ID ideals get mapped on to, to genetics. So I think that's a really important question to raise. And then the second question here, and I think it comes back to that DIY question, do it yourself. So this question is, you may have answered this with Eris's question, but if this technology is made affordable and may be available to lower income communities, what challenges may arise in terms of training people to use these technologies. So again, I think it's a question around democratizing use that that's, that's not just an issue of affordability, although of course cost is a major concern. But I think all other kinds of ideas about how do you ensure that people can use it, that people can use it safely. But I think also that people can use it to many diverse ends, right, they can use this technology in ways that make sense in their lives. And that's also a really big part of DIY in thinking about, you know, the bespoke quality of technology. Yeah, totally. I mean, I think, I think that again, there is an interesting kind of tension here because do you develop, for instance, training requirements and guidance for use that could be used in any context. And if you do that, are you kind of undermining this idea of DIY again, flexibility of use as, as Joanna points out. And at the same time, if you don't have those kinds of guidebooks or requirements for use, how do you actually kind of support people to ensure that they're using it in a way that is safe and stable and effective? Because of course, we are talking about a technology in which you're gestating a baby. So I think I think that that is a really significant challenge. But there are one place that I'm interested in sort of looking to in terms of those practical questions, are the kinds of feminist DIY groups who have developed and use technology. So there's a collective called GynaPunk, for instance, who has created speculums and incubators for cells. And this is not necessarily in the absence of supporting people for training in use because indeed that's part of the practice of DIY. So I think there would have to be reflection on to what extent do you kind of centralize knowledge and to what extent is every aspect of knowledge about how to potentially use the technology made publicly available so that people can adapt it in their own contexts. And where does law fit in with DIY? That's a great question. I think that's a really big question because I don't know if it does. I think, again, there is space. I think what I'm suggesting is imagining something outside of the laws and regulations that we have formulated. And part of the problem is I don't know what that outside space looks like because it's also the it is the quality of the law and regulation that we have and the ideals that it's founded on that make it so difficult to imagine how do we adapt this for something like DIY use of an artificial womb and could we? And is the space that is the kind of beyond space one where law and regulation can't reach? And I'm wondering, Claire, is the home birth movement involved or interested at all in artificial wombs and indeed in thinking about sort of extending, yeah, if you like, the birth process in the sense of pre-birth also being very much in the home and imagining the potential possibility that again, this kind of care, which as you say has traditionally been facility based care being part of home care during pregnancy. Yeah, and I don't know in terms of I think it's interesting because I think that there's so many in terms of home birth and birth outside of hospital spaces, there are just so many different traditions in which that occurs. And so in some contexts where there's such a focus, where there's a real focus on natural birth, I don't know that a technology like the artificial womb is necessarily going to be compatible. But then there are other contexts where birth at home is done to support choices, including the use of technology. So perhaps in that context, there is this space for kind of extending that relationship as well. Excellent, I don't see any further. We have another question from Aris. So I'm going to ask it here. It's an interesting one. Aris was wondering about liability and negligence. So here you have the law question for you. Medical malpractice and neonatal injury obviously has the highest damages. Would DIY defend against that? Who owns the fetus adds to this? And if you no longer need to gestate, do damages drop dramatically? So I think this idea of would this entirely reframe the nature of really thinking about, I think in this case it's really about where responsibility lies, right? Because that's at the core of thinking through a negligence frame. Totally. Yeah, and I think there's also a question here of like in the current sort of contemporary discourse about the existing technology within the context of the neonatal intensive care unit, there's this bizarre assumption that happens that nothing will go wrong. There's going to be this platform and it could potentially be safer for the fetus than a human pregnancy. And this is absurd and ridiculous because of course, is it the person that develops the technology? Like in terms of this question of responsibility, you have the person that develops the technology, you have the neonatologist that is fundamentally in charge of running the technology, you might have doctors and nurses that are also involved in part of this process. So yes, there is significant scope for issues of negligence. And if we look to a kind of DIY context, it's not like those issues go away within our existing circumstances. So I don't know, Claire, there might be a product liability future for this work, because indeed, you know, really thinking about how you would bring this artificial womb to market, if you like, is I think a very different question than of course, the questions around how do you bring it into community use. And so just thinking of those two tracks, I think is a fascinating outcome of this seminar. So I want to thank everyone, Claire, unless you have any last thoughts for us moving forward, I think the only thing to do is really to thank you very much for a stimulating presentation, a really active seminar. And I think you've given people a lot to think about, and stay carry on on their Friday. So thanks so much, everyone, again, for joining us. Thank you for all of your questions. And thank you, Joanna, for moderating as well. Great. All right. Goodbye, everyone, and see you for the next seminar. Bye-bye. Thanks.