Thai in vitro

The first in vitro fertilization (IVF) baby in Thailand was born in 1987, less than a decade after the first success had been made in the United States. The technology and its rapid expansion in Thailand has been portrayed as a sign of modernity and Thai excellence. Thai in Vitro is a study of assisted reproduction in Thailand but yet so much more. Like an onion, the authors skillfully peel away the layers of gender, culture, kinship, class, spirituality and even nationalism that are involved in the quest to fulfill the wish for children. Throughout the nine chapters of this book, the reader clearly hears the voices of the men and women in treatment as well as the practitioners, including doctors, nurses and technical staff. It is these voice that guide us through a journey of assisted reproduction in Thailand. 

Childlessness (chapter 2) in Thailand is a state of incompleteness. Upon marriage, couples are expected to have children as soon as possible. Children are highly valued in Thai society. They cement the relationship between the parents and carry on the family name. The inability to have children is mostly blamed on women who are perceived as not trying hard enough or even being bad people whose karma is not good enough for a child to want to be born. The pressure to have children is heightened by the centrality of motherhood for Thai women’s femininity. This is paired with fears of desertion by their husbands who might abandon them for a younger, more fertile woman. Men, however, are not immune to the issue as fertility is equated with potency and virility. Thus, parenthood is important to couples to feel complete as well as to fulfill their respective gender roles. Adoption is not seen as a viable solution due to the lack of a biological connection to the child. Further, the existence of birth parents is seen as highly problematic. For these reasons, couples who can afford the treatment opt for assisted reproduction.

On the quest for parenthood, couples engage with a ‘sacred geography of fertility’ (chapter 3) as well as with modern biomedicine (chapter 4). To increase their chances of getting pregnant couples visit religious sites and make offerings to spirits and deities asking for babies. The offerings given which are often for sale at the temples may appear as commercialization but are understood by Thai people as part of an exchange of gifts that allows them to negotiate with the god. The sites visited spread over a wide religious spectrum, including Buddhist temples, Chinese or Brahmin deities as well as animist spirits. This praxis of appealing to religious forces for help is not in opposition to medical treatment or a final resort after all other measures have failed. It is, rather, a form of care that ‘complement[s] and enhance[s] other forms of intervention’ (p. 73). The medical treatment itself also has its own kind of enchantment. To achieve their goal of having a baby, couples undergo a number of medical procedures and protocols within the liminal space of the clinic. It is the clinic that helps to transform couples into families but also offers a space where unsuccessful couples can come to terms with their losses. The clinic is also a liminal space because despite all the medical intervention successful treatment remains a mystery.  

The mystery of assisted reproduction is in no small part in the hands of doctors and other professionals. This ‘clinical ensemble’ (chapter 5) is seen as benevolent and in a very literal way the givers of life. This fits well into the highly prestigious status that doctors have in Thai society that goes well beyond the realm of medicine. However, assisted reproduction has a very low chance for success leading to almost inevitable disappointment. Such failure to reproduce is placed on the couples (mainly the women) but also lead to disillusionment with the doctor. ‘[T]he image of the doctor as that of a healer with special moral status and expertise may transform into an image of a doctor as a businessman engaged in profit-making activities’ (p. 153). This doctor–patient relationship and commercialization of medicine that Whittaker points out here open up more opportunities for future research, also beyond reproduction.

The women and men that are seeking to have children through assisted reproduction both have their own agency that functions within their relationship, the wider kinship group and society at large. While some women willingly undergo infertility treatment out of a desire for a baby, this is not the case with every woman. Some have no desire to have children or they are fertile while their husbands are not. The decision of these women to undergo treatment is part of a ‘patriarchal bargain’ (chapter 7) in which women give up some of their agency or are subjugated to male control in form of their husband or doctors in exchange for a secure relationship, fulfillment of their gendered roles in society or obligation to the kinship group. These bargains are made under constraints specific to Thai society, such as the status of women in society and relationships, high moral emphasis on motherhood, male sexual privilege and related concepts of fidelity, the continuity of bloodlines and the perception that children make the couple complete as a relationship and as individuals. While these concerns are overwhelmingly more relevant to women, it should not be overlooked that men, too, are under pressure to father children. Male fertility has been culturally linked to strength and power. Further, men are pressured to produce an heir and to continue the bloodline as well as help their wives achieve motherhood. Assisted reproduction and other related technologies ‘give [infertile] men hope’ (chapter 8). However, they remain marginalized in the fertility clinics and academic studies of assisted reproduction. Here Whittaker has made some inroads into the role of men in infertility treatment and their feelings about it.

With Thai In Vitro Andrea Whittaker, has continued her work on reproduction in Thailand and created what could be called a trilogy. In her first monograph she focused on reproduction and giving birth, while in the second, she explored the issue of abortion. That her third monograph is about assisted reproduction creates a logical continuation of her inquiry. The book is of the same highly detailed ethnographical spirit but also offers insightful theoretical analysis. I would highly recommend reading this book to anyone who is seeking to understand the inner workings of Thai society. Its implications go well beyond its subject matter.

Katja Rangsivek, Burapha University, Thailand