Analysis of Fertility Market, Pregnant With Business Jargon

President George W. Bush’s opposition to stem-cell research is grounded in his belief that life begins at conception. For him, government financing of the destruction of embryos for any purpose is tantamount to state-sponsored mass murder. This position suggests that the millions of infertile couples who have sought out new reproductive technologies which produce unused embryos as a necessary byproduct are at best morally bankrupt and at worst serial killers—at least if they don’t make those superfluous embryos available to other couples or pay to keep them viable indefinitely.

This is just one of many fascinating issues raised by the recent emergence of the multibillion-dollar industry that Debora L. Spar examines in The Baby Business. A Harvard Business School professor and chair of a program called “Making Markets Work,” Ms. Spar wrote The Baby Business for the Harvard Business School Press. Unfortunately, despite its timeliness and pedigree, the book fails to provide either a thorough description of the remarkable developments in this field or a usable framework for analyzing them. Ms. Spar consistently deploys economic and business jargon in ways that are either unhelpful or inconsistent with the raw facts as she herself presents them.

Her central premise is that “infants and children are indeed being sold” and that, rather than pretend they are not, we should analyze this “market” to ensure that it operates appropriately. The “market” encompasses everything from adoption to in vitro fertilization to high-tech procedures to eliminate birth defects. As soon as she turns to the supposed characteristics of this market, however, Ms. Spar runs into trouble. Demand in the fertility market, she claims, “is nearly constant,” with “the crucial fact [being] that 10 to 15 percent of any given population” is infertile. Yet the data provided demonstrate that a woman’s age is the single biggest variable in the likelihood of a successful pregnancy. Presumably, therefore, the fact that women are systematically waiting longer and longer to have children is inconsistent with the “crucial fact” of “nearly constant” demand.

Though she includes plenty of charts and statistics, Ms. Spar’s methodology is essentially anecdotal. She describes a hypothetical situation in order to suggest that fertility clinics have an economic incentive to continue to provide expensive treatments to largely hopeless cases. Only five pages later, however, she quotes clinic directors to the effect that some service providers refuse to treat difficult cases because published “success” statistics are an important marketing tool. It’s all true, I’m sure—but Ms. Spar doesn’t even acknowledge the inconsistency of the two observations, much less make any effort to analyze whether, on a net basis, the “market” is providing too much or too little treatment.

Her essentially journalistic approach sometimes wanders into tabloid territory: “Most [sperm bank] recipients … never want their offspring to know that Daddy arrived via FedEx.”

There’s nothing wrong with an objective, journalistic approach per se, but Ms. Spar seems to strain to avoid expressing any substantive point of view on the myriad controversies touched on in her narrative. The one broad argument she does make isn’t particularly compelling: this single “market” demands a single, holistic regulatory regime.

It’s actually impossible to judge this argument on its merits because, after 200 pages, Ms. Spar declines to say what specific regulatory regime she would propose. How can we be expected to compare the current fragmented regulatory framework with an integrated one to be named later? The justification for punting on the core thesis of the book is equally unsatisfactory: “[T]he baby business,” she offers by way of explanation, “is running so quickly and expanding so radically that time is likely to render any detail moot.”

Instead, we’re encouraged to engage in a healthy, open political dialogue to develop the best framework. To help us along, Ms. Spar mentions a variety of principles and factors that could shape the debate. These do not amount to a roadmap: Be equitable, she tells us, and take into account the cost of any proposal.

Strangely absent from Ms. Spar’s calculus of conception are the children that it produces. In all the pages describing factors and variables to be weighed, she barely mentions (and then only parenthetically) the governing principle in most family-law cases: the best interests of the child. In her description of the adoption “market,” Ms. Spar oddly describes “open” adoption (which she defines as a system in which “birth parents actually choose the adoptive parents and the child is fully informed”) as a “radical” fringe phenomenon. But some type of openness—one form or another of continuing communication between the birth parents and the child—is the general trend rather than the exception. Significantly, the regulatory movement for openness was driven by the generation of adopted children who came of age in the second half of the last century. The interests that Ms. Spar focuses on almost exclusively are those of the parties to the “transaction” in the “marketplace.” My guess is that whatever regulatory regime or mosaic of different regimes takes hold in the future will be largely driven by the children who are born thanks to the recent wave of technological innovation.

Jonathan A. Knee is a senior managing director at Evercore Partners and director of the media program at Columbia Business School. Analysis of Fertility Market, Pregnant With Business Jargon