The global fertility industry has become a lucrative and complex market, offering hope to those who want children while raising new financial and ethical questions about the use of women’s bodies. Journalist Alev Scott examines these tensions in her book Cash Cow: How the Maternal Body Became a Global Commodity and the Hidden Costs for Women.
Cash Cow, published by HarperCollins, takes a closer look at the companies around IVF, egg freezing, egg donation, surrogacy, and breast milk. Cash Cow blends investigative journalism with the stories of those who have been through it and considers who profit and what they give back.
Scott’s core argument is that fertility has become increasingly commercialized. Advances in reproductive medicine have created opportunities that were difficult or impossible for previous generations, but they have also led to the development of markets for biological material and reproductive services. The book raises challenging questions about where the boundary lies between personal choice, financial opportunity, and exploitation.
One instance of this is egg donation. Women who donate eggs may receive payments and would-be parents could endure substantial expenses as they search for a donor and undergo the processes of fertility treatment. Scott investigates the rise of so-called ‘VIP’ or ‘premium’ donor markets and asks whether features such as looks, education, or perceived ‘genetics’ are transforming reproductive choices into consumer markets.
Surrogacy is another major focus. The industry has expanded across borders, with intended parents sometimes traveling to countries where treatment or surrogacy arrangements can be less expensive or subject to different regulations. Scott’s reporting looks at how international fertility markets can create significant differences between what intended parents pay and what surrogates receive, while legal protections vary much from one jurisdiction to another.
Some of these issues have gained fresh traction in recent reports from northern Cyprus. These have also prompted concerns about clinics operating in a relatively lightly regulated jurisdiction, with investigations into supposedly rogue practitioners allegedly involving mix-ups with donors, and the transfer of embryos across borders. These incidents highlight the potential hazards when reproductive medicine becomes an international enterprise.
The book extends past fertility treatment. Scott considers the formal and informal milk markets, where breast milk is bought and sold outside of the traditional breast milk banks. By reading these industries alongside IVF and surrogacy, she expands her argument about the increasing commodification of the maternal body.
Crucially, Cash Cow is not an argument that all commercial fertility is inherently exploitative. The book does but explore the fine-grained boundary between empowerment and exploitation. People can receive a significant income from compensation, and reproductive options can be empowering, yet the impact of economic inequality and lack of options can have a significant impact on decision-making. That fraught dynamic is one of the book’s central themes.
Cash Cow questions are in particular apt in the light of technological developments and increases in fertility treatments and procedures that mean we are seeing a much more international fertility industry. Eggs are increasingly frozen, donor conception and surrogacy become more common, IVF treatments become more popular, sales of services increase and bio-needs seem to clash with consumer needs.
