By: Alexis Jimenez Maldonado
This conversation occurred on November 17, 2022. The transcript of the interview has been edited for clarity.
Elizabeth Chloe Romanis is an Assistant Professor of Biolaw at Durham University, UK. Before this, Chloe completed her PhD in Bioethics and Medical Jurisprudence at the University of Manchester. She passed with no corrections and was awarded the University’s Distinguished Achievement Medal for Humanities Research Student of the Year in 2020. Chloe also has an LLB (Hons) and LLM in Healthcare Law and Ethics from the University of Manchester. Chloe does research in healthcare law and bioethics with a particular interest in reproduction and the body (abortion, gestation, pregnancy, and birth). Her principal publications concern artificial womb technology and are published in leading journals including the Medical Law Review, Journal of Law and the Biosciences, and the Journal of Medical Ethics. Chloe has also published widely on matters related to abortion and birth, including her first co-authored book on telemedical abortion published by Oxford University Press in 2021. As a Fellow-in-Residence at the Edmond & Lily Safra Center for Ethics and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Chloe will work on her book, under contract with Oxford University Press, entitled Biotechnology, Gestation, and Legal and the Law.
Alexis Jimenez Maldonado: You joined the Center’s community this year through a joint fellowship with the Edmond & Lily Safra Center for Ethics and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. What drew you towards pursuing a joint fellowship with both Centers?
Elizabeth Chloe Romanis: I've trained primarily as a lawyer and my PhD is in law and bioethics, so Petrie-Flom was a natural fit for my research interests. When I was looking at the Safra fellowship, I thought it seemed like a great fit for me as well. I thought it'd be a great idea to put the two together and make the most out of both centers. That's something I've really been enjoying doing. Because of my particular training and research interests, being at both centers really opens more doors than just being at one.
Alexis: Can you talk about your experience with the joint fellowship so far? How has it been splitting your time?
Chloe: I've only been here for a few months at this point, so my experience is kind of preliminary. It's been a lot of getting used to things especially because I've moved really far. But it's been good!
I split my time in lots of ways. There's twice the amount of events, twice the amount of seminars, and twice the amount of people to have coffee with. I have an office at both centers, and I use both. The E&L Safra Center is great because there are lots of other fellows around, so I'm here quite a bit, but I go to Petrie-Flom when I'm going to law school events that day, for example.
Alexis: Your research is focused on healthcare law and bioethics and is especially interested in reproduction and the female body (abortion, gestation, pregnancy, and birth). Can you talk more about this?
Chloe: I've always been fascinated by reproduction. This interest developed during my undergraduate degree in law; I went to a university that specialized in health law. And so, I did a lot of health work immediately. But it was really pregnancy that that spoke to me and fascinated me and reproduction sort of more broadly. I've really been working on this since I was about 20 years old. It just really piqued an interest.
I did my PhD in artificial placenta technology, so artificial wombs. Because I was so interested in pregnancy, I was also interested in what would happen in a world where pregnancy or a complete pregnancy wasn't always necessary. Since finishing my PhD, I started to think more broadly about different forms of assisted gestation. Now I also do research on surrogacy, which obviously, is something that is already quite widely used amongst people who aren't able to gestate and want biological children. Also, uterine transplantation, which is an emerging practice for people born without a uterus who might want the experience of gestating as well as having a biological child.
However, my research focus really shifted during the pandemic, which I think it did for a lot of people, because we all want to be useful in a situation where the world is changing, and we're all struggling to make sense of it. And so, in my own way, I wanted to do something to help and in the particular context of the UK with medical abortion. Abortion medications are the most common method of abortion in Great Britain, but it was unlawful for people to administer those medications outside of clinics. A person could take the second abortion medication – misoprostol - at home, but they had to go to a clinic to take the first medication - mifepristone. And so, when people needed to go to clinics for their abortions during the lockdown, they were struggling to do that and it was a clear injustice. I shifted my energy in that direction. Simultaneously, hospitals stopped allowing birth partners [to attend a birth]. So, there were people giving birth alone in hospitals, and there were also people being denied a choice about how they wanted to give birth. Home births were suspended across a large portion of England. There were also parts of the country where people could not request a caesarian section either, because of the pandemic restrictions.
I was fascinated and angered by how the pandemic disproportionately impacted people with physiology assigned female because it became harder for them to get abortions, they had to give birth alone, and they also didn’t get the same choice of about what birth they wanted. That is all against the backdrop of real gender disparity [in the UK] during COVID. More was expected of people in terms of home life in England and a disproportionate number of people from marginalized backgrounds lost their jobs and didn't have any more support. I really wanted to do my bit and my bit was thinking about abortion and birth.
Alexis: How has your fellowship influenced this work?
Chloe: I'll talk about two strands of things. The first thing is I'm here to write a book about assisted gestation that is under contract with Oxford. One of the things that's really been amazing for me here is being surrounded by people from disciplines that I am not used to working in. That really has enhanced my thinking and my work. I have done bioethics before, I have a bioethics and law PhD, but I have no formal training in philosophy. At E&L Safra most of the people I'm working with are philosophers. That's been super fun because it is pushing me in new directions. We have really fun conversations that make me think about things in a different way. I think it is strengthening my arguments and introducing different dimensions to my work. It's also just generally been quite fun to learn about things that are very out of my wheelhouse. There isn't anybody else writing about gender and sex and reproduction (we all do very different things!) and how we come to each other's projects is really interesting.
The other thing is my writing about telemedical abortion. Remote means of abortion have only gotten more important in the US, in the current context and landscape. I published a book, Early Medical Abortion, Equality of Access, and the Telemedical Imperative, with my co-author Jordan Parsons, which came out in September 2021 about telemedical abortion. It was a comparative examination of the importance of the practice, but also the legality of it in England and Wales, Scotland, Northern Ireland, and the United States. But this came out before the Supreme Court decision in Dobbs and before telemedicine got made permanent in England and Wales. So, it's out of date! One thing that's been interesting for me being here is being able to connect in person with people who do similar research here who have a lot more expertise on American abortion jurisprudence than I do.
Alexis: You’ve been doing research at the intersection of law and reproductive justice for some time now. Can you share a bit about how this work has changed in the post-Roe landscape?
Chloe: One of the things I've always been absolutely fascinated about is the intersection between rights and access. In the US until Dobbs, there was a declared constitutional right to abortion, however, access just didn't exist for huge sections of the population. Whether that's because their insurance didn't cover it or because they lived in a state that was very hostile to abortion rights in ways that were unfortunately legal under the old regime. So, in the Roe era, American people had a right to an abortion, but it was often very difficult to get – especially for poorer and/or racialized people.
In England and Wales, we have a very different situation. There's no right to abortion, it's always a crime with a subset of defenses. We have a very comprehensive regulatory system, that means that access is very good. So, it's criminal, but there are carve outs for abortion in the vast majority of circumstances. Therefore, abortion is very accessible. There are still issues, but it was just much better than the picture in the US. That's why Jordan and I wrote the telemedicine book because we thought telemedicine has the potential to be game changer in terms of access. I found myself thinking a lot about what telemedicine looks like in a country where there's a right to abortion versus a country where there is no right, but laws and regulations that move with the times? The reason access evolves in Great Britain and Northern Ireland, of course, is due to the work of so many amazing reproductive justice advocates and the providers themselves changing things.
Now we're in a very different situation, because there is no longer a constitutional or recognized constitutional right to abortion in the US. That only makes telemedicine and self-managed abortions more important. The need for abortion does not change just because the law does. Abortions will continue to happen, people will continue to seek those means, and the telemedicine and self-managed abortion in the US is important in terms of access. Some individuals who have funds and privilege but live in an anti-abortion state might be able to travel to somewhere like Boston to have their abortion. But there are lots of people for whom that kind of travel and that kind of expense just is not possible. Abortion pills, and the fact that abortion pills aren't necessarily consigned by borders, I think is going to change things.
My research is moving more towards questions about how we can ensure people get these pills in their hands? And how can we ensure that they get these pills in their hands with minimal legal risk? It might be that abortion pills aren't that risky in medical terms; they're very safe, but at the same time they're incredibly risky, because if you take these medicines without a doctor's advice, could you be facing a prison sentence or other consequences? And in this country these legal risks disproportionately impact Black women and people of color, so I think that we need to direct our efforts there.
Alexis: How do you think we will be handling assisted gestation technologies in 10 or 20 years? Are we going to move forward or backwards?
Chloe: It's such a good question and I think it's such an important time to be asking it as well. If we just take surrogacy as an example, there are such huge divides in how surrogacy is talked about depending on which country you're talking about and the circumstances in which people are using surrogates. I think there are some interesting things to pull out from the surrogacy experience that might be able to tell us something about uterus transplantation, and maybe in the future gestation outside of bodies. Mainly, I think a lot of the attitudes towards assisted gestation, in social terms, are laden with quite a lot of animosity towards the choices of people: people with physiology assigned people and women in particular. I think prevailing social attitudes and complicated legal issues that impact on potential future parents and surrogates may also come to impact on people seeking a uterus transplantation and those people willing to donate one. Further, if we live in a world where all of these forms of assisted gestation are available, I can imagine people being placed under a lot of pressure to use one rather than the other e.g., some philosophers have argued that if an artificial placenta exists, then we should preclude people from having dangerous uterus transplants or outsourcing gestational labor to others via surrogacy. Similarly, there are some philosophers who've argued that if artificial gestation gets so good, then a human pregnancy is just too risky to comprehend. “Why would we expose a fetus to such a risky environment?” All of this will impact people’s choices about pregnancy and gestation.
I'm so fascinated by gestation because I think people have such a complex relationship with it. People want biological children and that's a slightly separate issue. What I'm interested in is their feeling about how they want that biological child to come into existence. For some people, they really want the experience of gestating and at the moment, they can't do that whether that is because they were born without a uterus, whether male or female or they lost their uterus to cancer. There are all sorts of ways in which people become unable to carry a pregnancy and for some people that experience is something that they really want. I would love to live in a world where there was freedom and choice to explore what kind of gestation they want when becoming a parent – acknowledging, of course, that there are lots of other options that do not involve any gestation, such as adoption. Do you want to be pregnant? Absolutely fabulous, we should have legal and social infrastructure that supports that and supports your bodily autonomy. If you don't want to be pregnant, we need to facilitate things like, willing (male) partners doing the gestating. Or, why can't a machine gestate for intended parent/parents?
Lots of the discussion around gestation tends to be very heteronormative and cis-heteronormative. And the thing is, these machines could be absolutely amazing for breaking the confines of reproductive biosex. Wouldn't it be fabulous if everyone could gestate, not just people who were born biologically typically female? Wouldn't it be fabulous if same sex couples could reproduce without using a surrogate? I mean, they might still want to, but I think there are ways in which different possibilities – like uterus transplantation and artificial placentas - can be amazing for marginalized groups who need options. My major concern and what my book is about, is how do we make that happen? How do we make sure the law and social circumstances are going in the right direction to support a diversity of gestations and a diversity of families?
I'm naturally a pessimist, so I guess I would say probably not optimistic long term. I would love to be optimistic. But I think particularly when it comes to reproduction and attitudes around gender and sex and reproduction, conservative views take a long, long time to change. Is 20 years long enough? I hope so, but probably not.
Alexis: You touched a bit on the issue of access and the way that marginalized groups sometimes lack access to something as basic as safe abortions. Can you talk about this question of access and affordability as reproductive technologies advance and expand the possibilities of gestation?
Chloe: I have a whole chapter in my book about that. One of the things that's been eye-opening coming here is the divides around things like reproductive health care. This divide is appalling in the UK, but in the US, these divides are even more entrenched by things like private health care, and what insurance companies can dictate to people. I am really learning a lot from being here. But I think this is exactly it. Reproductive technologies are expensive, and they are often very difficult to access. Even in the UK, where some fertility treatment is funded, not enough is funded and it's often not funded for marginalized groups. It's only in 2022 that the NHS committed to providing IVF for same sex female couples.
Take artificial gestation as an example. My worry is that we're already living in a world where maternal mortality is rising. It's rising very markedly in marginalized populations. For example, Black women in the UK remain four times more likely to die in childbirth, I think the statistics are even higher in the United States. I worry about a world where groups that are rendered structurally disadvantaged in socio-economic terms, as well as by discrimination on racial grounds, are still giving birth and carrying pregnancies, but rich white women have access to technology that does that for them. In such a world, people who are the most privileged don't have to risk their lives to have children, but some of the most disadvantaged by social and institutional circumstances do. Institutions that have problems with structural discrimination continue to, unfortunately, enable the outcomes that we're seeing at the moment.
Alexis: You have an upcoming online roundtable titled “Advancements in reproductive care and technology: perspectives from equality law” that will facilitate discussion between biolawyers/ethicists working on medical and technological advancements in reproduction and lawyers working in equality (broadly construed) in multiple jurisdictions. What do you hope to accomplish with this roundtable?
Chloe: Dr. Victoria Hooton and I, we've been friends for a long time. We did our PhDs in the same department at Manchester. She was working on European citizenship and social welfare law and I was working on reproductive technologies, the law, and bioethics. Our work has never really obviously intersected, but when I started working on gender equality and sex equality surrounding this technology, and what would it really do for women and gender minorities, that we started seeing some intersections in our research interests. We ended up publishing a paper “Artificial womb technology, pregnancy, and EU employment rights” together where we dissect aspects of European employment law, specifically maternity leave and non-discrimination, to work out whether it's actually protective enough to support a choice about how to gestate. We feel that it is important that people can make a decision about gestating outside the body or continuing to be pregnant without facing discrimination from their employer for that decision.
We really enjoyed writing this paper and couldn’t help feeling that it wasn't really the end of the conversation. Our paper was about just one choice and just one futuristic technology. A lot of the law we looked at in writing that paper was about existing technologies, like IVF, and surrogacy, and the way in which existing parents can be discriminated against for infertility or even for their decisions about how to become a parent. We wanted to broaden our scope. The object of this roundtable is to bring together people from different disciplines. We want lawyers, but also bioethicists and people interested in reproductive politics or sociology, together to talk about what the challenges are from reproductive technologies in the workplace, and how reproductive decisions are influenced by structural issues in workplace.
We've got two roundtables. One is about conception where we're going to talk about IVF and the discrimination people can face if their employer finds out that they're seeking fertility treatment. This is a huge story in the UK at the moment, lots of people have raised concerns about the fact that they're scared of their employer finding out that they are undergoing fertility treatment, because there's almost a weird loophole they are concerned about: employers can't terminate individuals for being pregnant but, if they find out that an individual wants to be pregnant/is trying to become pregnant, they might be able to take advantage of that. That's one of the things we want to talk about. There's also the phenomenon of social egg freezing. This is where younger people undergo fertility preservation for social reasons. But there are also some real concerns about it being a coercive tool for employers. There are some employers like Google, Facebook, and Amazon who subsidize it. Then there are worries that if your employer is subsidizing it, what do you do if you don't want to do freeze your eggs? What do you do if you want to be a mother at 22? These are interesting questions. We also want to talk about miscarriage. You can't always get extended leave if you experience a miscarriage and so we were thinking about that as well.
The other roundtable is about assisted gestation. How can we protect workers when they use surrogacy, when they use uterus transplantation, or when they use gestation outside of the body?
We're not anti-reproductive technology. We think it does amazing things to help people build families in different ways. But we think that some of the questions about why people want to use them, and in what circumstances they feel pressured to use them are interesting and worth thinking about before the technology comes to fruition. We're already seeing problems with IVF and with social egg freezing, and with these more futuristic things, where you're really interested in thinking about what the problems could be now, so that we're better equipped to solve them later.
Alexis: What projects are on the horizon for you?
Chloe: I need to write my book, that's on the horizon and I'm working on that at the moment, chapter by chapter. I'm also doing some thinking about telemedicine abortion in the United States. So, I guess my work is really at the center is a continuum of things I've been interested in for a while. And I'm trying to use it in a new context to inject a new lease of life, so to speak, into those ideas. That's my major focus.
Alexis: How do you unwind when you’re not working, do you have any hobbies?
Chloe: I have a small sausage dog who, aside from my husband, is the absolute love of my life. I would say my hobbies genuinely revolve around her which is absolutely nuts, isn't it? But she is so sassy. Everything is about her. Where we live at home, we live quite near the beach, and right near wildlife reserves, so we take her for lots of walks. She's quite happy about that.
Alexis: I’ve heard you have strong opinions on American cider! Could you explain your controversial take on what constitutes real cider?
Chloe: This all comes from when we went on a Center trip to go apple picking, which was amazing, even though it was raining a lot. We were going to go get cider doughnuts and apple cider. Being British, cider is alcoholic. Cider must be alcoholic whether it is fizzy or not. There's lots of different types of cider, but cider is an alcoholic drink. I guess I was just a bit surprised to find out on this trip that the cider here was just apple juice. I think it's very delicious but it's not cider. It's just apple juice. I think that you guys just have your terminology messed up, that's what I'm trying to say. I was just, quite fairly, confused.
Alexis: Do you have a podcast or show that you are currently listening to/watching?
Chloe: I'm a big podcast person and I like lots of random stuff. At the moment, I'm listening to this thing called “British Scandal” where they just talk about bad things that happened in England, but that actually ended up being both worse and funnier than you’d think. The current series is about Boris Johnson so, obviously, that's a hoot. In general, I like true crime podcasts. It is what it is. There are a few of us who did our PhDs together who are all into true crime, so we often listen to podcasts and Whatsapp about them constantly.
Alexis: I am also a true crime podcast fan. You're the first person to answer this question by saying true crime!
Chloe: I'm a big “Red Handed” fan, that's a British one. I also like listening to “Bad People” as well, that's another British one.
Alexis: I personally am a "Crime Junkie" podcast fan, but I am excited to check the ones you mentioned out! Thank you so much, Chloe!