Rah Old Indian IVF Moms

Thursday the Post lamented the fact that India (population 1.2 billion) is growing twice as fast as China (population 1.3 billion), and may soon have by far world’s most in vitro fertilizations, perhaps 600,000 a year (~2% of India births), costing about $2500 each.

The Post reserved its strongest disapproval (between the lines, but still pretty clear) for the fact that many Indian IVF moms are 60 and 70 years old, and so are taking on bigger health risks. Supposedly regulation is needed to keep such women from succumbing to “cultural pressures.” Apparently, since Post reporters know no colleagues who would consider taking such an action, they conclude that elderly Indian IVF moms must be suffering from some horrible patriarchy. (No further evidence of illicit pressure is given.)

This seems to me cultural arrogance of the worst sort. Yes, new people induce some negative externalities, such as congestion. But overall economists’ best estimate is that new people give others a net benefit, especially via increased innovation. Thus creating (and raising) a new person is an incredibly altruistic act. The new person gets to have a life, and the rest of the world gains as well.

Yes, creating more people may reduce per-capita wealth in the short run, but if [most] everyone benefits, what’s wrong with that?  Yes, a high enough mom health risk could make this a net bad deal. But the Post quotes a 60% baby success rate, and I’ll bet mom mortality is below 6%, which means there’s at least a ten to one life gain ratio. And the gain ratio must be far larger in quality-adjusted life years.

These Indian women are not taking advantage of some overly-generous health insurance loophole – they are paying cash from their own pockets to give life to a new person. And they are not acting on some strange perverted desires – they are expressing an extremely basic, ancient, and revered desire, the desire to mother a child. Who are US elites to tell elderly Indians that their altruistic gift is not worth the cost? Shouldn’t we be subsidizing such altruism, instead of discouraging it?

This seems a lot like the phenomena of “Looking Too Good“:

Unselfish members (those who gave much toward the provision of the good but then used little of the good) were also targets for expulsion from the group. … Social comparison tends to induce feelings of inter-personal competition. People feel driven to outdo the group member who is setting the standard. … Removal of this person would eliminate that competitive standard.

If we praised poor elderly Indian IVF moms, that would implicitly criticize rich Western women who refuse to have even one kid even when young and healthy. Rather than raise our altruism standards, we’d rather exclude these women from the group of reasonable altruists. Quotes from that Post article:

Rohtash is a 60-year-old mother of five and a grandmother of eight. She’s also nine months pregnant, the result of an in vitro fertilization clinic, one of hundreds that have opened recently in India. …

With 1.2 billion people, India is still growing rapidly, and there are few efforts to control population growth, in sharp contrast to China’s one-child policy. Some planning advocates argue that India’s population is stalling [India’s] development. There are no government regulations for IVF clinics, especially in rural areas of northern India, and women older than 50 make up a surprising number of their patients, in a country where giving birth to many children defines a woman’s worth. …

In the past 18 months, the doctors at this clinic have helped 100 women older than 50 become pregnant. About 60 were able to carry those pregnancies to full term. … “The women come to us and say, ‘Even if I die, at least I won’t face the stigma of being barren.’ … They may die, but their family and country will live.”

Many fertility experts say performing IVF on women older than 45 can be dangerous for the mother, a stress on her heart and blood pressure. … The baby is also more likely to be born premature and to face health problems. The average life expectancy in India is 63. … One of the country’s leading centers … discourages the procedure after age 55. …

Fertility experts here say India is facing a unique problem because there is so much pressure for women to have children and the technology is relatively affordable. One IVF attempt at this clinic costs about $2,500, while in the United States it can run up to $15,000. … About 150,000 cycles were performed in the United States last year and about 80,000 in China, Pai said. No data were collected for India … but some experts think the number could reach 600,000 in the next three years. …

“The need of the hour is regulating these clinics.” … United States … doctors advise against IVF after 45 and can refuse in situations in which it is considered too risky. “There’s an argument that says that if a man of 70 years and can have a child, why can’t a woman of 70 have a child. … But what we need in India, because of our cultural pressures, is a policy to advise against it. It’s not safe.”

At the Hisar clinic, hundreds of worried-looking couples — ranging from those in their 20s to senior citizens — clutched scans and medical forms.

M.R. Bishnoi sat in his medical office under a poster of the Hippocratic oath and photographs of happy babies.

[IVF doc] Bishnoi … offered evidence that his procedures are safe by introducing … Lohan, 72, who gave birth to a daughter, Naveen, 18 months ago. … But Lohan has several health problems. Her husband, Balaram, is a farmer who always wanted a child. … He asked Lohan to try IVF after he read about the clinic in a Hindi newspaper. A relative donated an egg. His sperm was used.

Lohan said she worked through her pregnancy, milking cows, … After Naveen was born, she was even able to breast-feed. Bishnoi said his clinic bought life insurance for Lohan and her husband so their daughter will receive money when they die.

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  • http://www.blogger.com/profile/10546265581296919974 Rob

    >> creating (and raising) a new person is an incredibly altruistic act. The new person gets to have a life <<

    Not so fast.

  • Jess Riedel

    Seeing as that the author for the Post probably does not advocate extermination of humanity, Robin Hanson’s criticism stands.

    • Jess Riedel

      Rob’s link points to a book by David Benatar, who argues (both in that book and in several academic publications) that bringing humans into existence is morally bad. A summary of his argument, and a quick sketch at a refutation, is available from Jean Kazez (Phil. Prof. at SMU) at

      http://faculty.smu.edu/jkazez/articles/Benatar.htm

      (I am placing this comment long after this thread has died down.)

  • Matthew

    I wonder how healthy these babies are likely to be. . . Any metrics on this? Even with a normal pregnancy in a young, healthy mom we end up with a couple percent of serious birth defects. I have to imagine with a 65 y/o woman that chance skyrockets. Then again, I’m sure the vast majority of such babies die in India lacking PICUs and the like. . .

  • Jeffrey Soreff

    ” Yes, new people induce some negative externalities, such as congestion. But overall economists’ best estimate is that new people give others a net benefit[emphasis added], especially via increased innovation. Thus creating (and raising) a new person is an incredibly altruistic act. The new person gets to have a life, and the rest of the world gains as well.

    Yes, creating more people may reduce per-capita wealth[emphasis added] in the short run, but if [most] everyone benefits, what’s wrong with that?”

    Wait a minute – if creating more people reduces per-capita wealth, how can it be a net benefit to the people who already existed? What exactly are you claiming about the net marginal effect of adding another person to the welfare of those already existing? Could you point to a paper where these were calculated?

    • http://www.meteuphoric.wordpress.com Katja Grace

      Note ‘in the short run’ after your second added emphasis

      • Jeffrey Soreff

        Note ‘in the short run’ after your second added emphasis

        Agreed – but I would still like to see a more explicit statement of what Prof. Hanson predicts, and why. Is the situation analogous to what “On The Internet No One Knows You’re a Dog” described, or more positive, or more negative? Aggregating effects over an average lifetime (with some reasonable discount rate) would be one reasonable measure.

    • Carl Shulman

      “Wait a minute – if creating more people reduces per-capita wealth, how can it be a net benefit to the people who already existed?”

      The new people are created, and are poorer than existing people, while existing people’s wealth stays steady or increases. If creating more people reduced per-capita wealth of *existing* people, then a net benefit would be surprising (but possible, some parents are happier to have had kids, despite the decline in their household wealth per capita when the kids are born).

    • On The Internet No One Knows You’re a Dog

      This works even if you think per capita GDP is a perfect measure of utilons.

      Imagine a society with 10 people and 200 utilons distributed among them, for a mean per capita utility of 20. Then add one baby. Let’s say this baby is poor, but not so poor as to wish ey had never been born, and receives a lifetime allotment of 1 utilon, a net positive (barely). In addition, since over eir life ey will participate in the economy, producing things that benefit others, let’s say that adds another 8 utilons to Gross Domestic Utility, distributed equally.

      So we’ve defined two changes that are both net positives; the new life gains 1 utilons and the rest of the world gains 8 utilons. But per capita utility is now (200 + 8 + 1) / 11 = 19 < 20, so per capita utility has decreased fro 20 to 19, even as total utility has increased and no one is worse off.

      Therefore, if the utility of different people is cumulative (i.e. you can add it up to get a measure of total utility, rather than averaging), then it should be possible to add a person and make everyone else better off, and still reduce per capita GDP.

      • Jeffrey Soreff

        Many thanks! So in that scenario, the addition of another person is in the interests of the 10 existing people provided that they can rely on inequality to persist over their lifetimes. If, say, wage competition had the effect of leveling the utilons per person, they would see the average drop in utility personally, dropping from 20 to 19 – and in that case the addition of the extra person would not be in their interests.

  • Fructose

    Right now, I suppose people do, on net, benefit from a new human being. But at some point, the sign of the value of an extra person (to other people) flips and becomes negative. Evolution programmed us to keep reproducing even when the population is at Malthusian limits, and another human being leads to someone going hungry. So, while I agree that these IVF mothers are not doing anything wrong, at some point I think humanity should cooperate to limit birth rates.

    Unfortunately, that isn’t evolutionarily stable, so it would be hard to maintain such a situation.

    • Jess Riedel

      Well, you scenario is considering a situation where it is no longer in the interests of existing people for another person to be born. But that doesn’t mean that it may not still be good for another person to be born, according to some morality where bringing people into existence is a good thing and worth sacrifice by exiting people.

      I assume Robin Hanson subscribes to such a morality.

  • http://www.meteuphoric.wordpress.com Katja Grace

    I doubt it is about ‘looking too good’. People don’t view childbearing as a huge benefit to the child, or even much of a benefit to others, so having children isnt seen as altruistic at all amongst westerners (though looking after them nicely is if you have some). If having children were seen as such a praiseworthy thing that women who go too far may raise the standard further or get too much respect, we would see more young fit mothers going almost that far. I think the opposite is true, having children is one of the less respectable things a woman can do in western society.

    Alternative explanation for the Western author’s disdain: most people are disgusted by the idea of old women getting pregnant.

    • http://www.xuenay.net/ Kaj Sotala

      Agreed. Note also the disdain heaped on mothers who have lots of kids while living on welfare: it’s frequently viewed as exploiting the system, and not as any kind of altruism.

      • Jess Riedel

        Agreed with both of you, except: I think the distain behind mothers who have lots of kids while living on welfare is because people claim those mothers have the kids in order to claim more welfare benefits, not because they want to bring children into the world.

  • mjgeddes

    There’s likely some optimal level of agents which achieves the best trade-off between quality of life and productivity, it is a net negative for there to be more people than above this optimum. I did a rough calculation as to what the optimum might be based on the size of social groupings, the hierarchy goes roughly like this:

    2, partnership
    10, team
    100, organization
    1 000, community
    10 000, society
    100 000, city
    1 million, state
    10 million, nation
    100 million+ union

    Once level 9 is reached, ‘union’, I don’t see any more complex behaviour occurring. So 100 million agents seems optimal, and the world population is way over that and is probably a net negative.

    PS Certain ‘probes’ are in progress, watch for appearances of the number ’27’

    • Fructose

      PS Certain ‘probes’ are in progress, watch for appearances of the number ‘27′

      That was cryptic.

      • John Maxwell IV

        I think mjgeddes is a bit of a crackpot.

      • mjgeddes

        John,

        You have me confused with someone else again. I’m not the one obsessed with paper clips and lottery tickets.

  • http://t-a-w.blogspot.com/ Tomasz Wegrzanowski

    How can you hold new people to be net benefit, and also believe in Malthusianism? They are completely incompatible.

    inb4 You cannot explain it away with total utility – if people are net negative to average utility, and net positive to total utility – essentially everybody agrees that this should be treated as net negative.

    Either that, or Malthusianism is false.

    • Doug S.

      Answer: Given current technology, we’re currently far from the Malthusian limit.

      • http://t-a-w.blogspot.com/ Tomasz Wegrzanowski

        It doesn’t matter if we’re far from limit now. If you believe in Malthusianism, other people having babies brings Malthusian collapse closer on the margin, and therefore is negative in long term.

        Of course if you reject Malthusianism you have no such problem, but Robin has extremely Malthusian views.

  • David Jinkins

    As noted in the first comment, it isn’t so clear that bringing children into the world is a net benefit. Innovation gives strong support to the argument that children have a positive average effect on society. However, it is hard to compare existence to non-existence, and thus hard to know whether it is better for the children themselves to live or not to live.

    Robin has previously used the lack of mass suicide to argue that existence is preferable to non-existence: http://hanson.gmu.edu/meat.html
    But the comparison shouldn’t be “continue living” to “die”–it should be “never exist” to “exist”, and it doesn’t follow from lack of widespread suicide that “exist” is preferable.

    At the very least, I have never heard a convincing argument concluding that existence is beneficial to a person. If it is not, then it may not be altruistic to have children.

    (Note: I am also not convinced by David Benatar’s arguments that existence is necessarily bad.)

  • http://timtyler.org/ Tim Tyler

    Re: “Thus creating (and raising) a new person is an incredibly altruistic act.”

    That is not how biologists see it. According to them, reproducing is normally a self-promoting act, that increases the prevalance of your own genetic heritage in the population. Unless, of course, it is not your kid – in which case you are probably doing it becaues you are getting paid to.

  • Jack

    How is it altruistic to create a child that will almost certainly become an orphan in a country already overwhelmed with orphans?

    • http://un-thought.blogspot.com/ floccina

      Because in their life time they on average will produce a little more than hey consume.

  • http://timtyler.org/ Tim Tyler

    Re: “Yes, creating more people may reduce per-capita wealth in the short run, but if [most] everyone benefits, what’s wrong with that?”

    If there is only room for a certain number of people on the planet at any moment in time, then – given the choice – it would be better for there not to be any 60 and 70 year old-mums at this stage. Their possibly developmentally-challenged offspring may take resources that could otherwise be allocated to more healthy and viable individuals who receive better parental care.

  • http://hanson.gmu.edu Robin Hanson

    Rob and David, I consider it obvious that most human lives are worth living, and better than not existing.
    Matthew, I can’t see how a small percent of birth defects changes the overall tradeoff much.
    Jeffrey, kids are investments, and any investment reduces consumption in the short run. Also resources for new kids may come at the expense of assets given to siblings. But why not let parents choose more kids over richer kids?
    Fructose and Tomasz, kids can be net benefits to others (i.e., positive externalities) even at Malthusian limits.
    Tomasz, I do not agree that less ave util and more total util is bad.
    Katja, Kaj, Jess, this case seems to me an extreme example of a more general Western trend of not granting moms their due altruism credit, because doing so would make non-moms look bad.
    Tim, I consider your act altruistic if it benefits others greatly, regardless of your motives for it.
    Jack, I think you are misinformed on India’s orphans.

    • Consumatopia

      I consider it obvious that most human lives are worth living, and better than not existing.

      That seems like a belief that might enhance one’s fitness for reproduction for reasons unrelated to its truth value.

      kids are investments, and any investment reduces consumption in the short run. Also resources for new kids may come at the expense of assets given to siblings. But why not let parents choose more kids over richer kids?

      Kids are investments that compete with other investments–like education of already existing children, or more scientific research and innovation in the present (that might make future scientific research and innovation faster)

      this case seems to me an extreme example of a more general Western trend of not granting moms their due altruism credit, because doing so would make non-moms look bad.

      Apparently, population control measures in countries all over the globe, rather than reflecting widespread fears of overpopulation, are actually just part of a conspiracy to allow non-parent females avoid looking bad.

    • Jeffrey Soreff

      “Jeffrey, kids are investments, and any investment reduces consumption in the short run. Also resources for new kids may come at the expense of assets given to siblings. But why not let parents choose more kids over richer kids?”

      ‘scuse the long delay in my response.
      I have no argument against investing in kids – provided that the average
      lifetime per-capita standard of living does not get reduced. As per
      “On The Internet No One Knows You’re a Dog”‘s example, there can
      be scenarios where per-capita utility decreases while each individual
      gains be per-capital utility drops – but only if inequality is
      guaranteed to persist, which I’d rather not count on.

      Ideally, I’d prefer to see parents subsidized or taxed based on the
      incremental impact, positive or negative, that child has on
      per-capita utility. You seem to be saying that this impact is positive.
      Can you point to an analysis supporting this? Frankly, I’m
      skeptical. With our current technology, we seem to be pushing up
      against a number of resource limits (as suggested by species loss
      rates, and to some degree CO2 effects). Cranking up the
      population further seems at least imprudent to me.

  • Gil

    So are humans the primal measure of wealth? That the only point to have economic and technological growth is so we can support more people? If the world goes to 12 billion is the world twice as wealthy as a world population of 6 billion regardless of what the average per person wealth is?

  • Philo

    What’s going on in India? It’s a poor country, yet a lot (number unspecified) of elderly women are undergoing pregnancy through (expensive) *in vitro* fertilization. (I take it this is supposed to be more common–*much* more common?–in India than anywhere in the West.) Maybe pressure from patriarchy is no part of the explanation, but what *is* the explanation?

    • http://williambswift.blogspot.com/ billswift

      The one mother quoted said it was to be released from “the stigma of barrenness”; as in other traditional societies, having children is considered a good in itself. And not just for women, the traditional Jewish perspective, for example, is that a man isn’t really a man until he has become a father.

  • http://ninebandedbooks.com/?p=292 Chip Smith

    I consider it obvious that most human lives are worth living, and better than not existing.

    Well, I consider it obvious that most human lives are not worth starting, and that is is better to never exist than to be brought into existence. The never-existent suffer no deprivation, nor are they burdened with mortality. To posit that people are “benefited” by being brought into existence, you need to explain how the alternative of never existing is a comparative harm to those whose lives are hypothesized. The relative rarity of suicide is not relevant to this question because actual lives are qualitatively and existentially distinct from lives that are merely contemplated in this context.

    I know this isn’t Robin’s main issue and I don’t want to derail the discussion. Those of you who are interested in the antinatalist position might want to check out frequent OB commenter TGGP’s anti-antinatalist essay along with Jim Crawford’s thoughtful response. Jim Crawford is the author of Confessions of an Antinatalist., and I am his publisher.

    • Noumenon

      I feel the opposite of Robin just like you, but it’s definitely an emotional issue and not something I can think about rationally. I actually stopped reading Katja Grace’s blog because I got to her posts about this issue and thought “She might have a good case for natalism there, I have to wrestle with these arguments further” and then the thought of going back and wrestling seemed like a really unpleasant task to be put off (for a good 18 months now).

      In conclusion, I have no good reason to think so, but Robin is obviously wrong.

  • Dave

    So old women in India pay to get “pregnant”. Of course the egg is not necessarily hers,but you can bet the sperm is in most cases the husband’s.The reason given for the pregnancy is either to make sure the father and mother have a son,or to avoid the stigma of the family being being barren. Yet this is not a sign of patriarchalism, really??

    Next a shift in logic.Well, It is still altruistic,because it is known that more people means more talent. Yet would the same people who make this argument stand out in front of an abortion clinic protesting the talent and future wealth being killed of? No.

    I think the real reason to support this practice seems to be a strong belief in personal autonomy but not so strong a belief personal responsibility.
    The elderly mother is likely to die and pass that off to “society.” Local social norms come first.and let someone else take care of the consequences. Perhaps this works in a wealthy society with a good social welfare system, but in India?
    Since we live in an urban and cosmopolitan world, the government and even the world will be given that responsibility,without having been asked .

    • http://williambswift.blogspot.com/ billswift

      There was a mention in the article about the clinic buying life insurance for the parents, in order to provide for the child if it becomes orphaned.