Biotechnology, Gestation, and the Law By Elizabeth ChloeRomanis, Oxford: Oxford University Press, 2025, 240 pp., £100.00

Abstract

In Biotechnology, Gestation, and the Law, Elizabeth Chloe Romanis offers a rigorous and conceptually rich examination of how emerging biotechnologies are reshaping the nature and meaning of human gestation. Gestation, defined by Romanis as ‘the process of becoming before birth’ (p. 1), has historically been confined to the uterus of those assigned female at birth. However, as she persuasively argues, recent innovations such as uterus transplantation (UTx) and ectogestation challenge this biological and social containment. UTx renders pregnancy possible in bodies previously unable to sustain it, effectively ‘unsexing’ gestation and unsettling long-standing associations between reproduction and female embodiment. Ectogestation, by contrast, represents a more radical departure, enabling gestation to occur partially or wholly outside the human body. Together, these novel technological interventions, which enable gestation in different modalities and transform the process of gestation itself, are the focus of this book. The book offers a sophisticated and forward-looking exploration of how emerging biotechnologies are reshaping both the process and the meaning of human gestation. It is organized into eight chapters, which can be broadly understood as two interrelated sections. The opening chapters (2–3) establish Romanis’ transdisciplinary theoretical framework, while the later chapters (4–7) apply this framework to examine pressing socio-legal questions around access to reproductive technologies, parenthood, and abortion. understanding pregnancy, gestation, and birth and also what the law takes these concepts to be is a critical prerequisite to the examination in this book of how novel technologies will change our perceptions of modes of being and the generative work in procreation. (p. 25) Romanis demonstrates that legal frameworks inconsistently conceptualize pregnancy, at times recognizing the foetus as part of the pregnant person, but more often treating the pregnant individual as a container. This chapter explores the metaphysical nature of pregnancy, gestation, and birth, and the legal assumptions surrounding them. It is original in interrogating how law conceptualizes these embodied experiences and the transformations involved in creating new life. By exposing the complexity and fluidity of these processes, the chapter highlights how metaphysical inquiry enriches our understanding of life's beginnings and the ontological premises that shape legal thought. Chapter 3 develops a taxonomy of technologies enabling gestation, including surrogacy, UTx, ectogestation, and reciprocal effortless in vitro fertilization (IVF), and distinguishes them from technologies that facilitate conception. Romanis argues that different modalities alter procreative experiences in distinct ways and meet diverse needs, underscoring the insufficiency of legal frameworks designed solely for assisted conception. This chapter argues that current reproductive regulation in the United Kingdom (UK), embodied in the Human Fertilisation and Embryology Acts 1990 and 2008, was designed primarily around assisted conception technologies such as IVF and therefore cannot easily accommodate emerging gestational technologies such as ectogenesis or UTx. Romanis acknowledges my argument in Regulating Assisted Reproductive Technologies, where I describe the 2008 act as a ‘missed opportunity’ to anticipate a ‘third era’ of reproduction, one defined by technologies that enable gestation outside the traditional womb.2 She agrees that horizon scanning was limited but considers my critique perhaps harsh, noting that fundamental reform was unlikely given the narrow policy remit of the 2008 review process. Her engagement with my work highlights an important tension in the field: whether lawmakers should be expected to anticipate paradigm-shifting technologies or whether regulation must remain responsive and incremental. In taking a more sympathetic view of the 2008 reforms’ limitations, Romanis adds nuance to the debate by situating the lack of foresight within structural and procedural constraints, rather than solely a failure of regulatory imagination. Her taxonomic classification of the different modalities of gestation that new technologies may offer and their potential value for different users is helpful in providing conceptual precision. Chapter 4 builds on this foundation by addressing normative questions – specifically, when and under what circumstances access to such technologies should be supported or facilitated. This transition marks a move from descriptive categorization to prescriptive ethical and policy analysis. Romanis argues that technologies enabling gestation create new possibilities and choices for would-be parents, yet access to these technologies is shaped and often constrained by entrenched notions of what is ‘biological’ or ‘natural’. She highlights that such values are embedded not only in legal and clinical regulation but also in the very design and conceptualization of these technologies, since science itself is socially and politically situated rather than value neutral. Romanis challenges claims that there is a moral or legal ‘right to gestation’, arguing that even if such a right existed, it would not be absolute. She engages with John Robertson's narrow conception of procreative liberty, which restricts access to gestational technologies to those for whom gestation is necessary to achieve genetic parenthood.3 My own work challenges this view, arguing that the choice of how to procreate, not merely the ability to have a genetic child, is morally and legally significant.4 Romanis critiques my position on two fronts. First, she observes that I do not fully address the obligations that recognizing a broader right to gestate might impose on others, particularly in contexts such as surrogacy or UTx. Second, she contends that my claim to a legal right to gestate under Article 8 of the European Convention on Human Rights overstates Strasbourg jurisprudence, which recognizes only a right to respect for decisions about procreation, not a positive entitlement to state-facilitated access, as illustrated in Dickson v. United Kingdom.5 While both critiques are valid, they do not undermine the normative point that gestational modality matters. Recognizing choice in how one gestates highlights the transformative potential of emerging technologies and the relational and regulatory complexities that they entail, emphasizing the need for frameworks that respect autonomy, anticipate ethical challenges, and promote equitable access. Crucially, Romanis emphasizes that her critique is not an argument against facilitating access to technologies that enable gestation. Drawing on Gulzaar Barn, she notes that rights-based justifications are complicated; even if a moral or legal right to procreate existed, questions would remain about the state's obligations to realize it.6 Nevertheless, respecting individuals’ choices remains important. Systemic restrictions on access risk infringing private life or non-discrimination principles, particularly for marginalized groups, and overlook the fact that the mode of becoming a parent can be integral to identity and life planning. The key normative issue is therefore not whether there is a right to gestation, but how access can be structured to enable individuals to realize their procreative aspirations meaningfully. Instead, Romanis proposes focusing on equitable access to gestational technologies, grounded in equality of opportunity and concern over stratified procreation. She critiques the UK's Human Fertilisation and Embryology Acts 1990 and 2008 for privileging ‘biological’ over broader procreative needs, thereby reinforcing biological essentialism and limiting access for marginalized groups. Without targeted social and legal reform, she warns that technologies enabling gestation risk being inaccessible to marginalized groups, particularly those seeking to procreate outside the cisheteronormative ‘biological’ family. Chapter 5, my favourite chapter, explores the implications of emerging gestational technologies for sex and gender, assessing their potential to promote equality. Romanis emphasizes that it is not women per se but people assigned female at birth (AFAB) who bear the burdens of pregnancy, and argues that the discussion should focus on the ‘unsexing’ rather than the ‘degendering’ of gestation to better acknowledge trans and non-binary experiences. She critiques accounts that locate inequality in biological functioning rather than in societal responses, and cautions that technologies such as artificial amnion and placenta technology (AAPT) and UTx are often overstated in terms of their social and legal transformative capacity. While removing gestation from AFAB bodies does not automatically produce equality, Romanis affirms that AAPT and UTx can be morally valuable and practically beneficial, particularly for AFAB individuals and sex and gender minorities, including lesbian, gay, bisexual, trans, and queer (LGBTQ+) communities. Drawing on Shulamith Firestone, she stresses that these technologies alone cannot deliver liberation under existing social conditions, which remain shaped by systemic oppression.7 Their transformative potential depends on broader social and legal reform, and treating them as necessary for equality risks obscuring the equally vital need for reforms in parenthood and responsibility attribution. Chapter 6 interrogates the role of gestation in defining legal parenthood. Romanis explains that under English law, the person who sustains a pregnancy is always the legal mother, reflecting the principle mater semper certa est. While much critique has focused on surrogacy, she shifts attention to the underlying rationale for privileging gestation as the anchor of parenthood, particularly in light of technologies such as UTx and ectogestation. Romanis shows that ‘gestation’ functions legally as a proxy for pregnancy, and argues that expanding gestational possibilities challenges entrenched sexed and embodied assumptions about parenthood. She highlights that UTx in cis men may have greater transformative potential than ectogestation in redefining who can be a mother or father. The chapter persuasively demonstrates that current law is increasingly misaligned with technological and social developments, and calls for a reassessment of parenthood attribution free from biosexed essentialism. This analysis compellingly adds to debates in family law and reproductive ethics by foregrounding how legal concepts of parenthood must evolve alongside gestational innovation. Chapter 7 addresses abortion, emphasizing that no one should be compelled to undertake gestational work unwillingly. Romanis foregrounds bodily autonomy and integrity, arguing that novel gestational technologies such as AAPT do not alter the moral justification for abortion. She stresses that the right to end a pregnancy always resides with the person gestating, regardless of parental intention. Romanis also engages with literature on ectogestation, noting claims that technologies such as AAPT could allow pregnancy to continue without foetal death, potentially changing ethical debates about abortion. She situates these arguments within feminist scholarship, highlighting ongoing critique of claims that such technologies could diminish the moral and political importance of abortion rights. In her conclusion, Romanis reflects on the transformative potential of novel gestational technologies, including UTx and AAPT. She emphasizes that gestation beyond AFAB bodies, or even beyond biological bodies entirely, could challenge fundamental assumptions about identity, relatedness, and parenthood. However, she cautions that social and legal regulation, rooted in biological essentialism and cisheteronormative frameworks, limits this emancipatory potential. Romanis reiterates the importance of conceptual clarity; distinguishing between gestation, pregnancy, and birth and understanding technology as a genus with an array of different species allows a more precise analysis of how these innovations affect lived experiences, social norms, and legal frameworks. Romanis’ book bridges philosophy, feminist theory, and legal scholarship, situating emerging gestational technologies within their socio-legal contexts. She demonstrates how these exciting technologies challenge entrenched assumptions about parenthood, sex, and gender, showing that ethical and legal implications cannot be understood without attending to both embodied experience and normative frameworks. Extending existing scholarship on assisted reproductive technologies, Romanis combines conceptual rigour with applied socio-legal analysis, highlighting the reactive nature of law and the need for anticipatory regulation of technologies that ‘unsex’ pregnancy or externalize gestation. Her analysis of gestation as a legal and social category illuminates how current frameworks limit access, reinforce binary gender norms, and constrain the transformative potential of these technologies. Structured from conceptual foundations to practical application, the book presents a well-researched, well-written, coherent, and persuasive thesis. It makes a substantial interdisciplinary contribution, offering scholars, ethicists, and policymakers a rigorous framework to navigate the evolving intersections of technology, law, and human reproduction.