A 21st century reprohub
Since the beginning of the new millennium, the Arab world has experienced unprecedented levels of political violence and disruption. However, against this bloody backdrop, a high-tech reproductive revolution has quietly unfolded. Namely, by the mid-2000s, the Arab world had developed one of the most robust in vitro fertilization (IVF) sectors in the world. To be more specific, among the 48 countries performing the most IVF cycles per million inhabitants, eight Arab nations—including Lebanon, Jordan, Tunisia, Bahrain, Saudi Arabia, Egypt, Libya, and the United Arab Emirates (UAE)—could be counted.
The UAE was an early entrant into this burgeoning field of IVF globalization. The UAE opened its first IVF clinic in a government hospital in 1991, only five years after Saudi Arabia introduced IVF to the Arab Gulf. By 2005, the UAE hosted seven IVF clinics, five of them private facilities. By 2012, that number had doubled to fourteen, twelve of these privately owned.
In my recent book, Cosmopolitan Conceptions: IVF Sojourns in Global Dubai (2015), I take readers into the “womb” of a busy IVF clinic called Conceive, where I met 125 couples from 50 nations and five continents. Most of these couples were transnationally sophisticated, highly educated, dual-income career couples, who had traveled to Dubai to seek IVF in a comfortable, cosmopolitan milieu.
Although this phenomenon of IVF travel has been called “reproductive tourism,” “fertility tourism,” or “cross-border reproductive care” (CBRC), I have abandoned these terms in Cosmopolitan Conceptions, out of respect for my interlocutors, who told me that traveling for IVF was “no holiday,” and that the term “tourism” sounded “gimmicky,” making a mockery of their suffering. Although they were “travelers,” they did not consider themselves to be “tourists,” even in the global tourist hub of Dubai. Thus, I came to think of these globally mobile, cosmopolitan couples as reprotravelers, who were moving across national borders in sometimes desperate quests for conception.
For many of these reprotravelers, Dubai’s well-developed tourism infrastructure was part of the “lure of Dubai” as their destination for reprotravel. There, they could gain easy access to hotel accommodations and could receive month-long visitors’ visas, extendable for up to three months, before they were required to leave the country. By making extended stays so easy, Dubai has rapidly become one of eight major destinations for medical travel within Asia, on par with other global cities such as Bangkok, Mumbai, and Singapore.
Furthermore, within the Middle East, Dubai is home to the region’s only medi-city. Called Dubai Healthcare City, this medi-city is registered as one of 36 tax-exempt free zones in the UAE, a list that also includes Dubai Silicon Oasis, Dubai Internet City, Dubai Academic City, and Dubai Knowledge Village. Dubai Healthcare City, which was initially developed with Harvard University oversight, is said to include more than 100 medical facilities and more than 3,000 healthcare professionals. Despite some setbacks associated with the Great Recession of 2008–2009, this medi-city has become a destination point for medical travelers from around the globe.
This new-millennial development of Dubai Healthcare City, and other more recent “health and wellness” centers cropping up across the emirate, has been undergirded by the international tourism industry, which is now the main engine of Dubai’s economy. As a tourist destination, Dubai is famous for its iconic architecture—including the sail-boat-shaped Burj al-Arab, which is the world’s only seven-star hotel, and the sparkling, stalagmite-shaped Burj Khalifa, which is now the world’s tallest building. However, what attracts most tourists to Dubai is the shopping. With more than 70 malls—including the Dubai Mall, the world’s largest, and the Mall of the Emirates, with its mind-boggling indoor ski slope—Dubai has been called the “shopping capital” of the Middle East. It is a veritable mecca of consumption, with shoppers coming from around the world, as well as from other countries in the Arab Gulf.
Given Dubai’s “brand” as a global shopping paradise, it was the eighth most visited city in the world in 2012 (thereby displacing Rome), and at the top of the top-ten “destination cities” in the Middle East and Africa, according to a Forbes survey. Despite the currently bleak prospects for tourism and travel in other parts of the Middle East, Dubai has flourished as the region’s most iconic destination point in new global tourism and medical travel trajectories. There, in the Middle East’s most global city, healthcare delivery to patients from many other countries has, in fact, become an increasingly profitable form of Emirati statecraft.
In late 2016, I returned to Dubai to revisit Conceive, where I observed scores of infertile couples coming to the clinic from Africa, Asia, Europe, and other parts of the Middle East. I also saw Emirati patients, some returning to show off their IVF children to the clinic staff. Wearing different national garb, speaking softly in different tongues, having traveled from vastly different geographical locations, these infertile patients had nonetheless found Conceive and were there on a bright Friday morning—the beginning of the Emirates’ weekend—to make their test-tube babies.
Conceive, I would argue, provides an excellent example of 21st century medical cosmopolitanism—a feature of healthcare delivery in a small, but growing, number of global cities. With more than 20 staff members hailing from the Middle East, Africa, South and Southeast Asia, and Western Europe, Conceive practices a kind of global gynecology, making infertile patients from abroad feel comfortable with the high quality of its IVF services and with its multicultural patient care, delivered in multiple languages, including Arabic, English, Hindi, Tagalog, and Urdu. These reprotravelers are often fleeing from home countries where IVF services are either absent, inaccessible, ineffective, illegal, or even harmful. Thus, by coming to Conceive, they hope to enact their test-tube baby-making in a safe and medically cosmopolitan milieu, where clinicians can deliver IVF care across national, ethnic, religious, and cultural boundaries. And, although IVF at Conceive and other UAE IVF clinics is relatively expensive—at nearly $6,000 per IVF cycle, versus the $3,500 global average—it is still less than half the cost of IVF in the US, where a single cycle averages $12,513 and the actual costs of making a test-tube baby are much higher, at $41,132 per live birth. Thus, Americans, too, are becoming reprotravelers, heading to places like Dubai in search of safe, affordable IVF.
As I argue in Cosmopolitan Conceptions, Dubai has become a global reprohub, sitting squarely in the center of a reproscape—a world of assisted reproduction in motion, characterized by new global reproflows of actors, technologies, and body parts. Having never encountered a medically cosmopolitan reprohub until I reached the global city of Dubai, I would encourage other medical anthropologists to follow suit, exploring the landscapes of reproductive mobility, medical transnationalism, and cosmopolitan healthcare delivery in the other booming metropolises of the global South.
Marcia C. Inhorn is the William K. Lanman Jr. Professor of Anthropology and International Affairs at Yale University. A medical anthropologist focusing on gender, religion, and health in the Middle East, Inhorn has conducted numerous research projects on the social impact of infertility and the emergence of assisted reproductive technologies to overcome both male and female infertility. She is the author of five books on the subject, and the editor of nine volumes on medical anthropology, gender, and health.
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