It started out as something simple, and then your comments took it in all these different directions. This is how the question arose: I was reading about QALYs - Quality Adjusted Life Years - and how they may be used in decisions about the distribution of scarce healthcare resources. The idea is that "if an extra year of healthy (ie. good quality) life is worth one [year], then an extra year of unhealthy... life must be worth less than one...[and] the value of the condition of death is zero.(1)" Healthcare is then distributed along utilitarian lines, so as to produce the greatest amount of quality-adjusted life years (as opposed to the greatest number of calendar years).

I asked Mr Bea how many years he would give up for the opportunity to have a child, and he refused to answer. "It's like you're asking me to put a value on having children," he protested.

"It's not like what I'm asking, it is what I'm asking."

"You might as well ask how much money a child is worth."

"I could do that, too(2). Apparently, for example, women place a price tag of three hundred thousand US dollars on male fertility. You're just lucky I have expensive taste. But the problem there is that a grand is worth a lot more to someone with one grand and ten, than to someone with ten grand and ten. Life is a more universal currency."

Until, that is, you post the question on your blog and the first thing everyone says is, "It depends how many years I have left..." I suppose I was assuming a "standard" life expectancy of, say, 80 years. Then again, there's got to be a twenty-year age spread amongst you readers. If I'd included this assumption in my question, would the answers have been skewed by age, with younger readers willing to give up more time? And would this have been because youth places less value on being old, or because age has more to lose? What if I'd asked you to assume you had another forty years, regardless of what age you are now? What if I'd said you were being asked this at twenty? What if I'd had you express your answer as a percentage of the time you have left?

But the complications go beyond concerns over accuracies of measurement. Most medical conditions affect the patient to a far greater extent than they affect the patient's family and friends. Infertility is different - there are the children to think of, and most of us also have partners. Some of you mentioned grandparents - the desire to become one before you die, or to give that gift to your mother and father - but I think it's fair to say these are lesser stakeholders. There will always be lesser stakeholders.

At the extremes, Pamela said she would not have children knowing she was going to die, as it wouldn't be fair to them, and Aurelia, also ignoring her concerns for herself and husband, said she'd be happy just to bring her kids into the world(4). That the same focus can lead to such opposing conclusions is interesting in itself.

The general trend, however, is that most of us would give up at least some of the years of our life in exchange for our parenting dream. Rachel chose to phrase it positively, instead of negatively, but it amounts to the same thing. Bascially, what most people agreed was this: life as a parent is more valuable than a childless life. Well, duh. I mean, we're all here blogging about infertility and how robbed it's made us feel.

Let's examine this result from a distribution of healthcare point of view. It leads us in two very different directions: on the one hand, we should be helping couples to overcome infertility (one way or another), since this will cheaply produce a lot of QALYs throughout society. In other words, if an involuntarily childless year is only worth 0.7 voluntary parenting years, and 12.5% of the population is infertile, the sooner they can get kids, the more QALYs can be produced in society as a whole. In other words, overcoming infertility will arguably, dollar for dollar, raise the general standard of welfare to a greater degree than, say, cadaverous organ transplants. Infertility vs organ transplants. Organ transplants? Infertility(4).

On the other hand, if a young, childless fertile woman and a young, childless infertile woman - with the same life expectancies, aspirations, health complaints and prognoses - both present at the door of an ICU with only one bed, does this mean we should choose to treat the fertile woman, simply because her future life is more valuable to herself? How many times have you heard it said, in the wake of a tragedy, "And the worst thing is she had three kids"? On the other hand, how many times do people also say, "If I go, at least I'll have had the chance to raise my family a bit"? What do these statements say about the value society places on parents vs other individuals?

More importantly, what does it say about you? Pamela explains herself from the point of view of her hypothetical children, but I wonder how much her answer reflects her gradual reconciliation with living childfree? Those willing to give up the most time, on the other hand, were Geohde, M, and Aurelia - 2ww, 2ww, and pregnant after recurrent loss. Invested? Fuck yes. I'd say so. Would their answers be the same if I'd asked them in a break between cycles? I don't know, but I wonder.

When I posed him the question, Mr Bea accused me of trying to put a value on having children. "How many years do you think a child is worth?" he said, in an attempt to turn the tables.

"I'm not sure" I answered, and I was tempted to say both all and none. "Maybe ten years? Fifteen?" I guess I think I'm worth 25-40% more as a parent. That's the thing, you see. In the end, are you really putting a value on your kids? On your desire to parent? Or are you placing a value on yourself?

I want to see what you think of this. I have some further thoughts of my own.


--
1. Beauchamp and Childress, Principles of Biomedical Ethics, 5th Edition, p207. (Back)

2. Financial decisions in the real world of infertility are, of course, complicated by the gambling factor. And then the whole thing is complicated by all sorts of other factors. (Back)

3. Barb also said she wouldn't give any, but her answer revolved around a healthy mistrust of magical creatures instead of thoughts for her offspring. Similarly, there were others who would "give all", but Aurelia was the one who specifically centred her explanation around her children. (Back)

4. I am nakedly making up figures here, but I bet if you collect and crunch the numbers, that's true. Not saying it's right - bald utilitarianism makes me itch - but a lot of people use it to argue against funding for fertility treatment ("the money would be better used...") and I don't believe that's the correct utilitarian conclusion.
**Updated to add - on page two hundred and fifty something, B&C make exactly this point, but using arthritis vs organ transplants. I'm feeling pretty clever over here. (Back)

Before I tell you about how I've started looking pregnant in the past week or so, I want to ask a question about infertility:

Imagine a genie appeared to you out of... I don't know... a bottle of prenatal vitamins. The genie says, "I will grant you your dearest wish! You will have a child! But there is a price to pay - your life will not be as long as it would otherwise have been. I will shorten it by taking some years away from you."

"How many years?" you ask, tilting your head to one side in consideration.

What would an acceptable answer be? How many years of your life would you exchange for the fulfilment of your parenting desires? None? All of them except for a single moment with that baby in your arms? Something in between? I want to discuss this after I see people's answers.

--

"Sort of." Apparently that's what my brain will come up with when caught off-guard by a direct question seeking to affirm my current gestatory status. "Hey, are you pregnant?" "What? Um... Sort of."

I am off-guard, mind you, despite the new maternity wardrobe, the fact that I have twice been offered seats on public transport in the past week, and have only several days left to sort out which scheme will best pay for our prenatal care and delivery. "Sort of." Yes, well done. Feeling I should offer some kind of explanation, I add, "We haven't really started talking about it yet."

My friend nods with understanding, then gently replies, "It looks quite obvious, though."

I guess we'll have to start talking about it soon.

--

Last night I was lying in bed on my back watching my belly, trying to decide if it had grown, or changed shape, or starting wagging school to smoke cigarettes behind the bike shed or whatever, since the last time I looked.

And... it moved. If I'd blinked I would have missed it, but there was this kind of jabbing sensation and the skin poked out momentarily. Funny, I expected a lot of steps between "maybe, unless it's gas" and "holy shit I can see it from here!" Needless to say, I called Mr Bea in and we sat staring at the spot for several minutes, seeing and feeling nothing, until eventually he said, "Well, you know what they say about a watched belly..."

"It isn't hot?"

Which brings me to the other thing. I playfully sat on Mr Bea's lap last week, and he's asked me to refrain from doing so again for the duration of the pregnancy. The way he grunted was quite unflattering. Then, a few days later, he unthinkingly kissed my belly during an intimate moment, and then he got this startled look, like, "Holy crap - that's not the shape I'm used to!" and it completely threw him off his game and we had to start all over again. Despite his protestations, I don't think he finds the bump sexy.

This was further confirmed when he came home drunk from the work Christmas party and tumbled amorously into bed, saying, "Hey babe - shall I go to the twenty-four hour supermarket to get something for you to eat?"

He also seems overly confident that I'm going to be back to my former shape in the future. This week I had to pack away the pre-pregnancy jeans I'd been wearing unbuttoned. "You can wear them again next year," said Mr Bea with confidence. "You think they'll fit?" I replied. "Sure," he said, waving his hand dismissively. "Why not?"

It's lucky I have so much confidence in his ability to look past the superficial. Otherwise I might start feeling insecure.

--

Last thing - I've posted a couple of belly pics up where I put the Vietnam Travelogue earlier this year. It's password protected, but some of you already have access. If you don't, or can't remember what I'm talking about, but want to see, email me. I need your email address to add you. Ultrasound gallery coming later on the same site.

Don't forget the genie question!

I was quite bothered that the Handmaids took on the names of their Commanders (Ofglen, Ofcharles, Offred). Seems so domineering, de-personalizing -- another tool in taking power away from women in Gilead. So archaic, even. Then I realized that we do the same in our culture, but with last names. Does this make it okay? Even women who keep their maiden name (no pun intended) after marriage tend to refer back to their father's name. Do our customs continue to de-power and de-identify women? What would a culture that values the matrilineal look like?

Several couples we know have chosen to combine their two surnames into a new family name, and I think that's ideal - symbolic not only of equality between husband and wife, but of the new family unit which is formed by marriage. Unfortunately, though we toyed with the idea ourselves, we couldn't put together a name that wouldn't have made all our wedding guests snort their toasting champagne out through their noses, so we had to let it go. I, like many of my married friends, am known as "Ms (My Surname)" or "Mrs (My Husband's Surname)", with the former being used 99% of the time*. Only a minority of my female friends go by their husband's surname in day to day life.

But even there lies a big difference between this society and Offred's. Feminism includes the right to submit. These friends of mine - like my mother - have freely chosen to take on that name, and they can choose to keep it. Moreover, all these women keep a name of their own - the first, or given name. Offred is named merely for her current usage, which is decided by the unseen Powers That Be. Not only does the name identify her work, instead of her unique self, but that identity is completely lost and changed each time she is reassigned, and her ability to choose her identity is virtually** removed. Becoming Mrs (Your First Name) (Your Husband's Surname Here), of your own free will, is a very different thing - especially since the role of "Mrs" is so flexible in the modern day.

There should be a passage here about the use of matrinymics in various cultural traditions around the world, and the effect of those traditions in the modern day (preferably with statistics about women's pay, domestic violence, and a comparative breakdown of the roles males and females play both inside and outside the home, etc etc) but I'm going to leave it there, because man, there are enough doctoral theses in that to keep a whole anthropology department going for decades.

*As an aside, I've only found this difficult in the UK. "Ms" wasn't on a lot of forms, and sometimes I didn't even have the option to write it in. Our bank, for example, could never think outside the Mrs/Mr dichotomy. I also found myself having the following conversation when giving details: "It is Miss or Mrs?" "It's Ms." [Wary Look] Whereas at home, or in Asia, I get asked, "Miss, Mrs or Ms?" without the blinking of an eye. It's particularly puzzling, because the Australian and Asian attitudes to marriage are, if anything, more conservative than the modern Brit's.

Most puzzling are the times a British person is heard to say how they want a certificate that legally recognises their relationship - and they describe, as points of inclusion, all the legal rights and responsibilities of marriage, including those which are permanent and ongoing - but they don't want to get married. I always ended up raising an eyebrow and saying, "Sounds like you do." There's probably some connection there with the culture's relative inability to recognise non-traditional name choices.

**She has a sort-of choice, but it's one horrible situation against another.

On pg. 112, during the birth day while Ofwarren is in labor, Offred is thinking about the baby that is about to be born. At this time she also talks about the unborn babies and the fact that they had no way of telling until birth what type of baby would be born. She states: There's no telling. They could tell once, with machines, but that is now outlawed. What would be the point of knowing, anyway? You can't have them taken out; whatever it is must be carried to term. While reading this, I found myself thinking back to my first pregnancy where I wound up with conjoined twins. Then and even now, I wonder if I would've been better off not knowing. I miscarried, so I did not have to make a choice, but in light of that, ignorance may very well have been bliss. How do you feel about the abundance of technology when it comes to reproduction and pregnancy? Do you think that sometimes not knowing so much can be a good thing?

People are fond of saying, "They didn't used to have all this back in the old days, and people got along just fine!" Actually, people did not get along just fine. Women and children died or became seriously, even permanently ill. It's true that much of the time there's nothing you can fix simply by knowing - a lethal defect is still lethal, no matter when you find it out, and a whole host of measurements fall under "wait and see and hope the odds go your way". Some of the people in these situations will be glad just to know, and some of them will regret their loss of ignorant bliss.

But. But. There are also tragedies which can be averted today. Averted because we know about them on time, and can act. So, much as it can be hard sometimes to deal with the overload of information available to us, I wouldn't trade the angst for a single mother or child who might be saved.

On pg. 70, Offred is discussing her past studies of psychology and at this time she mentions a study done on three pigeons trained to peck at buttons for grain. She states: Three groups of them: the first got one grain per peck, the second one grain every other peck, the third was random. When the man in charge cut off the grain, the first group gave up quite soon, the second group a little later. The third group never gave up. They'd peck themselves to death rather than quit. While reading these lines, I could not help but identify with the third group of pigeons. Sadly, I think I've come to a point where I will never give up, even if it means death before success. How about you? Do you identify with one of these groups? What do you think Atwood's intention was in including this bit of information?

This very much explains the way couples can get "trapped" into following a certain path for too long. If results were predictable, the point of moving on would be clear.

Intrigued by the idea of a book tour and want to read more about The Handmaid's Tale? Hop along to more stops on the Barren Bitches Book Brigade by visiting the master list at Stirrup Queens and Sperm Palace Jesters. Want to come along for the next tour? Sign up begins today for tour #9 (The Jane Austen Book Club by Karen Joy Fowler with author participation!) and all are welcome to join along . All you need is a book and blog.

At a certain point this year I figured something out. Life is better if you can learn to be happy with "so far, so good". It's a struggle - it doesn't come naturally, or at least not to me. I have to do things to manage my focus - I have to consciously and demonstrably highlight happy circumstances and events, so making them into something that can't be as easily overshadowed by uncertainty or despair.

A glass of wine for a good result on a recurrent miscarriage exam.

Two mooncakes for a successful transfer.

A special dinner for a heartbeat.

And a good deed for every week that goes by where I still have enough left to give.

Adsense wrote me a cheque for my Fifty Good Deeds campaign, and I feel like the money is ours. You read and clicked, and you helped me get by from one deed to the next. I couldn't have done it without you, so I want you to tell me where the money should go. I didn't raise great, gaudy piles of money, but there's a little over USD $100, so I'd like to donate it to several charities, keeping an international focus. Please leave suggestions in the comments, and if I'm still confused, I'll set up a poll later.

I guess I will often be tempted to worry over the uncertain future. But this week I think I can feel him move, and that deserves some sort of celebration.

--
P.S. Awards Ceremony post at IIFF.

Short Version: Mr Bea brings his sister up to date, and I remember Jester's would-have-been birthday.

Mr Bea told his sister over the weekend. The conversation was definitely due. Because of a complex and tedious array of social interactions, every other member of our immediate families - including both my sisters - is fully up to date with our story except for her, so as you can imagine that's a fair old information gap. The conversation went like this:

Mr Bea: So anyway, here's a piece of news - Bea's pregnant. Eighteen weeks.

SIL: Oh my goodness congratulations! Has everything gone smoothly so far?

Mr Bea: Uh. Well...

---

It was Jester's due date a few weeks ago. I was asked how I feel about it, and I feel ok. In many ways, I think it helps to have The Foetus to focus on - a baby who is here, now, who I can still do something for, and with all the lovely pregnancy hormones to boot - but it's not just that. For every due date that passes, there has been a slight release, as if I have to bring each embryo to term in my mind, if not my body, and once that's done, my responsibility is over. I mean, clearly he's not here demanding feedings or nappy changes - my work must be finished.

I suppose it's the final point at which the loss becomes a reality. Sitting here, even now at 18.5 weeks, I can't quite get hold of the fact that The Foetus is in there. My entire experience of pregnancy is very abstract, especially for those pregnancies which were "biochemical". But not having a take-home baby - that I can't fail to comprehend.

So as each due date passes, something in my mind pulls the last piece of understanding into place. Oh, I get it - it's over. It really is time to move on.