Social Science & Medicine 67 (2008) 1747–1756

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Social Science & Medicine

journal homepage: www.elsevier.com/locate/socscimed

The fetal tissue economy: From the abortion clinic to the

stem cell laboratory
Julie Kent*
Department of Sociology and Criminology, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom

a r t i c l e i n f o a b s t r a c t

Article history: This paper examines the exchange relationships between women undergoing abortion, the
Available online 22 October 2008 clinicians who procure fetal tissue and stem cell scientists in Britain, and argues that the
fetal tissue economy is an important dimension of the gendered bioeconomy that
Keywords: underpins stem cell science. In so doing it suggests that the path from the abortion clinic to
Britain the stem cell laboratory differs from the route taken by pre-implantation embryos from
Abortion
the in vitro fertilisation clinic in important ways. It reports on a study which included 29
Stem cells
in-depth, semi-structured interviews with stem cell scientists, policymakers, clinicians,
Bioeconomy
Fetal tissue activists and sponsors of stem cell research. The paper explores the meanings attached to
UK aborted fetuses and how women’s relationship to fetal tissue is constructed in the inter-
views, the law and official guidance on the use and disposal of fetal tissue. This is linked to
variability in consent procedures and procurement practices.
Ó 2008 Elsevier Ltd. All rights reserved.

Introduction features of ‘the fetal tissue economy’ in Britain as a partic-

Stem cell science relies on the procurement of human
tissue and cells from a variety of sources including eggs,
embryos, umbilical cord blood, bone marrow, aborted
fetuses, and other tissues from the body. At present it is not
known which source will prove most useful in new thera-
pies to treat disease, or new tools for drug discovery. In
Britain some stem cell (SC) researchers collect and use
aborted fetal tissue.
Once tissue is removed from the body and donated,
medicine and biotechnology mobilize productivity; ‘‘a
tissue economy [ ] is a system for maximising this
productivity, through strategies of circulation, leverage,
diversification and recuperation. An economy is also
a system for adjudicating value; thus a tissue economy
involves hierarchizing the values associated with tissue
productivity’’ (Waldby & Mitchell, 2006, p. 31). This paper
explores the following research questions – what are the
* Tel.: þ44 117 3282356.
E-mail address: julie.kent@uwe.ac.uk
ular set of arrangements for the sourcing, distribution,
governance and use of aborted fetal tissue in stem cell
science? How might we understand the exchange rela-
tionships between those women undergoing an abortion,
the clinicians who procure the tissue and the users of the
tissue, the SC scientists? And in what respects does the fetal
tissue economy differ from ‘embryonic economies’
(Franklin, 2006a)? Following Waldby and Mitchell I suggest
that in ‘the fetal tissue economy’ an unwanted pregnancy is
transformed into a valued research resource. That is to say
a particular form of female reproductive labour is being
reconfigured and SC technologies potentially convert ‘‘the
generative power of female reproductive biology into
regenerative therapy’’ (Waldby & Cooper, 2008, p. 58).
To begin I briefly describe the regulatory framework for
abortion and the use of fetal tissue in research in Britain. I
then describe and analyse the ways in which women
undergoing abortion are constructed as ‘donors’ and how
this differs from understandings of women donating
embryos created in the in vitro fertilisation (IVF) clinic.
These differences may be partly understood in terms of
a woman’s relationship to the ‘dead’ fetus. This in turn

0277-9536/$ – see front matter Ó 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2008.09.027
1748 J. Kent / Social Science & Medicine 67 (2008) 1747–1756
relates to the procedures for obtaining consent. The law
and guidelines on the use of fetal tissue in research mobi-
lize particular constructions of women donors and the
aborted fetus and this influences practices in seeking
consent and the collection of the tissue. I discuss women’s
relationship to the fetus and the ways in which the aborted
fetus is materialized as a baby, mother’s tissue, waste
tissue, a cadaver, an organ donor, a scientific object and
a source of stem cells in the accounts of those interviewed
in this study.
Methods
The study investigated the collection and use of fetal
tissue in stem cell science in Britain. It combined a number
of methods including – analysis of documents and web
based materials; interviews; focus groups; and participant
observation at a range of meetings. Twenty nine interviews
were conducted during 2006 with 34 SC scientists (SS),
policymakers (PM), tissue bankers (TB), sponsors of
research from the public and voluntary sectors (SP), clini-
cians and nurses (CL), activists engaged in either providing
abortion services or opposing the destruction of embryos
(AC). Seven people declined to be interviewed, and some
interviews included more than one person. Interviewees
were selected because they were known to be using fetal
tissue in their work, had responsibilities for policy relating
to human tissue collection or were directly involved in
procurement, funded stem cell research or were opinion
leaders in abortion politics. The interviews were non-
directive and loosely structured, flexible enough to develop
an in-depth conversation with respondents and were
analysed for emergent themes. This paper draws on the
interview data, fieldnotes and documentary analysis.
The regulatory and health care context of the ‘fetal
tissue economy’
Termination of pregnancy is legally permitted in Britain
under certain circumstances. The Abortion Act 1967
provides that a registered medical practitioner may
lawfully terminate a pregnancy that has not exceeded its
twenty-fourth week in an NHS hospital or on premises
approved for this purpose. Two registered medical practi-
tioners have to agree that continuing the pregnancy would
involve risk to the life of the pregnant woman, or injury to
her physical or mental health, or to the physical or mental
health of any existing children. Any risk must be greater
than if the pregnancy were terminated. After 24 weeks, the
grounds for termination are more limited. Abortion law in
Britain may be seen as highly restrictive but liberal in its
operation and there is a broad consensus about the avail-
ability of abortion in the interests of public health (AC1).
The health of the woman, rather than her right to choose, is
embedded within the law. The right to choose to terminate
a pregnancy and autonomy to make decisions about
medical interventions is undermined by current law
(Jackson, 2000; Lee, 2003).
Almost every year the number of pregnancies legally
terminated in England and Wales has increased from just
over 54,000 in 1969 to 193,700 in 2006. At least one in
every three women will have undergone a termination by
the time they reach the age of 45 years. Abortion is carried
out mainly in approved independent clinics before 10
weeks gestation. Medical abortions, which are recom-
mended for terminations in early pregnancy, are on the
increase – rising from 24% in 2005 to 30% of the total in
2006. Abortion is the most common surgical procedure on
women of reproductive age. Most (87%) are funded by the
National Health Service (Department of Health, 2007).
Termination of pregnancy in order to provide tissue for
use in research or treatments is illegal but the collection of
aborted fetal tissue for research is permitted. In 1989 when
there were experimental treatments for Parkinson’s
disease using aborted fetal neural tissue, the Polkinghorne
Guidelines were drawn up to guide researchers. At their
centre were ideas about the need to protect women, from
themselves and from researchers; and significantly,
a particular framing of the fetus as a cadaver (Kent & Pfeffer,
2006; Pfeffer, 2006; Pfeffer & Kent, 2007a, 2007b; Pol-
kinghorne, 1989).
SC research is just one area of the biosciences using fetal
tissue. It is difficult to trace the extent of use of fetal tissue
in research in Britain because no formal records are kept or
publicly available and there is no national oversight of such
research (Pfeffer & Kent, 2007b). So it is not possible to say
either how many fetuses are collected, which laboratories
use them for what purposes, or indeed how many fetuses
are incinerated, cremated or buried. But this study identi-
fied seven laboratories in Britain using fetal tissue for stem
cell derivation and a national fetal tissue collection based at
two further institutions.
Different kinds of donors
In Britain there is strong government support for the
development of SC technologies. In a complementary and
insightful analysis of ‘the IVF–stem cell interface’ Franklin
(2006a) describes attempts to manage the national embryo
supply through processes of standardisation of consent
procedures, co-ordination between clinics and SC centres,
regulatory and governance policies. This contrasts with
a much less tightly regulated or managed system of the
supply of fetal tissue. ‘The special case of embryos’ Franklin
describes is tied to the ‘double reproductive value’ of
human embryonic stem cells (hESCs) that is both biological
and social value, and leads to an examination of transitions
in meaning, value and form. However embryos are just one
source of SCs, moreover they are also used in fertility
research. The route taken by fetal tissue into the SC labo-
ratory is very different to that taken by the pre-implanta-
tion embryo produced in the IVF clinic (Franklin, 2006b).
While the embryo supply is, following Franklin’s analysis,
a strictly regulated, managed economy, the sourcing,
distribution and management of the supply of fetal tissue
are different and in this study significantly women were
seen by interviewees as different. A scientist, who uses both
embryos and aborted fetuses in his research, thought
women donating embryos and those donating fetal tissue
were different kinds of donors:
 J. Kent / Social Science & Medicine 67 (2008) 1747–1756 1749

‘‘.the patients that are coming to infertility treatment are concerns about being the target of anti-abortion activists,
very well informed anyway, they’ve sort of read up about drawing comparisons with using animals for research
IVF and they sort of know that their treatment comes out of purposes. This study showed that arrangements for the
research. So they are motivated to altruistically give collection of fetal tissue varies and lacks transparency
embryos for research I think because of that. While for (Pfeffer & Kent, 2007b).
women for termination, they just want to get the termi-
nation over and done with; they’re not really thinking Fetal tissue collection and consent procedures
about it at all. This is my interpretation, I’m not sure it’s
correct.’’ SS7 SC scientist. Women who have abortion are constructed differently
from other types of tissue ‘donors’. The Polkinghorne
Comparisons between these two groups of potential
guidelines say women should not be given information
donors are fruitful. Current debate on SCs focuses on the
about the specific research in which the fetus will be used
use of ‘spare embryos’ from the IVF clinic (Parry, 2006), left
because it might influence their decision to terminate the
over from IVF treatment or prenatal genetic diagnosis
pregnancy (Polkinghorne, 1989). It was thought that they
(PGD) and the use of donated eggs from healthy women for
might have an abortion in order to donate the tissue for
SC research (Wainwright, Williams, Michael, Farsides &
research so they were denied the right to information
Cribb, 2006; Williams, Wainwright, Ehrich & Michael,
about how tissue would be used. This is out of step with the
2008). Issues around the destruction of the embryo in
notion of informed consent which remains problematic in
research, the embryos’ potential for life, the need for
this context and there is confusion about what kind of
informed consent and the health risks to women of ovarian
information women should be given (Pfeffer & Kent, 2006).
stimulation have received attention (Human Fertilisation
The separation principle enshrined in the Polkinghorne
and Embryology Authority, 2006; Parry, 2003). There are
guidelines says that there should be separation between
key differences between the IVF clinic and the abortion
the woman and the researcher, and separation between the
clinic in terms of both the aims and services provided. I am
decision to terminate the pregnancy and to donate the
unable to assess women’s reasons for donating fetal tissue
tissue. This was to protect the women from any undue
directly because women donors were not interviewed in
pressure from researchers to have a termination. So in most
this study. But the scientist above sees the women in the
cases ‘research nurses’ are employed to talk to women
IVF clinic as well informed about infertility treatment and
about giving the tissue for research after the decision to
research in the area and as part of a community of patients
terminate the pregnancy has been reached. The nurses are
committed to advancement in treatments and therefore
not directly involved in the woman’s care but mediate the
more likely to want to contribute to research. He also
relationship between the women and the research team.
suggests that IVF patients are altruistic. In contrast, rather
They described how some women didn’t want to know
negatively, he sees the women in the abortion clinic as ‘not
what happened to the fetus or details of how it might be
thinking’ and ‘wanting to get the termination over’ with no
used.
long-term commitment to either abortion care or research.
One scientist had collected fetal tissue from 800 women
The circumstances of the women and the context of the
over 6 years. He said the research nurse selected out
abortion clinic are distinct from that of the IVF clinic. Access
women who might be too distressed to ask and though
to IVF services is limited by patchy public provision, the so-
women seldom wanted a lot of detail the team felt they had
called ‘postcode lottery’, and the ability to pay (BBC, 2007;
to give certain information about their research.
Pfeffer, 1993). The supply of embryos relies on the avail-
ability of ‘surplus’ embryos that couples (both the woman ‘‘.from the surgical termination, list. It’s yes I want to help
and her partner) donate following IVF treatment. The or no, this is just too. I want to blank this whole kind of
possibility of stem cells being derived from the embryo can thing out in a way. And so the reason why I come back to
be expected to carry very different meanings and signifi- saying about people who are upset is from the women who
cance for them. For women undergoing abortion what is say yes, and it’s a, some good can come of this. We’ve come
important is that the fetus no longer continues to exist to realise, we’re actually a significant part of the grieving
(Pfeffer, 2008) but little is known about why some women process in this.’’ SS2 clinical scientist.
agree to donate a fetus for SC research or how they view the
Another scientist referred to what he regarded as the
ways in which associated tissue is collected.
large number of aborted fetuses nationally saying it was
Indeed little is known about the use of fetal tissue in SC
better they were used for some ‘beneficial purpose’ than
science outside the scientific community. One well known
not (CL2). For these scientists and, according to them, for
anti-abortion activist interviewed for this study, despite
the women themselves, tissue donation was a way ‘good’
being well informed about the use of embryos in SC
came from an abortion.
science, described the collection and use of fetal tissue as
Women did sometimes ask questions as this research
‘hush-hush’ (AC2). Companies seldom provide information
nurse described:
about the source of fetal derived SCs and obscure their
origins by referring to them as ‘adult SCs’ or tissue specific ‘‘: .They do ask, I have been asked, will the baby once it’s
(somatic) SCs (Kent, 2007). The scientists interviewed had born, is it dead? You know and I’ve also been asked so you
NHS research ethics committee approval for their research, wanna take it’s brain out and use it, you know quite
most were willing to discuss the collection procedure but explicit terminology like that, which I think you know if I
didn’t want their activities advertised. They expressed said to them at the beginning of the discussion, we want to
1750 J. Kent / Social Science & Medicine 67 (2008) 1747–1756
take your fetus’ brain out and use it for research, that’s
a really quite hard thing to ask but if they ask me in that
terminology, I will say yes, because there’s no point in
pussy footing around you know. At the end of the day,
that’s what we are going to do.’’ CL6 research nurse.
She said women talk about a ‘baby being born’ and
express concerns that it might still be alive. She gives them
an information leaflet that explains the procedure and that
the fetus is not alive after termination.
In British law, the fetus is the woman’s tissue and she
has the right to consent to what is done to her body (Pfeffer
& Kent, 2007b). So where the fetus is recognised as part of
her body, her ability to consent to donation or its disposal is
acknowledged. Those working in abortion care are careful
to avoid using the term ‘mother’ to describe the pregnant
woman. But in guidance from the UK Human Tissue
Authority on disposal of fetal remains it refers to ‘mother’s
tissue’, apparently conferring the status of motherhood on
women seeking termination at the same time as attributing
responsibility to them for decisions relating to fetal
disposal (Human Tissue Authority, 2006a, 2006b).
There are then competing views of both the woman’s
relationship to her fetus and of her ability and right to
consent to what happens to her body in law, guidelines and
the accounts of respondents. Where the fetus is acknowl-
edged as part of her body by the law the woman is accorded
a level of autonomy (self determination) and bodily integ-
rity. However, the Polkinghorne guidelines undermine this
autonomy, by denying the woman information about how
tissue might be used in research. In the scientists’ accounts
above, the act of giving the tissue, ‘doing good’, appears to
be seen as an act of redemption and the woman’s status as
a good citizen is recovered by the act of ‘donating’ the tissue
for the public good (see also Ariss, 2003; Hogle, 1999).
Although not permitted under Polkinghorne, the Depart-
ment of Health sanctions the idea that the method of
abortion may be modified to suit the needs of the research
as long as the woman consents and it doesn’t pose addi-
tional risk to her (Department of Health, 2002). Separate
consent for HIV and other testing is needed where the
tissue may be transplanted into patients.
Abortion, risk and tissue quality
What also emerged from the data are a number of
diverse views of women. Women seeking abortion are
sometimes represented as ‘out of control’ of their lives and
themselves and morally suspect. Rather than unwanted
pregnancy being seen as part of the everyday life of thou-
sands of women, ‘certain types’ are assumed to end up in
the abortion clinic. One clinician suggested that there were
different kinds of risk of transmissible disease associated
with different populations, and important differences
between women who have abortion and those who don’t.
She referred to different ‘risk populations’, explaining that
with other types of organ donation for transplantation,
donor selection, screening and risk assessment are criti-
cally important to reduce risks of disease transmission.
While most fetal tissue being collected for SC research does
not need to be assessed in this way where cells will be
transplanted into patients, donor screening and testing is
necessary – for example, cell transplantation for the
treatment of Huntington’s disease. She said the risk
behaviour of women seeking termination, compared to
those seeking maternity care (or IVF treatment), means
that fetal tissue is more likely to be contaminated.
‘‘.in the early days when anonymous screening for the
prevention of HIV was undertaken, it was done in obstetric
units with antenatal women and it was also done, as
a separate study, anonymous HIV prevalence was also done
in abortion clinics. And the two populations were very
distinctly different, the risks were different. And I think that
shows that the populations vary probably not only in that
particular respect that was looked at, but in others. One
would imagine that a woman who was attending an
antenatal clinic and a woman who had chosen to attend an
abortion clinic might have different backgrounds and
different behavioural risks and perhaps different epidemi-
ology from other points of view.’’ TB3 clinician
She suggested that procurement of the tissue needed to
comply with good manufacturing practices, and that the
need for training in donor selection was of critical impor-
tance if cell lines were to be used in transplant therapies.
For her, the conditions of procurement raise important
safety issues:
‘‘So the big item first of all being, how would one obtain
such material in a way that was bacteriologically safe?
Because tissue banks spend a lot of time assessing the
bacterial bio burden, as it’s called, on tissues procured in
a non-sterile environment. And I can’t imagine techno-
logically how that is achieved.’’. TB3 clinician
Three key points emerge from this interview. First, that
the behaviour of women is perceived as potentially risky;
second, that the collection process in the clinic increases
risk of tissue contamination; and third, that those selecting
donors and seeking consent are unlikely to be equipped to
carry out a risk assessment. Safety issues have been a focus
of attention in the IVF clinic where embryos are being
collected for SC derivation, but according to this clinician,
the same safety concerns have not been widely discussed in
relation to the procurement of fetuses in the abortion clinic.
Indeed I can confirm that such methods of donor selection
or training of staff seeking consent were not widely
evident. But only one of the teams interviewed were
extracting ‘primary neural cells’ from fetal brain for trans-
planting into patients with Huntington’s disease. Screening
and testing of the tissue itself was being carried out and
viral screening of the ‘maternal donor’:
‘‘We screen for HIV, for syphilis, HTLB1, CMB, toxiplasma.
So those are the ones we screen the maternal donor for. So
once we get to that stage we also ask them to self-exclude if
they think they’re at risk of HIV. And that’s done using. I
don’t know if you’ve donated blood recently but when you
donate blood you get a self-exclusion questionnaire that
you do. So in other words you know, have you been
exposed to someone who has HIV? Have you slept with
someone of the same sex? Have you had sex in Africa? You
know those sorts of questions.’’ CL5 clinical scientist
 J. Kent / Social Science & Medicine 67 (2008) 1747–1756
Despite recognising that fetal material is bacteriologi-
cally contaminated it is seen as having a high value as
transplant material (Kent, 2007). The risk assessment, by
adopting the method used for screening of blood donors,
creates links between the women’s sexual behaviour, their
health status and donor suitability. Overall what emerges is
a view of women undergoing abortion as potentially high
risk donors, whose behaviour and personal history need
especially careful monitoring, and who produce material
that is both biologically and symbolically contaminated.
Different kinds of scientific objects
A set of diverse objects and tools are used in SC science.
In her analysis of the use of embryos Franklin says
The embryos that form the basis of hES derivation and
banking have a dual reproductive identity: their repro-
ductive past, or pedigree, is determined by their
production in the context of the highly emotive and
labour-intensive process of IVF – a procedure that
usually fails. Their reproductive future, or potential, lies
in the capacity of science to transform the vital power of
individual cells into colonies of regenerative cell-
s..embryonic economies based on the reproductive
value of stem cells ‘in themselves’ both can and cannot be
separated from their reproductive value in the context of
assisted reproduction, where they embody a different
domain or reproductive potential (Franklin, 2006a, p.
73).
The reproductive value of aborted fetal tissue may be
contrasted with this. In utero, the fetus has potential but
terminating a pregnancy destroys that potential. Ex utero
the capacity for reproduction may only be defined in terms
of the potential to transform the tissue into ‘colonies of
regenerative cells’. So the reproductive past of the ex utero
fetus is distinct from that of the pre-implantation embryo.
The context of its ‘production’ and also separation of the
reproductive value of the fetus and its use in SC science is
more clear cut. The ‘fetal tissue economy’ therefore is
characterized by a different set of social relations between
both the ‘producers’ of the source material – the women
seeking an abortion, the distributors – the abortion clinic,
and the users. Moreover, unlike in Franklin’s analysis, the
possibility of a ‘two way model’ or reciprocal exchange
relationships between SC scientists and the women donors
is never raised. No research using fetal tissue is expected to
benefit women seeking a termination.
Most SC researchers using fetal tissue need ‘fresh’
fetuses and therefore make ‘local arrangements’ with an
abortion clinic to provide a continual supply of tissues. If SC
lines can be made then the need for large numbers of
fetuses will be reduced because the cells will be maintained
in culture. At present this is technically difficult so fresh
supplies are needed for the work to continue. Surgical
abortion using electro-mechanical vacuum extraction
‘macerates’ the tissue and makes identification of different
parts difficult. One team therefore uses manual syringe
extraction to reduce this problem. Other teams collect
tissues from medical abortions because they are more
readily available and easier to dissect.
1751
Dissecting tissue and ‘harvesting cells’ is a technically
skilled and difficult work. The fetus becomes fragmented
into different cell types or ‘scientific objects’. Scientists
collect ‘germ cells’ from the gonadal tissue; liver tissue,
neural tissue and mesenchymal SCs. Different under-
standings of what a SC is influence how scientists and
others talk about cells sourced from the fetus (Kent, 2007).
The same fetus might be used to provide a variety of cells
for different research projects or one type of cell. Thera-
peutic aims for the research are diverse but include Par-
kinsons’ disease, type 1 diabetes, Huntington’s disease and
stroke. In some programmes the tissue provides research
tools for comparisons with SCs derived from pre-implan-
tation embryos (hESC). At the cellular level the aborted
fetus has very different characteristics from the pre-
implantation embryo.
So, as Franklin (2006a) describes, the ‘‘new biology () is
not about development and form in the older sense of the
whole organism but about parts. This is a biology that is
about multiplication and reassembly. It is about using the
logic of the system or totality, but applying it to parts,
which in turn are being used to make ‘wholes’’’ (pp. 77–78).
She refers specifically to the growth of hESC lines ‘sepa-
rating reproduction from development in this way is the
most important form of biological control now, at the
outset of stem cell propagation’ (Franklin, 2006a, p. 78).
Stem cell biology dislocates reproduction and regeneration
and the connections between ‘life’ and ‘death’ are ‘remade’
(Franklin & Lock, 2003). Culturing cells from a ‘dead’ fetus
raises especially complex technical and theoretical issues.
Whether or not SC lines may be derived from aborted
fetal tissue is still a contested and disputed practice. Claims
to have ‘conditionally immortalised’ such lines by the
addition of an oncogene, hormone and growth factors
which stabilise the cells, preventing them from differenti-
ating or becoming specialised (ReNeuron, 2003) are
controversial because the potential adverse effects are not
known. The use of fetal SCs in the development of cell
therapies represents attempts to create ‘biovalue’ (Waldby,
2002) and the construction of ‘dead’ fetuses (or embryos)
as waste provides a justificatory discourse, in moral and
economic terms, for creating such value (Ariss, 2003; Kent,
2007; Wainwright et al., 2006). Morgan’s (2002) historical
analysis of the changing claims on fetal remains (in the US)
suggests that notions of fetal remains as waste are not new,
but new forms of social value are attached to these remains
(Waldby & Mitchell, 2006). Fetuses have acquired new
forms of exchange and use value.
Fetal remains as waste from a woman’s body
Once a pregnancy has been terminated, whether by
surgical or medical methods, the fetus is expelled. Surgical
abortion takes place under general or local anaesthetic
using manual or electro-mechanical vacuum extraction.
Medical abortion involves the administration of two drugs,
mifepristone and misoprostol. Choice of method relates to
a woman’s preference, service availability and good prac-
tice for the stage of pregnancy (Royal College of Obstetri-
cians and Gynaecologists, 2004). Leaving aside debates
about the viability of a fetus, fetal tissue from pregnancy
1752 J. Kent / Social Science & Medicine 67 (2008) 1747–1756
loss up to 24 weeks, whether through miscarriage or
induced abortion, may be disposed of as clinical waste and
incinerated (Human Tissue Authority, 2006b; Kent &
Pfeffer, 2006; NHS Management Executive, 1991; Pfeffer,
2006; Pfeffer & Kent, 2007a; Royal College of Obstetricians
and Gynaecologists, 2005).
The woman produces, through the act of abortion,
‘abject waste’. Ariss’s (2003) discussion of waste tissue
highlights how the reproductive labour of women is closely
tied to notions of wastefulness; for example, constructions
of menstrual blood as waste, and women ‘wasting’ eggs and
embryos which have the potential for life, mobilizes
specific cultural values about what their role is and rein-
forces social obligations of women to be productive in
specific ways. Such a view also underpins pronatalist poli-
cies. Following this analysis, women who terminate
a pregnancy are especially ‘wasteful’, and by inference
morally suspect. In her analysis of the use of fetal ovarian
tissue as a source of donor eggs in fertility treatment she
refers to the prohibition of this practice in Britain in 1994.
Some respondents to the HFEA consultation thought
making ‘purposeful use of fetal or cadaveric material which
would otherwise be discarded’ was an opportunity to ‘do
good’, a view also expressed in this study above (Human
Fertilisation and Embryology Authority, 1994 p10; also
cited in Ariss, 2003).
Ariss contrasts the production of waste from ‘miscar-
riage’ and induced abortion saying
Scientific characterization of the process of miscarriage
as wasteful leads to the conclusion that the dead fetus,
which is the product of such a process, is waste. It also
reflects the notion that reproduction is simply another
form of commodity production, and either a new
product, or waste, must be the result (Ariss, 2003, p.
264).
According to her, fetal tissue from induced abortion has
more value than a miscarried fetus because ‘collection can
be timed and tissue received in a sterile environment’
(Ariss, 2003, p. 264). Additionally, drawing on Kristeva and
Cornell’s work, Ariss proposes that ‘if abortion is seen as
abjection, it is one route through which fetal tissue can
come to be seen as waste – it is out of a body and, as
abjected, waste’ (Ariss, 2003, p. 270). That is to say, in
asserting herself and securing her bodily boundaries the
woman produces the fetus as waste but at the same time
‘an ‘I’ has been produced/recognized/reclaimed. However,
the fetal corpse, when seen as abject, is both an object and
a part of one self. As such, it hovers on the borders of
selfhood (Ariss, 2003, p. 270). For Ariss the proposal to
harvest eggs from a ‘dead fetus’ undermines the subjec-
tivity of the woman and her assertion of her bodily
boundaries by creating ‘the possibility of future out-of-her-
own-control bodily connections to the world’ (p. 271). So,
she argues, defining the fetus as ‘waste’ and proposing its
‘use’ as ethical imposes limits on the way in which the
woman imagines and maintains bodily borders. Simulta-
neously, she suggests that the aborted fetus is doubly
abjected because it has been cast out by the woman and
because it is ‘dead’. She reminds us that in Western culture
the corpses of people who have lived are not treated as
waste and organ donation is seen as ‘a memorializing act
for the person who was embodied in the corpse. It is not
seen as a ‘productive’ response to waste’ (p. 275). However,
waste may be seen as having latent value (Waldby &
Mitchell, 2006) and therefore by defining the ‘dead’ fetus as
waste the potential for its re-valuation as a source of stem
cells, and accumulation of biovalue, comes into view.
In the context of this study a view of fetal remains as
waste may be seen as having at least two effects. First it
makes the tissue available for use and second it influences
how the material is handled by the laboratories. For
example the scientist below collected the fetal tissue for
research, dissected it and harvested the cells for their
project in the laboratory and returned the residual material
to the originating clinic for disposal. This was considered
ethically desirable, respectful of the ‘sensitive’ nature of the
material and compliant with the guidelines.
‘‘So basically we disaggregate the cells to some extent
ready for transplantation and then it’s stored here. The
other tissues that are discarded then are taken back up to
the hospital and then re-enter the same disposal route that
they would have done if they’d gone straight from gynae
theatre. So they go back to central pathology and are
disposed of through the route, which at the moment is an
incineration route. And they all have to be clocked in with
all their numbers and everything. So we keep all the
remains separate and they all go back up to the hospital.’’
CL5 clinical scientist
Fetal tissue was disposed of at the hospital but a scien-
tist at another laboratory described how cells, once no
longer needed, are disposed of according to standard clin-
ical waste procedures in the laboratory:
‘‘how do we dispose of our cells when we’ve finished doing
experiments with them? [ ] Well, we just kill the cells with
bleach. You know, and these are cells, these are not
a human being. We kill them with bleach and put them in
an incinerator bag and have them autoclaved and then
incinerated, normal clinical waste procedures’’. SS3
scientist
He distinguishes between what are just cells and ‘a
human being’ as did another scientist who said:
‘‘And so, we receive fetal material.when I put some
hepatocytes, liver cells into culture, they are cells; they are
no longer a fetus. They’re human cells but they are no
longer human in terms of how we understand human life,
they could as well be mouse or rat in terms of they are
hepatocytes, they are cells, primary cells’’. SS2 clinical
scientist
Once cells are extracted from the tissue they are, in this
view, no longer human life but a valued research tool.
The cadaveric fetus as a corpse and organ donor
Although fetal remains are in certain contexts con-
structed as clinical waste and incinerated (Morgan, 2002),
the view of fetal material as ‘just tissue’ was sometimes
unacceptable and has led to guidelines for ‘sensitive
disposal’. These guidelines (like those of Polkinghorne)
 J. Kent / Social Science & Medicine 67 (2008) 1747–1756
construct the fetus as a cadaver or corpse (Kent & Pfeffer,
2006; Pfeffer, 2006; Royal College of Nursing, 2002). A
nurse working in abortion care who was instrumental in
developing them explained:
. just seeing these wee tiny fetuses being put into a sluice.
I thought that’s not right that.
Q: Why did you think it wasn’t right?
A:[ .] I remember reading about the respect for fetuses is
due to its potential for life you know even though it has no
kind of legal status or anything. And I thought about the
women as well, I tried to put myself in her position, if I had
been pregnant and I’d lost the pregnancy for whatever
reason; whether it was a termination or a miscarriage, I
would want to know that that tissue was dealt with
respectfully coz it was still my pregnancy, my you know
potential baby sort of thing. And women had sort of said
that to me as well, you know they’d ask me what happened
to their, you know, what they’d passed if they’d had
a miscarriage and at that point you think what can you
say? You can’t tell them it’s gone to the bin.’’ CL4 nurse
Whether produced by spontaneous or induced abortion,
simply throwing the fetus away in the bin she saw as
insensitive and disrespectful, for her it was neither like an
appendix or a person but ‘in between the two’ and
deserving of respect because it was a potential baby.
So in relation to the aborted fetus contradictory mean-
ings are attached to it as both waste and a corpse (Maynard
Moody, 1995), or something in between. In Britain in the
hospital, the fetus ex utero may be treated as a corpse,
a dead person and, at the discretion of the hospital, it may
be buried or cremated following miscarriage even though
legally it has no status as a person but is ‘mother’s tissue’
(Human Tissue Authority, 2006a; Royal College of Obste-
tricians and Gynaecologists, 2005). ‘Respectful disposal’ has
become good practice and accords a ‘special status’ to the
fetus, acknowledging the moral controversies surrounding
it. Such practices have also been applied to the abortion
clinic, though interviewees said that respectful disposal is
costly and therefore seldom carried out in the independent
sector. Whether women want to be confronted with deci-
sions about how to dispose of the fetus was also ques-
tioned. It isn’t clear just how widespread the practices of
cremation or burial of fetuses are but since most abortions
take place in the independent sector, it seems that the
majority of aborted fetuses are incinerated as waste.
Respondents also drew parallels between the fetus and
an organ donor.
‘‘But if you can develop stem cells from naturally aborted
fetuses then there’s no difference to that kind of therapy or
to any therapy like organ transplants, it’s along the same
lines.’’ AC2 activist in abortion politics
Here the woman is seen as donating a miscarried fetus
in the same way as if she were donating an organ but in the
extract below, her relationship to the deliberately aborted
fetus is seen as distinct from that of someone donating
a kidney.
‘‘I mean that is an element that’s not present for someone
who is killed in a car accident. A person who is killed in
1753
a car accident, they are killed. In relation to having an
abortion, the growing life in the womb is to be terminated
and that’s clearly I think in anybody’s book, a serious
moral decision, the better or least bad decision to make but
it’s a different situation, there is an element not present in
relation to organ transplantation generally.’’ PM1
policymaker
While the moral status of the embryo/fetus is a conten-
tious issue, whether it can be likened to a dead person or
organ donor is also contested. In the first extract, if the fetus
died of natural causes it is likened to a donated organ but
the second interviewee distinguishes between a deliber-
ately aborted fetus and the car crash victim. He suggests
that using aborted tissue is analogous to using the organs of
executed prisoners.
‘‘I don’t see a parallel in relation to either material which
are by-products of surgical operations or which derive
from car accidents or whatever. There is a sort of double
ethical element present in the situation, which doesn’t
seem to be present in those other situations. If there’s any
sort of analogy, it’s related to, putting this in a blunt way, it
will of course be far too crude, but it’s analogous to saying
should we use organs that have been obtained from
executed criminals? Whether it’s again a second ethical
issue in relating abortion to execution by the death
penalty, but that’s a very severe reaction isn’t it?’’ PM1
policymaker
Interestingly here it is the fetus rather than the woman
who is regarded as the organ donor. The woman’s role as
donor disappears from view. The donation of an aborted
fetus is therefore an ambiguous and controversial practice
that is embroiled within the politics of abortion and moral
controversies surrounding the woman’s decision to termi-
nate the pregnancy.
Fetal tissue collection in utero
While most of the research teams interviewed collect
fetal tissue following its expulsion from the woman’s body
one team collect the cells at the time of the termination by
inserting a cannula into the woman’s uterus and the fetal
heart. As this clinical scientist explained:
‘‘So, there are two types of fetal tissue collection. Ours is
very unusual which involves instrumentation prior to the
termination – now maybe they’re asleep because they
can’t change their mind – instrumentation prior to the
termination to allow us to collect SCs, and then the clinical
termination takes place. Whereas many people you talk to,
just run round and fiddle through a bucket and pull out bits
of brain or eyes or pancreas or something and play with it
in the laboratory. Which is different.’’
‘‘In our research we collect blood and things from the fetus
before it dies or as it dies, collection may hasten its death.
But I think we approach that by saying it’s all part of the
termination procedure which has started at the end of
which the fetus ends up dead.’’ CL2 clinical scientist
This raises a number of complex issues in relation to the
collection procedure itself and the ethical dilemmas it poses.
1754 J. Kent / Social Science & Medicine 67 (2008) 1747–1756
In fetal medicine and maternity care the fetus is
frequently regarded as a patient. Women and health
professionals commonly regard it as a ‘baby’ (Williams,
2005, 2006; Williams, Alderson & Farsides, 2001). It is the
construction of the fetus as a patient and ‘work object’
which erases and conflicts with the women, and under-
mines notions of bodily integrity (Casper, 1998). In utero the
fetus is accorded the status of a patient and clinicians and
pregnant women in the maternity unit frequently ascribe
independence to it and interventions are directed towards
assuring its well being.
In the abortion clinic the fetus is a different kind of work
object. Staff try to minimise and counter references to the
fetus as a ‘baby’. Ultrasound to confirm and date the
pregnancy before termination is common practice but
women are not encouraged to look at the screen, nor have
a copy of the picture, nor look at what they pass if they have
a medical abortion:
‘‘Q: Do you call it an embryo or a fetus?
A: Fetus or pregnancy tissue depending on who I’m talking
to.
Q: And what does it depend on?
A: To patients, I would talk if they were having a – at the
moment I only look after women who are having abor-
tions. So I would usually say ‘pregnancy tissue’ to them and
explain to them the procedure. If they were further on in
their pregnancy and they were having a late medical
termination, I would probably use the word ‘fetus’ because
it’s more developed and formed and they need to know
that before they come in for the procedure.[...] because
the fear is if they’re having it done medically that they
could see the fetus being passed, so we kind of encourage
them not to look at anything they pass and to let us look,
but at the same time, have to warn them that it’s not just
a ball of cells, it does look like a wee tiny fetus.’’ CL4 nurse
In this view then the woman who loses a pregnancy
‘miscarries’ a ‘baby’ but a woman having a termination
passes ‘pregnancy tissue’ or a ‘fetus’.
In accordance with the separation principle of the Pol-
kinghorne guidelines most stem cell researchers do not
themselves have direct contact with the woman in the
abortion clinic but, as indicated above, a research nurse acts
as an intermediary. Collection takes place once the abortion
procedure has been completed. In contrast, the method of
collecting SC in utero, though rare, brings the researcher
into direct contact with the woman who agrees to
a different method of abortion. However, in the context of
fetal medicine, this method of collection appears ‘normal-
ised’ as this clinician explained, linking his daily clinical
practice and research:
‘‘..the standards for doing anything therapeutically to
fetuses are very high, you can’t do anything more than
trivial risk yet you’re dealing with conditions that have
a huge mortality and morbidity rate.’’ [.] And that’s why
most fetal research is probably done without ethical
permission, starting off with someone just trying some-
thing semi-experimentally, but not in a research sense, in
extremis trying to do something that might save a baby’s
life. And they do a few cases and it seems to work, so they
just start doing it. There’s a strong history of that in fetal
medicine.’’ CL2 clinical scientist
The clinician slips between ideas of the fetus as a baby
(subject) and as experimental object. The experimental
nature of fetal medicine (Casper, 1998) provides a particular
kind of context for the collection of SCs in utero where
penetration of a woman’s body and interventions which
require cannulation of her uterus are commonplace.
Conclusions
At the beginning of this paper I set out to explore the
features of the fetal tissue economy in Britain, to under-
stand the exchange relationships between women who
have an abortion, those who procure and use fetal tissue in
stem cell science, and to explore how an unwanted preg-
nancy is transformed into a valued research resource. I also
wanted to draw out some comparisons between the fetal
tissue economy and ‘embryonic economies’ and draw
attention to a different group of women who are enrolled in
stem cell science in order to suggest that fetal tissue use is
another dimension of the gendered bioeconomy under-
pinning SC science (Waldby & Cooper, 2008).
There are then a number of key features of the fetal
tissue economy in Britain and a number of comparisons
that can be drawn between the fetal tissue economy and
‘embryonic economies’. First, abortion is a common
procedure strictly regulated by law and abortion in order to
provide fetal tissue for research is illegal. It is permitted for
fetal tissue to be used in research and there are guidelines
for researchers but these have been interpreted in different
ways and there is local variation in the kinds of information
given to women asked to donate tissue to stem cell science.
There has been no national oversight of research using fetal
tissue and, outside the scientific community, little is known
about the numbers of fetuses collected or their value to
stem cell science. The extent to which women should be
given specific information about the use of the tissue in
research was a matter of concern and confusion amongst
scientists who thought that the Polkinghorne requirement
of general, that is non-specific, consent contradicted good
practice in other areas such as the collection of embryos for
SC research. The notion of informed consent therefore is
problematic in this context but there were also suggestions
that some women might not want to know what happened
to the fetus after the termination. Research nurses act as
intermediaries between the abortion clinic and the
researchers in the laboratory. In contrast, as the work of
Franklin and others testifies, there have been concerted
attempts to develop national standards for human
embryonic stem cell derivation and banking and ethical
protocols for patient information and informed consent
(Franklin et al., 2008). The supply of embryos for stem cell
research is more strictly regulated and centrally managed.
Second, women who have abortion and those under-
going IVF treatment were seen as different kind of donors.
The former were perceived as more likely to be engaged in
‘risky’ (sexual) behaviour and to produce material that is
both biologically and symbolically contaminated. Donation
was thought to be a way of redeeming them as good
 J. Kent / Social Science & Medicine 67 (2008) 1747–1756
citizens but also to potentially assist with grieving around
the termination. There was no evidence of expectations
that research would benefit women undergoing abortion,
or of reciprocal exchange relationships like those in IVF
clinics described by Franklin. But while it was suggested
that, in contrast to women in IVF clinics, women under-
going abortion had no long-term commitment to either
abortion care or research, the reasons why some women
will donate fetal tissue were largely unexplained by the
data collected in this study.
Third, women’s relationship to the aborted fetus was
seen as different in important respects to that of the couple
in the IVF clinic making decisions about the fate of their
embryos. Legally the fetus is the woman’s tissue, or
‘mother’s tissue’ – a part of her body. It has no separate
legal status but despite this could be viewed as a corpse
deserving of the respect of a dead person and disposed of
by cremation or burial, and tissue collection was sometimes
seen as like organ donation. Specific practices of ‘sensitive
disposal’ which takes place in some, though not the
majority of, abortion clinics was linked to particular notions
of respect for the fetus as having a special status. Although
most abortions take place in the independent sector, the SC
scientists interviewed have local arrangements with NHS
hospitals in the public sector to collect tissue. Most collect
tissue following surgical abortion, though medical termi-
nations may produce a fetus that is intact, which has some
technical advantages. At the same time the notion of fetal
remains as ‘clinical waste’ shaped policy and practices
relating to disposal of tissue in the hospital and laboratory
by incineration. While the pre-implantation embryo is
afforded a high level of protection under the law, the dead
fetus has both a different legal status and is assigned
different meanings which in turn shape practices in the
abortion clinic and the laboratory. Both the context and
character of the exchange relationships between women
donating fetal tissue in the abortion clinic and those
procuring and using the tissue are distinct from those
relationships which characterize the ‘IVF–stem cell inter-
face’ (Franklin, 2006a).
Fourth, the fetus is a source of diverse cell types and has
a range of potential uses and was regarded as a highly
valued biological resource (as are pre-implantation
embryos). The discourse of ‘waste’ provides both a justifi-
cation for using the fetus and a means of releasing its latent
‘biovalue’ (Waldby & Mitchell, 2006). The fetus has
a reproductive past that is distinct from that of the pre-
implantation embryo, in so far as it is a product of sexual
relations. Its reproductive value, once a pregnancy is
terminated, may only be defined in terms of the potential to
transform tissue into regenerative cells. Women’s labour in
‘producing’ an aborted fetus and making it available for
research is also distinct from that of the woman undergoing
IVF treatment. Conceiving, carrying a pregnancy even for
a short period and undergoing elective termination are
quite different corporeal and emotional experiences for
a woman compared to undergoing IVF treatment and
having to make decisions about the future of pre-implan-
tation embryos. The path from the abortion clinic to the
stem cell laboratory is one which deserves to be better
understood and taken account of in discussions about the
1755
ways in which stem cell science transforms the connections
between death and life.
Acknowledgements
ESRC grant Res-340-25-002. Thanks to the interviewees,
Geraldine Kinsella for transcription work, the anonymous
reviewers and Klaus Hoeyer for their helpful comments.
Naomi Pfeffer collaborated on the project, was involved in
the design and collection of data, data analysis and com-
mented on drafts of this paper. An earlier version was
presented to the BSA Reproduction study group in
December 2006.
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