Art Review by Ellen Wright Clayton, MD, JD

Rosaline E. Franklin Professor of Genetics and Health Policy, Professor of Pediatrics, Professor of Law, Director of The Center for Biomedical Ethics and Society at the Vanderbilt University Medical Center

Motherhood is about caring and connection. Recent developments present new challenges to this fundamental institution. Some of the developments are social. Women have always cared for other women’s children, especially since women until recently frequently died in childbirth.  Women historically confronted pregnancy, labor, and delivery with no small amount of fear.  Literature is full is stories about stepmothers, some of whom were wonderful, and a hopefully exaggerated proportion who were not. In today’s society, with divorce and remarriage, children often have two or more mothers at the same time, which can stress notions of the unitary family that characterize our society’s dominant discourse. Other developments are scientific. New technologies can enable pregnancies that otherwise would not occur.  Conception can be separated from carrying and birthing. The fetus can be visualized during pregnancy. Baby’s first picture is often a sonogram. And while blood ties have always had particular social salience, increased understanding of genetics has t ended to make them even more important. Not so long ago, efforts to establish paternity depended on whether the child looked like the father. Now the relationship can be established with certainty, using a blood sample or a simple swab of the inside of the cheek.

The artists in TAKE CARE explore the ways that social and scientific developments influence our understanding of motherhood, of connection and caring.  Sometimes, new knowledge of connection is beneficial. Take the case of mitochondrial DNA, the focus of Annette Gates’ work.  Unlike most of our DNA which comes from both parents, the DNA in mitochondria, the energy sources of our cells, comes entirely from our mothers. As a result, we are connected directly with our mothers, and their mothers, through generations. Maternal inheritance became important after hundreds of young professionals and dissidents were “disappeared” by the military regime in Argentina in the late 70’s and early 80’s. Their children were confiscated and placed in new homes, seemingly without a trace. But the grandmothers, the abuelas, enlisted the aid of Mary-Claire King who used the mitochondrial DNA to identify and return their grandchildren.

But the supremacy of genetic connection is not always so benign. New reproductive technologies allow many to overcome infertility, but often at a steep price. Some women experience the process of hyper ovulation, egg retrieval, and pharmacologic support of gestation as alienating, as transforming them into the objects of the medical gaze.  Jeanette May’s at times almost comical images of eggs serve as a counterpoint to quotidian pictures of women and sonograms. And yet women pursue these procedures specifically to create a family with children to whom they are biologically connected. Notably, while some women use donated eggs so that they can have the experience of gestation, it is far more common for women to implant and carry to term embryos created with their own eggs, evidencing the importance of genetic connectedness.

Our laws often enact the primacy of genetic connections. A number of courts have ruled that gestational surrogates, women who carry embryos created using the egg of another woman, usually the woman in the couple who commissioned the surrogacy, are not “mothers” of the resulting children and so have no basis on which to seek custody or contact. In these cases, the experience of pregnancy, with its risks,

discomforts, and obviousness, simply disappears as a matter of law.  Monica Bock’s inclusion of bits of umbilical cord, amniotic fluid, and the amniotic sac into dustpans perhaps symbolizes gestation as waste, of women as fetal containers. In our legal system, children are permitted to have only two parents no matter how many adults play a role in their lives, and those two parents have supremacy over all the others. In blended families, where the genetic parents separate from each other and then form new relationships, the new adults – the stepparents – can struggle to define their roles as parents, particularly as against the genetic parents whose claims once cemented by a modicum of nurture persist unless severed by abandonment or abuse. It is rage against the iconification of the genetic link that Kristina Arnold explores in her work. In her Drip installation, red glass pieces encased in hastily stitched plastic covers, protrude from the wall.

While behavior is almost surely the product of complex gene environment interactions, much effort has been devoted recently to dissecting the genetic contributions. Several years ago, for example, Caspi and his collaborators demonstrated that children with a particular genetic variant who were seriously abused during childhood were more likely to have serious behavior problems as adults. Such findings can be used in a variety of ways – to identify children who need special protection (although all children deserve a safe home), to identify druggable targets for treatment, to undermine the inadequate mothering explanation for children’s problems. Each of these uses raises its own ethical and policy challenges. As light dancing on Obermeyer’s beadwork shifts one’s perception of the work, so might new findings shift our understanding of behavior.

For millennia, women have worried that their children would be born with something visibly wrong. The ability to visualize the fetus using techniques such as ultrasonography and MRI has transformed pregnancy, providing the potential to make these fears concrete. These technologies can and often do provide reassurance, which is one reason ultrasound has become routine. At times, however, they reveal variations, some of which resolve but many of which are serious problems, leaving women with decisions about whether to continue the pregnancy, whether to undergo fetal therapy where possible, or whether simply to prepare for what may lie ahead. These concerns are represented in very different ways by Sadie Ruben and Libby Rowe.  Ruben represents the fetus as alien, strange, frightening, floating in liquid evoking amniotic fluid within the womb, taking over the woman’s body. Rowe’s malformed sock monkeys, by contrast, suggest that we are meant to accept and love children no matter what their challenges.

Finally, some of the artists comment on the technology itself. Sher Fick celebrates pharmaceuticals, which allow her to live. Her pill bottles are covered with fabrics, many of which show story book characters from our childhood.

Adrienne Outlaw intersperses colorful scientific videos of the embryonic heart and blood flow using such techniques as confocal microscopy with pictures of the dailyness of mothering and taking care – breastfeeding, snuggling, nurturing. The science is spectacular, but which is the more wonderful?