Artificial wombs have the potential to help premature babies, but does the technology threaten body autonomy?

At first glance, it looks like a lamb trapped inside a plastic bag.

But this photo, first published in science journal Nature in 2017, marked a scientific breakthrough.

This foetal lamb was one of two used in a US study to determine if an artificial womb like this could support an extremely premature newborn animal.

According to the researchers, both foetal lambs were able to survive an additional four weeks in these liquid-filled "biobags".

So far, all trials on artificial wombs have only used animal subjects.

But in late September, independent advisors to the US Food and Drug Administration (FDA) met over two days to consider the possibility of human trials in artificial womb research.

They discussed the technology's potential to assist extremely premature infants born before 28 weeks gestation. A birth before 37 weeks is considered preterm.

In Australia, more than 26,000 preterm births occur each year. In 2020, 564 infants born between 22 and 35 weeks' gestation died in their first 28 days of life.

According to the World Health Organization, complications resulting from preterm births are the leading cause of death for children aged under five globally.

The FDA has not made an official decision about human trials of artificial wombs, but the advisory committee's meeting is one step closer to using the technology with humans.

And while it has some scientists excited, others hold concerns about the ethics of this technology and the problems it could unintentionally create.

Steps towards 'ectogestation'

Artificial wombs are technological devices that replicate the uterine environment.

Their main application is to support gestation in the event of premature birth. This process is also known as "ectogestation".

Research into artificial wombs has existed for decades, but recent trials specifically centred on artificial placentas have progressed the technology.

An artificial placenta is intended to provide oxygen and nutrients to an infant born prematurely, the same way the placenta would in a natural womb, but in an external environment.

One long-standing challenge in artificial placenta research has been addressing the risk of infant brain bleeding.

Using an artificial placenta would require an infant taking blood thinners, and for extremely premature infants, blood thinners increase the risk of brain bleeding.

But this year, researchers at the University of Michigan who were testing on sheep made a breakthrough and developed a way of using artificial placenta that didn't rely on blood thinners.

Matt Kemp, the chief scientist of the Women and Infants Research Foundation, says artificial placentas are designed to "make use of the foetal anatomy and physiology, as opposed to trying to fight against it".

In 2019, he was part of a team of Australian and international researchers that recorded normal foetal growth of premature lambs for 120 hours, supported by artificial placentas.

Professor Kemp says innovations such as these, if they were able to be used with humans, could address the limitations in existing technology that supports premature infants.

For example, ventilators can be used to assist the underdeveloped lungs of premature infants, but these can carry a risk of causing chronic lung disease.

'We don't know that it will work'

While artificial womb technology and ectogestation present opportunities for improved health outcomes in premature infants, some have expressed concerns about their use in humans.

Luara Ferracioli, an associate professor of political philosophy at the University of Sydney, says the technology could be used to undermine a person's bodily autonomy and reproductive choices.

Catherine Mills, a professor of bioethics at Monash University, agrees that's a risk.

She says there are concerns about the possible impact on access to terminations of pregnancy, and that "there would be a stronger pressure to use a technology, like an artificial womb, to extend a pregnancy".

But artificial wombs are currently an experimental technology, so there are still questions to be answered about potential harms and long-term risks.

"We don't know that it will work for human foetuses," Professor Mills says.

She's also concerned about issues of informed consent.

"Our clinical trial framework is really set up for participants who are persons ... and it's not yet clear that beings at 22 weeks' gestation are full persons, in the way that we typically attribute moral status."

'A much more valuable way'

Professor Kemp agrees that ethical concerns around artificial wombs are important, but he says criticism needs to be based on "an accurate understanding" of the technology.

He says, for example, the technology is unlikely to ever become very widely applied as it would be "ruinously expensive [and a] very technically demanding procedure".

But he also believes it's important to consider options that could provide improved outcomes for vulnerable premature infants.

He argues that if an adult who was facing death explored all options for survival, "no one's going to criticise you".

"It makes no sense to me that someone might turn around and [criticise the same behaviour] about a very small baby."

Professor Mills believes it's "very exciting that the technology is developing", but notes there are other approaches to addressing premature births, including preventative measures.

For example, the Australian Department of Health states there is a "significant association" between preterm, births and social disadvantage and lower levels of maternal education.

"And I think that's really where we need to be focusing our attention."

She believes artificial wombs are "not going to be a technological solution for everyone".

"It's going to be very high cost. It will be very limited in its possibilities, in some ways. So we just don't know what the benefits of it would be, and what the potential risks of it are," she says.

"I think that preventing premature birth in the first place would be a much more valuable way to go at this point in time."