2014 Faculty Research Grant Awardee: Dr. Joanna Mishtal

Dr. Joanna Mishtal is one of the recipients of the Miami-Florida European Union Center for Excellence’s (MEUCE) Faculty Research Grant. While settling in the U.S., Mishtal became interested in the politics of healthcare, especially reproductive health. She began to draw comparisons to the system in place in the U.S. and in her native Poland. The questions which emerged from her comparisons formed the basis of her doctoral work in anthropology. With the grant money, Mishtal researched the regulation of Assisted Reproductive Technologies (ART) throughout the European Union. In a recent email interview, MEUCE had the opportunity to ask Mishtal a few questions about her research.

MEUCE: How did you get the idea for your research question?

Mishtal: “For the new 2014 research project, funded by the EUCE, I wanted to better understand what are the main barriers and potential strategies to harmonizing ART regulation across the EU, from the perspective of key European public health stakeholders. To offer a bit of background about what is happening there: The use of infertility healthcare—known as Assisted Reproductive Technologies (ART)—in the EU has grown dramatically in the last 20 years, and is expected to rise further. This is mainly due to the fact that we have seen a steady fertility decline in Europe, i.e., women and couples are having fewer and fewer children. At the same time, people are postponing having a child until they are in their late 30s or 40s, which can lead to what is known as age-related infertility. This, of course, can (thought only in about 30% of cases) be remedied by infertility treatments or ARTs. ARTs now offer a wide range of possibilities but not without cost—these procedures involve incredible amount of physical, psychological and financial strain and hardship. They can also be unsafe as recent studies are starting to show and might be associated with an increase in, for example, certain type of hormone-related cancers in women who have been exposed to ARTs… In 2004, the EU released The Tissues and Cells Directive to harmonize regulation, requiring nations to control harvesting and storage of human tissues, and declaring ART oversight as necessary to protect public health through improved safety of clinical standards across states…A Europe-wide study shows that the less expensive and unrestricted ART services offered in Eastern Europe attract growing “infertility tourism” especially from the UK, Germany, and Italy…This issue is even more pressing with the 2013 Cross-Border Health Directive, which allows EU citizens to seek healthcare in other states and have costs reimbursed by their home nations.

My project this summer examined how the European Society of Human Reproduction and Embryology, one of the largest reproductive health organization in Europe, and European Society for Contraception and Reproductive Health, one of the key public health organization in the EU focusing specifically on reproductive health, is dealing with the growing ARTs tourism and the lack of regulation in many of the member states.”

MEUCE: How do you hope your research will contribute to the field of public health?

Mishtal: “There is certainly a great need to understand the barriers and potential strategies available to the public health community and EU policy-makers to harmonize ART regulation and to ensure the quality and safety of private sector care. My preliminary results show that this issue is indeed of great concern in the EU health community, but the key actors, such as the ESHRE and ESC organizations, are not always empowered to dictate or monitor whether any ethical guidelines are in fact followed in nations like Poland where no regulation exists. Nevertheless, my findings show that there are growing efforts at the level of the medical community to open a debate about how regulation can be promoted, in particular through an entry point of voluntary reporting from the unregulated clinics in Eastern Europe. This is a challenging and complicated task, but my work this summer also reveals that the local non-governmental organizations might offer an excellent leverage element at the local level, because of their growing role as patient educators. Educating ARTs patients about best practices and ethics in ART procedures might be an effective way of forcing ‘ethics and regulation from below.’”

MEUCE: What are your future plans for your research?

Mishtal: “I hope to continue this important research project and expand it to include the regulatory efforts taking place directly in the EU institutions in Brussels and Strasbourg. This issue of unregulated ARTs and the questions and concerns it poses for the EU policies is one that will only grow in urgency and relevance, as the EU debates are already showing.”

To read the original interview please click here.