Debora Spar, a Professor of Business Administration at the Harvard Business School has examined the modern processes of obtaining babies and evaluated them from a business point of view. While avoiding any significant moralizing she has concluded that market forces, greatly aided by modern technology, now dominate essentially all aspects of this industry.

Professor Spar’s basic conclusion is that these free market forces have been highly beneficial so far in developing a useful, amoral, and highly profitable industry but left alone these same forces will develop social inequities and risk situations beyond that which society would find acceptable.

Beneath the thorough and efficiently analytical tone of the book one gets the unmistakable impression of a utilitarian industry enabled by a self satisfying band of wanters who want a child even more than they want a mansion.

This well documented study – there are almost 600 reference notes – examines the businesses – the fertility clinics, the adoption agencies, the drug companies – the governments and government agencies, mostly US but also foreign, and most of all the customers, those anxious would-be parents ready and willing to spend enormous sums to have a child. The history and modern development of each of the components of the industry are described in easy reading detail. Infertility, the clinics, surrogacy, genetic diagnosis and modification, cloning, and adoption are each examined in turn both as a revenue business and as a function driven strongly by consumer demand. The study includes extensive data on prices and levels of availability and regulation in these.

The study points out that, while the “baby business” is a worldwide industry, the United States, as the most open environment for most aspects of the industry, has become its major driving force.

The commercial aspects of the industry, operating with few controls or oversights, has many benefits, not the least of which is enabling the various components to develop in the first place. However these same commercial aspects tend to drive the industry into some murky ethical and legal problem areas. (Many of these, such as sperm banks, started in such problem areas.) To the extent that the “baby business” remains in a free market mode it also has the potential to generate major societal problems such as a disparity of availability between rich and poor as well as the abuse of the poor, especially in foreign countries, for services such as surrogacy.

Professor Spar offers an analysis of four potential policy options which could be adopted by society. She terms these

1- Market forces

2- Prohibition

3- Insurance (My term)

4- Regulation

Left to market forces alone the study believes that the risks and inherent inequities would be too great. Prohibition is out of the question because this genie is already out of the bottle. Insurance (Spar calls this option the “hip replacement model”) would be difficult to extend over all of the suppliers already in place. That leaves Regulation.

At this point Spar chickens out on any specific recommendations but suggests five general principles which could form the basis for what she believes must be resolved by a political debate.

1- Expanded access to information by consumers

2- Equitable distribution of benefits

3- Some version of legal property rights

4- Recognition of the cost impact on society

5- Definition of the extent of parental rights

Overall the book does an excellent job of achieving its stated purpose which is to define "The Baby Business".  What it does not cover is the ethical and long range prospects and consequences of this increasingly tawdry business.