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Global babies: who benefits?

Children
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Surrogates in India, such as this woman, carrying a child for a couple in the US, earned around $6,000 for each pregnancy until the government banned it in August 2016. © dpa picture alliance/Alamy Stock Photov

❛Luke and Tony are a professional couple living in Sydney. After registering their civil partnership, they decided to start a family. With money no object, they purchased an online ‘egg catalogue’ listing the origins, age and mental and physical characteristics of potential ‘donors’, and decided they would like a baby with ‘Swedish’ features: ‘blonde, blue-eyed, strong and sporty’. The couple signed up with a surrogacy agency that recommended an Indian surrogate to carry the baby, but three months down the line, having spent around A$3,000 ($2,265), they shelved the idea and bought a puppy.

Then came Tony’s 40th birthday and the desire for a family resurfaced. The couple got in touch with a new agency and soon committed to using the services of an egg donor in New Zealand/Aotearoa and a surrogate in Thailand. The eggs arrived, were fertilized by both men and the resulting embryos swiftly frozen and flown to a small town south of Bangkok. Here, at a designated clinic, the embryos were thawed and implanted into the uterus of the surrogate. Two weeks before she was due to give birth, they flew to Thailand and, in 2013, Grace was born. She has since gained a brother using the same egg donor but born from an Indian woman in Nepal.❜

Luke and Tony’s story was told to me by a friend of the couple whose path to parenthood, with their permission, I have followed over the past three years. In some ways it is a heartening illustration of how far some societies have come in terms of sexual equality. Other aspects are deeply disturbing.

Wider acceptance of different family structures and advances in assisted reproductive technologies (ARTs), such as IVF and egg-freezing techniques, have led to unprecedented opportunities for same-sex partners, single people and couples with infertility to create a family of their own. Although most countries prohibit the practice of ‘outsourcing the womb’, a few exceptions have enabled it to flourish as a lucrative component of the global fertility trade. California leads the way, but the costs are ruinously high. Consequently, surrogacy agencies, mostly based in the US, Australia, Europe and Israel, have transferred their attentions to lower-income countries such as Ukraine, Mexico, Greece, Nepal and, until recently, India.

For nearly 15 years, a thriving privatized medical sector, a weak regulatory infrastructure and low-cost services rooted in the availability of cheap female labour made India the most popular surrogacy destination. There are no exact figures, but comparisons over the years suggest that before the government suddenly imposed a ban on all commercial surrogacy in August 2016, the arrangements referred to by one doctor as ‘maid business’ constituted a significant proportion of India’s billion-dollar medical tourism industry.

Winners and losers

So who gains and who, if anyone, loses? The main beneficiaries, of course, are the intended parents. By and large their motives are straightforward: a desire for parenthood otherwise denied them through infertility or some other medical condition and, for gay men, the constraints of human biology. Above all, they wish to take home a child with whom they are genetically related, and those who can afford it have been known to pay over $100,000 for the privilege.

For the online services, fertility clinics, recruiters, lawyers and other intermediaries that broker these arrangements, there are considerable profits to be made. But what about the women, the gestational surrogates and egg donors who provide the bodily ‘bits and pieces’ that make this process possible?

Depending on the location and number of embryos involved, a surrogate in India and Nepal receives around $6,000, rising to $20,000 paid to women in North America. While altruistic motives are encouraged, for most women who sign up to carry and give birth to another person’s child the incentive is financial: in parts of Asia, $6,000 can represent more than an entire family’s income over several years.

Egg ‘donors’, too, are driven by monetary gain. As Rene Almeling describes in Sex Cells, US college newspapers routinely advertise for candidates who, depending on their physical and mental characteristics, can earn anything from a few thousand to tens of thousands of dollars.

Surrogates and donors are seldom fully informed of the health risks involved. Long before the potential hazards of childbirth, surrogates have to endure the side-effects of the drugs ingested in embryo transfer. Similarly, in order to produce multiple mature eggs during one menstrual cycle, donors are given hormone drugs to stimulate their ovaries, which at best cause physical and emotional discomfort and, at worst, can lead to a potentially life-threatening condition called ovarian hyperstimulation syndrome.

Fairtrade surrogacy?

This lack of informed consent also arises in other aspects of the contracts that surrogates are expected to sign, regardless of language barriers or levels of literacy.

In Wombs in Labor, based on her prolonged ethnographic study into the lives of surrogates in India, Amrita Pande tackles these inequities by analysing the intersections between reproduction and production; she argues that commercial surrogacy constitutes a form of work in which surrogates are reproductive labourers. Rather than the all-out ban supported by the ‘Feminist No to Surrogacy’ campaign spearheaded by Sweden, which could well drive the practice underground, Pande advocates a form of ‘fair-trade surrogacy’ that incorporates labour laws and protections, including guarantees of informed consent and safeguards such as counselling and follow-up healthcare after the birth.

Much has been written about the plight of ‘stateless babies’ and their parents, yet scant attention is paid to the psychological implications of being born this way

Pande’s arguments are compelling. However, they overlook the rights of the offspring, the babies grown in a stranger’s womb who will one day be autonomous adults. Much has been written about the plight of ‘stateless babies’ and their parents, stranded in limbo by weak or poorly executed legislation, yet scant attention is paid to the psychological implications of being born this way.

As donor-assisted conception becomes more common, so is the demand for information about genetic and gestational origins. This makes it all the more pressing that details are properly recorded for safekeeping: the surrogate’s and egg provider’s name, date of birth, nationality, how they were recruited, fees paid and any advice or counselling given. Just as there is virtually no follow-up support for surrogates, few if any clinics have any systems for registering this type of information for the benefit of children wishing to access their histories later in life.

These issues and more were discussed at a ground-breaking Forum on Intercountry Adoption and Global Surrogacy in August 2014, hosted by the International Institute of Social Studies (ISS) in The Hague. The central question was whether a new international convention is needed to tackle the exploitation of women and the status of children born via transnational surrogacy arrangements, but the debate was far more wide-ranging. While few disputed that commercial surrogacy encourages the commodification of women, their bodies and babies, the arguments between ‘reformists’ and ‘abolitionists’ are set to continue. Would-be parents like Luke and Tony will always follow their hearts; it is up to governments to make sure that neither they, their children nor the surrogate mothers suffer as a result. n

Miranda Davies is the editor of Babies for Sale? Transnational surrogacy, human rights and the politics of reproduction (Zed Books, March 2017).