A couple has had miscarriages, considered in vitro fertilization (IVF), discussed adoption and finally opted for a surrogate to bear their baby in India. They visit her before signing on and feel that the agency’s “gestational mothers” are well cared for and decently compensated. But how much do they really know about the practice of cross-border surrogacy?
Thanks to a recent MacArthur Foundation grant to the Center for Genetics and Society (CGS) and Our Bodies Ourselves (OBOS), the information gap surrounding surrogacy and other assisted reproductive technologies (ART) will be addressed, with an emphasis on human rights and social justice. Light will also be cast on the rapidly growing industry ARTs have spawned.
“Cross-border surrogacy raises thorny questions,” says Marcy Darnovsky, Executive Director of CGS. “Some people look at women selling their eggs or reproductive capacity as an individual right within the context of wage labor. Others see these practices as deepening gender and class inequalities in a not-so-free market.”
“Most information available in the mainstream fails to paint a complete picture,” adds OBOS’s Ayesha Chatterjee. “With faceless images of pregnant bellies, the narratives of gestational mothers remain untold. Convenience, concierge-like services and various packages geared to attract intended parents in a competitive market are what get emphasized.”
Both CSG and OBOS support ART as a reproductive choice but they are deeply concerned by gaps in evidence-based knowledge to aid in comprehensive and well-informed decision-making within a rapidly growing, mostly unregulated market that positions surrogacy as women helping women, a win-win for all.
But what is the reality for gestational mothers?
“Often gestational mothers live in communities where cultural beliefs and systemic institutional oppression/marginalization makes it hard for them to achieve financial independence and security,” say Chatterjee, co-author with Sally Whelan of an OBOS paper on cross-border surrogacy. “In India, for example, many gestational mothers are poor with little social mobility. These factors create a power imbalance that makes it impossible for them to negotiate fair ‘work’ conditions within surrogacy arrangements. It allows those in positions of power like recruiting agents and fertility clinics to get away with a range of exploitive practices.”
These practices include the lack of “informed” consent since many women can’t read documents they are made to sign, minimal compensation and unfair payment schedules, isolation from family and restricted movement outside of surrogacy “residences,” constant monitoring, high risk medical procedures, and unnecessary C-sections to accommodate traveling parents. Post-partum medical care may be poor or lacking altogether and should problems occur there is no life or disability insurance.
Add to this the risks taken by egg providers when an intended parent’s egg is not used. “Egg providers must undergo an intensive and risky process using hormones that have multiple short and long term effects,” OBOS points out. “Similar to gestational mothers, many egg providers receive minimal and sub-standard information about the health risks and they are often provided with little to no follow up care.”
There are also issues for the babies “commissioned” by intended parents. These children have a genetic link to egg providers, are birthed by gestational mothers, and handed over to intended parents. As policy struggles to catch up with technology myriad legal issues remain unresolved regarding the child’s legal parent, immigration status, and best interests should custody disputes occur.
Another problem occurs when intended parents are scammed. Recent reports exposed a California-based medical tourism company. One couple reported sending Planet Hospital thousands of dollars but the company failed to deliver on its promises, or to return more than $20,000 the couple had spent in the process. This year Planet Hospital removed surrogacy from their list of medical tourism procedures and then claimed bankruptcy, continuing to deny any wrongdoing.
SAMA: Resource Group for Women and Health New Delhi, cites “an explosion of fertility services,” noting that the Indian fertility industry, worth more than 400 million U.S. dollars annually, is proliferating despite the absence of regulatory or monitoring mechanisms. “Commercial surrogacy is often portrayed as a win-win situation,” SAMA reports. “It is positioned as giving ‘desperate, infertile’ parents a child while providing poor surrogate women with income. But given growing globalization of capital and shrinking local jobs, women from marginalized communities find themselves more impoverished, powerless and vulnerable.”
Feminists offer diverse voices on surrogacy and egg retrieval. Some raise questions about women’s health while others focus on the implications for gender analysis and the effects of surrogacy on women’s lives and marriages. Others claim that “patriarchal ideology” focuses excessively on biology. But despite differences of opinion there is consensus that more needs to be known about ARTs and their impact on the personal, social, political and economic lives of those that use reproductive services.
Thankfully CGS and OBOS will bring much needed information about surrogacy and egg retrieval into the mainstream, helping to pave the way for “a real win-win for everyone.”
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This column is based on a blog posted to Our Bodies Ourselves Blog in August 2014.