Inherent Problems with Commercial Surrogacy in India

The degree to which financial incentives can muddle ethical deliberation and practice is evident in the commercial surrogacy trade in Indian. For years, “rent-a-womb” services to foreigners has been “big business” indeed, generating nearly $1 billion annually.

Would-be Western parents, many from the U.K. and Scandinavia, argue that commercial surrogacy arrangements are a win-win situation for everyone. They get the baby they’ve longed for and the Indian women receive significant financial compensation. Surrogates typically are paid $6,000 or more to provide their womb. In a country in which average monthly earnings are $215, this is an extraordinary amount. The financial incentives for Westerners to do business in Indian fertility clinics should not be underestimated either. Costs for a surrogate birth in India total $15,000-$20,000, approximately one-tenth the price that would be incurred in a California clinic. What’s not to like about people desperately desiring a baby receiving one at a bargain rate, while desperately poor Indian women receive several years’ worth of income for nine-months work?

There’s plenty not to like about these arrangements. One of the greatest concerns is the exploitation of the poor who comprise the vast majority of surrogates. Free and informed consent by Indian surrogates may not be as free as it appears. In her recently completed Ph.D. dissertation on commercial surrogacy in India, Kristin Engh Førde argues that financial desperation has the potential to override genuine personal autonomy: “They are forced to make money for their family and their chances for succeeding are extremely low…Some have a major debt to pay, such as a hospital bill…Many feel that surrogacy is a chance they have to take. And it’s important for them to distance themselves from the choice. It was not something they wanted; it was something they had to do.”

Julie Bindel contends that commercial surrogacy represents an exploitation of women generally, not simply of poor women specifically: “As a feminist campaigner against sexual abuse of women, and in particular the sex trade, I feel sick at the idea of wombs for rent. Sitting in the clinic, seeing smartly dressed women come in to access fertility services, all I could think about was how desperate a woman must be to carry a child for money. I know from other campaigners against womb trafficking that many surrogates are coerced by abusive husbands and pimps. Watching the smiling receptionist fill out forms on behalf of prospective commissioning parents, I could only wonder at the misery and pain experienced by the women who will end up being viewed as nothing but a vessel.”

Fortunately, the Indian government has taken notice of the actual and potential abuses inherent in commercial surrogacy. After all, what country wants to be known as the bargain-basement destination for the exploitation of women and the poor? As of October, 2016, foreigners are prohibited from “renting” Indian wombs, though it is doubtful this official action will shut down the trade completely and permanently. Big money talks, whether the market is officially opened or closed.

On a personal note, I am distressed by the effects of commercial surrogacy in India. Having travelled to India often over the years, I’ve come to love the country and its warm, friendly, and hospitable people. It is evident to this visitor that Indians highly value parenthood and family. I can hardly imagine a practice that has greater potential to destroy the wonderful family dynamics I’ve observed in my travels than commercial surrogacy marketed to rich Westerners. I applaud the India government for taking the first difficult step, at significant economic loss to the country’s economy. In the case of commercial surrogacy, market forces cannot help but impinge virtuous ethical decision-making.

An IVF Keepsake?

As a father of two teenagers (and one who will join that esteemed company in a month), I am fluent in “sarcasm,” the native tongue of this group. Mine only use English sparingly, to do business. So, I often read headlines of stories in newspapers (remember those?) and online as sarcastic, and the articles they lead as spoofs. This one, in the “Parenting” section of an Australian web journal called “Kidspot,” immediately led me there. It speaks of a company that will take embryos from in vitro fertilization (IVF) that have not been implanted, and for which the biological parents have no plans of implanting, and turn them into keepsake jewelry. But this is no spoof.

The couple interviewed in the piece, having completed a 6-year journey through infertility and IVF, has a 4-year old son and twin toddlers. With seven remaining embryos, they had a decision to make. For them, “Donation wasn’t an option, the annual storage fee was an added financial strain, and disposing of them unimaginable.” Enter a company called “Baby Bee Hummingbirds,” who placed the embryos in a heart-shaped pendant.

My first impulse, not without some merit, was to find this all a rather ghastly business. Each of these embryos is a unique genetic human created in the image of God. I find myself critical of parents who don’t seem to have fully thought out the ramifications of fertilizing ten or more eggs. If these are genuinely human beings, then the creation (if that’s the right word) of “leftovers” is itself deeply problematic. It takes a great deal of restraint for a mother, who must have eggs harvested after a somewhat risky hyperovulatory cycle, and the physician, who will be judged on the success rates of achieving pregnancy, to fertilize only enough embryos to be implanted once. That is understood. But the ethical choice usually follows the more difficult path of restraint, and that includes the decision on how many embryos are to be made.

On another level, one which is a bit more gracious, perhaps, I try to see some redemptive value in this. Presumably “donation” was for medical research, for which I would commend the parents’ avoidance. It does not mention embryo adoption, which could fall under “donation” and would be ethically the best decision. But, with hundreds of thousands of human embryos in liquid nitrogen in fertility clinics across the United States alone, this is no full solution to the problem, and shouldn’t be seen as an easy “out” ethically. In the parents, there is a reflection that these are more than just unwanted clumps of cells, as something beautiful is being attempted to serve as a kind of memorial to the lives that could have fully developed. Maybe this is some effort to take something, quite literally ashes, and redeem it. Maybe it is a message to the world that we should all think a lot harder about what assisted reproduction fully means, and to what it speaks of human life. We sometimes carry the cremated ashes of loved ones with us as a reminder of their significance, after all. Perhaps this helps affirm the humanity of these embryonic humans?

Yet…this ultimately shows us what kind of a mess we have created. We feel better about children that we never gave the opportunity to breathe and walk and talk because we have made something pretty to carry them around “close to our hearts.” That the parents made the choice that these embryos will not live on can’t be lost here.

From the mother interviewed:

“Finding this has brought me so much comfort and joy.
I [am] finally at peace and my journey complete.
My embryos were my babies – frozen in time.
When we completed our family, it wasn’t in my heart to destroy them.
Now they are forever with me in a beautiful keepsake.”

Assisted reproduction has been described as the “wild, wild West” ethically…there is little regulation of the industry worldwide, it exists in (to use another metaphor) “uncharted waters,” and it has offered hope to people who desperately dream of loving a child…and may spare no expense or physical burden to achieve it. I can speak to the difficult journey of infertility because my wife and I traveled it. We set our boundaries early and held to them, but could easily see how each step leads to the next, and how gut-wrenching it is to say, “done.” This is not a critique of IVF per se. It is a reminder that anyone who undertakes the process (or, indeed, makes the decision to bring children into the world) should reflect on the motives behind and consequences associated with it.

This industry, this process, at its worst, instrumentalizes children. It takes a beautiful desire that has been met with profound pain and somehow convinces us that we have a right to children…children who look like us, will give us an ideal-sized family, and (ultimately and chillingly) will be the best that science can make. It is when children become a means, maybe the means to our fulfillment, that we lose sight of the sacrificial love that parenting represents. In a world of idols, this is another, and it is one that is consequential.

Easter, Fertility, Surrogacy

Most of us who celebrated Easter yesterday likely took part in the tradition of the Easter egg hunt. The egg, an obvious symbol of fertility, is an essential part of our spring celebration. Interestingly, the subject of fertility and “social surrogacy” was the focus of an article in Elle magazine last week. The piece told the story of an aging professional who felt she needed to have a baby, but since actually being pregnant is so inconvenient she hired a surrogate. The interesting part about this article is that it gave voice to the concerns that using a surrogate for non-medical reasons was “wrong” or “selfish.” Of course, none of these concerns were articulated very robustly, but at least they were explored. They actually interviewed Ruth Faden of the Berman Institute of Bioethics at Johns Hopkins and quoted her as saying that the “why” influences the ethical dimension of surrogacy.  It is great that a magazine with such a large readership like Elle would try to tackle a subject like “social surrogacy” as it must feel that this topic is relevant to young women today. What is most striking is how there is clearly an uneasy conscience about this practice, but it cannot be described in a very meaningful way when the reigning paradigm for ethical behavior is utilitarianism and free-market economy. Issues such as the commodification of children are not even discussed.  The narrative that this practice exploits women of lower socioeconomic status is flipped to state that it can actually empower these women.
For those teaching undergrads or even med students, this is an accessible introduction to the issues and can be used to foster discussion. It is really hard to come down against this practice without a content-full account of the meaning of family, motherhood, and the notion that a child is a gift from God.  It is our job to help our students and trainees find that content.