Following multiple miscarriages, a U.S. couple considers in vitro fertilization (IVF), adoption and surrogacy options. They finally decide to employ a surrogate to bear their baby in India.
They meet with the agency and the selected surrogate before signing the contract and come away believing the agency’s “gestational mothers” are well cared for and decently compensated. But how transparent is 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 (or ARTs for short) will be addressed, with an emphasis on human rights and social justice. The rapidly growing industry that ARTs have spawned will also be examined.
“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.”
The two-year, $200,000 grant will enable CGS to interview egg donors and update its wiki-style compendium of various country-level policies on egg retrieval and surrogacy.
OBOS, working in collaboration with key partners domestically and internationally, will develop a web-based resource for intended parents considering or already engaged in a cross-border surrogacy arrangement but who are likely to be unaware of the troubling conditions for the gestational mothers they hire.
“Most of the information available in the mainstream fails to paint a complete picture,” adds Ayesha Chatterjee, program manager of the OBOS Global Initiative. “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 organizations support ART as a reproductive choice but they are deeply concerned by gaps in evidence-based knowledge that can aid in comprehensive and informed decision-making.
The rapidly growing (and mostly unregulated) markets position surrogacy as women helping women, a win-win for all. But what is the reality for women who become 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,” Chatterjee wrote in a paper on cross-border surrogacy co-authored with Sally Whelan, OBOS Global Initiative program director.
“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 a lack of informed consent since many women can’t read the documents they must sign. They also receive minimal compensation and are subject to unfair payment schedules, isolation from their own family, 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 there is no life or disability insurance.
There are additional risks for women who serve as 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,” Chatterjee 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 taken advantage of by unregulated companies. Recent reports exposed a California-based medical tourism company. One couple sent Planet Hospital thousands of dollars but the company failed to deliver on its promises, and didn’t return more than $20,000 they had spent in the process. Earlier this year, the company removed surrogacy from its list of medical tourism procedures and then claimed bankruptcy, continuing to deny any wrongdoing.
Sama Resource Group for Women and Health in New Delhi, one of OBOS’s partners, 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 noted in a 2012 study on commercial surrogacy. “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 question health and gender implications and effects on women’s lives, marriage and parenthood. Others think “patriarchal ideology” focuses excessively on biology. Despite differences of opinion, there is consensus that more needs to be known about ARTs and their social, political and economic impact on the lives of those that use reproductive services.
The Center for Genetics and Society and Our Bodies Ourselves aims to bring much needed information about surrogacy and egg retrieval into the mainstream, helping to pave the way for a real “win-win” for women on all sides.
Elayne Clift writes about women, health, politics and social issues from Saxtons River, Vt. Follow her @elayne_clift.