13 April 2015
ByAppeared in BioNews 797
BBC Radio 4, Monday 9 March 2015
Presented by Professor Laurie Taylor
Last month BBC Radio 4's Thinking Allowed examined a rather extraordinary invitation: 'See the Taj Mahal by the moonlight while your embryo grows in a petri dish.' The focus was on commercial gestational surrogacy in India, where local women carry babies for foreign couples. Discussing their research with host Laurie Taylor were Amrita Pande, a well-known expert on Indian surrogacy who recently published her latest book 'Wombs in Labour', and Michal Nahman, author of 'Extractions', who researches transnational egg donation with a focus on Romanian women selling their eggs to Israelis.
Laurie started by pointing out his confusion: how can fertility business be thriving in a country that is well known for its history of strict anti-natal policies? According to Pande, this paradox in fact reveals much of the nature of the Indian surrogacy business. Women from lower class backgrounds, who have thus far been excluded from biomedical health care, end up pushed head on into a hyper-medicalised form of reproduction, not as beneficiaries but as mere producers for richer classes.
Surrogacy in India is good business for all involved. Intended parents can save significant amounts of money, paying roughly £20,000 compared with up to £70,000 in California, Pande explains. The clinics end up with the lion's share of this fee, with only £5,000 - a disproportionately small amount - going to the surrogate. Still, even this may be enough for a woman to be pressured into becoming a surrogate by her husband or in-laws.
Pande confirms that since the vast majority of Indian surrogates come from families that live below the poverty line, money is the main motivation for joining the program. Many surrogates emphasise, however, that while they are doing this for money, it is out of need and not greed. By bearing the babies of foreigners, surrogates hope to offer a better life and a brighter future for their own children.
These women are easily subjected to complete control by the clinic. Indeed, Pande suggests that one of the main reasons for the popularity of India as a surrogacy destination for transnational clients is the use of 'surrogacy hostels', where surrogates are kept under full surveillance and control for the duration of their pregnancy. She describes an eerie regime of meals, rest, injections and family visits - all monitored by the hostel matron.
Yet this system might in some ways benefit the surrogates by hiding them from the stigmatisation they might encounter in their own communities. Despite the surrogacy boom, the practice itself is still relatively poorly understood in India - surrogates are often seen as prostitutes who actually have to sleep with their clients to get pregnant. Those who do understand the technology stigmatise surrogates for selling their wombs and their motherhood. Living in a hostel allows surrogates to hide what they are doing and to make up their own stories, such as getting a new job in a big city.
India isn't the world's only reproductive hub. According to Nahman, reproductive tourism is a growing global industry with surrogacy alone being worth $400 million. Nahman is interested in how transnational egg donation coupled with surrogacy helps people evade national restrictions on the use of these technologies. The networks of reproductive travel that she investigates can span multiple countries. For example, some women who can't get treatment in Israel travel to Cyprus or Romania for egg donation. At the same time, doctors successfully evade local laws around egg donation and surrogacy by fertilising eggs in other countries, then transporting them into a third country, implanting them into a gestational surrogate and then bringing the babies back home.
While this was all very interesting to listen to, I feared that this programme was turning out to be another two-dimensional description of the strange and problematic practice of reproductive tourism. Yes, such critique is justified and important but this topic has been covered in newspapers and documentaries for years now. Laurie had started out asking whether surrogacy should be seen as just another type of work or if this was, in some fundamental way, a profoundly exploitative degradation of motherhood. With such expert guests on board, why was the host not digging deeper? The bite I had been waiting for came, sadly, in the show's final minutes. Laurie asked both guests simply what their take was on all of it, how they viewed what was going on. Is this empowerment in a global marketplace or exploitation on a transnational scale? Should we ban or regulate?
Nahman argued that while the dynamics of transnational reproduction, where those in wealthy countries buy eggs and commission surrogacy from those in poor countries, indeed bear the signs of exploitation, we cannot and must not look at them as victims: 'In so many ways they are also exploiting a system. For the people for whom the ability to be part of a market was always so not present, not possible, to now take up that position is really vital.'
Pande is equally balanced in her response, claiming that a ban would merely push the business underground or to another country in the developing world. She concludes that instead of restrictive national policies, which end up pushing the morally sticky issue to some other country, what is needed is a very carefully thought-out law that regulates the industry and protects the rights of the women involved.
Pande's last words were cut off because time ran out. The new UK Government, however, will have a whole term ahead of it. Will they find time for such a carefully thought-out law?