07 October 2013
ByAppeared in BioNews 725
BBC4, Tuesday 1 October 2013
I'm not sure how a television documentary manages to be saddening, heartwarming, uplifting and worrying all at the same time. BBC Four's House of Surrogates, which focused on one provider of paid-for surrogacy in India, where all the women acting as surrogates for one Gujarati clinic spent 'their pregnancy away from home in dorms', managed it. I'm guessing the programme was designed to provoke strong reactions among viewers – and it certainly did, though I'm not sure all those it provoked in me were the ones sought.
The title doesn't do the programme justice – from it, I was expecting more of a focus on the horrible daily lives and grind of Indian women confined to dormitories while they farmed out babies for Westerners in a kind of re-imagining of a global Handmaid's Tale. But while there was some focus on the actual 'house of surrogates' (a 'hostel' where women stay pre- and post-embryo transfer, and then for the period of their pregnancy, if this was achieved), the women there seemed happy with their lot, well-treated, comfortable and looked-after in more ways than one – even if they were (in the words of some women) a little 'bored'.
Around 100 pregnant or potentially pregnant women can be housed in the hostel, which is attached (commercially not geographically) to a clinic run by Dr Nanya Patel - obviously a very successful woman and one I didn't really expect to like. Surrogates receive on average $8,000 of the clinic's $28,000 fee – a life-changing sum for her and her family. There are rules: a woman must already have her own children, may only be a surrogate a maximum of three times, must stay in the hostel, take her vitamins and enforced rest while pregnant and – crucially – must hand over the baby. For women where embryo transfer is not successful, $75 would still be paid. If miscarriage occurs before three months: $600. If between three and six months: $1,200. After six months 'whatever happens', the full sum is paid. The interviewer asked 'what if there are abnormalities?' Even this is taken care of – Dr Patel answered: 'the contract says that even if handicapped the couple has to accept the baby. The surrogate has no duty towards the baby'.
So, in among the chaos of daily life in an Indian city, the whole arrangement is very business-like and organised. Commercial surrogacy in India is worth an estimated annual £1 billion, so the clinic here was just one of many such centres. Even the taxi driver at the beginning of the programme knew that couples came from England, Australia, Africa, Germany… and we saw or heard of others too, from Canada, the USA and Japan. Which means – as I already knew – that there is widespread demand for the service offered.
Many of the prospective parents were desperate – none were what would be called young, and the oldest new mother was 53. All had difficult fertility histories and evidently, surrogacy was their last resort. I'm pretty sure that has to be the case –why else would a couple from a part of Australia where commercial surrogacy is criminalised go to such lengths? Why would the Canadian woman who assumed, along with her husband, that they would have loads of kids, who then embarked on a 31 year journey- failing at every step, end up here? Especially as she had to stay in India without her husband for four months after the birth of the child while the baby's documentation (to enter Canada) was sorted out.
So what was saddening? Much of it, but not necessarily the parts I expected. Obviously, some of the prospective parents' stories were sad, as were some of the problems encountered after the babies were born and arrangements being made to take them to the countries in which it is intended their lives will be. And it's sad that it comes to this – desperate people travelling the world to get the children they so badly want. And it's sadder still that the reason for this is largely down to cost, or the avoidance of home law that prevents them doing this an easier way. What I had expected to be saddened by was the notional or explicit exploitation of hundreds of Indian women living in poverty and forced into this 'house of surrogates'. While there was a little evidence of this (e.g. a small hint of a woman's back-story of an abusive and feckless husband), it wasn't the general picture conveyed. I also expected lots of heart-wrenching moments when it was clear surrogates didn't really want to go through with it. But again this wasn't overwhelmingly apparent – most seemed to be focusing on the practical side and what it would mean for them and their families afterwards. Lots of them expressed a desire to change their own children's lives. One surrogate, who was sad the baby was (eventually) taken away, had in fact – bizarrely in my view – been employed as that child's nanny (including nursing) for months after he was born, so had spent lots of time with the child, getting to know him.
So what was 'worrying'? Well, actually, the thing I worried about most was the ease with which one intended mother persuaded the clinic to transfer two of the five blastocysts that had been created with her eggs and her husband's sperm into the surrogate, not one, as Dr Patel first suggested. I don't know if that means I've just become hardened to the reality of the transactional nature of the rest of it or whether, because I already believed that the intended parents should be the ones who legally become the parents, that this bit was bothering me less. Still, the fact that you are dealing with someone else's body, in my view, should mean that their health and safety is uppermost in your mind (particularly when you would think you would also be concerned about the safety of any babies being carried) and opting for twins seemed – when it wasn't your risk to take – a bit reckless and ill-considered.
That leaves 'heartwarming' and 'uplifting': it's not hard to be heartwarmed when the outcome is happy all round. When the prospective parents are so clearly happy at the end of their long journey, when the surrogate has been well looked after in a clean, safe environment while pregnant, then is able to change her family's life for the better… Even Dr Patel – who as I said I didn't expect to like – and despite the triteness with which she dealt with some of the ethical questions posed to her – impressed me. Her own particular brand of feminism, and her mission to do well by these women, including providing 'lessons' in embroidery, sewing and beautician training so they could continue to earn afterwards and by encouraging them to stand up to husbands and other family members who might demand all/some of their money was admirable. Though all quite paternalistic, I got the impression she really meant it – and really wanted to protect these women who she views as doing a great thing. This was cemented when we saw plans for new future new clinic/lab/hostel/serviced apartments in one – definitely a one-stop-shop, where the whole process of the surrogacies – including the 'after-arrangements' will take place under one roof, and where she intends to employ some of the women who have previously worked as surrogates.
Don't get me wrong. I know this is a business for Dr Patel, and for others. I'm not advocating Indian or any other cross-border surrogacy. I wish there was a better way. But I understand why it's there and why it's not going to go away any time soon. And on that basis, I hope that its facilitators are as practically minded and as careful about the surrogates as Dr Patel is. I do think that everyone should watch this programme – it was really well made and left me feeling like (at least for one clinic) they can't have 'anything to hide' if they were prepared for this to go out. There are still lots of questions about surrogacy, particularly cross-border arrangements, but given the reality of surrogacy in India, this was no-where near as bad as I expected it to be.