'A choice without a choice: surrogacy or prostitution.'
This statement from Dr Olga Gajovic, a Ukrainian feminist and activist, to me is probably the most memorable piece of the Boston Calling episode 'Baby Guaranteed', on BBC World Service. The 26-minute programme contrasts the stories of couples seeking surrogacy with the women who carry the babies.
After a brief introduction on surrogacy terminology, the first part focuses on the Smiths, an American couple from South Pasadena, California, who had been trying to conceive a child. After unsuccessful fertility treatment they considered surrogacy, but were unable to afford it in the USA. They travelled to the BioTexCom centre for human reproduction near Kiev, Ukraine, where 26-year-old Kateryna carried twins for them.
In the podcast, we hear three sides to their story: the excitement of the parents over their new children; the clinic officials keen to assert their good practices and noble intentions; and the very pragmatic analyses of Kateryna, who was paid US$13,000 for her services as surrogate.
Kateryna already has children of her own and explains that she chose to act as a surrogate to pay for a house for her family and finance her own children's education. She says she regrets agreeing to the transfer of two embryos as she feels her body was not suitable to carry twins, despite the doctors telling her otherwise. This made me wonder how responsibly surrogates are taken care of under the Ukrainian system.
The Smiths were charged US$58,000 for a 'VIP-package', which guaranteed unlimited IVF cycles until a baby was born. Mrs Smith's comment that the hotel accommodation and food provided for her and her husband where not as luxurious as promised on the website left me perplexed. While I understand their criticism of false advertising, I believe given the budget the main emphasis should be on sufficient medical care and financial compensation for the surrogate. I get the impression from the reporting that BioTexCom is very focused on selling its fertility services as a luxurious vacation experience, gourmet meals and accommodation provided, at the end of which you take home your newborn child.
Dr Gajovic heavily criticises the Ukrainian surrogacy industry, saying most women are unaware of their rights and are often illiterate, unable to read the contracts they are given by the clinic and simply exploited for their bodies.
I was previously unaware that Ukraine is such a major player in the international surrogacy business. The programme pointed out that prices for surrogacy have actually decreased over recent years as a consequence of the political instability and subsequent economic decline in the country: the average wage is US$200 per month. This, Dr Gajovic says, leaves many women with a choice between surrogacy and prostitution to support their family, so with more Ukrainian women considering surrogacy as a source of income, the compensation offered to attract them has decreased.
After a brief mention of the Cambodian surrogates that have been charged with human trafficking in the recent past (see BioNews 958), the second report of the episode comes from India in the light of new legal changes regarding surrogacy.
Previously known as 'the womb of Asia', India introduced legislation in 2015 that banned surrogacy for foreigners. The government is planning to go further, introducing a new law that would ban commercial surrogacy entirely and only allow for altruistic surrogacy arrangements between close relatives.
Critics of the proposed bill for banning surrogacy have expressed concern that this would create a black market, with minimal care for the women and potential child trafficking implications. This is an interesting dilemma that I wish the podcast had explored further, beyond a side note.
For the moment, however there are still many women in India who carry babies for wealthier Indian couples. The podcast mentions that surrogacy currently contributes US$400 million to the Indian economy. The interviewed surrogates at Akanksha clinic who live in dormitories on the premises for their entire pregnancy, mention their incentive to agreeing to surrogacy is providing for their families. With up to US$11,000 for carrying twins, surrogates would often have to work more than 30 years in a 'regular' job to acquire this much money.
Dr Nayana Patel, founder of Akansha clinic, raises an interesting point when she argues India could have become a leader for fair and just international commercial surrogacy, which also would have helped the Indian economy, but missed out on this opportunity with the changes in law.
Overall, I found the podcast interesting to listen to, although in places I would have liked more in-depth research on the part of the journalists. I found the viewpoints of the surrogates themselves most interesting, but I would have liked a more detailed reporting on how they are being treated in commercial low-cost fertility treatment facilities and how a good legal framework would have to look like that protects surrogates, parents and the children being born while allowing women to use surrogacy as a mode of income.
I'm still thinking about whether it is exploitative for people in industrialised parts of the world to use surrogacy services in countries where women have limited alternative earning options. I have no answer so far.