On Indian Surrogates

Iron clad boundaries and clear roles, the sorts that the Akanksha Clinic in India insists upon for their IVF patients and surrogates, should matter immensely to potential parents.
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Most fertility center websites have some things in common. Regardless of where the clinic is located, no matter the city, state or country, usually there are photos of tantalizingly adorable newborns, a list of FAQs, and Excel spread sheets graphing success rates. The Akanksha Infertility Clinic isn't much different, putting aside a cutting-edge feature in their What's New corner. It's a 4-D Ultrasound Scanner showing images of fully-formed, dimensional babies in utero, rounded cheeks and dimpled chins, biscuity feet and hands with creased thumbs cocked for sucking. The Akanksha Clinic describes this technology, saying, "Parents can...appreciate the fetal parts like face, spine, limbs, fingers and every single organ as if they are actually looking at the fetus. 4-D ultrasound enables us to see real time images of fetal movements like yawning, thumb sucking, swallowing, etc..." Very cool, amazing, extraordinary, etc...

The other big difference is that this clinic, located in Anand, India in the Gujarat State, is responsible for a couple of the most controversial developments in the Assisted Reproductive Technology (ART) world. In January, 2004, a mother-daughter patient set made news when the mother gave birth to her own twin grandchildren (the daughter and biological mother of the twins was physically unable to carry them herself). The other biggie is that this clinic boasts -- and I do mean boasts, including on a recent Oprah Winfrey show -- a deep pool of local surrogates willing to get pregnant for Indian and foreign couples alike.

To be clear, these are professional surrogates, local women who receive decent medical care and detailed contracts. To be eligible, they must already have at least one child of their own, not only as proof that they can successfully carry and deliver a baby, but as a hedge against mourning the loss of a baby they have gestated, birthed and, perhaps, bonded with. Iron clad boundaries and clear roles, the sorts that the Akanksha Clinic insists upon for their IVF patients and surrogates, should matter immensely to potential parents, particularly in light of the ongoing Florida case in which a surrogate, enlisted by a couple who came across her on a surrogacy message board, a woman with two children of her own and three successful surrogacies under her belt, changed her mind one month into the pregnancy and kept the baby, this despite the contract and the fact of the husband's sperm. Because the surrogate was also the egg donor, Florida law granted her an absolute right to decide to keep the child up until 48 hours after giving birth.

Using a gestational surrogate in the U.S. can cost $50,000 and up. But an Akanksha surrogate costs only $5,000. The surrogates at Akanksha earn more than 100,000 rupees ($2,250 U.S.) per pregnancy, a massive amount compared to the average daily income of five dollars. Some people consider this a win-win situation. Foreign couples end up with the babies they so desperately want while Indian families earn more money in nine months than would be possible in nine years. It allows women to contribute to their household expenses and to afford better care for their children. It empowers them, gives them a sex-free way to make a buck, and so on. As Dr. Nayana Patel, founder and director of the clinic explains, the surrogacy program is meant to "uplift" Indian women, noting that India is poised to become a center of "reproductive tourism." In fact, India's health industry could likely earn billions of dollars by performing inexpensive surgeries for foreigners.

But bioethicists have their concerns. They worry that India is a paternalistic society and that women might be forced to unwillingly cede their bodies to strangers' fetuses. They worry about the post-partum health of the surrogates, questioning whether a sick or depressed mother would receive support. One such thinker is Kathryn Hinsch, Founding Director and Board President of the Seattle-based Women's Bioethics Project, a think tank dedicated to promoting the "thoughtful application of biotechnology to improve the status of women's lives.....(and) to protect vulnerable populations by anticipating unintended consequences, safeguarding women's bodies from harm and ensuring that women's life priorities are recognized."

Several years ago, Hinsch began voicing her concern over minority women ending up on the short end of the surrogacy stick. They'd be cheaper and more readily available than white surrogates, she reasoned, particularly in places without an established surrogacy tradition or market, and therefore easily exploited. She worried about mistreatment or under-treatment if post-partum complications developed. She also relayed a conversation she'd had with an African-American woman who agreed that these were serious socioeconomic issues and something to think about, but nothing to actually worry over since white women, by and large, would never be comfortable allowing women of color to carry their children (in utero, that is). Hinsch knew better.

Hinsch also voiced concern over the long term health implications of carrying another person's genetic matter, pointing to the fact that women who gestate even genetically-related multiple boys have increased risks for autoimmune problems, the genetic difference between the male and female of the species being enough to upset our natural physical make up. So what is the physical impact of carrying a non-related fetus? How is that risk compounded when carried out repeatedly which may happen at a place as well-managed as Akanksha in a developing region like Gujarat, India?

When you consider the combination of brisk globalization and the increasing medicalization of the human body, it isn't so curious that foreigners scan the global horizon, seeking out the best deal when it comes to medical interventions (just Google "Plastic Surgery, Argentina" for illustration). Indeed, enlisting cost-effective means for achieving a baby, particularly under the auspices of a skilled doctor with a successful track record, seems not only logical but constructive. And having been infertile and wholly dependent upon ART in building my family, I have immense stores of sympathy for infertile couples trying to piece together their own.

But we must proceed with caution, not taking anything for granted, whether the health and welfare of these surrogates, that these arrangements are purely business ones, or that there aren't complicated socio-economic and racial forces involved in hiring another woman to gestate one's baby, particularly a woman from a dramatically different culture. The act of bringing forth life, no matter whose constituent parts, no matter whose uterus or birth canal, is far too complicated to isolate it from history or the world as it is.