International Surrogacy: Wombs for Rent?

Theme: Ethics and Controversy


Venaya Binwani


Over the last few years, infertility has become a growing issue around the world, leaving many couples struggling to conceive a child on their own. Thanks to the developments in modern medicine, new forms of reproductive technology now offer a variety of treatment options for families looking to have a biological child. Whilst procedures such as IVF, gamete donation and genetic screening are increasing the chances of women having successful pregnancies, some individuals are still in need of an alternative solution[1][2].


Surrogacy is the practice that involves a third party individual carrying the baby for the couple wanting to have a child, and giving them parental rights once the child is born. There are two main forms of surrogacy: gestational surrogacy, where an embryo is formed in the lab through IVF, and inserted into the womb of the surrogate, or traditional surrogacy, where sperm from the biological father is inserted in the uterus of the surrogate, for her own egg to be fertilised.[1][2]


Oftentimes, the reason behind seeking out a surrogate is driven by an underlying medical condition such as  endometriosis or extensive fibroids. Other women who experience heavy pelvic pains or have uterine cancer may undergo a procedure called a hysterectomy to remove their uterus completely.[7] According to the Human Fertility and Embryology Association (HFEA), women who have experienced several failed rounds of IVF or recurrent pregnancy loss are the also more likely to seek out surrogates in the UK.[2] Therefore if people are usually seeking out surrogates as a last resort measure, why is it so controversial?


This is where the concept of international surrogacy comes into play.


In the UK, only altruistic surrogacy is permitted by law, which means that surrogates cannot be paid for the service itself, but can be reimbursed for the expenses involved with being pregnant. These costs often involve medical checkups, maternity clothes or loss of wages, which often surmounts to a cost of 10,000 GBP. Most of the time, these surrogates are close friends or family to the intending couple, wanting to help them have a child without the need for a financial incentive. However, the stark distinctions in surrogacy laws across the globe means that altruistic surrogacy isn’t a universal practice. The USA is an example of this, whereby surrogacy is offered as a commercial service - allowing women to be paid for carrying the baby. The price tag for such a service can cost up to 150 thousand USD.[2][5][6]


The commercial surrogacy industry in the USA is a highly controversial one, as it brings about this concept of ‘wombs for rent’. Does paying a woman to go through pregnancy for you commodify her body and your future child? Does it exploit her ability to carry a baby? People could say, no, of course not; these women applying to surrogacy agencies have probably made this decision on their own accord and are seeking the means to improve their economic status. However, people could argue the opposite, by pointing out how pregnancy and biological babies are not goods and services that to be bought and sold. [1]The argument may also depend on one’s motive to seek out surrogacy. If a woman who has battled uterine cancer and undergone a hysterectomy wants to have her own child, is it ethical to stop her hiring a surrogate willing to help her out?


What about in the case of a 27 year old swimsuit model who doesn’t want to gain weight?[6]


As I mentioned earlier, many people seek out surrogacy due to their health, however, in the USA, doctors are noticing an increase in the number of women seeking out surrogates who have no medical reason to do so. Dr Vicken Sahakian shares that at his fertility clinic in LA, many of his clients who are models or Hollywood actresses are beginning to seek out surrogates, for reasons to do with their career. Pregnancy is bound to lead to weight gain, stretch marks and discolouration of the skin, which these models deem will “disfigure” their bodies and jeopardize their chances of making their name in the industry. Whether these surrogates choose to carry a baby for a heart patient or actress, the act is essentially the same, yet people tend to feel that one circumstance is more ethically wrong than the other.[6]


With such high prices for commercial surrogacy in the USA, many couples have begun going to less economically developed countries in search for the same commercial service, creating a phenomenon known as reproductive tourism. Some of the main contributors to the industry are Mexico, Nepal and Greece, and before 2015, India was one of the largest providers of commercial surrogacy in the world. [1]


In India, women of low socioeconomic backgrounds often undertook the labour of surrogacy to help financially support their families. However, because these women were often illiterate, it put them in a vulnerable position to the exploitative behaviours by surrogacy agencies and intending parents. Many of these women would only receive 4-5 thousand USD, with middlemen in agencies making most of the profit.[3] Moreover, the legal representatives of intending parents would often draw up contracts in a language not understood by surrogates, and would leave out her right to medical treatment and counselling for any pregnancy related complications. Parents were also granted the right to refuse the child at birth if they had been born with genetic conditions. As a result, the Indian government outlawed such practices in 2015, only permitting altruistic surrogacy to local couples just like in the UK.[1][4]


However, Bronwyn Parry, Professor of Social Science at UCL, argues that surrogate women often didn’t have better options when it came to their jobs, having to work in toxic waste recycling plants or tanneries if not for the surrogacy industry. However, this could create the impression that the industry only further exploited the low socioeconomic status and poor job prospects of these women, for the benefit of the Western world, regardless of the money they earn as a result.[1]


One final argument that stands is, whether it is fair to make a woman give up a baby after she has bonded with it for 9 months, in addition to the physical commitment of gestation and labour. Surrogates have to have their own biological children by law, so that they have some idea of the experience they are going to endure. However, what they often can’t anticipate is the emotional strain of giving the baby up. Professor Parry once again argues that, whilst there is a general societal consensus that deems the “labour of labour” unique, the act of putting one’s body in the face of physical or emotional strain is not. She describes that there are several occupations involving hardships just as arduous as pregnancy and labour, for example brickmasons, builders, agricultural workers that subject themselves to a lifetime of physical work. The same can be said about nurses for dementia patients or workers in palliative care who have an emotionally tough job to do.[1] Whilst no one is in the position to question nor undermine the beauty of pregnancy and the unique nature of the “labour of labour”, should we go as far as to say surrogacy is unethical, which would stop families experiencing the joy of what comes after?[1]


The issue of surrogacy is not one with a definitive answer. Everyone’s own norms and values are going to shape what they think. However, one thing that we tend to agree upon as a society is that pregnancy and birth is a beautiful thing that binds women all over the world, allowing them to experience the joys (and often frustrations) of being a parent. It is hard to say whether we should stop women being paid for surrogacy if they are willing to go through the labour, however it is also hard to say that this doesn’t make babies seem like another product you buy off the shelf. It can also be important to consider whether surrogacy should be a booming industry when there are children in foster care who would highly benefit from being adopted by a loving family. What I would personally say is, if surrogacy grows as a commercial industry with the aim of promoting women’s reproductive freedom, there should be an international regulatory body that ensures that all surrogate women regardless of socioeconomic standing, are treated fairly for the service they’re willing to offer.


References:

  1. University College London,2020. Making Babies in the 21st Century [MOOC] Retrieved from https://www.futurelearn.com/courses/making-babies

  2. Hfea.gov.uk. n.d. Surrogacy | Human Fertilisation And Embryology Authority. [online] Available at: < https://www.hfea.gov.uk/treatments/explore-all-treatments/surrogacy/ > [Accessed 3 May 2020]. 

  3. Surrogate.com. n.d. Surrogacy In India: What You Need To Know | Surrogate.Com. [online] Available at: < https://surrogate.com/intended-parents/international-surrogacy/surrogacy-in-india/ > [Accessed 30 April 2020]. 

  4. Saxena, P., Mishra, A. and Malik, S., 2012. Surrogacy: Ethical and Legal Issues. Indian Journal of Community Medicine, 37(4), p.211. 

  5. Surrogate.com. n.d. International Surrogacy Ethics | Surrogate.Com. [online] Available at: < https://surrogate.com/intended-parents/international-surrogacy/ethics-of-international-surrogacy/ > [Accessed 30 April 2020].

  6. Kleeman, J., 2019. 'Having A Child Doesn’T Fit Into These Women's Schedule': Is This The Future Of Surrogacy?. [online] the Guardian. Available at: < https://www.theguardian.com/lifeandstyle/2019/may/25/having-a-child-doesnt-fit-womens-schedule-the-future-of-surrogacy > [Accessed 3 May 2020].

  7. Johnson, T., 2017. Who Uses Surrogates?. [online] WebMD. Available at: < https://www.webmd.com/infertility-and-reproduction/qa/who-uses-surrogates > [Accessed 3 May 2020].


Glossary


  • Endometriosis: a condition where the tissue that grows in the uterus, grows into other regions of the body such as the fallopian tubes

  • Extensive fibroids: when excess muscle tissue and fibres grow on the wall of the uterus, making it difficult for an embryo to implant itself into the womb

  • Uterine cancer: endometrial cancer where a cancerous tumour forms in the uterus wall 

  • Hysterectomy: a surgical procedure conducted to remove the uterus 

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