By Shona Kambarami


The International Gestational Surrogacy Market is a form of Exploitation


Pregnant surrogates in India wait in line. Photo Credit: Journeyman News via Journeyman Pictures YouTube Channel

“Our miracle baby is finally here,” wrote Tyra Banks, on announcing the birth of her first child by gestational surrogate on Instagram. Even more remarkable is that their first child is the manifestation of their hopes after a fairly public struggle with infertility.

We don’t talk much about infertility, but we don’t talk at all about gestational surrogacy – and it is important that we do.

Human reproduction has always held more than a simple biological meaning and the ‘problem’ of infertility has transcended the individual, positioning itself within a societal context. Today, infertility has shifted from a societal concern to a medical one, affected by changes in how modern society views womanhood and family. In large part due to the Feminist Movement, modern women (predominantly in the Global North) experience greater autonomy and freedom of choice and coupled with growing secularism around the world, views of womanhood have advanced beyond simply wives and mothers. The advent of birth control facilitated the separation of sexual activity from child bearing and in doing so, helped make reproduction largely a choice, rather than an obligation, of womanhood. Similarly, parenthood has also become decoupled from womanhood, as the growing acceptance of homosexuality and the international push for recognition of homosexual marriage has redefined the modern family. Thus in the last thirty years, ‘parenting as a choice’, particularly for the wealthy, has resulted in an increase in the demand for fertility services in the Global North, despite no corresponding increase in the prevalence of infertility.

Responding to this new “demand”, the biotechnology industry began to focus on infertility as a medical concern. Previous solutions to infertility, such as adoption, fell out of vogue as technological advancements meant that at least one parent would be genetically related to the child, as in ‘traditional’ surrogacy (one male in the couple provides sperm for a surrogate, who provides the egg and the womb). By the late 1980s, however, “gestational surrogacy” became the industry standard because it meant that both members of a heterosexual couple could be genetically related to their child, and now, for all couples, there is protection from a genetic claim of parenthood by the surrogate. This medicalization of a previously social concern narrowed the meaning of parenthood to simply ‘genetic relation’, characterizing the gestational surrogate as simply a biological vessel through which a child is born.

Respected anthropologist and critic of the international organ market Nancy Scheper-Hughes commented that “free-market medicine requires a divisible body with detachable and demystified organs seen as ordinary and ‘plain things’, simple material for medical consumption”. She contends that the social phenomenon leading to the dissociation of parenthood from pregnancy and birth has been exploited by the biomedical and biotechnological companies looking to make a profit. Thus the collective cognitive dissociation of pregnancy and parenthood in the Global North and the preference of contemporary medicine to resolve the ethical ambiguity of surrogacy in favor of neoliberal consumer-orientated principles have been the driving forces in the commercialization of gestational surrogacy.

Laws across the Global North regarding commercial gestational surrogacy remain non-uniform, with varying degrees of limited access from illegality to heavy regulation, standing in stark contrast to countries like India where gestational surrogacy is both legal and generally unregulated. Moreover, would-be-parents are ‘priced out’ of surrogacy in countries like the United States, where the cost of gestational surrogacy is between $59,000 and $80,000, while in the global capital of gestational surrogacy (India), Ishika Arora reports that “the value of an Indian woman’s womb is roughly $7,000”.

This is important.

In general, most commissioning couples are upper class or upper-middle class and are more educated than the surrogates that they hire with more legal protections, regardless of geography. When couples seek gestational surrogate women in India, it is an intentional (albeit perhaps subconscious) choice to exploit the asymmetrical relationship between would-be parents and the surrogate, a microcosm of the transnational inequality that exists in economic relations between the North and South. This ‘customer’ preference for a contract in which the surrogate is the disempowered party deprives the surrogate mother of having any rights to her body during her pregnancy, nor to the child after delivery, viewing her essentially as a biological vessel.

Making the case that the Indian commercial surrogacy industry is a form of exploitation, Ishika Arora contends that by ensuring that the ‘market price’ for renting an Indian uterus is up to ten times less than that of a woman in the Global North, “(t)his tells Indian women that in numbers they are worth less in comparison to their foreign counterparts”. Furthermore, these clinics provide world class health care for Indian women pregnant with implanted embryos, despite not granting access to similar health care when the same women are pregnant with Indian babies – an implied message to non-surrogate gravid Indian women that “their children are inferior to the foreign babies they (carry) in their womb”.

Proponents of the industry argue that there is a transformative financial benefit to the marginalized women of India, however, financial insecurity is written into the contracts: There is no guarantee of financial remuneration in surrogacy until the end of the pregnancy – contracts stipulate that payment is only available if a surrogate pregnancy is taken to term and a healthy, live baby is born – a ‘pay on production’ clause. There is no payment if she suffers a miscarriage, or if the baby does not survive a pre-term birth. And while ultimately, Indian women are signing the contracts, signifying their consent and implying that the trade is worth it, the exchange is predicated upon the surrogate acting under economic compulsion which compromises the legitimacy of the autonomy of that decision. In her thesis, Rachel Blatt asked, “are Indian surrogate mothers a muted group, subject to bodily exploitations without knowing it, objecting to it, or resisting it?”

The cumulative effect of this ‘free-market medicine’ has been the commercialization of fertility, making a coveted commodity out of the healthy, tested womb and an industry out of pregnancy. Consequently, a $500 million-a-year industry in gestational surrogacy has been created – a new modern route of capital with labor flowing from South to North and from poor to wealthy bodies. Rachel Blatt, who wrote a thesis on the subject, puts it another way, writing, “(T)he transnational surrogacy industry…originated in the West, became routinized, and then proliferated into the developing world, where its growth was fueled by the body parts of the desperately poor and socially marginalized people”.

While nobody can begrudge a couple like Tyra and Erik the joy of parenthood, the commercialization of pregnancy remains an incredibly important discussion to make for those of us interested in social justice, feminism and economic justice around the world.♦


Academic Paper Version (December 2015): Whose Womb Is It Anyway?

Learn More:  Vice News – ‘Lines in the Sand and Outsourcing Embryos’

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