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Beyond “Wombs for Rent”: Indian Surrogates and the Need for Evidence-Based Policy

“We know that if we take some trouble with our body, it will take care of the education of our children; or we will be able to have a house, so we will be able to live well; or we will be able to satisfy the expectations of our children. This is what every woman thinks. So, if she cuts her body, and gives a part of her body, then she should get her rights. It is for her children.” – Meena, 42-year-old former egg donor[i]

I was seated in a room with more than a dozen former surrogate mothers (women who carry pregnancies for other people) and egg donors (women who provide ova for fertilization through in vitro fertilization). We were in Nadipur,[ii] a city located approximately 40 miles outside of Mumbai, and as we discussed their views on surrogacy in Mumbai our conversation spanned a range of topics. Meena’s comment above reflected concerns shared by many of the women, which dealt with their health, rights, and security. Indeed, throughout our discussion, women spoke confidently and assertively about their work in the fertility industry, raising issues related to fair compensation, medical risks, and the impact of surrogacy on their family relationships.

Listening to the women tell their stories, it was hard to imagine them as simply “wombs for rent.” Doctors who provide surrogacy services often frame surrogacy in this way, emphasizing how surrogacy is merely the renting out of space—the empty womb—for someone else’s child (see also Pande 2009; Vora 2009). However, this discourse of wombs for rent isolates the surrogate’s uterus from her broader social context and her embodied experiences of surrogacy. The emphasis on the transactional value of wombs for rent effectively sidelines women’s lived experiences of surrogate motherhood. Yet women’s experiences and life histories belie facile representations of surrogates as merely disembodied wombs. But neither are they women who simply empower themselves by becoming surrogates (see Deomampo 2013 for further discussion).

Such representations—of women as wombs, or as empowered surrogates—constrain and problematically shape the views of those who access surrogacy services. As I will discuss in this post, the discourse of wombs for rent obscures women’s diverse concerns and fears about their work in the surrogacy industry. By moving beyond such representations that limit debates around how to regulate surrogacy, I aim to broaden current debates around assisted reproduction policy in India.

 

Returning to the field

In December 2013 I returned to my field site in Mumbai, India, where I studied the sociocultural and ethical implications of transnational surrogacy. The practice of transnational surrogacy forms part of a broader phenomenon known as reproductive tourism, transnational reproduction, and cross border reproductive care, which involves the travel of prospective parents in pursuit of assisted reproductive technology (ART) services. When I began this research in 2008 I was especially interested in how various actors—including commissioning parents, surrogate mothers, and egg donors—understand notions of kinship and race as they undergo assisted conception across national, ethnic, and class boundaries. Yet, as I delved deeper into fieldwork, my interests expanded to include questions related to the power and agency of different actors, especially the Indian women who become surrogate mothers for foreign clients and wealthy Indians.

These questions are important to consider, particularly as surrogacy remains unregulated in India. With the growth of medical travel for ARTs and gestational surrogacy, doctors and other stakeholders have pressured the Indian government to pass a law regulating ART clinics. Yet after the Indian Council for Medical Research drafted the Draft ART (Regulation) Bill and Rules in 2008 and released a revised version in 2010, the bill continues to await decision in Parliament. As debates continue around how to legislate the flourishing fertility industry, various groups have argued that major gaps exist in the protection of surrogate mothers and children in the current draft bill.

Most striking are the changes in the provision for payment to the surrogate woman, which undermines her rights and favors the commissioning parents (called “clients” by surrogates and doctors). The 2010 Draft recommends that surrogates should be paid in five installments (instead of three, as in the 2008 Draft) and 75 percent of the payment is to be disbursed at the fifth installment, following delivery of the child (in contrast to the 2008 Draft, in which 75 percent was to be made at the first installment). This move not only prioritizes clients’ and doctors’ concerns, but also downplays the risks associated with surrogate pregnancy, labor, and related emotional and physical risks. Moreover, the draft increases the number of permitted live births for a surrogate from three to five, inclusive of her own children. The Draft trivializes the real threat to surrogate women’s health by repeated pregnancies.

However, while discussions around ART policy and legislation are ongoing, the voices and perspectives of Indian women who participate in commercial surrogacy remain largely absent. Because of this, I wanted to return to India to follow up with women about their surrogacy experiences and to provide a forum in which they could voice their hopes, desires, and visions for the future of surrogacy in India. The aim was to provide an opportunity—through an open group, participatory discussion—for surrogate mothers and egg donors to articulate their concerns around the medical, social, and contractual aspects of commercial gestational surrogacy.

 

Reflections on surrogacy: Women tell their stories

Working with my Marathi translator, Prachi, I began by meeting informally with current and former surrogate mothers and egg donors, many of whom participated in my dissertation fieldwork in 2010. My goal was to disseminate key findings and to provide women a space in which to reflect on these findings and their own personal experiences of surrogacy. During these discussions, we focused on women’s individual reactions and reflections on how surrogacy has affected their lives. Their stories spanned a wide range of experiences. While some women told of how they successfully purchased a new home or paid off their debts with their surrogacy earnings, others recounted tales of ongoing struggle, to which surrogacy offered only a brief reprieve. To be sure, women’s narratives illustrated the diversity of their experiences and personal histories, showing how there is no “single story” of surrogacy in India.

Malaika was particularly outspoken about the importance of surrogacy in lifting her family out of financial duress. Malaika, 33, had an arranged marriage at 12 and gave birth to her first child at 13. But after 15 years of marriage, Malaika’s husband died, leaving her to care for their three young children. With only a fourth-grade education, Malalika struggled to make ends meet; she worked intermittently as a housecleaner, making $50 to $70 monthly. But when Malaika learned about surrogacy through a friend, she knew immediately that this could help solve her financial woes. When she decided to become a surrogate, Malaika said, “I was helpless…I thought, how will I take care of my children? I wanted to do something for my children’s future.” With three teenage children at home, Malaika was honest about her decisions to become a surrogate and explained to them that this was “a holy kind of work”: punyache kam, a good deed for which one would get something in return.

Malaika was engaged to be married to a man she described as open-minded and supportive, yet she opted to postpone her marriage until after she completed her surrogate pregnancy. Wanting to leave nothing to chance, Malaika knew she had to do surrogacy first because, she said, “What if he doesn’t permit me to do surrogacy after marriage; then what will happen to my children’s future?” Malaika, like many women I interviewed, challenged claims that women were coerced into surrogacy by their husbands. Instead, because most doctors required that married women obtain their husband’s permission to do surrogacy, women described how they strategized to convince their skeptical husbands to allow them to become surrogates. Shortly after she gave birth via cesarean section to twins in 2012, Malaika married her second husband in 2013.

For her labor as a surrogate mother Malaika received approximately $4,700 (her doctor increased payments for twin pregnancies and cesarean deliveries). With the money, she bought a home in her village and a moving truck, which she rents to companies for income. She placed the rest of the money in savings. In our interview, Malaika appeared proud of the work she had done; she explained, “After doing surrogacy, I feel I have not only done something for my kids, I have also come to know about duniyadari.” In other words, Malaika felt that surrogacy offered her a broader worldview and a sense of openness about the ways in which people live and work in the world.

On the other hand, Indu, a 33-year-old widow with two sons, recounted how her surrogacy payment—she earned approximately $3,300 after completing her surrogate pregnancy in 2010—was not enough to purchase a house in Mumbai, where real estate prices are among the highest in the country. She told me she would have needed more than twice her earnings to buy her own home. Since owning a house was out of reach, Indu used her payment to purchase a small life insurance policy, some gold, and various household goods. Having spent all of her earnings, Indu tried to become a surrogate four more times, each attempt without success, and now laments that she is too old to do surrogacy again. She earns modest daily wages working for a small catering company in Nadipur, making around $60 monthly. About her current situation, Indu tells me, “I have struggled and survived before. I will find a way to survive again.” While surrogacy may have temporarily eased her financial worries, Indu continues to struggle in her day-to-day life.

Women discussing the surrogacy industry in Mumbai, India

Collective concerns

These meetings culminated in a participatory workshop with women who had previous or current experience in surrogacy or egg donation. The workshop took place at the home of Aruna, a former surrogate mother who now works as an agent-caretaker. While our previous discussions tended to focus on individual and personal experiences of surrogacy, my goal in the workshop was to generate discussion around women’s collective concerns and visions for the future of surrogacy. I hoped to foster a discussion of key issues that women believed should be accounted for in ongoing policy debates.

Our discussion traversed a range of themes as women considered the following questions: what are the issues that matter most to you? What issues would you want to see included in policy discussions and debates about surrogacy? What changes would you like to see in current surrogacy practices in India?

Several key themes emerged in the discussion. First, women called for increased compensation, arguing that the current payments are simply not enough given the high cost of living in Mumbai.[iii] As Leena described, “If one gets two to two and a half lakhs (approximately US$3,400 to US$4,200), you can’t do anything with that. Even children’s education cannot be covered with that. If one wants to buy a house, it costs five to seven lakhs (US$8,500 to US$11,800). If one receives at least five lakhs, then maybe you could take out a loan of two lakhs and buy a house.”

Others believed that the payment was not enough to address the health risks and the physical toll involved in surrogacy. As Madhuri explained, “Yes, they should increase the payment. If one is going to cut her stomach (via cesarean section), it should be worth doing that. Our health is also concerned.” Malaika concurred: “We are not just taking clients’ money for nothing; it is our blood and sweat. We should get paid for that.” The issue of fair compensation was paramount. While women in this study acknowledged that they were drawn to surrogacy by the prospect of earning much needed income, their experiences also challenged the belief that surrogacy offered a panacea for women’s problems of poverty. Payment practices varied widely among doctors and clinics, and surrogates called for greater attention to the question of fair remuneration and pricing standards.

Another theme raised in the discussion examined the relationship between surrogates and commissioning parents. In many cases, surrogates told stories of how they never had a chance to meet the clients who commissioned their surrogate pregnancies. While many doctors I interviewed chose not to encourage intended parents to meet with surrogates, the women said that this made them feel poorly treated. They believed it was important to foster connections with their clients, if only to acknowledge the significance of the role the surrogate plays in assisted conception. Prema explained that it was not necessary to meet very frequently but that surrogates and clients should meet at least once during embryo transfer; she asked, “If your own wife were pregnant, would you have stayed so far away?” Another surrogate, Priti, noted that in addition to developing a personal relationship with the clients, it is important to negotiate contractual details directly: “The doctor should allow us to meet the other party. Whatever is done, should be done in person. I mean, when payment is to be discussed, the clients should speak with us directly. If we agree, we will do it; if we don’t agree, we won’t do it. But there should not be so much distance.” Surrogates’ comments demonstrate the need for increased transparency and attention to the social relations embedded in surrogacy.

While I am unable to detail all of the issues raised in the space permitted, I want to note that throughout the workshop women articulated a range of concerns, from the importance of staying close to their children (in cases where surrogates are obligated to live away from their families in clinic-arranged housing) to problematic practices with respect to payment and disbursement of funds. Overall, women’s comments illustrated the diverse ways in which surrogacy affects their social lives, family dynamics, and economic status.

 

Toward an evidence-based policy

As discussed above, major pitfalls remain with the current ART bill, particularly with respect to insufficient attention to the social and medical risks involved in surrogacy. Yet my research shows that surrogates have additional concerns not addressed in the bill. While this engagement project offered a forum for women to voice their concerns and experiences with surrogacy, these voices are typically absent from policy discussions, despite the fact that it is these women who bear the brunt of the medical and social risks associated with ARTs.

Here I want to argue for the importance of evidence-based policy in efforts to regulate the ART industry. Empirical and ethnographic researchers have the potential to make important contributions to policymaking. Such research can influence policy by grounding the conversation in the lived experiences of women, rather than in abstract principles or rules. Moreover, an evidence-based approach would take into account the interests of the full range of actors involved, not only those of the doctors and clients involved in surrogacy. By connecting social scientific knowledge to policy programs and practices, and by focusing on evidence that derives from local knowledge, policymakers can draft a more balanced and effective policy that addresses the needs of surrogate mothers and egg donors.

With greater attention to empirical evidence that documents the everyday lives of surrogate mothers, and increased participation of surrogate mothers and egg donors in policy discussions, could future efforts to regulate the ART industry attend to the diversity of women’s experiences, needs, and desires? Perhaps then we may be able to move beyond stereotypical representations of “wombs for rent,” and toward an evidence-based policy that accounts for the complexities of women’s experiences with surrogacy.

 

Daisy Deomampo is Assistant Professor of Anthropology at Fordham University in the Bronx, NY. She is currently completing a book manuscript about kinship, power, and transnational surrogacy in India.

 

References cited

Deomampo, Daisy. 2013 Transnational Surrogacy in India: Interrogating Power and Women’s Agency. Frontiers: A Journal of Women’s Studies 34(3):167-188.

Pande, Amrita. 2009 “It May Be Her Eggs But It’s My Blood”: Surrogates and Everyday Forms of Kinship in India. Qualitative Sociology 32(4):379-397.

Vora, Kalindi. 2009 Indian transnational surrogacy and the commodification of vital energy. Subjectivity 28(1):266-278.


[i] This post expands on an article written for the Wenner-Gren Blog, based on a project that was funded through the Engaged Anthropology Grant program.

[ii] All names of research participants and locations have been changed.

[iii] Surrogates who participated in this research in 2010 reported receiving between 2 lakh rupees (US$3,400) and 3.5 lakh rupees (US$6,000); surrogates who gave birth to twins via cesarean delivery earned closer to the latter figure.


One Response to Beyond “Wombs for Rent”: Indian Surrogates and the Need for Evidence-Based Policy

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