Inequality in the Business of Surrogacy

Carvings of men and women on Jagdish Temple, Udaipur. Photo credits: Adrian

Last month, Dr. Sheela Saravanan gave an excellent colloquium talk based on her research of commercial surrogacy in Gujarat. She highlighted the economic and legal inequality in these transactions. For example, Indian surrogates are not even given the copy of the contract and have little knowledge of the legal guidelines, while US surrogates have a choice over closed or open contract and choose the closeness of the ongoing relationship between her and the intended parents. The participants of the colloquium asked great questions, such as the role of doctors. Doctors have a lot of power to conduct this business and there seemed to be minimal regulation; there is still no authoritative data on the number of surrogate births in India. A Mumbai doctor in the business once even replied to Saravanan’s persistent questioning, “We are doing a favor for the mothers.” Another question asked the caste background of the surrogate mothers. One of the clinics Saravanan researched had a book of surrogate profiles for the intended parents to browse. In that book, most of the intended parents ask about religion and usually wanted mothers to be of the same religion. Furthermore, if the surrogate mother was a Brahmin, then she could receive more money. If one is better looking then one would also have higher chances of being chosen from the book. Yet this process does not occur in the reverse: the surrogate would not choose the parents or sometimes not even the number of fetuses inserted in her body.

Inequality between the global north and south pervades medical tourism. Indian film Ship of Theseus poses bioethics questions in one of the segment where an illegal organ trader poached a poor Indian man one of his kidneys. The organ trader provided it to man who needed a new kidney in Europe who knew nothing about the source. Later two Indian good Samaritans traced down the European man and questioned him about this problem. The European man coughs up more money for the man who lost a kidney, yet one of the Indians saw this act as an easy way for the European man to buy out of his guilt. The segment ends with the good Samaritans bringing the Indian man the money but still feeling ambivalent regarding the nature of the trade. Surrogates who sign up for money in the global south also are susceptible to deceit. The 10-minute documentary Mothers Anonymous shows that surrogates who give birth to twins or triplets may not always receive the promised compensation and have few legal channels of dispute. Saravanan noted in her paper on surrogacy that “Asymmetries of individual capacity (knowledge, contacts and financial capability) lead to trust amongst actors. This trusting process results in experiences that can either be positive or potentially exploitative.”

But the starkest aspect related to surrogacy among the many forms of medical tourism is the gender aspect. Many kinds of medical tourism arguably can become more transparent and legally regulated for both parties, but the gender issue of surrogacy will still remain a stickler: the social contract has been conveniently neutralizing patriarchy in legalese, and the same may happen to surrogacy. Sarvanan writes,

In her book, The Social Contract, Carole Pateman critiques the social contract theory and asserts that patriarchal control prevails in the marriage contract, the prostitution contract, and the contract for surrogate motherhood. She claims surrogacy contracts are the means by which women’s reproductive capacities are dominated and patriarchy is upheld. In Feminist Morality, Virginia Held regards the social contract theory as inadequate in representing children and women and in capturing the meaningful moral relationship between people.

Surrogates may read, understand and sign a surrogacy contract, but the contract would not signify the same amount of shame and guilt as for a person to read, understand and sign a contract for trading in his or her kidney. Cultural baggage is attached to surrogacy in the South Asian context. While some think that being a surrogate mother is fine for money in an otherwise a conservative society, with patriarchy in mind, I still found it hard to believe that women can ever pursue this chance in the open: understandably many work in collaboration with their husbands and immediate family to keep this as a secret. Another gender question: how does surrogacy threaten the social understanding and definition of motherhood? The surrogate mothers in the documentary feel emotion attachment to the babies, even though they are not genetically related. (In contrast, the popular trope regarding men is that they expect their offspring to be genetically “theirs.”) Women around the world face critiques that they are selling their wombs, which should somehow be regarded as a sanctified zone. Motherhood seems to mean legal ownership of the child, but in the case of surrogacy without the same amount of effort, which is so often labeled as “sacrifice.” The intended parent also may not experience the typical birth defining motherhood but still expects to enjoy all the experiences with “her” child thereafter.

Many surrogates rationalize their decision by citing their economic needs and contribution to family income, as seen in the documentary. This attitude poses is a stark contrast with another group of women who also earn money for their family in Pakistan. Zehran Yasmin Zaidi’s Chaddors and Pink Collars in Pakistan: Gender, Work, and the Global Economy shows in one chapter that oftentimes women can

participate in non-traditional employment outside of home, but requires women to observe cultural norms in non-work related matters. The dynamics of this process can be understood by examining how class and gender operate in Pakistan. Many women workers who were interviewed by the author came from working-class backgrounds, yet made contradictory claims about working out of choice rather than economic necessity.

But in both cases, women earn approval through bringing financial gains to the family despite the acts are against previous convention.

Unfortunately there was not a lot of anthropological data on the gender questions: who makes the decision to become surrogates in the family and what are the different opinions of the informed participants (e.g. Fathers, mothers, in-laws)? How does gender relations impact the surrogates’ economic “rationality?” The intentions are very elusive, compounded with layers of ethics and gender politics. I speculate that it is possible that both sides who are participating in this transaction would not even approve of this kind of deal when asked in a polling exercise.