Because most philosophies that frown on reproduction don't survive.

Monday, October 12, 2009

Outsourcing Maternity

If you thought the modern world couldn't get any more messed-up in its understanding of reproduction and the family, you need turn no further than the WSJ weekend section, and a feature article on people hiring surrogate mothers from India to bring their children to term.
According to Hrishikesh Pai, a Mumbai-based in-vitro fertilization specialist and vice-president of the Indian Society for Assisted Reproduction, India now has about 350 facilities that offer surrogacy as a part of a broader array of infertility-treatment services, triple the number in 2005. Last year, Dr. Pai says, about 1,000 pregnancy attempts using surrogates were made at these clinics. This year, he estimates the figure will jump to 1,500, with about a third of those made on behalf of parents from outside India who hired surrogates.

Rudy Rupak, president of PlanetHospital, a California-based medical-tourism company, says that in the first eight months of this year he sent 600 couples or single parents overseas for surrogacy, nearly three times the number in 2008 and up from just 33 in 2007. All of the clients this year went to India except seven who chose Panama. Most were from the U.S.; the rest came from Europe, the Middle East and Asia, mostly Japan, Vietnam, Singapore and Taiwan.

Mr. Rupak says that because of growing demand from his clients for eggs from Caucasian women, he's started to fly donors to India from the former Soviet republic of Georgia, where he has connections with clinics. The first woman arrived last month. A PlanetHospital package that includes an Indian egg donor costs $32,500, excluding transportation and hotel expenses for the intended parent or parents to travel to India. A package with eggs from a Georgian donor costs an extra $5,000.
For the Indian surrogates themselves, it's an experience often fraught with emotional conflict. In most cases, the egg comes either from the woman who wants to become a mother but can't carry a child, or from an egg donor. The egg is then fertilized with sperm from the intended father, or a sperm donor, and implanted in the womb of a surrogate who bears the child. Sometimes, no money changes hands, particularly when a friend or relative acts as the surrogate. Alternatively, it's a commercial transaction, which is almost always the case in India for would-be parents from overseas.
Still, it's a way to raise money in sometimes desperate circumstances. Take Sudha, a 25-year-old mother of two who now works as a maid in Chennai earning $20 a month. She owes moneylenders about $2,700, borrowed to pay bribes to secure a government job as a streetsweeper, which never materialized. A neighbor told her she could earn about $2,000 at a local clinic by bearing a child for an infertile couple. She gave birth in July 2008 -- and is haunted by the memory. "Whenever I have free time and I lie down, I think about the child. I pray that the child is safe and happy and is taken care of well."

Sudha, who like other surrogates asked that only her first name be used, has reduced her debt to about $600, but the family still struggles to eat. One solution, her husband Umat says, is for Sudha to act as a surrogate again. But he adds that he "won't force her if she says no."

For other women, like 29-year-old Lakshmi, a pregnant surrogate in Chennai who already has an 11-year-old daughter, a 12-year-old son, an alcoholic husband and a $4,000 debt, having someone else's child sounded like a better option than her other plan: selling a kidney. A doctor advised her that with a single kidney left, "I might live for a shorter time. I have a daughter. I have to get her married...I prefer" to be a surrogate, she says.

Some middle-class Indian women, too, are becoming surrogates. In Bangalore, a cash-strapped high-school-educated wife, who earns about $20 a month selling Oriflame brand cosmetics, waits for a call from a local clinic that she has been chosen as a surrogate. Her husband, an office manager, owes more than $30,000, borrowed to start a company that faltered, and the couple can't repay the loan.
[emphasis added]

As human beings, we're meant to reproduce via sex -- and children are meant to be raised by their parents. Our instincts continue to reflect that, even if culture and money convince individuals to act some other way. So it's hardly surprising that the women in India who are pushed into offering themselves as surrogates feel like they've lost a child, and suffer accordingly. The problem is that the people in America and elsewhere in the developed world who are seeking to "have a child" this way don't seem to recognize that trying to pursue their wishes this way is hurting the birth mother of "their" child -- and arguably the child as well in the long run.

Why do people seek these services?
Michael Bergen and Michael Aki, a gay American couple who got married in 2004 and work as graphic designers in Massachusetts, decided to try surrogacy in India after they waited unsucessfully for three years to adopt a child in the U.S. To hire a surrogate, "we looked at Panama and the Ukraine," recalls 39-year-old Mr. Bergen. "But India had better infrastructure, more high-tech facilities and the healthier lifestyle. (Most women) don't smoke, they don't drink and they don't do drugs."
With travel costs, Mr. Bergen estimates the couple spent about $60,000 in all, including compensation of $10,000 for each surrogate. That's roughly half what he thinks the total cost would have been in the U.S.

For others, money is no object. Last year, a former U.S. investment banker in her early 40s, who asked that her name not be used, spent $128,000 to reach her goal. She approached a dozen fertility clinics in India for help. Despite her age, she and her husband wanted to try with her eggs. In the initial attempt, a doctor implanted several embryos in two separate surrogate mothers. That failed. In the second round, the doctor relied on three surrogates. Still no pregnancy. In the third round, he repeated the procedure with two additional surrogates. Bingo. The seventh surrogate gave birth to healthy twin girls.

It's the kind of determination that Rhonda and Gerry Wile understand. She's a 39-year-old blond registered nurse. He's a hefty 43-year-old fireman. Originally from Canada, they married in 2000 and resettled in Mesa, Arizona, three years ago.

The couple started trying to conceive in mid-2005. After several months, Ms. Wile consulted a specialist who found a problem: She has two small wombs instead of a single one. Two months later, though, she was thrilled to find out she was pregnant. But she soon learned the fetus had no heartbeat, and she had to undergo a drug-induced abortion.

Next the couple tried artificial insemination. It failed. They started to consider other options. They ruled out adoption, discouraged by the red tape. A doctor, meanwhile, had recommended surrogacy, and Ms. Wile saw a TV program about surrogacy in India on "Oprah" in October 2007. The Wiles then trawled the Internet for information. In January 2008 they settled on Surrogacy India, a newly established private Mumbai clinic. They liked the quick response to their questions and the clinic's policy of encouraging surrogates to move into designated quarters with their families during the pregnancy, rather than splitting them apart.

"It's been hard for me, being a woman," Ms. Wile said during a trip to India last April. "I've always believed that part of my job as a woman is to have a child." For her, surrogacy seemed as close as she could get to creating a child. The price was also right. "We didn't want to go broke" and "bring a child into the world bankrupt," she added.

The Wiles figured it would cost them between $50,000 and $80,000 for each attempt if they had used a surrogate in the U.S. By comparison, they spent a total of about $50,000 on three attempts in India, including travel expenses for four round trips to India, $550 for the baby's birth and a few days' hospital stay and $5,625 paid to a woman they call "KT," who carried their son.
In October, the Wiles selected an Indian egg donor over the Internet using the clinic's Web site. Then they picked out a new surrogate, KT, a married woman with the Indian equivalent of a seventh-grade education who has two small boys of her own. In her profile, KT described herself as having a "supporting nature" and listed her motivation for becoming a surrogate as "financial, to educate (my) kids."
A month or so before the birth, they finished the nursery in their Mesa home and held a baby shower. Mr. Wile bought the baby a set of golf clubs. Despite the ultrasound, they didn't know whether they would be bringing home a boy or girl; to discourage the selective abortion of girls, Indian law prohibits disclosure of a fetus's gender.

Mr. Wile says: "We've had a very good experience with surrogacy and we're definitely going try it again." They will have to find yet another surrogate, though. Mr. Wile says KT declined to carry a second baby for them.

Part of the problem here is people who want to have children in situations that don't naturally result in children: Same sex couples. People who are too old to conceive and carry to term naturally.

Their pain at not being able to have their own children may be real, but this, "I should be able to have whatever I want," attitude towards childbearing -- turning children into a consumer commodity -- only moves the pain to someone else, and makes it worse.


Jenny said...

It does seem like they are buying their children.

Anonymous said...

Sad. So many people don't seem to know why they even exist. Without the hope of heaven and the guidance of God, so much is wrong with our lives.

Al said...

Another sad sign of how depraved our culture has become. Children a commodity, like a new washer or a new puppy.

God have mercy on us.

Catholic Bibliophagist said...

Can we say, "Exploitation of women"?

Anonymous said...

Exploitation, or an opportunity to get out of poverty? If anyone can cite evidence that these Indian surrogates have been forced into this business then I will agree that it is exploitation. Otherwise, no.


mrsdarwin said...

Just because someone is not forced physically into some practice does not mean that the practice itself is not exploitative.

crankywife said...

" mrsdarwin said...
Just because someone is not forced physically into some practice does not mean that the practice itself is not exploitative."

Touche! Just look at the porn industry.

Anonymous said...

Is McDonald's exploitative? Or orchards that hire migrant farm workers?

If you say yes then I will grant, under the terms as you define them, that the surrogate parenthood discussed here is indeed exploitative, though I normally wouldn't use the term that broadly. (Ditto re: porn.)


Darwin said...


While I suppose one can object to it if one wishes, making use of other people's sexual and reproductive faculties in return for money (especially when this is done by offering people in desperate circumstances amounts of money they would otherwise be in no position to get by any means) is widely considered exploitive even under the relaxed moral norms of modern Western society.

McDonalds and agricultural concerns hire people to do work that is culturally accepted as normal and honest (if hard) work for fairly low wages. These surrogacy clinics are holding out what for poor to middle-class Indian women amount to up to a year's salary in return to bearing a child and then immediately giving the child away. Not only is that in and of itself deeply immoral, but it's also something deeply shaming in Indian society -- such that many move away from everyone they know while going through the pregnancy.

So no, I really don't see how paying someone less than we might like them to make to do perfectly honest and useful work is at all in the same ballpark as using massive amounts of money to tempt a financially desperate woman into doing something which is unnatural, wrong and will likely cause her some degree of emotional suffering throughout the rest of her life.

The mere fact that one is able to leverage someone into consenting to something semi-voluntarily does not mean that it's right.

Anonymous said...

Hmm, it appears that we are farther apart on this issue than I thought. I note that the practices of sperm donation, egg donation, and surrogate parenthood have been around in the west for decades and are widely accepted in society. Your statement about "making use of other people's sexual and reproductive faculties in return for money" would seem to be lacking support from most of the public.

The only new thing in this situation is that surrogate parenthood is now being outsourced to another country, a particularly poor country. Frankly, I would much prefer to see Indian women hired as surrogates rather than Americans, precisely because Indians are poorer. You grossly underestimate the economic difference when you say that the $10k being paid to an Indian surrogate is "up to a year's salary". In fact, it's way more than that. It's enough to start a business, enough to send her kids to a good private school for several years, enough to buy four Tata Nanos. The fact that these women are being paid handsomely to do something that western women have been choosing to do for decades cannot be called exploitation under any reasonable terms.

Finally, you say that surrogate parenthood is inherently "unnatural, wrong", and ""deeply immoral". I reject that notion utterly. Surrogate parenthood is the *only* way that some couples can have children. The desire for couples to reproduce is natural, right, and deeply moral. Now, I am not Catholic, and I have previously noted that the Catholic view of sex and marriage is different from everyone else's and leads to some highly odd conclusions, including the blanket prohibition on contraception, something that pretty much no one else in the world shares. Your view of surrogate parenthood may be another necessary corollary of the Catholic view of sexuality. If so, then we'll have to just agree to disagree.


CMinor said...

The medical techniques required for collecting donor eggs and implanting embryos in women's wombs put the women at risk of conditions that can harm the embryos being implanted, the surrogates' future reproductive ability, and their health (possibly their very lives.) I don't mean something analagous to a nasty fryer burn, either, which, by the way, the individual worker has some personal control over.

It's one thing to argue that women should be able to choose to undergo these techniques themselves having thoroughly reviewed the risks; it's something entirely different to blithely dismiss the moral implications of wealthy, educated women hiring somebody else--who may not have been advised of the risks and may be under strong financial pressure to overlook them anyway-- to take on those risks for them.

j. christian said...

I have previously noted that the Catholic view of sex and marriage is different from everyone else's and leads to some highly odd conclusions

As if the prevailing culture's views of sex and marriage don't lead to some odd conclusions.

DMinor said...

I note that the practices of sperm donation, egg donation, and surrogate parenthood have been around in the west for decades and are widely accepted in society.

Morality is not determined by "wide acceptance." If it were, many horrible practices would be moral and morality itself would change over time.

Anonymous said...

CMinor referenced "the moral implications of wealthy, educated women hiring somebody else--who may not have been advised of the risks and may be under strong financial pressure to overlook them anyway"

First, let's remember that these wealthy, educated women are unable to have children on their own.

Second, if the Indian surrogates are not being advised of the risks, then they need to be. This, if it is true, is a program management problem, not an inherent moral problem.

Third, the "strong financial pressure" is more accurately described as "incentive". People in other risky occupations (high voltage electricians, frex) get paid more, too.

DMinor suggests that surrogate parenthood is immoral in spite of its social acceptance. I disagree, and in fact argue that surrogacy is more moral than adoption. Adoption usually is the result of irresponsible teenagers screwing at random, motivated by hormones or peer pressure. Surrogacy is the result of artificial insemination, motivated by a couple who want a child.

Finally, I would remind everyone in this thread that surrogacy is a traditional practice that goes back at least to the days of Hagar.

Darwin said...

Finally, I would remind everyone in this thread that surrogacy is a traditional practice that goes back at least to the days of Hagar.

That didn't exactly go so well either in the end, though...

Okay, a couple things here:

1) India is a poor country, which means it has much greater disparity of income than the US. However, let's be realistic here. The people I work with on a daily basis in India, who do work similar to mine, make 25-30k/yr. That's not unusual for a college educated professional in India -- making roughly 25-30% of what a US equivalent worker might make. So no, the surrogacy fees being given out here are not something to totally change someone's life. Remember, one of the women had incurred $2700 in debt just to pay bribes in order to secure a city street sweeper position. This indicates, at the least, that a steet sweaper makes well over $2700 per year.

2) To say that surrogacy is widely accepted is probably stretching a point. Many US states and developed nations (Japan, Canada, France, Australia, UK) completely ban commercial surrogacy (that is, a woman receiving financial compensation in return for an agreement to bear a child for another person or couple. One of the reasons this is being sent to India is because many countries entirely ban the practice, and in others, it's very hard to find anyone willing to go through it. That doesn't sound like wide acceptance to me.

3) I'm having a hard time with the claim that surrogacy is "more moral" than adoption. Adoption consists of finding a couple willing to take in as their own child a child who otherwise has no parents or relatives able to rear him/her. Surrogacy involves artificially conceiving a child because a couple is hung up on having a child which is genetically "theirs" despite an inability to conceive naturally. The former involves finding a loving home for someone in danger of lacking one -- the latter involves going out of one's way (and to considerable expense, and causing a certain degree of suffering on the part of others) to create a child of highly complicated parantage. (Many of these cases involve the man from the "parent" couple, another woman's egg, and yet another woman to carry the pregnancy.) Honestly, if one doesn't have some sort of mystical hang-up about DNA, if a couple can't have kids naturally there are plenty of kids already alive in the world who need homes.

4) Yes, my thoughts on this do spring in part from a Catholic understanding of sexuality -- though I'd point out that the Catholic understanding of sexuality is hardly novel. It was shared by all Christian denominations until the 1930s, and it pretty much consists of holding that sex is what biology says it is, with the addition of holding that using our reproductive functions in ways contradictory to their purpose is wrong.

Warren said...

It's funny for someone who is completely morally relativistic (Joel) on sexual issues to call someone else's conclusions odd, isn't it?

Catholics happen to be upholding a view of human dignity that raises the bar on how we treat human beings.

Having a person live in such abject poverty conditions that she is forced to resort to surrogacy to survive is a grave moral evil in that culture. In fact, because her very survival is at risk, you could make a Catholic moral argument that by accepting a role as a surrogate by choice, to survive, she is doing the best thing she can do, if that is truly her only option.

However, surrogacy is fraught with issues, medical problems, etc. A catholic moral thought process must be large enough to encompass all possible problems and side-effects that such a moral choice on her part could entail. Is this woman choosing surrogacy taking a risk that she herself could be seriously harmed or die, if these procedures are botched? Yes, she is. Does she have the right to make such a choice, endangering her own life, merely to make money, if it was the money that motivated her choice? Is that not irresponsible of her, if others depend upon her, and if her life is viewed by God, as precious?

If there is no God, and we are merely blobs of accidentally mobile goo, then a lot of moral issues go away (conveniently). If God gave us our lifes, and our dignity, as the Christian religion insists that he did, then there is quite a lot that we may not justly do to ourselves. Suicide, for example, is morally wrong, and harming yourself through surrogacy is wrong, too. Paying someone to harm herself is wrong.


CMinor said...

--Finally, I would remind everyone in this thread that surrogacy is a traditional practice that goes back at least to the days of Hagar.

--That didn't exactly go so well either in the end, though...

Whoa--Joel, was that a tacit approval of the practice of ravishing the domestics?

I'll agree, though, that though the mechanics today are generally different, there are some eerie parallels.

The Opinionated Homeschooler said...

Joel, man, I'm usually right there with you politically; but the suggestion that opposition to renting the wombs of impoverished Third-world women is somehow a uniquely Catholic hangup just makes my feminist blood run cold.

Women aren't to be used in this way. And to say "but it's better than poverty" starts taking you places I don't think you want to go. I hope.

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