Surrogate motherhood in developing countries: fine in theory, nasty in practice

Medical tourism is a burgeoning global industry. The nature of the market is governed by economic realities: demand for medical services comes from those with money (normally, those from affluent nations) and the supply or execution of those services fall to entities in developing countries. Consider the growing “rent-a-womb” business in which couples from wealthy nations outsource gestation to surrogate laborers abroad, especially in India. The practice has been hailed as a win-win for both the couple and surrogate mother, most notably on Oprah in 2007. Frustrated couples who have exhausted fertility options and/or cannot afford surrogacy in their home countries take advantage of a cheaper alternative abroad and ultimately return home with a smiling (or crying) baby in arm; on the other hand, surrogate mothers earn sums they could only have dreamed of previously, creating, presumably, a brighter future for their families.

But if one digs beneath the warm, fuzzy veneer projected by the industry, one finds an undersoil less fruitful than a surrogate mother’s womb. Mother Jones recently published an exposé of the industry that reveals unfortunate realities on the ground. For example, surrogate “laborers,” the poverty-stricken carriers of privileged Western fetuses, are often required to live in modest residential dormitories away from their families for the entire duration of the pregnancy, resigning their freedom of movement. New economies are developing as outgrowths of the industry as “recruiters” are hired to scour the slums for women open to the surrogacy-for-money scheme. Exploitation becomes an ethical consideration whenever there is a hierarchical system in which the wealthy seek services from the poor. When a woman living in the slums of Chennai is offered money (a fortune to her and a mere drop-in-the-bucket for her hirer) to lease her womb to a Western couple for 9 months, how much of a choice actually exists when the alternative is the status quo? Poverty is the figurative gun held to the woman’s head as she mulls her “choice.”

There are even larger questions, however. Should surrogate motherhood be forbidden as in some countries like the Netherlands, France, and Japan? If not, should surrogate motherhood be strictly voluntary without any financial incentive? One thing is for sure: if the practice of surrogacy is to continue (which I believe it should, as an option for those couples who have exhausted all other avenues to fertility), it needs to be regulated to reduce exploitation and protect the rights of surrogate mothers. As it stands today there “are no rules” regarding surrogacy in India according to a local health official. No official guidelines exist on a local or national level in India, and the entire industry operates un-policed. But the acts of surrogacy—carrying a fetus and enduring labor—are not benign undertakings devoid of risk, and those bearing these risks deserve protections. Who, for example, should cover the costs associated with a surrogate mother’s health care should she develop a condition related to childbearing in the perinatal period? Unfortunately, the case of Easwari, a surrogate mother who died of severe post-partum hemorrhage, illuminates the industry’s lack of preparedness to deal with these situations. Easwari was told that no help could be found at the clinic that had hired her and was instructed to pay her own transport expenses to a local hospital. She died en-route. Responsibility for the surrogate mother’s health care ended at delivery, apparently.

Guest post by David Kennedy,
Medical student, University of North Carolina-Chapel Hill