International Surrogacy: A Global Opportunity or Unregulated Exploitation?

Mother and son in India
Mother and son in India

By: Jesse Fishman

Since 2002, when India legalized commercial surrogacy, India has become the one-stop-shop for international surrogacy.  Despite the increasing popularity, this international baby phenomenon has many critics.  They range from believing that the process is inherently exploitative, to the less critical: those that simply believe more legal regulations would help the process.  Proponents, on the other hand, believe that the practice isn’t exploiting the population; rather, it is providing women with an opportunity for income.  Whatever the stance, opponents and critics alike can agree on a few points: international surrogacy is growing rapidly, and regulation may be the only way to protect the rights of both the surrogate mothers and the hopeful adoptive parents.

While no official agency keeps track of the number of hopeful would-be parents that travel to India for surrogacy, it is clear that the practice is growing at alarming rates.  For example, the president of California-based medical-tourism company PlanetHospital sent 600 couples or single parents to India for surrogacy in the first eight months of 2009.  From the Indian perspective, Dr. Kadam, the medical director of an infertility clinic in Mumbai, “delivered 18 babies born to Indian women for foreign couples” within the past year.  She has six to seven couples visit a month from overseas to discuss surrogacy, and she says the demand for Indian surrogates is growing.  In 2008, the Vice President of the Indian Society for Assisted Reproduction claimed, “about 1,000 pregnancy attempts using surrogates were made” at “about 350 facilities that offer surrogacy.

Would-be parents choose India for a variety of reasons, including: price, lack of regulations, and health benefits.  Surrogacy costs $10,000 to $15,000 in India, or an estimated $70,000 in the United States.  Many would-be parents choose India because they worry that surrogates in other, more regulated, countries would choose to rescind the agreement and keep the baby.  One couple chose India because it “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.”

Whatever the reasons, it is apparent that the practice is increasing and India’s surrogacy regulations aren’t equipped to deal with the influx of would-be parents.  As experts are quick to point out: “Right now, India has only voluntary guidelines, and it’s not clear whether future laws would be adequately enforced, and standards vary widely.”  India’s laws don’t address the complexities of surrogacy; however, “an assisted reproductive technology bill is before Parliament and expected to be ratified by early next year.”   Many people believe that the upcoming legislation doesn’t provide adequate rights for the surrogate mothers.  For example, women that agree to be surrogates “will have no rights over the child they have contracted to bear.” Add

Mother and son in India
Mother and son in India

itionally, the bill does not address what a surrogate would be paid if she had a miscarriage or if other complications arose.

Some critics say that surrogacy is inherently exploitative and treats children as “commodity[ies].”  “University of Pennsylvania ethicist Arthur Caplan worries the relationship is inherently lopsided between poor, minimally literate women and well-heeled couples who commission them to have their children.”  The President of WomenPowerConnect argues, “[t]hey are using the vulnerability of the poor.  Making (a woman) a child-producing machine is not acceptable to us.   There should be controls so it is not an open market as it is at the moment.”

On the other end of the spectrum, many consider Indian surrogacy a “win-win” situation because the surrogate mothers receive an unbelievable income and incomparable access to healthcare.  As Dr. Kadam, from the infertility clinic in Mumbai, explains: “[t]here is no exploitation” because many of the women “either start a small business or they have bought a better home to live in.  Some have spent money on education for their children and the couple are so happy they’ve received a baby.”  As Dr. Ruma Satwik, associate consultant at Sir Ganga Ram Hospital in Delhi, argues: “[m]ost clinics provide protection to the woman in many ways, looking after her health, nutrition, daily needs, and some will even offer to take care of her family.”  Many doctors recognize the irony of it, but point out that clinics often give the surrogate mothers skill training and prenatal care unlike anything they could experience giving birth to their own children. Similarly, many Indian women agree that surrogacy provides an incredible opportunity.  A PBS correspondent interviewed Indian women to learn their perspectives on surrogacy.  He reported: “The money—$7,000-$8000—would otherwise take them decades to earn. Most say they were happy to have helped infertile couples.”  For example, Manju, a 29-year-old woman from Delhi, has considered surrogacy ever since her sister-in-law was a surrogate two years before.  Manju explains that: “she made a lot of cash, much more than my income for a year . . . It’s good money.” When asked about risks, Manju replied, “Risks? What risks? Any fool can have a baby, it takes a smart woman to get paid for it.”

It is clear that many questions will remain unanswered.  Is surrogacy inherently exploitative?  Does surrogacy provide an incomparable opportunity for Indian women?  What rights should the Indian government give to surrogate mothers?  While many questions will remain unanswered, international surrogacy is growing rapidly, and the Indian government will soon need to address the changing market.