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The booming baby business: Commercial surrogacy in India and beyond

Updated Thursday, 30th July 2015

It's still stigmatised, but it's a commercial relationship growing in popularity - and not just in India. Thinking Allowed explores the business of international surrogacy.

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Clip – Surrogacy Ad
See Taj Mahal by the moonlight while your embryo grows in a petri dish.

Laurie Taylor:
While your embryo grows in a petri dish! Well that extraordinary invitation comes from a website devoted to advertising Indian commercial gestational surrogacy. That is the opportunity for moneyed couples to pay for an Indian woman to use her womb to house the embryo produced by in vitro fertilisation involving the egg of the intended mother (or of an egg donor) that has been fertilised with sperm provided by the intended father.

Taj Mahal Copyright free  image Icon Copyright free: via Wikimedia All this and a baby too - the Taj Mahal is a selling point for some commercial surrogacy clinics

It's a technique of course in which the surrogate genetic make-up has little relevance to the clients because she provides only her womb.

Well I also know from reading a very fine new ethnography called Wombs in Labour – Transnational Commercial Surrogacy in India that this is an industry that is rapidly developing in that country partly because of price but also because it can operate there [without] state interference.

So perhaps it's no surprise there are now around 300 surrogacy clinics in India. But what is life like within such clinics? How are the surrogate mothers treated by the staff, by their own family? How do they justify their work to the outside world? And, more analytically, is this surrogate work nothing more or less than another form of labour or is it profoundly exploitative – a degradation of motherhood?

Well these are questions for the author of that fine book Amrita Pande, who’s Senior Lecturer in Sociology at the University of Cape Town. She now joins me on the line from that city. And here with me in the studio, I haveMichal Mahman, Senior Lecturer in Sociology at the University of the West of England and she’s the author of Extractions: an ethnography of reproductive tourism.

Amrita, coming to you, you describe surrogacy as India’s new form of out-sourcing but when I began to read about it I thought there’s a bit of a paradox here really, isn’t there, at the heart of this thriving industry because India is a country which is associated with pretty strict antinatalist policies. Can you perhaps tease this contradiction out for me a little?

Amrita Pande:
Exactly Laurie. So one of the fundamental paradoxes that I outline in my book is exactly this, that surrogacy, an industry of assisted reproduction, is booming in a country like India which has such an aggressive antinatalist past.

India’s the first country in the world to initiate an official population control programme in 1952 and of course being a democratic state it has to maintain its liberal pretensions but the reality is that the state typically still promotes very aggressively methods like sterilisation and hormonal implants that diminish lower class women’s power to choose. And this antinatalist propaganda has constantly portrayed the fertile bodies of lower class women in India as recklessly reproductive and to be blamed for their own poverty.

And related to that is another paradox that lower class women in India are typically given very little access to professionalised reproduction and for a variety of reasons, both on the demand and the supply side, medicalisation of childbirth and hospital births are still not the norm in India. So suddenly the same women who were completely alienated from biomedicalisation are being pushed head on into a very hypermedicalised system of reproduction [...] as reproducers of babies for richer classes.

Laurie Taylor:
Absolutely, I mean India with the highest absolute number, I think, of maternal deaths as well.

Let’s turn to the clients who pay for these surrogacy services in India. I mean they pay, I should imagine, far less than they might in the States but what are the sort of fees paid to the Indian women who become surrogates; and how does that compare to the fees which are paid to the doctors and the clinics where this surrogacy takes place?

Amrita Pande:
If you compare how much it costs in India to the United States for instance, California is still the world leader in commercial gestational surrogacy. In California it would cost a client up to 70,000 British pounds, while in India they can get the whole procedure done for 20,000 pounds. And out of this the surrogate ends up getting say between 5,000 to the maximum I have seen a surrogate get is about 8,000 British pounds. So [for] the rest of it, of course, more than three times of that goes to the doctor and the clinic.

Laurie Taylor:
And some of these women they do it more than once don’t they, they act as a surrogate more than once?

Amrita Pande:
Exactly, so these are the women who are the repeat surrogates who – and some of them I interviewed and they are the chief characters in my book who have done it even three times.

Laurie Taylor:
So I mean between $2,000 and $8,000 going to the women. So I suppose it is a source of income. I’ve got a reading here from the interview that you conducted with Panna. This is a woman who’d already had three children of her own and ended up embarking on surrogacy.

Panna (reading):
I don’t know where my husband and my sister-in-law heard about this but once they had the idea of making me a surrogate they just would not give up. When I refused my husband came to the clinic and met up with doctor madam instead. He came home and told me about other women at the clinic and told me it looked safe. But even when they were putting me in the auto-rickshaw and I was on my way to the clinic I was crying.

Laurie Taylor:
How typical, Amrita, is this story, what motivated the women in general to become surrogates, was it straightforwardly just a question of money?

Amrita Pande:
Yes I have to say that all the women were doing this out of sheer financial desperation. So if you look at the demography of women who are doing this you’ll see that almost all of them coming from families whose income is below the poverty line. So the motivation is money.

But also if you just look at the women’s narrative you’ll see that they all emphasised the selflessness of their motives. So they do know that they’re doing this for money but they say that it’s not out of greed, they’re doing it because they want to save up for their children, for their daughter’s marriage or their daughter’s education. It’s something that keeps coming up in the narratives of the women.

Laurie Taylor:
Now you interviewed altogether 52 surrogates, husbands, relatives, intending parents, doctors, surrogacy brokers but you focused on one clinic in India and this had become some sort of transnational hub, its popularity related to the rather unusual way in which it was organised. If a woman goes in there to be a surrogate what can she expect to experience?

Amrita Pande:
Okay, so the reason why the clinic I studied has become the transnational hub for commercial surrogacy in India is that it runs, apart from several other reasons, the biggest reasons that it’s attracting so many clients, international clients, is that it runs what are called surrogacy hostels. So the women are kept under constant surveillance during the months of their pregnancy, what they eat, their activity, their interaction with their family – everything is being monitored by the medical staff and the hostel matron.

And nowhere else in the world can you find something like this. So what the clinic does is that – although the doctor will never agree that she does this but brokers are sent out, and these brokers are usually midwives and nurses and they literally go from door to door recruiting women, fertile women, to become surrogates.

Once these women get convinced and once they have their husband’s consent they are brought into the clinic, they sign in to or put their thumbprints on a contract and then the process starts. And almost all of them are kept in the hostel for the entire length of their pregnancy.

Laurie Taylor:
They’re lying in bed and having injections and being constantly supervised to check that everything’s going alright?

Amrita Pande:
Exactly, so that’s exactly how it works. So I talk about the routine – the regime – of the hostel in my book where it starts with a very good breakfast, is what the surrogates would always tell me, that this is the best breakfast they’ve always had, followed by their injections, so hormonal injections or iron tablets, followed by rest hour, then visitation hour and then again some injections, some food and it goes on and on.

They’re always sitting in their nightdresses, the leisure time is watching TV or they are expected to attend computer classes and English classes and then there’s the compulsory prayer hour when these good surrogates sit and pray. And – because I was doing participant observation - [I] actually participated in all this and it was quite eerie to be a part of.

Laurie Taylor:
I mean even though this surrogacy has grown dramatically in India since the time you started your study back in 2006 it’s still pretty well stigmatised isn’t it? Tell me about how the women deal with this sort of stigma which is attached to this process; how do they resist the stigma?

Amrita Pande:
Sure, I would want to add that it’s – there are about 3,000 clinics, not 300, 3,000 clinics, surrogacy clinics in India right now. And when I started the work in 2006 it was really not the norm, there were very few clinics which were actually allowing commercial surrogacy or participating in commercial surrogacy and now you can see that it’s really boomed.

But despite the economics of it, that it has boomed, there is a huge amount of stigma around this industry, partly because a lot of Indians do not understand the technology part of it. So they think that the surrogates are actually sleeping with the clients, so the surrogate prostitute analogy is what you hear very often, so that’s one part of it.

But even if you do understand the technology or just this whole notion of commodifying your reproduction and selling out your womb is something which is highly stigmatised. So how do the women deal with it? So the women deal with it by one, not telling the community that they’re doing it, they often lie to their community and say that they’re actually going to become domestic workers in the Middle East or in a bigger city and that’s how in a way staying in a hostel is something that they need to do because they’ve hidden if from the rest of the community.

But they also do that at the discursive level where they constantly talk about how it is not immoral, the work that they’re doing is not immoral, and actually it’s so much better than being a prostitute or selling their baby or giving their baby for adoption. So they’re constantly doing boundary work because they realise that the work that they’re doing is highly stigmatised.

Laurie Taylor:
I want to pick up on this stigma thing by turning now, if I may, to Michal, who’s here with me now. Michal Mahman, you’ve looked at surrogacy in other countries, I mean still highly controversial isn’t it, I think France and Germany have banned it in all its forms, Thailand recently banned it, other countries – there’s the UK and Canada – got partial bans and only allow altruistic surrogacy. I mean what’s happening, if you like, to the phenomenon of reproductive tourism?

Michal Mahman:
Well reproductive tourism is a growing industry, it’s associated – surrogacy alone, the industry - is associated with 400 million US dollars as an industry, so it is booming business.

Laurie Taylor:
I mean when you look about this, you look at the way in which people manage to move around in order to evade local national bans?

Michal Mahman:
Yeah that’s right. So what I’ve studied specifically is transnational egg donation and that coupled with surrogacy helps people to evade national bans on these practices, so eggs are fertilised and frozen and taken to different countries.

Laurie Taylor:
Give me a couple of examples of how people move from country to country, or how this cross-national surrogacy goes on. I think we talk about French single women who can’t get fertility treatment in France will go to Belgium, for example.

Michal Mahman:
That’s right, so French single and lesbian women can’t get egg donation and surrogacy in France so they would travel to Belgium. The women that I studied in Israel had to travel to places like Romania and Cyprus to get egg donation.


But doctors were trying to evade local laws around egg donation and surrogacy by fertilising eggs in other countries and then transporting them to a third country to implant it into a gestational surrogate and then to bring the babies back home.

Laurie Taylor:
Now I mean how do you regard this? I know you’ve done research on Romanian women selling eggs to Israelis and putting this alongside the Indian surrogacy. [...]Somebody might say 'these are just examples of women empowering themselves, I mean they’re selling services on an open market in a way'?[...] What take do you have on this, how do you view what is going on here in terms of these transnational reproductive tourist examples?

Michal Mahman:
Yeah it’s a really good question because there have been so many debates around this, round is this like sex work, should we ban transnational egg donation and surrogacy, should we have a global ban, should we have local bans? There have been so many debates around this.

And it really is important to see it from the perspective of the women because this is a market where wealthy people in rich countries can afford to buy the services of other women in poor countries who are destitute and who are deeply exploited.

Now when seen from the perspective of the women themselves, who are doing it, we cannot - and I think we must not - look at them as victims because in so many ways they’re also exploiting a system, so there’s all these debates around does being part of a market; does selling your body on a market degrade or stigmatise…

Laurie Taylor:
Is this a different form of labour if you like.

Michal Mahman:
Yeah, so does it degrade or stigmatise you and your body and no, not – you know the people for whom the ability to be part of a market was always not so present, it’s not possible to now take up that position is really vital.

Laurie Taylor:
Let me come to you Amrita almost with the same question because talking about the inequalities, the exploitation, you’ve looked at years of intensive research. Do you believe that the practice should be banned or heavily regulated – what is your view of this?

Amrita Pande:
I actually believe that a ban would be counterproductive given that what a ban would do is just push the whole industry underground and reduce whatever little right that these women workers have. And I also suspect that a ban on surrogacy in India would just push the whole industry to another country in the global south.

So a ban would definitely be counterproductive, so instead of restrictive national policies which end up pushing the moralistic issue to some other country what I think is required is a very carefully thought out law that regulates the industry and protects the rights of the women workers who are…

Laurie Taylor:
I’m so sorry Amrita, but there we have to stop, time’s beaten us, but thank you very much, Michal Mahman, and Amrita Pande; thank you very much.

This debate was originally broadcast as part of Thinking Allowed on BBC Radio 4 on 9th March 2015.

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