By Ishika Arora
Wombs for Rent, a multimillion dollar industry that recruits poor Indian woman as surrogates for foreign citizens, is an unethical business that should be banned by the government (1, 2). After outsourcing thousands of jobs to India, Americans are now outsourcing pregnancy with little regard to morality (3). The rapid growth of this industry warrants a thorough examination of many of its aspects including safety, human rights, and legal issues. Mainly, it begs an answer to the question “Is this exploitation?” Foreigners justify this act through monetary compensation – a $7,000 surrogate fee that could transform the lives of lower class Indian women (4). However, through the analysis of the different facets of this lucrative business, it can be proven that outsourcing surrogacy merely allows people of richer nations to exploit the poverty-stricken women of India. As a consequence, it hinders further social, political, and economic development for the nation as a whole and should be deemed illegal. Note: This paper will focus solely on gestational surrogacy, which occurs when a fertile woman can produce healthy eggs but cannot successfully carry a child to term (2). These eggs are harvested, externally fertilized with the father’s sperm, and implanted into the surrogate’s uterus, a process called in-vitro fertilization (IVF). In addition, the foreign couples are primarily referred to as American or Western, as the majority of abroad clients tend to be from these geographic areas (5).
Infertility is a medical issue that plagues 15% of couples across the globe (2). Surrogacy, however, is not available or a legal option worldwide. Countries such as Japan and France have banned the act while others, like Australia and the UK, have deemed commercial surrogacy illegal. Laws in the US vary in between states, but only a few acknowledge surrogacy as a legitimate solution to fertility (6). These legal issues in combination with the high price of commercial surrogacy in states such as California (it can cost approximately $80,000) make it difficult for average citizens to have their own test tube baby (2). Because surrogacy is legal in India, these childless couples have found relief in the Assisted Reproductive Technologies (ART) clinics that have mushroomed in the nation’s largest cities. In India, these medical centers run without government regulation, which allows them to avoid heavy taxation and thus decrease the cost of IVF births to a meager $12,000 (7). It should also be noted that some clinics offer IVF services to foreign women who do not want to get pregnant due to career decisions or other social inconveniences. Overall, through this context it becomes very clear why so many Western couples are beginning to outsource surrogacy to a lower developed country.
Jessica Ordenes is a 40-year old woman who became infertile after a complicated C-Section from her first child (8). After spending too much time on a waitlist in the US, she traveled to India, most likely after reading about foreign surrogacy from a simple Google search that sent her to clinic sites such as www.iwannahaveababy.com and www.surrogacymumbai.com. She sat in a room in Akanskha Infertility Clinic awaiting the arrival of her surrogate. Najima Vohra, a petite Indian woman in an electric blue tunic entered the room to make awkward conversation with Ordenes using the help of a student translator. “You’re my angel!” Ordenes cooed as she hugged her, praying for a successful embryo implantation. Unfortunately, Ordenes could not stay to see Vohra through the embryo transfer as she desperately needed to get back to the US to renovate her basement. But she felt great about the arrangement. She will receive a baby in 9 months and Vohra, an uneducated woman who helps her husband earn $1.50 per day, will earn the money she needs to pay for a brick house (that will not get eroded with the monsoon rains) and her daughter’s education. Ordenes returned home happily, feeling excited and secure thanks to her Indian surrogacy contract.
The ART’s surrogacy contract serves as a record of the sale between two parties (2). This document alone separates outsourced surrogacy from altruistic surrogacy, a practice more commonly accepted worldwide. It is a business contract, which commoditizes motherhood and assigns the value of an Indian woman’s womb to be roughly $7,000. The contract is also unique in that, unlike in the United States, it deprives the surrogate mother of having any rights to the child after the delivery. Further, such an arrangement not only devalues women by viewing them essentially as emotionless biological vessels, but also deems Indian women to be inferior to Western women who receive at least three times the payment to provide the same miracle. Even if the potential surrogate chooses to sign such a contract, she is still likely to be at a great disadvantage. Specifically, many women of lower socioeconomic status in India are illiterate and cannot read the contracts (2). In a country with a high level of corruption, any staff member of the ART center could be easily bribed to relay incorrect information about the document that would encourage the woman to rent her womb. In addition, many of these women have not heard of IVF, and though the complications are listed in the contract, may not fully understand the health ramifications of surrogacy (9). Thus, the hiring of socioeconomically poor women lends itself to great exploitation.
As previously mentioned, there are health risks that are associated with IVF and pregnancy in general (2). A woman can only become a surrogate if she has not had any complications during a previous pregnancy (4). However, because these women have a lower financial status, they generally cannot afford quality healthcare. As a result, many birthing complications may have gone unnoticed during a home delivery or labor at an overcrowded free clinic. Surrogacy would thus greatly increase their risk for a variety of health problems. Another medical issue is the number of implanted embryos. In the US, surrogates are given no more than two embryos for their safety, whereas in India, surrogates are implanted with up to five embryos in order to increase the chances of pregnancy. This practice clearly favors the foreign couple, saving both their money and time by increasing the embryo count, even though “it compromises the interest of the babies,” according to University of Pennsylvania Ethicist Arthur Caplan. Dr. Nayna Patel, the founder of Akanksha Infertility Clinic, admitted that using such a large number of embryos heightens health risks for both the babies and the mother. Because many embryos are implanted, it is possible that more than one will turn into a viable pregnancy. In this case, the intended parents can choose to selectively abort certain fetuses even though it puts the others at risk. This aspect of the surrogacy contract thus proves to be a method to maximize the profit in a “Costco-size” manner (most number of children per round of IVF) without fully considering the value and health of the fetus. Additionally, a much forgotten medical issue that must be considered when discussing surrogacy is mental health (2). There are few scientific studies on postpartum depression of surrogates who are forced to part with the child that grew in her womb. If such psychological conditions are an issue, they are likely to be ignored because of a lack of mental health trained personnel in rural areas where these women are from (10). These medical risks must be taken into consideration by the ART centers as well as the Indian government.
Exploitation in this manner not only causes health problems for the surrogates, but creates social hurdles as well. Najima Vohra, for example, explained that the local residents of her village would perceive her surrogacy to be “dirty” (8). She added sadly that her family would be shunned if her neighbors knew. In order to keep her pregnancy a secret, Vohra was forced to leave her family for nine months and join other surrogates in gestational dormitories (4). There she would be provided with better prenatal healthcare to protect the foreign baby inside of her, a luxury she did not have for her own children.
In general, liberalists believe that entering a surrogacy contract enhances a woman’s rights by granting her the right to choose (2). However, it is difficult to fully know whether these women are truly exercising their rights or whether they are being forced to rent out their wombs. Lower class women in India tend to live in joint families for both social and economic purposes. In such housing situations, the woman can be subjugated by her husband and mother-in-law, the matriarch of the household, who force her into a surrogacy contract in order to maintain the family’s financial stability. While Dr. Patel promises that she does not hire surrogates that she feels are forced into the decision, other unregulated ART clinics may not have the same level of integrity (4). With the issue of forceful surrogacy arises the problem of youth surrogates. Indian women living in rural areas tend to be married at a younger age. In Najima’s case, she was married off at the age of 16 (8). Though the government is attempting to establish a minimum age requirement for surrogacy, all laws are currently considered optional (11). This would turn exploitation to direct abuse if a young girl is forced into surrogacy for a family’s financial gain. In a nation where law enforcement is extremely difficult and documents are easily forged, this is a problem that will likely plague this industry in the future. Additionally, among the lower class, dowry, though illegal, is still very common (8). Much of the money that surrogates earn will be spent on dowries for their daughters. Thus, womb renting indirectly promotes a highly misogynistic tradition instead of abolishing it. These surrogacy contracts would undo years of social progress.
Because the greatest motivation for fertility tourism in India is monetary, it is necessary to consider all of the finances and resources involved. According to a 2010 statistic, 37% of India’s population lives below poverty line (12). In an article from February, Times of India asked: “In a country crippled by abject poverty, how will the government body guarantee that women will not agree to surrogacy just to be able to eat two square meals a day?” (13). The simple answer is that $7,000 could improve the standard of living for these women so drastically that the money is no longer merely an incentive – it is an aid for their exploitation. Lower class Indian women are thus forced to accept the surrogacy contract to keep from starvation or illness. India as a nation is likely interested in fertility tourism because of the increase in foreign investment in Indian economy. However, Dr. John Lantos from the Center for Practical Bioethics in Kansas City and Nalini Mahajan, a fertility specialist from India, both point out the negative consequences of such an investment (2). They argue that India will shift its focus from promoting growth of the education sector because a poor woman who is minimally literate can earn much more as a surrogate than most educated middle class citizens. This outcome “perpetuates surrogacy as a more lucrative option” and thus “discourages public expenditure on education,” impeding India’s economic development in the long run with fewer professionals in the work force. Fertility tourism may be a simple way for India to make some “quick cash” but it will hurt the nation’s economy and impede social development due to a lack of education. Further, improper allocation of medical resources will impede the nation’s development. In a nation where healthcare services are limited, it is appalling that these medical resources (doctors, nurses, nutritionists, etc.) are being used for foreign surrogacies instead of Indian mothers. India’s horrifically high maternal mortality rate of 450 per 100,000 live births is ignored as resources are reserved to protect the surrogates of Western children (14). Within two years, fertility tourism within India has increased by 50% (15). Growth at this rate will truly strip Indians of the minimal healthcare they are receiving, and India’s Millennium Development Goals will surely be unable to achieve its reduction of the maternal mortality rate to a hopeful 109 by 2015 (14).
Furthermore, self-image of the surrogate and that of the nation are directly affected as a result of fertility tourism. After undergoing surrogacy, the mother and other Indian women are likely to feel inferior to Western women. American surrogates are paid around $20,000 to carry a child while Indian women earn only $7,000 (2). In addition, when they gave birth to their own children, they and their babies received little to no prenatal and neonatal care (5). This tells Indian women that in numbers they are worth less in comparison to their foreign counterparts: their children are inferior to the foreign babies they carried in their womb. In addition, the contract commoditizes their bodies in a way that is similar to the concept of dowry that is already practiced. This further subjugates an already oppressed class of women who desperately need to be empowered. As long as they are recruited for IVF, India’s lower-class women cannot advance. This has geopolitical ramifications as well. Overall, India is getting international attention as a developing nation and a future superpower, thus it is important for India to protect its image across the world in order to become more politically prominent (2, 16). With womb renting however, India will be known as the #1 hotspot for fertility tourism – the one-stop-shop to get a baby. If the people of the nation can be objectified and considered to be worth less, then India will not be able to gain the worldwide respect necessary to become a superpower equal to the United States and will thus remain inferior.
The Indian government has begun to recognize the adverse affects of the industry and is currently attempting institutionalize regulation, though a bill will not solve many of the critical issues related to foreign surrogacy. The ART (Regulation) bill is currently in bureaucratic limbo (2). It aims to provide guidelines that will protect the interests of both the intended parents and the surrogate mothers (11). It establishes a minimum age limit, a minimum surrogate fee, and prohibits surrogates from providing egg donations. However, it is unclear whether the bill will be properly enforced and if the “legal vacuum” of this industry will be filled so that disputes can be properly settled in court (2). In addition, the bill is contradictory in its attempt to protect the anonymity of the surrogates for social purposes (11). It states that the name of the surrogate will not be listed on the child’s birth certificate, legally classifying her as the vessel that was rented for nine months. When it comes to documentation requesting medical treatment, however, the surrogate must register under her own name. This would make it difficult for her to maintain her anonymity. Overall, the bill haphazardly attempts to make fertility tourism work in India even though the costs outweigh the benefits making it much more beneficial to ban it altogether.
In order to prevent the inhibition of India’s development, the government needs to legally prohibit commercial surrogacy. It is clearly an exploitation of India’s poorest; and instead of passing bills that condone women selling their bodies on a foreign market, the government should focus on laws and programs to help empower these women to rise to a middle class socioeconomic level. India has developed greatly over the past ten years. The per capita income doubled due to the expansion of the IT and manufacturing industries, PM Vajpayee made education more accessible to young girls, and the Legal Services Authority Act was passed to provide legal services to vulnerable groups throughout the nation (16, 17). It would be a shame to allow foreign powers and monetary incentives to undo this progress. On her television show, Oprah Winfrey advertised India’s surrogacy industry “Wombs for Rent” (18). She described it to 8 million people as “women helping women.” In this warm-and-fuzzy interpretation, she ignored all of the signs that point to the exploitation of Indian women. Oprah, like many other couples today, choses not to see the negative social, economic, and political consequences of outsourcing surrogacy. With the prohibition of fertility tourism, Indian women will have a real chance at empowerment and India can resume its social and economic development.
1: Fontanella-Khan, Amana. “India, the Rent-a-Womb Capital of the World,” Slate, August 23, 2010. www.slate.com/articles/double_x/doublex/2010/08/india_the_rentawomb_capital_of_the_world.html
2: “Surrogate Motherhood in India,” Stanford University, 2008. www.stanford.edu/group/womenscourage/Surrogacy/index.html
3: Otterman, Sharon. “Trade: Outsourcing Jobs,” Council on Foreign Relations, February 20, 2004. www.cfr.org/pakistan/trade-outsourcing-jobs/p7749
4: “Indian Surrogacy Helps Lift Some Poor, but Raises Ethical Issues,” PBS, August 5, 2011. www.youtube.com/watch?v=TeNZrfWiI9o&feature=relmfu
5: The Associated Press, “Outsourced ‘Wombs-For-Rent’ In India,” February 11, 2009. www.cbsnews.com/stories/2007/12/31/health/main3658750.shtml
6: Roberts, “Surrogacy Laws in U.S.A,” Surrogacy Clinics Blogpost, www.surrogacyclinics.com/surrogacy-laws-in-u-s-a/
7: “Indian Surrogacy Helps Lift Some Poor, but Raises Ethical Issues,” PBS. www.youtube.com/watch?v=TeNZrfWiI9o&feature=relmfu
8: Haworth, Abigail. “Womb for Rent: Surrogate Mothers in India,” WebMD Feature from “Marie Claire” Magazine.
9: “MADE IN INDIA,” The Economist. http://film.economist.com/film/made-in-india
10: Khandelwal SK, Jhingan HP, Ramesh S, Gupta RK, Srivastava VK. “India mental health country profile,” International Review of Psychiatry Feb-May 2004, 16(1-2):126-41. www.ncbi.nlm.nih.gov/pubmed/15276945
11: N, Sarojini and Aastha Sharma. “The draft ART (Regulation) Bill: in whose interest?” Indian Journal of Medical Ethnics www.issuesinmedicalethics.org/171co36
12: Nanda, Rupashree. “It’s official: 37 pc live below poverty line,” CNN-IBN, April 18, 2010. http://ibnlive.in.com/news/its-official-37-live-below-poverty-line/113522-3.html
13: Gentleman, Amelia. “India Nurtures Business Of Surrogate Motherhood,” March 10, 2008. New York Times http://query.nytimes.com/gst/fullpage.html?res=9B05EED91138F933A25750C0A96E9C8B63&pagewanted=all
14: “International Women’s Day, 2010.” www.internationalwomensday.com/article.asp?m=11&e=55
15: Smith, “India Surrogacy Journey,” Surrogacy Clinics Blogpost. www.surrogacyclinics.com/india-surrogacy-journey/
16: Bajpai, Nirupam. “India’s Decade of Development: Looking Back at the Last 10 Years and Looking Forward to the Next 20,” Columbia Global Centers. http://globalcenters.columbia.edu/content/indias-decade-development-looking-back-last-10-years-and-looking-forward-next-20
17: “India,” United Nations Development Programme. www.undp.org.in/national_human_development_report_india