Saturday, December 11, 2010

Commercial surrogacy in India: A $2 billion industry

The sleazier side of assisted reproductive technology, the world of IVF, renting of poor women's wombs, and the separation of reproduction from love and marriage, and even sex. "The Confederation of Indian Industryhas predicted that surrogacy will be a gigantic US$2.3 billion industry by 2012. This is becoming an increasingly familiar statistic. But what is life like for a surrogate mother? An article in the University of Chicago feminist journal Signs is an in-depth investigation of the recruitment and life of surrogates. Author Amrita Pande did fieldwork in the town of Anand, in Gujarat, between 2006 and 2008. She interviewed 42 surrogates, their husbands and in-laws, 8 intending parents, 2 doctors, and 2 surrogacy brokers." Michael Cook, Bioedge.

"They are just the wombs"
by Gina Maranto, Biopolitical Times guest contributor
December 6th, 2010

Since its legalization in 2002, commercial surrogacy in India has grown into a multimillion-dollar industry, drawing couples from around the world. IVF procedures in the unregulated Indian clinics generally cost a fraction of what they would in Europe or the U.S., with surrogacy as little as one-tenth the price. Mainstream press reports in English-language publications occasionally devote a line or two to the ethical implications of using poor women as surrogates, but with few exceptions, these women's voices have not been heard.

Sociologist Amrita Pande of the University of Cape Town set out to speak directly with the “workers” to see how they are affected by such “work.” In her multi-year project, Pande has expanded the cultural perspective on international reproductive tourism, delineated its “structural reality, with real actors and real consequences,” and provided an intimate look at the lot of women serving as commercial surrogates at Hope Maternity Clinic in Anand, a thriving city in India’s westernmost state, Gujarat.

By 2006, Anand was gaining a reputation as a center for reproductive services, and Pande began conducting fieldwork at a clinic there run by Dr. Usha Khanderia. Khanderia was not only performing IVF procedures, but matching infertile couples from larger cities like Mumbai, or from other countries, with surrogates, nearly all from nearby agricultural villages. Pande’s in-depth, open-ended interviews with dozens of surrogates and their family members confirmed that the chief motive was economic: 34 out of 42 had family incomes at or below the national poverty line. Some surrogates said their husbands had persuaded or coerced them into undertaking pregnancy-for-pay. The fee, for most of these women, was equal to roughly five times their normal annual household income.

All but one woman in the group had “decided to keep their surrogacy a secret from their communities, villages, and very often, from their parents,” Pande writes in “Not an ‘Angel’, not a ‘Whore,’” published in the Indian Journal of Gender Studies [subscription only] in 2009. Surrogacy is highly stigmatized in India, in part because it “involves the bodies of poor women.” Moreover, “many Indians equate surrogacy with sex work,” mistakenly believing intercourse is involved. Too, “getting pregnant for associated with the ‘immoral’ commercialization of motherhood.”

Accordingly, during the course of their pregnancies, the women working for Hope leave their homes to reside in hostels near the main clinic or on two of its upper floors, there occupying rooms “lined with 8-10 single iron beds with barely enough space to walk between.” In the clinic, the women “have nothing to do the whole day except pace up and down on the same floor (they are not allowed to climb the stairs and must wait for the nurses to operate the elevator), share their woes and experiences with the other surrogates and wait for the next injection.” At the hostels, there is greater freedom of movement: the women have access to a kitchen and can be visited by their husbands.

In the women’s narratives regarding their experience, Pande traces “resistances” to their stigmatized condition. Many endeavor to enhance their self-esteem through moral comparisons. For example, they are at pains to draw boundaries between themselves and prostitutes and to distinguish their actions from those of women who put their biological children up for adoption. What they are doing - giving a child to a couple who will provide it with a good home - is not the same as “giving away our own child,” which is far less moral. At the same time, many of the women seek to emphasize their husbands’ “high morality” and “generosity” in having allowed them to be surrogates. Ultimately, however, Pande sees their narratives as “eroding [their] recognition of the significant role they play as workers and breadwinners for their family.”

In the end, the women themselves do not view surrogacy as a form of legitimate labor (Pande notes the dual implications of the term in this context), rather as a choice forced upon them by economic dire straits. Says Salma [not her real name], a 25-year-old Muslim housewife with a middle school education, “This is not work, this is majboori (a compulsion)....This work is not ethical - it’s just something we have to do to survive.”

But, Pande writes,
Economic desperation does not make a perfect surrogate; a new subject has to be produced, a surrogate who is a willing worker and, simultaneously, a virtuous mother. The surrogate is expected to be a discipline contract worker who will give the baby away immediately after delivery without creating a fuss. But she is simultaneously expected to be a nurturing mother attached to the baby and a selfless mother who will not treat surrogacy like a business. This mother-worker combination is produced through a disciplinary project that deploys the power of language [in the form of the surrogacy contract and the discourses deployed by medical staff] along with a meticulous control over the body of the surrogate.

As one physician at the clinic explains, “We make sure the surrogates know that they are not genetically related to the baby, they are just the wombs.” At the same time, clinic staff and matrons endeavor to downplay the commercial aspects of the enterprise, praising surrogates alternately for altruism or for their luck in having received a gift from God in the form of money for “renting their womb.”

Pande, in an article in the Summer 2010 issue of Signs: Journal of Women in Culture and Society [subscription only], probes the strategies used by clinics and their brokers to enlist potential surrogates and to ensure that they do not attempt to negotiate higher wages with clients or violate the terms of their contract. One broker worked at an abortion clinic and drafted impoverished women who had undergone abortions because they could not afford another child. Other brokers preyed upon women’s fears of being “bad mothers - mothers who were unable to provide for their children or, especially, mothers who could not get their daughters married on time” for lack of money for the dowry.

Although “The Assisted Reproductive Technologies (Regulation) Bill,” drafted this year by the Indian Ministry of Health & Family Welfare, would supposedly ban such recruitment efforts, the bill’s language is sufficiently vague concerning advertising and “local guardians” that clinics are likely to find workarounds. In an August 6, 2010 post about the bill, Gauri, a non-resident Indian physican who blogs at beinformed notes, “Most of the rules proposed by the new Indian law seem to be directed at only making the process just run smoother, rather than making it harder for non-Indians to use Indian women to incubate their babies.”

Indeed, reproductive tourism to India is unlikely to diminish, and the Confederation of Indian Industry has predicted that surrogacy will generate revenues of $2.3 billion by 2012. Amit Sengupta, in “Medical Tourism: Reverse Subsidy for the Elite,” in the Winter 2010 issue of Signs, explains how the “virtual collapse” of India’s public health system in the last five years has led to the untrammeled growth of the for-profit sector, supported by tax breaks and direct and indirect government subsidies. The Indian government has built medical tourism into its National Health Policy, which “strongly encourages” medical providers to seek foreign clients.

Sengupta, a health analyst who is associate coordinator for the People’s Health Movement, points out the unfortunate irony that “while women from across the world flock to India to take advantage of the booming market for assisted reproductive technologies, a very large number of Indian women are denied basic health care. Women are truly invisible to the public health system in the country - the latest available data indicate that just 17.3 percent of women have had any contact with a health worker.”

• Pande Amrita, 2010. “Commercial Surrogacy in India: Manufacturing a Perfect ‘Mother-Worker,’”, Signs: Journal of Women in Culture and Society, Vol. 35, No. 4, 969-992.
• -----------------, 2009. “Not an `Angel,' Not a `Whore:' Surrogates as `Dirty' Workers in India,” Indian Journal of Gender Studies, Vol. 16, No. 2, 141-173.
• Sengupta, Amit, 2011. “Medical Tourism: Reverse Subsidy for the Elite,” Signs: Journal of Women in Culture and Society, Vol. 36, No. 2, 312-318.
Gina Maranto directs the English Composition program at the University of Miami and is interim director of the graduate program at its Leonard and Jayne Abess Center for Ecosystem Science and Policy. She is the author of Quest for Perfection: The Drive to Breed Better Human Beings (1996).

Previously on Biopolitical Times:
• Outsourcing Pregnancy: Surrogacy as "Emotional Labor"
• Reproductive Tourism: Surrogacy Outsourcing Takes Hold in Guatemala
• Struggling to Control Fertility Tourism
• Egg Raffles and Shadow Markets: The Fertility Industry Goes Global - and Skirts Laws
Retrieved December 10, 2010 from

1 comment:

  1. Doctors at Kiran Infertility Centre that gets around 120 foreign nationals for Surrogacy In India say the move will be a drain on the economy.Dr Samit Sekhar, chief embryologist and surrogacy and IVF program director, said that as per the new directive, except a foreign "man and woman" who have been married for a period of at least two years, no one else will be eligible to have an Indian surrogate bear their child.