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Mailorder Wombs: Outsourcing Birth to India

So much of America's economic activity takes place on faraway shores, from call centers in Mumbai to sweatshops in Shanghai. Still, you'd think that making a baby would be one job that's hard to offshore. But today, for a fee, a woman in another country can serve as a "gestational surrogate," carrying a fertilized egg to term and then delivering the baby straight to your door, halfway around the world. We're not used to talking about that kind of labor as an outsourced job. But farmed-out childbirth has become a full-fledged industry in India, turning the rural poor into wombs for hire.

The practice has become increasingly common with new advancements in in-vitro fertilization. The efficiency of the technology raises ethical, legal and cultural questions about the meaning of parentage.

Like Autotune and drone warfare, the transaction might feel disturbingly mechanized: someone, an infertile couple, for example, creates an embryo in a lab, ships it abroad for gestation in a stranger's body, then takes possession again after birth. But in a consensual financial arrangement, what's the big deal, really? There's less (but still some) stigma surrounding child care services, though that also involves contracting out the duties of motherhood.

But maybe what makes the global surrogacy market so different is that the service providers are women in poor countries who feel compelled to lease their bodies to care for their own families.

In a parallel to the international adoption controversy, the potential for coercion is pervasive: To what extent are impoverished surrogates really free to negotiate their labor, especially if they are controlled by a childbirth clinic that regularly processes "recruits" into a $445 million industry.

Nicole Bromfield at RH RealityCheck describes the dynamics of the "recruitment" of rural Indian women:

In some of the Indian clinics, the surrogates are recruited from rural villages, with most recruits being poor and illiterate. Surrogacy recruits are brought to the clinics where they are required to stay in the clinic's living quarters in a guarded dormitory-like setting for the entire pregnancy. Supposedly this practice not only allows the clinics to monitor the surrogates' activities and behaviors during the pregnancy, but also is seen as protecting the surrogate from ridicule by family members and neighbors; most Indian women acting as surrogates keep it a secret because it is seen as dirty or immoral. What is alarming about the recruiting process is that it is notably similar to the recruitment process used by human traffickers to coerce rural women into sex work in cities. Also similar to other trafficking situations, the women have to sign documents (often in English) that they cannot read and then are kept "under lock and key" until the obligations set forth in the contract are fulfilled. Most surrogacy contracts prohibit sexual contact between surrogates and their husbands and surrogates are generally allowed only minimal contact with their partners in any case.

This regulation of the bodies of surrogate women (typically young, impoverished, and of color) challenges common assumptions about individual rights in the global labor market. Even outside the ethical debate on surrogacy itself, there's a clear need for government oversight to ensure that both the women, and the babies they are commissioned to bring into the world, are protected from abuse.

Noting that some families have faced legal disputes over the citizenship of global-surrogate babies, Bromfield writes, "it is imperative that global standards be developed and the USA, European, and other nations take an active role in setting requirements. This can be done under rights of citizenship and immigration."

As with most global trades, it all comes down to price: Bromfield reports, "Surrogacy costs about $12,000 to $20,000 per birth in India, whereas in the U.S., it is upwards of $70,000 to $100,000." A rural Indian woman may earn roughly $5,000 to $7,000 from the surrogate pregnancy, far more than a regular low-paying job. But the easy flow of money across borders underscores another ethical quagmire. The same pattern emerges in global migration: wealth crosses national boundaries and products flow back the other way, but the movement of workers and families is brutally restricted. For better or worse, transnational surrogacy challenges us to reconcile human relations with commercial transactions in the global marketplace.

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