A fascinating AP article about commercial surrogacy in India. It’s legal to pay someone to have your baby here in the US and in many other countries, but apparently the Indian clinic profiled in the article is on the leading edge of making surrogacy less niche and more routine. Infertile couples need only supply the sperm and eggs and sign on the dotted line. The clinic finds and cares for the surrogate mothers, making the process easier and more affordable for the parents-to-be. Included in the article are the stories of several of the surrogates and couples, all upbeat and heart-warming. But of course, there are “critics.”

Critics say the couples are exploiting poor women in India — a country with an alarmingly high maternal death rate — by hiring them at a cut-rate cost to undergo the hardship, pain and risks of labor.

My first reaction was “ick.” Don’t let these people pass laws than make surrogacy like organ donation. (Here’s an MR post that links those two subjects.) Let me be a little more careful, though. Regarding the high maternal death rate, the clinic might do well to keep its costs low by making sure that the pregnancies are successful and healthy for both woman and child. Perhaps the proliferation of such clinics would actually lower India’s rate of deaths in childbirth. The fear is that the incentives will run the other way.

Or, Lantos [of the Center for Practical Bioethics] said, competition among clinics could lead to compromised safety measures and “the clinic across the street offers it for 20 percent less and one in Bangladesh undercuts that and pretty soon conditions get bad.”

Clearly, clinics will compete on price. The question is whether this leads them to be more or less interested in the mother’s health. (Even if these clinics end up being baby mills, it still needs to be shown that the surrogate mothers are misled or coerced for there to be a problem.) 

There appear to be two different strategies a clinic could pursue: make safety a priority or forget about it. On the one hand, a clinic could spend the bare minimum and match or exceed India’s high maternal mortality rate. Medical costs would be reduced. However, as the job becomes riskier, local women will become less willing to be surrogates (unless they are somehow systematically misled, but that might be tough to do). In the case of this article, the compensation for the surrogate is a large chunk of the clinic’s costs, $4500 out of a typical $10,000 that the hopeful couple pays. So making surrogacy a risky occupation could be costly. Also, I would think that the surrogate mother being in poor health or dying probably correlates pretty well with the baby being in poor health or dying, which seriously increases costs. If the baby doesn’t make it, the clinic has to pay again for a surrogate and the couple has to wait another nine months. If nothing else, the clinic should be very interested in the health of the baby. I don’t know about how it works medically, but I presume that ensuring the baby is healthy means ensuring the mother is healthy as well.

And I wouldn’t worry about the infertile couples being too focused on price only. I would expect them to be concerned about the health of the surrogate mother and the conditions she lives in, both for the sake of the baby and perhaps also out of altruism. I imagine that, for a couple from a wealthier country at least, the burden of proof is on the developing nation clinic to show that it can deliver a healthy baby in nine months. I would be more worried about clinics that cater to local couples with fertility issues, though the healthy route might still be the low cost one.

The critics have yet another concern:

“You can picture the wealthy couples of the West deciding that pregnancy is just not worth the trouble anymore and the whole industry will be farmed out,” said Lantos.

So what? Sounds great. Heck, one of the Indian surrogates in article was going to use her fee to buy a house for her family (compare $4500 to her $25 monthly salary as a maid). She gets a house, the mother from a wealthier country avoids pregnancy. What’s wrong with this picture? To go back to the first bit I quoted, where’s the exploitation? What about the “hardship, pain and risks” of coal mining or crab fishing? Are we exploiting those workers because we don’t mine our own coal or catch our own crabs? And a “cut-rate” price? I’m not sure what makes a price cut-rate. If the women are being misled or coerced, then there’s a problem, although not one that is peculiar to this situation. Sure, keep an eye on how these clinics evolve, but let’s not get in the way of a good thing.