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.
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December 31, 2007 at 3:13 pm
jsalvati
If you were worried that surrogates were being systematically mislead, the low cost solution would be to require firms to provide statistics on injury and death rates for surrogates.
January 1, 2008 at 12:33 pm
cdfox
Hmm, aren’t there certain pieces of information that the law requires employers to provide to their employees, or businesses to their customers, but that are frequently not provided? Perhaps there should be a program to educate women that clinics must provide these statistics, so that they demand it, along with sufficiently stiff penalties for clinics that don’t.
January 3, 2008 at 9:16 am
Luddites and Libertines « Thinking Things Through
[…] and Libertines Technology continues to provide ever more novel ethical problems. Check out this blog post on surrogate pregnancy. Most of us get our ethical bearings from a list of ethical do’s and […]
January 10, 2008 at 12:27 pm
Erika
I think that this article provides a unique prospective on this debate, however, there are other questions left to consider regarding the health and legal rights of both mothers. Because this is an unregulated industry, growing quickly in a rather economically unstable region of the world, certain issues are bound to arise. One is question might be, if multiple babies are conceived (on average a surrogate is implanted with five fetuses, more than is allowed in the US or UK), and the adoptive parents only want one or two, what happens to the other babies? Or, conversely, if the surrogate only wants to bear one child due to the added risks involved in multiple births, does she have the right to abort the additional fetuses?
There are many questions that arise from this issue, not just ones of morals and ethics. Do I want to be able to buy my eggs from a Ivy grad supermodel in NY, have it born in India, and raised in LA? Is this the future of a truly globalized society? I invite you to lend your voice to the discussion taking place on this issue right now at http://www.TheIssue.com
Erika, Editor,
http://www.TheIssue.com