"I told him (doctor) I didn’t have work, my children go hungry, my husband gets only Rs 3000 (US $65 approx) a month and we have four children to feed. I told him I would do whatever work there was, whatever work he would ask me to do." -Rashmi,* a surrogate
"...exploitation and opportunity are bound and wound up in one."
- Betsy Hartmann1
In recent years, the sharp growth in commercial surrogacy in India has drawn much attention and raised several ethical concerns. Surrogacy, the practice of gestating a child for another couple or individual, involves the use of various assisted reproductive technologies (ARTs). India's fertility industry is an integral part of the country's expanding medical market and medical tourism industry, within which commercial surrogacy is often portrayed as a win-win situation, seen to give "desperate and infertile" parents the child they want, and poor surrogate women the money they need. This article will bring a feminist health lens to bear on the practice of commercial surrogacy in India, thus highlighting that ethical, economic and political questions are contained in issues commonly regarded as personal. Surrogate women are engaged in a constant and shifting negotiation with their realities, which reveals the agency they exert even within a restrictive paradigm. Their body is their resource, and its use to earn money impacts their lives in complex ways. Feminist thought and action walks a thin line between questioning and respecting women's choices, and as such, this article is an attempt to deepen our collective understanding of the choices women make.
Reproduction, and its more recent avatar of technologically assisted reproduction, is a site of inquiry that feminists have dislodged from the domain of the strictly biological, medical, private and the familial. Feminist critiques of surrogacy have highlighted that the ART industry lies at the intersection of patriarchy and market, wherein these technologies meet rather than question the pressure on women to be mothers. Surrogacy is able to push pregnancy from the private to the public, from care to work, and in doing so, is able to destabilize the 'destiny' of women's biology, and indeed gender itself; yet the body in surrogacy is more a survival tool than an easy, happy right.
"Actually, the surrogates do not disclose that they have been inserted with someone else's sample. They tell everyone that the child is theirs. Do you know how Punjab (a north Indian state) is? They think this is wrong. After the child is born, some say it expired, some say they gave it away to a friend or relative. You know this is Punjab. It is not how it might be in a country outside somewhere." -Navneet,* a surrogacy agent
Commercial surrogacy remains highly stigmatized in India, with many surrogates spending the term of their pregnancy in surrogate hostels (such as in Anand, a town in the western state of Gujarat), away from their families and communities. Surrogates may want to keep what they do secret, as reproduction is considered acceptable only within marriage; taken outside the domestic sphere of family, childbearing for financial gain may be seen as 'dirty work,' 'baby-selling' or 'womb-renting.'2 For this reason, some argue that altruistic surrogacy is more acceptable than commercial. However, altruism has also been an area of much contest and debate. Notwithstanding the impossible question of how the "emotional" quotient or the "charitable" feeling in any relationship can be determined, it must be recognized that altruistic surrogacy is hardly without coercion or its own power dynamic, particularly in the South Asian context. It is unlikely to be completely benevolent, and in many ways it renders women more vulnerable than commercial arrangements that carry the same health risks but at least provide some compensation.
"First of all, she should be between 25 to 30 years of age. Her family should be complete. She should be good-looking. Her brain should be okay. She should be educated. It cannot be that the one who is taking the child is very fair, and the surrogate is very dark."
- Dr Sumitra,* an embryologist-cum-counselor at an IVF clinic
"Yes, I have something in mind when I look for a surrogate. I see that the family is poor."
The commodification of the body in surrogacy is clear: the child becomes a product of the arrangement while the woman's body, specifically her reproductive labor or organs, become a resource. The questions one must ask are: Is the body a legitimate resource? What of the accompanying objectification and exploitation that poses serious threats to the health and rights of women?
In answering these questions, we can draw from the sex workers' struggles and sex work debates. Do we not posit in our political and analytical lives a mind-body dualism, albeit couched in feminist vocabulary? As such, are we guilty of invoking moral rhetoric particularly when the bodies of poor women are in focus?3 Shah (2009) argues that surrogacy must be understood as "a possible choice, restricted but made with dignity, knowledge and consent."4 However, does an admission that surrogacy is a 'legitimate' choice satisfy all political and ethical concerns associated with surrogacy? It is, after all, in and through our acts of agency and choice that we contribute to the functioning of heteronormativity and patriarchy. As such, it becomes important to view the compulsions and implications contained in choices.
"We don’t find any other work. There is no work in the village. We poor people are helpless you see. That’s why we have taken this decision. Only if I find other work will I do other work." -Sunita,* a surrogacy candidate
"This globalization of baby-making comes at the peculiar intersection of a high reproductive technology and a low-tech work force." -Goodman 2008
The political economy context of women's labor under globalization presents a picture of informalized and sexualized labor that is inattentive to women's rights and health, while also destroying indigenous livelihoods and rolling back state investments in social security. With the onset of globalization, India's economic policy has shifted away from centralized industries and manufacturing units, and towards new industries that operate with minimum regulation and controls, including for labor. In particular, women now find themselves pushed into more informalized jobs such as export zones and the service sector, where there is a demand for their cheap, "docile," even "sexualized" labor.5
A case is thus made to consider commercial surrogacy as "a new kind of labor-gendered, exploitative and stigmatized labor, but labor nonetheless."6 In the Indian subcontinent today, women who are garment workers, sex workers, and surrogates, are engaged in contemporary and commercial forms of sexualized and reproductive labor-all of which were generally, traditionally considered economically non-productive, apart from being seen as dignified only if domesticated. Surrogacy in particular is boosted by both domestic and international demand, because of India's cheap rates (as compared to the West); lack of regulation of ART clinics; easy availability of surrogate mothers and egg donors; and to match specifications such as skin color.
"They (hospital staff) have said you need to first get selected, then we will discuss everything with you. They have also told me that there will be no problems. It will be like your previous deliveries… I want myself to be safe and okay. I have two children, I have to bring them up. This is it. When they put in the sample, this is what I will pray to God for. I will ask the doctors also. My body should not become weak. My health should remain good." -Sunita*
A ban on surrogacy has been opposed on grounds of practicality or principle. The rights of infertile, as well as gay/queer individuals and couples to have their own biological children through surrogacy may also be seen as reproductive rights. We know that historically, while the fertility of a certain section of women (e.g. upper class, white) is encouraged, the fertility of another (e.g. poor, third world/black) is not. With the use of ARTs by non-conformist constituencies, such as LGBTQs, single people, and unmarried couples, the potential in these technologies for subversive reworkings of the heteronormative family cannot be written off. Yet, while today gay couples from the global north come to India for surrogacy arrangements, India's legal position on homosexuality is being contested. Despite a landmark high court judgment decriminalizing gay sex in 2009, a Supreme Court challenge is underway. The proposed legislation for the regulation of the ART industry is ambiguous about whether ARTs can be accessed by gay couples at all. Thus, transnational movements must be understood within international and national matrices of power that allow or disallow certain flows over others.
Further, the dilemmas in commercial surrogacy are all too evident. The possible creation of three mothers (commissioning mother, the gestational mother, and in case of use of donor eggs, the genetic mother) has medical, ethical and legal implications. No credible, long term studies on the health implications of the procedures and drugs in ARTs have been done, for either mother or child. The custody and citizenship of the child may be contested, such as in transnational surrogacy arrangements. In the absence of regulation, the surrogate's bodily integrity, freedom and autonomy may be compromised; for payment too, she is at the mercy of agents, commissioning parents, or doctors. In more extreme instances, women may be sold or trafficked to be surrogates. This was the case in an orphanage in Haryana that sold a girl twice in three years to bear children for childless couples, and has been the case more recently in Thailand, where Vietnamese women were being held in an illegal surrogacy racket.
As such, a section of feminist health activists in India, including Sama (the authors of this piece) has taken a pro-regulation stand to put in place a comprehensive legal framework that can address concerns that result from the unchecked proliferation of these technologies. With each of the two drafts of the proposed legislation, the Draft Assisted Reproductive Technologies (Regulation) Bill (2008 and 2010), Sama has critiqued the document from a gender and rights lens, highlighting provisions that need revision.
"See, I also eat, my children also eat!"
"I haven't done anything wrong, have I?"
"Theoretical descriptions cannot produce universals. They can only ever produce provisional generalizations, even as the theorist realizes the crucial importance of their persistent production."
G. C. Spivak7
The critical question of representation demands some reflection here. Feminists are all too aware that to represent the embodied experience of another woman faithfully, let alone an entire "constituency" or "class" of women, is a task considerably crisscrossed with differences in identities of caste, class, religion, ethnicity, race, sexuality, nationality and so on, as well as individual differences of position, opinion, or preference. Surrogacy poses several questions to which feminist responses have to catch up both analytically and politically. As a start, we must break out of the liberal imaginary that thinks only in terms of agent and victim.
Vrinda Marwah works with the Sama Resource Group for Women and Health in New Delhi, India.
*Names have been changed to protect the identities of interviewees.
1. Hartman, B. (2010). The Gene Express: Speeding Toward What Future? In Unraveling the Fertility Industry: Challenges and Strategies for Movement Building by Sama- Resource Group for Women and Health
2. Pande, A. (2009). Not an 'angel', not a 'whore': Surrogates as 'dirty' workers in India. Indian Journal of Gender Studies, 16(2): 141-173
3. Pande, A. (2010). Commercial surrogacy in India: Manufacturing a perfect mother-worker. Journal of Women in Culture and Society, 35(4):969-992
4. Shah, C. (2009). Surrogate motherhood and women's sexual and reproductive rights. Paper presented at the Consultation, My body, my life, my rights: Addressing violations of women's sexual and reproductive rights, Asia Pacific Forum on Women, Law and Development. Thailand
6. Pande (2010).
7. Spivak, G. C. (1998). In Other Worlds: Essays in Cultural Politics. London: Routledge