Women's inferior status throughout the world renders them more exposed than men to poverty, gender-based exploitation and all forms of trafficking. One of the newest forms of trafficking has emerged as a result of exponential growth in the worldwide use of new reproductive technologies. The international community faces a reality in which medical knowledge and technologies that were developed for healing purposes are used not for saving lives, but rather for allowing people with economic means to fulfill a very specific kind of parenthood that often exploits the economic distress and risks the health of certain other women. This situation causes great concern among feminists, as transnational surrogacy and the trade in human eggs have become pervasive international phenomena.
Mediating agencies use various international trade routes to connect doctors, parents-to-be, and women willing to sell their eggs or rent their wombs.
Ova trade: Would-be parents often travel from western countries such as the USA, Germany, the U.K and Israel to Eastern Europe, India, Cyprus and other countries where payment for ova is cheaper or not legally regulated as it is in their home countries. In countries where ova sale is prohibited, hormones may be administered in the home country to the women who are then flown to a second country where their eggs are harvested, fertilized and inserted in the receiving woman's uterus. Many significant short-term health risks to women are incurred in the process of extracting abnormally large numbers of eggs from their ovaries per a single cycle. Long-term effects are less well understood but are known to include infertility and possibly reproductive and other cancers. Inadequate long term research has been conducted on these health risks. (See the accompanying article in this issue by Diane Beeson for more detail.)
Surrogacy trade: Fertilized eggs often travel across international borders, sometimes arriving from one country while the sperm arrives from another country. The fertilized eggs may be passed to a third country where the woman who will become the surrogate mother resides and where the procedure of the insertion into the uterus is performed. Great concern regarding human rights violations resulting from the exploitation of low income and poor women, along with the absence of truly informed consent, is growing among advocates and many fear that the situation resembles trafficking in organs such as kidneys.
These procedures frequently involve the administration of synthetic hormones injected to produce abnormal numbers of eggs. As a result, when a pregnancy is successfully produced, it often consists of multiple embryos. The surrogate is then subjected to much higher levels of risk than a normal single pregnancy involves. Post-natal health care costs for treatment of complications are often not covered. Furthermore, the costs of health care provided to infants born with congenital problems may not be claimed by the intended parents. A typical situation is the case of the surrogate mother who was pressured to have an abortion after the fetus she was carrying failed to meet the quality specifications of those who hired her when they were informed that the fetus had Down Syndrome.1 Surrogate transactions are often facilitated by entrepreneurs operating without supervision or monitoring of women's health, and with little apparent concern about protecting surrogates from exploitation or criminal abuse.
In 2009, what is known as the "Romanian scandal" was exposed. Israeli doctors were involved in the trafficking of eggs of young poor women at SABYC clinic in Romania, some of whom were only 15 years old, with little understanding of the health risks involved. In one example, a 16-year-old factory worker was left in critical condition after the procedure. The arrest of the doctors and agency operators by Romanian police revealed the ways the international reproductive industry is working as a free zone with no ethics or responsibility for respecting human rights or human dignity.2
Information on the magnitude of international trafficking in reproductive organs is scarce and partial, rendering many questions unanswered. Of particular interest is information regarding the health and social repercussions of this industry on women, and the economic gains of the various players in this field.
While there is legislation of varying degrees among different countries, ranging from full prohibition of egg donation and surrogacy to weak attempts at regulating aspects of this reproductive trade, the gaps are enormous and the industry metastasizes largely without any accountability. Such laws as exist are implemented solely at the national level.
The phenomenon of trafficking is not limited to countries that lack regulation. Black markets are known to develop alongside the publicly authorized services, offering leniencies that give them advantages from the buyers' point of view. Within this market, many grey areas remain. For example, in Israel, young women may receive hormonal treatments to stimulate egg production legally, while the harvesting takes place illegally outside of the country.
The transnational nature of reproductive trafficking means that activism at the local level to reduce it is not enough. In light of these realities, women's health advocates have begun an international initiative to address the increasing problem of reproductive exploitation and commodification. Over the past year, action has begun to draft a call for a UN declaration on human rights abuses in reproduction.
Documents that should inform such a declaration include the Nuremburg Code (1947)3 on human experimentation; the World Health Organization's Draft Guiding Principles on Human Organ Transplantation (1991) and its Commentaries;4 the European Convention on Human Rights and Biomedicine (1997)5 and its Additional Protocol on Transplantation of Organs and Tissues of Human Origin (2002);6 and the Helsinki Declaration (Sixth Revision 2008) on human experimentation.7 Although these documents more specifically pertain to human experimentation and organ transplantation, in some cases even deliberately excluding reproductive tissues including ova, they can be applied to reproductive organs and tissues as in the case of the Draft Guiding Principles on Human Organ Transplantation of 1991.8
Universal legal agreements on the trafficking of ova and surrogacy should protect the basic rights and interests of women, which form part of the set of legally binding obligations on countries that have agreed to these treaties. An international regulation might offer a basis for determining when eggs are being trafficked. It could also determine what precautions every country should take within its boundaries in order to protect all women concerned.9 For example, the European Committee's 2004 resolution condemns any trade in human tissues and places crucial importance on encouraging EU members to incorporate in their laws the principal of voluntary donation (see clauses 14 (2) 12(1)). Furthermore, the resolution mentions the need for creating a monitoring mechanism on import and export that will take into account both the protection of donors and the quality of organs and tissues (clause 9).10
The practices of reproductive organ, tissue and cell trafficking and trade, particularly ova sale and surrogacy, infringe upon several basic human rights under international law and are violations of international agreements on health and medical standards. Trade in reproductive surrogacy, organs and tissue must be recognized as a unique kind of human exploitation.
The absence of an international stance on reproductive trade allows the free market to set the standard for using and selling human organs, including reproductive organs, cells and tissue. Medical technologies become a tool for people who, in the name of creating or saving life, are using women as objects of human organ stock.
It is our belief that taking a feminist stance on this issue will be beneficial for women throughout the world. There must be an international platform for discussion. The field of reproductive technologies raises complicated issues regarding autonomy and commodification of women's bodies, the medicalization of women, trafficking, children's rights, and a plethora of other issues. Alongside these questions are another set of issues regarding the right course of action. Could international regulation protect women or simply achieve legitimization of reproductive trade? Although there is awareness of these questions, recognition of the legitimacy of the fertility-industrial complex and its practices affects women's rights and health negatively. Recognizing the problem and bringing these issues to the forefront of the international agenda is the crucial first step. The need to convene an international meeting of women's health and human rights advocates to develop a universal feminist stance on the issue of reproductive trade is urgent.
The opportunities that these medical technologies provide also require that we face the question of who truly is paying the price. The obligation of each one of us is to acknowledge the irrelevance of national borders concerning this issue and to focus on the abuses occurring and to develop protective measures that will ensure the health and safety of women throughout the world.
Several elements provide a framework for the creation of an international declaration on human rights abuses in human reproduction that protects the rights and health of women and the children to whom they give birth:
- The commercial use of women's reproductive capabilities both within and across national borders should be prohibited.
- Surrogates and ova donors should be recognized as human participants in a complex birth-giving process, rather than as biological resources. Consequently, practices that bar human contact between surrogates, egg providers, and the children born through these processes should be strictly prohibited.
- Surrogacy and egg donation should be permitted only under circumstances allowing for the viable possibility of a prolonged relationship between and/or among surrogate, gamete donor, child, and growing family.
- All medical procedures must be conducted within the country of origin of the intended parent(s) by legally authorized fertility experts in licensed hospitals and/or clinics.
- Recipients of fertility treatment hormones of any kind must be informed that past uses of synthetic hormones have led to significant increases in cancer rates among women to whom they were prescribed, and that the long-term medical risks of hormones currently used in fertility treatment (often unapproved for this purpose) are unknown due to a dearth of long-term studies of the effects of these drugs on recipients.
The hope is that these elements will be a basis for international dialogue between women and organizations that address the increasing problem of reproductive organ trade and trafficking. We have seen the effects of these phenomena on women's lives, and we are asking the international community to take social responsibility and actively defend human rights.
Hedva Eyal is Women & Medical Technologies Project Coordinator with Isha L'Isha (Woman to Woman) Haifa Feminist Center, Israel.
Editorial assistant: Kathleen Sloan, Program Coordinator, CRG.
1. Guichon, J. "Don't let market forces govern human procreation," BioNews, 22.November 2010.
2. Scott Carrny, Red Market Blog," International Baby Market" http://redmarkets.com/2010/08/international-baby-maker.html
3. The Nuremberg Code (1947) In: Mitscherlich A, Mielke F. Doctors of infamy: the story of the Nazi medical crimes. New York: Schuman, 1949: xxiii-xxv.
4. The World Health Organization (WHO) is an organ of the United Nations and is the leading authority on health within the United Nations system
7. The Helsinki Declaration was developed by the World Medical Association. It is not a binding legal instrument, but its principles were drawn from worldwide regional and national legislation.
8. Such is the case in the Draft Guiding Principles on Human Organ Transplantation of 1991
9. Ingrid Schneider, (2007)
10. DIRECTIVE 2004/23/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 31 March 2004