A reader sent me a link to a Slate article about the burgeoning practice of reproductive or fertility “tourism.” This is an increasingly common practice by which infertile people from one country access fertility services in another country, often for economic reasons, but also for regulatory reasons. For example, people from relatively wealthy Western nations hire low-income Indian women to serve as surrogates, often also procuring donated gametes through the same clinics that recruit and care for the surrogates. In a different example, British couples travel to American clinics for IVF using donated eggs, because British fertility clinics are government-regulated and thus cannot compensate egg donors at the levels that American clinics can. Here, a lack of clear guidelines on how donors are compensated means that donors are often paid thousands of dollars, and we thus have a much larger pool of donated eggs from which to choose.
The Slate article points out that, in an attempt to make use of Indian surrogates more cost-effective, clients can choose to have fertilized eggs implanted in more than one surrogate at the same time. While the provider this article focuses on used to allow clients to then terminate one of the pregnancies if both surrogates became pregnant, the company now says that clients who opt for two surrogates must agree to keep all of the babies produced.
The article concludes by insisting that, despite the appealing idea that Indian surrogacy arrangements are mutually beneficial because couples get the babies they want and Indian women get far more income than they could otherwise (Oprah has even cited such arrangements as examples of “women helping women”) the economic motives so clearly involved are troubling. As the writer says,
If for-profit companies are going to continue to approach baby-making like an import-export business, maybe it’s time for governments to start treating it that way, adapting oversight and protections for all parties involved. In the meantime, in the absence of meaningful regulation, the rights of surrogate mothers are being bought, sold, and signed away.
The article is worth reading in full. It brought me up to speed on some developments in this troubling industry, including the use of two surrogates, as well as the requirement that some clinics impose saying that surrogates will always deliver their babies via c-section for the “safety” of all involved (despite data that c-sections are not necessarily safer than vaginal births, and the risk this imposes on the surrogates should they get pregnant with their own babies in the future and deliver vaginally). The article reminded me as well of the documentary Google Baby that aired on HBO2 in 2010. In that film, which followed several people involved in an Indian surrogacy clinic, one disturbing scene showed Doron, an Israeli broker specializing in matching couples with surrogacy services in India, on the phone with a father-to-be. Doron floats the idea of using two surrogates to maximize the chance of success. After chuckling a bit at the idea of having multiple babies as a result, the client says that it’s fine, because selective reduction (terminating embryos in a multiple pregnancy to control the number of babies born) was always an option he was open to. Apparently, such a response to ending up with multiple babies via multiple surrogates is no longer allowed by some providers. It’s a step in the right direction, but still far too small. (I wrote about this scene and several others from Google Baby here.)
As I wrote for Christianity Today in 2010:
Fertility tourism might be one area of reproductive ethics where conservative Christians, who traditionally focus on the sanctity of human life, and liberal Christians, who traditionally focus on human rights, particularly for women, can speak out together for justice and compassion. We don’t have to project some dystopian future to witness instances in which human dignity — the dignity of Indian mothers serving as surrogates and the babies they deliver — is violated by clinics, entrepreneurs, and aspiring parents who are turning procreation into a fee-for-service market.