Commercial Surrogacy: choice and health

Being pregnant comes with its advantages. One of these is that a healthy amount of pampering is expected and endured. Pregnant women can put their feet up more than usual, or at least that’s how it should be, how we want it to be. Because for most of us, this is supposed to be (at least ideally, at least in reasonably okay families), a special time.

Why am I thinking of this now? Well, it’s baby season with balding William having a baby. If I could be bothered, I’d think of something cute to say but given that the world’s topmost designers are busy proposing designer prams, I’ll pass. In the meantime, there have been other babies back home that made news; yes, I’m talking about Shahrukh Khan’s surrogate baby. Also, more importantly, the draft Assisted Reproductive Technologies (Regulation) Bill will soon be tabled in parliament. The bill, also called the ART Regulation Bill, is an attempt to regulate the fertility industry including In-Vitro Fertilisation, sperm donation and surrogacy.  But the section titled “Rights and duties in relation to surrogacy occupies only a few pages and many of the clauses focus on protecting the rights of the buyers. In this multimillion dollar industry, the woman who carries a child only plays a small part, it would seem.

So the inherent specialness of the time or the woman—that’s relative, isn’t it? In commercial surrogacy, for example, pregnancy and reproduction are nothing more or less than a service. It can be bought and sold, contracted. There are middlemen. It is an industry. Sometimes, it is a celebrity decision and a celebrity baby. The baby is special. The baby is god’s gift. The woman, ah, that’s another matter. There’s a lot of fuss about celebrity babies and sometimes about celebrity moms. There’s less fuss about surrogate moms of celebrity babies and absolutely no fuss about surrogate moms of ordinary babies. In fact, ensuring a basic minimum of health for them seems difficult.

Western feminist perspectives on commercial surrogacy are varied with issues of personal autonomy, reproductive choice and dehumanisation all making an appearance. Take a look at this Stanford University group for an overview though their subtle tilt toward supporting surrogacy is troubling. Boiling the debate down to an issue of choice is simplistic. There are perspectives on power, dominance and inequality that Indian feminists have explored and it’s worth revisiting these. Most importantly, there are questions on women’s health that need to be foregrounded.

A paper called Birthing a Market which was published by SAMA in 2012, reveals how irrelevant the discussion of choice can be in a scenario where women are misinformed or do not understand the implications of what they are participating in. Often, they feel intimidated or alienated by their surroundings and don’t feel like they can ask questions. An excerpt from the paper:

Surrogates in the clinical setting experienced a general atmosphere of intimidation to open communication. In such an atmosphere, it was improbable that surrogates themselves would seek information. Asked whether she desired any further communication with the doctor, SD1 said that she could not ask too many questions, “With these people, if you talk too much, it doesn’t look good.”

As the paper says, the surrogate was meant to give her consent under these circumstances. What are the chances that ‘consent’ here became a bit skewed?

The paper talks about the lack of information around possible medical repercussions.

On discovering that she was carrying twins, SP4 expressed concern about the effect of this on her health. The agent told her, ‘It does not matter. It will be fine.’ In such a context, surrogates could not possibly anticipate any effects or problems that they may face afterwards. They were required to simply resign themselves to the situation, undergo the procedures, and bear the unexpected pain and complications stoically. The possible impact on their bodies and the effect on their health were neither considered while making the decision, nor did these considerations figure as meaningful factors when it comes to the remuneration and longer term health coverage.

Inequality is measured in the daily meals, the missing nutrients, the messed up medical procedures. It’s all very well to talk of choice but when it comes to health issues, I’m suspicious of double standards. The full set of prenatal check-ups and oodles of emotional support is required for one woman but a careless legal formality is okay for another?

The paper also gives a chart of common health problems experienced by surrogates. These include weakness, double pneumonia, gilti (lumps where injections are given), fatigue, vomiting, dizziness. One surrogate said: “Used to have aches in my body and stomach from the first day. The child was born with a lot of trouble. I had got an infection in that area after three–four months. They gave me an injection so I don’t lactate, one hour before discharging me. But the milk had been formed. It hurt very much later when I was home.”

The entire paper is an interesting read and is available here.

The choice argument is obviously based on an assumption that a woman is fully aware of all the possible repercussions—medical and emotional—that she may have to bear. Clearly, this is not the case for many women who choose to become surrogates. Worse, in many cases, gross negligence gives way to deliberate cruelty for profit. In a recent article in The Hindu, Ranjana Kumari, Director of Centre for Social Research (CSR), said: “…some surrogate mothers are also impregnated without their knowledge to ensure high success rate. In case of unhealthy pregnancies, abortion pills are given by the doctor to terminate the pregnancy and the surrogate simply thinks that she had a spontaneous abortion.”

The hope is that legislation will help improve some of these health problems but the bill is lacking in its very formulation. This review of the draft bill mentions that it does not address concerns related to informed consent and counselling of the surrogate. The bill also “fails to mention any of the physical risks, such as those involved in egg retrieval, common in the ART process”. The review points out that the nature of the industry is such that doctors and clinics will gain from not informing the surrogate of possible negative impact. By not enforcing this legally, we’re clearing the path for rampant exploitation.

No discussion of rights can take place in an elitist, idealised and unrealistic cocoon removed from concerns such as health. The mundanity of headaches and blood leaks have the power to build or destroy a woman’s life, and her personal autonomy. Because commercial surrogacy is intimately bound up with the body, the people we need to hear from are women whose bodies are undergoing these procedures, not just during the procedures but long after. We also need to ask questions: who guarantees that the woman’s health is going to be privileged over the child’s? Typically, expenses cover the woman’s health expenses only until childbirth and not after. What if complications are discovered later? Who will take responsibility for the woman’s health at that point?

Also read this article by SAMA in Kafila.org which talks about the 2010 draft of the ART Bill and its problems and this slightly older article by Imrana Qadeer & Mary E. John, again in Kafila.