Sayantani Dasgupta and Shamita Das Dasgupta, eds, Globalization and Transnational Surrogacy in India: Outsourcing Life. Lexington Books, 2014. Hbk $100/£70; pbk (2015) $39.99/£24.95.
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RATING: 75
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Buy this book?
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Yes
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From one perspective the transnational market for surrogates is of a special kind, with profound normative and ethical implications that revolve around the separation of gestation from conception, motherhood and parenting, and the exploitation of poor women in the South by wealthy would-be parents in the North. From another, it is just a global market, like any other. Both perspectives are reflected in this volume. It is a useful addition to the growing literature on transnational gestational surrogacy, a particular virtue being the space given to direct testimony in practically every chapter from surrogates and others involved in the industry. The editors provide a scene-setting introduction (a little duplicated in a good overview chapter by Varada Madge that might have come earlier) and on the whole the collection is strong and well put together. As is increasingly the way it lacks a reflective conclusion - the final chapter, a discussion by Amy Feinberg and Jennifer Maisel of a play they respectively directed and wrote, There or Here, about outsourcing, surrogacy, cultural identity and phone sex, doesn't fit that well. The normative and ethical aspects of commercial gestational surrogacy are covered thoroughly and well, with a range of points of view represented, but it is the material on the character of the global market for the 'commodification of the womb' that points in the most interesting direction, along with a couple of good chapters that detail the lack of regulation of this growing global industry, and recommend ways forward.
Ethical and normative themes are best approached though Alison Bailey's excellent contribution (first published in Hypatia, 26, 4, 2011), which offers the notion of reproductive justice as a 'conversation starter' and a perspective capable of engaging the best insights from normative and ethnographic traditions. She provides a pertinent set of questions: 'Should commercial gestational surrogacy be promoted in a country that has an abysmally poor record on women's health, or that has such an extraordinarily high maternal mortality rate? What does it mean if the women who have been historically targeted for sterilization and aggressive contraception policies turn out to be the same women targeted for surrogacy work? Isn't there something unsettling about pushing women to limit their own families while offering them huge incentives to carry children for wealthy families? Should we be troubled by the fact that a medically vulnerable population is doing such draining and intimate bodily work? Can fully autonomous health and employment decisions be made under these conditions? Shouldn't clinics be required to provide medical care to surrogates for a determined time after the delivery?' (35, 42). Several other contributions address this agenda. Preeti Nayak, reflecting from the perspective of Sama-Resource Group for Women and Health, argues in a well-balanced contribution that as things stand 'it would be difficult to envisage surrogacy arrangements operating in a just and ethical manner; that is, arrangements that are equally responsive to the interests of all involved parties' (19). And the editors themselves contribute two chapters, the first exploring online blogging communities of intended mothers/parents, the second focused on 'the violence of reproductive trafficking'. In the first, they argue that 'practices of "othering" both Indian surrogates and India itself, as well as colonial/capitalist worldviews are prominent and cohering factors of this emerging IM cyber-nation', one that manifests 'many of the features of the nineteenth-century colonizers' (69-70). I felt that the argument was rather weakly supported by the evidence brought forward - but enough material is provided for you to make up your own mind. In the second, they describe 'gestational surrogacy as it is commissioned to women in India by intending parents in the West' (179) as human trafficking, putting reproductive traffic into the same frame as sex traffic and labour traffic. The key section makes the case for surrogacy as 'violence against women' (190-93). But if 'her "choice" to be a surrogate stems from the differences of social class and uneven economic power between the surrogate and the intended parents' (190), this puts it in the same frame as all labour performed by propertyless producers of surplus value, and suggests that the underlying violence (which is real) is common to all forms of labour under regimes of private property. So I'm not convinced that the trafficking analogy is helpful.
The analysis of the transnational market for gestational surrogacy that runs through a number of other contributions reminds us that the boundary between commercial transactions and family life, or between production and social and biological reproduction, is a socially constructed one, and one that capitalist innovation, accumulation and commodification does not respect. While they raise similar normative and ethical concerns, they suggest that such issues are common to all global markets, and to labour markets above all. Most significantly, they show how participants in the market are able to 'normalise' their participation in commerce, whether as surrogates or customers of their services, by the ways in which they themselves construct their actions, and thereby give an insight into the process by which activities considered to be outside the market are drawn into it. The context is set by an informative contribution from Seema Mohapatra, on the lack of regulation of these essentially uncontrolled private global or local markets, and the consequential role of the courts and spreading application of contract law to the gestational transaction. In the US (California being a major global site for surrogacy) state laws vary, with no overall federal regulation (149). In India commercial surrogacy was legalized in 2002, as part of a growing development of medical tourism, but no attempt was made to regulate the market until the Assisted Reproductive Technology Regulation Bill was brought forward in 2010. It never became law, and a new Surrogacy Regulation Bill brought forward in November 2016 remains under discussion. Mohapatra concludes that 'domestic law regarding surrogacy varies greatly and encourages forum shopping in the jurisdiction that is most favorable to intending parents' (154), and calls for an international surrogacy convention to be drawn up. In another good and thought-provoking contribution, Marsha Darling addresses the related issue of an appropriate welfare principle for children born through transnational gestational surrogacy, who can potentially fall between jurisdictions and become stateless and parentless, or be denied rights of citizenship. She draws inter alia on UN conventions and norms surrounding international adoption to do so, pointing out some significant areas of risk and concern. Not least, intending parents, by virtue of their financial resources, can by-pass issues of suitability and requirements for counselling that would attend national or international adoption (164-6). Darling is rightly concerned that 'children not become mere commodities' (166): 'A child is not a thing,' she insists, 'but a person' (167). The truth, of course, is that in the case of 'contract motherhood', the child or children are both, as her review of varying state laws in the US confirms; and in the meantime, the global market grows apace. Sharmila Rudrappa (the author of a subsequent monograph, listed below) shows how neatly it fits into familiar sociological accounts of global commodity chains driven by consumer demand and choice at one end, and the supply at the other of workers available by virtue of poverty, and lacking choices. The 'global assembly line in producing babies' (128-9) is enabled by not so new ART technology, structured by local recruiting agents (often egg 'donors' or surrogates themselves), private clinics, intermediary agencies such as PlanetHospital, and ancillary medical and legal services, and promoted through the world-wide web. In Gujarat it recruits from rural families where husbands often have only intermittent casual work; in Bangalore it recruits women whose alternative is to work long, gruelling and dangerous hours in the garment industry. As Rudrappa points out, a 'suitable surrogate' has the attributes of a 'good worker' - reliability, deference to authority, and adaptability - along with 'compliance to invasive medical procedures' (141). But these attributes are not left to chance. Surrogates are immured in hostels, policed, and surveilled, to ensure that their behaviour is conducive to the best development of the foetus, tutored in their role as gestators but not mothers, and subjected to a regime of high-tech medical intervention of a level entirely unavailable to them as ordinary citizens.
Gestational surrogacy has had a bad press, and is viewed negatively by some in the communities from which surrogates are drawn, in part because of the mistaken assumption that they must have intercourse with the intending father. But a number of contributors suggest that attitudes are changing as the industry develops, the impact of the resources on family lives is felt, and misconceptions about the production process are dispelled. Anindita Majumdar explores mass media representation of surrogacy in India, dealing with the Baby Manji (Points, 2009) and Balaz twins court cases, which involved disputes between surrogates and clients, and the high-profile 2011 case of actor Aamir Khan and his filmaker-wife Kiran Rao, with whose announcement of the birth of a child through surrogacy 'the stigma attached to infertility and the hiring of a surrogate to carry a baby was seemingly removed' (107). Majumdar finds that press accounts now generally profile the surrogate as a woman in need: 'desperate for money and support, which has led her to rent her womb. Most importantly, she is not a "fallen' woman, but a mother of children she cannot feed. In addition, she is a wife to an abusive, absent, or financially unstable man' (115). She also recounts how initially hostile foreign media accounts were countered by a press drive to promote the industry and extol the virtues of the 'empowered' surrogates, and the highlight the benefits to infertile couples and same-sex partners. What this points to is a process of 'normalization' through which surrogacy becomes an industry like any other, re-constructed and re-presented as an effective anti-poverty initiative that both promotes female entrepreneurship and empowerment, and gives rise to a product that brings nothing but joy to the customer. Such a representation is just as suspect as its opposite. But its significance is that as the development of grassroots enterprise trumps the sanctity of motherhood and family life, it assimilates surrogacy into the globally dominant OECD/World Bank narrative in which the development of capitalist markets among the poor is paramount, and especially so when women play a central role. As noted above, there is a good case for the regulation of the industry, including the establishment of clear global standards - but this, too, is of course at the same time part of the process of normalization.
Parallel mechanisms at work at the level of individual mentalities are acutely observed by Amrita Pande, who recognises commercial surrogacy as a ‘cultural anomaly’ that ‘commodifies and hence threatens the traditional understanding of families as grounded in love, marriage and sexual intercourse. It also challenges the assumption of a pure and complete maternal role: the genetic mother giving birth to and raising the child’ (87). She goes on to explore the discursive tools and narratives that surrogates and intended parents deploy to minimise the commercial aspect and downplay the contractual nature of transaction, anomalous because ‘by constructing families through the marketplace, it disrupts the assumed dichotomy between private and public, between production and reproduction’ (91). In empirical terms, she finds a contrast: while surrogates in the US tend to talk in terms of the 'gift of a child', those in India are more likely to construct surrogacy as 'a god-sent opportunity for desperately poor Indian women’ (94). She explains this difference in terms of the disparity in class between surrogates and their clients, and the severe poverty of most of the former. So 'choice talk' is not much in evidence, as compulsion or lack of choice is more likely to be articulated: 'It is just something we have to do to survive', as Salma puts it to Pande (95). As common motivations are to provide for children's welfare and education, and daughters' marriages, surrogates can construct themselves as ‘dutiful mothers in service to the family rather than wage-earning workers’ 104. From the perspective of classical Marxist political economy, the point is that these discursive resources do facilitate and enable the disruption of the assumed dichotomy between private and public, and between production and reproduction, revealing it for what it is - an unstable 'fix' that is broken down in the end as the production and reproduction of life is inexorably brought under the command of capital.
References
Pande, Amrita (2009) 'Not an Angel, Not a Whore: Surrogates as Dirty Workers in India', Indian Journal of Gender Studies, 16, 141-173.
Points, Kari (2009) Commercial Surrogacy and Fertility Tourism in India: The Case of Baby Manji , Case Studies in Ethics, Kenan Institute for Ethics, Duke University.
Rudrappa, Sharmila (2015) Discounted Life - The Price of Global Surrogacy in India, NYU Press, 2015.
Ethical and normative themes are best approached though Alison Bailey's excellent contribution (first published in Hypatia, 26, 4, 2011), which offers the notion of reproductive justice as a 'conversation starter' and a perspective capable of engaging the best insights from normative and ethnographic traditions. She provides a pertinent set of questions: 'Should commercial gestational surrogacy be promoted in a country that has an abysmally poor record on women's health, or that has such an extraordinarily high maternal mortality rate? What does it mean if the women who have been historically targeted for sterilization and aggressive contraception policies turn out to be the same women targeted for surrogacy work? Isn't there something unsettling about pushing women to limit their own families while offering them huge incentives to carry children for wealthy families? Should we be troubled by the fact that a medically vulnerable population is doing such draining and intimate bodily work? Can fully autonomous health and employment decisions be made under these conditions? Shouldn't clinics be required to provide medical care to surrogates for a determined time after the delivery?' (35, 42). Several other contributions address this agenda. Preeti Nayak, reflecting from the perspective of Sama-Resource Group for Women and Health, argues in a well-balanced contribution that as things stand 'it would be difficult to envisage surrogacy arrangements operating in a just and ethical manner; that is, arrangements that are equally responsive to the interests of all involved parties' (19). And the editors themselves contribute two chapters, the first exploring online blogging communities of intended mothers/parents, the second focused on 'the violence of reproductive trafficking'. In the first, they argue that 'practices of "othering" both Indian surrogates and India itself, as well as colonial/capitalist worldviews are prominent and cohering factors of this emerging IM cyber-nation', one that manifests 'many of the features of the nineteenth-century colonizers' (69-70). I felt that the argument was rather weakly supported by the evidence brought forward - but enough material is provided for you to make up your own mind. In the second, they describe 'gestational surrogacy as it is commissioned to women in India by intending parents in the West' (179) as human trafficking, putting reproductive traffic into the same frame as sex traffic and labour traffic. The key section makes the case for surrogacy as 'violence against women' (190-93). But if 'her "choice" to be a surrogate stems from the differences of social class and uneven economic power between the surrogate and the intended parents' (190), this puts it in the same frame as all labour performed by propertyless producers of surplus value, and suggests that the underlying violence (which is real) is common to all forms of labour under regimes of private property. So I'm not convinced that the trafficking analogy is helpful.
The analysis of the transnational market for gestational surrogacy that runs through a number of other contributions reminds us that the boundary between commercial transactions and family life, or between production and social and biological reproduction, is a socially constructed one, and one that capitalist innovation, accumulation and commodification does not respect. While they raise similar normative and ethical concerns, they suggest that such issues are common to all global markets, and to labour markets above all. Most significantly, they show how participants in the market are able to 'normalise' their participation in commerce, whether as surrogates or customers of their services, by the ways in which they themselves construct their actions, and thereby give an insight into the process by which activities considered to be outside the market are drawn into it. The context is set by an informative contribution from Seema Mohapatra, on the lack of regulation of these essentially uncontrolled private global or local markets, and the consequential role of the courts and spreading application of contract law to the gestational transaction. In the US (California being a major global site for surrogacy) state laws vary, with no overall federal regulation (149). In India commercial surrogacy was legalized in 2002, as part of a growing development of medical tourism, but no attempt was made to regulate the market until the Assisted Reproductive Technology Regulation Bill was brought forward in 2010. It never became law, and a new Surrogacy Regulation Bill brought forward in November 2016 remains under discussion. Mohapatra concludes that 'domestic law regarding surrogacy varies greatly and encourages forum shopping in the jurisdiction that is most favorable to intending parents' (154), and calls for an international surrogacy convention to be drawn up. In another good and thought-provoking contribution, Marsha Darling addresses the related issue of an appropriate welfare principle for children born through transnational gestational surrogacy, who can potentially fall between jurisdictions and become stateless and parentless, or be denied rights of citizenship. She draws inter alia on UN conventions and norms surrounding international adoption to do so, pointing out some significant areas of risk and concern. Not least, intending parents, by virtue of their financial resources, can by-pass issues of suitability and requirements for counselling that would attend national or international adoption (164-6). Darling is rightly concerned that 'children not become mere commodities' (166): 'A child is not a thing,' she insists, 'but a person' (167). The truth, of course, is that in the case of 'contract motherhood', the child or children are both, as her review of varying state laws in the US confirms; and in the meantime, the global market grows apace. Sharmila Rudrappa (the author of a subsequent monograph, listed below) shows how neatly it fits into familiar sociological accounts of global commodity chains driven by consumer demand and choice at one end, and the supply at the other of workers available by virtue of poverty, and lacking choices. The 'global assembly line in producing babies' (128-9) is enabled by not so new ART technology, structured by local recruiting agents (often egg 'donors' or surrogates themselves), private clinics, intermediary agencies such as PlanetHospital, and ancillary medical and legal services, and promoted through the world-wide web. In Gujarat it recruits from rural families where husbands often have only intermittent casual work; in Bangalore it recruits women whose alternative is to work long, gruelling and dangerous hours in the garment industry. As Rudrappa points out, a 'suitable surrogate' has the attributes of a 'good worker' - reliability, deference to authority, and adaptability - along with 'compliance to invasive medical procedures' (141). But these attributes are not left to chance. Surrogates are immured in hostels, policed, and surveilled, to ensure that their behaviour is conducive to the best development of the foetus, tutored in their role as gestators but not mothers, and subjected to a regime of high-tech medical intervention of a level entirely unavailable to them as ordinary citizens.
Gestational surrogacy has had a bad press, and is viewed negatively by some in the communities from which surrogates are drawn, in part because of the mistaken assumption that they must have intercourse with the intending father. But a number of contributors suggest that attitudes are changing as the industry develops, the impact of the resources on family lives is felt, and misconceptions about the production process are dispelled. Anindita Majumdar explores mass media representation of surrogacy in India, dealing with the Baby Manji (Points, 2009) and Balaz twins court cases, which involved disputes between surrogates and clients, and the high-profile 2011 case of actor Aamir Khan and his filmaker-wife Kiran Rao, with whose announcement of the birth of a child through surrogacy 'the stigma attached to infertility and the hiring of a surrogate to carry a baby was seemingly removed' (107). Majumdar finds that press accounts now generally profile the surrogate as a woman in need: 'desperate for money and support, which has led her to rent her womb. Most importantly, she is not a "fallen' woman, but a mother of children she cannot feed. In addition, she is a wife to an abusive, absent, or financially unstable man' (115). She also recounts how initially hostile foreign media accounts were countered by a press drive to promote the industry and extol the virtues of the 'empowered' surrogates, and the highlight the benefits to infertile couples and same-sex partners. What this points to is a process of 'normalization' through which surrogacy becomes an industry like any other, re-constructed and re-presented as an effective anti-poverty initiative that both promotes female entrepreneurship and empowerment, and gives rise to a product that brings nothing but joy to the customer. Such a representation is just as suspect as its opposite. But its significance is that as the development of grassroots enterprise trumps the sanctity of motherhood and family life, it assimilates surrogacy into the globally dominant OECD/World Bank narrative in which the development of capitalist markets among the poor is paramount, and especially so when women play a central role. As noted above, there is a good case for the regulation of the industry, including the establishment of clear global standards - but this, too, is of course at the same time part of the process of normalization.
Parallel mechanisms at work at the level of individual mentalities are acutely observed by Amrita Pande, who recognises commercial surrogacy as a ‘cultural anomaly’ that ‘commodifies and hence threatens the traditional understanding of families as grounded in love, marriage and sexual intercourse. It also challenges the assumption of a pure and complete maternal role: the genetic mother giving birth to and raising the child’ (87). She goes on to explore the discursive tools and narratives that surrogates and intended parents deploy to minimise the commercial aspect and downplay the contractual nature of transaction, anomalous because ‘by constructing families through the marketplace, it disrupts the assumed dichotomy between private and public, between production and reproduction’ (91). In empirical terms, she finds a contrast: while surrogates in the US tend to talk in terms of the 'gift of a child', those in India are more likely to construct surrogacy as 'a god-sent opportunity for desperately poor Indian women’ (94). She explains this difference in terms of the disparity in class between surrogates and their clients, and the severe poverty of most of the former. So 'choice talk' is not much in evidence, as compulsion or lack of choice is more likely to be articulated: 'It is just something we have to do to survive', as Salma puts it to Pande (95). As common motivations are to provide for children's welfare and education, and daughters' marriages, surrogates can construct themselves as ‘dutiful mothers in service to the family rather than wage-earning workers’ 104. From the perspective of classical Marxist political economy, the point is that these discursive resources do facilitate and enable the disruption of the assumed dichotomy between private and public, and between production and reproduction, revealing it for what it is - an unstable 'fix' that is broken down in the end as the production and reproduction of life is inexorably brought under the command of capital.
References
Pande, Amrita (2009) 'Not an Angel, Not a Whore: Surrogates as Dirty Workers in India', Indian Journal of Gender Studies, 16, 141-173.
Points, Kari (2009) Commercial Surrogacy and Fertility Tourism in India: The Case of Baby Manji , Case Studies in Ethics, Kenan Institute for Ethics, Duke University.
Rudrappa, Sharmila (2015) Discounted Life - The Price of Global Surrogacy in India, NYU Press, 2015.