Amrita Pande, Wombs in Labor: Transnational Commercial Surrogacy in India. Columbia University Press, 2014.
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RATING: 84
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Buy this book?
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Yes
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This is an excellent book - empirically hugely informative, theoretically significant, analytically subtle, neatly structured, admirably concise, and, unusually for an academic monograph, a delight to read. Its topic - transnational commercial gestational surrogacy, in which the surrogate carries another woman's fertilized egg - has emerged as a conspicuous feature of international political economy over the last 25 years, expanded massively in the last decade, and attracted a considerable literature that Pande covers well. India was a major world site with an estimated $2 billion industry until it was banned in late 2015, and looked likely to phase out or go underground. The significance of Pande's approach arises from the consideration of production and reproduction in a single frame: 'Instead of burying surrogacy within the usual debates of motherhood and reproduction, Wombs in Labor analyzes commercial surrogacy as a form of labor that traverses the socially constructed dichotomy between production and reproduction. I demonstrate that commercial surrogacy in India is a new kind of labour emerging from globalization: gendered, exceptionally corporeal, and highly stigmatized, but labour nonetheless' (5-6). This does not lead as it might have done to a dense theoretical tract. Pande's method is ethnographic, drawing heavily on field notes collected over five years, and allowing the various subjects in and around the industry to speak for themselves. Sensibly steering away from 'the implicit reification of gender-based dichotomies - private/public, nature/social, reproduction/production, and non-market/market', and related concepts such as 'intimate labour' and 'priceless children', she explores both 'how a labour market for wombs is created and how the laborers experience this market' (8). In doing so she directs our attention to the recruitment and disciplinary tactics characteristic of the surrogacy labour regime, and the strategies employed by surrogates to negotiate and resist it, pointing out that 'the real laborers in this study, the surrogates themselves, either actively or inadvertently resist classifying surrogacy as labor and themselves as laborers. ... Their discursive strategies ultimately reify the predominant role of women as virtuous reproducers rather than wage-earning producers' (11). This 'motherly' attitude even extended to the researcher herself: '"This poor girl, she needs to fill up her whole notepad before she can make a book out of it. We should all talk as much as we can and help her do it as quickly as possible"' (Rita, cited 17).
The great majority of surrogates in the study live below the official poverty line, and the money earned through surrogacy may equate to as much as five years of previous family income. In a country that is aggressively anti-natalist, and views surrogacy as on a par with prostitution, and in a locality in which medical care is patchy and most births take place at home without medical intervention, 'the hyper-medicalized surveillance of commercial surrogacy was often their first encounter with medicalized birth and health care' (21). So 'a perfect commercial surrogate is not found ready-made but is actively produced in fertility clinics and surrogacy hostels' (22). In response, the disciplined surrogates of India 'construct surrogacy as God's gift to needy and poor Indian women' (22-3). At a broader social level, the combination of anti-natalism and transnational gestational surrogacy amounts to what Pande calls neo-eugenics: a 'new, subtle form of eugenics whereby the neoliberal notion of consumer choice justifies promotion of assisted reproductive services for the rich, and, at the same time, justifies aggressive anti-natalist policies by portraying poor people (often in the global south) as strains on the world's economy and environment' (23). The predominant focus of the book as it unfolds is on the discursive and material strategies surrogates adopt both to resist stigmatization and to challenge the medical establishment's view of them as 'disposable mothers' (24). The surrogates speak at length for themselves; their attitudes and strategies are explored with empathy and insight; but at the same time Pande applies her own independent critique of their subject positions, from a perspective that I regard (though she may not) as broadly materialist.
A brief scene-setting chapter (Chapter 2) explains that commercial gestational surrogacy emerged against a background of post-independence 'family welfare planning' in which 'unlike in the global north, where many women historically had to struggle to get access to the most basic birth control methods, in India the state forced it on them' 30. In the current context of neoliberal reform, this leads to a distinctive contradiction: 'On the one hand, government expenditure on public health infrastructure is shrinking and poor women are being subjected to population control targets [the 'voluntary two-child norm']. On the other hand, Indian scientists are investing in new reproductive technologies like test tube babies, IVFs, and surrogacy, and medical tourism (especially in these assisted reproductive services) is booming' (35).
The title of the chapters that follow give a clear idea of the overall structure of the book: 'When the Fish Talk about the Water' (introducing a number of surrogates and outlining their different circumstances, degrees of autonomy, and levels of understanding of the process, with a mild side-swipe at James Scott); 'Manufacturing the Perfect Mother-Worker' ('The surrogate, who is expected to be a disciplined contract worker who gives up the baby at the termination of the contract, is simultaneously urged to be a nurturing mother for her baby, and a selfless mother who will not negotiate the payment received', 64); 'Everyday Divinities and God's Labor' ('In the narratives of the surrogates, the process of surrogacy is sacralised and Dr Khanderia [the head of the clinic] becomes a demigoddess on a par with Lord Krishna', 86); 'Embodied Labor and Neo-Eugenics' ('Surrogacy is an extreme example of the manifestation of worker embodiment, where body is the ultimate site of labor, where the resources, the skills, and the ultimate product are derived primarily from the body of the labourer ... But while at one level these women appear to fulfil feminist ideals, their life stories are not just heroic tales of resistance. The decisions they make about their own reproduction conform to the global imperative of reducing the fertility of lower-class women in the global south' 106, 114); 'Disposable Workers and Dirty Labor' ('Ironically, the narratives that resist the clinic's construction of the surrogates as dirty and disposable workers and instead emphasize their moral worth ultimately undermine their identity as workers and as wage earners for their family. ... It is almost as if the surrogates do not resist the image of women as selfless dutiful mothers whose primary role is to serve the family' (141, 142); 'Disposable Mothers and Kin Labor' ('Women respond to the medical construction of surrogates as disposable mothers by forging kin ties with the baby, the intended mothers, and other surrogates' 144); and 'Aporia of Surrogacy' (the conclusion, mainly discussing banning versus regulation). All of them are original and insightful, but I won't summarize them here. Read the book! Instead, I focus on a couple of issues, of particular relevance to the project of a critique of political economy that treats 'production' and 'reproduction' as aspects of a single totality.
First, Pande's characterization of commercial gestational surrogacy as an extreme example of 'embodied labour’, involving 'a rental of the use of one's body by somebody else' (106) recalls the general characteristic of the production of value in capitalist society, in which money can only be turned into capital 'through exchange with living labour capacity' (Marx, 1861-63 Manuscript, in Collected Works, Volume 30, p. 36), a capacity that has to be renewed from day to day for the process to continue. Where agricultural and industrial 'hands' expend their energy in manual labour, surrogates 'use their bodies, wombs and sometimes breasts, as instruments of labour' (166). In each case, the 'sweat and blood' of bodily exertion generates the value that capital demands, the unique feature here being that the commodity produced is a child which becomes a use value for the commissioning parents. Pande's detailed analysis of the emergence of a labour market for wombs in commercial surrogacy documents beautifully the presence of the requirements for capitalist reproduction identified by Marx: money can only buy labour capacity 'to the extent that the latter is itself offered for sale as a commodity, sold by its owner, the living possessor of labour capacity'; and for this to be possible its 'owner' must be able to dispose of it as a commodity, and obliged to do so because she has no commodity to offer other than her living labour capacity, present in her own 'living corporeity' (Marx, ibid., 37).
Second, Pande is excellent on the significance of the world market for gestational surrogacy. Although brief, her identification of neo-eugenics as a central feature of the global regime leads her beyond the concept of ‘stratified reproduction’, ‘where the fertility, bodies, and reproductive decisions of lower-class women become more valuable only insofar as these women serve as human incubators for their richer sisters’, to the identification of a ‘global reproductive hierarchy’ (126). Emerging remarkably quickly after the first successful case of IVF in 1978, the global industry of commercial surrogacy is nevertheless at an early stage of development: the 'socially necessary labour time' for the production of a child is as yet a constant (managed here through the practice of delivery by Caesarian section in all but a couple of cases); the gathering together of workers in 'factories' where they can be efficiently supervised and intervened upon reflects formal rather than real subsumption to capital; and the market depends entirely on the bespoke hosting of fertilized eggs for specific commissioning customers. But as Marx remarked in a broader context, capital not only creates new techniques, products and markets in its constant search for value, but habitually overcomes apparent natural barriers in order to do so - large-scale modern industry 'views each process of production in and for itself, resolving it into its constituent elements without looking first at the ability of the human hand to perform the new processes' (Capital, I, 616). There is no reason to assume that the same is not true of the human womb.
The great majority of surrogates in the study live below the official poverty line, and the money earned through surrogacy may equate to as much as five years of previous family income. In a country that is aggressively anti-natalist, and views surrogacy as on a par with prostitution, and in a locality in which medical care is patchy and most births take place at home without medical intervention, 'the hyper-medicalized surveillance of commercial surrogacy was often their first encounter with medicalized birth and health care' (21). So 'a perfect commercial surrogate is not found ready-made but is actively produced in fertility clinics and surrogacy hostels' (22). In response, the disciplined surrogates of India 'construct surrogacy as God's gift to needy and poor Indian women' (22-3). At a broader social level, the combination of anti-natalism and transnational gestational surrogacy amounts to what Pande calls neo-eugenics: a 'new, subtle form of eugenics whereby the neoliberal notion of consumer choice justifies promotion of assisted reproductive services for the rich, and, at the same time, justifies aggressive anti-natalist policies by portraying poor people (often in the global south) as strains on the world's economy and environment' (23). The predominant focus of the book as it unfolds is on the discursive and material strategies surrogates adopt both to resist stigmatization and to challenge the medical establishment's view of them as 'disposable mothers' (24). The surrogates speak at length for themselves; their attitudes and strategies are explored with empathy and insight; but at the same time Pande applies her own independent critique of their subject positions, from a perspective that I regard (though she may not) as broadly materialist.
A brief scene-setting chapter (Chapter 2) explains that commercial gestational surrogacy emerged against a background of post-independence 'family welfare planning' in which 'unlike in the global north, where many women historically had to struggle to get access to the most basic birth control methods, in India the state forced it on them' 30. In the current context of neoliberal reform, this leads to a distinctive contradiction: 'On the one hand, government expenditure on public health infrastructure is shrinking and poor women are being subjected to population control targets [the 'voluntary two-child norm']. On the other hand, Indian scientists are investing in new reproductive technologies like test tube babies, IVFs, and surrogacy, and medical tourism (especially in these assisted reproductive services) is booming' (35).
The title of the chapters that follow give a clear idea of the overall structure of the book: 'When the Fish Talk about the Water' (introducing a number of surrogates and outlining their different circumstances, degrees of autonomy, and levels of understanding of the process, with a mild side-swipe at James Scott); 'Manufacturing the Perfect Mother-Worker' ('The surrogate, who is expected to be a disciplined contract worker who gives up the baby at the termination of the contract, is simultaneously urged to be a nurturing mother for her baby, and a selfless mother who will not negotiate the payment received', 64); 'Everyday Divinities and God's Labor' ('In the narratives of the surrogates, the process of surrogacy is sacralised and Dr Khanderia [the head of the clinic] becomes a demigoddess on a par with Lord Krishna', 86); 'Embodied Labor and Neo-Eugenics' ('Surrogacy is an extreme example of the manifestation of worker embodiment, where body is the ultimate site of labor, where the resources, the skills, and the ultimate product are derived primarily from the body of the labourer ... But while at one level these women appear to fulfil feminist ideals, their life stories are not just heroic tales of resistance. The decisions they make about their own reproduction conform to the global imperative of reducing the fertility of lower-class women in the global south' 106, 114); 'Disposable Workers and Dirty Labor' ('Ironically, the narratives that resist the clinic's construction of the surrogates as dirty and disposable workers and instead emphasize their moral worth ultimately undermine their identity as workers and as wage earners for their family. ... It is almost as if the surrogates do not resist the image of women as selfless dutiful mothers whose primary role is to serve the family' (141, 142); 'Disposable Mothers and Kin Labor' ('Women respond to the medical construction of surrogates as disposable mothers by forging kin ties with the baby, the intended mothers, and other surrogates' 144); and 'Aporia of Surrogacy' (the conclusion, mainly discussing banning versus regulation). All of them are original and insightful, but I won't summarize them here. Read the book! Instead, I focus on a couple of issues, of particular relevance to the project of a critique of political economy that treats 'production' and 'reproduction' as aspects of a single totality.
First, Pande's characterization of commercial gestational surrogacy as an extreme example of 'embodied labour’, involving 'a rental of the use of one's body by somebody else' (106) recalls the general characteristic of the production of value in capitalist society, in which money can only be turned into capital 'through exchange with living labour capacity' (Marx, 1861-63 Manuscript, in Collected Works, Volume 30, p. 36), a capacity that has to be renewed from day to day for the process to continue. Where agricultural and industrial 'hands' expend their energy in manual labour, surrogates 'use their bodies, wombs and sometimes breasts, as instruments of labour' (166). In each case, the 'sweat and blood' of bodily exertion generates the value that capital demands, the unique feature here being that the commodity produced is a child which becomes a use value for the commissioning parents. Pande's detailed analysis of the emergence of a labour market for wombs in commercial surrogacy documents beautifully the presence of the requirements for capitalist reproduction identified by Marx: money can only buy labour capacity 'to the extent that the latter is itself offered for sale as a commodity, sold by its owner, the living possessor of labour capacity'; and for this to be possible its 'owner' must be able to dispose of it as a commodity, and obliged to do so because she has no commodity to offer other than her living labour capacity, present in her own 'living corporeity' (Marx, ibid., 37).
Second, Pande is excellent on the significance of the world market for gestational surrogacy. Although brief, her identification of neo-eugenics as a central feature of the global regime leads her beyond the concept of ‘stratified reproduction’, ‘where the fertility, bodies, and reproductive decisions of lower-class women become more valuable only insofar as these women serve as human incubators for their richer sisters’, to the identification of a ‘global reproductive hierarchy’ (126). Emerging remarkably quickly after the first successful case of IVF in 1978, the global industry of commercial surrogacy is nevertheless at an early stage of development: the 'socially necessary labour time' for the production of a child is as yet a constant (managed here through the practice of delivery by Caesarian section in all but a couple of cases); the gathering together of workers in 'factories' where they can be efficiently supervised and intervened upon reflects formal rather than real subsumption to capital; and the market depends entirely on the bespoke hosting of fertilized eggs for specific commissioning customers. But as Marx remarked in a broader context, capital not only creates new techniques, products and markets in its constant search for value, but habitually overcomes apparent natural barriers in order to do so - large-scale modern industry 'views each process of production in and for itself, resolving it into its constituent elements without looking first at the ability of the human hand to perform the new processes' (Capital, I, 616). There is no reason to assume that the same is not true of the human womb.