Tuesday, January 23, 2018

Surrogate motherhood

The grey areas of life:


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According to the website information-on-surrogacy.com, surrogacy has been around since biblical times — when Sarah told Abraham to sleep with her handmaiden, Hagar, so that Sarah and Abraham could have a child by her. It was not until the Baby M case of 1986 in the United States, however, when the issue of surrogate motherhood garnered widespread fame and attention (I recall my mom, sister and I being glued to the TV set, watching the Baby M miniseries and being rather annoyed at Mary Beth Whitehead for not wanting to hold up her end of the bargain). Since then, surrogacy has gained in traction, whether traditional or gestational, commercial or altruistic. Traditional surrogacy, where the mother is the biological mother of the child and gestational surrogacy, where the mother is not the biological mother of the child but is possible through in vitro fertilisation and embryo transfer — are the two main types of surrogacy.

Each may be either commercial (money received for the act of surrogacy) or altruistic (free surrogacy according to information-on-surrogacy.com). There are many reasons why a couple may decide on getting a surrogate: infertility, sickness and the female partner's desire to not ruin her body because of the demands of pregnancy. Whatever the form of surrogacy, however, is it right? Or, is it that there is no right or wrong answer to it? And does surrogacy, like my philosophy professor had suggested in one of my college philosophy courses, devalue a baby so that it becomes a thing you give away? And does it take advantage of the less privileged?

Where traditional surrogacy is concerned, I have my doubts (whether commercial or altruistic). I think the catastrophe that is the Baby M case of 1986, is sufficient explanation for my doubts. There is always the possibility of the surrogate having second thoughts about giving up the child. And she would be justified. I, honestly, do not feel that any woman should subject herself to that type of heartache. It just does not sit well with me. Some surrogates might contend that it is quite possible to divorce oneself emotionally from that child, and not change one's mind, as in the case of Megan Thomas, a traditional surrogate who was able to give the baby up without much emotional tumult. Thomas's case is highlighted on the website www.parentingpartners.net. But even so, my eyebrows go up at the thought of traditional surrogacy, and there is still the fact that Mary Beth Whitehead, the surrogate in question in the Baby M case, had second thoughts.*

Some may counter that the drawing up of an airtight legal contract between the parties involved is enough of a solution to this. In effect, the Baby M case has resulted in more careful attention being paid to the drafting of legal documents for surrogacy. "It would be difficult to exaggerate the impact of Baby M on the legislative regulation of surrogacy arrangements…" writes Elizabeth S Scott in Surrogacy and the Politics of Commodification. However, I do not feel that a contract would nullify any feelings involved. It is too emotional of a scenario, for the surrogate, the couple who has solicited the surrogate and the baby. Traditional surrogacy comes off as emotionally taxing and unfair to all involved.

Gestational surrogacy, on the other hand, warrants some consideration (commercial or altruistic). In this case, as the Committee Opinion of the American College of Obstetricians and Gynecologists notes, "in vitro fertilisation and embryo transfer are combined with surrogacy arrangements…and the surrogate fulfills only the role of gestational mother." Here, the child is not biologically linked to the surrogate, but to the couple who has solicited the surrogate. Personally and generally, I think pregnancy is a miserable experience. I am not sure I want to undergo it for my own child far less someone else's; so I do find it a bit silly to the extent that I do not understand why a woman would want to put herself through that for someone else. But to each his own, I guess. And in this case, there is no emotional tie or there should be no emotional tie between the surrogate and the baby, because it is not her own child. She would be, as I see it, morally out of place to not want to give the child up.

Nonetheless, gestational surrogacy does not necessarily involve the implanting of the gestational surrogate with the ovum of the intended mother or even the sperm of the intended father. According to uscfertility.org, "gestational surrogacy may be achieved with the intended mother's eggs, or with an egg donor. Analogously, the sperm can come from the intended father or from a sperm donor." In this case, gestational surrogacy does pose some ethical problems, problems similar to those posed by the use of sperm and egg banks. It is possible, that at some point, the child in question will want to know who his real father or mother is. Mark Ballantyne writes in My Daddy's Name is Donor: Evaluating Sperm Donation Anonymity and Regulation that, "donor children have been calling for reform, seeking the right to know the identities of their biological fathers and further regulation of the sperm industry." He also notes that, "internationally, countries have been moving towards regulation of sperm and egg donation over the last 20 years." Ballantyne's findings suggest that the utilisation of sperm banks and egg banks can result in children who, born as a result of these donations, suffer identity crises in terms of wanting to know who their real parents are. Gestational surrogacy where a donor egg or sperm is used poses a similar problem.

Whatever the form of surrogacy, however, some urge a complete ban claiming that it is disproportionately underprivileged women who act as surrogates, suggesting that surrogacy, in essence, takes advantage of the less privileged. Now deceased New York Times journalist, Iver Peterson, wrote in his 1987 piece about the Baby M case, that, "…one of the most disturbing elements of surrogate motherhood is the overtone of class exploita-tion. As in the case of Baby M, surrogate mothers tend to have less education and less money than their clients." Indeed, Mary Beth Whitehead, was a "high-school drop-out," while William and Elizabeth Stern were holders of graduate degrees and enjoyed professional careers, as Scott notes this in her Surrogacy and the Politics of Commodification.

The recent practice of foreign gestational surrogacy further supports the contention that surrogacy takes advantage of the less privileged. A classic example is the situation in India – Anand, India – recently referred to as "the rent-a-womb capital of the world" in the title of a Slate magazine article. "Surrogacy costs about $12,000 in India, including all medical expenses and the surrogate's fee. In the US, the same procedure can cost up to $70,000…Another example of third-world exploitation? Globalisation gone mad? The system certainly lends itself to the criticism that foreign women unwilling or unable to pay high Western fees happily exploit poor women at a 10th of the price it would cost back home. The system also avoids the legal red tape and ill-defined surrogacy laws women face in the U.S…All surrogates at the clinic sign a contract agreeing to hand over the baby — which reassures prospective parents, but also supports arguments that the women, many of whom are illiterate, are being taken advantage of," notes a recent article, "Surrogate Mothers: Womb for Rent" in Marie Claire on the outsourcing of surrogacy to India. Therefore, it is disproportionately poor women who become surrogates and it does appear to be a form of exploitation.

Some still contend that surrogacy is a choice, and this is the dominant pro-surrogacy argument, according to a piece entitled "Re-orienting the Ethics of Transnational Surrogacy as a Feminist Pragmatist", "the dominant argument for those in favour is based on the notion of "choice". People in this camp (often understood as advocating a kind of "reproductive liberalism", to use a term introduced by Raymond in her book, Women as Wombs) argue that the surrogate has the right to choose and make decisions about her own body and reproductive capacities. It is also quite common to think of transnational surrogacy as appearing to give women and especially the surrogate, new opportunities for greater autonomy like she never had before." However, the fact is that these women are arguably coerced into surrogacy because of their dire financial circumstances. Judith Warner writes in her New York Times article, "Outsourced Wombs", that, "indeed, one of the ways that surrogacy survives here is under cover of the fiction that the women who bear other women's babies do so not for the money – which would be degrading – but because they "love to be pregnant". But our rules of decency seem to differ when the women in question are living in poverty, half a world away…poor Indian women don't have an awful lot of choices so far as real money-making. Thus, these women, arguably, do not become surrogates freely, but because their financial circumstances compel them to. In this case, based on Warner's reasoning, surrogacy is in a way forced and so, exploitative.

Nonetheless, the same argument – that surrogacy disadvantages the lower classes – could be made for adoption. The Committee Opinion of the American College of Obstetricians and Gynecologists states that, "opponents of surrogate motherhood also have argued that if a fee must be paid to the surrogate mother, only affluent couples will be able to access surrogacy services. This access barrier, however problematic, exists for most services related to infertility, for certain other medical procedures, and for adoption and, thus, is not specific to surrogacy agreements." Therefore, in the same way that one might contend that surrogacy favours the wealthy, the same argument could be made for adoption.

Lastly, opponents of surrogacy assert that surrogacy, whatever its nature, commodifies women and babies. OK, so it does raise eyebrows. I suppose in demanding payment for a child or even giving a child as a gift, surrogacy devalues life; and perhaps it reduces women to "wombs" as stated in "Re-orienting the Ethics of Transnational Surrogacy as a Feminist Pragmatist", "It is argued by this camp of ethicists that surrogacy, instead of making the feminist project a reality by giving women control over their bodies, in fact serves the opposite purpose. It ends up reducing women to, defining them and controlling them in terms of their reproductive capacities, their wombs." The "camp of ethicists" spoken of here is those who contend that surrogacy commodifies women. When one thinks about it…

But there is a final objection to surrogacy, and it is mine. Could it be said that surrogacy is selfish? I worry that this is the case because no one seems to be thinking about the impact that a surrogate arrangement would have on the child. But I am not a judge or juror over anyone, for I do not know what a couple wanting a child goes through. Yet, I worry.

Conclusively, surrogacy, whatever its form, is questionable. It is possibly psychologically harmful to the intended parents and the baby, who may question his or her identity once he or she is old enough to do so. While, in my opinion, the only form of surrogacy that seems feasible is gestational, where the egg and sperm of both intended parents are used, I fear that overall, it is a selfish act.

Author's note: Regarding traditional surrogacy, some religious leaders, as noted in the NY Times article, "Baby M, Ethics and the Law", have asserted that "surrogacy makes the relationship between the mother and the biological father a form of adultery. I disagree, but I will say that it complicates the relationship for the intended parents and everyone else involved. It could even open the door to adultery.

Author's e-mail: akholder22@aol.com