The global baby - is international surrogacy ethical?
In an age when international business and outsourcing is booming, it seems that globalization is seeping into even the most unusual markets. Hoping to avoid complicated adoption procedures and expensive American surrogacy rates, infertile and same-sex couples are increasingly turning to international surrogacy, looking to rent a womb for nine months from a woman living thousands of miles away.
But laws differ between countries, and each fertility clinic and tourism company has its own rules and regulations, making this surrogacy process a complicated one that often raises a number of ethical flags. How are these surrogates treated? How much are the clinics and the liaison companies paid? Is it ethical to use multiple surrogates simultaneously, and if so, what happens if both have successful pregnancies?
The answers are not clear cut. Clients must have a comprehensive understanding of the process and its intricacies before making a decision.
There are a few countries that participate in international surrogacy, including Panama, Malaysia, Ukraine, Georgia and Guatemala. Business is booming particularly in India, racking up $500 million from the hundreds of clinics across the country that offer surrogacy. These clinics partner with various medical tourism companies, which act as consultants and liaisons between parents-to-be, the clinic and the surrogate. Intended parents can work directly with the clinic, or they can work through a medical tourism company.
The surrogacy can work in multiple ways. Both the egg and sperm can be donated from the parents-to-be and then implanted into the surrogate. Also, it is often the case of same-sex couples, either an egg or sperm will be donated by one of the parents-to-be, the other reproductive cell will be donated from a bank in one country and then the two will be joined and implanted in a surrogate in a third country. This creates what is often termed “the global baby.”
Depending on the practice of the agency or the clinic, surrogates might spend the duration of their pregnancy at home, at the clinic or at a guest house organized by the clinic, where their behaviors, diet and medications are monitored.
Like most clinics, PlanetHospital, a medical tourism company based in California, sets rules for its surrogates. They must previously have had their own children – in order to ensure that they can properly carry a child and so that they won’t get emotionally attached to the baby – and all babies must be delivered by Cesarean section – so that the delivery date can be scheduled and the parents-to-be can fly in to pick up their newborn.
The medical tourism company 360 Global Health also has certain qualifications for its surrogates. CEO Kelly Jenkins said that their partner Gynaecworld Fertility Clinic in Mumbai, India interviews potential surrogates, their families and neighbors and then evaluates the women to make sure they are in good health and live in good conditions. They also must have at least one child of their own.
Clinical embryologist Dr. Samit Sekhar is the In Vitro Fertilization and Surrogacy Program Director at the Kiran Infertility Centre in Hyderabad, India. He said the clinic no longer works with American medical tourism companies but has a case worker in the U.S. His surrogates also endure a lengthy process of selection. First, they are recruited by various nongovernmental organizations that work for the social upliftment of the poor. The women and their families are interviewed and counseled and then undergo a social and criminal history background check. They are then reviewed by the clinic’s psychiatrist, medically examined for sexual and general wellness and then administered hormone therapy to gauge their bodies’ response. If they pass all the tests, they are enlisted into the program. For the clinic’s American clients, the surrogates are married and have children. For the clients from Europe and Japan, the surrogates are single because of governmental requirements.
According to PlanetHospital’s website, the median price for surrogacy in the United States is about $100,000. Doing it in India would cost between $35,000 and $45,000. A 2007 report from the Centers for Disease Control and Prevention states that surrogates in the U.S. are usually paid between $12,000 and $25,000, whereas the surrogates in India are paid between $7,500 and $9,000. PlanetHospital keeps about $3,600, the egg donor gets $5,000, the clinic is paid $15,000 and $3,000 is used for travel expenses. The prices differ for each couple because their situations are often different and they request varied packages, which may or may not include airfare. Additional costs may incur from medical complications with the surrogate.
Exploitation versus Empowerment
Critics of international surrogacy argue that liaison companies take advantage of surrogates because most of them come from lower-income backgrounds. But PlanetHospital founder Rudy Rupak, in an email to a reporter from the online magazine Slate, said, “While some people might scream exploitation, bear in mind that the per capita average income of a typical [Indian] surrogate would be $600/annum. She is thus making close to 12 times her annual salary by being a surrogate.”
Jenkins shares that sentiment. She said her American clients are generally those who have exhausted all other means of getting pregnant or adopting. By the time they enlist the company’s service, they cannot financially afford the steep prices of surrogacy in the U.S. Thus, they are not looking to exploit cheap “labor” in a foreign country but are merely paying for a service they can actually afford.
“$25,000 in America is hardly a year’s salary for most young women,” she said. “By contrast, $10,000 for an Indian woman is the equivalent to many years’ salary for her. The money they receive generally results in very positive situations, education for their families, a better standard of living.”
Sekhar said that his surrogates stay in quarters at the clinic where their families are allowed to visit and are provided with food, security and entertainment. They are also trained in various activities like tailoring and handicrafts.
“It’s a life-changing experience for the surrogates and their families, as the compensation they receive is more than three times what a fresh graduate would earn in a year,” Sekhar said. “Some even start their own businesses with it.”
Critics also argue that surrogates are not autonomously choosing to engage in surrogacy but are instead being forced by parents, spouses or someone else. Jenkins suggests that people investigate individual clinics’ practices for finding surrogates before they make a judgment. The surrogates she works with are all willing participants and feel empowered by engaging in this activity.
Additionally, a benefit for some parents to be, is that they do not have to go through such a through screening process as in traditional adoption. Rupak said in an article by the Wall Street Journal, “Individual clinics use their own standards to make these decisions. Our ethics are agnostic. How do you prevent a pedophile from having a baby? If they are a pedophile then I will leave that to the U.S. government to decide, not me.”
Perhaps one of the larger ethical concerns involves the use of multiple surrogates for one couple. Often times, doctors will implant two embryos into one woman to ensure that at least one takes. However, this also creates the possibility of the surrogate having twins. Additionally, some clinics might implant embryos into two surrogates simultaneously to increase the chance of a successful take. But what happens if both surrogates become pregnant? The intended parents may now have four babies instead of one or two.
Depending on the rules set forth by the clinic and/or the medical tourism agency, the parents might have the option to abort one of the pregnancies. 360 Global Health has never used multiple surrogates, Jenkins said, because it “takes a more conservative approach.” Its doctors will, though, implant more than two embryos into one surrogate if the surgeon and parents agree to do so. In that case, if the surrogate has twins, the parents-to-be must accept both babies. However, if all three or four embryos take, the parents are allowed to decide if they want to abort any of the embryos.
Sekhar said that in his clinic, abortion is prohibited if multiple embryos successfully take. Additionally, he said that his clinic used to use multiple surrogates but now use them only in special cases when an intended mother is in her late 30s and 40s and has a limited number of embryos.
According to the Slate article, PlanetHospital use to market the “India Bundle” which would implant embryos in two surrogates at a time. Their website use to state, if both surrogates became pregnant the client could decide to have the extra pregnancy aborted. This was an option they offered until Rupak’s lawyers advised him not to.
While the surrogate has the potential to make a large amount of money which could benefit her and her family, there are also some choices that she has no input on. What if she is the extra pregnancy and is forced to have an abortion, how will that affect her? Additionally, in some cases surrogates are taken away from their homes by requirement of the clinics and are forced to live in guest houses and have their every move monitored for nine months.
Each country has its own laws about surrogacy, so it is often easier for wishful parents to use international surrogacy because regulation in the U.S. is generally stricter than in other countries. For instance, in Greece, surrogates can be prosecuted for trying to keep the baby, whereas American surrogates are allowed to claim rights to the child.
In India, there are no special laws controlling surrogacy in India. Instead, there is one regulatory measure called “National Guidelines for Accreditation, Supervision & Regulation of ART [assisted reproductive techniques] Clinics in India.” Because no official law exists and these clinics often are not monitored, some clinics can exploit their surrogates and/or the parents.
For clients looking to engage in surrogacy in India or anywhere else, “it is crucial that you ask important difficult questions and find out how [clinics] enlist their surrogates, how they take care of them and how they assist you with the exit process to exit the country,” Jenkins said.
Other issues can sometimes arise after the baby has been delivered. For example, if a baby is born in India to parents who live in Japan, Spain, Germany, Italy or France – all countries that either prohibit or severely restrict surrogacy – the baby might be denied citizenship in the home country.
Jenkins said that 360 Global Health works only with clients in the U.S. and Canada, where they can be sure they won’t have that problem. While each U.S. state has different laws that regulate surrogacy, the U.S. just requires that the baby’s DNA match one of the intended parents in order to receive citizenship.
As with most things in society there are pros and cons to surrogacy. Is eliminating the screening process for parents to be ethical? Is abortion of the extra fetus ethical if it was a choice to get pregnant? On the other hand, is it right to deny a family the chance at having children, if this is their only option? Do the benefits for the surrogates outweigh the negatives? Do the questionable morals of this carry more weight than anything else? With the rapid globalization even in this market, it is time to really examine the facts along with the laws of the government in each country before taking a stand either way.
