Three Mothers, One Baby and a Whole Industry Around Them

surrogcay  and ivf header
Surrogacy & IVF (istockphoto.com & shutterstock.com, 2017)

Dear readers,

Half a year ago, I learnt that I have three mothers. The astonished reader might curiously ask: how is that possible? Did you just dream that? Or are you working on a new science-fiction short story and made that up? Let me tell you: Thanks to modern medicine it is possible. More specific, we’re talking about gestational surrogacy. 

I jokingly like to call myself a „baby on demand“ and who’s better suited to offer you insights on the new, confusing marketplace of modern human reproduction?

GESTATIONAL SUR… WHAT? PLEASE EXPLAIN

First of all, let’s take a look at the question what we’re actually talking about: The technical term gestational surrogacy is not a phrase you’ll commonly hear everyday. It refers to the process of using one woman’s uterus to implant and carry an embryo and deliver the baby for another person.

In my case, the oocyte was donated by my „donor-mum“. I was received by my „surrogate-mum“ and raised by „intended-mum“. That makes three mothers for one child. You can count it.

7822496-made-in-india-red-stampTo make things more complicated I’m not a baby „made in the U.S.“. My intended parents hired a surrogate mother from India but used oocytes from an egg donor in the US. Interestingly enough, my „donor-mum“ got paid a way higher salary than my „surrogate-mum“.

And there’s the crunch:

How is it possible that an Indian woman carrying a child for nine months receives less than an American egg donor, whose egg donation process takes only a few weeks? Is this unequal compensation justified?

I did some research and I would like to share my findings with you.

SURROGACY IN INDIA: BEHIND THE SCENES OF A SEEMINGLY „EASY-MONEY“ JOB

From 2002 to 2016, India became a major international hub for surrogacy thanks to a cheap clinical labour force. In August 2016, this trend was put to an end with the Surrogacy Bill 2016. The latter forbids commercial and gestational surrogacy and excludes foreigners, Indians living abroad as well as same-sex couples – who were already banned in 2012 (Rabinowitz, 2016) -, heterosexual ones with a child and singles from having recourse to this service. Only altruistic surrogacy, defined as “the process where a surrogate mother agrees to gestate a child for intended parents without being compensated monetarily in any way” (Information on surrogacy, n.d.), is accepted and regulated (The Hindu, 2016).

So, my intended parents benefited from the fact that surrogacy was legal when I was born.

Is there a common denominator for all surrogate mothers?

Through my research, I realised that surrogate mothers in India have common characteristics. First of all, they are Indian and usually between 21 and 35 years old since most of the agencies recruit women in this range (Wallerö, 2014, p.11). They are only used for their reproductive services since the foetus they are carrying is not created using their own oocytes, but the ones from an egg donor. They are required to have had a child previously in order to prevent them from having any emotional attachment to the baby. Surrogates are also often poorly educated and belong to the lowest class of Indian society. In fact, while reading a study from Bindel (2016), I was astonished to find that most of them are illiterate and are thus not even able to read the contract they sign with a clinic.

I put below a table which depicts the educational and social situations as well as the motives of nine Indian surrogate mothers and their husbands.

Screen Shot 2017-06-11 at 11.45.42.pngTable 1: Characteristics of Surrogate Mothers (source: https://iussp.org/sites/default/files/event_call_for_papers/Mother.pdf)

On top of that, I came to understand that it is very common for Indian surrogate mothers to be talked into surrogacy by their family and especially their husbands who struggle to provide them with a proper life. In some clinics, “without the husbands’ [of the surrogates] consent, they do not perform surrogacy” (Bindel, 2016).

A child for your own child’s education

Business Model Dynamics - Assignment #1
On the road to a long-lasting eduction (Pixabay)

Finally, as indicated in the table above, money appears to be a strong driver for women performing this type of clinical labor. Indeed, most of them use it to overcome important financial difficulties for instance giving their children a good education (Kroløkke & Pant, 2012, p. 240), as mentioned by an Indian surrogate mother:

“If my children do not get food to eat, will the people from the society come and feed them every day? I cannot see my children die out of hunger. I need money, not another child. I cannot dare to be weak”.

It is likely to assume that my surrogate mother had the same motives. I conducted an interview with Julie Bindel – an English writer and feminist – in order to have more practical insight on surrogacy. She strongly opposes surrogacy: “It’s better to put food in a woman’s belly than a fetus in her womb.”

After all of these information, I was interested in the compensation my Indian surrogate mother could have received. First of all, what was interesting to me was that surrogates‘ salaries varied slightly from clinics to clinics at that time. For example, women could earn between $5000 to $7000 in some cases (Haworth, 2007), and between $3275 and $6551 in others (Wallerö, 2014, p.11). During my research on salaries, I could not help but wonder why the price difference between the clinics was so small. In fact, the main reason for that is that the women are usually only valued for their reproductive services. Therefore, there is no real preferences on who to choose to deliver a baby as long as it is a gestational surrogacy. (Schurr, 2016, p.17-18).

When I learnt that my mum was just a „means to an end“ and exchangeable, I was quite astonished… to say the least. Also it saddened me to think that maybe, me too, I was just „a means to an end“ for her to earn money and that she did not have any emotional attachment to me at all . But who knows?

Anyway; I read in an article written by Haworth (2007), that these wages are “the equivalent to upwards of 10 years‘ salary for rural Indians.”

In India, these salaries may be justified by the risks these females exposed themselves to. Indeed, the emotional experience is dreadful: carrying a baby for nine months and giving him/her away as soon as he/she is born is difficult may lead to depressions and other psychological impacts (Kroløkke & Pant, 2012, p. 243). Physically, this job implies risks as well. Being pregnant causes many inconveniences such as decreased mobility, tiredness, mood swings and nauseas (Nestlé, n.d.). More importantly, most of the Indian females give birth through caesarean section, which may lead to serious infections and even to death. Also, as put in France Winddance Twine’s book, “most people do not perform their services 24 hours a day unless they are slaves. And most people only sell their labor performed by the body, perhaps but distinguishable from it.

Surrogates on the other hand, perform their services 24 hours a day and sell the body itself… She is never off duty” (2011, p.15).

This justifies the comparably high salaries.

Now, that I know more about surrogacy, I realise that my surrogate mother had clear motives to perform a job with major drawbacks. She was courageous enough to put her health, her life into play to probably change and upgrade her children’s future and I have a lot of respect for that. However, I now cannot help but think that maybe the emotional attachment I have for her is not reciprocal. Perhaps she forgot me the minute she gave me away to my intended parents…

Comparing price differences in macroeconomic numbers

As I wanted to dig a little deeper in the subject of compensation, I extended my research to other countries in the world where surrogacy is allowed. I realised that surrogates’ earnings vary from countries to countries. The difference between Indian and American surrogates’ wages for instance is abyssal. In the U.S., the women earn on average more than $40,000, an amount which is incomparable to the one in India. The cost of living might explain this salary gap. Indeed, in India, prices are 70% lower (Numbeo, n.d.) – than in the USA. Also, looking at the Purchasing Power Parity of India in 2016, it takes 17.240 units of Rupees to buy the same amount of goods and services in the domestic market as one dollar would buy in the US (OECD, 2017).

INTRODUCING MY BIOLOGICAL „DONOR-MUM“

Of course, I wouldn’t exist if it wasn’t for my donor-mum. We already found out that surrogacy is a lucrative industry like every other. As you might have already guessed my parents also didn’t just walk up to a random woman (although it is possible that they have asked a friend or relative). But it is more likely and common that they used an egg donor agency. 

But what exactly do future parents pay the donor for? On the website of the Human Center for Reproduction, I found the following statement: “Our current egg donation compensation for your time, commitment and services is $8,000 on average for a completed egg donation cycle (i.e. retrieval of eggs). You can earn up to $14,000 depending on your qualifications and the number of eggs you produce.” This matched the other findings of my research and it appeared to me that two main factors influence the payments for egg donors: the time and side-effects resulting from egg extraction and the donor’s genetic material.

The documentary Google Baby made me realize the implications of egg donation.

Egg donors are not only investing time but are also faced with a lot of medical risks. Before extracting the eggs, donors have to get daily hormone injections. Short-term side-effects of those hormonal cocktails can be: mood swings, headaches, abdominal bloating, weight gain and nausea. In a next step, the donor’s oocytes are stimulated to produce multiple eggs, a process known as ovulation induction (again through the injection of hormones). This process causes the true risk of egg donation. Ovulation induction increases the risk of ovarian hyper stimulation syndrome, whose effect can range from harmless bloating, to kidney failure or even death. Lastly, the oocytes are extracted through an invasive surgery, which can cause damage to the organs near the oocytes. This can lead to major injury to the bladder, bowel, uterus, blood vessels or other pelvic structures. As one can see, donors put themselves into a risky situation and part of the payment is meant to compensate for it.

It is hard to clearly define what price donors put on their health, in contrast the parents’ willingness to pay for a certain outcome is more evident. Although a surrogate child can fulfil a couple’s biggest dream, sometimes it is very difficult for the parents to cope with the fact that their genetic material will not be or only be partially present in their child. Historically, standard surrogacy was the only option. Thus, the baby would carry the surrogate’s genetics. However, with the growth of this industry came also the opportunity to choose from thousands of women on online agencies willing to offer their eggs for remuneration. Couples have become much more particular about what they are looking for in their perfect egg donor. This comes with the hope to influence the baby’s look and character as much as possible.

“Yes, a blonde, blue-eyed girl – preferably talented at playing piano – please!” 

Characteristics that are considered when choosing an egg donor are physical appearance, ethnicity, body mass index, and education. Most parents use agencies such as the Donor Egg Bank USA to choose their egg donor online. On such websites you can filter donors’ according to specific characteristics (see pictures below) and the payment is then defined depending on the donor’s traits. Payment can thus range from 500 USD to 50,000 USD (Schurr,  2016) . Going through such websites made us realize that oocytes are really commodities like any others. See for yourself: Is there really a difference between donoreggbankUSA.com and zalando.ch?

Screen Shot 2017-06-11 at 11.43.44.pngScreen Shot 2017-06-11 at 11.42.57.png

 

 

 

 

 

 

 

Graphic 1 & 2: Buying and selling oocytes – racial discrimination in market systems?

Also, I stumbled upon a video of students from St. Gallen. Although it is a mockery it actually underlines the way how I feel like babies are sold as goods where you can choose their features:

One characteristic that repeatedly created discussion in surrogate research is the skin color: As Carolin Schurr (2016) calls it, “racial matching” (to choose a donor with the same skin color) is considered as common reaction to make the family look authentic and possibly hide surrogacy. While this seems understandable it is shocking to see the different payments donors receive according to their skin color. The market for oocytes has become a racialized order in which productive body parts of white egg providers are seen as more valuable and receive a higher compensation than non-white bodies, as put by Julie Bindel „eggs from caucasians are always more expensive than those of coloured women“. She also points out this “phenomenon of classic racism and colonialism: The powerful and privileged exploiting the wombs of poorer women.”

So if you look at my origin we can compare it to a commodity’s value chain: the products characteristics come from the egg donor and the actual production is completed by the surrogate mother, true to the motto:

„Designed in America, Made in India“

An interesting point to observe is the differences in payment between surrogates in egg donors. You might have gotten some insights by now, however I want to get a closer look and compare the two „workforces“.

COMPARING TWO “JOBS”

In the course of my research it became evident that through the process of commodification, egg donation and surrogacy resemble to any other kind of labor. And just like in any other labor market, equilibrium wage derives from interaction between supply (egg donors, surrogate mothers) and demand (parents, agencies). The price of labor is determined by various factors which are weighted for each country and each type of labor. While surrogacy is more process-oriented, egg donation focuses on the product itself. This leads me to my final question: What exactly is compensated? How do the different factors add up to the price?

 

State of inequalities

To be able to concretely assess the state of inequalities between surrogacy in India and eggs donors in the US, I made a table summarizing the medical risks, the inconveniences, the potential transmission of genetical traits as well as the time duration of both surrogacy and egg donation. The prices of both procedure is also quickly recalled in the beginning of the table.

  Surrogacy in India (Gestational Surrogacy) Egg Donation
Prices Between $5000 and $7000 depending on the clinics. Between $8,000  and $14000 for a complete egg donation. It depends on your qualifications, the number of eggs you produce as well as your genetic traits (physical traits especially skin colour). For “Ivy-League eggs” prices can go up to $50.000.
Medical Risks Caesarian can lead to infection or death of the surrogate. Ovarian hyperstimulation syndrome, whose effect can be the  failure of the kidney or even death (occurs in about 1-10% of IVF cycles). The surgery to extract oocytes can damage the organs near the ovaries which can lead to major injury to the bladder, bowel, uterus, blood vessels or other pelvic structures.
Inconveniences Specific diet, no smoking nor drinking, decreased mobility, heartburn, hormonal rise might lead to a slow down of the bowel habits, nauseas, tiredness, mood swings, frequent urination. Mood swings, headaches, abdominal bloating, weight gain and nausea, egg donors are subject to racism coming from potential parents who wish their child to have specific genetic traits.
Genetic Traits Genetic traits not transmitted, therefore not compensated for in the final price. Genetic traits transmitted, therefore compensated for in the final price.
Time Duration Whole process: 15-18 months, duration of inconvenience: 9 months Donation cycle between 3-6 weeks.

Table 2: Summary of medical risks, inconveniences, potential transmission of genetical traits, time duration and prices of both surrogacy and egg donation. (Own depiction)

Referring to the last point in the table it is clear that a pregnancy takes longer than the process of donating oocytes.

Screen Shot 2017-06-15 at 22.47.41

Graphic 3: Comparison of price range (own depiction)

My interview partner Dr. Heike Bracke stated that she assumes the risks of a pregnancy greater than donating oocytes. Apart from the medical risks I assume the surrogate’s mobility being limited over a relative long time period as particularly inconvenient.

Although all three aspects – time, medical risks and inconveniences are weighted more severe for pregnancy this is not shown in the compensation. On the contrary: Even if we exclude genetic traits from the egg donation (assuming the donor is not compensated for that) the price is still unequal.

Are inconveniences only physical?

In reality – as shown in the graphic above – the inconveniences are not compensated according to this purely physical logic. On the psychological level, I think egg donors’ endurance of racism makes it especially inconvenient. As mentioned above, egg donation gives the possibility to potential parents to choose the genetic traits of their children. Because many of the parents who have recourse to egg donation to have children are white (rich Occidentals), they often favor white egg donors to keep a authenticity at the heart of their family. In this sense, Blacks, Coloreds or Asians egg donors for instance are disfavored, which per definition is a form of racism. Fourth, genetic traits are transmitted by the potential parents to their children in the case of egg donation only. This explains the current high differences in prices between both procedures.

Even though I reckon this leads to racism, I can somehow understand the wish of potential parents to transmit their genetic to their children.

Adding a new aspect: Price difference as a result of globalisation

dd
The world is getting smaller (Pixabay)

Finally, the price discrepancy is partly due to differences in purchasing power. On that issue distinct opinions can be hold. The use of cheap Indian surrogacy can be seen as an evident consequence of globalisation and the theory of individual profit maximization. Thus, if someone wants to use the services of a surrogate while minimizing his/her costs it makes sense to go to India. In addition, one could argue that there is no consistent difference between using surrogate services and hostelry services; in the end both are a service provided by indians and hostelry services used by occidental people are much less criticized than surrogacy ones. On the opposite, many argue that the core product is closely linked to the human body and its commodification, which in general is highly controversial. Focusing on ethical concerns would thus prohibit occidental (rich) people to employ Indian services as it is considered as exploitation.

Steinbock adds a different view on exploitation and illustrates freedom of choice by the example of the lecherous millionaire: A mother’s child will die without expensive surgery, which is not covered by her insurance. A millionaire offers to pay for the surgery if the mother has sex with him. Although he is not threatening her and won’t harm her if she refuses we get the idea that she has „no choice“. For this reason we might see the offer as coercive. We can also refer this to the raised issue of exploitation. Egg donors are mostly middle-class professional young women. In comparison to surrogate mothers who are often uneducated and come from poverty egg donors do not face the coercive choice of having to enter this profession.

So people pay for blonde hair – but are we allowed to judge?

The facts speak a clear language. Surrogates in India as well as egg donors in the US are not only paid according to the relevant medical risks they take upon themselves, their time and their inconveniences. There are tremendous price differences which are being paid in order to choose a certain set of oocytes, mainly white/caucasian ones. This is mostly due to personal reasons and latent racism in the choice process. But when we see a white couple who has the wish for a white baby because they do not want to be bothered by the societal stigma obvious surrogacy might cause – who are we to judge them? In the following you can find our personal opinions. Very distinct from each other and each depicting very different reasons for finding an answer to the question we want to answer with this small text. Make up your mind and don’t judge too quickly – especially when it comes to topics that affect some of us very highly but are for most of us still something we do not think about too much in everyday life. This probably is the most important lesson that we are taking.

A SPECTRUM OF OPINIONS

Coming back to my life. I don’t exist. Sorry to tell you. Unfortunately, I’m a just the narrator of this blog entry. If I existed, I would of course be an amazing „product of modern reproduction“. However, the group of people who made me up collected a lot of opinions towards the findings of my research. They were not able to agree on one opinion, but this once again only underlines the divisiveness of surrogacy and egg donation. But please see for yourself:

Louise: llMy opinion is that the price difference should be justified by the hindrances endured by the surrogates and egg donors; and not by the range of options available to customers. Hence, I do not think the catalogue of egg donors is a valid reason for a price increase. Thus, i do not think the price of egg donation should be decrease, but that surrogacy compensation should be considerably increase to cover the risks and pain endured by surrogate mothers.

Martha: Are we talking about a commodity? mbThen yes sure the price difference is justified.  Let’s look at the facts: You have a variety of egg donors to choose from, extensive information on each, and thus the possibility to individualise the final product (your baby). On top of that delivery time only takes three to six weeks! Surrogates can’t keep up with that, they won’t influence the outcome as they are only means to an end: easily replaceable and time-consuming. Through the objectification of body parts and bodily services we consider surrogacy as a traditional value chain that is normally applied to commodities. Personally, I believe that the market is going too far, we can’t treat body parts like commodities. The physical and psychological labour of women should be weighted more than superficial caractersitics, like skin colour and beauty.

Kathi:  Since the products we’re talking about are just commodities like every other good it is of course justified to put a price tag on it. Equilibrium wage is purely based on market interaction between supply and demand. ktIf oocytes from white babies are more in demand there’s no reason why there shouldn’t be a higher price for that. However, racial discrimination of willing egg donors has to be criticised if eggs from white mothers are seen as superior. Often parents only want their child to look-alike and if there are more white people interested in surrogacy I subsequently don’t see a difficulty with the price difference. As a lookout, it would be interesting to see to what percentage and for what reasons people prefer a white baby.

Niklas:  For me the whole discussion about the justification of wage and price differences is kind of hypocritical. Referring to the results and examples of our research, egg donation is a free decision and prices are defined by the market. Speaking about surrogacy people might argue that the decision-making of surrogacy mothers is not completely independent from influences like monetary needs and societal pressure to earn enough, but still, wages are extraordinarily high when taking a look at the wage average in India. nlClothes are produced in China, India, Bangladesh because it is cheaper and for the majority western consumers prefer their products to be cheap. Where is the difference to surrogacy? Or prostitution? In the end these are all markets which will continue in their existence and are likely to grow because of technological advancements. So policy makers are supposed to find ways to ensure the safety and well-being of egg donors and surrogacy mothers because black markets will only lead to more dangers and less security for any involved party. We should not complain too much about wage gaps but take concrete measures to fight the real problems of surrogacy – which for me are criminalization leading to fragile circumstances and the societal stigma surrogacy mothers are suffering from.

Andréas: I believe the difference in compensation is not justified. aaIn my opinion, although egg donors play a major role in the conception of the baby by giving him/her psychological and physical traits, surrogate mothers are the ones that connect all the dots. First, without them, it would be impossible to conduct surrogacy. They have a crucial and central role in this process. Second, they are exposed to considerable health risks (physical and emotional) and suffers major inconveniences for nine months. Finally, surrogates are only used for their reproductive services and reduced totheir womb only, which is particularly degrading. Therefore, I believe surrogate mothers should be more valued than they used to be and one should appreciate the amount of sacrifices they take to deliver a baby.

REFERENCES

Bindel, J. (2016). Outsourcing pregnancy: a visit to India’s surrogacy clinics. The Guardian. Retrieved from https://www.theguardian.com/global-development/2016/apr/01/outsourcing-pregnancy-india-surrogacy-clinics-julie-bindel

Cafeyak (2014). Surrogacy: the basics explained. Retrieved from http://cafeyak.com/index.php/baby/surrogacy/

Center for Human Reproduction (n.d.). Retrieved from https://www.centerforhumanreprod.com/egg-donation/donors/faqs

Conceptualoptions. What is Surrogacy. Retrieved from Youtube: http://timesofindia.indiatimes.com/india/Govt-introduces-Surrogacy-Regulation-Bill-2016-in-Lok-Sabha/articleshow/55547454.cms

Donor Egg Bank USA (n.d.). Egg Donors – Browse our egg donor registry online. Retrieved from https://donoreggbankusa.com/our-egg-donors/egg-donor-search

Dey, S. (2016, Nov. 21). The Indian Times. Govt introduces Surrogacy (Regulation) Bill, 2016 in Lok Sabha. Retrieved from http://timesofindia.indiatimes.com/india/Govt-introduces-Surrogacy-Regulation-Bill-2016-in-Lok-Sabha/articleshow/55547454.cms

Frank, Z. B. (2009). Google Baby. Retrieved from https://www.youtube.com/watch?v=pQGlAM0iWFM 

Haworth, A. (2007). Surrogate Mothers: Womb for Rent. Marie Claire. Retrieved from http://www.marieclaire.com/politics/news/a638/surrogate-mothers-india/

Information on Surrogacy (n.d.). Altruistic Surrogacy – Surrogacy Pregnancy for Free. Retrieved fromhttp://information-on-surrogacy.com/altruistic-surrogacy

Kroløkke, C. H., & Pant, S. (2012). „I only need her uterus“: Neo-liberal Discourses on Transnational Surrogacy, 0 (0),. p. 234-248.

Nestlé (n.d.). The Little inconveniences of Being Pregnant. Retrieved from http://www.nestle.com.au/nhw/nutrition-for-everyone/whenpregnant/thelittleinconveniencesofbeingpregnant.

Numbeo (n.d.). Cost of Living Comparison Between United States and India. Retrieved from https://www.numbeo.com/cost-of-living/compare_countries_result.jsp?country1=United+States&country2=India.

OECD (n.d.). Conversion rates – Purchasing power parities (PPP). Retrieved from https://data.oecd.org/conversion/purchasing-power-parities-ppp.htm

Rabinowitz, A. (2016). The trouble with renting a womb. The Guardian. Retrieved from   https://www.theguardian.com/lifeandstyle/2016/apr/28/paying-for-baby-trouble-with-renting-womb-india

Schurr, C. (2016). From biopolitics to bioeconomies: The ART of (re-)producing white futures in Mexico’s surrogacy market. Environment and Planning D: Society and Space, 0 (0),. p. 1-22. Retrieved from https://www.alexandria.unisg.ch/248107/1/Schurr2016_Epd.pdf

Twine, F. W. (2015). Outsourcing the Womb, p. 15. Retrieved from https://books.google.ch/books/about/Outsourcing_the_Womb.htmlid=_l80a5DueW4C&redir_esc=y

Unknown (2016). Surrogacy bill gets the Cabinet nod. The Hindu. Retrieved from http://www.thehindu.com/news/national/Surrogacy-bill-gets-the-Cabinet-nod/article14591267.ece

Unknown (n.d.) „Mother’s Market: An Explanatory Study on the Surrogacy Industry in India“. Retrieved from https://iussp.org/sites/default/files/event_call_for_papers/Mother.pdf

Wallerö, I. (2014). Commercialisation of the female body As wombs become a „stock-in-trade“ (Lund University, Centre for East and South-East Asian Studies, Lund, Sweden). Retrieved from      http://lup.lub.lu.se/luur/downloadfunc=downloadFile&recordOId=7764254&fileOId=7764269

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