TOPIC GUIDE: Fertility Tourism
"Commercial surrogacy in poorer countries is exploitative"
PUBLISHED: 01 Jan 2014
AUTHOR: Dolan Cummings
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It is estimated that 9% of couples worldwide are infertile [Ref: Human Reproduction]. Although it remains difficult, women unable to conceive naturally, or who are past their reproductive prime, are still able to have a child. To do so, many seek high-tech, low cost help from developing countries like India or relatively poor Eastern European countries like Russia or Hungary. Long waiting times related to a shortage of eggs and sperm in the UK and elsewhere, the lack of donor anonymity, over-regulation [Ref: Mother Jones], high costs and poor experiences of treatment are cited as reasons for going abroad for help [Ref: Scotsman]. In India, which leads the world in fertility tourism, ‘commissioning couples’ can expect high-quality care, cost effective treatment, a high success rate and few legal hurdles. Donor eggs, sperm, and embryos are available, and women can become pregnant through IVF or can hire a surrogate - a woman who bears a child, genetically unrelated to herself whom she will give up on delivery. But while demand for such services keeps growing, so too do the legal, moral and ethical concerns related to its practice. Dubbed the ‘wild, wild west of medicine’ by bioethicist Arthur Caplan, many argue that the unregulated, global nature of commercial surrogacy and egg and sperm donation is highly vulnerable to exploitative practices. In India the Assisted Reproductive Technologies (Regulation) Bill - 2010, is just the latest attempt to regulate fertility services that some fear are spinning out of control [Ref: PRS]. Should we celebrate the material and emotional gains brought about by fertility tourism, for surrogates, donors and commissioning parents alike? Or do we need to be more circumspect about the thriving ‘rent-a-womb’ market and the ‘outsourcing of pregnancy’? There are growing calls for regulation, with particular concerns that current arrangements may unfairly exploit surrogate mothers [Ref: Reuters].
DEBATE IN CONTEXT
This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.
What’s on offer?
Egg donation and surrogacy remain the most controversial and talked about practices within the fertility tourism debate, both because of the potential health risks posed to the donor and surrogate, and because of the moral ambivalence involved. Both involve highly technical and complicated clinical procedures: egg donation is the process by which a woman provides one or several eggs for the purpose of assisted reproduction. Donors are injected with a follicle-stimulating hormone, which increases ovarian activity, producing more eggs than during a normal cycle - often between 10 and 15. Surrogacy refers to the process in which a woman carries the baby in her womb ‘for’ another couple. Through in vitro fertilisation (IVF), an embryo created from the sperm or egg of donors or from the couple wanting a baby is implanted in the surrogate’s womb. In India, surrogate’s own eggs are not used, to ensure there is no biological link between her and the baby. Rules stipulate that a surrogate must already have a child of her own to minimise the potential negative emotional consequences of giving up the baby at birth.
A win-win situation?
Surrogacy affords many infertile, often desperate, couples the possibility of having a child [Ref: Medindia]. For many couples in the West, the procedure is forbiddingly expensive, affordable only to professionals like doctors and lawyers [Ref: New York Times]. Moreover, in most other countries legal issues and red tape deter couples from availing of surrogacy [Ref: Wall Street Journal]. Commercial surrogacy can be seen as having benefits for both parties. For the surrogates, choosing to carry a child [Ref: Cubically Challenged] for contracting couples is an opportunity for financial empowerment [Ref: Rediff India], enabling them to secure a ‘better life’ for themselves and their families [Ref: India Today]. Others point to an altruistic dimension: in a country where childbirth is almost sacred, Indian surrogates may feel happy to help infertile couples [Ref: Medindia]. While there are always health risks involved in fertility treatment, pregnancy and childbirth, India has highly trained doctors and sound medical facilities that provide good healthcare for both the surrogate and the baby [Ref: Today]. Some worry that surrogates may suffer psychological damage after giving up the baby, but most women receive counselling to help them cope with the situation. Also, most clinics stipulate that surrogates already have children of their own so they will be aware of the physical and emotional tolls of pregnancy.
Dehumanising and exploitative?
Commercial surrogacy is big business. Legalised in India in 2002, it is now a $2 billion-a-year industry, with an estimated 1,000 clinics. Indeed, many of these clinics advertise ‘healthy young women – superovulated exclusively for you’ [Ref: Guardian]. Critics argue that placing a profit motive at the heart of fertility treatments can be dangerous, however, pointing to the risks posed to egg donors and surrogates inherent in IVF fertilisation, such as ovarian hyper-stimulation. The growing number of Western couples seeking donors and surrogates in India has prompted many to view this as the exploitation of women [Ref: MightyLaws.in] based on reproductive health inequalities [Ref: Expert Reviews]. The charge of exploitation finds the use of bodies or the ‘renting of wombs’ of poor women in developing countries in exchange for money disconcerting and dehumanising [Ref: Nature]. Terms such as ‘outsourced pregnancy’ suggest the practice of egg donation and commercial surrogacy is akin to other outsourced business operation exploiting cheap labour in countries like India [Ref: Slate]. In commercial surrogacy, it is argued, women are viewed primarily as an instrument of childbearing, and their wombs treated as commodities; all of which has implications for how society views women, and the emotional relationship between mother and child. The discussion has also become inextricable from concerns about poverty, with many questioning whether poor women, sometimes in financially desperate situations, really do have a choice [Ref: Dr. Malpani’s Blog]. Others have also expressed concern that women may be coerced by their husbands or in-laws into becoming surrogates, and many argue that uneducated poor women are forced into surrogacy by middlemen, some of whom have been accused of cheating the surrogates out of their compensation [Ref: wscpedia.org]. Others, however, make the point that poor women are still capable of making choices [Ref: Stanford University]. They argue that commercial surrogacy should be viewed as a welcome and effective means of assisting infertile couples, whilst at the same time providing reasonable financial compensation to those women prepared to help them.
It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.
Mamata Nanda Huffington Post 3 October 2013
Dr. Raywat Deonandan Huffington Post 29 October 2012
Tamara Audi and Arlene Chang Wall Street Journal 10 December 2010
Amana Fontanella-Khan Slate 23 August 2010
Sarah Boseley Guardian 30 June 2009
Amindita Majumdar Daily Mail India 15 July 2013
University of Huddersfield 17 January 2013
Kamayani B Mahabal Tehelka 8 June 2011
Jennifer Lahl The Centre for Bioethics and Culture Network 20 January 2011
Kendal Youngblood Culture Wars 27 June 2013
Global IVF 25 May 2013
Mina Chang Harvard International Review 6 July 2009
Uday Mahurkar India Today 13 September 2007
Hemlata Aithan Oman Tribune
Olga van den Akker Expert Reviews 2010
Raekha Prasad Guardian 30 July 2008
Amelia Gentleman New York Times 4 March 2008
Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.
Useful websites and materials that provide a good starting point for research.
HM Government 19 June 2013
Cherrill Hicks Telegraph 10 February 2013
Prachi Bharadwaj MightyLaws.in 1 May 2011
BioNews 14 March 2011
Paul Troop Practical Ethics 20 January 2011
Gina Maranto Biopolitical Times 6 December 2010
Nature 26 July 2010
Scott Carney Mother Jones March 2010
Naomi Canton Hindustan Times 9 December 2009
Mike Celizic Today 20 February 2008
Cubically Challenged 2008
Stanford University 2008
PRS India 2008
Sheela Bhatt Rediff India 1 November 2007
Abigail Haworth Marie Claire 29 July 2007
Jacky Boivin, Laura Bunting, John A. Collins and Karl G. Nygren Oxford Journals 2 January 2007
Dr Alka Sehgal wscpedia.org
Links to organisations, campaign groups and official bodies who are referenced within the Topic Guide or which will be of use in providing additional research information.
IN THE NEWS
Relevant recent news stories from a variety of sources, which ensure students have an up to date awareness of the state of the debate.
Independent 13 January 2014
Reuters 30 September 2013
Hindu 16 July 2013
Daily Mail 16 July 2013
Global Post 10 June 2013
Indian Express 28 May 2013
NDTV 25 February 2013
Times of India 21 January 2013
Telegraph 18 January 2013
Scotsman 30 June 2011
India Today 25 April 2011
Times of India 27 January 2011
Russia Today 13 December 2010
New Zealand Herald 14 September 2010
Daily News Analysis 14 May 2010
Telegraph India 13 December 2009
Dr.Malpani's Blog 28 September 2009
Medindia 1 January 2008
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