“Fair Trade Surrogacy.” That’s what sociologist Amrita Pande told me was needed when we spoke about her new book, Wombs in Labor: Transnational Surrogacy in India, recently released by Columbia University Press.
After reading her book, I interviewed Pande, now a lecturer at the University of Cape Town, South Africa, via Skype and discussed her view of pregnancy as work in the growing billion-dollar-a-year industry of paid surrogacy in India.
In her book, Pande recalls reading a 2006 newspaper article in The Guardian that covered “India’s new form of outsourcing.” The article described how couples from all over the world were coming to India to hire surrogates to bear their children—and paying a fraction of what it would have cost in their home countries. At that time, Pande was a recent immigrant studying in the United States. She was deeply troubled by thoughts of her native India becoming filled with not only slum dogs and call centers, but exploitative baby farms as well. Pande describes herself as “haunted” by these “chilling visions.”
Her new awareness of a growing baby market—and her discovery that there has been little serious research on this industry—launched her into a five-year study on surrogacy in India. Her research culminated in Wombs in Labor. This important book contributes greatly to a much-needed international conversation about surrogacy. However, the author’s conclusion—that surrogacy should not be banned but merely regulated—leaves room for troubling human-rights abuses.
The Work of Pregnancy
Pande begins her book by challenging common perceptions and media distortions around the Indian surrogacy market. She suggests that it is much more complex than a simple clash between the needs of women from two different classes: the affluent in India and abroad who buy, and the poor women in need of money who are forced to sell or rent their wombs. She insists that we not bury this debate in terms of motherhood and reproduction, but instead consider the practice through the lens of work that crosses production and reproduction constructs.
Pande’s research depends heavily on the many interviews she conducted and on the data gathered on her trips to meet various stakeholders in this emerging market. Over a five-year period, Pande made three trips to India (in 2006, 2007, and 2011). She visited surrogacy clinics and interviewed surrogates, their husbands, and their in-laws. She also spoke to intended parents, doctors, nurses, surrogacy brokers, and hostel matrons, who run the housing where surrogates stay during their pregnancies.
What she expected to see when she arrived in India were reproductive brothels—quite literally baby-farms—that needed to be shut down. However, once there, she was surprised not to find baby factories. Instead, she began to interview these women and noticed how much this enterprise resembled work to her.
As she explained to me in our conversation, pregnancy is a “hell of a lot of work,” and being pregnant is labor. She compared their experiences to her research on factory workers and laborers in Bangladesh, realizing that these women were also being trained to be disciplined workers. The women organized together to share their grievances with the agencies, to demand changes in the surrogacy market, and to have a say in the negotiation of compensation and payment.
What stands out strongly in her book are the voices and the stories of the surrogate women. Overwhelmingly, these women are of a very low educational background. At one typical clinic, she found that six of the women were illiterate, seven had only a primary-school education, sixteen had attended middle school, twelve had received high-school level education, and only one had graduated from college. She readily admits the irony of the situation: these financially destitute women (who may or may not be coerced into this practice) normally have little to no access to proper medical care. Yet, during their surrogate pregnancies, they become “hyper-medicalized,” receiving disproportionate numbers of medical interventions and surgical procedures. In her 2007 data from Armaan Maternity clinic, in a city Pande calls Garv (she uses pseudonyms), Pande records the number of women who successfully delivered their own children vaginally but who were required to deliver surrogate pregnancies by Cesarean section. Thirty-seven out of thirty-eight surrogate deliveries were by Cesarean section. Pande writes, “A vaginal birth not only meant fewer medical interventions but also increased the possibility that they could become surrogates again. These negotiations can be seen as labor-management strategies, used by the women in seeking to protect their own interests, although their definitions of 'interests' often vary. Simultaneously, these victories give the women the feeling of being in control: of their bodies and their lives.”
Do Women Freely Choose Surrogacy?
As she unpacks the tricky concept of “choice,” Pande writes about three categories of women. First are the women who became surrogates by their own choice. Second are the women who are recruited by surrogacy brokers. Third and last are those women “convinced” by their husbands or in-laws to serve as surrogates.
Pande documents the stories of these women in order to connect their surrogate pregnancies with their educational and work experience. Did they feel pressured by family to enter into a surrogacy arrangement? Did they keep their decision a secret? These connections are part of the complexities of why women choose to be surrogates and how their experiences as surrogates are shaped. Pande concludes, “whether nudged into surrogacy by their families, nurses, or brokers, or of their own accord, all the women I met at Garv clinic were motivated by the sheer need for money.”
What most surprised me is Pande’s description of the women who entered into paid surrogacy, motivated by the belief that their financial circumstances would dramatically change for the better. Ultimately, they did not. Here’s one woman’s story:
Savita planned to quit the low-paying, backbreaking job at the clinic and use the money earned through surrogacy to live comfortably. She was confident that the money would change her life. A year after the delivery I bumped into her while she was sweeping the clinic courtyard. She revealed that there has been no improvement in her living standard and she continues to be a cleaning lady at the clinic: “I get paid such little money at this clinic that I had to use part of the money for daily purchases. I couldn’t save anything. A lot of it went for my husband’s treatment (medical expenses). Then my granddaughter fell sick with tuberculosis and though I spent a lot in her treatment we couldn’t save her. I did not ever want this, but now my daughter is also trying to become a surrogate.”
Over the course of her research, Pande shifted her position that the practice of surrogacy needs to be prohibited, and came to view surrogacy as ethical work that needs regulation in order not to exploit the women (workers) and babies. She believes surrogate mothers must be given the right to organize in labor unions, negotiate with the intended parents what, if any, contact or visitation they may have with the children after the birth, whether they can refuse Cesarean-section deliveries when medically possible, and even whether they can be listed on birth certificates if mutually agreed upon in advance.
How Should We Protect Women?
In Pande’s view, surrogate women must be part of the dialogue as they grapple with the stigma of being seen as “disposable and dirty workers” rather than respectable workers and mothers. In fact, in our conversation she told me that banning surrogacy (which I support) is counterproductive, hurts the workers, and only shifts the market to other countries. Pande thinks the long-range solution is to relax surrogacy regulation in other countries so that people don’t need to leave their home countries to find surrogate mothers. She proposes in her book “an international model of surrogacy founded on openness and transparency on three fronts: in the structure of payments, in the medical process, and in the relationships forged within surrogacy.” Her proposed solution to prevent exploitation of women is again reinforced by her belief that surrogacy is work and that the workers should be able to negotiate payments, their medical care and treatment, and be involved in decisions around their role with the intended parents and the children they will bear them.
In a time when the debate surrounding surrogacy is not whether we should allow it but how it will be practiced, Wombs in Labor is an important contribution. I favor a global ban on the practice, so hearing from voices such as Pande’s and engaging with them in the conversation is vitally important. Still, even after reading her book and speaking with her in person, I was left wondering how women can freely choose surrogacy. I am not persuaded that surrogacy is a job like any other or that it needs to be regulated through labor laws. Reading Wombs for Labor, I found myself wondering: given its inherent risk of exploitation, how could such a practice ever be redeemed through government regulation?
Pregnancy is not simply a job, like filing papers or working retail. It should not be turned into a global financial enterprise. Surrogacy undermines the dignity of women and of the children produced by these means of procreation. Surrogacy demands that mother and child not bond, a very important part of human reproduction that safeguards the physical and psychological well-being of both mother and child. When motherhood becomes a mere avenue to a paycheck, both the woman and the child she carries are wronged; commodifying them is incompatible with their dignity as human beings.
Jennifer Lahl is the Founder and President of the Center for Bioethics and Culture and producer of the documentary films, Eggsploitation, Anonymous Father’s Day, and Breeders: A Subclass of Women? Her latest film, Maggie’s Story, tells of a ten-time egg donor and her battle with stage-four cancer.