Wombs for Rent: Outsourcing Birth

By Anastacia Mott Austin

Couples who have tried for years to have a baby unsuccessfully become increasingly desperate to achieve their dream of having a family.

Sometimes the medical costs of infertility can skyrocket, with in vitro reaching $40,000 or more for a three-cycle round of treatment.

Adoption fees can be expensive also, and the process can take a lot of time, something couples who have been waiting years already don’t want to have to go through.

Many infertile couples are increasingly turning to surrogacy, in which a healthy woman carries the couple’s baby to term, then gives it to them after the birth. There are problems here as well, however. In the United States, the parental rights of a surrogate mother are not terminated until she signs the baby over at birth. If the donor’s genetic material, her eggs, have been used to create the pregnancy, then the issue becomes even murkier, as she is then both the gestational and the biological mother of the child.

Surrogacy is not cheap. One source reports that combined medical expenses and a surrogacy fee can reach upwards of $80,000.

What’s the solution for infertile couples without the resources for these options? One increasing workplace trend has transferred to the infertility community: outsourcing.

Poor women in countries like India are eagerly signing up to become surrogates for couples in other areas of the world, saying that the fees they are paid will help emancipate them and their families.

They often live in communal housing, sometimes attached to the clinic where they receive medical services, because the social stigma of being pregnant with a child not their own makes it difficult for them to live at home.

Marie Claire magazine followed one such clinic in Anand, India, where several women live together while awaiting the births of other people’s babies.

The leader of the clinic, Dr. Nayna Patel, defends her clinic and its practices. "There is this one woman who desperately needs a baby and cannot have her own child without the help of a surrogate," says Patel to reporters. "And at the other end there is this woman who badly wants to help her family. This female wants to help the other one ... why not allow that?"

Many of the surrogates tell the reporters that they will use the money they receive, usually from $6,000-$10,000 (about a fifth of what the same services would cost in the United States), to buy a home for their own families, or use it for their children’s education. The money is equivalent to what a woman could earn working a typical job in India for 15 years.

The financially strapped hopeful parents see this as a way to have a baby without the prohibitive cost, and they like to feel that they are helping support another woman’s family half a world away.

Many other countries have outright banned surrogacy, with some outlawing any kind of assistive reproductive technology. France’s Supreme Court ruled in 1991 that "The human body is not lent out, is not rented out, is not sold," and many other countries agree.

India, however, has not outlawed the practice, and the country has become a veritable surrogate for the rest of the world, becoming a multi-million dollar industry.

So what’s wrong with it, you may ask? An infertile couple doesn’t have to pay exorbitant medical costs, and a woman in India gets a better life.

Some questions come to mind. The surrogates profiled in the Marie Claire story live in luxury at the clinic compared to their normal lives. They get room, board, full medical care and careful monitoring. One of the women there told reporters, "I’m being more careful now than I was with my own pregnancy."

I think that’s one of the questions to ask. Why wasn’t this kind of special care available to her during her pregnancies with her own children?

Why does she live in conditions where $50 a month is a living wage? We can’t necessarily fix all of the world’s evils, nor blame them on outsourcing pregnancy, but before we blindly agree that this is helping everyone, we should definitely be asking some questions.

What about the woman who told an interviewer that she was planning to use her fees to pay for her daughters’ future dowry? While dowry has been outlawed for years, many Indian families bankrupt themselves to follow this ancient practice.

What about women who aren’t going to be able to keep any of the money, whose husbands or fathers control their finances? Dr. Patel insists that there are careful procedures in place to ensure that each surrogate can have control and access to her own money. Who is to monitor that once the woman has surrendered the baby and returned to her normal life?

What if a surrogate has complications during the pregnancy, or the birth? India has one of the world’s highest maternal death rates. What happens to a woman’s family if she dies giving birth to someone else’s child? What if all clinics who provide this service are not as careful as Dr. Patel, and the women involved do not receive optimal prenatal care?

What if the baby has a birth defect and the parents don’t want to accept it? Where does it go?

Perhaps most pressing--what does the practice say about the worth of a woman’s body? If she rents out her womb for money ("They provide a needed service and they receive money which helps them," claims one doctor), what draws the line between this practice and say, prostitution?

What does this say about a world in which the only real resource a woman in a third world country has for bettering her life and those of her children is her capacity to reproduce?

I don’t have the answers. I can’t say that this does not better the lives of the surrogates, or that the couples involved are abusing their services. But the idea makes me uneasy, both for what it says about our world and the condition of the women in it, and for the possible ramifications in the future.