The Bioethical Debate Around Surrogacy

Updated: Sep 23



Visual by Akruthi Akula


Surrogacy is often understood to be the work of God by being the ‘treatment’ for the infertile or an alternative to adoption, and so helps fulfilling people’s desires to be parents. It enables people with reproductive issues, serious medical problems and other contraindications for pregnancy, to achieve parenthood through the implantation of autologous or donor-derived embryos in the uterus of a medically screened gestational carrier. However, surrogacy involves a lot of complex ethical issues around gender and cross-cutting gender, caste, class, labour, payment, exploitation and inequality. It can safely be considered to be a boon to humanity made possible by the advancements in medical sciences. On account of the gigantic medical and living expenses that are demanded by the procedure, the children born with the assistance of surrogacy typically go to households that strongly desire children and make sure to provide their best to them. Nevertheless, surrogacy has been identified to involve a number of risks at multiple levels.

There have been recorded deaths of surrogate mothers/carriers worldwide. As a consequence of the high medical and financial cost involved in surrogacy and the desperation to boost success rates, multiple embryos are often transferred into the carrier which leads to further complications for both the surrogate carrier and the babies, (source: What If the Surrogate Mother Dies ? : Sonali Kusum, Healthworld, Economic Times)

Children born through surrogacy are much more likely to suffer from low birth weights. Additionally, a study conducted in 2014 (source: The Journal of Perinatology) found a 4-5 fold increase in stillbirths from pregnancies through artificial reproductive technologies. Nearly always, the ones desiring to be parents cover medical, living and travel expenses of the surrogate mother but whether or not this gestational process should happen in return of money is tricky. “Commercial Surrogacy” is a matter of debate because providing financial security to another woman for taking the pains of bearing and birthing their child seems valid until this practice turns into a dehumanising- offspring-producing-industry, which in ample number of cases, it has. Moreover, Surrogacy often depends on the exploitation of low income and poor women. These unequal transactions result in “uninformed consent”, coercion, low payments, poor health care, and severe risks to the short- and long-term health of women. As the European parliament stated in a 2011 resolution, surrogacy is “an exploitation of the female body and her reproductive organs’’. International Institutions like The Center for Bioethics and Culture (CBC) argue that Commercial Surrogacy could not be distinguished from the sale of children and that it places children at significant risk of harm, while encouraging commodification of women’s bodies, endangering the personhood of both the baby and gestational mother involved in the procedure. The Assisted Reproductive Technology (ART) is estimated to be a multi-billion dollar industry in the United States alone. A review of most agency websites reveals a dehumanizing approach where patients are referred to as “clients’’ and surrogate pregnancy arrangements referred to as “sales”, somewhat on the lines of the “Medical Gaze” that Michel Foucault blatantly criticises as the Doctor’s dehumanising approach towards his patients where they only look at the latter as a set of organs and their job only as a means to earn capital and popularity.

What is alarming is how the surrogacy industry of the developed countries reinforce socio-economics differences by targeting and exploiting the women of the lower income groups from developing countries. Let us focus on the Indian context.

Commercial Surrogacy was legalised in India in the year 2002, to promote medical tourism, which made India the hub of surrogacy. Unregulated business and flimsy laws led to unethical practices. Middlemen and commercial agencies sprouted, leading to the exploitation of surrogate mothers. Abandonment of children, especially with disabilities is distressfully common. There’s also always a propensity for either or/and both the child and the parents, or maybe one of the parents to not feel biologically attached to the child, which causes trauma to the child and hinders their holistic mental and emotional growth. It has been noted that the women who end up being a part of this procedure are mostly unaware of the risks involved and the scope and limitation of their rights. Since the marginialised people of all communities happen to always be hit the hardest, young women from the Dalit Bahujan Community in India have been statistically recorded as “hired” the most as surrogate carriers.By its inherent nature, surrogacy is an expensive and inaccessible practice, hence is only serves to people who could afford it. Practically, it is not within the capacity of all childless couples to actualise it for themselves, which is why its practice leads to further divides. How a handful of affluent people like the celebrities can voluntarily choose not to bear their children by themselves and simply outsource it in exchange of money. Meanwhile, many individuals and couples fail at becoming parents due to biological, medical and financial restrictions which doesn’t make it look like a fair deal in the bigger socio-economic picture. Moreover, going out of their way to produce an offspring of the “same blood” as that of the couple further reinforces race, caste and colour exclusivities.

Same sex couples often opt for surrogacy to have a child that they and their partner can genetically relate with, since becoming parents through the traditional means like the heterosexual couples is not possible for them. In this case, their desire to have that child is understandable because it roots from a more complex idea of identity, the conception of which can be traced down to their own struggles to exist and establish themselves as a couple in society (source: Circle Surrogacy). Yet, adopting and providing a home and family to an abandoned child is always a more ethical option, serving greater good to a larger number of people when seen from a humanitarian, feminist and Bioethical perspective.


 

References

  1. Media/cultural studies : critical approaches-Rhonda Hammer, Douglas M Kellner

  2. “Bioethical issues and legal frameworks of surrogacy: A global perspective about the right to health and dignity”- Vol 258, March 21, Science Direct,

  3. “The impact of the war against Ukraine on women European Parliament resolution of 5 May 2022 on the impact of the war against Ukraine on women” (2022/2633(RSP)) European parliament Resolutions, 2011

  4. Surrogacy in India and it’s Legal Aspects”- Manali Singh, Penacclainms Journal, Volume 10, May 2020

  5. The Birth of the Clinic- Michel Foucault.



Prerna Sinha is a Major in Philosophy from Miranda House, Delhi University and currently pursuing her Masters at the Department of Philosophy, Delhi University. Her areas of interest are Ethics, Aesthetics, Phenomenology, Existentialism, Feminist and Socio-Political Philosophy and aspires to further study them in a South Asian/Indian context.


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