It all started with a bit of miscalculated PR. Nicole Kidman and Keith Urban, upon expressing their gratitude to the woman who carried the newest addition to their family, Faith Margaret, made the mistake of calling the surrogate mother by her proper medical industry name: a "gestational carrier". The outcry in Australia was instantaneous; people thought that Nic and Keith's cold and detached description of the surrogate mother sounded... wrong. How could they be so insensitive as to describe the woman who'd housed their child for nine months as some kind of incubating machine? Surely she deserved more respect.
At first sight, surrogacy might look like a kind service, done almost as a favour by a surrogate to help the infertile (or homosexual) commissioning parents. Certainly, this is what is emphasised by those who defend the practice. The fact that some women (in the US, at least) are paid handsomely for this "favour" does not diminish their incredibly self-giving motive. Advocates try to woo us with tales of surrogates happy to go through gruelling pregnancies and ultimately give up the child for the sake of a couple's happiness. They rend our hearts with the suffering of infertile couples and their obsession with having children, which has made them ruthless in their quest, as if this obsession is proof that they actually deserve kids. They say critics of surrogacy are conservative or religious bigots who are afraid of the "unnaturalness" of assisted reproduction, for no real reason.
What they downplay are the cold, hard facts. Here's one -- stated eloquently by author Deborah Spar: "In the reproductive business -- which is a business -- you have this very strange denial of the commercial aspect of what people are doing. The truth of the matter is that there is commerce going on -- and it's pretty expensive and high-priced commerce".
This is made more obvious by another hard fact: the "gestational carrier" business is booming in India. While most countries except the US have banned commercial surrogacy, India legalised it in 2002. With next to no regulation and with the aid of cheap medical care and an abundance of poor women, the "baby business" has expanded in leaps and bounds. At one Delhi-based surrogacy clinic there are 100 babies due before September this year, with 120 clients enrolled. The clinic, which is only one out of approximately 300 in India, receives about 300 enquiries every year. To get a picture of how many dollars this translates into - we're talking up to US$445 million a year.
Who are the women carrying these foreign babies? Of course, there are the uneducated, often desperately poor women of the lower castes. According to Dr Anoop Gupta, who is in charge of Delhi-IVF, some middle-class women are also becoming surrogates to pay off their debts, buy a house and educate their kids.
In either group, however, the resounding theme among the women interviewed for one magazine feature is that, while they see that they can help infertile people, they do it for financial reasons. Mothers do it to pay for expensive medical care for their children, or for their daughters' dowries. Receiving approximately US$3000 to have a baby for a desperate stranger is more that they would make in years in a menial job -- say, crushing glass, which will only get you a mere US$25 a month.
The Indian Ministry of Women and Child Development itself said in February of last year, "In a country crippled by abject poverty, how will the government body guarantee that women will not agree to surrogacy just be able to eat two square meals a day?"
And what is wrong with it, really? The foreigner gets a child, and the struggling Indian surrogate mother gets a windfall for her family. Is this really exploitation? As a New York Times story observes, "In the clinic, it is clear that an exchange between rich and poor is under way."
But the idea that Indian surrogacy clinics are helping to redistribute wealth and balance the trade between rich and poor countries, while appearing to bring greater dignity to the lives of the poor and greater justice in the world, does just the opposite. It is one thing for an American or Australian to rent office space in Delhi or Mumbai and do business there; it is quite another thing to rent a woman's womb and turn it into a commercial space -- indeed, to turn the woman and her motherhood into the equivalent of a factory unit.
Even if she agrees. Financial desperation or aspirations explain but they do not excuse a woman's denial of her own dignity and the natural integrity of becoming a mother -- and those who tempt her into such denial seem even more to blame.
Some women even acknowledge the depersonalisation involved. A surrogate mother interviewed by an Australian newspaper said that she was "strictly a hotel". The very intimate and human nature of pregnancy and motherhood has profound psychological and physiological effects on a woman, and that forges the necessary bond between mother and child. But the surrogate mother has to deny that and is forced to look at the child as a commodity, just as the commissioning parents do. Another woman said, "I had to forget I was pregnant. There was not the same joy and wonderment. In some ways I felt sorry for this baby that it didn't receive the same attention [as my others]."
What will the long-term effect be on a child who is denied the formation of the psychological and physical maternal bonds (which are generally accepted as important for a child's well-being) in the womb because the woman carrying it is determined to "forget" she is pregnant?
According to international law, the child not only has rights but also interests, which ought to be paramount. No real attempt has been made in the public sphere to ascertain what these interests might be, much less how they might be protected. And the industry does not want to take any responsibility. This reality is eloquently expressed by Rudy Rupak, founder of Planet Hospital (a middle man company) who has said: "Our ethics are agnostic," he says. "How do you prevent a paedophile from having a baby? If they're a paedophile then I will leave that to the US government to decide, not me."
The truth is that once you deny the human dignity of the child by making him or her the object of manipulation and commercial dealing, not only their interests but even their basic human rights go out the window. They are dispensable and completely at the mercy of the commissioning parents' wishes and the clinics or the middle men (brokers and lawyers) in terms of the kind of parents they will get, or even if they will live or die.
This is clear in circumstances where more children than the commissioning parents wanted are imminent, which can happen when multiple embryos are implanted into more than 1 surrogate woman to improve the odds of successful pregnancy. One example involved a gay couple from Massachusetts, who planned on having two children: the deal involved implanting two sets of embryos into two surrogate mothers, each set of embryos fertilised by one of the men. Things did not go according to plan: both sets of embryos in both women were successfully implanted, leaving the couple to face the prospect of four children, rather than the two "on order". Ultimately, they decided to abort one of each of the twins, justifying it by calling it a "reduction" rather than an abortion. Their attitude clearly reflects the view that children are dispensable commodities -- if you don't get what you paid for, just get rid of it.
While these babies do not have voices, the outcry of adults determined to be parents at any cost are sounding loud and clear. No one has the "right" to have a child, no matter how much they might want one. But as long as these adults' interests (not "rights") are put before the child's rights, they will continue to create the demand that poor countries like India are only too ready to supply.
Where does that leave Australia's famous film star daughter and her husband? Ultimately, even if they were violating the basics of PR 101, they were not being crass when they called the surrogate mother a "gestational carrier". They were just calling a spade a spade. The woman was essentially a dispensable commodity, not because Nic and Keith called her one, but because the commercial transaction of surrogacy made her one. Yes, it makes us cringe. But it should. We're only human after all.
Audrey Echevarria is a Sydney lawyer.