Commercial surrogacy is a bitterly divisive topic on which we have published a number of articles . Bill Houghton's perspective is unique. He is the manager of a surrogacy agency for heterosexual and gay intended parents who has discovered that surrogacy in developing countries is exploitative and unethical. MercatorNet disagrees with surrogacy in principle, but has published this viewpoint in the interest of dialogue.
I have been a surrogacy agent for seven years, and I confess that gestational surrogacy is often unethical and exploitive. I have my own children via surrogacy, and I have brought dozens more into the world for childless couples. Nevertheless, I have often been ashamed at my own complicity in its exploitations.
Most of my time as an agent was narrowly focused on the intended parents and a quick and uncomplicated birth. I was willfully ignorant of the daily lives of surrogates themselves. Even as I paid lip service to their saintly role in the miracles I touted, I delegated their care and oversight to my "recruiter" who brought us profiles. I didn't ask many questions about where these women came from.
I fell into the "surrogacy business" the way most agents do… as a continuation of my own surrogacy journey and the birth of my children in India. That was 2012. I had done the appropriate due diligence on clinics and vendors in various countries. The Mumbai clinic we chose was modern and reliable, and when our second baby was born, the administrators asked if I was willing to recruit clients. I was not hard to convince - after our own journey, I received constant questions from distant friends and curious strangers. The clinic's offer seemed like a perfect way help other childless families, as well as my own.
I wasn't expecting to get rich, but it was a lucrative part-time job at home close to the babies. Plus, the process had not been difficult to manage. I didn't need specialized training or medical expertise to set up shop.
Looking back at my own journey, I cringe at the possible abuses that could have been happening while my husband and I were blissfully unaware.
I met my second surrogate only shortly after our son was born. She was a lovely woman, and although I did not see her during the delivery, we met afterward at the Consulate where she was to officially waive her parental rights. She was present when we arrived, with a long blue and gold sari – she looked like she had gotten dressed up for the occasion. She was accompanied by her husband, and they sat rigidly at one end of the waiting room. My husband and I sat on the other end with a several rows of folding chairs between us. She smiled at us, and I remember wondering if she was curious to see the baby. I held the baby snugly and was reluctant to introduce the two. I feared that such a beautiful baby as ours might incite her to renege on her promise to give us parental rights. How could anyone resist wanting to take this beautiful baby home!?
We finally met. I introduced our son, and she smiled adoringly (but not too adoringly) at our baby. We went into the Consulate separately, she first while we waited. We crossed paths when it was our turn to enter and swear testimony, again with an awkward but friendly smile. When we returned, she and her husband were both gone. Inside the office we were told that she signed the papers without delay and relinquished all her rights to us without question. I never saw her again.
We had paid her US$12,000 dollars for her year's effort. That's the equivalent of about $50,000 if she had been living in the United States. I don't know what her husband did for a living, or if he worked at all. But clearly that was a good salary for a year's work.
So far so good. We left India, two doting parents, terrified at the new lives we had just brought into the world. We tearfully promised that our children would want for nothing. Our love for them was so overwhelming, there was no room for anything else in our minds.
The problems came years later. Because surrogacy was unregulated in India, the baby still carried the name of the surrogate as the legal mother. To ensure my own parental rights, I had to adopt my son – in Spain, where my partner lives - and replace the surrogate's name on the birth certificate with my own. But our conservative Catholic judge in Spain refused my application to adopt my own child. His written decision made it clear that he believed surrogacy to be an affront to his faith. Our first child had sailed through his adoption process, but this judge spent years punishing us for our perceived sins. Within his court, my son was not my own (in a legal or moral sense), and the child's official name remained a hyphenation of my husband's and the Indian surrogate. I was excluded. My name was nowhere.
The struggle with the judge continued for six years. Finally, having been given no choice by higher courts, the judge relented– but with some strings. We were given one last herculean task to perform. The judge insisted on our surrogate's in-person sworn testimony, at the Spanish embassy in India, confirming she was still willing to waive her parental rights.
But when we reached out to her through the agency, she was nowhere to be found. Six years had changed a few things while we were not paying attention. Our agent checked the address and was told that she had moved. When asked about a forwarding address, we were told to go away. The husband answered the house phone, but when asked to speak with his wife, he refused to put her on the line. Repeated attempts to visit or call were met with hostility. Eventually we offered more money as an incentive, and the husband just hung up the phone.
The scenario played on for months. I was dumbfounded by the reaction… the couple had seemed so pleasant six years earlier. Now the wife had disappeared, and the husband became hostile and verbally abusive when questioned about her. In a last-ditch effort, we hired a detective to bypass the husband and find her directly.
As months wore on, it seemed clear… something dark had happened in the years since our babies were born. While our lives moved forward as happy parents, the lives of our surrogate's family had gone in a much different direction. What could have happened? Were they now separated? Divorced? Was she even still alive? Why was the husband so hostile whenever asked about her? He wouldn't give any clue where she was, and soon he began hanging up the phone when we called.
We wondered if our $12,000 payment had become a motive for a variety of imagined crimes. Was she all right? Had she been abused or worse because of the money? But mostly, I wondered if our own disregard had brought about some unanticipated harm? We loved her when she was carrying our baby. But once we were successfully out of India, our surrogate had disappeared from our thoughts. Now she had more literally just disappeared.
Now I would not claim that all surrogacy journeys are unethical. Unlike our judge, I don't believe conceiving families in-vitro is a sin. Nor do I think babies suffer when given to their intended mothers (or fathers) rather than birth mothers. True, these are hotly-debated topics, but in my opinion are overblown and not based on fact.
That said, India is in the process of banning surrogacy, and it's pretty clear why.
Even in a country the size of India, there is a limit to the number of moderately educated and informed women who can enter an informed consent agreement regarding surrogacy. When the pool of local surrogates begins to dwindle, agencies widen their search to more remote locales. In my case, my recruiter eventually trawled the rural farmlands where the local population had no exposure to terms like 'endometrial stimulation', 'invitro fertilization' or 'parental rights'.
In India, about 56 percent of adults living in urban areas have completed high school, according to UNESCO. But in rural areas that sad figure drops to just 36 percent. The figure is far worse for women than men. A separate study by Desingu Setty& Lamar Ross "A Case Study in Applied Education in Rural India" revealed that women were only about half as likely to receive a high school education as men. And even among those with high a school education, only a fraction were actually able to read at even a primary school level.
Statistics are similar in other developing countries where surrogacy has become a hotspot. For example, rural adults in Mexico are 40 percent likely to have a high school education. In Kenya, only 29 percent of rural adults have a high school education (and again, fewer women than men).
Several studies have shown that a lower level of literacy rates among women results in higher fertility levels (not so bad if you're looking to hire women to carry babies) but also higher infant mortality and malnutrition. The same studies suggest that illiteracy prevents women from being able to make sound household decisions.Women's lower educational levels adversely affect the health and living conditions of children.
Clearly women making up the bulk of surrogate candidates are not only lacking the ability to give informed consent regarding their own health, but they are also less likely to be able to care for themselves and the unborn babies they are asked to carry.
As surrogacy has become more popularized in the media, special interest groups have battled over ethical concerns about the practice.
Feminists argue a surrogate pregnancy is forced upon poor women because of their economic disadvantages. I confess that's true in developing countries where intended parents are far more common than informed and educated surrogate candidates.
I don't support surrogacy programs in developing countries anymore.
My company publishes the Sensible Surrogacy Guide , which includes a ranking of popular surrogacy destinations worldwide. India is flagged with a strong warning. So are other popular destinations: Kenya, Cambodia. Laos, Guatemala. We post advisories for countries such as Georgia or Mexico. We also publish what I consider to be a manifesto of sorts on the ethical approach to surrogacy .
First and foremost, we believe that potential surrogate mothers are entitled to independent medical and legal counseling. Not only should they understand what's being asked of them, but they should have complete autonomy in their decisions. To protect the poorest women from financial coercion, would-be surrogates from the lowest financial rungs should be removed from consideration.
But even my professional recommendations fall short of what I hope intended parents would accept as their personal obligation. At their best, surrogacy programs create families. But the obligation goes beyond just introducing a baby to a childless couple. Surrogacy creates extended families by introducing the surrogate as a sort of ad-hoc family member. Parents should accept the permanent relationship created through the surrogacy agreement.
I wish I had established that ongoing connection between my own extended family and followed through on my pledge to support and care for the woman who brought my son into the world.
Seven years ago, I met a wonderfully kind woman, and she carried our son for us. She was happy to do it, and we were grateful for her generosity. There was nothing exploitive about that arrangement. I remember that first meeting; she was joyful and appreciative.
If there was exploitation, it must have occurred sometime after the baby was born. And as much as I would like to blame the agent who recruited and compensated her, they fulfilled their role exactly as promised. I wish I could be confident that I did the same.