Frances Woolley: Surrogate motherhood, the case for commodification
fullcomment.nationalpost.com/2011/02/18/frances-woolley-surrogate-motherhood-the-case-for-commodification/
Nicole Kidman and Keith Urban have one. So do Elton John and David Furnish, and that woman in the New York Times.
They all have children borne by surrogate mothers.
In Canada, as in the UK, Australia, France and several other countries, it is illegal to pay surrogate mothers for anything more than their expenses — food, living costs, forgone wages, and so on.
Canada’s ban was prompted by the recommendations of the 1993 Royal Commission on New Reproductive Technologies, which emphasized the potential harms of commercialization (p. 676):
Those who hold that commercial preconception arrangements should be prohibited believe that they are inherently exploitive; that they treat children as commodities; that they are dehumanizing and degrading to women and their reproductive capacity; that they are harmful to the participants and to children born as a result of these arrangements; that they foster harmful social attitudes about the role and value of women, children, and families; and that they reinforce and perpetuate sexual inequality in our society . They also point out that such arrangements have significant implications for the gestational woman,…
There is good reason to be concerned about exploitation. Surrogate mothers typically have fewer resources than the commissioning or intended parents. In India one study reports that ”women are typically pressured into the socially unacceptable job of surrogacy by their economic conditions, and sometimes, by their own families desperate for income.” In the US the typical surrogate is white, Christian, married, from a modest (but not poor) working-class background, with children of her own. Commissioning parents are, by definition, those able to pay tens or hundreds of thousands of dollars for a child.
If surrogacy was something that we could ban – like, say, the mining and export of asbestos – there are reasons to do so: the potential for exploitation, and the risk of psychological or physical harm to one or more of the participants.
But the practice of surrogacy dates back to biblical times:
And Sarai Abram’s wife took Hagar the Egyptian, her handmaid, after Abram had dwelt ten years in the land of Canaan, and gave her to Abram her husband to be his wife.
(Even back then, the arrangements didn’t always work out.) Anything as easy to arrange and difficult to detect as traditional surrogacy, that is, fertilization using donor sperm and the surrogate’s egg, is hard to ban.
Moreover, now that there is an established international surrogacy industry, anything less than a coordinated global ban on surrogacy will be ineffective or counter-productive. The current bans on payments in the UK, Canada, and elsewhere, to the extent that they make it harder for would-be parents to find local surrogates, increase the likelihood that such parents will seek out surrogacy services in India or other countries where protections for women are weak.
Also, there are real benefits to surrogacy arrangements, and people who are genuinely happy to be surrogates – if one of my sisters had needed me, I would have volunteered gladly. The joy that surrogacy arrangements can bring to so many people argues against a blanket ban.
Surrogacy is here to stay. The question is: to pay or not to pay?
Adverse selection is a good reason not to pay for donations of blood or sperm. The story of donor 150 (see this movie trailer) is a case in point. Donor 150 was six foot tall, good looking, a musician, a dancer and a philosophy major. His sperm was so popular -- and his other sources of income so meagre -- that he donated about 500 times. What donor 150 did not disclose - simply because he was never asked - was a family history of alcoholism and mental health issues. It's the classic adverse selection problem: if you pay for sperm donation, you'll end up with donors who donate for the money. And that may not be the kind of sperm donor you want.
Yet there are far fewer reasons to believe that adverse selection is a problem for surrogacy. Payments to surrogate mothers in the US are around $22,500 to $25,000. Going through hormonal and in vitro fertilization treatments, carrying a baby or two for nine months (in vitro fertilization raises the risk of twins), and giving birth is a pretty tough way of earning $25,000. That alone makes adverse selection problems relatively unlikely. Moreover, monitoring of surrogates through nine months of pregnancy reduces the problems of adverse selection further.
Indeed, being a surrogate is so demanding that non-payment could lead to adverse selection problems, that is, you'd have to be crazy to do it for free.
While writing this post I came across the blog of someone I'll call Jasmine (I've chosen not to include a link). Jasmine is 19 years old. She is now in the second trimester of her surrogate pregnancy, and she already has two children of her own. By my reckoning, she became pregnant as a surrogate when her youngest was five months old. She chose to become a surrogate in part because she had close family members who had trouble conceiving, and in part because, after experiencing childbirth, she knew that she was capable of giving up her own child. She describes the birth of her firstborn as being like a movie or a television show, like watching someone else's baby being born. Jasmine makes no mention of payment in her blog, and since she lives in Canada, it is entirely possible that she is an altruistic surrogate.
Others choose to volunteer for surrogacy for quasi-religious reasons. The Surrogacy in Canada On-line website suggests that women volunteer for altruistic surrogacy because they 'feel they have a "calling" to carry a child for someone else.' The same sentiments are echoed by one Christian surrogate mother-blogger who feels that being a surrogate is like being called to preach, an act ordained by God (again, I have chosen not to link).
Then there is the rarely discussed side of new reproductive technology: eugenics. For example, a recent article on a Ukrainian surrogacy website announces Australian Ethicist Stands Up For A Smarter Society Via Genetic Embryo Screening. This thoughtful critique of surrogacy emphasizes the racial politics of reproductive technologies: "the high-tech frenzy to conceive has been whipped up by alarm over the falling birthrate of white career women." (emphasis added). Scary stuff. I would be happier knowing that someone was choosing to become a surrogate just for the money!
Many people appear to be of sound mind and body when they choose altruistic surrogacy, like this sister and this grandmother. But certainly there are reasons to doubt that relying on altruism completely solves adverse selection concerns.
Another good reason not to pay surrogates would be evidence that altruistic surrogacy is psychologically or physically better for the woman involved. There is remarkably little known about the psychological impacts of surrogacy, but it is not hard to find illustrations of the risks surrogates face.
The most recent post by Jasmine, the 19-year old surro-mom introduced earlier, is a case in point. Jasmine is pregnant with twins, and has just been diagnosed with pregnancy-induced hyperthyroidism. With her two young children, she is overwhelmed by household chores. She and her partner are thinking about separating. She is still sympathetic towards infertile couples who don't have a lot of money, but her idealism has faded. Next time, she will be making sure that SHE gets something out of it.
The psychological risks of surrogacy are as serious as the physical ones. One good reason for banning payment would be that altruism is psychologically protective. Although data on surrogate mothers is relatively scarce, one study I found reached the exact opposite conclusion. Payment helped protect women from forming a strong attachment to the baby. In the words of a surrogate interviewed during the research: "I feel the surrogate needs to have that to latch onto emotionally. I am doing the job, I am being paid to do a job, to keep the emotions a little bit at bay."
Advocates of altruistic surrogacy can point to an alternative strategy for psychological protection: the surrogate mother bonds with the intended parents and the new family she helps to create. Yet this ignores the psychological needs of the intended mother. Whether she feels jealous or threatened or guilty or just uncomfortable crossing the socio-economic gulf that separates her from the surrogate, it is more than likely that, as in this story, the intended mother will wish to distance herself from other mothers (surrogate, gestational,...) over time. As a psychological crutch, bonding with the intended parents is unlikely to work over the long term.
Moreover, the idea that the surrogate bonds with the new family she is helping to create ignores the fact that she almost invariably has a partner and children of her own. Her own family's financial needs can put a woman on the path towards surrogacy, as in this Ukrainian surrogate's story: "My mother was seriously ill and we needed money for her surgery." Is it totally unreasonable to think that a woman's family, and especially her husband, will be more supportive of her journey through surrogacy if they can see some concrete benefit? That a woman who is seen to make a substantive financial contribution to the family will have a higher status? That knowing she is doing something that will set her own children on a path to a better life - pay for their education, say - will make it easier for a surrogate mother to part with her newborn?
(As an aside, religious faith, and the belief that one's surrogacy is a calling, may also be psychologically protective for surrogate mothers, but this is just speculation).
In sum, the little that we know about the psychology of surrogacy provides no evidence to support the contention that altruistic surrogacy is less psychologically damaging that commercial surrogacy.
A final argument against paying surrogates is commodification: commercial arrangements treat children as commodities, things to be bought and sold. (As an aside, it is ironic that Canada's commission speaks of commodification of children, as if children were something separate and separable from the woman who carries and gives birth. This alienates the child from the mother, and every good Marxist knows that alienation is the first step in commodification). Let me explain why concerns about commodification are misplaced.
First, it is not at all clear why the payment of surrogate mothers commodifies life any more than the payment of nurses, doctors, lawyers and all of the other folk who make a living in the reproductive technology business.
Second, one has to ask, as Naila Kabeer does in this excellent analysis of women's empowerment: what are the alternatives? Is meaningful, rewarding work that does not involve commodification on offer? If not, that is the problem, not the availability of commercial surrogacy.
Third, process of commodification begins when a worker experiences alienation - she is separated from the product of her labour, and from the act of production.
Not one of the articles that I have read about surrogacy and commodification has noticed: this is the point of surrogacy! The surrogate must separate herself from the child she is carrying, she must be ready to give him or her up. If payment for surrogacy, by alienating the child from the gestational carrier, makes that separation easier, then it is a good thing.
People often risk their bodily integrity for the good of others: soldiers, participants in medical trials, workers who clean up toxic or hazardous materials.
In Canada there is no conscription - people who do such jobs are volunteers. But they are compensated for the dangers that they face.
As surrogate mothers, too, should be compensated.
