Saturday, January 10, 2009

Another stupid article about surrogacy

In an age of science and globalisation, surrogacy should be seen as an opportunity to question patriarchal conceptions of the family and social perceptions of infertility, not deepen ties of blood and inequality, writes Imrana Qadeer and Mary E John

Surrogacy is suddenly front-page news. First, there was the uncertain future of baby Manji, following the divorce of her Japanese commissioning parents; then the happy pictures of an Israeli gay couple with their son born to a Mumbai-based surrogate mother. India is becoming a cheap location for foreigners wanting to use ‘assisted reproductive technologies’ (ART) and local clinics are promoting surrogacy arrangements because they are seen as lucrative ventures.

Why the continued emphasis on "cheap" in these articles? Surrogacy in India is not cheap. It is cheaper than in the USA, but it is still not cheap. Given the average income of an Australian being $50,000, (or $40,000 in the USA) by the time a couple completes the trips to India, pays for medicals, accommodation, flights, legal fees, fees for the surrogate, clinicians fees, most of a year's wage is gone. Surrogacy in India is affordable for the average income earner, whereas surrogacy in the USA is out of the reach of the majority of infertile couples. Cheap to me is $5,000, not $30,000 plus. Compare that with the actual cost of becoming pregnant oneself. Even with private medical care, an average pregnancy in Australia can cost as little as $500. Add to that our generous government who will the give a couple up to $5000 "baby bonus" to pay for the costs of setting up a nursery, well, what is cheap?

While there is hardly any public debate on the ethical, social, epidemiological and medical questions around infertility and surrogacy, the extremely problematic ART Regulatory Bill (2008) is being hurried through. It barely addresses important concerns and ignores national health and population norms. It permits, for instance, three surrogate pregnancies to a woman.

There is debate. Anyone can put in a submission to the decision makers who are reviewing surrogacy laws. The media has made the topic of surrogacy known to the public. If people want something changed, deleted or included in the new laws it is up to them to contribute to the debate, rather than write non-sensical articles about what should be. As for permitting three surrogate pregnancies, that is your point? Are three pregnancies too many? Or too few?

To understand surrogacy in the Indian context, one must begin with the fact that while the Transplantation of Human Organ Act, 1994 banned sale of human organs, organ loaning ~ equally difficult and risky ~ is being promoted through paid surrogacy.

Where is the writers' medical proof to back up their claim that organ loaning is as equally difficult and risky as organ selling. Personally, I would prefer to act as a gestational surrogate to an infertile couple than sell them one of my kidneys. There are many studies that expose potential problems that may be encountered by the donor of a kidney. Compare them with the potential problems faced by a gestational surrogate before you make unqualified statements. Where are the studies to back up the claim surrogacy is equally as risky. Further, to reduce a woman down to one organ, her uterus, is demeaning and anti-feminist. Sorry, but we surrogacy IPs "use" or "rent" the whole woman, not just her uterus.

This is due to a medical industry that welcomes all profitable ventures like ‘reproductive tourism’, even when infertility constitutes a small segment of local priorities. Total infertility is estimated at about eight to 10 per cent, and for the vast majority of Indian women it is preventable as it is caused by poor health, nutrition, maternity services and high levels of infections. Only about two per cent of the cases are because of ‘primary’ infertility amenable to ART alone.

Again, where are the medical studies to back up these statements? To say that Indian women suffer infertility due to poor health and nutrition places the blame of infertility on the infertile woman. It is estimated globally that between one in six to one in ten couples suffer primary infertility. Why then does India have a national primary infertility rate of only two percent, as suggested by the writers?

Because ART amplifies deep-seated notions of “blood”, now bolstered by genetics, it tends to overshadow safer, cheaper and more progressive options like adoption.
How is adoption safer, cheaper and more progressive? The process of inter-country adoption for Australian couples costs, on average, $50,000, a figure much higher than costs for surrogacy in India. Further, many couples do not fit the restrictive criteria of adoption agencies and governments worldwide. As for adoption being more progressive. There is a growing trend for countries that have been open to inter-country adoption programs to cease their adoption programs. The reasons for this appear to be that some countries recognise potential difficulties faced by the children taken from their country of birth and their culture.

ART clinics do not provide reliable information about low rates of success, the probability of multiple pregnancies and the high possibility of foetal abnormalities.

Prove it. Have the writers ever contracted an Indian ART clinic and learned first hand that success rates are low and rates of foetal and multiple pregnancies are high? The ART clinic to which I am contracted has most certainly discussed success rates and the possibility - not probability - of multiple pregnancies. As for the high possibility of foetal abnormalities ... are the writers assuming that surrogacy and/or Indian ART clinicians cause a higher percentage of foetal abnormality than occurs in the general population? How do they back this statement up? Are the doctors of lesser quality and therefore damage the embryos? Do they not know how to weed out problem eggs, sperm and embryos? Perhaps the surrogate is to blame. How insulting.

The starting point for tackling the question of surrogacy is in recognising that this new technology splits up older notions of natural reproduction into three parts ~ ‘social’ parents, a gestational mother, and the genetic matter that links the first two.

What exactly is a social parent? Whose term is that? My take on the term "social parent" is a parent who wants to have children to be part of society .. ie. have children only to show them off to society. without really wanting the children, nor being prepared to undergo a pregnancy in order to create those children. The term implies the parents - who in the majority of cases with Indian surrogacy have two genetic parents, and the rest have at least one genetic parent - are not interested in being biological parents. Well, we are. We have to be. At least one of us has to be.

The ‘stakeholders’ thus created often have conflicting interests - the “commissioning” parents; the surrogate mother; her family, if any; the new baby; and the commercial sperm banks and ART clinics.

The writers assert there is a conflicting interest between the partes involved. Prove it. the commissioning couple are happy that there are sperm banks and egg donor banks to help them have children. I see us all on the same team working towards a common goal - creating a family. So where is the conflict?

Ethical practice must take its cue from the experiences of surrogate mothers, who ~ motivated primarily by a shortage of personal income ~ often endure the social stigma associated with surrogacy. They may leave their homes, lie about the parentage and claim the death of the baby after it has been handed over.

And that is their right to do so. Surrogate mothers are adult women who have a right o do with their body what they like. They are not forced into surrogacy. Yes, they may have a motivation to earn some money through becoming a surrogate, bu surely is that not better than commissioning parents not paying at all? If surrogate mothers have to lie and hide from their families, that is the problem of the family that does not understand, not an inherent problem of the surrogacy process itself. Articles such as this one only serve to point attempt to point out the negatives of surrogacy, and thus keep this often beautiful process underground.

Given this situation, the State must strive to help create an environment free of secrecy and anonymity. As equality and volunteerism may be rare in surrogacy agreements, arrangements to ensure informed consent, proper counselling and legal assistance for drawing up contracts for safe procedures, as well as total health care insurance and compensation, must be ensured through the state regulatory institutions proposed in the Bill. A surrogate mother should not only have the right to abortion but also to keep the baby if she cannot part with it. Her name should be on the baby’s birth certificate and parentage legally transferred to the new parents later. Her family should be aware of the contracting parents and be included in health care arrangements.

A surogate mother enters a cleegally binding contract to carry and nurture a growing baby and deliver that child to the parents. In the majority of cases the sdurrogate mother has no genetic link to that baby. If a surrogate mother wishes to have an abortion, of course she can do this. But she will be breaking a contract and will receive no payment for her services. From what I know from surrogate mothers themselves, their biggest fear is the IPs not wanting to take the baby. The majority of surrogates go into the arrnagement with their family complete. They tend to not want more babies, much less babies that are not genetically related to them. Stories of surrogates wanting to keep the baby are few, and the majority of surrogacy relationships that go sour are where the surrogate uses her own eggs and therefore has a genetic link to the child. New Indian laws will prevent surrogates from using their own eggs.

Today, ART markets as well as the State emphasise relationships of blood and the genetic basis of paternity, marginalising the essential social and biological contribution of nurturing children in an enabling environment. Is it ethical to use prevailing social constraints that prevent open surrogacy arrangements, to promote the business of surrogacy and ART? The amount of compensation given to the surrogate mother is another particularly difficult aspect when what is involved is the creation of life ~ a baby no less. It is telling that in the West up to 50 per cent of the total cost goes to the surrogate mother while in India most of the money is appropriated by sperm banks, ART clinics and lawyers.

This is simply untrue. Out of the $160,000 we were looking at paying for surrogacy in the USA, the surrogate would have received only $40,000 (AUD conversions used). A US surrogate barely gets half of the average American income. In India the fee paid to the surrogate is more like ten times the average Indian income.

There is also an in-built bias against the newborn baby as the surrogate mother is constrained to underplay her bond with the growing baby from the beginning. Early separation is at the cost of the baby’s immunological and psychological health. The baby is denied the right to breastfeeding even for three months. This aspect is completely ignored with the burden of surrogacy being shifted to one who cannot protest. Every child born through ART, whether disabled or one of a multiple pregnancy must have the same rights of survival and care as any other child. The proposed right of social parents to ask for “pregnancy reduction” goes against this.

There is a right to be breastfed? Who made up that rule? You will find many debates about whether to breastfeed or not to breastfeed. Not every baby born to the woman who carried them is breastfed. What does the writer know of a baby's psychological health. Where are the studies that show that infants who are not breastfed are psychologically impaired. Surrogacy IPs can elect to have the surrogate express breast milk to feed their babies, so potential immunological disadvantages, which are debatable, can be avoided.

The social parents, too, must not simply be commissioning agents, but participants in the custody and nurturing of the baby. There is the opportunity here of involving both parents equally and early ~ whether heterosexual, gay or lesbian ~ and, therefore, of challenging patriarchal and biologistic notions of mothering. Same sex couples and single parents in India must be beneficiaries of surrogacy. Adoption laws need to be improved or amended, so that all religious groups can promote adoption.

ART is widely canvassed for its scientific potential ~ stem cell research and cloning. The proposed Bill, too, defines surrogacy as “a pregnancy achieved in furtherance of ART” and, therefore, does not address unethical practices and exploitation sufficiently. The State and the public must debate the issue: How are the interests of the baby to be best protected? What are the rights of the surrogate mother? What should the role of the adopting parents be? All these three factors should converge within an ethical framework.

Women’s Feature Service

No comments: