When I was in Delhi in the spring of 2008, I came across a photo on the bottom of a page in the International Herald Tribune that caught my attention. Three Indian women were lined up next to each other. Their heads and necks had been cut out from the photo and only their bodies, from the shoulder down draped in traditional heavy silk saris, were shown. The women were pregnant; the pallus of their saris pulled over to one side of their bodies with their arms, bangles bunched at the wrist, resting by their waist, thus exposing their heavily rotund stomachs. The title reads: 'the globalization of baby-making' and the article goes on to elaborate the emergence of international surrogacy trade. Rural Indian women are paid anything between $5-7,000 (a decades worth of wages in rural India) by Euro-American couples, for the gestation and delivery of a child.
The article highlights the economics of the practice. "We give them a baby and they give us much needed money. It’s good for them and for us" states a surrogate mother. The seemingly unencumbered simplicity of the transaction however, arouses suspicion, in both myself and the author. The author goes on to register concern with the emerging economisation of human bodies, particularly those bodies that are presumably in disproportionate socio-economics positions, as she gently tilts the moral scales, pinching our sensibilities a little tighter as she informs us that these women are illiterate, signing the surrogacy contract with the print of their thumb.
Yet it is also the commercialism of motherhood that is the troubling factor here and in a world where motherhood has become divided, from genetic mother, to gestational mother to birth mother and now “contract mother”. An ethical issue also lies in the abstraction of the idea and process of motherhood itself. That this can be turned into an economic calculation (indeed what is the price of giving birth to a life?) unsettles fundamental beliefs about our bodies, perhaps the sanctity of creation and of course, life itself. Thus the author states: “some things we cannot sell no matter how good ‘the deal’”.
The point that this article addresses, that in today’s world no longer are just geographical borders crossed but also ethical and moral ones too, is a pertinent one and speaks to ongoing and emergent issues in global health and the rapid development of biotechnologies. As we witness large scale shifts in the dynamics of biotechnological and medical processes, be it commercialism, commodification, or fetishization even, as persons, on either sides of the ocean are having to make sacrifices in order to make do and live ‘good enough’ within terms that constitute well being for them. This is not just for the poor women selling, but also the women and men who are buying, and the unimaginable difficulties they may be facing in trying to conceive a baby that eventually led them to a village in India.
From a glance, this transaction would seem neat and clean, akin to, one would hope, that of the surgeon’s knife; simple and effective. Indeed as the woman quoted in the article states, it’s a win-win situation for all. Yet does this kind of maternal transaction then, from one mother to another, present some of kind conflict? Perhaps my quick assumption that the situation is more complicated, problematic even, reflects my own moral and ethical positioning as a western trained medical anthropologist, that I assume there will always be something more to it. Yet, as we have learned from Nancy Scheper-Hughes and many others working in all areas related to medicine, such exchanges are anything but simple. Therefore, the idea of ‘renting a womb’ resonates with other medical issues, particularly organ transplants and trafficking, where what has previously been cloaked in language of the ‘gift’ is in some sense not only transformed into a functional and cold reality of economical exchange, but can, if left to it’s own devices, reify entrenched positions of social inequality. A point in case is that of the Indian surrogacy sellers, which potentially reiterates the flows of biological commodities and monies along well trodden inroads from rich to poor. As Scheper-Hughes advocates, such paths are rife with suffering, pain, irresponsibility and in some cases violence. This is not what I am suggesting is necessarily happening with the international surrogacy market, but I highlight it to emphasis that these exchanges are often very rarely free from the ethical and moral underpinnings. Firstly, this can be in terms of what we think as fundamental human rights (is there even a problem with a divided, transnational motherhood?) and secondly, what actually matters to the persons involved in these processes can be radically different and thus creates potentially ethically ‘messy’ contexts. Both raise serious implications for the ways in which those who are legislating the procedures and formulating regulations should handle this practice.
Now, from the outset, I would claim that no scientific, biological nor medical innovation that becomes translated into technology is amoral, or ethic free. The creative enterprises that give birth to novel ideas and then feed those ideas in technologies that will then be packaged, distributed and sold on to a global medical market to be used in locally contingent ways, are inherently moral, and moral of the polyvalent kind. These technologies arise from and within a specific context, imbued with its culture, history, economics and politics that will then have specifically practical and moral consequences when applied in diverse settings. Thus biology and the social are inextricably and complexly intertwined and this entanglement is neither static nor uniform, but rather dynamic, constantly changing and shifting within the larger dialectical flows of local and global processes. Thus for this very reason one cannot assume that the medical transaction is value free. And if it is value laden-what are we to make of this? - Just being aware of ‘value’ that we place on technologies such as transplantation and modes of surrogacy, is only part of the puzzle.
Focusing on the value of ethics as morals, from within an opposition of ‘right’ or ‘wrong’ isn’t perhaps always so helpful as it doesn’t necessarily move our thinking forward, nor help the persons involved. This is not to suggest that these are not important questions to ask, but I feel in conceiving of the ethical as moral and thus valued as good versus bad (never mind for the moment the pressing issue of whose moral? Whose ‘right’ and whose ‘wrong’?), draws attention away from the complexity of the situation. Rather, thinking of the ethical as one of the many ways in which we think about how we can live refocuses us as to why these transactions are taking place in the first place. Take, for example, the point in the article that got my ears pricking. The author states one rural woman offered her womb for rent in order to procure money to buy a heart operation for a son. Here I am reminded of Lawrence Cohen’s (University of Berkley, California and co-researcher with Scheper-Hughes on Organ Watch) excellent research on kidney selling within Indian families, whereby the utter wretchedness of poverty is pushing slum women to sell their kidneys in order to pay back loans. This enacts a certain kind of ‘operability’ towards the state, whereby failings of state are forced upon bodies to undergo ‘voluntary’ operations. In a similar vein, I read the sacrifice of a woman’s body to pay for her son’s operation, one surgery for another, indeed one life for another, as part of a similar process. Are other choices made available? Is this the only way? Equally, what choices do the American couple have when they seek pregnancy elsewhere? What wider, complexities does their search in and of itself, speak? Indeed, to look outwards, globally, than to seek help inwards- because it’s easier, cheaper, quicker, faster- is perhaps a particular preoccupation of modern globalised living? Although I know very little of the international surrogacy trade, I wanted to take the opportunity to discuss some of the current issues surrounding organ trade and extend them into an emergent area of bioethics. If anything I would hope to put across the point that the globalisation of baby making is much more than a market economy. As with all the other ‘globalised’ biomedical assemblages that are forming, mutating and uniting in unprecedented and unexpected ways, we always have to ask: what really is at stake here, and there?
Alison MacDonald is a PhD Candidate in Medical Anthropology at UCL.
