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Surrogacy in India: Exploitation?

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In a recent CBS News report on surrogacy in India, the question of whether Indian women are being exploited is at issue.

Indian women lined up to become surrogates

In an effort to save money on the high cost of surrogacy, many couples and individuals from around the world are choosing India for their surrogacy arrangments.  There are strong proponents and opponents on both sides of the debate as to whether Indian surrogacy should be regulated or whether it should be made illegal.  The question of whether these women are being exploited is at the center of the debate.

These women are living in a developing nation, are mostly very poor and are having babies for foreigners from first world nations so the issue of exploitation certainly would be at the forefront of the discussion.

Opponents often argue that those facts alone point to exploitation of the rich by the poor.  Proponents often simply argue that women have the right of reproductive freedom and may choose to do with that right as they wish.

As with most issues, I think the truth is found somewhere in the murky waters in between both opinions.

Advocates for Surrogacy has worked in Guatemala offering Guatemalan women the opportunity to become surrogates for Americans who are seeking surrogates abroad mostly to avoid the high costs associated with U.S. surrogacy.

When we were developing the program, ethical issues were at the forefront of our thinking.  We started with the opinion that women do have the right to reproductive freedom and that right should cross national, social, and economic boundaries.  In other words, the fact that a woman is poor should not mean that she is unable to understand and make fully informed decisions concerning her right to reproductive freedom and consequently her right to choose to carry a child for a couple or individual unable to have a child.  However, theory and practice quickly converged and we soon had to grapple with practical issues and the ethical implications of how we approached the process.

Let’s start with living arrangements.  Guatemala is a poor country and we knew that our clients would be concerned with issues such as nutrition, safety and compliance with medical instructions.  The most expedient solution to that dilemma would have been to require surrogate carriers to live in group housing for 10-12 months.  As we considered this issue from a strictly programmatic viewpoint, it was a good solution.  From a humanistic standpoint, we quickly determined that this was not feasible.  How could we ask a woman to leave her children, her family, her friends, her home, her community to live in a dorm-like setting?  We certainly would not require this of a surrogate in the U.S. so how could this be justified in Guatemala?  To consider otherwise is to disregard and disrespect the lives of these women.  This is exactly the ethical dilemma that programs in India present.

The second issue was concerning the literacy of candidates.  We determined that only women who were able to read and write would be accepted into our program. While it is possible to imagine that an illiterate woman could understand the emotional and procedural aspects as well as the risks inherent in the process, we determined that the undertaking is so serious that we required a candidate to be literate.

Thirdly, we determined that each candidate was psychologically assessed (equivalent to the MMPI which is a standard assessment tool used in the U.S.) by an independent psychologist and received monthly counseling as well as post partum counseling and more frequent counseling during the pregnancy if she was depressed or suffered post partum depression.  This was standard practice in the U.S. and was recommended by the American Society of Reproductive Medicine and therefore, we should maintain the same standard of evaluation for the Guatemala program.

Finally, we looked at the life insurance and disability insurance.  Again, life insurance is standard practice in the U.S. and so without question we would hold to the same standard in Guatemala.  Disability insurance was a more difficult

Each surrogate carrier was covered by a life insurance policy.  With respect to disability, we had not yet figured out that piece but it was certainly one that we were determined to conquer.

In examining the practices of the Indian surrogacy programs that the CBS report explored many points stand out to me as being potentially problematic:  1) living arrangements in which women are apparently housed in dormitory-like or group home environments; 2) illiteracy; 3) the quality of psychological assessment and evaluation and independent counseling available for surrogate candidates and surrogate carriers; 4) life insurance; and 5) disability insurance.

The problem with international surrogacy is that not all programs are created equal and all too often ethical considerations are disregarded in favor of financial considerations.

Visit: Are Indian surrogacy programs exploiting impoverished women? – CBS News  for more on the story.


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