In recent weeks, the private reproductive decisions of Elton John and Sofia Vergara have spilled over into prime time news cycles -- albeit by the celebrities themselves. Elton John called for a boycott of all Dolce and Gabbana merchandise after the designers regrettably referred to babies born through in vitro fertilization as "synthetic" children. The swift backlash caused the designers to issue statements of clarification and apology. Elton John's twitter followers accused D&G of being woefully out of touch -- not only with contemporary fashion, but also baby-making. In part, they are right.
According to the Centers for Disease Control (CDC), tens of thousands of children are born each year in the United States through assisted reproductive technologies (ART). These technologies provide a stunning candy store of options: a spectrum so vast in array, scope, and breadth as to make heads spin: in vitro fertilization, ova selling, cryopreservation of ova, womb renting, pre-implantation genetic diagnosis, embryo transfer, assisted hatching, intracytoplasmic sperm injection (ICSI) of ova, embryo grading, and more. However, these technologies are not just for celebrities.
One scholar, Professor Martha Ertman from the University of Maryland argues that ART corrects for Mother Nature's discrimination against gay men and women, providing them access to biological parenting. Others point to IVF's equalizing effect: it affords infertile couples the opportunity to parent as well as unmarried men and women.
Contemporary child-making no longer resembles the outgrowth of coital intimacy, even when the couples are heterosexual. Consider the dispute between Sofia Vergara and David Loeb. In that case, Vergara refuses to surrender embryos to her ex-fiancé, pointing to a contractual agreement that stipulates the embryos can only be implanted in a surrogate if both parties agree. Ironically, if Ms. Vergara surrenders the embryos Mr. Loeb would still need to recruit a woman to gestate and deliver the baby. And depending on what state or country she lives in, she might legally be the "mother."
The reality is that family-making today increasingly includes a mixture of sophisticated science, contracts, and negotiations. Unfortunately, at times some of that negotiating is characterized by unequal bargaining power, coercion, international outsourcing, and mechanized -- assembly type -- deliveries.
A recent special investigation by HBO's Vice news series exposed the more troubling side of the baby-making business. Viewers witness the routinized nature of the deliveries: Indian woman on her back, belly slit open, baby delivered, cleaned, and then new parents whisk away with the newborn in tow.
In such cases, inevitably those who are seeking surrogacy services in poor countries are wealthy and educated (often Americans and Europeans). These men and women pay for their embryos to be implanted in women living in India, Thailand, Mexico, Nepal, and other developing countries. The costs are much cheaper in these countries -- a fraction of what surrogacy services cost in the U.S. -- in some European countries it's simply banned. To soften the commercialized or baby market aspect of these transactions, clinics suggest that the surrogates are like new family members. Yet, I've argued that such references mask the true financial nature of these transactions and fail to account for disparate power dynamics.
Proponents of international surrogacy claim that these transactions pass legal muster, because they are bound in clear, legal contracts -- and in India where medical tourism drives a significant part of the economy, commercial surrogacy is legal. Indeed, surrogacy services account for 25 percent of the medical tourism revenue in that country.
On closer inspection, however, contracts may obscure problematic legal and social norms. In the case of international surrogacy, typical surrogates are uneducated, from impoverished ghettos and slums, willing to risk their health to make in one nine-month period more than they would make in four or five years. Some would argue, why not make that deal? Do the math, this is a better option for poor women, right?
Impoverished surrogates often sign elaborate contracts stipulating that they will abort fetuses unwanted by the "intended parents," gestate multiple fetuses if necessary, and essentially do whatever is asked or demanded of them with a thumb print, because they are illiterate and cannot read or write. Unsurprisingly, there have been deaths, severe health harms, babies left behind, and a slowly emerging black market in foreign babies left behind in places like India. More recently, in Nepal, after the tragic earthquake, the Israeli government airlifted babies born through surrogacy back to safety, but left the women who gestated them behind.
Professor Imrana Qadeer, a public health specialist describes India's surrogacy market as "total madness," emphasizing that "[i]t is a totally unregulated thing... in India the doctors get away with a lot of things because people trust them..." She warns, "women are vulnerable, they can be pressured, and it's spreading like wildfire." One doctor who regularly implants four embryos joked, that his services have produced more than 1,000 sets of twins, making it a "two-for-one bonus."
Thus, despite media's sustained fascination with celebrities' utilization of ART, gone unnoticed are the more interesting and often troubling ways in which these technologies impact U.S. and international medical, social, and legal norms. Few journalist or scholars for that matter scrutinize the socio-economic implications of these technologies or how women of color are frequently called upon to service pregnancies that require surrogates, or how an international market in womb renting now includes human trafficking in babies.
Michele Goodwin is the Author of Baby Markets: Money and The New Politics of Creating Families and Founder of the Baby Markets Roundtable Series.