by K. Blaine

The structure of the surrogacy market does not enhance individual freedom. Surrogate mothers are willing to abide by the rules imposed by the clinic and the intended parents in their desperation to bring their families out of poverty.

outline map of IndiaImagine you live in India. You live in extreme poverty—poverty like most Americans have never witnessed. The kind of poverty that leads you to sign a contract that you cannot read. You relinquish your home, your friends, your family, your children, your body. You leave your community to live in a dormitory where your every move is monitored and recorded. You have no control over the medical interventions performed on you. You are told what you can watch on television, what you can eat, where and how far you can walk, and even what you can listen to.

This is not a spin-off of the “Handmaid’s Tale.” It’s the true story that Dr. Sheela Saravanan has studied and written about in “A Transnational Feminist View of Surrogacy Biomarkets in India.”

At the beginning of the summer I planned to read and write on Saravanan’s book. Almost five months and several pages of notes later, here I am. My conclusion? This book is extremely important.

Saravanan studied two IVF clinics in Western India. She interviewed and observed thirteen surrogates, six of the surrogates’ spouses, four intended parents, and two doctors. Her research “revealed several ongoing illegal surrogacy cases, near-death situations of surrogate mothers, neonatal and perinatal mortalities, unreported abandonment of disabled infants by intended parents and morbidities among surrogate mothers.”

Surrogacy is a global problem. Men and women from places like the United States, Canada, Germany, and the Netherlands travel to places like Thailand, Nepal, Mexico, Laos, Dubai, and Cambodia to take advantage of lax legislation, inequality, and indescribable poverty to build their families.

Cross-border surrogacy situations create unsafe conditions for surrogate mothers. Women and girls are trafficked out of their homes and captured to breed babies to be sold. Babies born with birth defects or simply the wrong gender are abandoned in the street by intended parents. Saravanan writes, “several cases of missing girls and trafficking” have been attributed “to commercial surrogacy in India.” For example, “In 2015, a thirteen-year old girl was trafficked from Jharkhand into Delhi, forced into surrogacy … made to deliver six children … [and] made to breastfeed the babies for six months before they were sold.” According to the National Crime Record Bureau, in India “almost 20,000 women and children were victims of human trafficking in 2016, a rise of nearly twenty-five percent from the previous year.”

Overall, Saravanan’s research found, not surprisingly, that surrogacy is a money-making business that exploits both surrogate mothers and intended parents. She states, “surrogacy was a bazaar where everything about women’s reproductive capacity and the children born was priced,” including the number, weight, and gender/(dis)abiliites of the child(ren) born.

Surrogate Mothers

Dr. Saravanan’s work shows how the combination of crippling poverty, limited educational and employment opportunities, and deep dedication or duty to the family unit create the vulnerability that #BigFertility likes to exploit. She found that “surrogate mothers were mostly women who were already involved in the biomarket … and were easy recruits into the process of surrogacy in India.” In fact, fertility clinics comb these clinical sites to recruit women living in dire circumstances.

All the surrogate mothers she interviewed were “facing severe economic difficulties at home.” Sarala, one of the surrogate mothers, explained that “this process is so distressing that I would not have done it even if someone paid me ten times the remuneration, had I been well-off, but I am so desperate [for money] that I would do it even if I was paid just one third the amount.”

Although each of the surrogate mothers in Saravanan’s study could read and write, none had studied beyond higher secondary level. These women had limited negotiation powers and were led into “unjust surrogacy arrangements.” Lalitha Kumaramangalam, chairperson of the National Commission for Women, argues that “the only reason they (the women backed by her family) come into [surrogacy] is poverty, that is their only choice.”

Even though surrogate mothers are given constant medical attention, the medical care actually violates good medical practice. They were overfed (because bigger babies were more desirable), unable to exercise, and kept on bed rest for the first trimester. An unsafe and illegal number of embryos were implanted into the womb, leading to selective abortions and compulsory cesarean sections. These mothers also did not have health records pertaining to their time as surrogates, because all clinical records were registered under a pseudonym or in the name of the intended mother “without any mention of the role of the surrogate mother.”

Intended Parents

In addition to surrogate mothers, #BigFertility also exploits intended parents. Infertility has received a lot of publicity in the last twenty years. Unfortunately, we have created a world where “infertility and childlessness are considered unnatural and lead to a perceived sense of a ‘an unfulfilled’ life for the woman [and] ‘emasculation’ for the man.” #BigFertility preys on these notions. In the United States surrogacy costs about $200,000. In India, it’s about one fourth of that, including all travel and living expenses. Saravanan reports that intended parents were overcharged and the surrogate mothers were underpaid. There was a “difference between what was asked from the intended parents on behalf of the surrogate mothers and what was actually paid to her.” So where is all of that money going?

Not only does #BigFertility exploit intended parents and surrogate mothers but, perhaps unknowingly, intended parents are also exploiting surrogate mothers. Saravanan explains:

“Those seeking surrogacy arrangements face social stigma, psychological problems, physical stress of infertility treatment, and violation of bodily integrity. However, opting for surrogacy is likely to put another woman (the surrogate mother) through the same set of problems … and also put the surrogate mother’s health, freedom, liberty, and even life at stake. Violation of another person’s dignity, integrity, economic needs, hence, cannot be a constitutional right.”

Likewise, intended parents often feel superior towards the surrogate mother. Instead of calling her by her name, some refer to her as “the surrogate,” “the nanny,” or “the surrogate mother.”

The Children

Children born from commercial surrogacy are frequently mistreated—or worse. Saravanan witnessed instances where “disabled [children or] children of undesired sex were left in orphanages, sold or left on the streets in India.” In 2012, an Australian couple had twins and decided to sell their baby boy and keep the girl. Cases like this are happening all over the world.

Saravanan explains that, in addition to disregarding the needs of the child, “some have suggested that surrogacy is a rebirth of scientific racism and eugenics driven by consumerism and reproductive choices that feeds into parental desires of a perfect child.” Surrogacy requires gamete selection and embryo transfer. If the intended parents do not use their own sperm and egg, then they are able to select gametes from donors with certain skin colors, educational achievements, religious affiliations, etc. This “reinforces racist prejudices, with differing market rates and pricing based on which gametes are considered superior.” She adds, “it is a well-known fact that human eggs of white-skinned women are worth more than those with brown and black skin, hence, the entire baby business is based on racism and colonialism.”

These children may also never know they were born through surrogacy. Each of the surrogate mothers wanted to continue contact with the children she bore—or at least know about “their well-being and progress.” However, in most circumstances contact between child and surrogate mother was completely severed. The intended parents even gave out false contact information or fled India without warning. Many of the surrogate mothers “celebrate the birthdays of these children and feel the pang of separation for several years after relinquishment.” How will the children feel if they ever find out their birth story?

Fertility Clinics

Saravanan saw the dichotomy between the treatment of intended parents and surrogate mothers. Intended parents were treated as people, whereas surrogate mothers were referred to as “wombs in labor,” “containers,” and “rented wombs.” Doctors and nurses were accommodating to intended parents but showed ridicule and judgment toward the surrogate mothers. The fertility clinic staff kept a close eye on the surrogate mothers that Saravanan spoke with; in one clinic there were cameras in every room. The surrogate mothers were given a set of instructions on what they could discuss with her. During interviews, if clinic personnel passed by, the surrogate mothers would start praising the doctor.

Finally, the medical practitioners seem to be completely ignorant of the maternal-fetal bond that develops while the surrogate mother is carrying the baby. According to Dr. Nisha, a provider at one of the IVF clinics, bonding doesn’t occur between the surrogate mother and the child: it is “nothing but a false idea,” and “the surrogate mother is prepared right from the beginning and taught that the child is not hers.” This is in direct contrast to what the surrogate mothers felt and expressed to Saravanan. One surrogate mother states, “I felt as my soul is parting from my body. But it was my duty as a surrogate mother that I had to abide by, if I had to get the final payment.” Another stated, “I have to give them away as a gift though my heart is hurting, these children are part of my life but the deal was made right at the beginning.”


Saravanan’s work provides an internal perspective on just how exploitive #BigFertility and surrogacy are. Saravanan, and the team I work with at the Center for Bioethics and Culture, call for a global alliance to #StopSurrogacyNow. Many more are “concerned that people, especially women, are becoming mere body parts in the flourishing global markets and that women may feel pressurized to become a part of it.”

Saravanan describes the decision of a surrogate mother as a choice “between two evils—being poor and being exploited.” Thus, the structure of the surrogacy market does not enhance individual freedom, it capitalizes on “socio-economically disadvantaged women willing to become surrogate mothers.” These women are willing to abide by the rules imposed by the clinic and the intended parents in their desperation to bring their families out of poverty.

Thankfully, in 2015, commercial and transnational surrogacy was banned in India. Unfortunately, it has moved to countries where the laws are more lax.

Originally posted on Public Discourse

Graphics by Vecteezy