Assisted Reproduction Across Borders

Feminist Perspectives on Normalizations, Disruptions and Transmissions

Merete Lie, Nina Lykke

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317200673
• Edition: 1
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

Today, it often seems as though Assisted Reproductive Technologies (ARTs) have reached a stage of normalization, at least in some countries and among certain social groups. Apparently some practices – for example in vitro fertilization (IVF) – have become standard worldwide. The contributors to Assisted Reproduction Across Borders argue against normalization as an uncontested overall trend.

This volume reflects on the state of the art of ARTs. From feminist perspectives, the contributors focus on contemporary political debates triggered by ARTs. They examine the varying ways in which ARTs are interpreted and practised in different contexts, depending on religious, moral and political approaches. Assisted Reproduction Across Borders embeds feminist analysis of ARTs across a wide variety of countries and cultural contexts, discussing controversial practices such as surrogacy from the perspective of the global South as well as the global North as well as inequalities in terms of access to IVF.

This volume will appeal to scholars and students of anthropology, ethnography, philosophy, political science, history, sociology, film studies, media studies, literature, art history, area studies, and interdisciplinary areas such as gender studies, cultural studies, and postcolonial studies.

Part I

ARTs in a Neoliberal World of Transnational Reproflows

1 Citizen, Subject, Property

Indian Surrogacy and the Global Fertility Market

Kalindi Vora and Malathi Michelle Iyengar

International fertility travel engages structural inequalities arising from histories of conquest, capture and colonialism, and is entwined with the landscape of mobility, migration and rights. To better understand these relationships and their effects on participants in transnational fertility markets, this chapter explores how transnational surrogacy arrangements in India raise new issues around the legal and social construction of citizenship as a technology of mobility and of marking rights-bearing subjects. Locating foreign-born offspring, who are born to Indian surrogates but have the citizenship of their parents, within the history of birth and citizenship in the USA, we raise the question of how histories of labor, mobility, and citizenship influence the market for surrogacy. By bringing recent research on surrogacy together with critical theoretical work on the construction of citizenship, we highlight the ways in which the practice of transnational commercial surrogacy both grows out of and reinforces structures of inequality produced and controlled through apparatuses of the state.

We use theories of citizenship and the nation-state to analyze the practice of US commissioning parents who contract commercial surrogacy in India, focusing in particular on US citizenship and its racial underpinnings, and suggest lines of inquiry for the ongoing scholarly examination of transnational surrogacy. Using the concepts of differential and flexible citizenship, we think through the consequences of the relatively weak citizenship of low-earning subjects like those who become surrogates in India by relating this to scholarship on women of color who are mothers in the USA. We also compare the context of citizenship issues raised by Indian surrogacy to historical instances where infants have been regarded as property, aliens, or citizens in the USA and India. We focus specifically on how foreign-born offspring complicate the history of citizenship through jus sanguinis in the USA. Through these relational and comparative analyses, this chapter brings a new analytics to scholarship on the exposure to risk of actors in surrogacy arrangements in terms of long-term health and social consequences, precarity and potential rightlessness.

Background to Commercial Surrogacy in India

Commercial gestational surrogacy in India, which arose out of historical, social and market inequities, is already a sociologically complex phenomenon that is increasing in volume and scope. Rapid growth in the surrogacy market is occurring without the resolution of legal inequalities and medical risks that are likely, in different ways, to affect surrogates, commissioning parents, and the children born from these arrangements. ART clinics in India are currently encouraged to adhere to national “guidelines,” but are not actually bound by any enforceable legislation, a situation similar to that of South Africa (see Namberger, this volume). There is also no mandatory reporting by clinics, so the full scope of clinics and their practices can only be estimated. Research suggests that around 2000 babies were born to gestational surrogates in India in 2011. For example, as many as 1000 are thought to have been commissioned by British client-parents, although figures involving British citizens may be underreported because commercial surrogacy is illegal in the UK (Knoch 2014). The number of clinics offering surrogacy services in India is roughly estimated to be in the 600s, and the Indian Council for Medical Research predicts that fertility travel to India will soon be a six-billion-dollar industry (Rudrappa 2012).

The global geography of commercial surrogacy arrangements, like that of reproductive tourism in general (Deomampo 2013), is racialized and gendered in complex ways. The first surrogacy clinics established in India catered primarily to North American, Israeli, Australian, and European clients, with additional clients from Taiwan, Japan, and Gulf nations. Newer clinics serve populations from Pakistan and Bangladesh, where ART technology and practice is less available (Kashyap 2011), with a similarly motivated growth in clients from Tanzania, Nigeria, and Ethiopia (Deomampo 2013). Marcia Inhorn has argued that, in nations where lack of preventative medicine is the primary cause of infertility, earlier intervention is more important than ART treatments for fertility issues in local populations (Inhorn 2003), and so ARTs are not a demographic necessity for the local population. India is one such country, and despite the rapid development of fertility services, this growth is not in areas of necessity for local residents. For these reasons, ART clinics offering surrogacy arrangements usually do not serve the needs of their local communities, nor the communities of the women who are recruited to become surrogates.

The long-term health impacts of gestational surrogacy are understudied, particularly in light of how rapidly the number of clinics offering this service is multiplying (Knoch 2014). Obstetrics research has shown that conception through IVF increases the risk of gestational hypertension, pre-eclampsia, placenta previa, hyperemesis gravidarum, venous thromboembolism, and cholestasis (Knoch 2014), and the low-resource context of women who become surrogates in India is likely to increase the chances of these complications, many of which can have long-term health consequences. Despite the fact that surrogates are at risk of serious adverse health effects, permanent injury, and death, ethnographic accounts make it clear that the surrogate is not seen as a patient in ARTs, but as a tool for commissioning parents who are the patients (Vora 2009, 2012; Riggs and Due 2010; Sama 2012; Saravanan 2013).

Surrogates are provided with little information about the process of IVF and, although clinics may obtain formal consent through a signed form, in general surrogates are not treated as clinical subjects and therefore informed consent is not sought. Surrogacy contracts offer little protection for women in cases where long-term care becomes necessary. The Draft ART Bill (2012),¹ if passed, will require that commissioning parents pay for one year of medical insurance for the surrogate following delivery of the infant, but the Bill provides no rights, compensation, or care for the surrogate and/or her family in cases of longer-term illness or permanent injury. This lack of long-term protection means that the surrogacy arrangement has the potential to pose substantial financial risk for the surrogate’s family, as well as medical risk for the surrogate herself.

While commissioning parents are conscious of the economic disparity between themselves and surrogates (Førde this volume; Vora 2014), they are less likely to be aware of the health risks to surrogates. Not only is a woman’s regular income lost to her family if she is unable to return to her usual work due to a pregnancy-related injury; the family is also burdened with the financial costs of the woman’s lifelong care. Adverse outcomes of pregnancy and delivery can include paralysis, blindness, the need for repeated surgeries, and lifelong dependence upon medications to compensate for damaged organs. The single year of medical care proposed in the Draft ART Bill 2012 does not protect surrogates and their families from medical and financial devastation in such cases.

Most Indian surrogates are recruited from the informal economic sector, and therefore they and their families receive low wages for unstable employment with few if any benefits, despite sometimes unsafe working conditions that can endanger their health (Sama 2012, 58). Ethnographic research shows that surrogates and their families:

often do without many necessities that commissioning parents would not do without, including basic health insurance, medical privacy, reliable electricity, clean and reliable water, a permanent home/residence, the ability to seek and find another job when one is lost, access to a variety of foods or the ability to grow them (requiring land and water), and so on.

(Vora 2012, 687)

Many are in situations of “acute financial desperation” (Pande 2014, 49). This type of financial desperation on the part of potential surrogates, alongside India’s technological, medical and economic infrastructure, makes it possible for commissioning parents from the global North to avail themselves of surrogacy services in India much more cheaply than they could in their home countries.

The nature of transnational surrogacy in India is further obscured by less-than-accurate assumptions about who the participants are – i.e., whose labor is making the surrogacy process possible. While only the clients, the medical staff and surrogacy brokers, and the surrogate herself are named in the contract, the entire arrangement is also underpinned by the labor of the surrogate’s family. Surrogacy clinics often require surrogates to live away from their families, in clinic-run hostels, throughout their pregnancies (Vora 2009). The family – notably the surrogate’s own children – thus bear the affective burden of making the surrogacy possible via this prolonged familial separation. The labor normally performed by the woman within her household must be taken on by others during her absence. The mandate that surrogates reside in hostels also speaks to the artificially low cost of transnational surrogacy in India: when clinics require surrogates to live in hostels to make sure they are getting nutritious food, clean water, and medical services during pregnancy, it suggests that the surrogates’ usual family lives do not include such benefits. Rather than paying enough for a surrogate’s family to eat a variety of healthy foods, drink consistently safe water, and access professional medical care, the clinic can simply require the surrogate to leave her family and stay in a hostel. The bulk of the surrogacy fee is generally paid upon successful delivery of the infant to the commissioning parents but, given the uncertainty of this outcome, a woman could theoretically undergo six or seven months of pregnancy (with all of its accompanying dangers and discomforts), separation from her family, and absence from her normal paid employment, only to have a miscarriage which (in addition to potentially endangering her own life) means that the whole process has resulted in a net financial loss for her family.

The exponential growth of the transnational surrogacy market in India demonstrates the satisfaction of international clients, who see in India an amenable and affordable location for the outsourcing of gestation and reproduction. At the same time, the low cost of surrogacy arrangements in India is actually enabled through the enforcement of a de facto lower standard of living and more limited understanding of rights for the Indian classes from which surrogates are drawn. While the fees promised upon successful completion of the pregnancy are many times what the woman would make through her regular work, the exposure of the surrogate’s body and family to long-term risk and potential rightlessness is elided in the limited understanding of surrogacy as a nine-month labor contract.

Race and Reproduction in the Construction of Citizenship and Property

The conditions of possibility for transnational surrogacy in India, in addition to involving new developments in biotechnology, arise from very old structures of imperialism and race. In this regard, the different types of human commodification involved in nineteenth-century racial slavery and twenty-first-century Indian gestational surrogacy, while clearly distinct and incommensurable, are not structurally unrelated. Thinking about the economies of slavery, particularly in terms of United States history, both provides historical context for the current position of middle-class US clients (as having the means to outsource the bodily labor of biological reproduction) and helps to set up an analytical lens for an examination of the relationships between citizenship, non-citizenship, and the commodification of reproduction.

During the seventeenth and eighteenth centuries, evolving structures of race and empire gave rise to an international economic order founded upon the circulation of captive humans as commodities. The commoditized human body played a foundational role in the political and economic development of the US settler state (Takaki 2000). Even before the US separation from Great Britain, white settlers in what would eventually become “the United States” had developed a profitable economy built upon the labor of enslaved Black and Native peoples. By the nineteenth century, the profitability of the enslaved Black body for the white owner (or potential owner) was understood to be divisible into a number of constituent components: slaves too old or sick to work might be sold to medical colleges or to individual scientists for experimentation and dissection, and the reproductive capacity of the enslaved Black woman was regarded as possessing a financial value separate from and in addition to her capacity for field labor or domestic work (Morgan 2004). The enslaved Black woman had the potential to give birth to children who would inherit their mother’s slave status; hence, to purchase a female slave was to invest in a self-multiplying commodity (ibid.). In this sense, to pay a higher price for an enslaved female regarded as a “breeder,” or for a visibly pregnant enslaved woman, was to make an investment in the predicted financial value of lives yet to exist. After the formal banning of the transatlantic slave trade in 1808, the still rapidly expanding domestic slave trade relied entirely upon the reproductive capacities of enslaved Black women (Harrison 2009). In other words, economies depending on human reproduction are not a new phenomenon. Rather, the accumulated resources allowing some people to access transnational surrogacy arrangements emerge from generations of commodified human reproduction.² In the USA, this process also recapitulates racialized constructions of citizenship and non-citizenship, as we will now discuss.

Racialized Constructions of Citizenship and Non-Citizenship

Gestational surrogates in India lack full protection as Indian citizens as a result of their low-earning status and as contracted workers in a transnational agreement. “Citizenship,” notes Lynn Fujiwara, “is a multilayered construct at constant play on the local, national, and international political terrain” (Fujiwara 2008, 24). The notion of citizenship serves as an instrument for sorting and classifying bodies and subjects. The hegemonic status of the concept of citizenship naturalizes the ability of the nation-state to prescribe and enforce notions of who belongs where, of which bodies are allowed to move into and out of which geopolitical spaces, and when, and under what circumstances. Within the US context, citizenship, like property, has always been constructed through the technology of race. In this regard, Cheryl Harris’s analysis of “whiteness as property” (Harris 1993) provides a generative model for the analysis of US citizenship.

Harris outlines the ways in which the legal construction of property in the US settler state has been co-constituted with the social construction of race. The development of the US economy, and of the US state itself, has been predicated upon a racialized system of property, a system based on “the valorization of whiteness as treasured property in a society structured on racial caste” (1713). The nineteenth-century Market Revolution, the formative historical “moment” for the US settler state as a political and economic entity, hinged upon a particular set of articulations between racial identity and property: Indigenous people were displaced and killed in order to free up land which could then become the basis of white property; whites had the potential to own this property, while Blacks were enslaved and therefore could not own property because they were legally figured as property. Later in the nineteenth century, the construction of “Asian” as a racial identity became linked to an ambivalent set of relationships to property: Asians could sometimes hold property, but could also have their property – including citizenship-as-property – revoked on ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Notes on Contributors
• Acknowledgments
• Permissions
• Editorial Introduction: Assisted Reproduction Across Borders: Feminist Perspectives on Normalizations, Disruptions and Transmissions
• PART I ARTs in a Neoliberal World of Transnational Reproflows
• PART II Perplexed State Regulations, Legal Inconsistencies and Cultural Tricksters
• PART III Religious Fundamentalism, Humanist Values, and State Dilemmas in an Era of Technological Monsters
• PART IV ARTs as Entangled in Demographic Agendas and Biopolitics
• PART V “New Normals” and their Discontents
• Glossary
• Index