Pregnancy without Borders: Reproductive Tourism's Global Reach
India
With many hundreds of fertility clinics offering fertility services to people from other countries, India remains the global capital of reproductive tourism. And the competition is encouraging innovation. According to the Times of India, clinics in the Gujarati city of Ahmedabad now offer mail-order surrogates.
Aspiring parents no longer need to show up except to take delivery of a child. Instead, they can use either their own or purchased gametes to have embryos produced in a clinic near home, and send them by courier to an Indian facility where they are transferred into a surrogate. The Times explains that "[b]usy childless couples and even singles who cannot afford to take extended leaves are now shipping their children-in-the-making to state clinics to be implanted in the wombs of surrogates."
A recent article on the Indian surrogacy industry in Slate emphasizes the class and cultural divide between intended parents and the surrogates they hire. The surrogates are typically "cash-strapped [women] from rural India [who] travel to metropolitan centers to offer their services as a last-ditch effort to get money." Some see this as an exercise of women's agency and choice. Slate reporter Amana Fontanella-Khan differs:
To exercise one's freedom meaningfully requires information and education, and many surrogates are deeply ignorant about what the procedure entails. It is not uncommon for surrogates to authorize contracts with a thumbprint as opposed to a signature because they are illiterate. Even those who are literate often aren't able to read the contracts, which tend to be written in English.A three-part series in RH Reality Check [1, 2, 3] makes a similar point:
[T]he contexts of poverty and gender inequality in which [reproductive tourism is] taking place underscore the troubling elements of international surrogacy as a family-building strategy.
Another critical perspective on India's booming reproductive tourism industry is offered by Memorial University Faculty of Medicine Professor Shree Mulay on Radio Canada International.
While women's health advocates tend to focus their concern on the well-being of surrogates, many media accounts (1, 2, 3) have centered on the plight of contracting parents from countries that prohibit or restrict commercial surrogacy, and who therefore ran into problems getting their home countries to grant citizenship to their newborns. In July, the consul generals of eight European countries sent letters to a number of Indian IVF clinics that cater to Europeans, asking them to desist from initiating any surrogacy pregnancies for citizens of these countries who had not previously conferred with their consulates about the laws in their home countries.
Other destinations for reproductive tourism
As Biopolitical Times noted in June, RH Reality Check has reported on the emergence of reproductive tourism in Guatemala. Surrogacy contracts there are being arranged by some of the same people formerly implicated in Guatemala's highly troubling international adoption practices, which according to one child rights advocate amounted in some cases to children being "manufactured" to supply the system. And the "labor force" - the women who relinquish babies they have borne - will be drawn from the same impoverished communities in a country that the UN recognizes as having the greatest gender inequality in the Western hemisphere.
Other destinations for commercial surrogacy reported in the news stories include Argentina and Spain. Fertility Argentina holds "patient conferences" in New York City, and advertises "affordable egg donation" in Argentina. Its website also offers a "Personal Concierge [who] will assist you in all of your needs and requirements with specific solutions, before, during and after your stay."
And in China, commercial surrogacy has taken on the trappings of fertility tourism within the country. According to an article in the English-language Xinhuanet, "Most would-be surrogates come from small or medium-sized cities or rural areas and almost all have financial problems."
Upcoming conferences
The thriving business of surrogacy is reflected in two upcoming conferences. Both prefer to call their topic not "reproductive tourism" or "fertility tourism" but "cross-border reproductive care."
On November 24, the UK organization Progress Educational Trust (PET) is holding its annual conference, this year titled "Passport to Parenthood: The Evidence and Ethics Behind Cross-Border Reproductive Care." The event is supported by Merck Serono, a division of the pharmaceutical giant. According to Lobbywatch, PET "was established to promote the benefits of reproductive and genetic science" and "is very closely linked with the pharmaceutical industry."
And this coming March 24-27 in Florence, the new trade group Society of Cross-Border Reproductive Care is holding its second annual congress, "An International Conference on the Global Quest for a Baby." Topics include "Cross-border gestational surrogacy: providing opportunity or exploitation of the poor?" and "Worldwide gamete donation: fulfilling an undeniable need or a form of organ trafficking?"
Those are good questions. Let's hope that those running fertility businesses and groups closely linked to the pharmaceutical industry aren't the only ones providing answers.
Previously on Biopolitical Times: