Surrogacy as an Iceberg: 90 Percent Below Water

The 2015 US Surrogacy Conference was held in San Francisco on September 26. Attendees were greeted by a series of representatives from surrogacy agencies (based in the US, Mexico, and India) who sought to assure them that although surrogacy can be a trying process “not for the faint of heart,” it is often a tremendously rewarding “journey.” Psychologists, lawyers, and physicians similarly celebrated the quest for children via third-party reproduction.

The audience at various panels ranged from about 15 people (mainly for presentations pertaining to international surrogacy) up to 50 for popular presentations such as The Psychology of Surrogacy and Pre-Genetic Testing & Embryo Transfer Decisions. A substantial portion consisted of male couples, and they were the target demographic for most presenters. Both at booths describing services and during presentations, images of happy babies, pregnant bellies, and glowing families were unavoidable. Happy families are, after all, the “happy ending” that surrogacy is designed to attain.

I came to the event not because I was considering hiring a surrogate, but because of a range of questions about commercial surrogacy that I haven’t seen widely considered. Who is served by the “happy ending” that’s so widely advertised, besides parents who want families? The assumption is that babies born from surrogacy arrangements will have loving parents, who expended time, effort, and money on their creation. What about babies who may never know the truth of their origin, or who may experience consequent health risks that are currently unknown and consistently understudied? Surrogates who say they experience great joy after seeing the family they helped to create certainly seem to benefit. But others claim they are taken advantage of and subjected to needless health risks.

These questions were largely sidelined at the US Surrogacy Conference: they linger below the surface-level concerns of family creation. Granted, physicians did stress the health risks of multiple births for surrogate mothers, and agency representatives did try to emphasize the important of building a relationship with one’s surrogate. But those warnings were overpowered by the happy-family imagery, by the reassurance that surrogates are thoroughly screened and selectively chosen, and by instructions on how to choose the right agency for you or construct a comprehensive legal contract. In other words, the ideas and jargon presented at the conference toggled between a narrative of wholesome, joyful family creation on one hand and caution on the other.  The “happy family” rhetoric constitutes the surface narrative offered by surrogacy agencies, while the caution reflects the (often submerged) complexity of surrogacy.  Which narrative is more accurate?

If surrogacy is indeed an ethically complicated commercial transaction entailing significant risk, then cost is a concern, regulation is needed, and agencies and surveillance are necessary to manage the process. If surrogacy is merely an alternative family-building method free of substantial concern, then cost is not an issue, and third-party reproduction (and PGD, sex selection, and monetarily valuing certain traits over others) can be mediated by personal decisions alone rather than by formal regulation. Critics of surrogacy and third-party reproduction often assert that yes, there is a market, and it needs regulation, while most speakers at the conference ignore the market even though, paradoxically, they themselves constitute key players. What should we make of this?

Debora Spar famously posited that we ignore the “baby business” because we are reluctant to consider babies and commerce in the same breath. In addition, I venture to guess that most representatives of surrogacy agencies would like us to forget that their activities are embedded in that business. Thus, money—a key component of any financial market—becomes an important concern.

Several speakers addressed the price of surrogacy and admitted that it is indeed “a costly adventure.” Among the costs: $4500–5000 for pre-implantation genetic screening, $1000 for blood tests at 10 weeks of gestation, $32,000 for an egg from an Indian donor, $45,000 for an egg from a Caucasian donor, and $20,000 for lawyer’s fees (all US dollars).

In the United States alone, the fertility industry is estimated to generate over $3 billion in revenue each year. But overall the price tags were muted by industry representatives who wanted to showcase their compassionate expert services, not advertise dollar signs that hint at the commodification of bodies and babies. Cost is obviously an issue for many people, including those who came to the 2015 US Surrogacy Conference. But to find such information, attendees would have to mine their brochures.

Further, if caution is necessary due to the risks of surrogacy, there is an accompanying need for regulation. Currently, registered clinics only voluntarily follow Society for Assisted Reproductive Technology guidelines. If they fail to do so, there are no repercussions. There are no federal laws in the United States that specify how much or little egg donors can be paid or that prohibit discrimination against non-heteronormative couples. The United States, in fact, is widely considered the “Wild West” of the global fertility market. This leaves agencies like those represented at the conference to self-regulate; and however altruistic the principals of these businesses (indeed, many have children via some type of third-party reproduction themselves), the bottom line is omnipresent.

Brokers and agencies at once deny the existence of a market in favor of a more family-oriented ethos and embody the existence of the market themselves. Conference speakers routinely warned that agencies are absolutely necessary to navigate the many bureaucratic hoops that define the surrogacy process. Sam Everingham cautioned that if intended parents don’t do their “due diligence” and create trust in the process, they will “get burned.” Steve Snyder claimed that “the cases that go awry are cases that are not well-monitored.”

In other words, if you wish to create your family and avoid risks, hire an agency. Thus, agencies position themselves as shields against an otherwise harsh marketplace that they themselves create and uphold. This apparent contradiction must force us to seriously question the ramifications of the existing baby market.

If, on the other hand, surrogacy is simply an alternative “family-building” mechanism free of substantial ethical risks, several opposite conclusions follow. Third-party reproduction then becomes not about money—cost isn’t an issue!—but about family creation, which is priceless. Dr. Kim Berman of Growing Generations said that surrogacy is a “relationship, not a business transaction.” Victoria Ferrara of The Ferrara Law Group reminded the audience that “we don’t want to think about this as buying a baby.”

She’s right: we don’t. So instead of a business transaction or baby selling, third-party reproduction becomes a “journey” in which surrogates (whom one participant dubbed altruistic “angels”) give families the “ultimate gift”: a child (genetically-related, of course). Money is sidelined in favor of more profound concerns.

In addition to “journey” and “gift-giving” rhetoric, libertarian ideals about individual choice were a pronounced theme. From the idea of personal “choice” family-building flows unfettered personal “choice” in a variety of more particular decisions. You can choose to have pre-implantation genetic screenings, and choose whether or not to terminate the pregnancy based on the results. This is about your family, nothing more. You can choose to practice sex selection—or, as those at the conference would say, “family balancing.” You will not singlehandedly reinforce society’s devaluation of female-bodied people. You can choose to pay a premium for a Caucasian egg donor rather than an Indian one. You are not personally upholding systemic racism.

Indeed, slides presented at the conference routinely mentioned sex selection, screening for Down syndrome, and paying more for certain traits in “high demand” without even hinting that such practices might be problematic. In fact, the nonchalance with which they were referenced can only indicate that the speakers were confident their audience wouldn’t object. These practices are now a part of the myriad options open to the rational individual consumer, appropriate choices in the free market surrogacy agencies would like to pretend doesn’t exist.

On the surface, then, surrogacy is a journey that simply fulfills parents’ desires for children. But the interplay I witnessed between the “happy family” rhetoric and the many doses of caution reflect the complications bubbling beneath.

Image via Wikimedia Commons

Previously on Biopolitical Times:

• "Eggsploitation: Maggie's Story" Reveals Unknown Risks of Egg Retrieval
• Ohio Abortion Bill Stokes Old Tensions between Disability and Abortion Rights Advocates
• Stars, Bars, and Embryos