Outsourcing Baby-Making in India

It's a typical story in our global economy: Citizens of wealthy nations hire Indians to provide goods and services that cost less than the same goods or services domestically produced. But in the case of "reproductive tourism," the Indian laborers are surrogate mothers who literally labor on behalf of foreign couples. They are paid to 'host' babies who are later carried home to the U.S., Britain, Israel, Australia, and other developed nations.

One expert recently referred to reproductive tourism as a "global growth sector," with India leading the trend. (Reproductive tourism is not limited to India. British women regularly travel to U.S. fertility clinics to access a larger pool of donated eggs, and Indian-style surrogacy programs are springing up in Guatemala.) Fertility clinics in India market their services by offering foreign clients travel services so they can sightsee while in India for an IVF cycle or retrieving their baby. The clinics also recruit surrogates, usually poor Indian mothers; help clients obtain donor eggs and sperm; perform in vitro fertilization (IVF); house, feed, and provide medical care to surrogates during their pregnancies; and deliver babies.

Advocates for this business claim that everyone wins. Childless couples get the babies they long for, and surrogates receive income for better housing and education for their own children. But it's not that simple. Indian surrogates must live in special housing while they are pregnant. They are well-fed and taken care of, but what does it say about whose families are more valuable when Indian mothers are away from their own children for months while they gestate babies for wealthier foreigners? According to a recent Slate article, many of the women cannot read their surrogacy contracts. Those from higher castes are paid more than those from lower castes, and surrogates are paid only if they deliver a living child.

Two scenes from the HBO documentary Google Baby illustrate the injustice and heartbreak in the fertility tourism boom. In one scene, an Indian woman who recently gave birth to a baby for a foreign couple sits by her husband as he talks about the difference their surrogate payment has made, allowing them to buy a house and other comforts. He says he expects his wife will serve as a surrogate again. He says that, although women's brains are generally inferior to men's, his wife made a good decision. The wife, who admitted in an earlier scene that handing the baby over right after birth was very painful, listens in silence.

In another scene, an Indian woman is on the operating table, giving birth via C-section. She says she can feel the doctor cutting, and it becomes clear that her anesthesia is not working. The anesthesiologist puts something into her IV line and soon, she is lying still, sedated. One doctor standing by her head pushes hard on her belly over and over, as if he is kneading a stubborn loaf of bread. Another doctor pulls the baby out. Immediately after delivering the baby, the doctor answers a phone call while a staff person wraps the baby and takes her away. The baby's intended parents will not arrive in India to pick her up for several days, so in the meantime, the staffer will care for the infant.

The surrogate lies on a stretcher, her eyes dazed and vacant as her husband holds her hand and strokes her hair. A baby was just born, an event that usually brings people together. But all of the parties involved are essentially alone, disconnected from each other and from the central event of the baby's birth: The doctor takes a phone call, the surrogate woozily recovers from sedation, the intended parents make travel plans, and the baby is whisked away.

In researching reproductive ethics, I come across those who scoff at the possibility of "designer babies" in which children are manufactured to meet cultural expectations. Many insist that such fears are overblown, because the public would never accept such violations of human dignity. Certainly most fertility patients set out to build a loving family, not exploit poor women or manufacture a child to their specifications.

But as reproductive technology grows in scope and capability, it raises significant moral questions that deserve our attention (as I wrote about IVF two weeks ago). Fertility tourism might be one area of reproductive ethics where conservative Christians, who traditionally focus on the sanctity of human life, and liberal Christians, who traditionally focus on human rights, particularly for women, can speak out together for justice and compassion. We don't have to project some dystopian future to witness instances in which human dignity—the dignity of Indian mothers serving as surrogates and the babies they deliver—is violated by clinics, entrepreneurs, and aspiring parents who are turning procreation into a fee-for-service market.