By Sneha Singh

“I am helping someone fulfil their dream of becoming parents. They have a need and so do I. It helps me pay my bills. I don’t think there is anything wrong with this,” says Leela, a woman from Nepal who moved to New Delhi to find a job. Leela’s story is similar to many other surrogates who were brought in contact with a local surrogacy clinic in Delhi through an agent.

Is it right if a woman decides to become a surrogate if that is the only way to feed her family?

The topic is polarising. While researching and talking about surrogacy with women who have been through this experience, I was fraught with concern and unease. The  over $6 billion global surrogacy industry has been a point of debate as for many it sounds like a win-win situation –  childless couples becoming parents and surrogates getting good amounts of money in return.

There are plenty of ‘heart-warming’ articles about couples/celebrity couples opting for surrogacy, movies have been made on the topic, and everything possible has been done to glorify it. The issues of power struggles, inequality and health concerns surrounding it are always mentioned in hushed tones.

The surrogacy arrangement carries significant health and psychological risks for the women renting out their wombs. There are reports of women confined to hostels, not given any information about the health risks of procedures, especially in the developing nations.

Since this other side of the conversation does not concern the rich and powerful, this discussion does not spark much interest.

Commodification and Power Imbalances

Often, there is a socio-economic inequality between the surrogate and the intended parents, who are are mostly wealthier, older and better educated than the surrogates. Surrogates are vulnerable to exploitation and the violation of their human rights, as well as having their health concerns, which might crop up during the antenatal, intrapartum or postnatal care, to be completely ignored. Not just a women’s body is commodified, this transactional arrangement turns them into disposable beings, a machine.

Just like sexual assault, prostitution and domestic violence cases, the surrogates who face exploitation rarely come out to speak and lack the means to challenge the wealthy. The industry lacks transparency as most of the clinics either operate underground or via the word of mouth of agents, who also take a huge cut from the money that is paid to the surrogate.

Just a Womb on Rent – Health Risks Surrounding It

At one of the biggest surrogacy facilities in India, Akanksha Hospital in Gujarat, surrogates get paid around $6,230 for a single baby. This money is paid in instalments, and in a case of a miscarriage the surrogate receives what she has been paid up to that point, plus an additional amount, around $135.

Most of these women are vulnerable and not well-educated. Hence, this arrangement looks like a ‘work’ opportunity and they are quick to agree to the medical procedures without completely understanding the health risks. There is difference between consent and informed consent. In cases of surrogacy, there is a lack of informed consent.

These women are unable to read and understand the contracts, hence there is a complete dependency on the ob-gyn or the fertility doctor and the intended parents. This could mean, in some cases, the health of the foetus can be prioritised over the health of the surrogate. In many cases, it was highlighted that a number of surrogates get a C-section, which is considered convenient for the intended parents so that they don’t have to wait around.

Many surrogates also choose to live away from home for the duration of their pregnancy. “I just told everyone in my family that I was going away for work. Being pregnant without a husband would have only given rise to a lot of rumours and they would have understood that I am just renting my womb. This has helped me lead a comfortable life,” said Lakshmi (name change), who has experienced this process twice.

There are documented medical and psychosocial risks to surrogacy. Loss of fertility, kidney disease, premature menopause, cancer and blood clots are just some of the health risks involved and since there is a lack of data on the short and long term effects of it, true informed consent is unattainable. Thus, women from the disadvantaged sections of society remain easy targets because they will not ask questions.

Let’s Talk Ethics

Because of the gendered nature of surrogacy, it triggers some important concerns surrounding bodily autonomy, inequality and rights. Do surrogates have the complete autonomy over their body when they are carrying the foetus for another couple? And in a case of any disagreement between the two parties, who gets the rights to decide the fate of the child? These questions are too complex to answer, but must be discussed when talking about a complex subject like surrogacy.

The current surrogacy situation in Ukraine is a shocking example of how complex this topic is. Ukraine has been a popular choice because of its surrogacy laws. When a child is born through surrogacy in Ukraine, the intended parents are listed as the mother and father. This means all paperwork is simplified and getting the child home is much easier.

Since the war broke out, surrogate babies are left stranded with the agencies to look after them since the intended parents cannot travel to collect them. Many surrogate mothers have been told to travel to Lviv by their respective agencies on the instructions given by the intended parents. Even if they did not want to leave their families behind, they are being forced to, because they signed a contract. Again the focus is on the power dynamics that charactarises this arrangement.

While there is no shortage of moving stories from intended parents about how surrogacy helped them realise their dream of becoming parents, the stories of the surrogate mothers rarely comes to the fore. Especially the stories that do not paint a rosy picture of this transaction; stories of surrogates who suffered physical or emotional repercussions, and who face the power imbalances with the intended parents and the fertility clinics.

Money does not provide a solution to everything. It may for some, but they too pay a price for it – a hefty one. A physical and psychological price.