Over the past few months, the media has been abuzz with news and international debate over the story of ‘Baby Gammy’ – the twin with Down’s syndrome who was left in Thailand with his Thai surrogate mother, who was commissioned by a West Australian couple. While some of the facts of the story remain contested, this is one of many ethically charged cases of reproductive tourism that have surfaced in the past decade.
The demand for third party reproduction – whereby a woman provides her uterus (as in surrogacy), and/or a person provides sperm, eggs or embryos in order to enable a person or couple to have a child – is on the rise. Increasingly, couples will travel to countries where laws are more permissible and/or services are more affordable to seek third party reproduction. Countries including Cyprus, India, and Mexico have become prime reproductive tourism destinations.
With the growing demand for third party reproduction, cases such as this one bring to the forefront questions about the commodification of body parts and the human reproductive capacity. They beg the question: what are the ethics of selling body parts, and reproductive labour? Should we be selling these at all? Additionally, is it ethical to be outsourcing gamete donation and surrogacy to countries, like Thailand, where labour is less costly?
A lucrative market
As this industry continues to grow, we should not close the dialogue on these types of questions. This market, however, is a unique one – at its foundation is the reproduction of life itself. Coupled with a powerful socially constructed notion of a biological imperative, and norms surrounding motherhood, fatherhood and family, it is driven by individuals and couples who will go to great lengths to have a baby. This market is a lucrative one – with the potential for high profitability for clinics and agencies, as well as for donors and surrogates. Thus, operating on the premise that for these reasons the baby business will persist, if we have learnt anything from the Baby Gammy case, it should be that our immediate focus orientates about identifying the pressing issues of this industry at the level of those involved. From there, we can try to minimise any negative ramifications for intended parents and the surrogate.
While I will not attempt to provide an exhaustive list, Baby Gammy and similar cases, give us some insight into what these issues might be. The Baby Gammy case, in particular, highlights those issues surrounding the exchange between intended parents and the surrogate. Both parties are vulnerable to not receiving their ‘goods’ (i.e. the surrogate not receiving full, or any, payment and intended parents not receiving the baby). Additionally, a surrogate may end up with a child, as in the case of Baby Gammy, that she did not intend to have. How do we ensure that contracts are created that protect the interests of both parties, and that these contracts are enforceable?
Second are those issues surrounding consent and care of the surrogate. What steps can we take to ensure that surrogates are well informed about the procedure and risks (both physical and psychological) in order to minimise the possibility of coercion and encourage informed consent. Subsequently, how do we ensure that surrogates receive proper medical care? Thirdly, there are issues surrounding the uncertain legal parentage and nationality of children born through surrogacy. Might we be able to increase transparency surrounding the process of achieving citizenship for children born of surrogacy? Alternatively, could we enable it in some instances, without opening the floodgates for reproductive tourism?
While the Hague Conference on International Private Law is considering drawing up standards and regulations for international surrogacy, this will no doubt be a long-term undertaking. In the meantime, major fertility professional bodies and leaders in the field need to take a role in promoting acceptable standards of care and addressing issues arising from reproductive tourism. The case of Baby Gammy has highlighted some of those issues that are pressing. With international attention focused on reproductive tourism, now is the time to harness this attention in order to promote dialogue surrounding this industry and take steps towards reducing harm for those involved.
*Katie Hammond  did an MPhil in Multi-disciplinary gender studies and is currently at Wolfson College studying for a PhD in Sociology at the University of Cambridge. This article was first published on Polygeia.com. Picture credit: BBC.