Action needed on reproductive tourism

gammy

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 [2011] 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.

 

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Rethinking the maternal bond

stuart

In employing the term ‘maternal’ we are often referring to a ‘maternal instinct, ‘bond’ or ‘relationship’ – this last being my intended use. A quick Internet search reveals the maternal relationship to be a bond between a mother and her child. The relationship is typically thought to be continuous in its development, with its foundation beginning in pregnancy and childbirth.

The maternal relationship is an important one. We need only look to examples of other non-human animals (mammals, amphibians, birds, fish, reptiles, invertebrates, etc) to understand its importance, if nothing else, for survival. Think of, for instance, the elephant mother. After 22 months of pregnancy she gives birth to a baby elephant: blind and dependent. The biological mother and the other female elephants in the group, called ‘allmothers’, care for the child until it can care for itself. For humans, the maternal relationship has been shown to lay the groundwork for social, emotional and cognitive development. As such, the maternal relationship has often been accorded a certain sacred status in society.

As the use of assistive reproductive technologies (ARTs), and the practice of adoption, proliferate, they challenge our existing conception of the ‘maternal relationship’, forcing us to re-visit our assumptions and re-engage with our existing conceptions.

ARTs are technologies that assist in achieving and monitoring a pregnancy – one of the most common being in vitro fertilisation (IVF). The use of egg donors means that intended mothers can now carry babies that are not their own genetic child; in addition surrogates can carry an intended mother’s genetic child (gestational surrogacy) or non-genetic child (traditional surrogacy). Surrogacy arrangements, in particular, challenge our conception of the maternal relationship as a bond with its foundations in pregnancy and childbirth.

Partially an attempt to protect this birth mother-child bond, in the UK when a surrogate gives birth she has an absolute right to change her mind. In the past 20 years, however, there have only been two reported cases of surrogates seeking to keep the baby that was not theirs. Studies on the experience of surrogate mothers have largely found that surrogates do not possess an overwhelming maternal bond with the child they carry. In my own research speaking with egg donors and surrogates, many women describe themselves as partakers in the process of helping intended parents achieve their goal of a baby, not as possessing a maternal bond with the child. Importantly, surrogate or adoptive children are able to have strong maternal bonds with their non-birth mothers. The maternal relationship is then perhaps not as dependent on the biological (pregnancy and childbirth) basis as its definition suggests.

The use of ARTs is also contributing to a growing number of single and same-sex parents. If the maternal bond is as sacred as the status it has been accorded, then what of the children of, for instance, same-sex male partners? (And on that note, what of the children raised solely by their father for various reasons, including maternal death?) Are they all emotionally and cognitively deprived? The answer is no. Perhaps this is because the paternal bond can substitute as a replacement for the maternal bond. Or, perhaps the maternal relationship (or at least elements of this relationship) is not limited to one between a child and the female sex.

Returning to the example of non-human animals, let us look for instance at the example of Marmosets – Marmoset fathers lick their newborns as their mother recuperates from the pregnancy, and then feed and carry them. Other examples include male penguins that watch over the fertilised eggs, going months without food, or the Hardhead catfish that carries around fertilised eggs in his mouth also foregoing meals. Facets of these relationships – nurturing, caring, gentleness, and being the prime caregiver – are all qualities attributed to the maternal relationship. When we speak of the maternal relationship we are perhaps referring to a set of traditionally feminine characteristics that are in fact possessable by both male and female. If that is the case, then a maternal bond is thus not necessitated by the relationship between a child and a particular biological sex: female.

It is important to clarify that I am not arguing that the maternal relationship does not hold extraordinary meaning. To do so would be to disregard a history of evidence of its importance among humans and non-humans. Most importantly, it would disregard the significant relationship that many women – as the primary caregivers – develop with their children. This is not my intention.

My wish is to highlight how the rising use of ARTs is re-shaping our existing framework of reproduction and parenthood. The use of ARTs is providing new sociological evidence that challenges the existing conception of the maternal relationship as having a basis in biology. Whether this will have a positive or negative impact is yet to be seen.

*Katie Hammond [2011] is doing a PhD in Sociology at the University of Cambridge, having completed an MPhil in Multi-Disciplinary Gender Studies. This article was first published on the Mapping Maternal Subjectivities, Identities and Ethics blog. Photo credit: Stuart Miles and http://www.freedigitalphotos.net.