I’m sure many of you saw and read this story that was in the NYT a couple of days ago. The headline (“Coming to US for a Baby, and Womb to Carry It”) doesn’t really do it justice. While it is, in fact, a story about the US as a destination for what is sometimes called reproductive tourism, it isn’t only that. It’s full of interesting little points about surrogacy and many of the hard questions surrogacy raises. From my point of view, this makes it hard to know where to begin. So I guess I’ll just dive in……
The article does a nice job of at least touching on some of the issues that can arise with surrogacy. So, for example, the question of compensation is raised. Do you pay a surrogate? How much and for what? Perhaps it isn’t clear that even within the US there’s enormous variation on the approach to compensation–from making compensation illegal to facilitating it.
Does the exchange of money mean that surrogacy exploits women? Or is surrogacy by itself, even if altruistic, exploitative? That’s the assertion of Dr. Ingrid Schneider, who is, I think, justifying the German ban on using IVF to transfer and embryo to any woman other than the one whose egg was used:
“We regard surrogacy as exploitation of women and their reproductive capacities,” Dr. Schneider said. “In our view, the bonding process between a mother and her child starts earlier than at the moment of giving birth. It is an ongoing process during pregnancy itself, in which an intense relationship is being built between a woman and her child-to-be. These bonds are essential for creating the grounds for a successful parenthood, and in our view, they protect both the mother and the child.”
I take it this means that in Germany not only is purely altruistic surrogacy (gestational or traditional) illegal, but the ban seems to also encompass any woman using a donor egg. That’s quite different from places where surrogacy can be altruistic but not compensated.
I suppose all I mean to suggest here is that there are many different ways to draw lines and many ways to think about why to draw lines in particular places. Do we care most for children? For the surrogates? For women generally? For couples who cannot have a genetic child without surrogacy? And what justifies our choices?
As is always true, anecdotes play an important roles in shaping our views–and indeed, they are deployed for that purpose. So there’s the story of Heather Rice, an Arizona surrogate. I won’t summarize it–I think you need to read it to appreciate the power of the story.
But what do we learn from it? That surrogacy can go terribly wrong? (It can.) That intended parents can find themselves in much deeper waters than expected? (Sometimes they do.) That surrogates can feel or be badly treated? (They can.)
I can certainly see all of those lessons there. But is this a typical story or a cautionary tale? And is there fault lurking somewhere? Can we avoid situatios like the one described and if so, how?
What I most want to know is who set up the surrogacy and what kind of screening/counseling that entity provided. Did the agency properly prepare the surrogate and the intended parents for the possibilities of very difficult choices? Did it help them forge a positive relationship? Because this, it seems to me, is the minimum we must expect of any agency or individual who makes their living arranging surrogacy.
I’m very struck by the comments of Andrew Vorzimer–who, if you do not know it, maintains a very good blog called The Spin Doctor. Again, I won’t summarize–you should read for yourself. But let me note two striking things he adds to the article.
First, there’s at least one instance recited in which Vorzimer said “no” to an intended parent. This highlights a point too infrequently made: If we’re going to have surrogacy (and truly, for the time being it seems to me we are surely going to have it, at least in the current patchwork form), then we need responsible people to run things.
Second, when we think about the risks of surrogacy I think lots of people think about surrogates who change their mind–like Mary Beth Whitehead in Baby M. Thus, we devote time and attention to preventing that potential problem. But this may be misplaced concern:
Since the Baby M case, the common wisdom has been that the main risk for parents is the surrogate’s changing her mind. But Mr. Vorzimer, who has tracked problem cases in the United States over the years, said it was the reverse: Trouble most often starts with the intended parents. One intended mother decided, well into the pregnancy, that she could not raise a child that was not genetically hers. Another couple, after a divorce, offered the surrogate mother money to have an abortion.
Over the decades, Mr. Vorzimer said, there have been 81 cases of intended parents who changed their minds and 35 in which the surrogate did
What this tells me is that if one supports surrogacy we need to spend a bit more time worrying about the intended parents and their follow-through instead of focusing all our worries on the surrogate.
I know that I’m not very organized here–too many ideas shooting off in all directions. But perhaps that’s exactly what makes the article interesting.