Surrogacy bill does not address risks faced by surrogate mothers, says researcher Daisy Deomampo

Introduced in the Lok Sabha in November, the Surrogacy (Regulation) Bill bans commercial surrogacy – that is women taking payment to be surrogates. Instead, the Bill favours altruistic surrogate arrangements between close relatives. It also bans surrogacy for single men and women, live-in couples, homosexuals, foreigners and persons of Indian origin living outside India.

Cultural anthropologist Daisy Deomampo’s book Transnational Reproduction: Race, Kinship and Commercial Surrogacy in India explores relationships between Indian surrogates, their families, aspiring parents from all over the world, egg donors and doctors in a setting marked by inequalities of income, race, nationality and gender. She spoke to Scroll.in about what the new bill means for the industry and our changing ideas of family and kinship more broadly.

How do you interpret the 2016 Surrogacy (Regulation) Bill’s emphasis on blood relations as a precondition for surrogacy?
While the bill demands that the surrogate must be a “close relative” of the intended parents, it does not specify that the surrogate must be blood related. However, what constitutes a “close relative” is not explicitly defined either, which raises questions about what counts as an acceptable or appropriate surrogate.

First, given the claim that the bill will avert exploitation of women, it assumes that hierarchies do not exist within families and that rich or more senior family members cannot compel poorer relatives to become surrogates. Social and emotional interdependence within family networks could lead to increased exploitation in the sense that a woman may feel pressured to become a surrogate against her will due to a sense of familial duty.

Second, it shows that transnational surrogacy arrangements across racial, cultural, and national lines were a major issue for proponents of the bill. Yet, surrogacy within families is deemed acceptable. In my book I show how people involved in transnational surrogacy in India rely on particular ideas about race in order to make sense of their relationships with one another. These “racial reproductive imaginaries” reflect and reinforce the ways in which hierarchies of class, nationality, gender and race bear upon the work of reproduction. While transnational surrogacy certainly intensified these inequalities, the current bill’s mandate that the surrogate and intended parents be related (and, by implication, share similar racial backgrounds) does not address unequal relationships between surrogates and intended parents, or the medical, social, and health risks the surrogate bears.

How has the landscape within India changed in terms of awareness and acceptance of surrogacy?
When I first started my research in 2008, doctors said that the majority of their surrogacy clients came from abroad. Very few Indians went for surrogacy. But increased media coverage along with several surrogacy cases involving high-profile Indian actors and celebrities played a major role in increasing social acceptance of surrogacy. When I returned to India in 2013, following the visa clause that limited surrogacy to heterosexual couples only, doctors told me that their international clientele had decreased, but business continued apace with an increasing numbers of Indian patients. Surrogates and agents also noticed the change. One surrogacy agent explained that in 2010, women seeking to become surrogates were “picked up” within a month, while by the end of 2013, the industry had slowed down dramatically. Women were compelled to work with doctors who arranged “budget” surrogacy packages for Indian couples, accepting significantly lower pay than what they would have been paid in transnational surrogacy arrangements.

However, the claim that the Bill is meant to mitigate the exploitation of poor women working as surrogates seems far-fetched. The Bill’s greatest repercussions are in the context of defining what constitutes a family, who can access surrogacy services, and who counts as a legitimate parent. By limiting surrogacy to heterosexual married couples, the Bill seeks to define what counts as a legitimate family in India, excluding single individuals and gay and unmarried couples.

Foreigners will no longer be allowed to hire Indian surrogates by this Bill. If passed into law, doctors argue it will effectively drive the transnational surrogacy industry underground. What impact will criminalising transnational surrogacy have on those involved, particularly the vulnerable Indian women who work as surrogates out of necessity?
To be clear, I observed many problems with surrogacy practices during my research, which stemmed from the lack of any clear laws or legally binding regulations. Many of the surrogates I interviewed knew little about their “clients” or intended parents, meeting them only once or twice, if at all. Surrogates wanted more information and direct interaction with them, first as a matter of dignity and respect, and second as a matter of business; several surrogates said they would have liked to negotiate their payment directly with intended parents. Ultimately, the surrogacy practices I observed offered temporary assistance to women, often helping them out of difficult financial situations, but in the long term, surrogacy did little to truly change women’s social or economic status.

The current bill does not hold great promise in addressing the inequalities that underlie transnational surrogacy. Rather than mitigate exploitation of poor women, as the bill’s proponents claim, criminalising surrogacy will serve to further deepen women’s vulnerability and economic uncertainty. Indian women who act as surrogate mothers will be most affected by the ban; the surrogacy industry will not recalibrate overnight, and unscrupulous doctors and agents will continue to facilitate transnational surrogacy arrangements under the table. The difference will be that surrogate mothers will have even less power to negotiate fair compensation for their labor.

Perhaps the most striking aspect of the bill is that it makes no explicit reference to the health of the surrogates or to the medical and health risks she bears. In my book, I write about how surrogate pregnancies are highly medicalised and involve many unnecessary interventions, including high rates of non-medically indicated cesarean sections. My findings show the impact that the lack of any regulation has on the health and wellbeing of surrogates. By focusing on criminalisation, the bill fails to address the medical and health risks that surrogates endure.

Documentaries on transnational surrogacy in India – Made in India, Google Baby – tend to portray surrogates as victims of an unjust system, coerced into surrogacy as a source of income by their husbands. You challenge and complicate this narrative in your book.
Many of the surrogates I interviewed did not fit the dominant model of the poor, uneducated, and victimised surrogate. On the contrary, women came from a range of socioeconomic backgrounds; while many completed only an elementary school education, some surrogates in my study had completed high school or college.

Moreover, the majority of the women I interviewed learned about surrogacy from a friend, acquaintance, or relative, and they took it upon themselves to learn more about the process. Husbands or in-laws did not force them into surrogacy; indeed, it was often the women who convinced their husbands to allow them to do surrogacy. In other cases, former surrogates described how their husbands supported them during their surrogate pregnancies by helping out with household chores and childcare.

However, while surrogacy offered clear economic benefits for many women, sudden financial windfalls from surrogacy payments often resulted in marital turmoil. One woman I wrote about saw her marriage become shaky as her pregnancy progressed due to the sudden change in power dynamics in their relationship. Another woman was able to save enough money – first from her payments as a surrogate and then as a surrogate agent – to purchase a home for her family. However, even though the home was paid for with her earnings, the deed was in her husband’s name alone, showing that much more than economic opportunity is needed to achieve true gender equality.

India’s first uterus transplant surgery took place last month. This push to produce “natural” motherhood and a family based on blood-ties at all cost. What do you make of it?
Assisted reproductive technologies such as IVF, surrogacy, and gamete (egg or sperm) donation certainly serve to reinforce bio-genetic ideas of kinship. In other words, assisted reproductive technologies reinscribe the notion that what counts in family are genetic connections. Rather than encouraging people to pursue other forms of family making, infertility is framed as a disease, requiring medical intervention. It clearly shows that genetic relationships are prioritised in cultural notions of the family.