Surrogacy, Ethnography, and Bioethics

This week’s readings build upon various concepts we’ve discussed so far and exhibit similar themes to the movie we watched in last week’s class. Each of this week’s articles focuses on concepts of surrogacy and overarching ethical dilemmas through definition, practice, and acceptance in various populations. Shirin Garmaroudi Naef delves into gestational surrogacy’s place in Shia Islam, exploring academics’ opinions and interpreting and arguing for the importance of juridical and social factors in interpreting the use and acceptance of gestational surrogacy in Shia Islam. In this, she pays particular attention to the concepts of zina and nasab. Elly Teman fights for the recognition of unbiased surrogate experiences in research and delineates various ways in which current research on surrogate practice embodies Western ideals of natural family and motherhood that ultimately bias findings and influence public perception. Finally, Arthur Kleinman’s work presents an argument for the use of ethnography as a valuable tool in understanding the increasing number of complex bioethical dilemmas today. He references various other researchers and qualifies his own position as he asserts that bioethics should account for moral and ethical relationships. Below, I briefly summarize each of these readings and pose questions that might be of interest for class discussion this week.

Shirin Garmaroudi Naef’s chapter, “Gestational Surrogacy in Iran: Uterine Kinship in Shia Thought and Practice,” in Marcia C. Inhorn and Soraya Tremayne’s Islam and Assisted Reproductive Technologies: Sunni and Shia Perspectives discusses Shia attitudes and acceptance of gestational surrogacy through concepts of gamete donation and other assisted reproductive technologies as mechanisms of reproduction. Naef conducts her research through participant observation, ethnographic interviews, and casual conversations with patients and workers in infertility and IVF clinics in Tehran (Naef in Inhorn and Tremayne 2012, 160). She also interviewed respected religious scholars for academic perspectives on Shia practice and belief (161). She begins by discussing foundational concepts that contain the root of disagreement in matters of gestational surrogacy. Nasab, or “legitimate or lawful,” lineage cannot be the product of zina, or “adultery” (158). Shia nasab, unlike more agnatic Sunni nasab, includes equality in male and female roles and importance (158). Shia Islam’s equal recognition in agnatic and uterine kinship relations allows Naef to argue that zina occurs not through bodily fluids coming into illegitimate contact and creating an embryo, but by physical sexual intercourse between two people (158). There is flexible interpretation of Shia nasab that permits gestational surrogacy as a legitimate practice. Naef first recognizes that universal kinship relations result from bodily substances. Naef then deduces that accepting this common belief allows Shia Islam to focus arguments of assisted reproductive technologies elsewhere, such as the importance of physical contact being the true root of zina rather than conception. In order to preserve nasab, Shia practice forbids contact of donor sperm with a woman’s uterus but allows the implantation of an already-formed embryo in a surrogate’s uterus (165). After the acceptable conditions are met to prevent zina in surrogacy, however, scholars vary in their views of what uterine kinship relations nasab permits. One view Naef describes is that the mother is the woman who births the child, regardless of egg ownership (166). Others, following the more “symmetrical” view of agnatic and uterine filiation, consider a mother of a child to be the woman who supplies the original egg (167). One might relate this view to one presented by Rothman, considering a mother and father each as a “half” contributor to an embryo. A final view of uterine kinship is that maternity is established by 1) conception and 2) gestation and birth (168). A child born of a surrogate in this view thus might have two nasab mothers, one of conception and one of birth and gestation. Naef holds that these flexibilities in juridical interpretation place less emphasis on bodily substances in reproduction and more on social and physical contact to produce nasab family structures.

The second part of Naef’s chapter attempts to describe actual experiences of surrogates in Iran – their motivations for and attitudes towards surrogacy and its place in society. In Naef’s studies, surrogates in Iran expressed financial and altruistic motives for agreeing to be a surrogate (175). Research participants’ personal views also aligned with scholars’ arguments that adultery is a result of intercourse itself and not the contact of bodily substances (177). All surrogates clearly viewed sexual intercourse and reproduction as two separate worlds and acts with different meanings. I find this observation worth more consideration, as it parallels the beliefs that sexual intercourse serves a purpose greater than just reproduction. Donum Vitae shares sentiments in the significance of intercourse in marriage. Naef further concludes from this observation that “the grammar of kinship is used to maintain social order in dealing with infertility” (182). People seek sources of normalcy and definition in abnormal situations. Placing significance and interpretation on different aspects of reproduction allows people to respond to changing environments and new technologies while preserving natural order.

Turning to a more Western perspective on surrogacy, Elly Teman critiques new views towards surrogacy research itself. She challenges the public perception that surrogates quickly bond with babies they birth and wish to keep them, a belief that is often a result of one or two popular media cases (Teman 2008, 1104). The foundation of Teman’s argument rests on the importance of family and motherhood in Western culture. Any new threat to such structures will be met with opposition in various forms (1105). She argues that research on surrogacy itself is biased because of Western researchers’ ignorance, assumptions, and resistance to change. Using literature, she presents three common assumptions researchers hold regarding surrogacy. The first assumption, that “surrogates are not ‘normal’ women,” frames surrogate mothers as deviant in their maternal emotions and tendencies. Teman lists various attempts of researchers to show the deviant emotions of surrogate women, but concludes that there lacks evidence to defend the thought that surrogates contain “abnormal” traits (1106). Anything considered normal must have an abnormal counterpart, thus surrogate experiences should be considered individually with their lives and external factors taken into consideration rather than generalizing them into a larger group. The second possible assumption Teman claims researchers make, that “surrogates are ‘normal’ but have a good reason [to be a surrogate]” also fails in its attempt to justify classifying surrogates as deviant. Researchers list financial, altruistic, and reparative reasons for a surrogate’s choice to bear another person’s child. Teman explains that when researchers found little evidence supporting these cultural assumptions, they sought an explanation for the lack of association in evidence. They construct surrogates as deviant again for their motives as being extreme to justify their position that there is a morally acceptable reason for a woman wanting to be a surrogate (1107). A third listed assumption is that surrogates are victims of nature – that “nature gets the better of them.” Proponents of this suggested that surrogates must exhibit trauma or a form of loss in giving up the child they birthed. When researchers found lack of evidence supporting this hypothesis, Teman again shows that they attempted to explain a lack of association by constructing a “deviant” surrogate who tricks herself into thinking that they can detach their emotions from their life (1108). In this, researchers attempt to maintain the idea that pregnancy is a special experience for mothers although evidence suggests otherwise (1108). How might Barbara Katz Rothman respond to this assertion in Teman’s research as it relates to her feminist argument?

Teman holds that researchers fear a change to the status quo of their Western perceptions, and that they make every attempt to prevent such change to norms. Instead of being influenced by popular opinion, Teman urges researchers to be truly open to each woman’s individual experience as a surrogate. She notes that grouping surrogates into categories that might not represent all of them can have detrimental effects on current and future surrogates’ experiences, and if this is to continue as a method of ART, is not beneficial to any party involved (1110). Instead, it is important to focus on other aspects of a surrogate’s identity, such as motherhood or citizenship. Regarding last week’s Made in India movie, how does Aasia (the surrogate in India) balance her role as a surrogate and a mother (particularly with respect to Teman’s points)? What common themes are seen in Teman’s article and Aasia’s case? How does Teman’s research support or undermine the progressing use of ART as a mechanism of family formation?

Continuing with a theme of ethical research, in “Moral Experience and Ethical Reflection: Can Ethnography Reconcile Them? A Quandary for ‘The New Bioethics,’” Arthur Kleinman supports the use of ethnography as a tool in formulating and understanding bioethical dilemmas for practical purposes. He explains the difference between “moral” and “ethical,” the former being “[…] what really matters to people locally in the social processes themselves […]” and the latter being “[…] the articulation of the value-based issues in a self-aware language that aspires to universal reflection, comparison, and criticism […]” (Kleinman 1999, 78-79). Ethnography, he says, gives insight into the murky area between people’s moral and ethical worlds (78). Kleinman notes that ethnographers join people’s moral worlds and then apply situations and circumstances to larger societal understandings, and that doing this shows areas where there is lack of the means necessary to apply understanding to action. As no local moral world can be understood in a vacuum nor should it be generalized on a larger scale, ethnography allows researchers to apply general understandings in specific cases to recognize pitfalls of systems (75). They do this by gaining “ethnoethical orientation” to learn culture-specific ethical beliefs and then apply such beliefs to larger, global ethical debates (79).

Kleinman then provides examples of applying ethnography to bioethics. Among others, he discusses the work of Rayna Rapp, commending her for using ethnography as a means to discover more about impacts of amniocentesis testing and her research’s illumination of true ethical dilemmas people experience in prenatal testing – no two of which are the same (85). Rapp’s work furthers Kleinman’s claims for the use of ethnography in ethical debates because it successfully depicts a social dilemma as well as the complications it involves, and shows that national ethical policies and beliefs do not affect everybody in the same manner. Finally, Kleinman critiques his own ideas throughout his work. I appreciate that he does more than express certain limitations of ethnography – he goes so far as to question the success of using ethnography in understanding ethical dilemmas, an aspect of his paper that I believe does not weaken his argument, but makes him a more credible academic. He recognizes his limitations as a researcher and urges for further consideration of his ideas. Using prior knowledge from readings and class discussions, do you agree with Kleinman’s distinction between the “moral” and the “ethical” and his theories for the ways in which ethnography can cover the shortcomings of each? What might be ethical barriers to ethnography’s ability to do this in cases we’ve read?


Haimowitz, Rebecca and Vaishali Sinha, dir. 2010. Made in India. USA: Chicken and Egg Pictures and The Fledgling Fund. DVD.

Inhorn, Marcia C. and Soraya Tremayne editors. 2012. Islam and Assisted Reproductive Technologies: Sunni and Shia Perspectives. New York, NY: Berghahn Books, Incorporated. Accessed March 27, 2019. ProQuest Ebook Central.

Kleinman, Arthur. 1999. “Moral Experience and Ethical Reflection: Can Ethnography reconcile them? A Quandary for the ‘New Bioethics.’” Daedalus 128: 69-97.

Teman, Elly. 2008. “The Social Construction of Surrogacy Research: An Anthropological Critique of the Psychosocial Scholarship on Surrogate Motherhood.” Social Science and Medicine 67 (2008): 1104-112.