Week 9: Surrogacy

Tiara Lewis-Falloon

Seeman, REL-358

March 20th, 2023

Week Nine: Surrogacy

        In class, we have discussed how many people, regardless of religion or not, are skeptical about reproductive technologies. Technology is definitely used during the surrogate process–but so is another human’s whole body for nine months–which is why I feel like it carries more pressure in regard to maintaining ethical practices. I did some light research about surrogacy after watching the film we watched in class, Made in India, and I discovered that there are two types of surrogacy: gestational and traditional. In traditional surrogacy, the surrogate undergoes intrauterine insemination but uses her own eggs. In gestational surrogacy (for a heteronormative couple), the mother’s eggs are retrieved and the father’s sperm is retrieved, and an embryo is made in a lab. A few of these embryos are then implanted into the surrogate until they give birth. There were a lot of themes present in this film that touched on different topics we discussed previous to the semester and left all of us with so many questions, including myself.

        After watching the film, it left many people in the room with mixed emotions–uncomfortable, upset, and even impartial. One question that we discussed at length was debating if the work itself was exploitative. Lisa and Brian knew that they could not afford these services in the US, so they outsourced to India where they could try eight to nine attempts of trying to get pregnant there for the cost of one attempt at home. On the other hand, Aasia admits that she is going through the process of being a surrogate because her poverty and illiteracy limit the work that she can do to make money for her family. This imbalance of power is concerning ethically and was something that made me personally uncomfortable. Last week we discussed how the ‘gift of life’ should be an altruistic and spiritual act in order for it to be valued and ethical. If someone feels as though they are obligated to complete the deed, it is not not considered to be altruistic, or within Buddist values. In this case, Aasia felt somewhat obligated to preform this duty due to her circumstances. She literally did give the “gift of life’ but not in an altruistic fashion. The question that I still do not have the answer to is–is this exploitative if people are willing to do these jobs for less money, and where do we draw the line?

        Another ethical issue that arose for me while watching the film was the lack of informed consent it appeared Aasia gave throughout the whole process. Due to cultural normalities, Aasia needed her husband’s signature to proceed further with the process of becoming a surrogate. He was not supportive of the idea of his wife ‘being impregnated by another person’, which is similar rhetoric that we saw in Inhorn’s, He Won’t be My Son. He did not feel that it was right that another man’s ‘seed’ was going to be inside of his wife, but she proceeded anyways with the help of he sister-in-law. Aasia then lied to her husband about the process to receive his signature–which I am not convinced that she truly understood herself anyways–and went forward with the implantation. Once he realized she was pregnant, he was disapproving but mentioned that they would not get rid of the child because that would be a sin; however, he did not want her to go through this process again. When asked about the process initially, Aasia claimed that she was told that she would be given medicine that would somehow make her pregnant. She was very scared when she realized she was pregnant with twins, something that is common with these treatments, which also makes me believe that she was not very informed about each of the processes.

        Near the end of the film, Aasia was held at the hospital for a few days due to an emergency C-section, and wished to get paid more. The couple noted that they were willing to pay her a little more, but did not have the money she was asking for. Throughout the film, it was evident that there was little to no representation of surrogates when it came to making decisions. What was particularly jarring to me, was at the end of the film where they showed Rudy, the third-party business man, and a doctor at this conference about procreative/medical tourism, but there was nobody there representing the voices of the surrogates. I was curious about if there were any updates on the matter since the film was from over ten years ago, and so I did some research and had some interesting findings.

        There are two new acts–the Surrogacy Act and the Assisted Reproductive Technology Act. The Surrogacy Act banned commercial surrogacy, meaning that it could only be allowed in “cases of altruism” from a relative who is already a mother. This act moreso aligns with the values and ideals we read about last week, but now there is a question of if a feeling of obligation blurs the altruism. The surrogates are not allowed to receive any money and ART can only be used for Indian heteronormative couples or single women who are widowed or divorced. The ART act established that there will be a national registry to oversee clinics and banks to regulate the conditions of usage. There has been backlash about the lack of inclusion with who can benefit from ART in India–only infertile indian heteronormative couples–and why can’t the women be paid for their labor. These were put in place with the goal of preventing exploitation, but some women are upset about how it affected their job opportunities. Is there a right way to handle this?


https://reproductiverights.org/assisted-reproduction-and-surrogacy-in-india/ https://timesofindia.indiatimes.com/city/chennai/surrogacy-act-is-a-law-with-a-flaw-heres-why/a rticleshow/95115675.cms


13 thoughts on “Week 9: Surrogacy

  1. Hi Tiara.
    This was great. It was cool that you looked up those two surrogacy acts to go along with your blog. And it was also good that you talked about the Buddhism and altruism that we went over last week. I do believe that it is an interesting debate to talk about altruism in the case of Aasia. She was not being selfless, or maybe she was in a way. There are degrees to these kinds of scenarios-what I mean to say is that maybe the benefits that Aasia was to gain here were much less than the risks that she was taking in relation to the fact that to the Switzers, the financial burden to them was much less than the benefits of getting this baby. The real thing to cnsider is how people are valuing and evaluating these cost-benefit ratios in making these decisions. Because if Aasia’s money that she was going to get mattered so much more to her than any risks, then in Buddhist terms, I do not think that she is being altruistic. That though leads to another point that you made-Aasia was not well-informed on what all she was doing and the associated risks. She really got screwed. But in the end, she did the Switzers a great service-and I think the Switzers understood that the best they could how much this woman went through for them.
    I also like how you talk about Rudy, the third party doctor/businessman. I do think that it was a little odd when he just started listing these low-income countries as his destinations to expand his business. But at the same time, if people want the money, and they do not care if its exploitative, at least not caring enough to refuse their offer, then I do not think that it is right for observers to deny them this chance to better their lives. But again-like you highlight, informed consent is key.
    Good job :)!!!!!!!!!!!!!!!!!

  2. Hi Tiara, thanks so much for your thoughtful and insightful reflection, I really enjoyed reading it! I also really appreciate the outside research you did to help contextualize some more of the concepts and applications of what we saw in the film. I think the topic you brought up about informed consent is crucial and also something that will be very interesting to discuss in class tomorrow. From my Western perspective, my instinct is to feel strongly that someone should be thoroughly briefed on what will occur with a medical event, the risks, the benefits, etc. So, when watching the film, I was obviously a bit disturbed by the lack of knowledge that was seemingly not given to Aasia before she took on this surrogacy. I do wonder if there are different cultural norms surrounding informed consent, though. I am getting a little broader than just surrogacy here, but I wonder if other cultures feel as though it is somewhat the responsibility of the patient to understand what will be occurring medically and if an informed consent signature carries less weight in other countries? I would be curious to know if anyone has any perspectives on this and I think this concept of informed consent would apply a lot throughout this class. I think it is necessary and important, but I have known nothing else with every medical encounter I have ever had. Thank you again for your thoughtful post Tiara and I look forward to discussing further in class tomorrow.

  3. Hi Tiara. Thank you for sharing such a thoughtful reflection. I found your outside research especially interesting and illuminating. In class, we discussed the contractual nature of surrogacy, and how Aasia wasn’t in the end paid enough for everything that she experienced. I agree with this, and I definitely think one of the things the film showed was how Aasia was being exploited in a monetary sense. My initial reaction, however, was that there was also something kind of off-putting about surrogacy being so contractual. It seems strange to me to think about the body as something that can be “rented.” Isn’t placing monetary value on the body or labor done within or by the body inherently a little exploitative and objectifying?

    All this said, I really like that you bring last week’s readings about altruism into the conversation, and connect it to your research on the updated policy. We can talk about exploitation of the body, and about the alternative of altruism, but those alternatives aren’t ultimately applicable to the world that we live in. I think you ask a good question in the end—is there a way for surrogacy to exist in a way that doesn’t burden anyone? Again, I think this returns to the idea that there isn’t really a solution per say—maybe just giving certain people (especially, as you point out, surrogates themselves,) more room to speak and work towards a way of solving problems that is more just.

  4. Hi Tiara!
    I really enjoyed your highly insightful post, and I really appreciate you staying current on the topic with the mention of the two new acts passed in India recently.
    Personally, I feel as though commercial surrogacy is extremely exploitative. I think it mainly comes from people like Rudy in the documentary who know that women in poorer countries are willing to carry these babies for less money than their American counterparts and start businesses based on this model. The couples shoulder at least some responsibility, though. I do not think that seeking a surrogate is itself a problem, but the way that they go about choosing the surrogate is problematic. Lisa and Brian knew that they could not afford a surrogate in America, so they chose to go to India for the process. However, the reason the prices for surrogate mothers are so high is due to the process of carrying a child being a brutal and unforgiving one, with many systems in place to maintain the health and happiness of both parties. To acknowledge this and choose to pay someone significantly less money solely because they reside in a poorer country is, in my opinion, exploitative. However, I think Lisa and Brian realized why the process is so much cheaper when they were faced with legal issues, less-than-ideal medical care for Aasia, and a lack of communication from all parties involved.
    I think the new laws passed will be initially jarring for those that normally participate in the surrogacy practice and potentially affect their means of making a living, and I acknowledge that this will have a negative effect. However, long-term effects of the laws will prevent foreigners from coming to poor countries and finding a surrogate because they do not want to pay the amount of money required for reasonable care in their home country.

  5. Hi Tiara! Thank you so much for this response – I appreciate your extra research on this topic, as surrogacy is constantly evolving and we cannot truly evaluate the ethics surrounding it without current information. I agree that Lisa and Brian’s choice to outsource a surrogate is problematic on many levels, but I think that it points to a bigger issue in the American healthcare system: why is surrogacy so much more expensive in the United States? Are there ways that we change our health system infrastructure to lower the cost of this process? Is outsourcing medical care ethical in any scenario? I feel that there are similar broader issues in Aasia’s case, but we must account for cultural relativism: is it ethical to provide a service (such as surrogacy) purely for financial compensation? How can we improve education outcomes for women overall to improve access to information? Should a woman have to involve her husband in a process like surrogacy? I was a little disappointed by the new legislation you shared because I’m not sure that it is accomplishing what needs to be in order to make surrogacy safer and more equitable. Again, thanks for your post! I look forward to our discussion.

  6. Hi Tiara, thanks so much for this response to our film this week! I love the connections you made between the film for this week and our readings for last week. As I wrote last week, I have a difficult time understanding why a person should be specifically obligated to give “the gift of life” in an altruistic manner. I think the conceptualization of gift is helpful here in understanding my logic. There are tons of individuals who are ‘gifted’ singers, dancers, actors, or anything else. But we don’t ask that they give their gift in an altruistic manner; rather, we know that all of those folks earn money and fame for their gifts. I just fail to see why the gift of life should be any different. If I’m given a gift, that should be mine to give, regardless of whether I choose to do it altruistically or for my own benefit. However, I do think your concerns about potential exploitation in this case or in similar cases make sense. Regardless of the fact that it should be one’s right to give the gift of life, its clear that if they are induced, they should be getting a fair trade for their labor and suffering. Overall, I think that these problems are more products of the systems that any of the individuals or small organizations that we see in this film. While a case could definitely be made that the clinic and Planet Hospital should be acting more ethically, we can’t necessarily expect these businesses to do so. Rather, the Indian and US governments should be acting to regulate these third party providers and clinics, and provide protections for surrogates and birth parents. I think that having these governments step up and act will make a huge difference for all the concerns that exist here.

  7. Hi Tiara! Thank you for your contribution to our discussion about surrogacy this week. I think that the beginning of your paper made an important designation that the surrogacy process is already complicated for heterosexual couples, and bringing couples who exist outside of the heteronormative into this conversation can shed light onto new and additionally complex considerations. This is a relatively new concept given that the United States only recently legalized same-sex marriage and adoption in all fifty states in 2016. Regarding the experience of Lisa, Brian, and Aasia that we all watched during the documentary, I think that your words captured how we all felt. Discomfort was certainly common, and in more ways than one. We were uncomfortable with the power imbalance that you mentioned, with the lack of cultural competence, with the financial situations of both intended parents and the surrogate, and with the legal loopholes that were jumped through in order for the process to be completed. It is impossible to frame this situation in a way that is not exploitive; however, situations like this will continue occurring into the future regardless of ethicality due to greed, disregard for ethics, and a lack of regulation on what is ultimately a moral issue. I think that Aasia was lucky that she had a sister in law who advocated for her and helped her through the process. I also think that she was lucky that her husband did not abuse her or hurt her out of anger for what she had done, indicating that she had some sort of autonomy and knowledge about what she was going to be putting herself and her family through. It is important to not that this may not be the case for most people, and Aasia’s story might be the best case scenario for overseas surrogacies. Those that die, are ousted, or abused in the process may never be known.

  8. Tiara,
    I like how you really dove into what made you uncomfortable in the film and proposed solutions for it. I also agree Aasia was not under informed consent, and I can only imagine how scared she must have been. It feels almost as if they didn’t see her as a human, but instead as a uterus, or an object. It makes me question if there were racial motivations behind the lack of informed consent. I think Planet Hospital did not handle this case well at all, and they are definitely not the model when it comes to what legal surrogacy should look like. Referring to your last paragraph, I don’t think altruism can really exist in the case of surrogacy, especially with The Surrogacy Act. If you see a relative struggle with infertility for a long time, and the only way they can have a child is if you are their surrogate, of course you would feel obliged to carry their child. Whether you want to or not, you will feel a sense of obligation that will impact your decision. And if you end up carrying their child, you may feel a sense of contentment for having done a “good deed”, or giving the “gift of life”. These good feelings are an incentive to be the surrogate, altering the effect of altruism.

  9. Hi Tiara, thank you for your interesting and insightful blog post. I appreciate how you clarified the difference between gestational and traditional surrogacy at the beginning. Your connection to the gift of life and altruism is interesting. I have the same question as you – if people are willing to engage in surrogacy is it still unethical? I have been having a difficult time grappling with this. As I mentioned in my response to Betty, I think I would be more comfortable with this if there was more education and support for the surrogates. There is an important distinction between being willing to engage and fully understanding what you are engaging in. For the act that banned commercial surrogacy – does this mean that what the Switzers did is now illegal? If this is the case, I wonder how this has impacted the industry. I assume these kinds of cross-continental partnerships are still happening under the table. I worry that they are more dangerous and there is less support for the surrogates because they would have a fear of retribution for disobeying the law.

  10. Hi Tiara. I appreciate how you explained the two main types of surrogacy. I also agree that this act of gifting a life was not an act of true generosity but mainly an act for monetary value. I also thought that it was unethical how Aasia did not fully understand the surrogate process. I believe that it should have been the surrogacy firms responsibility to ensure that she fully understands the process and risk that comes with it, since pregnancy can be a life taking toll on someone. It also saddened me how Aasia decided to go through a scary process that she did not fully understand and would take the pills that the firm gave her even though she did not know what it would do to. She took all of these actions that had the potential to harm her physical well being because she had no choice, and this is a reflection of a bigger problem which is the high poverty rates in India. I also found it shocking that there was not much representation of the surrogate other than her own family members, in this case her sister. I personally believe that surrogacy is ethical because there are many cases like this in which parents cannot have a child on their own. However, I think it was unethical for the surrogacy firm to not fulfill promises that they made to both parties.

  11. Hi Tiara!
    I enjoyed reading your post and also look forward to hearing your comments in class!
    I loved that you brought up altruism, because I feel as though surrogacy could only be altruistic if it is a family member. However, when family members do things such as adopt, surrogacy, and foster, they are not given any resources in order to make that altruistic choice sustainable. Therefore, I agree with you that this law does have a lot of gaps in terms of how much this would help. I also feel like passing this law would make it hard for women who will go through surrogacy regardless in order to get money, to get the support that they need from government level. I never thought that ethics surrounding surrogacy would make my mind do flips like it has done these past couple of weeks but it has. It has also made me think as to why children are such a commodity and whether they should be. And donna vitae does mention this theory in many ways. All children deserve and have the right to a parent, but do all individuals have a right to a child especially if the life they are bringing this child into is not done in the ideal manor. One pushback I have against this thinking, is that people can only have kids in the ideal and desire manner. However, I can see where this perspective is coming from. I also wondered after watching the film, would these children suffer any health consequences from this. For example, in one of my classes, we learned that the mothers environment is extremely important for predicting a child’s health later in life. This doesn’t mean Aasia was not living in a good environment, but the fact that her environment is so much different from the genetic parents. The babies were born low birth weight which means they are at risk for CVDs in the greater future possibly. We saw that one of the girls unfortunately died. I’m saying all of this to say, I think surrogacy is a great option for people who can’t bear their own children, but at what point do we consider pursuing this endeavor becomes unethical for multiple parties involved including the children.

  12. Hi Tiara! Thank you for your insights and reflections this week. I appreciate how you outlined specific yet overarching ethical questions from the film as well as your personal thoughts from the work. I also found very insightful your additional research on the ART act.

    I already focused on more of the ethical discussion in Betty Frances’s post, so I hope to hone in on another topic for your post. You mentioned your discomfort during and after the film. Many of us had mixed emotions, “uncomfortable, upset, and even impartial” as you proposed. Is it beneficial to tap into these emotions as an audience when digesting this type of content?

    On a related note, I recently watched When They See Us, a limited series documentary that covers the stories of the five young men in the Central Park 5. As a Hollywood piece, the series dramatizes the content, but also brings to light the importance of racial justice and the dangers of police brutality. However, with the drama of the piece comes a very strong response from the audience, emotion that can sometimes cloud and even reduce comprehension of the themes at hand.

    This being said, do you think that Made In India properly balances objective information and a subjective touch to the film? Do you see any bias toward the Switzers versus Aasia? I personally feel that the film does a good job of keeping everyone on a relatively equal playing field in terms of airtime, but I do wonder how certain elements inherently frame the piece and therefore affect audience reception.

  13. Hi Tiara, thank you for your research and insights. Your mention of Aasia’s husband is particularly interesting to me. Does informed consent mean that the surrogate’s partner is informed as well? In America, we’d likely argue that the spouse’s opinion or level of understanding shouldn’t have any bearing on what the surrogate is able to do. In other countries, this may not be the case. One of the reasons why some people might feel uncomfortable about the medical tourism depicted in the film is because of this spouse dynamic. The Switzers were a united front and were relatively highly educated throughout the process. On the other hand, Aasia did not have the support of her husband and both she and her husband lacked critical information about surrogacy (though, it seems as if Aasia’s husband had a more accurate idea of the procedure because he knew it involved another man’s sperm and Aasia thought it involved some sort of medicine).

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