Surrogacy is marketed by the idea that it will succeed where all methods of procreation have failed. But what happens when it doesn’t, and who pays the cost of failure?
The Indian industry of commercial surrogacy has often been called exploitative for ‘commodifying’ the bodies of women in the global south. Activists and policymakers in India have debated the practice at great length in recent years, with many promoting either strict regulations or a complete ban on surrogacy for overseas clients. Such discussions around commercial surrogacy, however, revolve around the rights of all the relevant actors when things go ‘right’—i.e. what should happen in the course of a regular surrogacy arrangement involving recruitment, conception, gestation, and relinquishment. What often fails to be considered are the ‘failures’ occurring during the course of the process itself. Not all in vitro fertilisations (IVF) performed as part of the commercial surrogacy process result in successful pregnancy conceptions; and not all surrogate conceptions lead to childbirth. But a systematic silence around missed conceptions, miscarriages, foetal reductions, selective abortions, foetal deaths, and even the deaths of surrogates prevents these possibilities from becoming relevant factors in the surrogacy decision making process.
The Indian surrogacy industry constructs, as part of its marketing strategy, a narrative of ‘success’ that deliberately suppresses the possibility of failure. This makes it unlikely that intended parents will give these issues due consideration. The exaggerated success rates and stories of success that dominate the websites of Indian surrogacy clinics and agencies offer a sense of security to the intended parents, establishing their faith in the technocracies involved in surrogacy. At the same time, assurances of success from ex-surrogates convince potential surrogates to take up surrogacy and re-plan their future around its outcome.
The verbal assurances and personal touches of these clinics do more than anything else to set the minds of both the intended parents and surrogate mothers at rest, including real or virtual tours of clinics, IVF labs, and surrogacy homes and hostels. Since surrogacy is usually the last option for achieving a ‘genetically’-related child, most intended parents demand guarantees or some kind of assurance before embarking on the process. Surrogates, on the other hand, opt for surrogacy only after being convinced of the safety of the procedure as well as of their ability to gestate and deliver a healthy child. The knowledge regarding the possibility of complications, or the use of invasive procedures to reduce the number of gestating fetuses or to induce abortion, hold the potential to drive both intended parents and surrogates away. As a result, the surrogacy industry consciously eliminates any discussion of failures from its daily discourse in order to better promise a smooth surrogacy experience.
Even though both surrogates and intended parents are likely to know something about pregnancy loss from previous experience—being heterosexual and having undergone fertility treatment—a few words of optimism are usually enough to keep them from probing too far. Moreover, agencies sell themselves as the gatekeepers of success by constructing a climate of additional risks, for example by suggesting that surrogates are unreliable and capable of ‘spoiling’ the pregnancy unless they are monitored. Risks are thus constructed to justify the governance of surrogates, which allows agencies to maintain their control over the industry and to charge a higher price tag for ‘managing’ risks. This ‘quality assurance’ also makes it possible for the industry to manage the anxieties and doubts of the key actors and to direct their minds towards a single positive outcome.
This silence takes place with the complicity of the vetern surrogates who have themselves experienced or witnessed a miscarriage or foetal reduction. Despite seeing this first-hand, if they return for a second round they usually adapt themselves to the unsaid norms of the industry and seldom share the experiences of loss or disruptions that they might have witnessed. Such deliberate silence leave new surrogates and intended parents unprepared for the many types of disruptions that can take place during the course of surrogacy. The consequence of this, of course, is that when crisis strikes the key actors remain unsure about their rights and responsibilities, and what to expect from the other actors.
Missed or failed pregnancy conceptions after an embryo transfer is common; something I witnessed multiple times during my fieldwork. But, since the established norms of the surrogacy industry hold that the job of a surrogate mother only begins only at conception, her ‘liminal embodiment’ of the embryo and her attachment to the ‘liminal’ entity remain unrecognised. Many remain unsure of the precise nature of what has been ‘lost’, but they nevertheless often experience immense grief at the disappearance of the liminal entity and the promise of a better life that came with it. This grief is compounded by the absolute need for silence, precluding any open acknowledgement of this loss. To do otherwise would expose their emotional attachment and dismiss future opportunities for being a surrogate again for the same or even different couples. The intended parents, meanwhile, experience a ‘disembodied loss’ with every missed conception that only adds to the failures they experienced in their course of fertility treatment. Although their losses are recognised by the surrogacy industry, their grieving is not offered much space. Their losses are normalised by dismissing them as an unfortunate yet commonplace occurrence. Instead, they are encouraged to ‘stay positive’ and prepare themselves for their next cycle.
A successful conception, on the other hand, marks a new beginning that enables the key actors to plan their lives around the next nine months of gestation and beyond. But instances of miscarriages, foetal reductions, selective abortions, or foetal death often disrupt these reproductive journeys and shatter the hopes and dreams of these actors. Due to their unpreparedness, the intended parents fail to foresee the chance of miscarriage or the possible implications of multiple transfers. Hence, they are often confronted with the sudden event of a miscarriage or with an unexpected decisions regarding foetal reduction or selective abortion.
Lack of prior discussions leave a surrogate feeling betrayed by her own reproductive capacities. Since the nature and possibility of risks is only partially ever explained to her, the surrogacy industry fails to protect her autonomy and rights over her own body. Disappointments for the key actors during surrogacy are likely because, instead of finding ways to improve upon the pregnancy experiences of the actors and address their needs, the industry ignores all disruptive occurrences and tries to present surrogacy as a ‘perfect’ experience. Past failures are usually isolated from the present and individualised, with the specific sperm, ovum, or surrogate to blame. The meaning of what assisted reproductive technologies (ARTs) can offer changes for the key actors due to the severing of the hopes and dreams they attached to the procedure.
Although these disruptions have both emotional and financial implications for both the surrogates and the intended parents, the loss for the surrogates is particularly acute as they are denied a large portion of their agreed upon compensation in the event of a failure. Only successful childbirths result in 'complete' payment—surrogates are paid through monthly installments but almost 75% of the promised amount is scheduled to be paid at childbirth. This reflects the overall power relations and bio-politics of the surrogacy industry, in which the healthy bodies of consenting adults are put to work until they fail, at which point they are replaced. This mitigates, manages, and quite often erases physical complications, loss, grief and moments of crisis.
The surrogacy industry is thus able to function efficiently by concealing the potential risks of pregnancy on the one hand, and governing surrogates through constructed narratives of risk on the other. Furthermore, the incentives that exist for all stakeholders to help mask failure opens up new spaces and instances of sufferings. With the rapid spread and shift of the market of commercial surrogacy around the world, the ethical debates need to focus upon this deliberate elision of failure from the dominant narrative.
Correction: the second to last paragraph of the original version of this article incorrectly stated that "only successful childbirths result in payment." This has now been changed to: "Only successful childbirths result in 'complete' payment—surrogates are paid through monthly installments but almost 75% of the promised amount is scheduled to be paid at childbirth." (19 Dec 2015)