Reproductive tourism also known as fertility tourism or cross-border reproductive care is a multi-dollar industry globally. It is regarded as the practice where people who are unable to conceive under natural conditions and want to seek genetic kinship and parenthood, travel transnationally more commonly to the Global South to seek various assisted reproductive treatments (ART) such as in vitro fertilization (IVF), gamete and zygote transfer, embryo transfer, commercial surrogacy or womb lending, etc. ART has transformed over the years from a secretive industry to a more socially received practice.
Today thousands of clients from middle-income and affluent families’ cross borders to seek surrogates from lower socio-economic backgrounds in hopes of conceiving their own. India is a leading pioneer in this industry, and the countries such as Thailand, Ukraine, Russia followed by Mexico, Nepal, and Poland being some of the most sought-after countries. India has legalized surrogacy since 2002 shortly followed by its boom after 2004. Further surrogacy can be divided into two parts, Gestational and Traditional with the later being the most common where the surrogates’ own ova is used and the egg is fused via artificial insemination. In case of gestational surrogacy, the zygote is donated from the parents and the women lends her womb carrying through the pregnancy.
Whereas the main motive for surrogates often lies in economic incentives while remaining oblivious to the inevitable social issues related to this international trade. Researchers have voiced their concerns about the growing demand for ART and how it is often leading to the commodification of women’s bodies, especially in low-income countries.
Motivations:
There are various socio economic, legal, cultural issues rooted in the growing demand of reproductive tourism, with the global south seen as a hotspot by international reproductive tourists. With greater desirability of genetic parenthood and kinship, ART fulfils the hope of many. Few reasons for the growing demand lie in:
Cultural expectations:
Notions of femininity associated with motherhood and childbearing still continue to permeate our culture. As society continues to operate under these systemic features women are often burdened with the expectations to carry out their maternal duties, thus straining and increasing the number of clients seeking ART.
Rapid industrialization:
As more individuals venture away from their homes and families in order to seek for better opportunities in cities. Familial roots are strained due to distance, high cost of living, busier lifestyles as a result we are relegated to our own private nuclear family homes. With the rise in nuclear families, it limits alternative forms of kinship other than childbearing.
Legal restrictions:
Inconsistency in international laws, ease of restrictions and permissive jurisdictions in terms of reproductive laws makes the global south a hotspot for international clientele. Coupled with attractive services, tourist friendly localities, lower costs, availability of people, rapid rise in technology in contrast to the legal restrictions in their own home countries. E.g., Countries such as Canada has forbidden paid surrogacy, New Zealand has lesser number of gamete donors and unavailability of certain treatments. With citizens from Europe and North America compromising highest number of reproductive tourists.
Advanced technologies and accessibility:
Due to the absence of a robust reporting system and since most donors and clients prefer anonymity it is difficult to calculate the number of people seeking these treatments. The availability of greater number of treatments, surge in medical professionals, advancement in technology and greater availability of donors and surrogates, has made India a desirable location.
Changing societal norms: Due to greater number of women choosing to delay their pregnancies, rise in single parents and homosexual couples, there is a greater demand in the market. Also altruistic sentiment among Indian women who see lending their womb rooted in a religious desire to help lift the curse of infertility from others.
Economic factors:
Due to access of a large population, more women are willing to be surrogates often times jeopardizing their own health and wellbeing for minimal money in return. Surrogates in India charge less one fourth of the cost compared to a surrogate in USA. This makes clients able to skip lengthy legals processes, bypass waitlists in their home countries, lend surrogates at a very low price. They will now be able to bear their own genetically related child, relish in this new found feeling of parenthood. But at what cost?
Ethical issues:
Commodification of reproductive services:
There is a very fine line between autonomy of a women and exploitation of autonomy in surrogates who are educationally and economically disempowered. Acknowledging the right of a women to use her body for any purpose as she pleases can be seen as exerting that autonomy to her advantage. But due to socio economic disparities women in countries such as India are often exploited for reproductive services, often times this line of autonomy is blurred. Often times coerced, taken advantage of their vulnerabilities for a very minimal amount of money and as they are blindsided, misinformed about the risks involved in carrying out such procedures.
Risks involved:
The risks involved could be of various types social, biological, psychological, emotional etc. Assisted reproductive services (ART) carry health risks such as migraine, gestational diabetes, premature delivery, miscarriage and death in extremely rare cases. Drugs used during egg retrieval could induce conditions such as ovarian hyperstimulation and could impair fertility. Surrogates carry the risk of physical scarring during caesarian section, and postpartum depression.
Carrying out such procedures is emotionally tasking for both the parties involved. For the international tourists it is navigating through complicated international legal processes and jargons, new cultural norms, bearing high costs for the procedure. For the surrogates she undergoes the possibility of maternal bonding with the child she’s bearing, facing social disapproval, rejection from family members. If autonomy is to be truly respected women undergoing such reproductive procedures should be educated about the risks involved and compensated fairly.
Widening social gap:
Such procedures and privileges seem to be reserved for the upper elites who could afford these treatments. This leaves us to question about disparities in global healthcare systems and lack of equitable reproductive services provided for all the citizens. This way financial disparities are more exacerbated.
Legal disparities:
There is a lack of standardized international regulation regarding reproductive healthcare services. While tourists prefer countries posing better laws, contracts in their favor often at the risk of surrogates. The legal contracts in place, are often times not binding in nature. Recognizing the legality of surrogate contract provides more assurance to the client and the surrogates. With countries having such frameworks in place are seen as lucrative tourist destinations for ART.
There is lack of a homogenous global regulatory framework and unified international laws regarding surrogacy. Few examples of state-imposed measures are: Israel was the first country to introduce state-controlled surrogacy. Georgia legalized surrogacy and imposed protective laws such as that the surrogate can’t exercise rights over the child. Russia prohibits all types of surrogacies except done for medical purposes. Thailand has banned foreigners from carrying out surrogacies since 2015. In India these procedures in overtly legal and the rights of the parents paying for such services are more pronounced. Indian surrogacy law requires consent from both parties, ban in sex selection, surrogates to be unrelated and preferably a stranger, prohibits selling of embryos to other countries, and more preference regarding surrogacy is usually given to heterogenous couples. Legal harmonization is required to carry such procedures in a safe, equitable and ethical way.
Way forward:
Reproductive tourism is a new yet burgeoning industry, which may pose as a boon for the host countries and provide hope and fulfilment for those who can’t conceive. There is a gap in policy formulation and reaching of a common consensus between countries due to the lack of reliable data sets.
It is important that host countries uphold high ethical standards in the form of binding legal contracts, providing privacy and autonomy to both parties involved, drafting of life and health insurances for the surrogates in case of death or injury while carrying out the pregnancy, enforcing a standard basic payment, upholding the safety and well being of the surrogates and while ensuring minimal conflict between both the parties involved. The surrogacy industry is rapid evolving, it upholds the aspirations of many expectant parents due to its inclusive nature and it will truly live up to its expectations if done in an ethically sound and righteous manner.
Honey Ngangom
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