Monthly Archives: August 2014

MacArthur Grant Sheds Light on Reproductive Technologies

A couple has had miscarriages, considered in vitro fertilization (IVF), discussed adoption and finally opted for a surrogate to bear their baby in India. They visit her before signing on and feel that the agency’s “gestational mothers” are well cared for and decently compensated. But how much do they really know about the practice of cross-border surrogacy?

Thanks to a recent MacArthur Foundation grant to the Center for Genetics and Society (CGS) and Our Bodies Ourselves (OBOS), the information gap surrounding surrogacy and other assisted reproductive technologies (ART) will be addressed, with an emphasis on human rights and social justice. Light will also be cast on the rapidly growing industry ARTs have spawned.

“Cross-border surrogacy raises thorny questions,” says Marcy Darnovsky, Executive Director of CGS. “Some people look at women selling their eggs or reproductive capacity as an individual right within the context of wage labor. Others see these practices as deepening gender and class inequalities in a not-so-free market.”

“Most information available in the mainstream fails to paint a complete picture,” adds OBOS’s Ayesha Chatterjee. “With faceless images of pregnant bellies, the narratives of gestational mothers remain untold. Convenience, concierge-like services and various packages geared to attract intended parents in a competitive market are what get emphasized.”

Both CSG and OBOS support ART as a reproductive choice but they are deeply concerned by gaps in evidence-based knowledge to aid in comprehensive and well-informed decision-making within a rapidly growing, mostly unregulated market that positions surrogacy as women helping women, a win-win for all.

But what is the reality for gestational mothers?

“Often gestational mothers live in communities where cultural beliefs and systemic institutional oppression/marginalization makes it hard for them to achieve financial independence and security,” say Chatterjee, co-author with Sally Whelan of an OBOS paper on cross-border surrogacy. “In India, for example, many gestational mothers are poor with little social mobility. These factors create a power imbalance that makes it impossible for them to negotiate fair ‘work’ conditions within surrogacy arrangements. It allows those in positions of power like recruiting agents and fertility clinics to get away with a range of exploitive practices.”

These practices include the lack of “informed” consent since many women can’t read documents they are made to sign, minimal compensation and unfair payment schedules, isolation from family and restricted movement outside of surrogacy “residences,” constant monitoring, high risk medical procedures, and unnecessary C-sections to accommodate traveling parents. Post-partum medical care may be poor or lacking altogether and should problems occur there is no life or disability insurance.

Add to this the risks taken by egg providers when an intended parent’s egg is not used. “Egg providers must undergo an intensive and risky process using hormones that have multiple short and long term effects,” OBOS points out. “Similar to gestational mothers, many egg providers receive minimal and sub-standard information about the health risks and they are often provided with little to no follow up care.”

There are also issues for the babies “commissioned” by intended parents. These children have a genetic link to egg providers, are birthed by gestational mothers, and handed over to intended parents. As policy struggles to catch up with technology myriad legal issues remain unresolved regarding the child’s legal parent, immigration status, and best interests should custody disputes occur.
Another problem occurs when intended parents are scammed. Recent reports exposed a California-based medical tourism company. One couple reported sending Planet Hospital thousands of dollars but the company failed to deliver on its promises, or to return more than $20,000 the couple had spent in the process. This year Planet Hospital removed surrogacy from their list of medical tourism procedures and then claimed bankruptcy, continuing to deny any wrongdoing.

SAMA: Resource Group for Women and Health New Delhi, cites “an explosion of fertility services,” noting that the Indian fertility industry, worth more than 400 million U.S. dollars annually, is proliferating despite the absence of regulatory or monitoring mechanisms. “Commercial surrogacy is often portrayed as a win-win situation,” SAMA reports. “It is positioned as giving ‘desperate, infertile’ parents a child while providing poor surrogate women with income. But given growing globalization of capital and shrinking local jobs, women from marginalized communities find themselves more impoverished, powerless and vulnerable.”

Feminists offer diverse voices on surrogacy and egg retrieval. Some raise questions about women’s health while others focus on the implications for gender analysis and the effects of surrogacy on women’s lives and marriages. Others claim that “patriarchal ideology” focuses excessively on biology. But despite differences of opinion there is consensus that more needs to be known about ARTs and their impact on the personal, social, political and economic lives of those that use reproductive services.

Thankfully CGS and OBOS will bring much needed information about surrogacy and egg retrieval into the mainstream, helping to pave the way for “a real win-win for everyone.”

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This column is based on a blog posted to Our Bodies Ourselves Blog in August 2014.

 

A Long Cold Summer When Civilization Seemed to Retreat

It’s been a summer of troubling drama, a time of “Sturm and Drang” (storm and stress) as one German writer put it, a season of disasters of Biblical proportion. Even those of us lucky enough to be a continent or an ocean away from various epicenters have not been left untouched by the seeming scourge of disease and human despair that seemed to jump borders with alarming speed.

Surely I’m not the only one who thought of Masada when the Yazidis and other religious minorities fled to the top of Iraq’s Sinjar Mountains to escape death at the hands of ISIS. Masada, the flat mesa on top of a mountain that rises in Israel near the Dead Sea, was the site of a mass suicide in 73 C.E. More than 1,000 Jews died there rather than fall into Roman hands. (One woman and five children hid and survived to tell the tale.)

masada

Nor could I have been alone in thinking about the exodus of the Jews out of Egypt when I watched the refugees who came down from the mountain as they crossed that rickety bridge over a river on their way to find refuge.

And then there was the Israeli/Gazan situation, a conflict as old as the Bible itself.

Did anyone else think of Tiananmen Square when they saw the horrific pictures of tanks lined up against the people of Ferguson, Missouri as they protested peacefully after an unarmed Michael Brown was shot to death by a policeman?

An unidentified man attempts to block tanks entering the square

Wasn’t the outbreak of Ebola reminiscent of medieval plagues, when borders were closed and bodies were carried away in carts, their homes marked as houses of death?

Didn’t the deaths of hundreds in a disappeared jumbo jet and other airline disasters, as well as the deaths of so many notable figures, bear the overtones of Greek tragedy?

And yet, among all the events that seemed to suggest a leap into a frighteningly dystopian future, is there some hope to be found? Might we be at some kind of turning point, a profoundly learnable moment that will ultimately render us capable of finding what writer Mary Gordon has called “the simple beauty of the good”?

Could it be that we stand on the fragile threshold of a time in human history when instead of “circling the drain,” we might, in an attempt to survive, find our universal souls, returning to truth and justice as guideposts, to ethical governance and sensible, compassionate leaders who would replace the oligarchs leading us into anarchy?

These questions were no doubt raised after the colossal tragedy of World War I (and many wars before that). Surely they were asked after World War II and the Holocaust. I remember them being raised in the 1960s when assassinations seemed endless and military might on the streets of America made us wonder if we had reached the apocalypse. So, too, did we ask ourselves if we could return to our better selves after the genocides of Rwanda and the Balkans. It seemed then and it seems now a Sisyphean question that we are doomed to ask in perpetuity.

But, without wanting to sound delusional, I think it may be possible that we are about to enter a moral epoch marked by a collective, rejuvenated spirit of good over evil, right over wrong, moral choices over inhumane acts.

I suggest this possibility because it seems to me that we all feel dangerously close to the precipice of madness. I say it because of all the people in all the cities who rallied in support of an end to police brutality after Michael Brown was killed. I say it because of a community that stood up to an unethical businessman when he demonstrated corporate greed. I say it because of organizations like MomsRising and I say it because of the outpouring of help that occurs when humanitarian crises perpetrated by political insanity and potentially fatal diseases happen. I say it because, as Bishop Desmond Tutu wrote in a moving commentary in Haaretz, “you add together all the people who gathered to demand justice in Israel and Palestine – in Cape Town, Washington, D.C., New York, New Delhi, London, Dublin and Sydney, and all the other cities [and] this was arguably the largest active outcry by citizens around a single cause ever in the history of the world.”

I say it because I see no alternative.

And yes, I say it knowing that history has proved me wrong again and again and that bad people flourish while “good guys finish last.” But just imagine a world in which we find within us the ability, the strength, the intelligence and compassion to move our communal heritage forward instead of falling back to the Dark Ages!

Surely the majority of us maintain a moral vigor, a life force that can enable us to recapture the soul of our communities and countries, to find again our better natures, and thus emerge with new hope and dignity in a sustainable world.

Dare one hope that in the face of so much sadness and threat we might yet be on the threshold of our greatest hour? At the very least, could the winter to come bring with it at least some renewed and reassuring warmth?