If I say “outsource” which country comes first to your mind?
India, of course!
The notion of outsourcing, or contracting out business functions to external providers, has become inextricably linked with India over the past few decades. With an abundance of cheap labour, a growing middle class armed with technical savvy and know-how, and a population hungry for Western-style consumerism, it was inevitable. While particularly popular in the scientific, technical and service fields, it did not take long for people to discover that - just as goods and services are less expensive in India - so too is health care. And so the industry known as medical tourism was born.
It really should have come as no surprise, then, that the creation of life could also be outsourced. Infertile couples from around the world renting out fertile wombs in India to carry their babies for them. And yet, somehow, it was.
Made in India, a documentary screened at the recent HotDocs film festival, explores the business of baby-making as it follows one such couple, Lisa and Brian Switzer, on their personal quest for a biological baby.
Faced with fertility treatment and surrogacy costs between $70,000 and $100,000 in the USA, contracting out for the same services in India for somewhere around $12,000 was economically-speaking, a much more attractive option. (I personally think the trips to India are an attractive feature of the whole arrangement, but I digress.)
So Lisa and Brian did what so many couples are now doing, they packed their bags and headed to India to have a baby. It is now estimated that the value of the international surrogacy market is a whopping $450 million.
This is how it works.
Lisa and Brian contacted Planet Hospital, a California-based medical travel planning company whose job it is to facilitate the whole trip, including making the arrangements for the necessary doctors and the accommodations. The parties entered into a detailed contractual agreement setting out the terms of the arrangement, including how much was to be paid to the surrogate, in this case $7000.
Enter Aasia, a simple Indian woman of limited means living in Mumbai, who wants nothing more than to provide a good education for her three young children. On her husband’s salary alone, they cannot hope to accomplish their goals, so she signs a contract to provide surrogacy services through the Rotunda Clinic. She, too, is doing this for the money, hoping to elevate her family’s economic position.
Overall, it seems like a win-win situation. One woman giving the gift of life, and the other giving the gift of a better life.
But international surrogacy is not without its problems or critics. Currently, there is no legislation setting out the legal rights and obligations of the parties, making the possibility of exploitation in developing countries a real concern and creating confusion in the legal relationships of the parties to the babies. Moral-ethical questions are also being raised about allowing women to “rent out” their wombs for profit, and for permitting a tiered health care system as between foreigners and the local population, which often has little or no access to the same quality of care.
As for our main characters, Aasia delivered twin baby girls for Lisa and Brian on May 30, 2008*. While she was well looked after, it did not come without personal cost to her and her family. Her surrogacy was carried out discreetly for fear of social repercussions; she endured the physical hardships of a pregnancy with twins, as well as a prolonged separation from her own children. While she had been promised $3000 by the Clinic, in the end she was paid $2500 because of her brief stay towards the end of the pregnancy at the home for surrogates. Not anywhere close to the $7000 Lisa and Brian expected her to receive. Aasia was left somewhat disappointed by her compensation.
Lisa and Brian suffered bureaucratic red tape while they waited for the hospital authorities, the Clinic and the US Embassy to determine the legal and biological parentage of the babies, as well as their citizenship, in order to have them released from the hospital. They also faced the moral challenge of ensuring that they really had made a difference in Aasia’s life, as she had done for their lives.
Ethical and moral questions aside (these will all continue to be debated in the years to come), it is time for the law to catch up to the practice of cross-boundary surrogacy and put into place some clear rules and much-needed safeguards.
…because international baby-making has a life of its own now…and, baby, business is booming.
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