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Thursday, January 6, 2011

Google Me a Newborn Baby -- Cheaper in India

I know in vitro treatments and surrogacy have been around for many years. Yet, until I watched Israeli filmmaker Zippi Brand Frank’s HBO documentary Google Baby, I knew very little about the process of "making a baby" in a global economy. The film left me with mixed feelings and an apparent need to research some new ground.

Surrogacy, once traditionally handled by an exclusive duo, is now open to a network of egg donors, fertility specialists, embryo brokers, foreign surrogates, and even short-term wet nurses. In this brave new world of outsourcing, technology has turned the act of creating a human being into a process independent of sex while globalization is making it more and more affordable.

In the not-so-distant past, a woman who experienced trouble conceiving might pay a clinic specializing in assisted reproductive technology. "Then, she might shoot herself with stimulants and have her eggs retrieved, fertilized and implanted, hoping that science and the gods of modern fertility would conspire to impose their good will. This remains an exhausting method of achieving pregnancy, but the complexity is nothing compared to what takes place in Google Baby," says reporter Ginia Bellafante. ("Surrogate Pregnancy Goes Global," The New York Times, June 15 2010)

I definitely agree with Bellafante: new conception is not only more complex but also more morally questionable. 

The cost is a major concern for those who desire surrogacy. As an example, the entire process in the United States can easily cost well over $100,000. The expense has driven customers worldwide to seek lower-priced markets.Surrogacy has now become an international business offering stiff price competition. Google Baby traces a budding worldwide industry of "producing" babies, run almost entirely from personal computers.

Surrogacy In India

India legalized surrogacy in 2002 as part of a long-term effort to promote medical tourism. Since 1991, when the country's new free-market policies took effect, private money has flowed in, fueling construction of world-class hospitals that cater to foreigners. Surrogacy tourism has grown steadily there as word gets around that babies can be incubated at a low price and without government red tape.

The Confederation of Indian Industry predicts that medical tourism, including surrogacy, could generate $2.3 billion in annual revenue by 2012. "Surrogacy is the new adoption," says Delhi fertility doctor Anoop Gupta. 

"One of the nicest things about [India] is that the women don't drink or smoke," says Kristen Jordan, a 26-year-old California housewife and Delhi surrogacy customer. And while most American surrogacy contracts also forbid such activities, Jordan says, "I take people in India more for their word than probably I would in the United States." (Scott Carney, "Inside India's Rent-a-Womb Business," Mother Jones, March/April 2010)

Surrogacy is not officially regulated in India. There are no binding legal standards for treatment of surrogates, nor has any state or national authority been empowered to police the industry. According to Carney, while clinics have a financial incentive to ensure the health of the fetus, there's nothing to prevent them from cutting costs by scrimping on surrogate pay and follow-up care, or to ensure they behave responsibly when something goes wrong.

India's parliament is in the process of crafting legislation to address some of the concerns about surrogacy, but most likely any strict regulation would fall to the states and be almost ineffective. Carney believes, at present, India is the Wild West of surrogacy with over 350 fertility clinics, although it's difficult to say how many offer surrogacy services since the government doesn't track the industry.

There hasn't been any effort to regulate surrogacy contracts on the receiving end, either. So long as a surrogate infant has an exit permit from the Indian government, the process for getting the baby an American passport is straightforward.

Google Baby

Gooble Baby centers upon Doron Mamet, a gay Israeli father-turned-embryo-broker, who is spurred to action by his own costly journey -- $100,000 plus -- to produce his daughter. During the filming, he's launching his business, Tammuz. (The month of Tammuz is a time given for the special ability to make substantial changes and significant transformation in many aspects of people's lives, to turn negative things into positive ones.)

The Israeli entrepreneur coordinates for Israeli sperm to be flown to the United States for the artificial insemination of American ova. It takes the viewer alongside Mamet first-hand, to witness an egg being made into an embryo by Tammuz's partner, fertility specialist Gad Levy. One scene shows many tanks, each the size of a small keg, that hold tens of thousands of embryos. ("We can't get rid of them without permission," the lab worker tells Mamet, then sighs, "They take up a lot of space.")

The frozen embryos are then transported to India, where they are implanted in the uterus of local surrogate mothers who spend their self-chosen exile in a "greenhouse" of Western lifestyle. Most mothers will spend their entire pregnancies living together in such housing provided by the clinic.

The Akanksha Clinic

 The documentary chronicles the operation of the Akanksha Infertility Clinic in India, used by Tammuz, which specializes in the in-vitro fertilization procedure. The facility is run by a doctor, Nayna Patel, who is insistent that her service not become a baby factory. A 2007 Oprah segment all but heralded Patel as a savior of childless middle-class couples and helped open the floodgates for the outsourcing of American pregnancies. Patel claims a waiting list hundreds deep and receives at least a dozen new inquiries from potential surrogacy customers each week. (Scott Carney, "Inside India's Rent-a-Womb Business," Mother Jones, March/April 2010)

Dr. Patel requires that clients either be childless or have no more than one child. Patel's clinic charges about $15,000 to $20,000 for the entire process, from in vitro fertilization to delivery. All told, a successful Akanksha surrogate makes between $5,000 and $6,000—a bit more if she bears twins. If a woman miscarries, she keeps what she's been paid up to that point. But should she choose to abort—an option the contract allows—she must reimburse the clinic and the client for all expenses. No clinic Scott Carney spoke with could recall a surrogate going that route.

Patel sees the service she provides as sisterly, “one woman helping another.” Offering a cost-benefit analysis to a surrogate, she explains that the prospective mother “cannot have a child which she longs for, which you are going to give, and you cannot have a house.”

“You cannot educate your son beyond school,” she continues. “For that they are going to pay.”

"We know all the women personally. We exclude many after psychological assessments, after learning of social problems, and we make absolutely sure that the money that they earn is well spent," Patel, who pioneered the industry in India, said. (Jason Burke, India's Surrogate Mothers Face New Rules to Restrict 'Pot of Gold,'", July 30 2010)

The surrogate mothers do, however, face social stigmatize. Many attempt to keep their pregnancy a secret or face being treated like social pariahs.

The housing for the surrogate mothers may be described as simple and cloistered. Some women live in a squat concrete bungalow enclosed by concrete walls, barbed wire, and an iron gate. Police once used the site as a storehouse for bootleg liquor captured in Eliot Ness-style raids. Now the building functions as one of two residential units.

Scott Carney describes Dr. Patel's Akanksha facilities: "The classroom-size space is dominated by a maze of iron cots that spills out into a hallway and additional rooms upstairs. It is remarkably uncluttered given the number of people living here—each surrogate has only a few personal belongings, perhaps enough to fill a child's knapsack. In a well-stocked kitchen down the hall, an attendant who doubles as the house nurse prepares a midday meal of curried vegetables and flatbread."(Scott Carney, "Inside India's Rent-a-Womb Business," Mother Jones, March/April 2010)

Carney reports, "Not a single surrogate I interviewed expected a vaginal birth, even though C-sections are considered riskier for the baby under normal circumstances and double to triple the woman's risk of death during childbirth. They are, however, far faster than vaginal labor—and some clinics charge clients extra for them. (Scott Carney, "Inside India's Rent-a-Womb Business," Mother Jones, March/April 2010)

In exchange for the inconvenience and physical discomforts, the surrogate mothers stand to receive a sum that's quite substantial by their meager standards (more than 15 years of average wages), but which the clinic's customers understand is a steal.  After the woman gives birth, the parents fly to India and pick up the baby. 
"The entire process resembles an assembly line of perfectly coordinated, non-union workers," says Lizzie Skurnick. ("HBO's 'Google Baby': Network of Surrogates, Egg Donors Remakes Childbearing," Politics Daily)

Skurnick continues, "And while Aldous Huxley's Brave New World showed test-tube babies serviced by quiet, white-jacketed technicians, the cast of baby-breeders in Google Baby is positively messy in its humanity."

Questions and More Questions 

Has this nontraditional method of developing a family, an act of goodwill in many cases, evolved to a purely financial transaction?  In other words, are the parents ordering the baby any different from someone ordering a television from Amazon, who presumably couldn't care less how the set was assembled?

Does the rank and power differential between the donors/surrogates and their clients make this surrogacy especially feudalistic and oppressive? Patel puts it philosophically to a prospective surrogate: "She cannot have a child. You cannot have a house. Now you can have a house." But, does renting the wombs of poor Indians create the potential for further exploitation?

What happens when there’s a disabled baby born of this process and the parents don’t want to collect what they’ve “special ordered"? (Debra Nussbaum Cohen, "Ordering a Baby Online" Israel's 'Google Baby' Comes to HBO," June 8 2010) For that matter, the documentary featured a rather offhand comment about a need for selective abortion of fertilized eggs.

What happens to the gestational surrogates when their extended families and community members find out where they have been for nine months? What type of ridicule do these parties face and will it be worth emotional price? The answer to this is especially important to Indian families.

What happens when some of these children age and learn the circumstances of their conception and birth? What laws will govern the rights of the offspring? Surely some people will demand to understand the conditions of their births.

Why do couples consider a surrogate mother the only means to a "child of their own"? Parents of an adopted child would respond that their adopted son or daughter is their "own" child, and that they could not love her any more even if she were genetically related.

Of course, the wild card, is what happens when surrogates decline to give up custody of their babies? This is the reason custody battles sometimes ensue in the U.S. All surrogates at the clinic sign a contract agreeing to hand over the baby — which reassures prospective parents, but also supports arguments that the women, many of whom are illiterate, are being taken advantage of.

Parting Thoughts

Yonatan Gher, a communications officer for the environmental group Greenpeace, and his male partner plan eventually to tell their child that it was made in India, in the womb of a woman they never met, with the egg of a Mumbai housewife they picked out from an Internet line-up of candidates.

In a clinic, it is clear that an exchange between rich and poor is under way. On some of the contracts, the thumbprint of an illiterate surrogate stands out against the signature of the clients. Gher agreed. "You cannot ignore the discrepancies between Indian poverty and Western wealth," he said. "We try our best not to abuse this power. Part of our choice to come here was the idea that there was an opportunity to help someone in India." (Amelia Gentleman, "Foreign Couples Turn to India For Surrogate Mothers," The New York Times, March 4 2008)

History may tell the long-term value of such exchange.

Trailer for Google Baby

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