Published: Book review

My review of Wombs in Labor: Transnational Commercial Surrogacy in India by Amrita Pande, for Asian Review of Books.

Capitalism and technology have increasingly come to the rescue of couples or individuals unable to bring a baby to term: one can arrange for a surrogate mother to bear and deliver the child. Demand forcommercial surrogacy has been on the rise as a result of fertility issues (some of which is related to late marriages and delayed family planning), as well as the rise of single and same-sex parenting (where adoption may not be an option).

But behind commercial surrogacy lies a minefield of legal, health, ethical, cultural, and religious issues, especially when the arrangement crosses borders and involves different jurisdictions. Children born through commercial surrogacy are particularly vulnerable: they may be at risk of being abandoned, caught in custody fights, becoming stateless, or without legally recognized parents. Surrogate mothers and commissioning parents are also vulnerable to exploitation due to a lack of transparency in the process, as well as complex and conflicting regulations governing cross-border commercial surrogacy.

In Wombs in Labor: Transnational Commercial Surrogacy in India, Amrita Pande brings readers into this complex world. Based on ethnographic fieldwork conducted between 2006 and 2011 in Armaan Maternity Clinic, a surrogacy clinic in a city Pande calls“Garv”, the author details the processes involved in “India’s new form of outsourcing”. The book frames the flourishing commercial surrogacy industry in India as a complex labor market involving the negotiations of bodies, women’s reproductive labor, motherhood, money, family relationships, morals and ethics, race and class, and global inequality.

While commercial surrogacy may be simplistically thought of as a contractual relationship between the affluent women “needing wombs” and the surrogate mothers “needing money”, Pande highlights that there are other stakeholders, each with different motivations and desires, involved throughout the process. Some of these stakeholders are instrumental in shaping the experiences of the surrogate mothers, as well as the outcomes of surrogacies. First, there is the state which has not yet set strict policies in the regulation of commercial surrogacy. Second, there are family members of surrogate mothers, who(alternatively) coerce the women into surrogacy, provide support during the pregnancy, or object to the women’s decision to become surrogates. Third, there are the clinics running surrogacy services, and the doctors, at least some of whom think of themselves as helping the economic plights of the surrogate mothers. For example, a doctor Pande interviewed thought of herself as “a missionary, not different from Mother Teresa”. Fourth, there are former surrogates who become serial surrogates or brokers working in partnership with doctors and clinics.

India is particularly attractive as a source for transnational commercial surrogacy for a few reasons. Indian surrogacy packages cost about a fourth of those in the United States. Transnational commercial surrogacy in India in addition offers an efficient and convenient solution for clients. There are English-speaking doctors with degrees from prestigious medical schools in India and abroad, and luxury hospitals with world-class technologies. Potential clients can thus be assured of medical safety, security and quality. The lack of regulation in India relative to other parts of the world means that clinics can offer services that are either banned or heavily regulated elsewhere; for example, there are no restrictions on the number of embryos transferred into the surrogate mother. Furthermore, the commercial surrogate industry in India has developed into one where there are various facilities and solutions designed for the ease of clients. These include package deals covering the entire process from searching for a surrogate mother to the delivery of the baby to the clients, as well as surrogacy hostels where surrogate mothers are kept under surveillance during their pregnancy.

Most significantly, the structural inequality between the surrogates and the clients means that almost everything throughout the process is in favor of the clients. Surrogates, who are often working-class and less-educated women, may not understand the legal and medical procedures involved, and may be less likely to fight for custody over the baby. The entire process has been set up in a way that enables the clients to conveniently get in and get out when the contract ends, often to the bewilderment of the surrogates. Munni’s recollection is typical of post-delivery stories:

My party was from America but they used to come to Garv often to visit their parents. They would call me every day from America and come visit me almost every month. They even allowed me to breast-feed the baby. They always said that when the baby grows up they would tell her about me – about her second mother in India. It’s been over a year now; she would have been one year old last week. There have been on phone calls, nothing. I don’t know what has gone wrong.

However, Pande also highlights cases where surrogates were able to negotiate with their family members, the clinics and their clients for better terms. Examples include better monetary compensation, as well as better access to prenatal and postnatal care otherwise closed to them. Pande also describes strong sisterhood support networks that developed in the surrogacy hostels. Although many of the surrogates do not experience the social mobility changes they envisioned prior to engaging in surrogacy, Pande ends the book with the hopeful story of Mansi and Mona, who are on their way to set up their beauty parlor.

The book is an honest and open account of the author’s journey in researching commercial surrogacy in India. But most importantly, the book offers a nuanced reading into the nature of transnational commercial surrogacy, positioned at the intersections of reproduction, labor and globalization. As Pande shows in the book, commercial surrogacy may provide a solution for some involved in the process, but it also raises questions about global inequality and human rights. Despite this, Pande does not suggest a complete stop to transnational commercial surrogacy, but instead advocates for a kind of “fair trade surrogacy” that recognizes the “mutual dependencies, between sellers of reproductive labor and buyers of the same”. Such a model would involve greater transparency in three areas: financial transactions, medical processes, and the “complex layers of social interactions embedded within surrogacy”.

Wombs in Labor is an important book that sheds light on the workings of transnational commercial surrogacy in India, particularly from the perspectives of the surrogate mothers, brokers, and doctors. What is perhaps missing are the perspectives of the commissioning parents, as well as what happens to their lives after they receive the babies. Despite this small misgiving, this book is a valuable read for anyone interested in commercial surrogacy, global inequality and women’s labor.

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