In a recent Slate magazine article, Douglas Pet highlights several worries with the international surrogacy industry, particularly in respect to the poor women who contract out their gestational labor. Pet focuses on India, and rightfully so–one report predicts that by the end of 2012, the medical travel industry in India (also a hotspot for organ transplants) will bring in $2.3 billion per year. Since commercialized contract pregnancy became legal in 2002, the industry is estimated to be worth $445 million dollars. Other destinations for reproductive travel in the Global South include Brazil, Guatemala, Malaysia, and Thailand.
The tensions between the limited options these women have, their vulnerability, the amount of control exerted by the reproductive travel industry is troublesome. Rather than discuss transnational surrogacy at this time, Pet’s article (read it!) pushes me to think about the surrogacy industry in North America. The information about transnational surrogacy, both from the media and from academics, is rapidly expanding. In contrast with contract pregnancy in India, we have little information about contract pregnant women in Canada or the United States. Just as we see surrogates being ignored by industry regulations in India, we also see them being ignored in North America.
However, the same degree of empirical attention is not being focused on contract pregnancy in North America as it is in India. I think that it is likely that the situations between contract pregnant women across the globe probably differs significantly. But how can we know, with so little information about the North American women who sell gestational labour?
Before listing the reported gaps in empirical work on contract pregnant women I find particularly troubling, here’s a bit of background on the contract pregnancy industry in Canada and the US, respectively. According to Canada’s Assisted Human Reproduction Act (2004), commercial contract pregnancy is illegal, though commissioning parties could reimburse surrogates for expenses or lost salary related to the pregnancy (part of the constitutionality of the Act is being challenged, but section 5 is not included in the scope of sections targeted). In California, the favoured destination for reproductive travel in the United States, regulation of surrogacy has been primarily established through the common law in cases such as Johnson v. Calvert and re Marriage of Buzzanca. These cases form a pattern of favouring Intended parents over surrogate parents when it comes to parental rights or responsibilities.
For this post, I’d like to set aside the ways in which regulations around contract pregnancy do not give enough attention to surrogates. Instead, I want to point to a number of gaps in what we know about the situations of contract pregnant women in the United States and Canada. Little demographic information on contract pregnant women., a problem which arises from the way in which statistics on contract pregnancy are recorded. The Center for Disease Control and Prevention (CDC) and the Society for Assisted Reproduction Technology (SART) do not collect information about the surrogates because the agencies track contract pregnancies through IVF cycles, not the women who undergo the IVF cycles. Moreover, the CDC and SART underreport the number of contract pregnancy arrangements because they only track gestational contract pregnancy, which relies on IVF, and not genetic contract pregnancy, which relies on Artificial Insemination procedures. Similarly, there are no published statistics on the nu
mber of contract pregnancies in Canada (given the Canadian legislation around contract pregnancy, many commissioning parties travel to places like India to hire a contract pregnant woman).
What little, current demographic information is available on contract pregnant women is mostly anecdotal. More research is needed to investigated alleged correlations, such as the targeting of poor women and military wives to be contract pregnant women. The implications for not collecting this data can be severe. From a reproductive justice perspective, we want to ensure that industry regulations expand women’s options and do not restrict them. Knowing that certain populations are targeted to be contract pregnant women could uncover ways in which the industry could be challenged to better promote women’s well-being.
Generally speaking, contract pregnant women face health risks typical to all pregnant women who use assisted reproductive technologies. These risks include multiple embryo transfers, the number of IVF cycles undergone, and risks from the hormones and drugs needed to induce ovulation. Because the long-term risks of multiple IVF cycles is uncertain, there may be additional, long-term risks to contract pregnant women who serve as surrogates multiple times. As research and advocacy groups like the Center for Genetics and Society and the Council for Responsible Genetics indicate, the lack of medical research has impacts beyond the physical well-being of women. Mental health, physical health, economic status, and a number of other social factors contribute to how well-off an individual is.
If we’re worried about the exploitation and vulnerability of contract pregnant women in India–as we should be–we also have good reason to devote more research resources and attention to the contract pregnant women in North America. Until we have more accurate information aboutwho contract pregnant women are in North America, we cannot adequately move toward more responsible and just assisted reproductive practices.
Katherine Fulfer, Rotman Institute of Philosophy
Assisted Human Reproduction Act, 2010 SCC 61,  3 S.C.R. 457
Assisted Human Reproduction Act, Public Law S. C. 2004, (2004): , http://laws-lois.justice.gc.
Allen, Amy. 2002. Power, subjectivity, and agency: Between arendt and foucault.International Journal of Philosophical Studies 10 (2): 131-49.
Bailey, Alison. 2011. Reconceiving surroacy: Toward a reproductive justice account of indian surrogacy. Hypatia
Galpern, Emily. 2007. Assisted reproductive technologies: Overview and PErspective using a reproductive justice framework. Oakland, CA: Center for Genetics and Society, ,http://geneticsandsociety.org/
Gugucheva, Magdalina. 2010. Surrogacy in america. Cambridge, MA: Council for Responsible Genetics.
Pet, Douglas. 2012. Make me a baby as fast as you can. Slate.Washington Post,http://www.slate.com/articles/
Twine, France Winddance. 2011. Outsourcing the womb: Race, class, and gestational surrogacy in a global market. Framing 21st century social issues. New York: Routledge.