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Medicine, Markets and the Pregnant Body: Indian Commercial Surrogacy and Reproductive Labor in a Transnational Frame

Through counseling and conversations with doctors, a surrogate is encouraged to think of her womb as a space she can rent out; the analogy many surrogates spoke of is that the womb is like a spare room in a home, where someone else’s baby will stay and grow. One of the doctors at the clinic described the approach of clinic staff this way:

“[We] try to explain to them that what you are doing, you are doing for someone else, whatever money or gifts they give you. The emotional attachment is going to be there, but they understand one thing, even if they are not educated that much, which is that we have to give the child back to the parents. That’s one of the most important things, and we haven’t had any case otherwise.”

In discussing the anticipation of parting with the infant upon its birth, a number of the women working as surrogates explained independently that since the baby wouldn’t look like her, she wouldn’t feel a bond with it. This explanation is used by doctors to guide surrogates in thinking of the child as not their own. Despite this coaching and the understanding that the babies are not theirs, women who had already delivered did say they missed the infants after they left India and hoped to hear about their development, receive pictures of the children, and maintain a connection to these families.

The prominent narrative of the distance between a gestational surrogate and the eventual infant she will deliver as an inevitable result of the genetic distance between the two is a product of a Western medical discourse of the body and biogenetics of parenthood. Emily Martin has observed the ways that the medical gaze, particularly as administered through visual technologies like ultrasonography, enforces the Cartesian mind/body dualism and alienates pregnant women from the process of being pregnant. She has elaborated this as the obstetrician becoming a “mechanic” and the pregnant woman a “laborer.”1 The relationship to and understanding of the womb as a separable body part from the woman’s whole body and from herself as a subject, and hence of the baby as a guest that is not part of her body, is a product of an understanding of the body and self which must be naturalized for the women acting as surrogates, and allows participants to understand gestation as a form of paid work. At the same time, this does not exhaust the meaning of how surrogates understand their social relations and even kinship relations with commissioning parents and the infant they bear, as Amrita Pande’s recent study of surrogates and kinship at a fertility clinic in Gujarat reveals.(( Amrita Pande, “It May be Her Eggs but it is my Blood: Surrogates and Everyday Forms of Kinship in India,” Qualitative Sociology 32.4 (2009): 379-397.))

Women who were currently working as surrogates explained the need for secrecy that many felt resulted from the fact that people in their communities would not understand that they had not had sexual relations in order to conceive, and therefore surrogacy would not be accepted as an altruistic act or as valid employment. At the same time, everyone I spoke to expressed conviction that carrying another person’s child as a surrogate was not compromising any moral standards around sexuality, a trend which is supported by Amrita Pande’s observations of commercial surrogacy in India.2 This conviction is at least partially the result of coaching in the process and meaning of conception and childbirth received through the clinic’s explanations of how surrogacy makes a guest fetus but not a mother. These explanations are based on the Western medical understanding of the genetic basis of parenthood, though whether or not the surrogate mothers themselves fully accept their role within these terms is not clear in their versions of the clinic’s narrative of how surrogacy works, and is challenged by the way that surrogates explain their role in terms of the divine, discussed below.

In addition to the intervention of Western medical discourses of the body and biogenetic parenthood, it is the availability of women in India as surrogates, through both economic necessity and the lack of formal regulation, that makes transnational Indian surrogacy possible. Barbara Katz Rothman has argued that in the U.S., discourse about surrogacy figures the surrogate’s womb as property to use as she sees fit, and the fetus as property belonging to the intended parent.3 This discourse has traveled with the technologies involved in surrogacy, so that the understanding of procreation and parenthood that surrogate mothers are taught includes the figuring of the womb as a place to rent out for use by someone else’s infant. The technologies that define and separate the roles of egg donor, intended mother, and gestational mother, in combination with the patriarchal discourse of infant-as-property, work with the commodifying logics of capitalist culture to objectify the work of gestation and the fetus so that they can participate as commodities in the transnational surrogacy industry. Even so, it is essential to note that this is not the primary economy to which women working as surrogates describe their labor as contributing. While women readily acknowledge that it is the demands of material circumstances that impel them to take up this otherwise undesirable work, many women also described their role of a surrogate in terms of an altruistic, or even divine, economy.

  1. Emily Martin, The Woman in the Body: A Cultural Analysis of Reproduction (Boston: Beacon Press, 2001): 57. []
  2. Amrita Pande, “Not an Angel, Not a Whore: Surrogates as Dirty Workers in India,” Indian Journal of Gender Studies 16.2 (2009): 141-173. []
  3. B. Katz Rothman, Recreating Motherhood (New Brunswick, NJ: Rutgers University Press, 2000): 29. []