Kalindi Vora, "Medicine, Markets and the Pregnant Body: Indian Commercial Surrogacy and Reproductive Labor in a Transnational Frame"
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II. Biogenetic Parenthood and the Work of Surrogacy

Hanging on the wall of the director's office in the small but growing Manushi clinic is a multi-media work commissioned by the clinic's director. A line of soft abstract shapes representing the salwar chemise-clad pregnant bodies and covered heads of six women arcs around a central and taller abstracted female figure dressed in white. A group of staff explained to me that the central figure in white represents the director, Dr. Bhakta, herself. Her arms are outstretched to draw in the group of women, whose most distinguishing features are their exaggerated wombs, marked as embossed circles with a centered fetal-imprint pressed into the plastic material of their bodily forms. According to one staff member, the piece is meant to portray the director's vision of the clinic's surrogacy practice as a form of altruism and care for the women who become commercial surrogates, and the image is a way to signpost this vision to commissioning parents who visit the clinic. The image also represents the pregnant body as imagined through the discourse of the medicalized body, where the uterus is an empty and un-utilized space. The artistic representation draws attention to the central importance of the once-empty uterus. Now filled, the womb marks the service being performed by the surrogates and reflects the primary way that the clinic encourages both potential and active surrogates to approach gestational surrogacy as a service.

Reproductive technologies and associated medical discourse were developed primarily in advanced capitalist countries and have since traveled to India, and with them come the co-constituting Euro-American notions of kinship as biogenetically based.[6] One of the outcomes of the way that medical discourse about reproductive technologies, through this linking of kinship and biogenetics, distances actual individualized bodies from the biology of reproduction, is that it creates a framework for commissioning parents, doctors, and surrogates to imagine the act of gestating a child as a paid occupation in which a service (gestation and childbirth) is exchanged for a fee. The exchange is not limited to these terms, but the way that medical discourse isolates the reproductive body and gametes from the social context in which they originated allows for gestational surrogacy to be conceived of as a form of paid work or service by participants.

Most of the women who come to the Manushi clinic come from at least an hour's bus ride away, and generally find out about the opportunity through friends or family. According to the clinic's guidelines, a potential surrogate must be married with at least one child and have permission from her husband to be eligible. Once pregnant, surrogates are highly encouraged to live in designated housing near the clinic where they can rest instead of working and providing care to their families. This arrangement also allows for surveillance by clinic staff. Their husbands, sometimes accompanied by children, come to visit them in these hostels during the weekends. Most surrogates hide their participation from extended family and sometimes even their own children because of the associated stigma.

The overall surrogacy process at this clinic costs clients roughly twenty thousand dollars, depending on whether or not they use donor eggs and how many in vitro fertilization cycles are necessary to accomplish a pregnancy. The clinic mandates that embryos be created using either the intended mother's ova or those of a donor, but never those of the gestational surrogate. Egg donors and surrogates are selected by the director rather than by the commissioning parents. After an initial interview, there is usually little contact between surrogate mothers and intended parents. The relationship between the intended parents and their surrogate is almost always completely mediated by the clinic staff. Clients who come to this clinic from abroad to hire surrogates cite a number of reasons for their decision, including the desire for a child who shares genetic material with one or both parents, the comparatively high cost and administrative complexity of domestic and international adoption, and because, in some cases, the clients' home countries do not allow surrogacy or only allow it under limited circumstances such as in non-commercial arrangements. The Manushi clinic only accepts client couples for surrogacy when they are heterosexual, and when the woman cannot physically support a pregnancy herself. The clinic has suspended this first rule in the case of a small number of male single-parent clients, and it is conceivable that these individuals might be part of non-heterosexual family formations. The latter rule is meant to insure that the clinic is only arranging surrogacy when it is 'medically necessary' and to prevent clients from using surrogates to avoid pregnancy.

Many non-Indian commissioning parents expressed a feeling of obligation to their surrogates beyond the portion of their fee that was intended for the surrogate, usually between five and seven thousand dollars. By giving gifts during pregnancy or additional gift monies after delivery, these parents both assuage the uncertainty and sometimes guilt they may feel about potentially exploiting the surrogates, and allow themselves to feel that they are improving the lives of the surrogates. While some intended parents write to their surrogates and send email correspondence and photos of the infant in the first year, most of the surrogates said they do not hear from their former clients very frequently. The clients I spoke to tended to express a feeling of connection to "India" rather than to individual women, some mentioning that they would inform their children of the circumstances of their birth or that they hoped to bring the child to India someday to see where it was born, but not necessarily to visit the clinic or surrogate. The sense of duty described by clients operates both with and against the commodity nature of their exchange. While gifts to their surrogates are not required, they are sometimes described as compensating for the relatively low fees paid to surrogates. To an extent, commissioning parents may thus feel a personal obligation to pay their surrogate something more than the market rate, but for those to whom I spoke who were still in the middle of the surrogacy process, they imagined that the stronger association would ultimately be with the homeland of the surrogate, not the woman herself.

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