The following is an interview with Amrita Pande, author of Wombs in Labor: Transnational Commercial Surrogacy in India:
What made a sociologist choose a topic like surrogacy?
Well, it started with a short newspaper article I read in 2006. Surrogacy was still at its infancy in India and the article – just about 400 words – described it as India’s new form of outsourcing. This newsarticle really unsettled me. Flashes of Canadian feminist Margaret Atwood’s book The Handmaid’s Tale passed through my mind, where a class of women is valued merely as breeders of children of the privileged race and class. I was then a doctoral student at UMASS Amherst and I have to confess the idea that my country would now be stereotyped as a land of not just child laborers, and “slumdogs” but also baby farms made me very queasy! After some quick digging around, I realized that there was no research (academic or otherwise) on this rather critical issue. So began my ethnographic journey into the first country in the global south to have a flourishing industry in both national and transnational surrogacy.
Why has India become the centre of transnational surrogacy?
One reason is the sheer economics of it – surrogacy packages cost about a fourth in India relative to the United States. But that is just one part of the puzzle. Clients are attracted by a combination of factors: the five star luxury hospitals that offer the most sophisticated technologies, English speaking doctors educated from prestigious medical schools and the lack of regulations which means that clinics can offer services that are banned or heavily regulated in other parts of the world (for instance, no restrictions on number of embryo transferred into the surrogate). Then there is the convenience of a package deal where everything from the search for surrogates to delivery of baby is promised to you, while you are free to take a trip to the Taj! But what makes India even more attractive is the immense structural inequality between the clients and the surrogates – which can be extremely convenient for the clients during and after the contract period. Is there anywhere else in the world where surrogates are kept under constant surveillance during the months of their pregnancy? Is a working class Indian woman with little understanding of the medical and legal procedures around surrogacy likely to fight for custody over the baby that she gave birth to for clients from California?
Were there any methodological challenges in access and field work?
To be the first one to conduct research on such a dramatic topic is both challenging and exhilarating. I think what worked for me was a creative mix of research methods (interviews, participant observation, focus group discussions and finally community theatre with the surrogates in a hostel) and my camaraderie with the surrogates, the nurses and the hostel matrons. Getting access to the field was hard. It required a determined pursuit of the doctors at first but a strategy thereafter to minimize any gatekeepers of research interactions. Simply put, I was dependent on the medical staff to get access to the clinics and hostels, but I did not want my interactions with the surrogates, their families, the brokers and the clients to be mediated by the medical staff. During my fieldwork I engaged in formal research activities like conducting interviews with the doctors and surrogacy brokers, preparing questionnaires for nurses and brokers and collecting demographic information on the area from local libraries. But I also had lunches and teas with the surrogates and their families, smuggled in tea-time snacks for surrogates, prayed and cooked lunches for them in the surrogacy hostel. I even spent nights at the surrogacy hostel. After months of constant interactions with the surrogates I found myself immersed in the intricacies of their lives and felt torn between my role as a researcher and a friend. I wanted to intervene when the nurses left out important information about side effects of some injections, when they gave minimal details to the (often illiterate) surrogates, or treated them callously. I initially tried not to immerse myself in the working of the clinic but ultimately this immersion became the source of the richest and the most invaluable conversations and experiences. This immersion got even deeper when Ditte Maria Bjerg, a Danish feminist stage director, approached me to collaborate with her on a theatre production on commercial surrogacy Made in India: Notes from a Babyfarm as well as to facilitate a livelihood-generating workshop with the surrogates. The workshop culminated into a community theater project in collaboration with the surrogates living in a hostel. I have performed this theatre in over 15 cities across the world now. This creative method complemented the ethnography and gave me much deeper insights into the world of surrogacy.
In your book you talk of surrogacy as a labor market. Why?
In my book I have questioned the existing frames for understanding surrogacy in general and surrogacy in India, in particular. Instead of discussing surrogacy in abstraction as a moral dilemma, I have chosen to analyze it as an empirical reality, a flourishing billion dollar industry in India. Once we start getting to the nuts and bolts of this industry, we realize that surrogacy in India is not simply the synergy of the needs of two classes of women –one needing healthy wombs and the other needing money. Surrogacy is about two sets of women trying to come to terms with a new form of mothering but it is much more than that. It is about Indian women grappling with their new identities as people involved in a stigmatized, corporal and unusual form of service provision. It is about women negotiating a medical system that was previously unavailable to them as lower class women in an anti-natalist state. While some of these women are coerced into surrogacy by their family, many others are negotiating with their families to gain control over their own bodies and their fertility in order to participate in this process. A linear focus on the reproduction and mothering component of commercial surrogacy discounts these intricacies of surrogacy. Thus, in the book I use another lens to view surrogacy: as a form of labor emerging with globalization, an unusual form of labor that traverses the socially constructed dichotomy between production and reproduction. Of course, the limited range of a surrogate’s alternative economic opportunities and the unequal power relations between the client and the surrogate call into question the voluntary nature of this labor. But instead of dismissing the labor market as inherently oppressive and the women involved as subjects of this oppressive structure, I recognize, validate and systematically evaluate the choices that women make in order to participate in that market. A comprehensive evaluation of these choices, in turn, reveals the many intersecting layers of domination impinging on these choices.
In your book you advocate for some version of free trade surrogacy. What does that entail?
Instead of restrictive national laws like bans and criminal penalties on buyers or sellers, in my book I propose a carefully thought out law that regulates the industry and protects the rights of the women workers – the surrogates themselves. But I also strongly believe that a global and complex issue like surrogacy cannot be resolved or regulated within national borders. A global issue like surrogacy needs a global dialogue. In the conclusion of the book I propose a way to extend fair trade principles to international surrogacy and outline an international model of surrogacy founded on open-ness and transparency on three fronts: in the structure of payments, in the medical process, and in the relationships forged within surrogacy. Transparency in financial transaction and allowing wage settlements through dialogue between the surrogates and intending parents are recommendations that have been highlighted by the surrogates themselves. For surrogacy in India, transparency in the second arena – medical process – needs to be much more than a signature indicating informed consent. For women who have little experience with bio medical technologies and professional medicine, being “aware” of the medical requirements and implications of ARTs, cannot be a mere signature, but should be a continuous process of explanation and interaction over a period of time. The final arena where transparency is critical is in the complex layers of social interactions embedded within surrogacy. Perhaps it is time to re-evaluate the emphasis on privacy and anonymity in these unusual markets such that the providers of essential, emotional and bodily services are no longer made nameless, faceless, anonymous and disposable. But most importantly, what is critical for a global dialogue is for us to view the surrogates not as vessels, not as guinea pigs in a baby farm, but as workers, and so that they are the ones facilitating and participating in these dialogues, and not just being discussed or even saved by anxious third parties.