Monday, October 14, 2013

Are we exploiting surrogates ?

One of the commonest criticisms against Indian IVF surrogacy programs is that IVF doctors and foreign patients exploit poor Indian women. The surrogates are usually poor women, who do this for money . A lot of people believe that these women are being underpaid and are coerced into becoming surrogates. They base their reasoning on the fact that while US surrogates charge over US $ 25000, the poor Indian surrogate is being paid a pittance in comparison – she gets only about US $ 5000. The general perception is that the IVF doctors keep a huge part of the fees and enrich themselves at the expense of these poor women who are defenseless and clueless.

I think this is an invalid argument. If you believe that surrogacy is an ethical procedure and if that it’s acceptable to this for altruistic reasons , then because it's being done for commercial reasons doesn't make it unethical . Just because money changes hands doesn't make a procedure unethical.

If you accept that commercial surrogacy is ethical, provided the surrogate is well- informed and is a willing participant who is being adequately reimbursed, the next question is – what is a fair and reasonable amount to pay her ?

This is a complicated question to answer , because it depends upon the person who's doing the surrogacy . This is not something which she is being coerced into doing against her will – and the payment is set by market forces. Are these unfairly biased against the surrogate ? Is the rich doctor the one who holds all the trumps ? This is a short-sighted view, because if a doctor starts exploiting surrogates, he will damage his reputation and will not be able to find women who are willing to become surrogates. He will end up harming himself and it’s in his best interests to create a win-win situation – after all, a doctor cannot provide surrogacy services unless there are surrogates who are willing to carry the pregnancy !

Is US $ 5000 a pittance ? Perhaps it is , by American standards. But by the same standards, it means that rich Indians routinely  exploit women who work in the their houses, because they get paid only US $ 200 for working for a month . Isn’t this exploitative ?  If a monthly salary for a domestic household staff member ( a euphemism for a servant) is $ 200, then being paid the equivalent of 2-years salary for carrying a pregnancy voluntarily for 9 months does not seem to be an unfair proposition.

Talking about the correct amount to pay surrogates reminds me of the famous Churchill story.

“Churchill: "Madam, would you sleep with me for five million pounds?" Socialite: "My goodness, Mr. Churchill... Well, I suppose... we would have to discuss terms, of course... "
Churchill: "Would you sleep with me for five pounds?"
Socialite: "Mr. Churchill, what kind of woman do you think I am?!" Churchill: "Madam, we've already established that. Now we are haggling about the price”

If we believe that the market can be relied upon to establish a fair price in a democratic society, then I think it's very unfair for people sitting in ivory towers , who have no idea about the hardships these poor women have to suffer in their daily life, to pass judgments about what is fair and unfair. If they are willing to sign up, is it ethical to stop them from doing so because you think they are being underpaid ? Why not respect them and allow them to decide for themselves what a fair price is ?

It's unfair to be critical , and these activists actually end up creating harm because they don't understand what these women go through , and do not try to put themselves in their shoes.

Now I'm not saying that exploitation does not occur.  I agree there are unethical doctors , who indulge in malpractice. For example, they promise the surrogate a certain amount of money, and then refuse to pay her. This is unfair and should be stopped – but to tar all doctors with the same brush and to brand the entire practice is unethical is extremely unfair.

The best way to solve the problem is to ensure openness and transparency. A signed legal contract, which specifies how much the surrogate will be paid helps to protect everyone !

You can learn more about an ethical surrogacy program works at

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