Christian bioethicist compares commercial surrogacy in India to slavery

A leading Christian bioethicist has compared the emerging trend of renting out the womb of poor Indian women to unethical baby–selling and slavery.

Indian women, usually lower middleclass housewives, are increasingly signing contracts to serve as surrogate mothers, carrying the child of American and international couples at a lower rate than it would cost the pair to have the child carried in their own country.

On average, service charge for an Indian surrogate mother is about US$ 5000–$10,000 – far less than the up to US$50,000 that a U.S.–based couple will spend to obtain a child through a surrogate mother, reported Reuters.

However, a leading American bioethicist has criticized outsourcing positions of surrogate mothers to India, saying that the Indian women are being economically "forced" to carry the baby.

"The primary ethical problems here are the commercial surrogacy itself – which is baby–selling – and going overseas to use women for a price that women in this country wouldn't accept. [It] is simply augmenting one of several ethical problems with this practice," said Dr. John Kilner, senior scholar of The Center for Bioethics & Human Dignity and director of the Bioethics program at Trinity International University.

Twenty–five percent of India's 1 billion people live below the poverty line, according to the CIA World Factbook.

Proponents of Indian surrogate mothers have claimed that although money is the primary motivation, the payment is simply a token of appreciation for the gift of helping a childless couple.

Kilner, however, argued, "If it is such a wonderful gift to an infertile couple to enable them to have their own child, then a surrogate should be willing to provide the service without a fee."

The CBHD senior scholar pointed out that the contracts used during surrogate programs say that if a surrogate does not deliver the child, for instance because the child dies, then the couple expecting to receive the child is typically not required to pay the entire price for the service.

"In commercial surrogacy, admirable gift–giving is replaced with demeaning baby–selling," Kilner emphasized. "It is not just the use of the surrogate's womb that is the reason for payment; it is actually obtaining the child."

He compared the practice to slavery where the ends does not justify the means; just because a purchaser plans to be nice to the one purchased does not justify purchasing a slave.

"Turning human beings into things to be bought is inherently demeaning," said Kilner, who pointed to philosophical, political, and religious reasons why the act is unethical.

"Christian faith tends toward a more theological grounding of the same human concern: People are made in the image of God and should not be reduced to 'things' to be bought, sold, or otherwise 'used.'"

Indian surrogate mothers interviewed by Reuters said that they would not have rented out their womb for any other reasons aside from money – which some desperately needed to feed their existing children.

"It focuses on women who are in extremely difficult and even inhumane circumstances of poverty," highlighted Kilner. "Rather than helping them with a gift or an opportunity to do humane work, it makes them put their bodies at risk and often to do something considered immoral in their culture in order to survive. It preys upon their suffering."

In addition to the physical risks involved with pregnancy, cultural attitude, especially in the countryside, consider it immoral to carry someone else's baby.

Most women are forced to lie that they are carrying their husband's child and then say the baby died after they deliver the child, while others go to another town with the excuse of visiting relatives until the baby is delivered.

It is estimated that between 100–150 surrogate babies are born each year in India and 500–600 surrogate babies worldwide, according to Reuters.

About commercial surrogacy in India:

Like other "jobs" which are being outsourced to low–cost economies such as India, commercial surrogacy or "hiring" a womb appears to be a win–win situation, both from the cost and quality of medical service.

The cost of renting a womb is under US$5,000, compared to more than $50,000 in the West. The entire procedure in India costs in the range of US$10,000, and the quality of treatment and technology and the expertise of the country's doctors compares with the best in the world.

Another reason, "embryo tourists" favour visiting India is because they are also able to dictate how their surrogate mothers will behave during pregnancy. One British couple, a 35–year–old interior designer and her engineer husband, paid an Indian woman to move her family from Calcutta to Delhi, rented a flat for them and stipulated which foods the woman should eat. Other women are told that they are not allowed to smoke, drink alcohol or have sex with their husbands.

About 10 percent of surrogate mothers are domestic servants or employees carrying babies for their bosses, while others are lower–middle–class women who want a lump sum to invest for their own children's education, according to the Delhi IVF and Fertility Research Centre.

As a result, fertility clinics have mushroomed in Delhi, Chennai, Bangalore, Hyderabad, Kolkata and Mumbai with British and American patients being lured to India by the easy availability and low–cost of in–vitro fertilisation (IVF) treatment.

It seems that while one life has been created, another has been saved, though there has been criticism regarding the "commoditization of motherhood," risk to health and exploitation of the poor by the rich. However, the "plight" of a smiling surrogate mother with a big bank balance still looks like a better option than being one of the thousands of destitute women who are pushed into prostitution and treated mercilessly.

According to Indian medical practitioners, 100 to 150 of the 500 to 600 surrogate babies born across the world every year are born in India. Many more are trying without success.

However, doctors say that given the fact that many women work and contribute significantly to household welfare, some may not want to take the time out to bear children and will choose the IVF option.

Many couples who adopt kids could also exercise this option. The Indian Council for Medical Research has estimated that the reproductive sector could soon be worth $6 billion a year.

As things stand, surrogate motherhood is illegal in Italy and banned for commercial purposes in Australia, Spain and China, and permitted with restrictions in the US, France and Germany.

Though new laws are being drafted, Indian medical statutes permit doctors to implant five embryos into a surrogate mother. In Britain the maximum is two, while many European countries are looking at a single embryo. India's existing laws permit the surrogate mother to sign away her rights to the baby, immediately after birth.

Reuters quotes C P Puri, director of India's National Institute for Research in Reproductive Health, as saying: "Every pregnancy and birth is associated with some health risk. We must not promote surrogacy as a trade. In addition, many surrogate mothers in India face issues associated with "traditional attitudes to sex and procreation."

A report by India Brand Equity Foundation and Ernst and Young says that outsourced healthcare will employ nearly 200,000 people in India by 2008, up from about 20,000 people in the medical, healthcare and pharmaceutical business process outsourcing space now.

According to estimates, the industry is expected to generate about US$ 3 billion per year by 2010. Medical outsourcing has four clients – provider (hospitals and physicians), payer (health insurance companies), pharmaceutical companies and healthcare information technology companies.

Today, the Indian medical tourism market (foreigners seeking medical treatment in India) is worth US$ 700 million and the projection is that it will swell to US$ 1 billion in the next couple of years. More than 150,000 patients, the majority from the US and the UK, have undergone treatment in India.

The price differential can be quite significant, especially for patients from the US. For example, a liver transplant in the US costs around US$ 450,000, while in India it is US$ 40,000; low–cost cardiac surgery in India costs US$ 4,000 to US$ 9,000, while in the US it can be in the US$ 30,000 to US$ 50,000 range; orthopedic surgery costs as little as US$ 4,500 in India, while in the US it is about US$ 18,000. A comprehensive health check–up for a US patient in India is around US$ 80, substantially less than the US$ 600 it would cost stateside.

It is estimated that 50 million US citizens do not have health insurance policies due to high premiums.