Moral frameworks of commercial surrogacy within the US, India and Russia

Abstract

In this paper, we draw on three ethnographic studies of surrogacy we carried out separately in different contexts: the western US state of California, the south Indian state of Karnataka, and the western Russian metropolis of St Petersburg. In our interviews with surrogate mothers, intended parents, and surrogacy professionals, we traced the meanings and ideologies through which they understood the clinical labour of surrogacy. We found that in the US, interviewed surrogates, intended parents and professionals understood surrogacy as an exchange of both gifts and commodities, where gift-giving, reciprocity, and relatedness between surrogates and intended parents were the major tropes. In India, differing narratives of surrogacy were offered by its different parties: whilst professionals and intended parents framed it as a win-win exchange with an emphasis on the economic side, the interviewed surrogate mothers talked about surrogacy as creative labour of giving life. In Russia, approaches to surrogacy among the interviewed surrogate mothers, professionals and intended parents overlapped in framing it as work and a businesslike commodity exchange. We suggest these three different ways of ethical reasoning about the clinical labour of surrogacy, including justifications of women’s incorporation into this labour, were situated in local moral frameworks. We name them “repro-regional moral frameworks”, inspired by earlier work on moral frameworks as well as on reproductive nationalisms and transnational reproduction. Building on these findings, we argue that any international or global regulation of surrogacy, or indeed any moral stance on it, needs to take these local differences into account.

Résumé

Dans cet article, nous nous inspirons de trois études ethnographiques sur la maternité de substitution que nous avons réalisées séparément dans différents contextes: l’État de Californie à l’ouest des États-Unis, l’État de Karnataka au sud de l’Inde et la métropole de Saint-Pétersbourg en Russie occidentale. Dans nos entretiens avec les mères porteuses, les futurs parents et les professionnels de la maternité de substitution, nous avons recherché les significations et les idéologies dont ils se servaient pour comprendre le travail clinique de la maternité de substitution. Nous avons constaté qu’aux États-Unis, les mères porteuses, les futurs parents et les professionnels interrogés comprenaient la maternité de substitution comme un échange à la fois de dons et de produits, où le don, la réciprocité et le lien entre les mères porteuses et les futurs parents étaient les principaux thèmes. En Inde, les diverses parties ont proposé différentes descriptions de la maternité de substitution: si les professionnels et les futurs parents la concevaient comme un échange où chacun y trouve son compte en mettant l’accent sur son côté économique, les mères porteuses interrogées ont parlé de la maternité de substitution comme d’un travail créatif pour donner la vie. En Russie, les mères porteuses, les professionnels et les futurs parents avaient des conceptions de la maternité de substitution qui se recoupaient et ils la considéraient comme une activité économique et un échange commercial de produits. Nous suggérons que ces trois différents raisonnements éthiques sur le travail clinique de la maternité de substitution, y compris les justifications de l’incorporation de ces femmes dans ce travail, s’inscrivaient dans des cadres moraux locaux. Nous les appelons des cadres moraux repro-régionaux, inspirés par un travail antérieur sur les cadres moraux ainsi que sur les nationalismes reproductifs et la reproduction transnationale. Nous basant sur ces conclusions, nous avançons que toute réglementation mondiale ou internationale de la maternité de substitution, ou même toute position morale à son propos, doit prendre en compte ces différences locales.

Resumen

En este artículo, nos basamos en tres estudios etnográficos de subrogación que realizamos por separado en diferentes contextos: el estado occidental de California en EE. UU., el estado de Karnataka en India meridional, y la metrópolis occidental de San Petersburgo en Rusia. En nuestras entrevistas con madres subrogadas, padres futuros y profesionales de subrogación, encontramos los significados y las ideologías por medio de los cuales entendieron la labor clínica de gestación subrogada. Hallamos que en Estados Unidos, las madres subrogadas, padres futuros y profesionales entrevistados entendían la subrogación como el intercambio de regalos e insumos, donde dar regalos, reciprocidad y parentesco entre madres subrogadas y padres futuros eran los principales tropos. En India, las diferentes partes ofrecieron diferentes narrativas de subrogación: mientras que los profesionales y padres futuros la definen como un intercambio donde se benefician todas las partes, con énfasis en el aspecto económico, las madres subrogadas entrevistadas hablaron sobre subrogación como la labor creativa de dar vida. En Rusia, los enfoques de las madres subrogadas, profesionales y padres futuros entrevistados con relación a la subrogación coincidieron en definirla como trabajo y como intercambio profesional de insumos. Sugerimos que estas tres formas diferentes de razonamiento ético sobre la labor clínica de subrogación, incluidas las justificaciones de la incorporación de las mujeres en esta labor, estaban situadas en marcos morales locales. Los denominamos marcos morales repro-regionales, inspirados por trabajo anterior en marcos morales, así como en nacionalismos reproductivos y reproducción transnacional. A raíz de estos hallazgos, argumentamos que toda regulación internacional o mundial de subrogación, incluso toda postura moral al respecto, debe tomar en cuenta estas diferencias locales.

Keywords:

• surrogacy
• surrogate mothers
• moral frameworks
• repronational histories
• clinical labour
• reproductive markets
• USA
• India
• Russia

Acknowledgements

We would like to thank Prof. Sarah Franklin, Prof. Linda Layne and other members of the Reproductive Sociology Research Group, as well as Prof. Charis Thompson (LSE) for their insightful comments on earlier drafts of this paper. We would also like to thank Prof. Nicky Hudson (Centre for Reproduction Research, De Montfort University, UK), and Prof. Charis Thompson (London School of Economics, UK; previously the University of California, Berkeley, USA) for their help in carrying out our research. We are also immensely grateful to Sarojini Nadimpally and SAMA Resource Group for Women & Health for inviting two of us as speakers at the symposium Unravelling Bio-markets at the Feminist Congress of Bioethics, World Congress of Bioethics, in Saint John’s Medical College, Bangalore (India), on 4 December 2018 – which eventually led to this publication. Finally, we owe our gratitude to our research participants in India, the USA and Russia.

Ethical approvals for the research were received from the Committee for Protection of Human Subjects at the University of California-Berkeley (protocol # 2014-10-6793), and from De Montfort University (reference No 1384).

Research Data

For any queries regarding access to data used in this article please contact the corresponding author Marcin Smietana at [email protected] or [email protected]

Notes

* In the introductory and final sections of this paper, we use common English-language terms “surrogate mothers” and “intended parents”. However, in the specific sections on the surrogacy contexts in the three different locations we follow the terms used by our interviewees in each context, e.g. “surrogates” in the US, “surrogate mothers” in India, and “surmamas” in Russia; as well as “intended parents” in the US and India and “client parents” in Russia.

† All interviewees’ names are pseudonyms.

‡ This and the other two studies in this article did not include interviews with participants in altruistic surrogacy arrangements, which, however, do exist not only in jurisdictions such as the UK that have legalised only altruistic surrogacy models, but also within those jurisdictions where commercial surrogacy is legal such as many of the US states, Russia, and India at the time of this research.

Additional information

Funding

Funding was provided by the British Wellcome Trust (Grant no. 100606, and Grant no. 209829/Z/17/Z); the Marie Curie International Outgoing Fellowship – Seventh Framework Programme of the European Union (FP7-PEOPLE-2013-IOF, Grant Agreement no. 629341, ‘SurrogARTs’), as well as and Spanish Ministry of Economy, Industry and Competitiveness / Feder / EU (grant no. CSO2015- 64551-C3-1-R). Funding was also provided by the De Montfort University, UK, via the PhD Studentship program 2013-17.