Indian Journal of Medical Ethics

REVIEWS

Breaking “natural” boundaries

Sylvia Karpagam

DOI: 10.20529/IJME.2019.071
The book Full surrogacy now: Feminism against family by Sophie Lewis comes at a time when the Surrogacy (Regulation) Act 2018 (1) in India proposes to replace commercial surrogacy with an altruistic version. While commercial surrogacy in India, with its array of private hospitals and agents, has tended to be exploitative of surrogate women, the new Bill riding on the back of patriarchy, caste and class, reserves surrogacy only for heterosexual, married couples while denying it to single, queer and live-in couples. The surrogate, in turn, is expected to be a close relative of the couple, who is married and has obtained consent from her own husband.

This book by Lewis challenges many notions around religion, patriarchy, gender, family, motherhood, love, class etc, that operate around surrogacy; while claiming that the solution to any kind of exploitation is more, and not less, surrogacy. The child, instead of being viewed as the “property” of a private nuclear family, exposed, as it will be, to many adverse social and cultural influences, should, rather, be considered as a social good. Lewis highlights how romantic articulations around pregnancy and child birth often hide its innate morbidity and mortality.

Lewis gives us the broad landscape of the surrogacy industry and the often unequal and exploitative conditions that surrogates work in. Lewis argues that the needs and protection of the surrogates should be primary, rethinking their relationship with the babies they gestate and recognising reproduction as productive work.

The book challenges many socially constructed presumptions around marriage, pregnancy, community, work, comradeship etc. through the lens of surrogacy. It suggests that collective ownership of a baby would drastically change our way of looking at kinship and family. Lewis lays out the idea of women as non-homogenous entities with varying levels of attachment (or not) to their wombs and the products of these wombs. In Lewis’ world, a child is born only because someone, not necessarily the one carrying the baby, wants it. The book attempts to convert the narrow family-centric notion of childcare to a broader community-based model where a child, although entitled to a family, also belongs to a community that is responsible for her care. The surrogate mother is seen, not as an angel offering to produce a child for someone else with love, but a woman who uses her body for the generation of labour that is also monetised, as are other organs like the hands, ears, brain etc.

The author holds up the individual attitude, behaviour and perceptions of Dr Nayna Patel, a doctor at the Akanksha Hospital (formerly Akanksha Infertility and IVF Clinic), in Anand, India as a mirror to Indian society at large; showing how hard-nosed business initiatives are couched as altruistic social initiatives.

She clearly distances herself from this exploitative, dishonest surrogacy model which is projected by Dr Patel as altruistic for the surrogate while, in fact, reaping dividends for herself. It is crucial that this class hypocrisy is exposed in the Indian context and Lewis does it well, unlike many other writers, who often tiptoe around these issues that are particularly explosive under the current Bharatiya Janata Party (BJP) government. She stops short of looking at some of the deeper structural and systemic issues that operate ─ how women navigate relationships within their families, their extended families, community, political landscape, employment etc. In the surrogacy clinic, middle men and women are a crucial link, and as can be seen in other women-centric sectors such as garment factories, sanitation, sex work, construction etc, these people exploit their unique position. The surrogacy clinic washes its hands of the misdoings of the agent leaving the surrogate women vulnerable to exploitation.

The value of surrogacy as “priceless” seems to be reserved for surrogates and never for the industry that has sprouted around it. Lewis calls this out. Words like “sister” or “aunty” seem to imply that surrogate women are doing this labour out of good will without monetary desire. A surrogate woman seem to be either forced into the role of a “nice woman” who does things for others, or a “bad woman” who doesn’t care enough for the baby she produces.

A major part of the theoretical basis of the book derives from Western literature, while the research, supposedly drawn from an Indian context, tends to be anecdotal. This can be somewhat dangerous given that a counter anecdotal narrative can then easily be created. Western theory is used without enough regional theoretical or empirical evidence. For instance the author quotes Erica Millar in Happy abortions and reaches the conclusion that “sustained negative emotions are extremely rare in connection with having an abortion.” In India, women, especially those who have never had a “successful” pregnancy, and who have undergone repeated abortions, experience a range of emotions, often created by family and community, that cannot be dismissed as “non-existent” based on one book from the West.

In a similar manner, Lewis criticises Barbara Bush for targeting overpopulation through “uncontroversial social policy goods like education for women’ because ‘it is implied that it is the poor women’s kids who are the problem and which could only be the result of a lack of education” (p 11). How does that position itself in the context of India where education of women is associated with better health outcomes for the women and their children, and long reaching consequences in terms of independence, decision making, labour rights, employment etc.?

Lewis loosely uses the term “caste” to describe Atwood’s characterisation of the different sex class groups into handmaids, Marthas, Jezebels, unwomen etc. but doesn’t use the opportunity to adequately explore how real-time caste operates in India around reproduction, surrogacy etc. While criticising “color blind white feminism’ the author doesn’t do much to address her own caste blindness. Effort is made to describe Soviet mass holiday camps for pregnant comrades, twilight sleep methods in Germany and discussions about midwives in the Motherhood Archives (pp 7-8), but the role of predominantly Dalit traditional birth attendants (or traditional midwives) in the Indian context is left out completely. The traditional birth attendant play an important role in India in what Lewis envisages as a “community” baby, a role that is sometimes central and sometimes completely rejected depending on the circumstance of the pregnancy, labour and childcare.

Lewis mentions the thoughts of theorist Banu Subramaniam on caste in surrogacy– the mystery of how “in a country where Hinduism is deeply entrenched in the politics of purity and pollution…so intimate a practice of gestational surrogacy isn’t centred around the primacy of caste”. This, in the words of Subramaniam, is attributed to the export-facing character of the enterprise and that in spite of wanting Brahmin surrogates to gestate their gametes, prospective Indian parents ‘can’t afford to be picky’ in the words of Dr Patel, the surrogacy expert. This aspect could have been further unravelled by the author given its extreme relevance.

Lewis draws attention to the religious fundamentalism of the West, particularly right wing governance in the US, but sidesteps the growing patriarchal, right wing politics in India which has been instrumental in converting commercial surrogacy into an altruistic one while reinforcing traditional patriarchal family norms on women. Lewis criticises trans-exclusionary radical feminism (TERF) and calls for ways to counteract the exclusivity and supremacy of “biological” parents in children’s lives while discouraging competitiveness and looking for non-genetic, communising family support systems. The transgender community in India is a strong presence and more detailed conversations with this community could have added depth to the understanding.

Lewis breaks the seemingly artificial boundary between “natural” pregnancy and surrogacy revealing-that natural boundaries are not in fact so natural or happy but fraught with many similar ethical, social, gendered issues that surround surrogacy. That one is protected and the other is criminalised is the crux of the book and she makes the reader rethink many preconditioned notions. If babies don’t “belong” to anyone, then surrogacy contributes to a world without boundaries and moral controls, while reproduction gains the same value as any other labour.

References

  1. The Surrogacy Regulation Act, 2018. Passed by the Lok Sabha on 2018 Dec 19[cited 2019 Oct 21]. Available from: http://164.100.47.4/billstexts/lsbilltexts/PassedLokSabha/257-C%20_2016_Eng..pdf