The United States has become an ideal marketplace for those seeking selective technologies that are illegal, inaccessible, or unavailable in their own countries. Specifically, technologies such as commercial egg donation, preimplantation genetic diagnosis, and sex selection are prohibited or highly regulated in many nations, but remain legal and largely unregulated in the United States. Based on in-depth interviews with US fertility industry providers, including physicians and egg donor and surrogate brokers, this article analyzes how the ideologies of genetic determinism and (...) consumer choice are embedded in the industry. These are transformed into competitive advantages that may appeal to foreign nationals unable to acquire the technologies, services, and reproductive materials to which they feel entitled. Regardless of providers’ particular attitudes regarding the uses of selective technologies, their overall practice reinforces intended parents’ desires to have some control over their potential children’s appearance, temperament, abilities, and behavior. Despite other nations’ laws and policies, ideologies supportive of the use of selective technologies do not, obviously, end at the US borders, and the globalization of communications, media, and transportation technologies enable their spread. (shrink)

BackgroundEgg donor agencies are increasingly being used as part of IVF in the US, but are essentially unregulated, posing critical ethical and policy questions concerning how providers view and use them, and what the implications might be.MethodsThirty-seven in-depth interviews of approximately 1 h were conducted – with 27 IVF providers and 10 patients.ResultsClinicians vary in their views and interactions concerning egg donor agencies, ranging widely in whether and how often they use agencies. Agencies may offer egg recipients increased choices, but (...) raise ethical and other concerns regarding respect for donors as individuals, potential harms, justice, and donors constituting a vulnerable group. The quality of agencies appears to vary considerably, from acceptable to problematic. Agencies’ medical and psychological screenings of donors can range, and be minimal. Not all agencies adequately track donors’ prior numbers of donations, or share the relevant records with clinics. Clinics may find that potential donors have genetic mutations and medical problems about which they were unaware. Yet agencies and clinics do not provide care for such donors, generating stress. Dissemination of donors’ personal data can potentially threaten confidentiality. Questions emerge of whether increased monitoring/oversight of agencies may be beneficial.ConclusionsThese data, the first to examine providers’ views and interactions regarding egg donor agencies, suggest wide variations in quality and use of agencies, and have critical implications for practice, policy, education and research. Given the potential limitations of the current model of self-regulation of agencies, the present data suggest needs to consider stronger professional guidelines or possible governmental regulations to establish, require and enforce higher standards for agencies to follow, regarding advertising to potential donors and recipients, arranging for appropriate informed consent concerning risks and benefits involved, and for quality control. Appropriate informed consent should be obtained from potential egg donors, including the fact that they may learn about mutations or medical problems about which they were unaware, but for which they will not receive treatment as part of this process. Enhancing understanding among the public-at-large about what egg donation entails may also be helpful. (shrink)

Despite the diverse legal approaches towards surrogacy in Europe, there are common socio-legal arguments attempting to legitimise it amongst the European Union member states. Regardless of the prevailing regulation in each country, surrogacy in general is confronted with common criticisms and faces similar obstacles. For instance, the operative definition of altruism is put under question in countries where altruistic surrogacy is permitted. Surrogacy is also considered an attack on a woman’s dignity and a risk to children’s welfare. Behind such claims, (...) however, rests the common yet unsubstantiated belief in a natural maternal instinct. Furthermore, a clear misunderstanding about the bonding theory still persists. Common debates around surrogacy in Europe show us that, beyond the national margin of appreciation, surrogacy challenges basic definitions of motherhood, filiation and family. These challenges are deeply permeated by gender stereotypes which partially explain the national similarities among the legal diversities. (shrink)

Feminist scholars have done much to identify oppressive forces within transnational commercial contract pregnancy and its social context that may coerce women into becoming gestational laborers. Feminists have also been careful not to depict gestational laborers as merely passive victims of oppression, though there is disagreement about the degree to which contract pregnancy offers opportunities for agency. In this article I consider how women who sell gestational labor may be agents against their oppression. I make explicit connections between resistance and (...) judgment, which I will take to be a critically considered, intersubjective evaluative claim. Drawing on work by Jennifer Nedelsky and Hannah Arendt, my main argument will be that individual judgments can better enable oppressed persons to resist some aspects of their oppression, and that judgment helps to develop agential capacities, in particular, the capacity for a person to be self-constituting, to see herself as giving reasons for her own actions. I use Indian contract pregnancy as a case study to think through connections between resistance and judgment. (shrink)

The ongoing debate on how best to regulate international commercial surrogacy defies consensus, as the most cogent normative and jurisprudential grounds for and against non-altruistic surrogacy remain controversial. This paper contributes to the debate by focusing on social justice issues arising from transnational, moneymaking surrogacy, with a focus on the Global South. It argues that existing theoretical perspectives on balancing interests, rights, privileges, and resources in the context of cross-border surrogacy—such as cosmopolitanism, communitarianism, liberal feminism, radical feminism, and neorealism—are not (...) sufficient to treat the question of justice underpinning transnational surrogacy in the Global South. An Afro-communal theory of social justice is proposed as an alternative model for addressing the shortcomings in existing global justice theories. Building on Thaddeus Metz’s construction of Afro-communal social theory and a bioethic of communion, this article reveals the fundamental nature of injustices in the Global South surrogacy foray. This approach provides prima facie grounds for making commercial surrogacy more just in the evolving global order. (shrink)

ABSTRACTGlobal demand for human ova in in vitro fertilization has led to its expansion in countries with falling average incomes and rising female unemployment. Paid egg donation in the context of national, regional, and global inequalities has the potential to exploit women who are socioeconomically vulnerable, and indeed there is ample evidence that it does. Structural injustices that render women in middle-income countries – and even some high-income countries – economically vulnerable contribute to a context of ‘omissive coercion’ that is (...) morally troubling. When egg brokers or fertility clinics take advantage of these background structural injustices and prospective ova providers’ vulnerability in order to pay them less than they need to meet their livelihood needs, they engage in exploitation. Analyzing paid egg donation as a form of reproductive labor, however, can direct our attention to reforms that would reduce exploitative instances of this practice. In contrast to those who see... (shrink)

This article explores the intersections of power within transnational surrogacy in India, using the lens of geography to examine surrogate women’s and commissioning parents’ experiences and perceptions of space and mobility. The author analyzes ethnographic data within a geographical framework to examine how actors embody and experience power relations through space and movement, revealing how power is not simply about who moves and who doesn’t. Rather, in recognizing the specificity of the Indian context, and how different actors inhabit and move (...) through distinct spaces, a geographical lens reveals the shifting complexity of structures of agency and power. Drawing on extensive ethnographic fieldwork in India, the author traces how both surrogate mothers and commissioning parents experience moments of mobility and movement punctuated by intervals of immobility and stillness, in distinct ways that illuminate the power relations inherent in transnational reproduction. (shrink)

It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive capacities, (...) and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage, or Fair-Trade guidelines. An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad. (shrink)

When an individual is unable or unwilling to become a parent the natural way, he/she can avail of a surrogate mother. Furthermore, when the surrogate pregnancy takes place in a foreign country, the practice is popularly referred to as ‘surrogacy tourism’ or ‘birther tourism’, which is the main topic of this research. In contrast to existing research most of which is confined to the medical angle, here we look at how marketing makes surrogacy tourism more accessible but concomitantly promotes unwanted (...) ethical and marketing practices, even if inadvertently. On one hand, rigorous promotion of surrogacy tourism has successfully spread the word and has made such option available to individuals who would have otherwise been unaware of such opportunity. On the other hand, excessive marketing has resulted in unethical, illegal and in some cases, unhealthy medical practices in which, service providers, clinics and doctors often participate, but on which there appears to be scant research. This analysis, therefore, has two-fold implications: first, the findings can be extended to several other related professions, such as the medical community, administrators, law enforcement agencies and most importantly, potential ‘parents’; secondly, it can aid administrators and regulators tighten extant loopholes in the system, and thereby, provide a more robust and safer option for surrogate tourists. (shrink)

When it comes to discourses around women's labor in global contexts, we need feminist philosophical frameworks that take the intersections of gender, race, and global capitalism seriously in order to arrive at a comprehensive understanding of women's lives within global processes. Women of color feminist philosophy can bring much to the table in such discussions. In this essay, I theorize about a concrete instance of global women's labor: transnational commercial gestational surrogacy. By introducing a “racialized gender” analysis into the philosophical (...) debate on this issue, I argue that women's reproductive labor is becoming increasingly stratified within the global economy along racial and other lines. This paves the way for a “transnational reproductive caste system,” which ends up reifying various social hierarchies and sustaining existing global inequities. I aim to expose the kind of violence that surrogates experience due to such stratification as women of color in a transnational space. I discuss how discourses of race and existing racial hierarchies play out in international surrogacy and ways in which these, and indeed, the very category of “woman of color” get complicated in international contexts when they intermingle with other localized social forms and global inequities. For the purposes of my argument, I engage several insights from feminist of color Dorothy Roberts's work on race and reproductive technologies in the US. (shrink)

Since the 1980’s, surrogacy has become a popular reproductive alternative for individuals experiencing infertility. The ethical and legal analyses of surrogacy have been rich and varied. Some bioethicists have charged the commercial surrogacy industry with the exploitation of global southern women or with the impermissible commodification of children and women’s reproductive capacities. Others have praised the potential for economic empowerment and bodily autonomy that surrogacy may accord to women. However, throughout these explorations of the ethics of surrogacy, comparatively little attention (...) has been paid to the moral status of a crucial actor: the fertility doctor. Without doctors willing to provide prenatal and postnatal care to surrogates and make use of assisted reproductive technologies (ARTs), commercial surrogacy would not take place. Yet, doctors’ involvement in surrogacy is far from morally neutral. In my thesis, I aim to explore what duties doctors have in the context of commercial surrogacy. To do so, I take up the framework of fiduciary obligation. I argue that doctors have fiduciary obligations to surrogates, and that these obligations shape if and when doctors can ethically facilitate surrogacy. My thesis is divided into four chapters. The first defends the view that the doctor-patient relationship is fiduciary in nature. The second chapter extends this view to the realm of commercial surrogacy, arguing that doctors also owe the surrogates they treat fiduciary obligations. The third chapter addresses a challenge posed by my view, namely that surrogacy seems to place doctors in positions where they constantly face conflicts of interest, and are therefore unable to uphold their fiduciary duty of loyalty to surrogates. I address this concern by arguing that conflicts of interest are not inherent in surrogacy, but that surrogacy arrangements must be substantially rethought in order to safeguard the doctor-surrogate fiduciary relationship. The final chapter considers the obligations doctors have to the children they help create through surrogacy and through assisted reproduction more generally. (shrink)