Surrogacy is an encouraging management for many childless couples and can hypothetically resolve many unbearable pain that they are confronted. Initially surrogacy treatment was frowned upon, however, surrogacy is more popularly accepted now a day. But different country has different regulations on surrogacy. However, there are some degree of divergence between official discourse and actual practice of surrogacy throughout world. There are positive changes in attitude toward surrogacy has been seen for some countries as well. This editorial brief about surrogacy (...) around the world. (shrink)

Since the development of assisted reproductive technologies, infertile individuals have crossed borders to obtain treatments unavailable or unaffordable in their own country. Recent media coverage has focused on the outsourcing of surrogacy to developing countries, where the cost for surrogacy is significantly less than the equivalent cost in a more developed country. This paper discusses the ethical arguments against international surrogacy. The major opposition viewpoints can be broadly divided into arguments about welfare, commodification and exploitation. It is argued that the (...) only valid objection to international surrogacy is that surrogate mothers may be exploited by being given too little compensation. However, the possibility of exploitation is a weak argument for prohibition, as employment alternatives for potential surrogate mothers may be more exploitative or more harmful than surrogacy. It is concluded that international surrogacy must be regulated, and the proposed regulatory mechanism is termed Fair Trade Surrogacy. The guidelines of Fair Trade Surrogacy focus on minimizing potential harms to all parties and ensuring fair compensation for surrogate mothers. (shrink)

What makes a multimillion-dollar, transnational intimate industry possible when most people see it as exploitative? Using the newly emergent case of commercial surrogacy in India, this article extends the literature on stratified reproduction and intimate industries by examining how surrogacy persists and thrives despite its common portrayal as the “rent-a-womb industry” and “baby factory.” Using interview data with eight infertility specialists, 20 intended parents, and 70 Indian surrogate mothers, as well as blogs and media stories, we demonstrate how market (...) actors justify their pursuits through narrating moral frames of compassion and altruism that are not incidental but systematic to and constitutive of transnational surrogacy. We observed two predominant moral frames: surrogacy liberates and empowers Indian women from patriarchal control; and surrogacy furthers reproductive rights. Within these frames, the market exchange of money for babies is cast as compassion, which allows commissioning clients to sidestep accusations of racism, classism, and sexism. Yet, we reveal that the ability to navigate around these threats relies on racist, classist, and sexist tropes about Third World working-class women. Further, we find that surrogate mothers did not experience significant changes in economic status after surrogacy. (shrink)

Advances in reproductive medicine have provided new, and much needed, hope for millions of people struggling with infertility. Gestational surrogacy is one such development that has been gaining popularity with infertile couples, especially those unable to benefit from other reproductive procedures such as In Vitro Fertilization. For many Muslim couples, however, surrogacy remains a nonviable option. Islamic scholars have deemed the procedure incompatible with Islam and have prohibited its use. This paper examines the arguments presented for proscribing surrogacy arrangements (...) in Sunni Islam in particular. These include preservation of lineage, exclusion of third parties in reproduction, upholding the rights of the child, and protection from the negative effects of surrogacy arrangements. The rationales for banning surrogacy are subsequently refuted utilizing Islamic law “Sharia”, bioethics, and medical evidence. The paper also presents reasons for why surrogacy is not only consistent with Sunni Islamic teachings, but is also both ethically justified and medically necessary. Lastly, Islamic scholars are urged to take into account the arguments presented in this paper and reconsider their rulings on the permissibility of surrogacy. (shrink)

In this article, it is argued that it is problematic to construe the debate around the process labelled ‘surrogacy’ as a form for infertility treatment. Firstly, this way of defining what happens opens up a new form of medical desire where a growing number of people wish to have children through ‘surrogacy’. This medicalizes childlessness and creates pressure within health services to respond to the desires of an ever-growing group of patients. Secondly, this labels the woman who carries the (...) child as a ‘surrogate’ and defines her as a core element in a ‘treatment method’. This way of phrasing and defining what happens puts the woman carrying the child in an unacceptable moral position within the health system. Thirdly, by viewing the woman carrying the child as a ‘substitute’ for a mother or as a ‘temporary custodian’ ignores the unique relationship between the foetus and the pregnant woman. To keep the ethical issues in focus in the ‘surrogacy’ process, it is necessary for health professionals to always... (shrink)

Infertile women in the developing world face an additional layer of vulnerability compared to their counterparts in the developed world due to social, cultural, political, and socioeconomic factors that truly render their infertility a disability. After exploring how infertility in the developing world fits the World Health Organization’s biopsychosocial model of disability, we will argue that feminists and disability rights proponents should jointly articulate and advocate for change.

Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six ethics lenses is used in the comparative analysis: reproductive autonomy and rights, informed choice/consent, (...) relevant critical relational theories, health equity, theoretical application of the accepted living donation standard, and comparative benefits and burdens considerations. Gestational surrogacy, as currently practiced in some high-income countries, is the assumed, theoretical base-threshold for determination of ethical acceptability in assisted reproduction practices. The analysis demonstrates that : 1) the ethical acceptability of living uterus donation/transplantation is less than that of gestational surrogacy in high-income countries, and 2) the ethical acceptability of deceased uterus donation/transplantation is roughly equivalent to that of gestational surrogacy. This leads to the conclusion that, at the present time, only one version of uterus transplantation practice, i.e., deceased uterus transplantation, should be considered ethically acceptable for possible clinical implementation in high-income countries. (shrink)

Gestational surrogacy as a treatment for infertility is being practised in some well-known medical institutions in Tehran and some other cities in Iran. While the majority of Muslims in the world are Sunni, the majority of Iranians are Shiite. Most Sunni scholars do not permit surrogate motherhood, since it involves introducing the sperm of a man into the uterus of a woman to whom he is not married. Most Shiite scholars, however, have issued jurisprudential decrees (fatwas) that allow surrogate (...) motherhood as a treatment for infertility, albeit only for legal couples. They regard this practice as transferring an embryo or fetus from one womb to another, which is not forbidden in Shiite jurisprudence. Nevertheless, there are some controversies concerning some issues such as kinship and inheritance. The main ethical concern of Iran’s experience with gestational surrogacy is the monetary relation between the intended couple and the surrogate mother. While monetary remuneration is practised in Iran and allowed by religious authorities, it seems to suffer from ethical problems. This article proposes that this kind of monetary relation should be modified and limited to reimbursement of normal costs. Such modification requires new legislation and religious decrees. (shrink)

Commercial surrogacy arrangements now cross borders; this paper aims to reevaluate the traditional moral concerns regarding the practice against the added ethical dimension of global injustice. I begin by considering the claim that global surrogacy serves to satisfy the positive reproductive rights of infertile first-world women. I then go on to consider three powerful challenges to this claim. The first holds that commercial surrogacy involves the commodification of a good that should not be valued in market terms, the second that (...) it involves the exploitation of the labor of disadvantaged women, and the third that it depends on the illegitimate privileging of positive rights over negative rights. I reject the first of these challenges and argue that global surrogacy arrangements are indeed exploitative on the dual basis of what I call intracontractual injustice and intercontractual coercion. The latter, I contend, depends on a preexisting negative rights violation, which cannot be permitted for the sake of satisfying another's positive reproductive entitlement. I conclude not in favor of a global ban but with suggestions on how developing nations that permit commercial surrogacy might better protect the negative reproductive rights of their female citizens, thereby making them less vulnerable to exploitation. (shrink)

Surrogacy and adoption are both family-making measures subject to extensive domestic and international regulation. In this nationally representative survey study (N = 1552), we explore public attitudes to various forms of surrogacy and adoption in the United Kingdom, in response to an early proposal to allow “double donor” surrogacy as part of the ongoing legal reform project. We sought to both gauge public moral support for adoption and surrogacy generally, the effect that prospective parents’ fertility had on this support, and (...) the extent to which the public would find equivalencies between “double donor” surrogacy (DDS) and planned private adoption (PPA) to be morally significant. Our findings indicate that whilst there is broad baseline support for all forms of adoption and surrogacy, this support increases significantly when one or both prospective parents are infertile. These findings also suggest that the language in which a family-making arrangement is characterized has a greater influence on moral support for the arrangement than practical features such as the biological relationship (or absence thereof) between one/both parents and the child. (shrink)

Surrogacy is an increasingly frequent form of family building and allows individuals to become parents despite an infertility diagnosis or a biological impossibility. Positive outcomes for both the surrogacy child and the surrogate mother have been reported, including in cases of same-sex male couples and single persons. There is an on-going debate because remuneration does not necessarily involve undue inducement of the surrogate or transformation of the child into a commodity. The right to regret and the doctors’ autonomy are (...) also addressed in this paper. Nevertheless, literature on surrogacy is scarce, and most of the existing studies have important methodological limitations, so further investigation is much needed. We believe that counselling should be granted for both intended parents and surrogate, in order to prevent the majority of problems. We also agree that parental vetting should be possible, focusing the doctor’s responsibility also in the future child. (shrink)

As of 2008, surrogacy is legal and openly practised in various places; Japan, however, has no regulations or laws regarding surrogacy. This paper reports the situation of surrogacy in Japan and in five other regions to clarify the pros and cons of prohibiting surrogacy, along with the problems and issues relating to surrogacy compensation.Not only in a country such as France that completely prohibits surrogacy within the country, but also in a country such as the UK that allows non-commercial surrogacy, (...) infertile couples travel overseas for the purpose of surrogacy. In addition, some couples might seek underground surrogacy if the government prohibits surrogacy. If an intended parent couple and a surrogate make an agreement among themselves and then a problem occurs, they cannot ask for support from professionals or bring a case to court, as can be observed in South Korea and Taiwan.We also conclude that there is little difference between commercial surrogacy and non-commercial surrogacy in the absence of a clear definition of ‘reasonable expenses.’ In the UK, the law does not allow surrogates to receive compensation. However, in reality, there may be little difference between the amounts paid to surrogates for profit in the US and those paid to surrogates for reasonable expenses in the UK. We conclude that the issue of surrogacy demands further discussion in Japan. (shrink)

This chapter explores current and prospective reproductive technologies and some of their likely implications for reproductive and family ethics and policymaking. The technologies discussed include uterus transplants, mitochondrial transfer, ectogenesis, the development of in vitro gametes, and solo reproduction. The chapter considers the impact of these developments on the content of concepts such as 'infertility', 'mother', or 'father'. Another layer to this process of redefinition originates in ongoing socio-cultural changes that shift the focus in parenting from the way in (...) which children have come into the world, to relationships within the family. Considering these scenarios beforehand can help to clarify some of the current challenges in defining and regulating infertility. The chapter therefore aims to raise a number of questions rather than provide answers. (shrink)

Increasing globalisation and advances in artificial reproductive techniques have opened up a whole new range of possibilities for infertile couples across the globe. Inter-country gestational surrogacy with monetary remuneration is one of the products of medical tourism meeting in vitro fertilisation embryo transfer. Filled with potential, it has also been a hot topic of discussion in legal and bioethics spheres. Fears of exploitation and breach of autonomy have sprung from the current situation, where there is no international regulation of surrogacy (...) agreements—only a web of conflicting national laws that generates loopholes and removes safeguards for both the surrogate and commissioning couple. This article argues the need for evidence-based international laws and regulations as the only way to resolve both the ethical and legal issues around commercial surrogacy. In addition, a Hague Convention on inter-country surrogacy agreements is proposed to resolve the muddled state of affairs and enable commercial surrogacy to demonstrate its full potential. (shrink)

A growing number of infertile couples and other individuals desiring children are seeking to fulfill their desire for parenthood transnationally through the use of donor gametes and a surrogate. The number of “fertility tourists” from developed countries to low-income countries is growing phenomenally. Indian women, too, are participating as producers in these “biocrossings,” turning India into the surrogacy outsourcing capital of the world in the globalized bioeconomy of assisted reproduction. I argue for a ban on commercial egg donation and surrogacy (...) and a social-justice approach that would hold the state responsible for providing basic social goods to low-income households. I also argue for a gender-justice approach so that women would not be compelled to adopt surrogacy as a strategy for survival and upward social mobility. (shrink)

ABSTRACTAs of 2008, surrogacy is legal and openly practised in various places; Japan, however, has no regulations or laws regarding surrogacy. This paper reports the situation of surrogacy in Japan and in five other regions to clarify the pros and cons of prohibiting surrogacy, along with the problems and issues relating to surrogacy compensation.Not only in a country such as France that completely prohibits surrogacy within the country, but also in a country such as the UK that allows non‐commercial surrogacy, (...) infertile couples travel overseas for the purpose of surrogacy. In addition, some couples might seek underground surrogacy if the government prohibits surrogacy. If an intended parent couple and a surrogate make an agreement among themselves and then a problem occurs, they cannot ask for support from professionals or bring a case to court, as can be observed in South Korea and Taiwan.We also conclude that there is little difference between commercial surrogacy and non‐commercial surrogacy in the absence of a clear definition of ‘reasonable expenses.’ In the UK, the law does not allow surrogates to receive compensation. However, in reality, there may be little difference between the amounts paid to surrogates for profit in the US and those paid to surrogates for reasonable expenses in the UK. We conclude that the issue of surrogacy demands further discussion in Japan. (shrink)

Reproductive health technology allows married couples who experience infertility to have a child through assisted reproductive technology (ART), such as the in vitro fertilisation (IVF) process. The transfer of the extracted embryo to the woman’s womb is called surrogacy technology (gestational surrogacy). The legality of the practice of surrogacy is still questionable, both on a national and international level. This research discussed the legality of surrogacy in some religious countries, focusing on Indonesia. This research used normative juridical research methods (...) or literature review through a comparative religion-legal approach. This study indicated that most do not have a specific legal instrument regarding surrogacy practice. International law also does not have a standard legal instrument regarding the legality of surrogacy. Legality is determined by each religious country’s national laws and customs. For example, Indonesian law prohibits this practice implicitly under Law No. 36 of 2009 concerning health. The United Kingdom legalised surrogacy through the Surrogacy Agreement Act 1985, which was amended to the Human Fertilization and Embryology Act 2008, Greece through the Greek Legislation Law 3089/2002 and Law 3305/2005, and India through the 2019 Surrogacy Regulation Bill. Those countries have their limitations and characteristics that rule surrogacy. Surrogacy is indeed a technological advancement in the health sector. However, for countries that are influenced much by religion, technological advances sometimes conflict with the culture and the belief that has long been followed by most of the population. For Indonesia, the largest of Sunni Islam ruled surrogacy against the law. Next, Iran, as a Shia Islam country, ruled that surrogacy is a legal action.Contribution: The research provided information and knowledge regarding the different settings of surrogacy practice. Most religious countries bravely rejected or put strict limits on the practice of surrogacy. (shrink)

Klein, Renate The practice of surrogacy in Australia has been controversial since its beginning in the late 1980s. In 1988, the famous 'Kirkman case' in the state of Victoria put surrogacy on the national map. This was a two-sisters surrogacy - Linda and Maggie Kirkman and the resulting baby Alice - in which power differences between the two women were extraordinarily stark: Maggie was the glamorous and well spoken woman of the world; Linda who carried the baby, was the demure (...) school teacher in child-like frocks and pig tails. Their IVF doctor applauded altruistic surrogacy. He called it 'gestational surrogacy' and proclaimed that if the so-called surrogate mother didn't use her own eggs, thus wasn't the baby's 'genetic' mother, no attachment would ensue! This statement is haunting us to this day. It is patently absurd: as a baby grows in a woman's body over the nine months of the pregnancy, it is hard to see why the 24/7 presence of the baby inside her body, its growth, its interaction with her would be any different whether s/he has the mother's genes! (shrink)

This paper explores the experiences of infertile women who occupy a liminal space in society, and argues that the fertility clinic served as a space to tolerate women's experiences of liminality. It provided not only rituals aimed at transition to pregnancy, but also a space where women's liminal experiences, which are caused by the existential chaos of infertility, could be tolerated. The British experience seemed to differ from the American one identified in the literature, where self‐management and peer group (...) support are described as strategies used by infertile women to manage infertility. The British women in this study did not appear to draw so much on self‐management or peer group support to deal with their experiences of infertility. They appeared to be isolated in their experience. The clinic thus provided a space in which recognition was given to their intensely private experiences of difference from those in the outside fertile world and allowed them to manage these socially unacceptable, culturally taboo and invisible experiences. However, because of its very limited success rate in enabling women to become pregnant, rather than facilitating the transition of status from infertile to fertile woman, the clinic also served to reinforce the liminal experiences of those women who remained infertile. Inadvertently, the clinic offered a way of being in limbo while at the same time reinforcing the liminal experiences of women. (shrink)

Surrogacy is an encouraging management for many childless couples and can hypothetically resolve many unbearable pain that they are confronted. Initially surrogacy treatment was frowned upon, however, surrogacy is more popularly accepted now a day. Though, surrogacy has not yet recognized by 199 country in the globe. Different country has different regulations on surrogacy. However, “there are some indication of the degree of divergence between official discourse and actual practice of surrogacy throughout world”. There are positive changes in attitude toward (...) surrogacy has been seen in some countries. This special issue of Bangladesh Journal of Bioethics has been organized on surrogacy to see the current thinking of surrogacy around the world and how people come out from the social, religious and political framework. (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)

This article proposes reconsideration of laws prohibiting paid surrogacy in Australia in light of increasing transnational commercial surrogacy. The social science evidence base concerning domestic surrogacy in developed economies demonstrates that payment alone cannot be used to differentiate “good” surrogacy arrangements from “bad” ones. Compensated domestic surrogacy and the introduction of professional intermediaries and mechanisms such as advertising are proposed as a feasible harm-minimisation approach. I contend that Australia can learn from commercial surrogacy practices elsewhere, without replicating them.

In this paper I examine what I take to be the best case for reproductive human cloning, as a medical procedure designed to overcome infertility, and argue that it founders on an irresolvable tension in the attitude towards the importance of being ‘genetically related’ to our children implied in the desire to clone. Except in the case where couples are cloning a child they have previously conceived naturally, cloning is unable to establish the right sort of genetic relation to (...) make couples the parents of their cloned child. If anybody is the genetic parent of a cloned child it is the natural parent(s) of the DNA donor. Paradoxically, in order to resist the claims of the parents of the donor to the cloned child, the argument for human reproductive cloning must place more weight on the intention to parent a child, than we do in cases of ordinary reproduction. It must insist that the parental relation is established by the intentions of the couple who bring a clone into the world and not by their genetic relation to the child. The emphasis placed on intention as establishing the parental relationship works to undermine the justification for cloning in the first place. For cloning to play a useful role as a reproductive technology, it must allow couples to become parents who could do so no other way. However, to the extent that intention is sufficient to establish parenthood, adoption or surrogacy, which are existing alternatives to cloning, will serve equally well to allow couples to become parents. (shrink)

Within the ethics and science literature surrounding uterus transplantation (UTx), emphasis is often placed on the extent to which UTx might improve upon, or offer additional benefits when compared to, existing ‘treatment options’ for women with absolute uterine factor infertility, such as adoption and gestational surrogacy. Within this literature UTx is often positioned as superior to surrogacy because it can deliver things that surrogacy cannot (such as the experience of gestation). Yet, in addition to claims that UTx is superior (...) in the aforementioned sense it is also often assumed (either implicitly or explicitly) that UTx is less fraught with ethical difficulties and thus should be considered a less morally problematic option. This article seeks to examine this assumption. Given that much UTx research has been performed in Sweden, a country where surrogacy is effectively although not currently explicitly forbidden, we do this through an analysis of the arguments underpinning a 2016 Swedish white paper which considered amending existing policy such that altruistic surrogacy arrangements would be permitted. By applying the white paper’s arguments for a restrictive position on altruistic surrogacy to the case of UTx using living altruistic donors we find that such arguments, if they hold in the case of surrogacy, apply similarly to UTx. We thus suggest that, for reasons of consistency, a similar stance should be taken towards the moral and legal permissibility of these two practices. (shrink)

Infertility is a prevalent worldwide health issue and is defined by the World Health Organization as a global health problem. Considering the importance of the psychological dimensions of infertility, various measurement tools have been used to measure the variables involved in infertility, of which the most widely used are the following: the Symptom Checklist 90, the Brief Symptom Inventory, the State-Trait Anxiety Inventory Form, and the Depression Anxiety Stress Scale. Therefore, given the problems of infertile people in (...) terms of psychological dimensions, the aim of this meta-analysis was to assess the psychological assessment score in infertility. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, we applied an online database with no time restriction. Data were gathered using a random-effect model to estimate the standard mean difference for the evaluation of the strength of association analyses. Our data demonstrated a significant higher SCL90 score, and a non-significant higher DASS score. It is essential to seek for strategies to help infertile patients overcome their infertility-related psychological problems. (shrink)

Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility (...) on the quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)

The issue of surrogacy has received a great deal of attention in the West ever since the famous Baby M case in the latter part of the 1980s. Ethicists, psychologists, and legal experts have struggled with the meanings and implications of this practice, especially in its commercial form. In contemporary times, however, the phenomenon of surrogacy has assumed new dimensions as it travels across national borders in the context of globalization. As a transnational phenomenon, it is now marketed as an (...) attractive part of "Reproductive Tourism," for the most part, by various clinics and organizations located in the global south to some of the so-called "First World nations."Until now, most of the philosophical literature. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:This Birth and ThatSurrogacy and Stratified Motherhood in IndiaAmrita PandeIn 2006, i came across a short newspaper article about the emergence of a new industry in India—the industry of paid birth or commercial surrogacy. People from all over the world could now hire Indian women to give birth to babies for them, for a fraction of the cost of surrogacy elsewhere and with no government regulations. After some digging (...) around, I quickly realized that there was scarcely any objective, academic research about this new industry, and so began my ethnographic journey to the first clinic in not just India but in fact in the entire Global South to have a flourishing trade in both national and transnational surrogacy.1Academic inquiry into surrogacy arrangements is adequately interdisciplinary and has generated feminist, ethical, legal, and social debates for more than three decades (see, for example, Andrews 1987; Anderson 1990; Bailey 2011; Brennan and Noggle 1997; Hochschild 2012; Markens 2007; Oliver 1989; Ragoné 1994; Pande 2011; and Teman 2010). While defenders of surrogacy advocate it as a manifestation of women’s freedom and choice, much of the scholarship has displayed intense anxiety about this practice (Corea 1986; Dworkin 1983; Harding 1991; Neuhaus 1988; Raymond 1993; Roberts 1998b; and Rothman 1988). One view is that surrogacy reduces women to a mere breeder class, to the class of prostitutes, and another is that it is just another form of baby selling. Others consider the development of such reproductive technologies as a form of class and gender-based exploitation of women’s bodies. Two additional trends in this scholarship are worth emphasizing. First, [End Page 50] much of the debating takes place in abstraction and is rarely based on the actual experience of surrogates.2 Second,much of this work is about surrogacy in the Global North. This is not altogether surprising, since commercial surrogacy is a very recent phenomenon outside of the Global North.In this essay, I address these two gaps in the literature by analyzing the birthing narratives of surrogates in a clinic in India. As the surrogates compare their experiences of giving birth as a surrogate mother to their previous pregnancies, they underscore the paradox of an industry based on pro-natal technology in an otherwise anti-natal state. As importantly, these narratives are a clear manifestation of a global trend of “stratified motherhood”—“the hierarchical organization of reproductive fecundity and birth experiences that supports and rewards the maternity of some women while despising or outlawing the mother-work of others” (Rapp 2001, 469).Surrogacy in IndiaThe moral and ethical ambiguity surrounding surrogacy has made many countries, including China, the Czech Republic, France, Germany, Italy, Mexico, Saudi Arabia, Spain, Sweden, Switzerland, Taiwan, Turkey, and some U.S. states ban surrogacy altogether. Some countries have imposed partial bans, for instance Australia (Victoria), Brazil, Hong Kong, Hungary, Israel, South Africa, and the UK. Canada, Greece, South Africa, Israel, and the UK permit gestational surrogacy, subject to regulations. Then there are other countries with no regulations at all, such as Belgium, Finland, and India (Markens 2007; Teman 2010). Apart from the recent spurt of surrogacy in India, commercial surrogacy is most prevalent in California, USA, and Israel, where surrogacy is tightly controlled by the state and restricted to Israeli citizens. The Indian structure is closer to the liberal market model of surrogacy in California, where surrogacy births are primarily managed by private, commercial agencies that screen, match, and regulate agreements according to their own criteria (Pande 2009).India is not the only country to experience a rise in transnational surrogacy. Couples from countries such as the UK, Japan, Australia, and Kuwait, where surrogacy is either illegal or restricted, have hired surrogates in the United States to bear babies for them. However, while the total cost of such transnational packages is roughly between $100,000 and $120,000, in India the package costs one-third of that amount. Another factor that explains the popularity of India as a destination for transnational surrogacy is the informality of the market. Although commercial surrogacy is not illegal in India in 2002, currently there are no laws regulating surrogacy in clinics. Fertility clinics... (shrink)

Congenitally infertile woman such as those with Turner syndrome or Mayer Rokitansky-Kuster-Hauser syndrome have available the technologies of oocyte harvestation, cryropreservation, in-vitro fertilization, and gestational surrogacy in order to have genetically related offspring. Since congenital infertility results in a variety of experiences that impacts on nearly every aspect of a person’s life, in the future it is possible that these women might desire a congenitally infertile child through the use of preimplantation genetic diagnosis so as to share this common (...) bond. While infertility results in a relatively normal quality of life, it is morally wrong to necessitate the future use of infertility services with its variable success rate on a child. Also, whereas the woman has fundamental reproductive autonomy, she lacks the substantive autonomy regarding the specific characteristics of her child. Finally, the infertile community does exhibit a strong presence, but it lacks characteristics that define it as a culture. (shrink)

Contemporary medicine offers more and more possibilities as far as procreation is concerned. They are available, first of all, to infertile couples (IVF – In Vitro Fertilization). However, the advanced reproductive technology is also used by people who are biologically capable of having children. These people are ready to resign voluntarily from pregnancy and childbirth difficulties. The surrogate motherhood appears as a phenomenon known already from biblical times but existing nowadays in a different context. At the same time, some issues (...) are emerging – questions concerning social, ethical, moral and legal consequences. This paper presents the issue of surrogate motherhood in the context of social changes, which could lead to a development of such practices as well as the reasons of parents and surrogate mothers. Can this phenomenon be perceived as a service for people who want to fulfill their desires for having children? Would surrogate motherhood become a socially approved practice? What are the ethical, religious and legal norms concerning this phenomenon? The religious norms are connected, first of all, with an attitude of the Catholic Church which recognizes surrogacy as unacceptable and states that “it offends the dignity and the right of a child to be conceived, carried in the womb, delivered to the world and brought up by their own parents”. The ethical norms refer to the biotechnological issues and include matters of creating and implanting human embryos as well as the problem of the surrogate mother – child – biological parents relationship. As far as legal norms are concerned, the case is still open hence Polish law does not take into consideration in vitro fertilization or the admissibility of surrogate motherhood. (shrink)

The rise of surrogacy in India over the last decade has helped individuals across the world to realize their parenting aspirations. In the macro-context of poverty in India and the hierarchical and patriarchal family set-up, concerns are expressed about coercion of women to participate in surrogacy. While the ethical issues engulfing surrogacy are widely discussed, not much is known about the role women play in the decision-making to participate in surrogacy. The paper aims to addresses this gap and is based (...) on a part of a larger ethnographic study conducted at a surrogacy clinic in Anand, Gujarat, India. We explored experiences of forty-one surrogate mothers using in-depth interviews and analysed the narratives to identify women’s own perceived role in the decision-making to participate in surrogacy. Narratives describing the decision-making process were identified and treated as a preliminary unit of analysis. We examined the use of singular and plural pronouns like “I,” “me,” and “mine” versus “we,” “us,” and “our,” along with the use of active and passive voice to determine whether women assumed responsibility for the decision to participate in surrogacy or they attributed the decision to others. Findings unravelled the complexities of the decision-making process and indicated that eighty-five percent of the women played an active role in the decision-making to participate in surrogacy, albeit with new avenues of exploitation in the commercial market space and raised serious bioethical concerns. (shrink)

Background Infertility is an increasingly prevalent disease in society and is considered by the World Health Organization to be a public health problem. An important ethical issue arises from the clarification of reproductive rights in a fair and equal way. The objective of this study was to deepen and update the knowledge and discussion about the difficulty of accessing infertility treatments in Brazil. Methods A cross-sectional observational study was carried out through the application of an online questionnaire that (...) collected the socioeconomic characteristics of couples and identify how barriers to infertility care affect the most vulnerable populations. We included couples who sought medical assistance to achieve pregnancy at two clinics in the states of São Paulo and Minas Gerais. Results A total of 201 questionnaires were analyzed. Most couples self-declared as white and the average age of wives was 36 years and husbands 38 years. 65% (65%) of couples would proceed with the treatment in a different city to which they lived, 37% evaluated as having easy access to a medical specialist only after indication, and more than half of the participating have thought about giving up the treatment due to some difficulty in accessing it. 39% of participants sought more than one medical service to find better reception, 42% of couples sought more than one medical service to define where it would be better financially, and 67.2% referred to the high cost of treatments, that is, financial issues, as a great difficulty in accessing medical services and/or treatment. Although 72.6% of couples considered having a good quality of life, 54.2% admitted that infertility and the search for treatment generated anxiety/stress in the couple’s life. Conclusion There is a need for public education on reproductive health and for policymakers to raise awareness of the importance of the difficulty that many couples face in seeking treatment to become pregnant, especially in countries with less financial resources. Indeed, it is commonly accepted that there is a universal human right to access healthcare of appropriate quality as a matter of justice. Discussion of access to reproductive technologies should be considered taking into account the longstanding ethical debate regarding fertility, fecundity, and infertility, as well as reproductive care. (shrink)

This paper investigates the gendered and racialized discourse on Polycystic Ovary Syndrome in India. A complex metabolic, endocrinal and reproductive disorder, PCOS is one of the most common endocrinopathies in women of reproductive age today. Due to an unclear etiology, there is no single clinical definition for PCOS, contributing to a sense of confusion around the syndrome. India has one of the highest rates of PCOS in the world. Medical and social discourses on PCOS suggest the high rates are due (...) to the failures of Westernized lifestyle and diet in women from developing countries. Taking the example of India, I argue that the lack of a clear etiology creates a discursive vacuum and that PCOS in itself is not a gendered and racialized syndrome, but the discourse on it is. Through the figure of the “new Indian woman,” I address the socio-political anxieties of nationalism projected onto the female body and suggest that the discourse on PCOS in India is in reaction to a rising nationalist rhetoric. As a syndrome that presents through “masculine” symptoms, PCOS acts a unique entryway into the intersectional issues of gender, race, sexuality, class and national identities. An analysis of the Indian setting might shed light on PCOS discourses that are increasingly relevant globally. (shrink)

Australian law affirms a binary construction of fertility/infertility. This model is based upon the medical categorization of infertility as a disease. Law supports medicine in prioritizing technology, such as in vitro fertilization, as treatment for infertility. This prioritization of a medico-legal model of infertility in turn marginalizes alternative means of family creation such as adoption, fostering, traditional surrogacy, and childlessness. This paper argues that this binary model masks the impact of medicalization upon reproductive choice and limits (...) opportunity for infertile individuals to create families. While medical technology should be available to enhance reproductive opportunity, infertile individuals will benefit from regulatory change which disentangles the medico-legal construct of infertility as a disease from the desire to create a family. This paper suggests that the medico-legal model of infertility should be reframed to support all opportunities for family creation equally, including non-medical opportunities such as adoption, fostering, and childlessness. (shrink)

Developing World Bioethics, Volume 21, Issue 3, Page 111-122, September 2021.

This article examines the construction of parenthood, drawing on Brazilian cisgender, heterosexual, and homosexual couples' experiences in using assisted reproduction technologies (ART), particularly the surrogacy. For that purpose, we interviewed: 1) a lesbian woman who had her daughter through her partner's pregnancy, using ART with anonymous donor semen; 2) a gay man who, together with his partner, used a surrogacy service under contract via a specialised offshore agency; 3) a woman who was a surrogate, in Brazil, for her sister-in-law and (...) brother who lived abroad and, from abroad, sent an embryo fertilised for surrogacy; 4) a woman who resorted to her sister-in-law in order to be a mother by surrogacy, with ovules from the woman herself fertilised with semen from her husband; and 5) the sister-in-law mentioned in 4), who acted as surrogate for her brother and his wife. These interviews made it possible to think about the discursive construction of the legitimacy of such parenthoods, as it is produced by access to, and manipulation and circulation of, reproductive technologies and persons. This biomedical management of bodies sets up a material and discursive circuit that, in turn, produces a complex web of personal, normative, legal, professional and market relationships, particularly with a view to construction of a parenthood anchored in a notion of biologically-constituted origin. In this respect, biological, affective and social bonds merge to produce a precise placement of who is the father and/or who is the mother, as well as who are the important others and how they are linked to the child in a broader web of parenthood. (shrink)

Critics of transnational commercial surrogacy frequently call our attention to the race, class, and cultural background of surrogates in the global South. Consider the following sampling from the critics: "the women having babies for rich Westerners have been pimped by their husbands and are powerless to resist" (Bindel 2011); our "rules of decency seem to differ when the women in question are living in abject poverty half a world away" (Warner 2008); and we should worry that "women of color are (...) easier to commodify" (Smerdon 2008, 51-52). Critics suggest—rightly, in my view—that the race, class, and culture of Southern surrogates matter to the moral acceptability of transnational surrogacy. But how, precisely, do .. (shrink)

Reality TV is immensely popular, and various shows in this media genre involve a storyline of infertility and infertility treatment. Feminists argue that normative and constructed realities about infertility and infertility treatment, like those in reality TV, are central to the emancipation of women. Such realities are able to steer viewers' perceptions of the world. This article examines the emancipatory significance of representations of women on 'infertility reality TV shows'. While the women in these shows (...) all have 'abnormal' qualities, we consider their portrayal as figurations of monstrosity. In the literature, monstrosity is understood as a way to challenge nonemancipatory norms by offering an alternative identity. Through a content analysis of seven reality TV shows, we identified four types of in/fertile monsters: the cyborg, the freak, the abject, and the childless. We show that these monsters are predominantly non-emancipatory as they all involve mechanisms of altering, excluding, or condemning infertility in relation to what is considered normal and acceptable womanhood. Therefore, at the end of this article, we make a plea for more diverse and emancipatory representations of infertile women in popular culture. (shrink)

The rise of surrogacy in India over the last decade has helped individuals across the world to realize their parenting aspirations. In the macro-context of poverty in India and the hierarchical and patriarchal family set-up, concerns are expressed about coercion of women to participate in surrogacy. While the ethical issues engulfing surrogacy are widely discussed, not much is known about the role women play in the decision-making to participate in surrogacy. The paper aims to addresses this gap and is based (...) on a part of a larger ethnographic study conducted at a surrogacy clinic in Anand, Gujarat, India. We explored experiences of forty-one surrogate mothers using in-depth interviews and analysed the narratives to identify women’s own perceived role in the decision-making to participate in surrogacy. Narratives describing the decision-making process were identified and treated as a preliminary unit of analysis. We examined the use of singular and plural pronouns like “I,” “me,” and “mine” versus “we,” “us,” and “our,” along with the use of active and passive voice to determine whether women assumed responsibility for the decision to participate in surrogacy or they attributed the decision to others. Findings unravelled the complexities of the decision-making process and indicated that eighty-five percent of the women played an active role in the decision-making to participate in surrogacy, albeit with new avenues of exploitation in the commercial market space and raised serious bioethical concerns. (shrink)

Background. South African surrogacy law includes a provision, known as the genetic link requirement, that commissioning parents must use their own gametes for the conception of a surrogate child. As a result, infertile persons who cannot contribute gametes for the conception of a child are prohibited from accessing surrogacy as a way to establish families. The genetic link requirement was previously the subject of a constitutional challenge, but the challenge was rejected by a divided Constitutional Court bench with a seven-to-four (...) majority. The genetic link requirement is again being challenged in a new lawsuit.Objective. In light of the history of the issue, this article investigates the viability of relying on infertile persons’ right to family life in the new lawsuit. Method. The investigation takes the form of a human rights analysis.Results. The right to family life was not considered in the previous case. As such, the right to family life constitutes a new legal issue that falls outside the scope of the precedent set by the Constitutional Court, and can therefore be relied upon. The genetic link requirement is a clear violation of infertile persons’ right to family life, which includes the right to establish a family. Potential justifications for such violation are considered, but found wanting. Accordingly, the genetic link requirement is unconstitutional and should be struck out.Conclusion. The outcome of the previous lawsuit was an injustice towards infertile persons. The new lawsuit presents an opportunity for this injustice to be rectified by vindicating infertile persons’ right to family life. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"MURTHER, BY A SPECIOUS NAME": ABSALOMAND ACHITOPHEVS POETICS OF SACRIFICIAL SURROGACY Gary Ernst Roger's State University d;,uring the late 1670's and early '80s, English political satirists 'participated in the endeavors of the rival factions, Dissenter or Whig and Royalist or Tory, to effect judicial violence. While juries condemned and the hangman executed Catholics as traitors during the Popish Plot persecution, John Oldham suggests in the "Prologue' to his Satires (...) upon the Jesuits that he writes to stoke the mass hatred fueling the slayings (2: 19-22). Such animosity powered this initial Dissenter effort to exclude Charles II's Catholic brother, James Stuart, Duke ofYork, from the throne, and left more than two hundred dead.' And Dryden's vituperative response to the striking of a medal to celebrate the grand jury's dismissal of high treason charges against Anthony Ashley Cooper, Earl of Shaftesbury, The Medall (pointedly subtitledA Satire againstSedition) seems to have a clear purpose of inciting Royalists to redouble their efforts to dispatch the opposition leadertothe gallows.2 Judicial slayings ofthis kind are perhaps not surprising in these years ofcrisis and fear. Dissenters like Oldham believed that English Catholics plotted to assassinate Charles, put James on the throne, martyr Protestants with the help of foreign Catholic armies, and destroy both the Protestantfaith and English culture itself; Royalists, on the other hand, saw as ever-looming Dissenter insurrection and another catastrophic civil war to take away their property, power, and perhaps the ' For studies ofthe Plot in this political context, see Miller 169-82; Jones 197-217; Greaves 5-32, and Kenyon's complete volume. 2 Harth studies The Medall as an example of Tory propaganda against the Whigs and supportive of Royal efforts to deliver the earl to the gallows (161-9). 62Gary Ernst life ofthe king.3 Duringthe bloodshed ushering in the two party system, the fatal goals ofsatirists seem quite realistic—and indeed may have been so. Thejudicial persecution ofCatholics consumed victims until the fervorthat Oldham labors to feed burnt out; and, in November 1682, eight months after The Medall found its first audience, Shaftesbury, accused by the crown of new treasons, went into hiding soon to flee England in mortal terror of successful Royalist prosecution. The greatest political satire of this turbulent period, Absalom and Achitophel, responds directly to the recent efforts of Charles's beloved, eldest natural son, the Protestant James Scott, Duke of Monmouth—now "Fir'd with near possession of a Crown " (684)—to displace York in the line of succession. The satire revolves around a depiction ofMonmouth's "War in Masquerade," his recenttour through the west ofEngland to gauge and gain support (682-725). Despite the factthatthe satire clearly posits the threat of national catastrophe, it hardly seems at first as intent upon the death ofthis target as either The Medall or Oldham's Satires seem oftheirs. But, to be sure, it is, although Dryden—committed firstly to York and secondly to king4—carefully conceals both his methods and his intentions against Charles's son. For the purpose ofleading his audience to imitate his attack and carry it from the printed page into the world of action and the courts, he conceives apoetics ofsacrifice that screens his hostilities toward Monmouth from the eyes ofthe very persons he undertakes to mobilized. By appropriating for his satire the cultural phenomenon defined by René Girard as the "scapegoat" or "sacrificial mechanism,"5 Dryden arouses and 3 According to Kenyon, in late 1678, the Commons' inflammatory speeches and addresses to the king gave the impression in the House of Lords that the members of the Commons "seemed intent on fighting the Civil Wars all over again" (129) 4 For a fuller discussion ofDryden's commitmentto York, see McFadden 91, 111 -202; Winn 243-75, and Erskine-Hill 22-5. Daly argues that Mac Flecknoe, written some three years before the beginning ofthe Exclusion Crisis of 1679-81, is an oblique but sustained attack upon Monmouth, a result ofthe laureate's concerns about the king's bestowals ofpower upon Monmouth and the possibility ofthe bastard's eventual succession (655-76). For another discussion that focuses upon Dryden's targeting ofMonmouth m Absalom and Achitophel... (shrink)

This article provides a donor-focused analysis of how transnational reproductive donation intersects with issues central to bodily autonomy of surrogates and egg donors from the global South. Little is known about the autonomy of surrogates and egg donors, especially among those from the global South. This article addresses this gap by examining two key issues on surrogacy and egg donation—conflict of interest and recruitment market. With these issues, this paper presents contexts of the reproductive body as a space of contestation (...) for autonomy. Analysis reveals that bodily autonomy is not an absolute entitlement available for surrogates and egg donors from the global South. Having bodily autonomy is a privileged disposition rather than a universal liberty for reproductive donors. The discussions in this work encourage further examination to understand the multi-layered experiences of reproductive donors from the global South, towards deeper interrogation of the processes of reproductive industry. (shrink)

Advances in reproductive technology have already revolutionized our culture in various ways, and future potential developments, particularly in genetics, promise more of the same. The practice of surrogacy threatens to upend the way we understand the family. Germline engineering of human embryos could, among other things, lead to the treatment of genetic diseases hitherto incurable; but the widespread use of such engineering could have broader ramifications for our culture, for better and for worse. Parents may eventually be able to select (...) for desirable traits in their offspring, whether by genetic modification at conception or by choosing to implant one of several genetically profiled embryos. Authors in this issue of The Journal of Medicine and Philosophy address some of the ethical implications of these technological and cultural changes. (shrink)

This book examines the field of bioethics from an international and regional legal perspective. It focuses on major international law documents such as the United Nations Universal Declaration on Bioethics and Human Rights and UNESCO declarations on human cloning and the human genome. Coverage of regional legal instruments includes the Council of Europe Convention on Human Rights and Biomedicine (the Oviedo Convention) and its Protocols on cloning, transplantation, and research with human beings. Work on surrogacy issues by the Hague Conference (...) on Private International Law is also discussed, as are some African regional legal instruments on biosafety, and stem cell research. (shrink)

Bioethics has changed considerably over the last few years. Increased global interaction, through the off-shoring of clinical trials, cross-border surrogacy, organ trafficking, and medical tourism, among others practices, has brought additional considerations to a discipline that has been, until recently, relatively contained within national borders. We aim to contribute to the discourse on exploitation and vulnerability in a way that reflects such global changes. We will explore the link between vulnerability and exploitation, and argue that exploitation can be understood as (...) taking advantage of vulnerabilities, provided we recognize that vulnerabilities are often embedded within existing structural injustices. (shrink)