The most incisive guide to issues facing the American family today . . . An invaluable resource for anyone wishing to stay on the cutting edge of research on family trends.

-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia 

International Construction of the Unnatural Family—The Horror!

Bryce J. Christensen and Nicole M. King

Though largely developed in affluent Western countries, the technologies of Medically Assisted Reproduction are increasingly affecting women in impoverished Asian countries—but again and again in ways that exploit rather than benefit them. Indeed, the plight of these exploited women emerges as an urgent concern of a working group of lawyers, ethicists, and medical experts who recently gathered in Israel to examine “a steady growth in a new global market of inter-country medically assisted reproduction (IMAR) involving ‘third-party’ individuals acting as surrogate mothers and gamete donors.” This working group interprets the emergence of IMAR as an increasingly popular “form of medical tourism” as the consequence of “restrictions on access to domestic surrogacy for same-sex couples and a chronically insufficient supply of egg cells for the treatment of couples and singles in need.” Even though this working group supports widespread use of the technologies of Medically Assistant Reproduction (MAR) technologies, they cannot blink at the ugly reality of  “a double standard of care for third-party women involved in IMAR, violations of human rights of children and women, and extreme abuses that are tantamount to reproductive trafficking.”

The working group acknowledges that “since the IMAR market is not regulated, there is no official data and a dearth of information” about the operation of that market. Nonetheless, they confront disturbing evidence that “for-profit trade in IMAR services involves the commodification of human beings (women and children) and body parts (gametes and wombs).” Few safeguards protect women and children involved in IMAR. After all, “there are no internationally accepted ethical principles or clinical standards for the quality and safety of MAR interventions.”   Worse, “there are no mechanisms in international law for transparency and accountability, nor for regulatory oversight in case of human rights violations, . . . and no criminal justice redress for instances of exploitation, deception and coercion.” Consequently, the working group identifies “ability to pay rather than considerations of justice or solidarity” as the driving force behind “the distribution of scarce human bio-resources” in IMAR. 

That driving force can be cruel to those involved. The working group detects that cruelty in the “double standard of care” in IMAR, with the paying customers receiving far better medical care than do the egg providers or the surrogate mothers. 

For egg providers, IMAR entails “the pain and discomfort of daily hormonal injections and harmful side effects, including anaesthesia complications, ovarian hyper-stimulation syndrome, damage to reproductive organs and post-retrieval complications of surgery.” What is worse, these exploited providers are expected to “undergo excessive repeat procurement cycles without being informed of the risks involved.”  Anecdotal evidence collected by the working group suggests that IMAR egg procurement may translate into “loss of fertility, stroke, cancer and premature death.” The working group even uncovers evidence that women who have been IMAR egg providers may suffer from “psychological risks of detachment from . . . children” born to them years later. Apparently, women habituated to selling their eggs through IMAR may lose their capacity to connect with their children born from eggs they have not sold. 

For surrogate mothers, IMAR looks less like medical care than imprisonment, if not slavery. The working group notes documented cases in which IMAR coordinators have “tricked or forced [women] into working as surrogates . . . in Guatemala, Poland, Myanmar and Thailand.”   The working group further finds instances in which IMAR requires surrogate mothers to live in dormitories where they are “monitored around the clock . . . and in extreme cases are not allowed to exit the site or engage in physical activity.” 

Surrogate mothers have suffered even worse indignities when IMAR coordinators have offered “potential customers a track of ‘parallel pregnancies’ in which several women . . . carry pregnancies for a single prospective family, so as to increase the chance of producing a child within a certain time frame.” The working group infers that “if the achieved pregnancies exceeded the planned number of children, the ‘excess’ pregnancies would be terminated” through abortion, with “the women carrying the aborted pregnancies hav[ing] no say in the decision.” These exploited women “might be deceived” by IMAR coordinators who have falsely informed them that the child they are carrying  is being aborted because of “a medical indication related to the health of the foetus.”

Even when it results in birth rather than abortion, IMAR exposes children to dehumanizing practices. The working group reports actual cases of “baby selling” when IMAR has “produced ‘extra babies,’ either because excess pregnancies are carried to full term or because intended parents do not claim the children they ordered.” IMAR coordinators have even “used surrogate mothers to create an inventory of unborn babies that would sell for over $100,000 each.” In other words, in IMAR “babies have become commodified as a marketable product of exchange.”

Predictably, no one is opening the check book when IMAR creates a baby with a birth defect. Such a child can easily end up among the babies that the working group finds that IMAR has “rendered parentless and stateless.” The working group indeed acknowledges the nightmarish reality of such a child abandoned by those who contracted for its creation but did not want to collect damaged merchandise. IMAR has also been known to result in an abandoned child when contracting customers cannot surmount unanticipated legal entanglements. 

Even when they are not abandoned, children created through IMAR may live in a shadow of uncertainty about their identity. The working group acknowledges that because “in IMAR no one has the legal obligation or responsibility to keep records of gamete providers and surrogate mothers,” the practice typically “compromis[es] the child’s ability to learn of his or her circumstances of birth later in life.” The working group worries about the “psychological and health-related aspects” of this issue, stressing that knowledge of parentage constitutes “a key facet of the child’s sense of self-identity and his or connectedness with heritage and kind”—not to mention “informed health-care decision making” when family history impinges on such decisions.  

No one will marvel that the working group recoils from the IMAR horrors they have uncovered nor that they call for legal reforms to prevent such horrors. But the character of the reforms they call for will strike sane observers as worse than naïve. The working group believes that current IMAR abuses can be prevented by an “international system . . . based on human rights and promot[ing] universal access to MAR for the treatment of infertility through the sharing of knowledge, transfer of technology and publicly funded services.”  

It will astonish sober observers that, despite knowing all of the evils it has incubated in international practice, the working group wants to see wider use of MAR. It will further astonish such observers that this working group draws inspiration for the international system they hope will end such abuses in “existing mechanisms of international monitoring, such as those operating within the UN human rights treaty bodies,” despite the alarming evidence that the United Nations itself is increasingly hostile to the natural family. 

But then, this working group—for all its concerns about the abuses incident to IMAR—apparently does not itself recognize that such abuses are inescapable in a world that has turned against the natural family. This confused working group in fact begins its call for reforms to prevent IMAR abuses with a statement symptomatic of complete social blindness: “First and foremost, international bodies and nation states should recognize new forms of family.” 

Those who truly wish to prevent the dehumanizing abuses incident to Medically Assisted Reproduction must, first and foremost, understand that every step away from the natural family makes such abuses that much more inevitable. 

(Carmel Shalev et al., “Ethic and Regulation of Inter-Country Medically Assisted Reproduction: A Call for Action,” Israel Journal of Health Policy Research 5 [2016]: 59, Web.)