Decolonising Healthcare: how ethical is surrogacy across different races and nationalities?

Illustration by Ragavee Balendran

Infertility can be a terrifying and stigmatising experience that can lead to relationship breakdown, mental health issues and even family upheaval. It’s no wonder that couples will go to extreme lengths to have a child. Transnational surrogacy – the act of seeking a surrogate across national borders – is a booming industry. A study in 2012 suggested that the surrogacy industry is worth $2.3 billion annually and even as fertility medicine improves, the number of people turning to surrogacy continues to swell. The most common reason for surrogacy is due to infertility – however, there are a growing number of people with health problems that are heightened in pregnancy, as well as couples in the LGBTQI+ community that require surrogates too. A surrogate may utilise their own egg or receive donor egg and sperm through In-vitro Fertilisation (IVF).

High-profile celebrities like Kim Kardashian and Kanye West, who have used a surrogate for the second time for their fourth child, have given the industry a boost. Kim has since stated that developing placenta accreta in her second pregnancy meant subsequent pregnancies would be unsafe. She has discussed how mentally difficult it was to find a surrogate and place that responsibility in the hands of another individual yet her surrogate, who was an African-American woman was allegedly only paid $45,000 dollars. While this is the going rate for a US-based surrogate and paying her surrogate more could be seen as reproductive coercion, the low sum fails to account for the three times higher risk of maternal death amongst black women in the US and five times higher for those in the UK. Surely, black women should be paid more if it is known that the risk of death amongst this group is much higher than any other demographic?

“Surely, black women should be paid more if it is known that the risk of death amongst this group is much higher than any other demographic?”

There are multiple ethical issues surrounding surrogacy, including the two-tiered system of reproductive rights, where a womb can be bought by the highest bidder. While $45,000 may seem like a small sum to millionaires like Kim Kardashian and Gabrielle Union (the latter became a mother to her first child after using a surrogate last year), to the average person with a UK household income of £28,400 ($34, 350) this is unobtainable.

In the UK, a surrogate cannot be paid more than reasonable expenses (including loss of earnings and maternity clothes) for their time and a surrogacy agreement is not legally enforceable. This means those choosing to be surrogates are unable to profit and those at higher risk of adverse outcomes cannot be financially compensated for their efforts. The lack of financial incentive means that there are fewer UK surrogates. This leads those with the financial means to seek surrogacy abroad, such as in countries like India where surrogates are paid as little as $3000. It’s unsurprising that the global surrogate marketplace continues to thrive, especially amongst those that possess disposable incomes and the means to travel abroad.

Transnational surrogacy nearly always involves poorer women living in the Global South and reports are rife of unethical practices where there is a lack of “informed consent” and the proceedings are undertaken in a language that the surrogate does not understand. At times women are treated well until the post-birth period where follow-up care is non-existent. When laws governing surrogacy become more restrictive like in the case of India, companies are quick to create inviting surrogacy packages elsewhere like in Nepal and Thailand. The 2015 Nepal earthquake revealed that there were tens of Indian surrogates carrying foetuses on behalf of Israeli couples stranded in the country as Israel forbids transnational surrogacy.

“There are multiple ethical issues surrounding surrogacy, including the two-tiered system of reproductive rights, where a womb can be bought by the highest bidder”

However, surrogacy is not just about those birthing but also the children born through uncertain agreements. The case of Baby Gammy, a baby born with Down Syndrome to a Thai surrogate with Australian adoptive parents highlighted the complexities of global surrogacy. Initially, it was alleged the Australian couple had abandoned Gammy but taken his sister Pipah (who does not have Down Syndrome) back to Australia. However, the court has since found that their surrogate mother Pattaramon fell in love with the babies during her pregnancy and decided to keep Gammy who she continues to raise. But other children have fared less well, finding themselves stateless as a result of adoptive parents seeking international surrogates but failing to account for their own countries’ domestic laws which forbid it, leaving a child left in limbo.

The booming surrogacy industry raises important questions about the continued reproductive oppression of women of colour. For centuries, predominantly black and brown women have been used to wet nurse and raise the children of wealthy colonisers whilst neglecting their own. As greater discussions about global warming and the world’s overpopulation gain media attention, the reproductive lives of poorer people and those in the Global South are drawn into focus and frequently seen as something to curtail – unless (of course) it is to assist the reproductive endeavours of wealthy, white Westerners.