Justice_ What's the Right Thing to Do_ - Michael Sandel [47]
Outsourcing Pregnancy
Melissa Stern, once known as Baby M, recently graduated from George Washington University, where she majored in religion.47 Over two decades have passed since her celebrated custody battle in New Jersey, but the debate over surrogate motherhood continues. Many European countries ban commercial surrogacy. In the United States, more than a dozen states have legalized the practice, about a dozen states prohibit it, while in other states its legal status is unclear.48
New reproductive technologies have changed the economics of surrogacy in ways that sharpen the ethical quandary it presents. When Mary Beth Whitehead agreed to undertake a pregnancy for pay, she provided both egg and womb. She was therefore the biological mother of the child she bore. But the advent of in vitro fertilization (IVF) makes it possible for one woman to provide the egg and another to gestate it. Deborah Spar, a professor of business administration at the Harvard Business School, has analyzed the commercial advantages of the new surrogacy.49 Traditionally, those who contracted for surrogacy “essentially needed to purchase a single package of egg-bundled-with-womb.” Now they can acquire “the egg from one source (including, in many cases, the intended mother) and the womb from another.”50
This “unbundling” of the supply chain, Spar explains, has prompted growth in the surrogacy market.51 “By removing the traditional link between egg, womb, and mother, gestational surrogacy [has] reduced the legal and emotional risks that had surrounded traditional surrogacy and allowed a new market to thrive.” “Freed from the constraints of the egg-and-womb package,” surrogacy brokers are now “more discriminating” in the surrogates they choose, “looking for eggs with particular genetic traits and wombs attached to a certain personality.”52 Prospective parents no longer need to worry about the genetic characteristics of the woman they hire to carry their child, “because they’re acquiring those elsewhere.”53
They don’t care what she looks like, and they are less worried that she will claim the child at birth or that courts would be inclined to find in her favor. All they really need is a healthy woman, willing to undergo pregnancy and to adhere to certain standards of behavior—no drinking, no smoking, no drugs—during its course.54
Although gestational surrogacy has increased the supply of prospective surrogates, demand has increased as well. Surrogates now receive about $20,000 to $25,000 per pregnancy. The total cost of the arrangement (including medical bills and legal fees) is typically $75,000 to $80,000.
With prices this steep, it’s not surprising to find that prospective parents have begun to seek less expensive alternatives. As with other products and services in a global economy, paid pregnancy is now outsourced to low-cost providers. In 2002, India legalized commercial surrogacy in hopes of attracting foreign customers.55
The western Indian city of Anand may soon be to paid pregnancy what Bangalore is to call centers. In 2008, more than fifty women in the city were carrying pregnancies for couples in the United States, Taiwan, Britain, and elsewhere.56 One clinic there provides group housing, complete with maids, cooks, and doctors, for fifteen pregnant women serving as surrogates for clients around the world.57 The money the women earn, from $4,500 to $7,500, is often more than they would otherwise make in fifteen years, and enables them to buy a house or to finance their own children’s education.58 For the prospective parents who go to Anand, the arrangement is a bargain. At around $25,000 (including medical costs, the surrogate’s payment, round-trip airfare, and hotel expenses for two trips), the total cost is about a third of what it would be for gestational surrogacy in the United States.59
Some suggest that commercial surrogacy as practiced today is less morally troubling than the arrangement that led to the Baby M case. Since the surrogate does not provide