Reproductive Tourism (Ethics of outsourcing surrogate motherhood)
Reproductive Tourism (Ethics of outsourcing surrogate motherhood)
Surrogate motherhood is among the latest in a long list of roles being outsourced to India and some other countries as it is far cheaper than in their home countries. A surrogate in India is generally paid about 250,000-400,000 rupees ($4,000-$8,000). Against this in the United States hiring a surrogate can take months and cost up to $100,000. Total cost works out just $25,000 in India, including all medical bills, payment to the surrogate, and air and hotel accommodations for two trips to India.
In India It is possible that due to poverty or some other reason, family members may compel a woman to act as a surrogate mother. The women who enroll for such procedures are mainly from a poor socio-economic background.
The conditions or circumstances in which the surrogate mothers are kept in the clinics also warrant consideration. Anand, a city in Gujarat where the practice was pioneered in India, more than 50 surrogate mothers are pregnant with the children of couples from the United States, Britain and elsewhere. Fifteen of them live together in a hostel attached to a clinic (1). The women are literally being kept in custody. Such practices violate basic human rights. In addition, these women may suffer mental anguish since the doctor ensures that they don’t bond with the babies by constantly reminding them that the fetuses they are carrying are not theirs (2). It is possible that even basic procedures such as informed consent of the mother may not be taken, or may be obtained in a questionable manner. Also, considering the money involved, the mother may not be inclined to ask the doctor about the dangers or risks involved in the pregnancy. Money seems to be a crucial factor for many surrogates.
Here I would like to know the following issues from individuals from the idustry.(here I mentioned the issues in Indian context, there might be a different rules & regulations, laws from country to country. I think that generally every country have a same issues).
Here issue is to know what to do with the child if the couple does not return to India to claim it, or refuses to take the child for some reason, or the couple dies or they divorce?
What happens if the child is born retarded or physically challenged? Neither the surrogate mother nor the putative parents may want such a baby. Legally, if the couple refuses to accept the child, the surrogate mother and her husband are grateful to keep the child since it is she who has given birth to the child. In divorce cases, who would be entitled to the custody of the child?
Is it ethical to find a surrogate mother through medical tourism facilitators?
Surfing the Internet, I have found many sites advertising the services of clinics. Is it ethical for medical practitioners and medical facilitators to advertise in this manner?
Surrogate motherhood is among the latest in a long list of roles being outsourced to India and some other countries as it is far cheaper than in their home countries. A surrogate in India is generally paid about 250,000-400,000 rupees ($4,000-$8,000). Against this in the United States hiring a surrogate can take months and cost up to $100,000. Total cost works out just $25,000 in India, including all medical bills, payment to the surrogate, and air and hotel accommodations for two trips to India.
In India It is possible that due to poverty or some other reason, family members may compel a woman to act as a surrogate mother. The women who enroll for such procedures are mainly from a poor socio-economic background.
The conditions or circumstances in which the surrogate mothers are kept in the clinics also warrant consideration. Anand, a city in Gujarat where the practice was pioneered in India, more than 50 surrogate mothers are pregnant with the children of couples from the United States, Britain and elsewhere. Fifteen of them live together in a hostel attached to a clinic (1). The women are literally being kept in custody. Such practices violate basic human rights. In addition, these women may suffer mental anguish since the doctor ensures that they don’t bond with the babies by constantly reminding them that the fetuses they are carrying are not theirs (2). It is possible that even basic procedures such as informed consent of the mother may not be taken, or may be obtained in a questionable manner. Also, considering the money involved, the mother may not be inclined to ask the doctor about the dangers or risks involved in the pregnancy. Money seems to be a crucial factor for many surrogates.
Here I would like to know the following issues from individuals from the idustry.(here I mentioned the issues in Indian context, there might be a different rules & regulations, laws from country to country. I think that generally every country have a same issues).
Here issue is to know what to do with the child if the couple does not return to India to claim it, or refuses to take the child for some reason, or the couple dies or they divorce?
What happens if the child is born retarded or physically challenged? Neither the surrogate mother nor the putative parents may want such a baby. Legally, if the couple refuses to accept the child, the surrogate mother and her husband are grateful to keep the child since it is she who has given birth to the child. In divorce cases, who would be entitled to the custody of the child?
Is it ethical to find a surrogate mother through medical tourism facilitators?
Surfing the Internet, I have found many sites advertising the services of clinics. Is it ethical for medical practitioners and medical facilitators to advertise in this manner?
Replies to This Discussion
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Permalink Reply by Renee-Marie Stephano on -
Mahender, I respect the challenge you have raised in these questions and on behalf of the MTA, I am extremely interested in the reply from industry participants through medical tourism city. This, amongst other ethial challenges, should be addressed in open forum, not to create rule, but to create best practices. I am looking forward to some of our facilitator members' reply to your inquiries. We have discussed the ethical issues in organ donation and I believe it is clear, there are many considerations which may raise a few eyebrows.
I am interested in learning from you, however, in additio to the city you cited, have you done an inquiry or survey of other cities and ther clinics so we can have an idea of how prevalent this practice is in other cities? Also interested in knowing, the example you cited of treatment of women "hostels" os this par for the course? How often does th situation arise regarding birth defects? I would be interested in knowing what pre-natal testing is done, which typically detects such defects and how that pas out in the whoe scheme? I look forward to your reply.
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Permalink Reply by MAHENDER REDDY GAVINOLLA on -
Thank you for your reply, here i did not do any survey i saw some articla,some issues regarding the surrogate.There is no clear statistics but it is growing in India,I mentioned inthe issue ANAND is a diatrict in Gujarath and most of cases are in this state.Yes there are some fecilitators (The Surrogacy Center in India, LLC and some clinics).But i did not found in corporate hospitals,it is happening in clionics.And example mentioned is that case happenD somewher,but is not every where that mentioned by JOURNAL OF MEDICAL ETHCS IN INDAI.I will look forward soon in detail.
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Permalink Reply by Raj K Bhalla on -
Mahender
This is highly disturbing and disgusting. In my opinion “Medical Tourism” is about providing world class “Health Care” to the global patient where it is either not available immediately or prohibitively expensive so the patient must get value and reason to travel out of their home country.
As an upcoming Medical Tourism Facilitator, I believe in first making sure that we have tie-ups with very high quality, globally certified ethical healthcare providers. If we go with this basic approach such shops get rejected in the initial stage.
Organ Transplants, Child Adoption and Reproductive/Surrogate motherhood are clearly the areas that are going to attract crooks and laws are very likely to get violated. If a situation arises where you have to deal with Organ Transplants make sure the donor requirement meets laws in both countries, where the patient is from as well as where the operation is being done.
Your posting highlights the pitfalls of getting involved in “Surrogate Motherhood” or anything questionable. We would rather avoid dealing in anything controversial, seems unethical or is illegal.
As part of this industry, one of our key responsibilities is to raise all possible awareness including filling of police complain and RTI application to local health department to see how much of what goes on there is legal and what steps are they talking to close such shops. Medical Tourism requires a very high level of trust and we should do our bit to make sure that people trust our community.
There are going to be some unethical and illegal operations in any business activity we can think of. What you have described is on the sleaze side and not the real Medical Tourism.
I believe majority of people in Medical Tourism or who join this forum are not looking for a quick buck or fast money. They are investing a lot of time, money and resources in making sure that they bring value and good health to their customers.
The Golden rule is to ask yourself first what the medical facilities we deal in are all about and then you can’t go wrong.
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