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International Surrogacy, Global Consumerism, Harms to Women and Children

Posted by Carmel Shalev, Biopolitical Times guest contributor on September 15th, 2014


Pattaramon Chanbua, Thai surrogate mother to Baby Gammy.
Pattaramon Chanbua, Thai surrogate mother to Baby Gammy.

Untitled Document

This summer two separate incidents highlighted the deeply troubling problems that can arise in inter-country surrogacy arrangements. In the most extensively covered situation, the “Baby Gammy” case, an Australian couple left their infant son who has Down syndrome with his Thai surrogate mother and returned home with his twin sister. The husband was then discovered to have been convicted of multiple child sex offenses that took place between the early 1980s and early 1990s against girls as young as 5.

In the second incident, a young Japanese businessman fathered 16 children with multiple Thai surrogate mothers, only weeks or months apart, and then told Thai police that he simply wanted a large family.

The New York Times covered these stories in an article titled “Thailand’s Business in Paid Surrogates May Be Foundering in a Moral Quagmire.

What should we make of these disturbing stories? Should we see them as revealing the ingenuity of consumers (commissioning parents and particularly fathers) in devising ways to exploit women as breeders in the unregulated global market of medically assisted reproduction? Is Baby Gammy’s story best understood as a tale of eugenics by a man convicted of abusing children (his words: "I don't think any parent wants a son with a disability")?  What does the story of the Japanese man who fathered (perhaps “sired” is the better term) all those infants share with Theresa Erickson's international baby-selling fraud, which also involved the abuse of unknowing women?  

Both stories raise policy questions about inter-country medically assisted reproduction, including the screening of intended parents, the parentage and citizenship status of children born of international commercial surrogacy, and these children’s welfare and interests in knowing their bio-social origins as a matter of identity.

Intermediaries in surrogacy agreements have certainly been ingenuous in navigating the economic opportunities and legal loopholes of the global market for their own profit. It appears from The New York Times report that Chinese women have been traveling to Thailand for impregnation, presumably to return home to carry a pregnancy and give birth to a child within a commercial surrogacy arrangement. In the wake of recent restrictions on international commercial surrogacy in India and Thailand, intermediaries operating out of other designation countries have devised schemes to transport surrogate mothers from those countries across borders to Nepal, where they are to give birth. These practices are conducive if not tantamount to trafficking in human beings. So is the cross-border movement of women who are paid to provide ("donate") eggs in response to the needs of infertile and post-fertile women and of single and gay men.

It is well-known that women who provide their bodily resources in transnational reproductive collaborations are subject to physical, emotional and social risks. Some egg providers and surrogate mothers have suffered irreversible damage to their own fertility. In India, where international commercial surrogacy has been most thoroughly studied and documented, some surrogate mothers are confined ("housed") in hostels following conception and for the duration of pregnancy, and subjected to 24/7 surveillance and control. In general, most surrogate mothers undergo Cesarean section in birthing, often without any clinical indication, for the convenience of intended parents or medical personnel. Double standards of medical care and ethics are pervasive, while emotional and social harms are neglected.

As The New York Times coverage notes, the surrogacy industries of Thailand and India are outgrowths of both countries' economic policies that promote a private market of medical tourism. Medical tourism is problematic in any event: private healthcare markets exacerbate disparities in the distribution of resources at both local and global levels. Travelling abroad for medical care is wrought with additional risks of fraud and exploitation (e.g., unproven stem cell therapies) or downright criminality (e.g., organ trafficking). These issues are compounded in the case of reproductive tourism, because at stake is the birth of a child.

Who should be held responsible for the harms to women and children involved in inter-country surrogacy arrangements? Women who work as surrogates or egg providers are certainly not to blame. Unfettered consumer desire, in the guise of a neoliberal “right to reproduce,” may be a major driver of the market. But medical entrepreneurs are at the heart of the matter.

Professional medical associations should take responsibility to prevent medical practitioners from dehumanizing women and children as commodities. Nations too should act to quell abuses perpetrated by their own nationals, both inside and outside their borders. And the international community must intervene in the unregulated global market to protect, promote and sanction the human dignity and human rights of women and children.

*****

Carmel Shalev, JSD, is chair of the Department for Reproduction and Society at the International Center for Health, Law and Ethics, Haifa University.





New Poll Finds Only 18% of British Adults in Support of "3-Person IVF"

Posted by Jessica Cussins on September 15th, 2014


Untitled Document

A newly released ComRes study conducted by the charity CARE has found that only 18% of British adults support “the creation of 3-parent children via genetic modification.”

The poll concerns the currently illegal technique, variously known as “3-person IVF” or more euphemistically as “mitochondrial donation,” which could move into UK fertility clinics shortly following an upcoming Parliamentary vote.

The technique involves the combination of one woman’s nuclear DNA with another woman’s mitochondrial DNA in the creation of a new child, with the hope of avoiding the transmission of mitochondrial disorders from an intending mother. It is currently illegal in the UK and several dozen other countries because it results in the modification of the genetic code passed down through the generations, something also explicitly prohibited in The Council of Europe’s Convention on Human Rights and Biomedicine.

Contrary to the protestations of advocates of the procedure — including the HFEA — total support for changing  the law to allow use of the technique is even less than the number who “strongly oppose” the move (23%), let alone the total opposition (46%). Only 5% “strongly support” the move, while just over a third of respondents answered “don’t know.”

A US FDA committee considered the safety and efficacy of the technique in February and concluded that significantly more animal and embryonic research is needed before human clinical trials should be considered.  When the participants in the latest poll learned that scientists around the world “have expressed concerns about the safety of the procedures for the children conceived” 42% were even less likely to support the change in UK law.

Furthermore, a full 65% agreed that the UK Government “should delay the introduction of 3-parent children until the surrounding medical, safety, and ethical issues can be better dealt with.”

The degree of public support on this issue has long been controversial. Indeed, a similar poll conducted by ComRes in February showed a much closer split (women opposed the procedure 36–31 but men supported it 40–31). That one, however, included slightly different wording, and did ask for reactions to the suggestion that “the procedure might help reduce the conception of children with some hereditary diseases,” which on balance made it significantly more likely that respondents would support a change in the law. It is clear that when dealing with powerful new biotechnologies, “wording effect” is a very significant factor.

It is also certain that there is a substantial reluctance among the British public to rush into such a major change. By 44–11 percent,   the public thinks the government is “in a hurry” and not “making patient safety its first priority.” It’s also a vote-loser: Pushing on would make 44% of respondents less likely to vote for the government, and only 6% more likely. That’s the least of the reasons to suspend this process, but it just might be the most crucial.

Previously on Biopolitical Times:





“Evolution right now is in the marketplace”

Posted by Pete Shanks on September 11th, 2014


George Church, professor at Harvard and MIT, multi-faceted researcher, entrepreneur, author and advocate of open-access genomics, gives good quote. He means what he says, and expresses it succinctly and vividly. The latest publication to exploit this is The Economist, which just ran a feature about him called "Welcome to my genome" that includes some of Church's predictions for human genetic modification:

In the future Dr Church sees a world in which individuals tinker with their DNA to eliminate diseases, give their offspring extra abilities or simply to look more attractive. … To travel beyond the Earth, astronauts could also have their bodies altered to give them a better chance of surviving the journey. They could be genetically engineered to resist radiation and osteoporosis, a weakening of the bones which would result from prolonged weightlessness. Those that remain on Earth could be altered to reduce their carbon footprint [by making] people smaller.

Church also endorses the concept of "backing up my brain into another that I have in my back-pack" and (smiling) suggests that things people "think are a million years away or never, are actually four years away."

This might be a shock to Neal Jordan, a young science-fiction author, who set his recently-published mind-uploading book Transgod 500 years in the future. Such uploading is also discussed in another new book, The Proactionary Imperative: A foundation for transhumanism, by Steve Fuller and Veronika Lipinska. Carl Elliott reviewed it in this week's New Scientist under the descriptive online headline, "a manifesto for playing god with human evolution." In print, the title was the catchier "More, or less, than human?" — presumably because the piece closes with the important observation that:

It is precisely because the powerless and disadvantaged have always made such tempting research subjects that strict controls on medical research are essential.

Newly published in the UK, though not due out in the United States till next February, is yet another book that considers such issues, Sapiens: A Brief History of Humankind by the Israeli historian Yuval Noah Harari. His take is darker than that of the techno-optimists. Not only does he question whether modern people are happier than our stone-age ancestors, he is deeply concerned that coming human enhancements will lead to a more unequal society than any we have seen:

"In the 20th century, the main task of medicine was to bring everybody to a certain level of health and capability. It was by definition an egalitarian aim," Harari told the Guardian. "In the 21st century medicine is moving onwards and trying to surpass the norm, to help people live longer, to have stronger memories, to have better control of their emotions. But upgrading like that is not an egalitarian project, it's an elitist project. No matter what norm you reach, there is always another upgrade which is possible."

As a consequence of the efforts of Church (who is mentioned specifically) and others:

"In the 21st century, there is a real possibility of creating biological castes, with real biological differences between rich and poor," said Harari. "The end result could be speciation. We're used to being the only human species around, but there is no law of nature that says there can only be one species of human. With this kind of upgrading treatment we could have, in the not too distant future, more than one human species on Earth again."

Harari is by no means the first to suggest this. Lee Silver notoriously made that prediction — which he seemed to relish — in Remaking Eden, which was first published in 1997. At that time, such expansive views of human possibilities were fueled by the approaching end of the Human Genome Project. Gene interactions turned out to be more complicated than was once hoped, and the wilder speculations died down for a bit. But now, with the advent of more precise gene-altering tools such as Crispr, ambition seems to be rising again, and the repeated warning is regrettably relevant.

The Economist is a business-focused newsmagazine, and notes that since 2007, "Dr Church has co-founded 12 biotech companies and advised many more." His enterprises are mostly focused on genomics, diagnostics, therapeutics and synthetic biology, with a possible sideline coming in DNA-based data storage — all related to his research. They are not apparently driving his choice of projects so much as derived from what he finds and publishes. But he does have a very capitalist orientation, leading him to tell the magazine:

We're well beyond Darwinian limitations to evolution. Evolution right now is in the marketplace.

Church is expressing here an odd combination of hubris and passivity. His ambition takes him "beyond Darwinian limitations" — he can casually discard a few billion years of evolution — and yet he is irresistibly bound to the current economic system. He has that the wrong way round.

Previously on Biopolitical Times:





An International Agreement on Commercial Surrogacy?

Posted by Marcy Darnovsky on September 4th, 2014


A lively and informative three-day forum convened in The Hague from August 11-13. The International Forum on Intercountry Adoption and Global Surrogacy brought together nearly a hundred scholars, women’s health and human rights advocates, and policymakers from 27 countries at the International Institute of Social Studies of Erasmus University, the Forum’s host organization.

The Forum aimed to provide a venue “to discuss ways to improve international standards around the evolving practices of cross-border adoption and surrogacy, in which children typically move from poorer to wealthier countries.”  The Center for Genetics and Society chaired the “Global Surrogacy Practices” thematic area of the conference.

Serendipitously, the Forum occurred in the wake of headlines about two disturbing surrogacy incidents in Thailand. In one case, an Australian couple was accused of abandoning their baby son, who has Down syndrome, with his Thai surrogate mother and returning home with his twin sister (1, 2); the husband was then revealed to have been convicted of multiple child sex offenses that took place between the early 1980s and early 1990s against girls as young as five. In the other news story, a young Japanese businessman fathered sixteen children since June 2013 with Thai surrogate mothers, claiming that he wanted a large family (1, 2).

These incidents took surrogacy out of its usual celebrity-driven spotlight and highlighted the risks of unregulated international surrogacy arrangements for a broader public. For Forum participants, they also underlined concerns about children born as a result of contract pregnancies, and set the stage for discussions of the “best interests of the child,” which is a foundational concept of the 1993 Hague Convention on Intercountry Adoption (HCIA).

By design, the Forum took place in advance of the Hague Conference on Private International Law’s upcoming considerations of its work on intercountry adoption and surrogacy. Implementation of the HCIA, and ongoing concerns about patterns of fraud and “failed” adoption, will be discussed by its Special Commission in spring 2015. In roughly the same time frame, the Hague Conference staff (known as its “Permanent Bureau”) expects to receive guidance from its member countries about whether and how to move ahead toward a possible convention on international surrogacy. Members of the Hague Conference Permanent Bureau participated in the Forum, and indicated their active interest in the discussions and evidence presented there.

Forum participants who have focused on surrogacy and those who have worked on intercountry adoption learned a great deal from each other over the course of the three-day event. Adoption experts presented data regarding the past and present challenges of international adoption faced in countries such as Ethiopia and Guatemala, while surrogacy experts shared findings from India, Mexico, Israel, and elsewhere. Several anthropologists and advocates presented accounts of their fieldwork with surrogate mothers in India, a major destination for international surrogacy, and the country in which it has been most intensively studied.

Meeting jointly and in smaller groups, participants identified and discussed several similarities between intercountry adoption and surrogacy, surrogacy and explored how lessons learned from decades of work by the international adoption community might inform surrogacy practices. One issue that is now more or less settled in the adoption context is that adopted children are entitled to “legal openness” about their biological origins; this raises the question of whether children born in surrogacy arrangements should also be granted access to information about their genetic and gestational origins. Adoptees repeatedly stressed the preservation of records as a primary concern for surrogacy practice. Another question turns on the similarities between the situations of birth mothers of adoptees and surrogate mothers, and on how their health, interests and rights can be protected. A third concerns the role of intermediaries in the two practices, and whether, and under what conditions, agencies are part of the solution or part of the problem.

Differences between intercountry adoption and international surrogacy are also instructive, and were the focus of many discussions at the Forum. In the case of adoption, the assumed starting point is a child in need of a home; with surrogacy, it’s adults who wish to create a child in order to become parents. Also, most countries see intercountry adoption as a practice that at least in some circumstances should be supported; in contrast, most countries currently prohibit commercial surrogacy altogether and face the quandary of what to do when their citizens flout these laws and go abroad to the handful of jurisdictions that allow it.

Participants whose work has focused on issues of parentage and citizenship of children born in international surrogacy arrangements, and those focused on the conditions of women working as surrogates, were able to easily agree that any international convention – as well as other policy or advocacy efforts – should protect the rights and well-being of all parties: children, women working as surrogate mothers, and intended parents. There was also agreement that any international convention should be structured so that it does not pressure  jurisdictions that prohibit commercial surrogacy to loosen their laws.

In its Preliminary Report on the Issues Arising from International Surrogacy Arrangements (March 2012), the Hague Conference Permanent Bureau focused primarily on the “best interests of the child” in intercountry surrogacy arrangements, especially these children’s citizenship and parentage status. But the Report also covers concerns about psychological and health issues they may face, and includes strong language about the urgency of addressing the documented patterns of abuse and human rights violations against surrogate mothers.

While Forum participants shared strong concerns about the problems that intercountry surrogacy arrangements raise, and about minimum standards for any projected international convention, many were fundamentally unsettled about commercial surrogacy itself and about the best policy option for addressing it. Some consider commercial surrogacy unacceptable, on the grounds that it commodifies and commercializes both babies and women’s reproductive capacities. From this view, commercial surrogacy should be prohibited because it exploits women, especially those who have few other economic options, and constitutes a form of baby selling.

Others believe that harms to surrogate mothers can be addressed by defining contract pregnancy as a form of work, and establishing regulation and oversight to improve labor conditions. Their views are based either on a pragmatic sense that international surrogacy is already an established fact and that policies to protect those involved are urgently needed, or on the belief that surrogacy can benefit women who have few other options for earning the kind of money this work can bring them. Some participants reported that they changed their mind on these questions during the Forum, in one direction or another; most agreed that the animated and thoughtful exchanges had opened their minds to aspects of the issues they had not previously considered or taken seriously.

The Forum’s discussions and deliberations made clear that the issues raised by international commercial surrogacy are complex and that opinions about it are varied, even among women’s health advocates and feminist scholars. The wide range of concerns expressed, and the evidence on which they are based, will help inform the Hague Conference as it continues to consider the feasibility of a convention on international surrogacy.

Recordings of the Forum’s three plenary sessions will soon be posted on its public website, and a report on the discussions and deliberations will be published later this fall.

Previously on Biopolitical Times:







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