Struggling to Control Fertility Tourism

Posted by Pete Shanks April 17, 2010
Biopolitical Times
A Bangalore fertility clinic

Several countries are trying to figure out what to do about their citizens who go abroad for assisted reproduction procedures to evade local prohibitions (or just to save money). Even when such travel seems to be thoroughly well-intentioned, there are issues of risk for mothers, children, egg donors and perhaps especially surrogates, who are often exploited. And when the parents return home, there may be difficulties with even the most appropriate legal frameworks.

Turkey is demonstrating an extreme response. The country has long banned the use of donor gametes, as well as surrogacy. (Turkey is officially secular, but the governing party has roots in political Islam and is very responsive to Islamic proscriptions, though Muslims are no longer unanimous on such issues.) An estimated 2-3,000 women a year have been getting around this by traveling to clinics in nearby Cyprus. Under a new regulation, they now face up to three years in prison when they return home. Turkish clinics face suspension and possible closure for "encouraging couples to have sperm or egg donations performed abroad, or even informing them about the possibility."

The regulation is intended to enforce "article 231 of the criminal code, which makes it a crime to conceal the paternity of a child," a spokesman told the BBC. "Mr Sencan at the Department of Health said it was essential for children to know who their fathers and grandfathers are; using sperm donors, he said, contravened that requirement." However, the rule -- adopted without parliamentary debate -- has sparked opposition and calls for reform.

In Britain, "reproductive tourism" is becoming both relatively routine and an issue of concern. A significant number of Britons ("thousands" says one newspaper) are seeking IVF treatment abroad. Some fertility treatments are available free in the UK, but older women do not qualify and others may face long waits or be declared ineligible. Private treatment in the UK runs roughly US$6,000–$12,000 per IVF cycle, but in the Czech Republic it's about $3,000 and in Romania, the Ukraine and Russia, even less.

Cost is not the only reason for traveling; sometimes the goal is to evade UK laws. Sex selection is one example (some US clinics specialize in selling this to British clients). Another is access to commercial surrogacy, which is banned in Britain. There is a regular surrogacy industry in India, some of it specifically catering to British couples, as do several U.S. fertility clinics, some with sensational promotions. Some British parents who use foreign surrogates do pay more than expenses, but it now appears that they may legally not be recognized as the child's parents -- even if one or both is genetically related to the child. (A court-approved "parental order" is required; by default, the surrogate is the legal mother in the UK.) In practice, a judge has at least twice recognized the parenthood of applicants despite "significant" payments (that would certainly be illegal in the UK) to surrogates in the Ukraine and California, but fertility lawyers are concerned that other judges may not be so lenient.

A recent survey article in BioNews suggests that cross-border reproductive care may in practice be a "safety valve that allows for dissent from majority opinion." The trouble is that one group tends to want to open the spigot, while another wants to weld it shut. The resulting issues are extraordinarily hard to resolve without considered international agreements.

Previously on Biopolitical Times: