The child vessel
I recently learned about the deeply moving story of the mother of a 2-grade pupil at the school where I am deputy principal, who had recently become a surrogate mother. Maybe because I have an adopted child myself, a 5 year old boy from Haiti, it struck a chord. This woman is a poor white Afrikaner from the suburbs of the big city, someone who has lived alone for years and who is barely able to make ends meet in this new South Africa where people like her no longer have the privileges they used to have under apartheid. She is looking after her little daughter but is having very hard times.
So, when a German family decided to use the opportunity that the local legislation provides for surrogacy, she was there in the list. And she agreed to give birth to their child, actually two children - twins. They provided the genetic material, it was implanted in her, and earlier this year she gave birth to the babies. The South African legislation allows surrogacy, but there were some serious complications from the German side, because in Germany, surrogacy is considered "immoral and unethical", and the German family almost saw the whole process failing, but for the intervention of a skillful lawyer who was eventually able to find a stipulation in the EU legislation, allowing the father to claim parentage. The story has a happy ending for the twins and the family. The surrogate mother? It's more complicated.
Anyway... long story short, they managed to get the twins, and this poor woman remained here, probably a few thousand dollars more secure than before the whole affair. But what must have remained as well is an emptiness in her, after the children she had given birth to, were voluntarily taken away from her. And I can imagine their new/genetic parents must be having some difficulties back in Germany, coping with the social stigma that comes along with having surrogate children there. Because it is "immoral and unethical"...
I have been to that clinic that provides the surrogacy service a couple of times before. The people I have seen sitting in the waiting room are from all around the world. And they don't come to South Africa for the safari. They want to have children. People from Europe, Australia, Canada... the one thing that could be seen in their eyes, is hope. Hope for an ending of their desperation, as many of them are unable to have children for one reason or another. And, hope and desperation must have been what has moved all those women who have agreed to "lend" their bodies to carry the children for these people.
In South Africa, the doctors are allowed to check the fertilised eggs for genetically inherited diseases. They can also take eggs from anonymous donors, if the patients are unable to produce living eggs for fertilisation. They can also implant a fertilised egg into the womb of another woman. The local legislation is very liberal in this respect compared to many other countries, including ones in the West.
The "import" of children from abroad is arranged by the Hague Adoption Convention from 1993. The purpose of this document is to stop the illegal baby trade worldwide. The Convention gives priority to adoptions by relatives, and when this is impossible, to families from the same country, and then to foreigners when there is no other option.
And the data is more than eloquent. Nearly every sixth couple in Europe who wants to have children, remains childless. Firstly, men's fertility is waning, most probably due to the poisons in the environment, and secondly, more women want to get a high education first, then secure a good job, and only then have a child. But the scientific research suggests that women are at their peak of fertility in their early to mid 20s, and some are beginning to reach their critical period as early as their mid 30s.
Desperate couples often spend up to 50,000 dollars or even more to get a child, and become indebted in the process. Others, after the first attempt, seek for options in other countries, where the doctors have their hands untied, and the procedure is considerably cheaper. Like here in South Africa.
This is indeed a vast global market. Because that's what it is, a market. But on this market there is always the problem of growing demand and scarce supply. And countries like South Africa are in a beneficial position in this respect, because the legislation about medical innovation is as liberal as it can be, the health care is generally at a European quality, while the salaries in the hospitals are more like those in the developing world.
As for this particular German family, the birth of their twins by a South African woman cost them 25,000 euro. Plane trips, stay at the hospital and the hotel, and of course the compensation for the surrogate mother. In comparison, those are roughly the rates for adopting a child in Peru or Vietnam. As I learned from first hand experience, Haiti's case is different, due to the urgent nature of the situation there.
From what I learned, the quality of medical service in the hospital in Cape Town is surprisingly good; the procedure is very strict and well thought out. An abortion is not allowed, except in the most extreme medical circumstances; the surrogate mother is allowed no alcohol and no cigarettes throughout the entire period of pregnancy; there is a strict diet and a regular check of the hormone balance. But let's face it. The woman is regarded solely as a vessel for reproduction - in fact this is clearly written black in white in the contract. It also says that she has no right to build an emotional bond with the baby (breast-feeding after birth is discouraged, as it would foster such a bond; the genetic mother is to undergo a hormone treatment that would allow her to breast-feed after the birth). Choosing the baby's name is also solely the parents' prerogative.
What moved me the most in this woman's story was when she told me about the thoughts the genetic mother of the twins had shared with her. "Isn't it strange that our babies would grow for months in the belly of another woman, who they will probably never know?" She also said that her own thoughts had been, "It must be awkward to know that your children are being born at the other side of the world, and you have no ability to influence their development, while sitting there with an empty belly. The one thing that is even stranger than this... is to know that someone else's children are growing inside my own belly".
To be honest, I had never considered surrogacy as an option for myself. I just spent some time on an aid mission in Haiti, and I decided to adopt a very young boy. And I did. The procedure was long and complicated, but it was absolutely worth it. Now I hope I can say that my boy lives a happy life, with a chance to achieve something in life. But this woman's story made me think real hard. Eventually, I decided to delve into the matter together with my pupils in class, and I touched on the subject during one of our "Conversation hours" that I sometimes have with the 6-graders. I formulated it as a hypothetical story. And it goes like this...
Imagine the following situation. In the biology class, some students are passionately discussing the issue of surrogacy and its ethical implications. At some point, a quiet student raises her voice and asks, "Look, I was born by a surrogate mother. My mommy could not have children in a normal way. So are you telling me that what we are discussing here is the question if I have the right to exist or not?" Those biology students would have given awkward silence in response, I imagine. Much unlike my pupils, who were quite eager to have their say on the issue.
The above scenario is of course just fiction, and I probably exaggerated it like this for a reason. But it is meant to illustrate and give a more personal face to this tricky ethical question that is the right of existence. Because every objection to surrogacy seems to revolve around the controversial notion that from a moral standpoint, it might be better if the child does not see the bright day, and is never born. The same is valid for the objection that the child would be harmed by this situation - after all, he or she owes their very existence to it. What might have sounded like pure theory initially, becomes a very real problem once the child is born. And that is perhaps the strongest argument in favour of surrogacy.
Another argument is the reproductive freedom of the genetic parents. The decision to deny somebody the chance to continue their family when it is demonstrably possible from a technical point of view, must rest upon very solid reasons, both social, practical and ethical.
The suspicions against surrogacy, and especially its commercial form, are centered around the following arguments, which are intertwined. Exploitation of the woman; degradation of the reproductive process; and with that, giving children a status of a commercial product for trade, which leads to long-term damages on both the child and the surrogate mother; and an insult to human dignity.
On the other hand, if we look closer at the "exploitation of the woman" argument, we could reach a surprising result: when looked from a certain angle, it could be argued that from a feminist standpoint, surrogacy is a positive phenomenon, because it gives the woman additional freedoms. First, the freedom to give birth to a child without getting pregnant (often because she cannot get pregnant, or because a potential pregnancy carries serious health risks). Then, it allows her to use her own body to her benefit, even if a material one. Think about the mother of my pupil - she already has a child who she could barely provide food for. Is it ethical to deny her the chance to ensure a better life for her child, while giving another family the chance to ensure a good life for two more children? Wouldn't denying the woman the right of this decision be a denial of her freedoms? "My belly is mine", women have argued during the heated abortion debate. Couldn't that be valid about surrogacy as well?
But in the meantime, we cannot deny the similarity between commercial surrogacy and prostitution. In both cases, the woman offers her body for money, often with the mediation of third persons - for a commission. The difference is that while prostitutes are paid for providing sexual pleasure, the surrogate mothers provide a new life.
And here the interpretations could vary too. From one side, we could condemn and reject prostitution outright, because it does not pursue any "higher" purpose. On the other hand, we could define surrogacy as a moral problem, because reproduction and creating a new human being is turned into a commercial product. And this involves the philosophical question of the emerging life - Kant has said that "Everything has either a price or a dignity". This is why some countries allow surrogacy only in its non-commercial form: apart from paying the medical expenses, no other compensation is allowed. But then, this narrows the chance of women like this one to volunteer for surrogacy.
As for the surrogate mother, her dignity is certainly damaged, when she is looked upon as a mere vessel, especially in cases when she is forced to carry someone else's child, or when she is compelled to resort to offering her body out of desperation from her difficult financial situation. But if she is doing this with the full knowledge about what she is getting into, and when she does it completely voluntarily, then what? Things become complicated ethically, and it is not so easy to judge any more.
The tricky part is how to define "a difficult financial situation". How do we define "a miserable life"? What if the woman needs money to provide a good education for her children? What if her husband or partner insists that she should share the responsibility for the family's income? (Provided she has a partner at all, which often she does not). Usually between the sides in such a surrogate "contract", there is a huge gap in material status, like in the case with this German family, and this often gives rise to concerns that one side is exploiting the other. Could we speak of an informed decision at all, provided that the surrogate mother has no way to know how she would be feeling during the pregnancy with the "foreign" child, even if she already has had other children? What if she suddenly decides she wants to keep the child, but she has already signed a contract and she is not allowed to?
If we look at the dignity of humankind as a whole, other doubts arise as well: could humankind itself be put under threat by any form of surrogacy, by intervention in the reproduction process and the creation of life? Because in the process, the human is now turned into an object, in a sense.
And then, there is the strong objection from the Church that Man should not equate himself to God. Only, let us not confuse the dignity of humankind with "naturalness". Just on the contrary - isn't it inherent to humanity that we humans should consciously organise our lives, and use the tools and knowledge we are gifted with, to improve our lives, instead of blindly adhering to what nature alone has given us, and nothing beyond that? Although the Church might argue that it is exactly this deviation from what is "natural" that has been pushing us to our gradual downfall.
All of these arguments, including the repeated claims about potentially negative effects of surrogacy on the child and on the surrogate mother, are causing serious suspicions and objections to commercial surrogacy. But the question remains exactly how serious and how grounded those objections are, and how able would they be to limit the reproductive freedom of women, and at the same time to adequately address the ethical problem of the right of existence.
So, when a German family decided to use the opportunity that the local legislation provides for surrogacy, she was there in the list. And she agreed to give birth to their child, actually two children - twins. They provided the genetic material, it was implanted in her, and earlier this year she gave birth to the babies. The South African legislation allows surrogacy, but there were some serious complications from the German side, because in Germany, surrogacy is considered "immoral and unethical", and the German family almost saw the whole process failing, but for the intervention of a skillful lawyer who was eventually able to find a stipulation in the EU legislation, allowing the father to claim parentage. The story has a happy ending for the twins and the family. The surrogate mother? It's more complicated.
Anyway... long story short, they managed to get the twins, and this poor woman remained here, probably a few thousand dollars more secure than before the whole affair. But what must have remained as well is an emptiness in her, after the children she had given birth to, were voluntarily taken away from her. And I can imagine their new/genetic parents must be having some difficulties back in Germany, coping with the social stigma that comes along with having surrogate children there. Because it is "immoral and unethical"...
I have been to that clinic that provides the surrogacy service a couple of times before. The people I have seen sitting in the waiting room are from all around the world. And they don't come to South Africa for the safari. They want to have children. People from Europe, Australia, Canada... the one thing that could be seen in their eyes, is hope. Hope for an ending of their desperation, as many of them are unable to have children for one reason or another. And, hope and desperation must have been what has moved all those women who have agreed to "lend" their bodies to carry the children for these people.
In South Africa, the doctors are allowed to check the fertilised eggs for genetically inherited diseases. They can also take eggs from anonymous donors, if the patients are unable to produce living eggs for fertilisation. They can also implant a fertilised egg into the womb of another woman. The local legislation is very liberal in this respect compared to many other countries, including ones in the West.
The "import" of children from abroad is arranged by the Hague Adoption Convention from 1993. The purpose of this document is to stop the illegal baby trade worldwide. The Convention gives priority to adoptions by relatives, and when this is impossible, to families from the same country, and then to foreigners when there is no other option.
And the data is more than eloquent. Nearly every sixth couple in Europe who wants to have children, remains childless. Firstly, men's fertility is waning, most probably due to the poisons in the environment, and secondly, more women want to get a high education first, then secure a good job, and only then have a child. But the scientific research suggests that women are at their peak of fertility in their early to mid 20s, and some are beginning to reach their critical period as early as their mid 30s.
Desperate couples often spend up to 50,000 dollars or even more to get a child, and become indebted in the process. Others, after the first attempt, seek for options in other countries, where the doctors have their hands untied, and the procedure is considerably cheaper. Like here in South Africa.
This is indeed a vast global market. Because that's what it is, a market. But on this market there is always the problem of growing demand and scarce supply. And countries like South Africa are in a beneficial position in this respect, because the legislation about medical innovation is as liberal as it can be, the health care is generally at a European quality, while the salaries in the hospitals are more like those in the developing world.
As for this particular German family, the birth of their twins by a South African woman cost them 25,000 euro. Plane trips, stay at the hospital and the hotel, and of course the compensation for the surrogate mother. In comparison, those are roughly the rates for adopting a child in Peru or Vietnam. As I learned from first hand experience, Haiti's case is different, due to the urgent nature of the situation there.
From what I learned, the quality of medical service in the hospital in Cape Town is surprisingly good; the procedure is very strict and well thought out. An abortion is not allowed, except in the most extreme medical circumstances; the surrogate mother is allowed no alcohol and no cigarettes throughout the entire period of pregnancy; there is a strict diet and a regular check of the hormone balance. But let's face it. The woman is regarded solely as a vessel for reproduction - in fact this is clearly written black in white in the contract. It also says that she has no right to build an emotional bond with the baby (breast-feeding after birth is discouraged, as it would foster such a bond; the genetic mother is to undergo a hormone treatment that would allow her to breast-feed after the birth). Choosing the baby's name is also solely the parents' prerogative.
What moved me the most in this woman's story was when she told me about the thoughts the genetic mother of the twins had shared with her. "Isn't it strange that our babies would grow for months in the belly of another woman, who they will probably never know?" She also said that her own thoughts had been, "It must be awkward to know that your children are being born at the other side of the world, and you have no ability to influence their development, while sitting there with an empty belly. The one thing that is even stranger than this... is to know that someone else's children are growing inside my own belly".
To be honest, I had never considered surrogacy as an option for myself. I just spent some time on an aid mission in Haiti, and I decided to adopt a very young boy. And I did. The procedure was long and complicated, but it was absolutely worth it. Now I hope I can say that my boy lives a happy life, with a chance to achieve something in life. But this woman's story made me think real hard. Eventually, I decided to delve into the matter together with my pupils in class, and I touched on the subject during one of our "Conversation hours" that I sometimes have with the 6-graders. I formulated it as a hypothetical story. And it goes like this...
Imagine the following situation. In the biology class, some students are passionately discussing the issue of surrogacy and its ethical implications. At some point, a quiet student raises her voice and asks, "Look, I was born by a surrogate mother. My mommy could not have children in a normal way. So are you telling me that what we are discussing here is the question if I have the right to exist or not?" Those biology students would have given awkward silence in response, I imagine. Much unlike my pupils, who were quite eager to have their say on the issue.
The above scenario is of course just fiction, and I probably exaggerated it like this for a reason. But it is meant to illustrate and give a more personal face to this tricky ethical question that is the right of existence. Because every objection to surrogacy seems to revolve around the controversial notion that from a moral standpoint, it might be better if the child does not see the bright day, and is never born. The same is valid for the objection that the child would be harmed by this situation - after all, he or she owes their very existence to it. What might have sounded like pure theory initially, becomes a very real problem once the child is born. And that is perhaps the strongest argument in favour of surrogacy.
Another argument is the reproductive freedom of the genetic parents. The decision to deny somebody the chance to continue their family when it is demonstrably possible from a technical point of view, must rest upon very solid reasons, both social, practical and ethical.
The suspicions against surrogacy, and especially its commercial form, are centered around the following arguments, which are intertwined. Exploitation of the woman; degradation of the reproductive process; and with that, giving children a status of a commercial product for trade, which leads to long-term damages on both the child and the surrogate mother; and an insult to human dignity.
On the other hand, if we look closer at the "exploitation of the woman" argument, we could reach a surprising result: when looked from a certain angle, it could be argued that from a feminist standpoint, surrogacy is a positive phenomenon, because it gives the woman additional freedoms. First, the freedom to give birth to a child without getting pregnant (often because she cannot get pregnant, or because a potential pregnancy carries serious health risks). Then, it allows her to use her own body to her benefit, even if a material one. Think about the mother of my pupil - she already has a child who she could barely provide food for. Is it ethical to deny her the chance to ensure a better life for her child, while giving another family the chance to ensure a good life for two more children? Wouldn't denying the woman the right of this decision be a denial of her freedoms? "My belly is mine", women have argued during the heated abortion debate. Couldn't that be valid about surrogacy as well?
But in the meantime, we cannot deny the similarity between commercial surrogacy and prostitution. In both cases, the woman offers her body for money, often with the mediation of third persons - for a commission. The difference is that while prostitutes are paid for providing sexual pleasure, the surrogate mothers provide a new life.
And here the interpretations could vary too. From one side, we could condemn and reject prostitution outright, because it does not pursue any "higher" purpose. On the other hand, we could define surrogacy as a moral problem, because reproduction and creating a new human being is turned into a commercial product. And this involves the philosophical question of the emerging life - Kant has said that "Everything has either a price or a dignity". This is why some countries allow surrogacy only in its non-commercial form: apart from paying the medical expenses, no other compensation is allowed. But then, this narrows the chance of women like this one to volunteer for surrogacy.
As for the surrogate mother, her dignity is certainly damaged, when she is looked upon as a mere vessel, especially in cases when she is forced to carry someone else's child, or when she is compelled to resort to offering her body out of desperation from her difficult financial situation. But if she is doing this with the full knowledge about what she is getting into, and when she does it completely voluntarily, then what? Things become complicated ethically, and it is not so easy to judge any more.
The tricky part is how to define "a difficult financial situation". How do we define "a miserable life"? What if the woman needs money to provide a good education for her children? What if her husband or partner insists that she should share the responsibility for the family's income? (Provided she has a partner at all, which often she does not). Usually between the sides in such a surrogate "contract", there is a huge gap in material status, like in the case with this German family, and this often gives rise to concerns that one side is exploiting the other. Could we speak of an informed decision at all, provided that the surrogate mother has no way to know how she would be feeling during the pregnancy with the "foreign" child, even if she already has had other children? What if she suddenly decides she wants to keep the child, but she has already signed a contract and she is not allowed to?
If we look at the dignity of humankind as a whole, other doubts arise as well: could humankind itself be put under threat by any form of surrogacy, by intervention in the reproduction process and the creation of life? Because in the process, the human is now turned into an object, in a sense.
And then, there is the strong objection from the Church that Man should not equate himself to God. Only, let us not confuse the dignity of humankind with "naturalness". Just on the contrary - isn't it inherent to humanity that we humans should consciously organise our lives, and use the tools and knowledge we are gifted with, to improve our lives, instead of blindly adhering to what nature alone has given us, and nothing beyond that? Although the Church might argue that it is exactly this deviation from what is "natural" that has been pushing us to our gradual downfall.
All of these arguments, including the repeated claims about potentially negative effects of surrogacy on the child and on the surrogate mother, are causing serious suspicions and objections to commercial surrogacy. But the question remains exactly how serious and how grounded those objections are, and how able would they be to limit the reproductive freedom of women, and at the same time to adequately address the ethical problem of the right of existence.