This chapter gives a brief overview of the composition of the volume and explains why it is important to undertake a detailed scholarly analysis and comparison of the following ethico-legal regimes of surrogacy and egg donation: the permissive-unregulated but transitory regime of India; the permissive regime of Israel, although highly regulated by professional, medical and religious norms, and the extremely restrictive regime of Germany, being legally permeable for particular forms of cross-border reproductive practice despite the non-permissive national law. (...) It uses an interdisciplinary lens to examine how the ethical, social, legal and cultural issues are interwoven in each regime. Moreover, we highlight the importance of a comparative analysis to understand how local developments cannot be isolated from each other, but deeply influence each other through transnational markets, modern media and the transfer of knowledge, people and body parts. (shrink)

A growing number of infertile couples and other individuals desiring children are seeking to fulfill their desire for parenthood transnationally through the use of donor gametes and a surrogate. The number of “fertility tourists” from developed countries to low-income countries is growing phenomenally. Indian women, too, are participating as (re)producers in these “biocrossings,” turning India into the surrogacy outsourcing capital of the world in the globalized bioeconomy of assisted reproduction. I argue for a ban on commercial egg donation and (...) surrogacy and a social-justice approach that would hold the state responsible for providing basic social goods to low-income households. I also argue for a gender-justice approach so that women would not be compelled to adopt surrogacy as a strategy for survival and upward social mobility. (shrink)

This book is the first to bring together an interdisciplinary collection of essays on surrogacy and egg donation from three socially, legally and culturally distinct countries - India, Israel and Germany. It presents contributions from experts in the field of social and cultural sciences, bioethics, law as well as psychology and provides critical-reflective comparative analysis of the socio-ethical factors shaping surrogacy and egg donation practices across these three countries. This book highlights the importance of a comparative perspective to ‘make (...) sense’ of controversies and transitions in this highly contested area of artificial reproductive technologies. It demonstrates how local developments cannot be isolated from global events and vice versa. Therefore, this volume can be used as a standard reference for anyone seeking to understand surrogacy and egg donation from a macro-perspective in the next decade. (shrink)

Although the term commodification is sometimes criticised as imprecise or overused, in fact it has a complex philosophical ancestry and can never be used too much, because the phenomena that it describes are still gaining ground. The issues that commodification raises in relation to reproductive technologies include whether it is wrong to commodify human tissues generally and gametes particularly, and whether the person as subject and the person as object can be distinguished in modern biomedicine. This chapter examines three (...) areas in which commodification is a serious concern for important reproductive technologies: the sale of eggs for IVF and research, the banking of umbilical cord blood, and the use of gestational surrogates both domestically and internationally. Sales of human eggs for IVF or research are frequently disguised as “gifts”, which conceals the very real bodily risks and harms associated with ovarian hyperstimulation and egg harvesting undergone by egg “donors.” Umbilical cord banking is a fast-growing industry, with donated cord blood trading globally at very high prices; women who consent to banking of cord blood ostensibly for the potential future benefit of their child may not be informed of the likelihood that it will be traded in commercial markets or that the method used for harvesting may increase risks of jaundice in their babies. Commercial surrogacy also exploits altruism but in addition involves wrongful sale of babies, particularly in the international context. In each example, the commodification of women’s reproductive labour is masked by the manner in which ‘the lady vanishes’ under a gift model, ignoring the true economic value of their labour. (shrink)

This article provides a donor-focused analysis of how transnational reproductive donation intersects with issues central to bodily autonomy of surrogates and egg donors from the global South. Little is known about the autonomy of surrogates and egg donors, especially among those from the global South. This article addresses this gap by examining two key issues on surrogacy and egg donation—conflict of interest and recruitment market. With these issues, this paper presents contexts of the reproductive body as a space (...) of contestation for autonomy. Analysis reveals that bodily autonomy is not an absolute entitlement available for surrogates and egg donors from the global South. Having bodily autonomy is a privileged disposition rather than a universal liberty for reproductive donors. The discussions in this work encourage further examination to understand the multi-layered experiences of reproductive donors from the global South, towards deeper interrogation of the processes of reproductive industry. (shrink)

California is the global hub for assisted reproductive technology practices, including egg donation. The rise of egg donation in the United States is surprising given the cultural context linking genetics and motherhood and rejecting the commodification of reproduction. Scholars in the hostile worlds camp have grappled with the relationship between intimacy and economics, yet employing this theory to explain the increase in egg donation is unsatisfactory. The concept of relational work, developed by Viviana Zelizer, provides scholars with a robust (...) analytical tool to account for the rise in egg donation. This paper analyzes the relational work of egg donors and fertility center staff. I argue that donors and staff construct an understanding of egg donation that avoids directly challenging the cultural context mentioned above. Analyzing egg donation as a case of relational work demonstrates the need to move beyond the reciprocity/market dichotomy upheld by the hostile worlds framework. (shrink)

This article seeks to illustrate egg donation's incompletely commodified status through an analysis of two cases of first impression, highlighting the tensions that arise from attempts to reconcile egg donation's reality as a robust commercial industry with the nonmarket norms that traditionally underlie reproduction. Antitrust and taxation litigation may seem unlikely sources for guidance in navigating the tensions in egg donation's uncertain place between the worlds of gift and market exchange. Nonetheless, this litigation forces an explicit consideration of how egg (...) donation is perceived, talked about, and operationalized, and where along the gift-market spectrum it fits. These cases also engage familiar questions of commodification, coercion, and exploitation, which are surprisingly central litigation issues. (shrink)

It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive (...) capacities, and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage, or Fair-Trade guidelines. An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad. (shrink)

This paper aims to evoke an alternative viewpoint on surrogacy, moving beyond popular Western feminist beliefs on the practice, by introducing the history and current context of East Asian surrogacy. To elaborate a different cultural perspective on surrogacy, this paper first introduces the East Asian history of contract pregnancy systems, prior to the emergence of the American invention of ‘modern’ surrogacy practice. Then, it examines Japanese mass media portrayals of cross‐border surrogacy in which white women have become ‘convenient’ entities. The (...) results of the analysis show how Japanese culture has adopted a rhetoric about the use of white women as convenient surrogate mothers in the global commercial surrogacy market. An essential aspect of surrogacy is the premise that a woman’s reproductive function should be accessible to others. Past discussions among feminists have neglected this important point. Moreover, they share the assumption that white surrogacy clients are exploiters, who take advantage of women of colour as surrogate mothers. The current situation in Asia flips this perspective—with white women regarded as easier targets for exploitation by wealthy people of colour. For Asian clients, Westerners can be easily regarded as ‘others’ whom they can use for their reproductive needs. In today's globalized era, the surrogacy industry is no longer for affluent Westerners only. Considering this change, it is crucial to discuss surrogacy issues by reconstructing feminist perspectives with a globalized view, to help protect women’s bodies, regardless of nationality, ethnicity, skin colour, or religion. (shrink)

This is a retrospective of surrogacy in Israel in the context of medically assisted reproduction. The practice of surrogacy emerged in the 1980s, suggesting a radical view of women as autonomous reproductive agents free from double standards of patriarchy. In 1995 Israel enacted a law that regulated domestic surrogacy for the benefit of infertile married women in accord with orthodox views of halakha. In recent years we see the growth of inter-country practices catering to otherwise ineligible intended parents, and (...) a demand for posthumous male reproduction. Meanwhile, women become objects of intrusive medical procedures and commodities of a global market, more often than not for the benefit of others rather than themselves. Yet the essence of human reproduction remains relational, and calls for care and responsibility. (shrink)

In the case of surrogacy, it is not new biotechnologies themselves that have challenged well-established principles in law and ethics, but rather political and social phenomena such as commodification of women’s reproductive tissue and labour, demands to allow new ways of forming families and (before Covid-19, at least) the comparative ease of international travel that enabled cross-border surrogacy to develop into a market valued at up to $2 billion annually in India alone as of 2016 (Dickenson 2016, citing (...) an estimate from The Indian National Commission for Women). This phenomenon stands the usual truth on its head: it is not new technologies but new pressures that have challenged the existing law and ethics of surrogate motherhood. (shrink)

Whilst India has been debating how to regulate 'surrogacy' the UK has undergone a major consultation on increasing the amount of 'expenses'paid to egg 'donors', while France has recently finished debating its entire package of bioethics regulation and the role of its Biomedicine Agency. Although it is often claimed that there is no alternative to the neo-liberal, market-based approach in regulating (or not) reproductive medicine--the ideology prevalent in both India and the UK--advocates of that position ignore the (...) alternative model offered by France's tighter regulation, as well as its overarching concern with protecting the vulnerable and ensuring social justice. Whilst the concepts underpinning the French model of regulation also have their provenance in Western political philosophy and not in the developed world, they embody a very different attitude and suggest that there is indeed an alternative to letting the market decide. However, even in France that alternative is highly contested. (shrink)

As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical (...) research in New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents’ demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. (shrink)

This essay develops a framework for thinking about the moral basis for the commodification of human reproductive materials. It argues that selling and buying gametes and genes is morally acceptable although there should not be a market for zygotes, embryos, or genomes. Also a market in gametes and genes should be regulated in order to address concerns about the adverse social consequences of commodification.

The introduction of contraceptive technologies hasresulted in the separation of sex and procreation. Theintroduction of new reproductive technologies (mainlyIVF and embryo transfer) has led not only to theseparation of procreation and sex, but also to there-definition of the terms mother and family.For the purpose of this essay, I will distinguishbetween:1. the genetic mother – the donor of the egg;2. the gestational mother – she who bears and gives birth to the baby;3. the social mother – the woman who raises (...) the child.This essay will deal only with the form of gestationalsurrogacy in which the genetic parents intend to bethe social parents, and the surrogate mother has nogenetic relationship to the child she bears anddelivers. I will raise questions regarding medicalethical aspects of surrogacy and the obligation(s) ofthe physician(s) to the parties involved. I will arguethat the gestational surrogate is a womb to rent,that there is great similarity between gestationalcommercial surrogacy and organ transplant marketing.Furthermore, despite claims to freedom of choice andfree marketing, I will claim that gestationalsurrogacy is a form of prostitution and slavery,exploitation of the poor and needy by those who arebetter off. The right to be a parent, although notconstitutional, is intuitive and deeply rooted.However, the issue remains whether this rightoverrules all other rights, and at what price to theparties involved. I will finally raise the followingprovocative question to society: In the interim periodbetween today''s limited technology and tomorrow''sextra-corporeal gestation technology (ectogenesis),should utilizing females in PVS (persistent vehetativestate) for gestational surrogacy be sociallyacceptable/permissible – provided they have leftpermission in writing? (shrink)

In vitro fertilization (IVF) and surrogacy have enabled many to achieve their dreams of parenthood. With a turnover of $500 million, reproductive tourism in India has helped transform the country into a “global baby factory.” However, as the surrogacy industry grew, so did concerns of women’s exploitation, commodification of motherhood, and human rights violations. In an effort to prevent women from being exploited, the Indian government had taken successive administrative measures to regulate surrogacy. The Surrogacy (Regulation) Bill, 2016 (...) and Assisted Reproductive Technologies Bill 2008 were introduced in the Parliament to regulate various aspects of surrogacy arrangements. Yet, it was not until 25 January 2022, that the Surrogacy (Regulation) Act, 2021 went into effect. The Act does, however, leave certain important points unaddressed. The article claims that the legislation’s purposeful exclusion of the LGBTQ population and emphasis on “familial altruism” stinks of inequity and moral conservatism. It also delineates the mechanics of altruistic surrogacy by examining documents that illustrate how the connections between money and morality are framed via the framing of altruism. The article therefore demands that a comprehensive dialogue must be held considering the socio-economic realities of Indian society, or else India risks enacting yet another law that cannot be implemented or that society dislikes. (shrink)

This article aims to lay out the ‘for money’ and ‘for dignity’ arguments that feminist ethicists have given about the reproductive labour women perform in providing oocytes or in getting pregnant for others. Feminist arguments about the morality of these two practices overlap significantly because, from a feminist perspective, the morally relevant facts about them are quite similar. Still, there are dissimilarities, stemming from the obvious fact that one practice involves giving up oocytes while the other involves giving up (...) a baby after a pregnancy. Some arguments by feminists reflect this core difference, in that they apply specifically to one practice but not to the other. The article highlights when the relevance of a particular argument differs for these different reproductive practices. (shrink)

In this paper, I attempt to bring together two topics that are rarely put into conversation in the philosophical bioethics literature: lesbian, gay, bisexual, and queer family equality on one hand, and, on the other, the morality of such alternative reproductive practices as artificial insemination by donor, egg donation, and surrogacy.2 In contrast to most of the philosophical bioethics literature on ARP, which has little to say about queer families, I will suggest that the ethics of ARP and the (...) respect for and protection of queer families are, in fact, intimately related topics.The connection can be clearly seen by considering the shape of the LGBQ rights.. (shrink)

One of the areas of concern raised by cross-border reproductive travel regards the treatment of women who are solicited to provide their ova or surrogacy services to foreign consumers. This is particularly troublesome in the context of developing countries where endemic poverty and low standards for both medical care and informed consent may place these women at risk of exploitation and harm. We explore two contrasting proposals for policy development regarding the industry, both of which seek to promote ethical (...) outcomes and social justice: While one proposal advocates efforts to minimize cross-border demand for female reproductive resources through the pursuit of national self-sufficiency, the other defends cross-border trade as a means for meeting the needs of vulnerable groups. Despite the conflicting objectives of the proposed strategies, the paper identifies common values and points of agreement between the two, including the importance of regulations to safeguard those providing ova or surrogacy services. (shrink)

With advances in assisted reproductive technologies, globalization, and the ease of contact via the internet, the use of gestational surrogates as a family building option has grown significantly over the past decade. In a gestational surrogacy arrangement, unlike a traditional surrogacy arrangement, the surrogate is not the genetic mother of the child she carries; the genetic mother is either an egg donor or the commissioning parent. There are only a handful of countries in which commercial surrogacy is permitted, with (...) the United States and India prominent among them. More surrogacy arrangements are carried out in the United States than in any other nation, and the number of gestational.. (shrink)

The Wall Street Journal article “Putting a Price on a Human Egg” triggered extensive media coverage of a rather unusual challenge to payments made to women providing ova for use in assisted reproduction. In Kamakahi v. American Society for Reproductive Medicine and Society for Assisted Reproductive Technologies, plaintiffs claim that ASRM and SART policies adopting limits on such payments violate the federal antitrust prohibition against price fixing.In 2007, an ASRM Ethics Committee Report, confirming a 2000 report, asserted that, (...) “[a]lthough there is no consensus on the precise payment that oocyte donors should receive, at this time sums of $5,000 or more require justification and sums above $10,000 are not appropriate.” SART is an affiliate organization of ASRM and counts as its members 90 percent of the clinics providing assisted reproductive technologies in the United States. SART requires that its members “[adhere] to all ASRM/SART Guidelines including ethical, practice, advertising, and laboratory.” The plaintiffs in Kamakahi claim that the agreement among SART members to abide by the ASRM policy restricts competition among agencies procuring oocytes and produces lower payments than women would otherwise be able to negotiate. It is through the requirement that SART members adhere to ASRM ethical guidelines that ethics goes to market and encounters antitrust law. Ethicists continue to debate whether payment for oocytes inappropriately commodifies the human body, and ASRM policy consistently refers to their procurement as the “donation process” and to women who participate as “donors.” Nevertheless, in the context of antitrust law, the procurement of oocytes is a business and clearly falls within the reach of antitrust restrictions on business conduct. (shrink)

In her controversial paper, Anna Smajdor proposes that brain-dead people could be used as gestation units for prospective parents unable or unwilling to undertake the act themselves—what she terms whole body gestational donation (WBGD). She explores the ethical issues of such an idea and, comparing it with traditional organ donation, asserts that such deceased surrogacy could be a way of outsourcing pregnancy’s harms to a populace unable to be affected by them. She argues that if the prospect is unacceptable, this (...) may reveal some underlying problems with traditional cadaveric organ donation. Smajdor’s analysis, however, overlooks several problems arising from WBGD. This paper provides an account of those issues and argues that, in addition to WBGD being viscerally unpleasant, it is also ethically unviable. The paper starts by providing an account of WBGD before acknowledging its negative response within traditional and social media. After arguing that such cursory and gut reactions are insufficient to reject the proposal outright, this paper then provides three concerns regarding WBGD omitted by Smajdor: (i) the co-opting of life-saving organs for reproduction, (ii) the discrepancy between using cadaveric organs to save a life versus creating one, and (iii) the universalization of feminist concerns regarding reproductive body commodification. The paper concludes by tentatively agreeing with Smajdor that considering WBGD may help reveal vulnerable assumptions regarding organ donation and surrogacy, but that the significant ethical issues raised may prove insurmountable and make the intervention—thought experiment or otherwise—untenable. (shrink)

This chapter contains sections titled: General Assessments of Assisted Reproduction Pre‐birth Testing Conclusion References Further reading.

In lieu of an abstract, here is a brief excerpt of the content:This Birth and ThatSurrogacy and Stratified Motherhood in IndiaAmrita PandeIn 2006, i came across a short newspaper article about the emergence of a new industry in India—the industry of paid birth or commercial surrogacy. People from all over the world could now hire Indian women to give birth to babies for them, for a fraction of the cost of surrogacy elsewhere and with no government regulations. After some (...) digging around, I quickly realized that there was scarcely any objective, academic research about this new industry, and so began my ethnographic journey to the first clinic in not just India but in fact in the entire Global South to have a flourishing trade in both national and transnational surrogacy.1Academic inquiry into surrogacy arrangements is adequately interdisciplinary and has generated feminist, ethical, legal, and social debates for more than three decades (see, for example, Andrews 1987; Anderson 1990; Bailey 2011; Brennan and Noggle 1997; Hochschild 2012; Markens 2007; Oliver 1989; Ragoné 1994; Pande 2011; and Teman 2010). While defenders of surrogacy advocate it as a manifestation of women’s freedom and choice, much of the scholarship has displayed intense anxiety about this practice (Corea 1986; Dworkin 1983; Harding 1991; Neuhaus 1988; Raymond 1993; Roberts 1998b; and Rothman 1988). One view is that surrogacy reduces women to a mere breeder class, to the class of prostitutes, and another is that it is just another form of baby selling. Others consider the development of such reproductive technologies as a form of class and gender-based exploitation of women’s bodies. Two additional trends in this scholarship are worth emphasizing. First, [End Page 50] much of the debating takes place in abstraction and is rarely based on the actual experience of surrogates.2 Second,much of this work is about surrogacy in the Global North. This is not altogether surprising, since commercial surrogacy is a very recent phenomenon outside of the Global North.In this essay, I address these two gaps in the literature by analyzing the birthing narratives of surrogates in a clinic in India. As the surrogates compare their experiences of giving birth as a surrogate mother to their previous pregnancies, they underscore the paradox of an industry based on pro-natal technology in an otherwise anti-natal state. As importantly, these narratives are a clear manifestation of a global trend of “stratified motherhood”—“the hierarchical organization of reproductive fecundity and birth experiences that supports and rewards the maternity of some women while despising or outlawing the mother-work of others” (Rapp 2001, 469).Surrogacy in IndiaThe moral and ethical ambiguity surrounding surrogacy has made many countries, including China, the Czech Republic, France, Germany, Italy, Mexico, Saudi Arabia, Spain, Sweden, Switzerland, Taiwan, Turkey, and some U.S. states ban surrogacy altogether. Some countries have imposed partial bans, for instance Australia (Victoria), Brazil, Hong Kong, Hungary, Israel, South Africa, and the UK. Canada, Greece, South Africa, Israel, and the UK permit gestational surrogacy, subject to regulations. Then there are other countries with no regulations at all, such as Belgium, Finland, and India (Markens 2007; Teman 2010). Apart from the recent spurt of surrogacy in India, commercial surrogacy is most prevalent in California, USA, and Israel, where surrogacy is tightly controlled by the state and restricted to Israeli citizens. The Indian structure is closer to the liberal market model of surrogacy in California, where surrogacy births are primarily managed by private, commercial agencies that screen, match, and regulate agreements according to their own criteria (Pande 2009).India is not the only country to experience a rise in transnational surrogacy. Couples from countries such as the UK, Japan, Australia, and Kuwait, where surrogacy is either illegal or restricted, have hired surrogates in the United States to bear babies for them. However, while the total cost of such transnational packages is roughly between $100,000 and $120,000, in India the package costs one-third of that amount. Another factor that explains the popularity of India as a destination for transnational surrogacy is the informality of the market. Although commercial surrogacy is not illegal in India in 2002, currently there are no laws regulating surrogacy in clinics. Fertility clinics... (shrink)

Commercial surrogacy arrangements now cross borders; this paper aims to reevaluate the traditional moral concerns regarding the practice against the added ethical dimension of global injustice. I begin by considering the claim that global surrogacy serves to satisfy the positive reproductive rights of infertile first-world women. I then go on to consider three powerful challenges to this claim. The first holds that commercial surrogacy involves the commodification of a good that should not be valued in market terms, the second (...) that it involves the exploitation of the labor of disadvantaged women, and the third that it depends on the illegitimate privileging of positive rights over negative rights. I reject the first of these challenges and argue that global surrogacy arrangements are indeed exploitative on the dual basis of what I call intracontractual injustice and intercontractual coercion. The latter, I contend, depends on a preexisting negative rights violation, which cannot be permitted for the sake of satisfying another's positive reproductive entitlement. I conclude not in favor of a global ban but with suggestions on how developing nations that permit commercial surrogacy might better protect the negative reproductive rights of their female citizens, thereby making them less vulnerable to exploitation. (shrink)

Embryo litigation -- Access to ART treatment : insurance and discrimination -- General professional liability litigation -- Paternity and donor insemination -- Maternity and egg donation -- Traditional and gestational surrogacy arrangements -- Posthumous reproduction : access and parentage -- Same-sex parentage and ART -- Genetics (PGD) and ART -- ART-related embryonic stem cell legal developments -- ART-related adoption litigation -- ART-related fetal litigation and abortion-related litigation.

John Harris criticises the European Parliament’s ‘waft in the direction of human rights and human dignity’ and rejects its suggestion that ‘human cloning violates the principle of equality since “it permits a eugenic and racist selection of the human race”’. He argues that, by parity of reasoning, so too do ‘pre-natal and pre-implantation screening, not to mention egg donation, sperm donation, surrogacy, abortion and human preference in choice of partner’. Conflating the techniques mentioned (ie, human cloning, egg donation, etc) with (...) human preference in choice of a partner, he holds that reproductive liberty must be the operative principle in determining what ought to be prohibited by law in the realm of human reproduction. This article challenges his two problematic assumptions. (shrink)

The push of biomedical profits and pull of consumer desire for greater happiness and superior performance heralds a robust market in offspring enhancement. There are two reasons we might worry about the reach of commerce into the realm of selective reproduction. The first concern is that for-profit genetic enhancement, under conditions of economic necessity, would exploit the poor, by coercing them, in effect, to part with reproductive material they would prefer not to sell for money, if not for their (...) desperate situation. The second concern is that the market valuation and exchange of sperm, eggs, and embryos would distort the meaning, and degrade the worth, of those procreative goods. I argue that the concern about exploitation does not give reason to resist a market in pre-natal enhancement, but that the concern about degradation does. This degradation concern gives rise to two specific worries: one about altruism and another about commensurability. I conclude by sketching several policy recommendations to regulate the transfer of money in exchange for sperm and eggs with specified characteristics. (shrink)

We consider what genealogical links, kinship and sociality are promised through the marketing of assisted reproductive technologies (ARTs). Using a mixed method of formal analysis of Facebook's algorithmic architectures and textual analysis of twenty-eight adverts for egg donation drawn from the Facebook Ad Library, we analyse the ways in which the figure of the ‘fertile woman’ is constituted both within the text and at the level of Facebook's targeted advertising systems. We critically examine the ways in which ART clinics (...) address those women whose eggs they wish to harvest and exchange, in combination with the ways in which Facebook's architecture identifies, and sorts those women deemed of ‘relevance’ to the commercial ART industry. We find that women variously appear in these adverts as empowered consumers, generous girlfriends, potential mothers and essentialised bodies who provide free-floating eggs. The genealogical and fertility possibility offered through ART is represented with banal ambiguity wherein potentially disruptive forms of biogenetic relatedness and arrangements of kinship are derisked by an overarching narrative of simplicity and sameness which excludes men, messy genealogies and explicitly queer forms of kinship. This rationalisation is supported by the simplicity and certainty of the Facebook targeted advertising algorithm which produces a coherent audience and interpellates users as fertile subjects whose choices are both biologically determined and only available through clinical intervention. (shrink)

We systematically examined the content of the websites of 46 agencies that buy and sell human eggs to understand how they market themselves to both donors and recipients. We found that these websites use marketing techniques that obscure the realities of egg donation, presenting egg donation as a mutually beneficial and fulfilling experience. Sites emphasize egg donors' emotional fulfillment and address recipients' anxieties by stressing the ability to find the perfect “fit” or “match”, suiting recipients’“preferences”/“desires”, and even designing/customizing a child. (...) Agencies attempt to create a sense of connection between the recipients and donors by reporting donors' personal characteristics — e.g., interests/hobbies, traits, mood/temperament, and self-reported childhood behavior/memories. Sites present donors as caring/generous and smart/successful/beautiful. These data, the first to examine several key aspects of egg donation agency websites, reveal critical aspects of how these companies communicate to prospective donors and recipients, raising several ethical concerns. Websites frame information in ways that may bias consumers, making emotional appeals that may distract from appropriate risk/benefit assessments and obscure the ethical challenges of egg donation. These data highlight needs for improved practices, adherence to guidelines, and consideration of enhanced guidelines or policy. (shrink)

What makes a multimillion-dollar, transnational intimate industry possible when most people see it as exploitative? Using the newly emergent case of commercial surrogacy in India, this article extends the literature on stratified reproduction and intimate industries by examining how surrogacy persists and thrives despite its common portrayal as the “rent-a-womb industry” and “baby factory.” Using interview data with eight infertility specialists, 20 intended parents, and 70 Indian surrogate mothers, as well as blogs and media stories, we demonstrate how market (...) actors justify their pursuits through narrating moral frames of compassion and altruism that are not incidental but systematic to and constitutive of transnational surrogacy. We observed two predominant moral frames: surrogacy liberates and empowers Indian women from patriarchal control; and surrogacy furthers reproductive rights. Within these frames, the market exchange of money for babies is cast as compassion, which allows commissioning clients to sidestep accusations of racism, classism, and sexism. Yet, we reveal that the ability to navigate around these threats relies on racist, classist, and sexist tropes about Third World working-class women. Further, we find that surrogate mothers did not experience significant changes in economic status after surrogacy. (shrink)

In Canada, laws and policies consistently reject the commodification of human organs and tissues, and Canadian practice is consistent with international standards in this regard. Until the Assisted Human Reproduction Act of 2004, gamete donation in Canada was an exception: Canadians could pay and be paid open market rates for gametes for use in in vitro fertilization. As sections of the AHR Act forbidding payment for gametes and permitting only reimbursement of receipted expenses gradually came into effect in 2005, Canada (...) did away with this anomaly. Medical practice and legal prohibitions in assisted human reproduction are now consistent with other areas of medicine where tissues and organs are taken from one person to benefit others: Altruistic donation, rather than selling and buying, will be the norm. (shrink)

My following comparative analysis is based on two main questions: How can we best understand and describe the social practices of modern medicine in a particular cultural context? And: What can we learn for our moral thinking from such a comparative approach? I will answer these two questions by engaging the comprehensive studies from law, medical sociology/anthropology and ethics in this volume from three different cultural/national contexts: Germany, Israel and India in a fictional, comparative discourse. Hereby, I identify three (...) cross-themes of surrogacy which I will discuss from a normative point of view: unsolved ethical concerns such as exploitation, child’s best interest and unethical motivations, a naturalised parenthood as global-cultural imperative, and the need for transnational discourses beyond relativism. (shrink)

Three-way baby making is not new: genetic surrogacy existed in Biblical times and donor insemination was recorded in Britain over 200 years ago. However, the gift of gametes between women breaks all social conventions. This paper examines the phenomenon of gamete-donation questioning whether a ‘gift’ of such magnitude can ever be ‘free’ (as the Human Fertilisation & Embryology Authority advocates), or a ‘true’ gift (in Derridian terms). Exploration of this unprecedented ‘gift’ from a psychoanalytic approach is supplemented by an interdisciplinary (...) one, drawing on the gift literature in philosophy, anthropology, ethnography and socioeconomics, as well as neonatal research and reproductive medicine. Critics note the dearth of analyses that take seriously the psychological ramifications of contemporary treatments, protocols and expectations in reproductive medicine. Based on psychoanalytic therapy within a clinical practice devoted to reproductive issues, the author argues that institutionalised asexual reproduction alters unconscious conceptualisations of the act of procreation – converting the passionate intimacy of primal scene into a clinical coupling of gametes in a mechanised arena. The author argues that, too charged to contemplate, the gamete's transcendent quality and blurring of elementary personae/res distinctions leads protagonists, including professionals, to defensive commodification. Multiple emotional meanings are ascribed to gifted gametes by each in the triangle of donor, recipient and offspring, illustrated here with verbatim material. This article addresses some of the far-reaching socio-political consequences for class, race, age, gender and sexuality of asexual reproduction, related to selection procedures and uneven global and local distribution of fertility treatment and its cost in financial, physical, practical and emotional terms. Similarly, feminist unease over (patriarchal) reproductive control and gatekeeping policies are considered, as well as ethical concerns over genetic manipulation, pre-implantation screening, sex selection, selective foetocide and potential exploitation of transnational donors and surrogates. (shrink)

Can't Regulate, Won't Regulate? As the global trade in human eggs continues to expand with logarithmic momentum, it is frequently argued that we could not regulate it even if we wanted to. Not all commentators do want to, of course. Many view regulation as counterproductive: reports have suggested that FDA governance has had the perverse effect of increasing levels of reproductive tourism to Latin America. Most of the other chapters in this volume are broadly in favour of letting market (...) forces take their course, with varying degrees of control. I will examine whether reproductive freedom and choice really are all-important. Before I begin that analysis, however, I need to clear away the argument that we cannot control black markets in human body parts, including eggs, even if we want to. This argument is common to commentators from many positions in the political spectrum. Some writers assert that “baby markets,” comprising egg sale, surrogacy, and paid adoption, are so firmly established that prohibiting or regulating them salves our collective conscience but amounts to no more than hypocritical pretense. Other commentators claim that the burgeoning demand for eggs simply makes even an honest attempt to ban markets unrealistic or imply that the natural and laudable desire for “procreative liberty” would inevitably drive couples to defy paternalistic legal bans. On any of these accounts, regulating global markets in human tissue is said to be a lost cause. I argue the opposite. (shrink)

Payment for eggs used in stem cell research puts women at unacceptable risk and encourages exploitative commodification of the female body. Thanks to the development of induced pluripotent stem cells, however, we no longer face a choice between good science and good ethics.

Surrogacy tourism in Asian countries has surged in recent decades due to affordable prices and favourable regulations. Although it has recently been banned in many countries, it is still carried out illegally across borders. With demand for surrogacy in developed countries increasing and economically vulnerable Asian women lured by lucrative compensation, there are efforts by guest countries to ease the strict surrogacy regulations in host countries. Despite a shift toward “altruistic surrogacy”, commercial surrogacy persists. Recent research carried out by international (...) organizations that seek to establish a legal relationship between the commissioning parents and children in cross-border surrogacy arrangements, under the guise of the “best interests of the child,” appears to promote a resurgence of overseas commercial surrogacy rather than restrict it. Further commercialization of surrogacy should be prevented by carefully investigating the reality of the surrogacy process. (shrink)

In the aftermath of allegations of the misuse of human eggs in the United States, questions are being raised about whether profitable reproductive services should continue to function in a free market under the aegis of physicians or should be regulated. Other countries in which reproductive technologies are employed to a significant degree have developed regulations governing their use, many as a result of recommendations made by inter‐disciplinary commissions that solicited public input. Policy makers in the United States (...) have been reluctant to regulate reproductive technologies, however, because their use is politically controversial, they want to whittle down government, some do not consider infertility an illness, and some believe regulation would interfere with the right to reproduce. Yet the unfettered use of reproductive technologies can create such harms as lack of informed consent, providing procedures not medically indicated for financial gain, practice by unqualified personnel, injury to patients and donors, failure to screen donated gametes, and inadequate medical record keeping. Americans place special value on the welfare of children and those who bring them into the world. Such values can outweigh individual procreative liberty when new reproductive technologies are at issue. Although the optimal course would be to establish a regulatory body to govern reproductive technologies, this is not politically feasible now. The newly established National Bioethics Advisory Commission provides a forum in which issues surrounding reproductive technologies should be addressed at this time in the United States. (shrink)

In recent decades, there have been major changes in the organisation of social reproduction. As middle-class women have entered the workforce in large numbers, and state provision of childcare and other welfare services has been scaled back under neo-liberalism, there has been an unprecedented outsourcing of household labour to the market. The resulting commodification of social reproduction has not liberated women from the demands of housework but has largely shifted this work away from women in the Global North towards migrant (...) women workers from poor and heavily indebted countries of the Global South. At the same time, there has also been a huge increase in internal migration within Global South countries, as newly wealthy middle classes in the cities are being serviced by poor rural women. Commodified domestic labour relies on the existence of gendered and racialised migrant workers. This article examines the domestic workers’ strike as an effective and urgent mode of political action given the massive and growing concentration of migrant women in domestic work. This requires a reassessment of earlier feminist strategies based on a nuclear family model and current advocacy strategies that, influenced by foundations, have rejected the strike tactic in favour of limited legal strategies. This article draws on my empirical research on domestic workers’ movements in the USA and India in order to highlight emerging strategies of labour movements. (shrink)

The article analyses the debate on egg donation in Norway using source material from the parliamentary debate of amendments to the Biotechnology Law. In both policy documents on bioethics and the Biotechnology Law, gender is not a spoken issue, but bringing egg and sperm directly to the fore highlights how gender is implicated in bioethics debates. Gender perceptions affect the understanding of `what egg and sperm may do' at the same time as the debate sets established perceptions of gender in (...) motion. In Norway, gender equality is a valid and important premise within the general political debate. It is, however, contested as a valid argument in the context of egg donation, which therefore becomes a field of negotiations about the limits of equal opportunities. The article analyses the egg donation debate as a process of cultural co-production and asks how the Norwegian emphasis on gender equality influences the debate on egg donation and, vice versa, how debates of assisted reproductive technology reopen debates on gender in relation to reproduction and parenthood. (shrink)

Khalafzai, Rida Usman The legalization of egg donation for medical research has resulted in the use of assisted reproductive techniques for the creation of embryos for research. This carries significant risks for the women undergoing these procedures and has brought humankind to a major ethical and moral crossroads.

This paper explores whether egg donation could still be ethically justified if in vitro gametogenesis (IVG) became reliable and safe. In order to do this, issues and concerns that might inform a patient’s reasoning in choosing to use donor eggs instead of IVG are explored and assessed. It is concluded that egg donation would only be ethically justified in a narrow range of special cases given the (hypothetical) availability of IVG treatment and, further, that egg donation could itself be replaced (...) by donation through IVG techniques. Two possible criticisms of this position are then considered: Ones based on respect for patient wishes, and on loss of donor benefit. It is concluded that whilst neither argument constitutes a strong enough reason to continue with programmes of egg donation, egg‐sharing programmes could still be permitted come the advent of IVG; these could then provide a morally acceptable source of “natural” donor eggs. (shrink)

In this article, I discuss cross-border egg provision by young South African women as a form of traveling biolabor that is critically about embodiment, and aspirations for mobility and cosmopolitanism. The frame of biolabor challenges the frames of altruism/commodification, and choice/coercion, and instead highlights the desires of egg providers, fundamental to the creation and maintenance of the global fertility market. When biolabor crosses borders as traveling biolabor, the analysis can focus on the specificities of inequalities embedded within such reproductive (...) mobility. Traveling or mobility is often a privileged decision and connotes freedom and cultural capital. Yet, when applied to young white egg providers from South Africa, this traveling biolabor relies on a particular kind of biopolitics wherein the reproductive potential of ova/egg is fundamental in facilitating women’s cross-border mobility. I divide the findings sections into three key themes—“cosmopolitan competency,” “alternatives to maternity,” and “productive pain”—to argue that, on the one hand, from recruitment of traveling egg providers to their management, this biolabor is built on the young women’s aspirations for cosmopolitanism. Traveling biolabor becomes a way to escape the normative expectations of their families and the national project of the volksmoeder. On the other hand, the pursuit of these aspirations is critically contingent on management successfully reframing the embodied pain of egg provision as well as the biolaborer’s own maternity. Laborers’ desires and management disciplining tactics converge to sustain the global fertility market. (shrink)

In this paper, I discuss the ethical underpinnings to the anthropological analysis of age and reproductive decline in the ‘management’ of infertility, by suggesting that assisted reproductive technologies ‘use’ age and reproductive decline to further endanger women’s bodies by subjecting it to disaggregation into parts that do not belong to them anymore. Here, the category of age becomes a malleable concept to manipulate women seeking fertility management. In ethnographic findings from two Indian ART clinics, amongst women aged (...) between 20 and 35 years visiting an IVF/art clinic in Hyderabad city in South India, and women above 50 years of age visiting an IVF/art clinic in Hisar in North India—reproductive bodies are similarly disaggregated. In case of younger women, the treatment is fixated on rescuing eggs that may be in ‘decline’, and in case of older women, the aim is to engineer a viable pregnancy. Thus, the constant focus on eggs and wombs in infertility treatment creates a body that is not only not whole but also completely without agency. Age becomes a category that has rhetorical value to ‘push’ or persuade women into particular forms of fertility management through infertility medicine. I undertake a problematization of the egg and the uterus through the identification of the recurring motif of the menstrual cycle within IVF treatment to suggest that bodily holism is not part of ART discourse that unethically thrives on promoting technological intrusions to promote its use and normalization. (shrink)

In order to reach its full potential, human embryonic stem cell (hESC) research requires the use of human oocytes. There is currently a shortage of human eggs for research, and this shortage is likely to continue, as many states and countries prohibit their sale for research purposes, while at the same time condoning unregulated markets for oocytes for use in assisted reproduction. In this essay I first explore possible alternative sources of oocytes for hESC research and conclude that, at present, (...) women are the best source. I then examine arguments about exploitation and commodification that are often raised to prohibit payment to women for oocytes in both the reproductive and research contexts and find these arguments wanting. I conclude by suggesting that ethical concerns raised about a market in oocytes do not warrant a prohibition on the sale of eggs, but that a regulated market can consistently minimize ethical concerns while respecting women and providing important resources for advances in hESC research. (shrink)

Monetary compensation for human eggs used in research is a controversial issue and raises major concerns about women’s health and rights, including the potential of exploitation and undue inducement. Human eggs are needed for various types of studies and without payment, it would be impossible to procure sufficient eggs for vital research. Therefore, a solution seems necessary to prevent exploitation and resolve other ethical concerns while ensuring sufficient supplies of human eggs for research. A brief review of legislation in different (...) countries shows the existing diversity and controversy over compensating human egg donation for research purposes. While in more economically developed countries procreative liberty and consumer orientation seem to be defensible, in some developing countries, where concerns about exploitation exist, adopting a more regulated approach to assisted reproduction is more prudent and wise. Egg sharing is a program that has been proposed to solve both the ethical problems of purchasing eggs and the shortage of human egg supply for research. In developing countries, however, regardless of whether the egg sharing or the monetary compensation model is adopted, some steps should be taken to guarantee the ethical nature of this practice. These steps include ensuring the existence of independent institutional review boards, confirming the validity of all steps in the process of obtaining informed consent, and ensuring the existence and viability of independent supervising and auditing bodies. (shrink)