Wednesday, December 03, 2008

Gestational surrogacy in the NYT

I'm surprised none of my fellow bloggers has posted this yet, so here goes. The cover story of last Sunday's NYT Magazine was "Her Body, My Baby," style reporter Alex Kuczynski's account of her experience hiring a gestational surrogate to bear a child conceived with Kuczynski's own egg and her husband's sperm.

The story has raised quite a flap in the blogosphere. On one side are ardent defenders of Ms. Kuczynski. Their comments tend to express sympathy for the writer's struggle with infertility, IVF, and miscarriages; support the absolute right to self-determination in matters of reproduction, assisted reproduction included; gratitude for the author's open and honest description of her experiences; and encouragement of the "you go, girl" type. On the other side are sharp critics, who question Kuczynski's motives and values, seeing her decision as driven by "narcissism" and fueled by "too much money," and in some cases, drawing parallels with Kuczynski's adventures in cosmetic surgery.

What should we make of all this? And what accounts for the vehemence of the commentary, on both sides?

The most obvious answer, in my mind, lies in the featured photos. The one on the left is of the author, babe in arms (not facing the camera), and the baby's brown-skinned, uniformed nurse, standing outside the author's well-appointed home. The one on the right is of Cathy Hilling, the gestational surrogate, barefoot and pregnant, sitting with her dog on the front porch of her home, which could use some new paint and maybe some landscaping help. The images clearly juxtapose differences in class and race.

I don't want to start (yet another) flame war about the article--there are enough of those out there already. (Maybe this is why the NYT has shut down comments on the article, having received 404 since Sunday.) I do think there is still room for civil discussion of some more important questions, though ... Anybody game?


Kathryn Hinsch said...

I attended a very fascinating Northwest Women’s Law Center salon on surrogacy last night. There is currently an effort to make commercial surrogacy legal in Washington State. Is this something we as progressive, pro-choice women should support? If so, under what circumstances and regulations should it be allowe? One woman asked the question: How is commercial surrogacy different than prostitution? In both cases, a woman sells use of her reproductive functions for financial compensation. While I found the question a little jarring (isn’t surrogacy all about cuddly babies for the unfortunate infertile?) it gave me pause. Asked another way, does commercial surrogacy degrade the experience of motherhood by being available on the open market in the same way that sex for sale degrades the physical expression of love between two partners by turning it into some you can purchase? Where ever you stand on the issue, I think it is important to consider the broader cultural implications of commercial surrogacy and what it means for our concept of motherhood, roles of women, and how we think about children.

Kelly Hills said...

I don't mind the idea of surrogacy for sale - I've long been of the mind that it's akin to renting a service, and paying for it should be allowed, within the guidelines that (surprisingly) the NYT magazine outlined. I think that the way it was set up, with people needing full time and stable income, health insurance, etc, does eliminate a large part of the concern people have over the idea of commercial surrogacy - that people below the poverty line would drift into a Margaret Atwoodian handmaidens tale nightmare.

I stayed away from posting this article myself for precisely the reasons you mention, Sue - I can only assume someone in the NYT art department dislikes Kuczynski, because those photos were bound to cause the exact reaction they did. Unfortunately, reading Kuczynski's essay doesn't ease up any of the classism concerns about surrogacy (in fact, it underscores many of them - especially her comments about the gestational surrogate having a computer and knowing how to use it, and the emphasis on where the surrogate's husband went to college). Surrogacy, even if structured to prevent the sort of exploitation of people below the poverty line, is still going to be an exercise in money, and those who don't have much being willing to exchange their body's capabilities for the money other people have.

Sue Trinidad said...

Kathryn, sounds like the NWLC panel was really interesting--I am sorry to have missed it. I do think the question about society's interest in / obligation to protecting ("protecting"?) women from unscrupulous surrogacy agreements is valid, though I agree with Kelly that it seems there ought to be some way of regulating how it's done, rather than just banning it. In most cases, at least (which I usually feel is the best policy can do anyway). And, too, I have no doubt that banning it would just push it underground, or outside US borders.

Interested to hear that you, too, had this mixed reaction to the NYT piece, Kelly. I keep asking myself, if I think surrogacy could be ok in principle, why this article still rubs me the wrong way on some level. I think it *is* how starkly drawn the class contrast is here, particularly at this moment in history, what with our first non-white President coming into office and the economy tanking.

I would dearly love to have been a fly on the wall for the editorial decision making process re photo selection!

SabrinaW said...

Part of why I see this as a difficult issue is because there are at least three different levels in question here: legality, ethics, and socio-cultural acceptability.

Legally speaking, a contract between consenting adults should be respected as a contract, and part of a liberal political orientation usually respects that fundamental idea. However, there are potential hazards when financial incentives and socio-economic inequalities are involved.

The social-acceptability aspect is also an interesting one, and one I am constantly faced with, as a woman who does not wish to bear children. While many women want to gestate a pregnancy, and most men expect a woman to "do her part" in reproduction, there is the question of whether a woman should be expected to bear her own child when a man does not have to endure the physical commitment that she does. I have a problem with the way that a woman is negatively portrayed if she does not march to the drumbeat dictated by society; is the social recoil in this story any different from the woman in the 60s who decided to stay single and pursue a career instead?

I see room for there to be respectful and intimacy-appropriate arrangements made between people for a variety of laudable reasons, and for that reason I do not feel that this practice should be outlawed or vilified. But on the other hand, because of the potential for great injustices, we should ensure that we have both a strong legal foundation that promotes equitable, consensual contracts and an ethical mindfulness to promote social justice and happiness for all involved.

margaret said...

There seems to be agreement (on this blog) that commercial surrogacy may be ok in some circumstances - and that the NYT article did little to advance discussion around what that might look like. At the Northwest Women's Law Center discussion Tues evening, which I moderated, speaker Amy Bhatt noted that "reproductive tourism" in India is now a $445 million annual business. Some Indian women state they will use the funds to pay for their children's education. Others acknowledge it will be used for their daughters' dowries. In the latter case it's hard to see this trend as furthering women's global autonomy and economic/ social status.

One could also argue that we undermine the principle of justice when we allow American women to go to India to pursue options that we do not allow here, or at least not in every state.

As noted above, a bill may be proposed this legislative session to allow surrogates to be paid for their services (beyond medical expenses). There's no doubt that becoming a parent - in the sense of the social parent who raises the child - is a critical role. Yet at a time when our state is facing budget shortfalls resulting in local school and health clinic closures and severe job losses, the livelihood of many women and their families may be more important to address through policy debate than the needs of those faced with having to travel to another state (or outside the U.S.) to find a surrogate in order to have a biologically related child to raise.

Sue Trinidad said...

Margaret, I really appreciate your focus on the broader social justice questions here--not just the contractual arrangement, but the implications of forcing the practice underground or outside US borders, as well as the general social context. Erich Loewy regularly criticizes what he sees as a US focus on "rich man's" (or, in this case, "rich women's") ethics, and the argument is important. When we have pregnant women who can't get appropriate prenatal care, I would have to say that's a better place to invest our collective resources.

So: what can we do to help raise the profile of such desperate, but perhaps not so media-friendly, problems?

Kelly Hills said...

Mmm, I think there's a problem, though, with dismissing technological issues as "rich Westerner's concerns". And ultimately, it is in large part a technology issue, and the fact that technology is always high-priced at first, before becoming common enough to be afforded by everyone. (Just track the price of iPods for a non-biological and non-ethical example.)

With no offense intended to Loewy or others who focus on issues of global justice and ethics, it seems like it's pointless to rate ethical issues as more or less valid, and creates needless infighting and factions.

We have done quite a bit, recently, to address the issue of health and resource access. We elected a pro-science president, who's tapped some of the leading minds in bioethics for key roles in his transition team; I don't think this should be discounted!

There seems to be an inherent danger in judging one social issue more deserving of attention than another. Why should a single issue be tackled at the expense of another, especially if there are people willing to tackle both?

(And here's hoping for coherency sans coffee!)

SabrinaW said...

Regarding policy changes, simply rolling back many of the oppressive restrictions imposed by the Federal Administration over the past 8 years should be the top priority - stop digging the hole deeper. When federal money is not arbitrarily restricted, domestically and abroad, from supporting organizations that offer comprehensive women's health care and education, we will have a more accurate baseline upon which to plan policy improvements.

One worry I have is that we are running up against the limits of low-hanging fruit that doesn't rely on more buy-in from the public as a whole. Fortunately, some states (like WA) are much more progressive and will have more freedom to pursue policy improvements, but even then, some policies that may make sense to us won't make sense to someone who still holds outdated views of women. The last thing we want is a large Prop. 8-style backlash from the public.

SabrinaW said...

Kelly, you bring up a good point. One trend that often follows with technology is that it alters social power dynamics - I remember a case study where bicycles were introduced to an African village and gender dynamics changed dramatically because women were able to travel more quickly and were even able to engage in business (selling items from their bicycles).

While to us the idea of paying one's daughter's dowry with money made from carrying someone else's child may seem to "buy in" to the system, from another angle, we see the mother has earned influence. She now is providing the dowry, not her husband, and that means that she has some amount of new leverage over the person her daughter marries. At the least, she would probably have different standards for her son-in-law than her husband would, and at best, she would now have veto-power over an unsuitable suitor. That is power. And power in the hands of women guarantees social change.

This is a significant issue; not only because it involves "women's sacred duty", but also because it is an international issue that gives access to a new technology that has great potential to shift power dynamics.

Sue Trinidad said...

Huh. Kelly, you said, "There seems to be an inherent danger in judging one social issue more deserving of attention than another. Why should a single issue be tackled at the expense of another, especially if there are people willing to tackle both?"

But don't we do this all the time? I'm thinking of politics and money, I guess, and maybe I'm getting cynical in my old age...but isn't politics always, and unavoidably, about *precisely* such choices?

SabrinaW said...

Just because it is done doesn't mean it should be done. :)

Also, I see a difference in setting priorities in the policy arena based on cost, feasibility, or number of people affected, and in choosing to drop an issue because there is something about it that makes it unpleasant or difficult to discuss.

Sure, there is a lot less that can be done directly for this surrogate issue, but perhaps policy is not the right tool for this issue. Perhaps something as simple as promoting more discussion and interaction with the women overseas who are doing this service will make things better to an extent.

SabrinaW said...

With regard to my earlier point about priorities for policy, note this Seattle PI piece on Bush's newest "moral objections" law that he's trying to squeeze in under the wire.

Kelly Hills said...

Okay, you two need to come over here and grade papers for me - you obviously have the spare time.


Sue Trinidad said...

lol--I've got the quarter off: no grading for me! I am free to hold forth in the blogosphere...

Sabrina, I think your distinction (between tradeoffs in deciding how to invest limited public resources and avoiding topics that make us itchy) is helpful. I was thinking along the lines of the former, and I guess you guys were thinking along the lines of the latter.

Even so, and maybe this is the result of a Catholic upbringing, I do believe we need something like a preferential option for the poor (or a Kantian maximin rule) in policy making. We ought to direct our attention to the concerns of the least well off first, even if there isn't money (per se) attached.

SabrinaW said...

Sue, I love seeing Kantian ethics applied to policy, and we definitely must always be mindful of the impacts of policies and practices on the least well-off. The challenge though is in figuring out which impacts can be harnessed to create opportunity and choices and which contribute to further oppressive social norms and structures (I read a few great papers on oppressive social norms a year ago that I could send you).

We in the United States have a different perspective on what constitutes opportunity and equity that may not be directly applicable to life in a country with fewer rights for women and with fewer social norms that promote opportunity for all. In those societies, having a way to generate any sort of income independently of anyone else may promise more future benefit than finding a solution that requires massive structural changes in a society in order for the perfect opportunities (by our standards) to be implemented.

Another way to think of it is that when individuals are able to gain a large benefit in ways that exist outside the system, they are empowered to change it more directly than they would have been able to if they had stayed completely within the system. We should meet up for coffee sometime to discuss this more!