By Robin von Halle

More and more Americans are choosing overseas gestational surrogates, particularly poor, uneducated Indians. It raises troubling issues that intended parents and the fertility industry need to consider.

The New York Times and The Wall Street Journal recently reported that India’s surrogacy industry has grown by $500 million since the process was legalized in 2002. Supporters claim the process is far cheaper than stateside surrogacies, but after factoring in plane tickets, the exhausting legal hurdles, and travel within India, the cost difference is negligible.

More importantly, as the number of clinics in India multiplies, few seem to have seriously wrestled with the moral consequences of these “baby factories.”

Proponents of Indian surrogacy cite the wages most surrogates earn in their nine months: between $2,000 and $10,000. This is an enormous sum for these women, equivalent to one or even two year’s salary, but how do we feel about paying them far, far less than we would pay a fellow American who experiences the same pains and challenges? What does it say about us when we choose a service where the women are often confined in a clinic for the duration of their pregnancy, where we never see her face or know her name? What does it say about us when the only way we know the human being who we’ve chosen to carry our child is by the thumbprint on her contract—proof of her illiteracy and perhaps her desperation?

All these questions underscore the huge differences between gestational surrogacy as it’s undertaken through the services of a reputable agency in the U.S. and in a country where fail-safes are not necessarily factored into the process.

Our surrogates typically undergo rigorous psychological screening to ensure they can handle the idea of carrying someone else’s child and giving it up to the biological parents at the end of nine months. They must have borne at least one child. They must have a strong family network in place, like husbands or partners, who support their decision to be surrogates. Typically, there is ongoing interaction throughout the pregnancy between the surrogate and parents. And finally, what comes out of the psychological testing, time after time, is this huge differentiator: The money is not the primary motivator. The ability to help others create families is.

Many of us know the feeling, the ache, of wanting a child, and the conviction that we would do anything to hold one of our own. But how far are we willing to go? In a country where colonialism is a not so distant memory, we have to ask. Are the women behind the boom in Indian surrogacies being given a hand up? Or are they being exploited?

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