Gendered Geographies of Reproductive Tourism

Surrogates, Movement, and Spatial Imprisonment

I first met Avani ³ in September 2010, at the one-room apartment she occupied with her two children and mother-in-law in suburban Mumbai. Avani sits on the one bed in the modest room so my translator and I can sit on the two plastic chairs she brought in from a neighbor’s apartment. In one corner of the bare, rundown room with peeling pink paint are two gas burners and a sink; across the length of the room hangs a clothesline. At the time of our meeting Avani is 25 years old and barely five months pregnant as a surrogate mother for a couple she describes only as “foreign.” ⁴ The surrogacy agency had arranged her move to these temporary accommodations close to the hospital where she will give birth at her doctor’s insistence. As the children play on the floor in the corner of the room, Avani tells the story of how she became a surrogate mother.

While Avani’s family is originally from Nepal, she was born and raised in an industrial city nearly 40 miles outside Mumbai. Avani tells me that she may have completed first or second standard in school, “which is equal to nothing.” She had an arranged marriage in 2000, at the age of 15 to a 20-year-old man. His education, too, was “not much, maybe up to a couple of standards,” and while his income is not fixed, he generally earns between US$40-60 per month as a watchman. Avani and her husband have two sons, an eight- and a five-year-old.

Avani first learned about surrogacy less than a year prior to our interview; a friend of hers had previously “gone through the process”—Avani refers to it in a sterile way—and brought Avani to the doctor to learn more about it. Her initial reaction was one of cautious curiosity: “I wanted to see for myself how it happens because it didn’t seem real.” Assured by the doctor of the safety of surrogacy and compelled by the prospect of earning much needed income for her family—Avani would earn approximately US$4,700 upon delivery of a healthy child—she decided to become a surrogate mother. However, the surrogacy agency required Avani’s husband’s permission; he had previously refused to allow Avani to get a job as a housecleaner, and he initially refused this, too. After some time, Avani and her doctor convinced him to agree. Avani prepared herself for the rigorous battery of medical exams, hormone injections, and pills that would prime her body for surrogate pregnancy.

Avani quickly became pregnant, and shortly afterward her doctor ordered her to leave her home and move to new accommodations with her family. During the course of my fieldwork, many doctors assured me that surrogate agencies provide housing solely for the benefit of surrogate mothers and the children they bear. This housing was ostensibly an improvement, and, as the doctors explained to me, surrogate pregnancy is a time of relaxation and repose, as women are not burdened by work or household chores in the arranged housing. I was deeply curious about Avani’s experience of the new housing.

As it turned out, Avani lamented her current accommodations and longed to live in her previous home near her extended family:

Of course I like my place more than this one. Here I’m instructed all the time where to sit and what to do. My husband only comes once or twice a week. He works in my old neighborhood, which is so far from here, so he must stay in our family home. At my place there are so many people living together in my house and every day is nice with them. Here, nobody is around to talk to and there are restrictions on my roaming as well. I get so bored. Our routine is just eating and sleeping. The only work we do is cooking for ourselves.

In my research I found that surrogates’ mobility, like Avani’s, is quite literally limited. Within the confined spaces of the maternity home, staff members monitor surrogates’ nutrition, health, and daily activities, ensuring that surrogates do not engage in any behavior that may harm the fetus. One doctor even admitted that she prefers that surrogates remain indoors at all times, leaving the house only if absolutely necessary. Within these small, one-room flats shared with children or other family members, the surrogates I spoke with shared stories of loneliness and restricted mobility. For Avani, feelings of isolation permeated her surrogacy experience in the apartment: “I live with my mother-in-law and kids but still I feel I’m isolated here. I really don’t like to stay without my [extended] family.”

Urvashi, six months pregnant at the time of our interview, shared Avani’s sense of isolation. She lived in the same apartment building. Throughout our interview, Urvashi spoke quietly yet clearly and sadly, her growing belly visible beneath her floral-patterned salwar kameez and orange dupatta. Urvashi married her husband at the age of 15 in an arranged marriage. She had completed the equivalent of an eighth-grade education and worked, as she said, “as a housewife only.” Her husband’s previous job as a watchman earned him a salary of approximately US$150 per month; however, poor health forced him to leave his job, and the family has struggled ever since.

After seeing Urvashi’s sister-in-law go through the process of surrogacy, Urvashi’s husband urged her to consider it, too. However, in contrast to Avani and many other surrogates I interviewed who needed to convince their husbands, Urvashi felt uncertain. Yet her husband, who had been ill and unable to work for several years, was convinced that surrogacy could help their family’s financial situation. Urvashi eventually agreed, although with some ambivalence. She said, “I was not ready to do it [surrogacy], but my husband has not been well for a couple of years and we need money to treat him. That is the reason I went for the process.”

Prior to Urvashi’s surrogate pregnancy, her life was marked by a series of disruptive moves from her native Nepal. Seeking work and financial stability, Urvashi, her husband, and their two children migrated to Pune, while her eldest daughter remained in school in Nepal under the care of Urvashi’s parents. Transience and insecurity continued to mark their life in Pune, as Urvashi’s husband’s job lasted only several months; at the same time, the family found themselves traveling long distances to the state border between Maharashtra and Gujarat to secure affordable medicine and health care for her ailing husband. Once Urvashi decided to pursue surrogacy, the family again relocated to Mumbai. Six months into her pregnancy, now 24 and the mother of three daughters, Urvashi reflected on the difference between her previous pregnancies and the current surrogate pregnancy: “The main difference is that I’m not allowed to move around and work. That is adding pains to me. I definitely like to go out and have a walk once in a while, but we are not allowed to do it.” Following a wave of movement and mobility, Urvashi was finally compelled to remain immobile in ways that left her powerless and dispirited.

The narratives of Avani and Urvashi reveal how different bodies are differently privileged in transnational reproduction. When surrogate mothers are expected to live separately from their families in unfamiliar neighborhoods, their own desires—to be near loved ones, to walk around their neighborhoods—are devalued against the risk of any behavior that may harm the fetus. While Western intended parents pursuing surrogacy in India may expect the surrogacy agency to provide housing, and assume the surrogate will enjoy living in new housing with few work responsibilities, my research revealed that many women experienced higher levels of stress and anxiety because of restrictions on their mobility and separation from their families. Though doctors suggest that surrogates should move to clinic-appointed housing in order to avoid the demands of household work and responsibilities, in doing so they discount the everyday realities of familial and community support that women receive at home. In this setting, Avani and Urvashi experience immobility as stressful and isolating, not restful, as the doctors suggest.

Similarly, in her research in a surrogacy hostel in the western state of Gujarat, Pande has noted the contradictions that emerge in such closely monitored spaces. While women have fewer work responsibilities in the hostel, their daily activities remain tightly controlled, and women follow a strict daily routine and diet: “Everything works like clockwork,” as one surrogate explained (Pande 2010a, 969). Yet, as some women have expressed, the daily timetable can be monotonous and unpleasant.

To be sure, surrogates do form small communities in maternity homes with fellow surrogate women, communities that are restrained to a particular place for the duration of their pregnancies. Particular socioeconomic processes connected to transnational surrogacy bring about such places and communities and the social relations within them. Yet, while the distinctive activities of those who dwell there constitute such places, temporariness and transience also inform them, as surrogates move through them only during their pregnancies. Alliances formed with other surrogates made Avani’s temporary home more bearable, but she planned to build a home for her family in Nepal. This community is tenuous and temporary, and surrogates return to their homes and families, who frequently have no knowledge of the surrogate pregnancy.

Avani’s and Urvashi’s stories of displacement, spatial imprisonment, and place-making provide important comparative data for studies of surrogacy in varied locations throughout India. While they lived in adjacent one-room flats in a shared apartment building, they remained cautious and typically stayed in their homes, avoiding interaction with other residents of the building. In contrast, Pande (2010a) has shown how the surrogacy hostel may constitute a gendered space, one that generates emotional attachments and sisterhood among women, and fosters opportunities for resistance and networking. The intensive contact among surrogates in the hostel enables them to share information, grievances, strategies for future employment, and even acts of collective resistance.

However, while communal surrogate housing may be the norm in other parts of India, most Mumbai clinics in which I conducted fieldwork did not arrange housing in shared dormitory-like spaces. Yet, surrogate women who do not live in maternity homes during their pregnancies, too, experience limited mobility. No legislation regulates surrogacy in India, and I encountered a wide range of practices and policies with respect to the treatment, care, and housing of surrogates during their pregnancies. Some clinics simply offered modest stipends for rent and made no arrangements for surrogate accommodations. The mobility of surrogates not bound to live in such housing was far from privileged.

Meera, like many others, became a surrogate and strove for an upwardly mobile future under tenuous circumstances. Meera was 25 at the time of our first meeting. When she was 13, Meera’s father became ill, prompting her parents to arrange her marriage with a man 10 years her senior. Meera regretted having to leave school at that time. By the age of 20, Meera had given birth to four daughters and one son and had undergone tubal ligation in order to prevent any further pregnancies.

On learning about surrogacy, Meera was determined to convince a doctor to take her on as a “patient.” She admitted to the doctor that she was married, despite the fact that her marriage was always tenuous and fraught with violence and that she was in the midst of a relationship with another man. Meera told the doctor she had only one son and one daughter, not five, because admitting that she was a mother of five would have disqualified her as a potential surrogate due to the Indian Council of Medical Research guideline that a woman may not act as surrogate for more than five births, including her own children. Savvy and strong-willed, Meera viewed surrogacy as a potential windfall that would alleviate her financial insecurity. She seemed willing to do whatever it took to become a surrogate, and she eventually became pregnant with twins for a foreign couple.

Meera’s doctor worked with an agency that did not have a fixed policy on housing; some women seemed to move because they wanted to, and others were forced to move to the hospital in order to monitor potential health issues, while most were left to their own devices, often remaining in their own homes. Meera was under constant pressure and had strained relations with her violent husband and in-laws. As she rejected and rebelled against the demands of her family, Meera would often escape to her boyfriend’s house. Meera’s constant movement made it difficult for Maryam, her caretaker, to contact her when necessary; she would often disappear for days, sometimes weeks, at a time, during her pregnancy. This freedom of mobility, however, would eventually come to an end when the doctor forced her to remain in the hospital for the remaining four months of her pregnancy, at Maryam’s request:

I told Madam [the doctor] that I’m not ready to take responsibility for her anymore. Admit her in the hospital, otherwise she’ll run away again with someone if you keep her in a house with the other surrogates. She is now in the hospital for the rest of her pregnancy and she is not allowed to go out for anything.

This spatial imprisonment at the request of Maryam, herself a former surrogate, reflects the subtle registers on which the relative power over mobility works.

In spite of these profound restrictions and surveillance on their movement and mobility at home, in their communities, and in the hospital, movement through Mumbai punctuated Meera’s, Avani’s, and Urvashi’s pregnancies. As Maryam often recounted, her job as an “agent” required her to shepherd women throughout the city, often to different clinics for different procedures within the course of one day. This often entailed long commutes on the local public railway system, because Maryam and most of her patients lived in an industrial city some 40 miles from Mumbai. I sometimes met Maryam and her “patients” during these harried days, and observed the toll these trips took on the women.

I noted, too, how the geographic space of the clinic reflected broader power relations between doctors and surrogates. As infertility clinics in Mumbai are nearly always privately operated, such spaces typically remain exclusive to clients of middle- and upper-class status. Within these same spaces, working-class women are viewed as secondary and out of place. The clinics reflected such inequalities, which manifest in their physical layout and the positioning of different clients of distinct backgrounds throughout. In one clinic, surrogate women recover from certain medical procedures in a storage room that doubles as a makeshift recovery room. The clinics also function as a space in which to reiterate medical authority over any concerns or questions surrogate women may have. Throughout many interviews, women divulged that they rarely posed questions about procedures or medications, nor were they offered the opportunity; they simply received instructions about medical care and medications and were expected to acquiesce to the doctor’s demands. The transfer of authoritative knowledge in the clinic and hospital reinforced already existing hierarchies between women and the medical establishment.

Intended Parents, Mobility/Immobility, and Places of Birth

In contrast to surrogates’ experiences of spatial imprisonment and restricted mobility, I was struck by the ways in which intended parents moved with comparative comfort throughout their travels. While women such as Meera, Avani, and Urvashi had little say over where and with whom they might live, many intended parents moved with the ease of cosmopolitan travelers whose higher socioeconomic status allowed them the comforts of luxury full-service apartments or five-star hotels. As a researcher, I experienced these disjunctures first-hand, as my interviews allowed me to traverse distinct geographies of class and privilege that would take me at times to luxury hotel suites in Mumbai, and at others to one-room apartments in working-class neighborhoods outside the city.

Yet at the same time, intended parents’ sojourns in serviced apartments indicate more than mobility; they also suggest a spatio-temporality of planning, waiting, and anticipating. For instance, Marla and John, an upper-middle-class Norwegian couple, had traveled halfway around the world in order to meet their newborn daughter born via surrogacy. When I first met Marla, a tall, blonde, blue-eyed woman, she was relaxing poolside at a deluxe, five-star hotel in the suburbs of Mumbai in the company of her husband and their newborn baby girl, Ada. It was a warm, humid monsoon afternoon, and Marla and John were clearly in ecstasy caring for Ada, the newest member of their family.

However, once in Mumbai, they found themselves in a liminal state of stillness and anticipation, as they awaited the travel documents that would allow them to return home. Indeed, parents sometimes spent months in this transient space, waiting for the bureaucratic process of assigning citizenship to unfold. At the time of our interview, Marla and John were approaching their fourth week in Mumbai. As Marla stated, “The woman at the consulate, she is deliberately delaying everything . . . and we are ready to go home. We want to go home to autumn, our family, our friends, and our animals, everything.” With the exception of trips to the Norwegian consulate, they rarely ventured outside the comfortable confines of their hotel, and their experience of surrogacy was marked by relative immobility and waiting within spaces of luxury that mark the stark contrast in economic and social status between surrogates and parents. Like Marla, many parents I interviewed who experienced long stays in Mumbai described waiting, liminality, and disruption to their normal, everyday lives. Yet it is worth noting that as Western parents pursued surrogacy as a way to build their families, these moments of disruption also served as opportunities to bond and care for their children, uninterrupted by the distractions of work and family at home. In contrast, the families of many surrogates, such as those of Avani, Urvashi, and Meera, also experienced disruption and instability, physically separated across space (sometimes across national borders, as in the case of Urvashi and her eldest child) during their surrogate pregnancies.

During these long stays, parents would often reflect on the meaning of “homeland” and “birthplace” for their children. Transnational surrogacy arrangements unquestionably problematize such places for intended parents and their children, as the relationship between homeland and birthplace is no longer distinct. The story of Adam and Ben, 38 and 37 years old, respectively, is instructive. An upper-middle-class couple from Israel, I first met them at their full-service apartment in a wealthy suburb of Mumbai. The couple had previously explored adoption as an option for family building, but gay couples find international adoption almost impossible and Israel has few adoptees available domestically. They eventually decided on surrogacy in India, settling on a clinic in Mumbai that was well known for providing services to gay couples from around the world.

Several weeks prior to our first meeting, Adam and Ben’s surrogate, Asha, gave birth via cesarean section to twin girls, Tara and Noelle, who were conceived with the assistance of an anonymous egg donor from South Africa. Throughout the course of our interviews, Adam professed that he viewed the labor of gestation and delivery as stronger and more enduring than the genetic connection that existed between the egg donor and the girls. Despite the genetic material contributed by the young white egg donor and the acknowledgment that Tara and Noelle share more in common with her, in terms of race and class, than with Asha, Adam insisted that Asha and his twin girls had a deeper relationship. He planned to work to reinforce this relationship through efforts to “maintain the Indian element in their identity.” “Indian-ness” became something that, in the absence of the Indian “mother” but originating in the girls’ birthplace, Adam will build and reinforce over time:

We will tell them about their histories, their heritage, the stories of how they were conceived, and we’re using all the pictures and home movies and stuff, and that is playing up the Indian part very much. They will have pictures of India, they will know about this hotel. They will hear stories of Ganpati and Raksha Bandhan. ⁵

As Adam’s narrative suggests, understandings about a child’s biogenetic origins emerge in tension with a child’s right to identity. This identity is viewed as inseparable from his or her “birthplace” in India, the surrogate, and her ethnic, cultural, and religious background.

Another expectant parent, Martin, revealed similar sentiments around his child’s connection to India. Martin, a 42-year-old from the southern United States, and his partner, Richard, were expecting twins conceived with the eggs of an anonymous Indian donor and Martin’s sperm; the resulting embryos were then transferred to the womb of an Indian surrogate. Martin explained that he looked forward to incorporating aspects of Indian culture into their children’s lives:

I’m very open to the idea of it [Indian culture] being a part of the child’s life. . . . Certainly, if the child is very interested in their heritage, I could see us returning to India. We are actually planning on giving the children Sanskrit names. So we’ve picked out two sets of girl names and two sets of boy names that are derived from Sanskrit. I think it’s important. For whatever reason, this is the path that our lives have taken us on and I think we need to be respectful of where this became a reality.

For Martin, the journey of building a family through surrogacy in India mobilizes new geographic imaginations that construct and rely on the notion of return. India becomes imagined as a place of origin: origins of family, conception, birth, and heritage. It, too, becomes a place to which parents imagine a geographic return, in order to shed light on their children’s site of origin (despite the very transnational nature of their conception). This was true for both Adam and Martin, despite the fact that Adam’s children might be phenotypically white, while Martin’s might appear more racially ambiguous.

Like Adam and Martin, many parents I spoke with articulated a strong desire to “maintain the Indian element” in their children’s identities through naming rituals, accumulation of material goods for the home (such as Indian fabrics, clothes, and decorative tapestries), and, most importantly, stories that reiterate exotic details of Indian social life. Many of my interviews reflected this thread of the conflation of race and the place of nation. Parents of surrogate children conflated the geographic space of India—and the attendant orientalist discourses that construct “Indian-ness” as exotically opposite to Western sensibilities—with the embodiment of the child’s identity through its gestation by an Indian surrogate mother in India. Further, such conflations reveal the pedestrian reliance on “multiculturalism” as a universalizing discourse, which ignores the specificity of local contexts. In constructing India as a place of origin and return, parents rely on a geographic imaginary that flattens out the specificity of India’s historical and political economic contexts.