Abstract
Vulnerability is a pivotal concept for understanding transnational commercial surrogacy and the ethics of reproductive travel. While implicitly recognizing vulnerability as important, existing scholarship falls short of understanding the dynamism of vulnerability. Placing our empirical analysis in conjunction with the rich theoretical literature on this concept, we explore vulnerability in surrogacy arrangements in India as a “mode of openness,” defined by its multilayeredness and context specificity. We focus on two retellings of vulnerability. In the first narrative, we analyse the journey of an intended parent who becomes an agent, while in the second narrative, we focus on the trajectory of a surrogate and egg donor becoming an agent. In both narratives, the layers of vulnerability across different interconnected circuits of reproduction—of intended parent, agent, and surrogate—are explicated. Our analysis illustrates the complex and conflicting meanings of vulnerability and illustrates vulnerability as an instigator of agency and resistance; how it can propel upward social mobility and animate attempts to transform an unjust system, but also how such individual agency and empowerment may serve to uphold exploitative relationships.
Contemporary academic research and theoretical engagements with surrogacy have led to conversations on the ways in which commoditization and medicalization of gestation and motherhood have a far-reaching impact on social life. Surrogacy entails forms of technologically assisted conception involving in vitro fertilization (IVF), with the surrogate gestating an artificially fertilized embryo through “donated” eggs and sperm from the adoptive/intended mother or an anonymous egg provider. The emergence of three potential mothers in the form of the gestational surrogate, the egg provider, and the intended/adoptive mother continues to trigger intense social debate about motherhood, vulnerability, and exploitation.
In recent ethnographic narratives on surrogacy, there is a struggle between idealized motherhood and commercial surrogacy (Berend, 2012; Deomampo, 2015; Jacobson, 2016; Majumdar, 2017; Pande, 2014; Rudrappa, 2015; Teman, 2010; Whittaker, 2018). The links between surrogacy and motherhood have been explored through the complex interstices of familial guilt and social conservatism (Jacobson, 2021). In Jacobson's masterful reading of Sharon Hays’s concept of “intensive mothering,” American surrogates are shown to feel guilty over their inability to fully contribute to their own children's upbringing and their husband's care while protecting and sustaining their surrogate pregnancy. The selfless, sacrificial model of mothering impacts women across cultures and classes in varying ways but tends to manifest itself in distinct renditions of social acceptances and undesirable pursuits. This is seen in its most acute form in the division between altruistic and commercial surrogacy. While commercial surrogacy remains the most popular form practiced globally, it undergoes continuous legal and social scrutiny through debates on exploitation/empowerment and regulation/ban (Bandelli, 2021). Often, countries like India, Nepal, and Thailand have seen commercial surrogacy as exploitative and problematic enough to ban it, and only allow the acceptable altruistic form of surrogacy where the surrogate is not compensated for her gestational labour. In her analysis of the new Surrogacy (Regulation) Bill in India, Sarkar (2021, p. 262; also see Corradi, 2021) suggests that the “rhetoric of natural altruism” essentializes motherhood while simultaneously de-recognizing surrogacy as work. Commercial surrogacy shies away from associations with work-labor (Majumdar, 2018) by splitting the role of the “unitary mother” through contradictory representations of the “sacrificing mother” and the “contract worker” who must relinquish the baby. In contrast, altruistic surrogacy proposes a hierarchized form of gift giving, wherein the surrogate “gives a gift” to the intended couple with no or little returns. Yet, as Rudrappa (2021) and Jacobson (2021) have discussed in relation to India and the United States, altruistic surrogacy is inherently alienating, just like commercial surrogacy, as both forms involve an inequitable exchange and distance the surrogate from her body and labour. Thus, Rudrappa (2021, p. 296) reaffirms the need to look at how “in commercial surrogacy, exploitation is established in production … [a]nd in altruistic surrogacy, domination is established in exchange.”
A pivotal framing that highlights the exploitative workings of transnational commercial surrogacy has been the relatively underexplored concept of vulnerability. In this article, we explore vulnerability in surrogacy in India, a world-leading hub for transnational reproductive treatment since the early 2000s, and a “mother destination” for cross-border commercial surrogacy, described as offering “First world at Third world prices” by Rudrappa and Collins (2015, p. 953). Lack of legal regulation, state-of-the-art medical infrastructure, and, most importantly, an abundance of poor women available as surrogate mothers are determining factors behind India's leading role. Drawing on existing scholarship, we argue that a discourse of vulnerability can be used to (a) claim entitlements; (b) override the fact that some people are made more vulnerable than others; and (c) mask the geopolitical workings of capital, class, and race by creating new geometries of power and powerlessness. Using reproductive vulnerability as political capital reproduces colonial value systems as the basis for the emerging labour patterns in the present globalized world order. This includes affective labor and biological labor (Vora, 2015) such as migrant care work, the transnational trade in organs, and reproductive work such as gestational commercial surrogacy. More precisely, we analyze how vulnerability is challenged and resisted through shifting positionalities within the surrogacy arrangement. We understand vulnerability as a “mode of openness” that incorporates (dis)empowering modalities—explicated when empowering transitions are made from a position of vulnerability—and that is moving from a position of an intended parent and surrogate to being an agent across different interconnected circuits of reproduction. We begin by mapping engagements with vulnerability as a theoretical concept before narrowing down to debates on reproductive vulnerability, and more specifically vulnerability in transnational surrogacy in India. In this paper, we focus on domestic surrogacy, which highlights a different configuration of stratifications, akin to but also beyond those analyzed in transnational arrangements.
Theorizing vulnerability
Vulnerability as a concept has been debated, contested, and reimagined in fields as diverse as international relations, bioethics, social work, legal theory, and feminist theory (Cole 2016; Crate & Nuttall, 2009; Hogan & Marandola, 2005; Watts & Bohle, 1993). In its early stages, especially in bioethics, vulnerability was narrowly conceived as “susceptibility to harm.” Gilson (2016, p. 74) considers this understanding as “reductively negative”, both by definition and in terms of its value since it (a) equates vulnerability with weakness, dependency, and powerlessness, and (b) devalues vulnerability by associating it with a quality or condition that necessarily leads to the harm for which it is really just a precondition (Gilson, 2013, pp. 5–6). Furthermore, when vulnerability is regarded negatively and perceived as something to fear, then, concomitantly, invulnerability is defined by complete self-sufficiency, self-sovereignty, autonomy, independence from others, and an imperviousness to being affected, even if these are impossible aims. Gilson (2013) contends that the division between vulnerability and invulnerability is oppressive, as the ideal of invulnerability—which she understands as a form of ignorance—demands not only disassociation from individuals and groups that are culturally positioned as vulnerable (and thus deemed inferior) but also “preclude[s] individuals from understanding themselves as constituted in and through relations with others, that is, as sharing in vulnerability with them” (p. 7). Thus, “vulnerability is not just a condition that limits us but one that can enable us . . . vulnerability is a condition of openness, openness to being affected and affecting in turn” (Gilson, 2011, p. 310). From this perspective, vulnerability cannot be perceived as a negative reified property that characterizes only certain groups or individuals, but a fundamental way of being that pertains to us all.
Extending Gilson's notion of openness, Petherbridge (2016) draws a difference between common vulnerability that we all share by virtue of being human and “situational vulnerability,” in which vulnerability is exacerbated by specific contextual conditions. Thus, Petherbridge (2016) argues, vulnerability is not only an ethical but also a political question, reminding us of the historical and political contexts in which different forms of vulnerability arise, as well as the different interpretations of vulnerability and the normative responses to it. In our paper, we use “situational vulnerability” as a key concept that notes vulnerability as potentially exacerbated by the personal, social, political economic, and environmental situation of a person or social group. Such an approach allows for the dynamism that Luna (2009) advocates through her idea of “layers of vulnerability”, which (a) points to the multiple, different, and overlapping layers of vulnerability; (b) disengages from a fixed idea of vulnerability as residing and embodied, and which persists throughout one's existence; and (c) opens pathways for resistance since the layers can be reassembled but also be dismantled. We are also inspired by Butler's questioning, on a similar tack, of the inherent paternalism and the fixed political position of powerlessness attached to vulnerable groups in human rights and legal debates, a critique that resonates with a similar paternalistic stance within public health and research ethics. In highlighting the importance of agency, her analysis can be seen as building on Goodin's (1985) principle of protecting the vulnerable approach (PPV), which underscores the conceptual connections between vulnerability, harm, and exploitation, but pays insufficient attention to “obligations to foster agency and autonomy” (Rogers et al., 2012, p. 23). Butler (2016, p. 25), like Gilson (2013), Petherbridge (2016), and Rogers et al. (2012), urges us to think of vulnerability as an “existential condition” (as we are all subjects to attacks and accidents that threaten our lives), but also as a “socially induced condition” (given the disproportionate exposure to suffering among the precariat to whom basic needs are limited). Furthermore, vulnerability can justify infliction of injury on certain precarious populations, since these groups are seen as having produced their own precarious situation (see also Bailey, 2011a); thus, the regime of power to which these groups are subjected is not seen as responsible for reproducing precarity in systemic ways (Butler, 2014; Cole 2016; Ferrarese, 2016). In contradistinction, the idea of vulnerability has been defended by human rights advocates and humanitarian agencies to facilitate legal and institutional protection of such groups, which enables them to position themselves as representatives of the powerless and in need of “care.” Thus, vulnerability works in two restrictive antithetical ways, “to target a population or to protect it” (Butler, 2014, p. 112), but which belong to the same rationale of power.
Reproductive vulnerability
Addressing what they perceive as a tendency to compare incommensurable vulnerabilities instead of attending to the various intersections between “differing vulnerabilities” within surrogacy arrangements, Riggs and Due (2013) highlight the “reproductive vulnerability” of intended parents. They draw on Turner's (2001) idea of reproduction as a marker of citizenship in contemporary Western societies, and his concept of “reproductive citizenship.” Turner (2008, p. 49) suggests that the State emphasizes reproduction in a way that promotes “the desirability of fertility and reproductivity as a foundation of social participation” and justificatory claims on social resources (citizenship entitlements). This leaves those who are unable to reproduce via heterosex, either due to medical infertility or “social infertility,” vulnerable to the normative understanding of reproduction, which includes the diminishment of one's cultural capital as a reproductive citizen (Riggs & Due, 2013, p. 957). This perspective is missing in existing studies, where the primary focus on surrogate women constructs commissioning couples as “successful” agentic citizens fulfilling their human right to reproduce. Instead, Riggs and Due (2013) seek to go beyond the critique of “reproduction as consumerism,” as examined by Kroløkke and Pant (2012) in their analysis of reproductive matters as commodities in neoliberal discourses (Kroløkke, 2012). Riggs and Due (2013; see also Riggs, 2009; Riggs & Due, 2010) focus on nonheterosexual and gay male couples, highlighting the vulnerability of intended parents, but also suggesting how (some) reproductive vulnerabilities are gendered.
We have argued elsewhere that some discourses on transnational surrogacy underscore the vulnerability of (White) intended parents, which overrides the vulnerability of commissioned surrogates, centers White fragility, and shores up privilege (Gondouin, 2014; Gondouin et al., 2018). This emphasis transforms White vulnerability into political capital, normalizing Whiteness and pushing race to the background. Analysing the affective biopolitics of repro-migration in Norway, Stuvøy (2019) discerns the reproductive vulnerability of intended parents as pivotal for exempting couples who seek surrogacy abroad from punishments. On a similar tack, Andersen (2013) analyses the Norwegian debate on surrogacy and contends that new and relatively privileged groups have appropriated the language of marginalized groups in their struggle for recognition. She argues that those who are medically or socially infertile tend to portray themselves as vulnerable victims, vis-à-vis the State, in order to gain rights.
Arguably, the vulnerability of some and the nonvulnerability of others “perpetuat[e] the disavowal of the infinite sets of needs that must be denied to devalued subjects/workers as a condition of rendering their bodies and life energies ‘surplus’ and available for export” (Vora, 2012, p. 696). As Vora remarks, arguing that the affordability of surrogacy in the Global South reflects low living costs fails to acknowledge that the majority of the women contracted as surrogates lack basic facilities such as access to clean water, permanent housing, and basic health care. The one-sided focus on White vulnerability consolidates “a discourse of white middle- and upper-middle class families as needing more care than working-class families and families of color” (Vora, 2012, p. 697). It is a discourse that makes differences in living conditions appear natural and validates more resources to certain homes whereas these remain necessities out of reach to less privileged families.
Furthermore, it is the imposition of Western understandings of the body that separates and makes hierarchical the physiological versus the social aspects of human reproduction. This results in a view of surrogates as mere bodies in which genetic material is matured into babies, where new reproductive technologies reinforce processes of invisibility and devaluation. We contend that changing biomedical expectations have created a “prosthetic language of socialisation,” which operates at the interface of local intersectional realities such as gender, caste, and religion, and the globalized market of transnational commercial surrogacy (Gondouin & Thapar-Björkert, 2017). The aim is to facilitate detachment of the mother and the surrogate–child (prostheses), which renders invisible the labour(s) of the surrogate mother.
Vulnerability and surrogacy in India
As the emblem of reproductive outsourcing, Indian commercial surrogacy has attracted ample scholarly attention. Feminist ethnographic research has focused on the lived experiences of women surrogates and highlighted the unequal structures of socioeconomic and caste hierarchies that limit South Asian women's options to secure living wage jobs (Twine, 2015, p. 18). Emphasizing the abyssal stratifications of Indian society, Rudrappa (2015) insists on the necessity of addressing the “endemic social, political and economic inequalities among different communities which shape individuals’ abilities to access a good life” (p. 170). The economic vulnerability of surrogates, particularly in terms of potentially limited alternative financial options (Blyth & Farrand, 2005; Damelio & Sorensen, 2008; Markens, 2007), and their weak negotiating power (Dasgupta & Dasgupta, 2014) also make them medically vulnerable and prone to maternal deaths (Bailey, 2011b, p. 729).
Furthermore, research has highlighted the agency and resistance of women living under constrained and exploitative conditions (Rudrappa, 2015; Vora, 2015). This body of work demonstrates the need to go beyond Western moral frameworks of autonomy, choice, and coercion—concepts that tend to be mobilized in discussions of transnational commercial surrogacy—to understand commercial reproductive labor as it is practiced in the Global South. As pointed out by transnational feminists, a conceptualization of surrogacy in these terms distorts the reality of surrogates and can be seen as a form of discursive colonialism (Bailey, 2011b; Pande, 2014), and, most importantly, does not shed light on their vulnerabilities. When inflected by caste, Dalit feminist standpoint theory has pointed out that social locations shape women's “choice” of becoming surrogate mothers, but also the conditions in which they find themselves once within the industry (Gondouin et al., 2020). Furthermore, ethnographic accounts add further complexity, which makes it impossible to see surrogacy as either a win–win situation or one that transforms surrogate mothers into passive victims of exploitation (Pande, 2014).
Some scholars have used a reproductive labour approach through which ovulation, gestation, pregnancy, childbirth, and mothering are analyzed as value-producing practices within the extractive and exploitative regimes of global capitalism (Newman & Nahman, 2022; Vertommen & Barbagallo, 2022; Vertommen et al., 2022). On the same register, scholars have also explored how reproduction is increasingly stratified (Panitch, 2013; Vora, 2015), according to hierarchies of class, race, ethnicity, and migration status, creating an “international division of reproductive labor” (Parreñas, 2000, p. 560). Vora (2015) reads Indian surrogacy through the prism of colonial history, arguing that it offers the conditions of possibility for the present international division of reproductive labour. Imperial/colonial regimes of exploitation inform contemporary practices of globalized reproduction and underscore “the centrality of raced, sexed, classed, and ethnicized bodies as sites through which imperial/colonial power was imagined and exercised” (Gondouin & Thapar-Björkert, 2022, p. 18).
While implicitly recognizing vulnerability as important, existing scholarship falls short of understanding vulnerability as linked to specific discursive positions (as opposed to being a characteristic of certain individuals), including the position of the agent, which has been relatively underexplored. Furthermore, we suggest that experiences of vulnerability can motivate individuals to seek more sustainable livelihoods. While individual trajectories’ vulnerability can be an instigator of agency and resistance, it may simultaneously reproduce an arrangement that systematically renders others vulnerable. Thus, the dynamics that we explore challenge powerlessness while simultaneously bolstering an exploitative system.
Being in the field: Researching surrogacy in India
Qualitative interviews with surrogates and egg donors were conducted in the southern Indian city of Hyderabad by the second author in 2019–2020. Twenty-five respondents were interviewed, including two IVF specialists, one embryologist, two clinic administrators, three surrogacy agents, one adoptive mother, eleven egg providers, and five surrogates (one of these surrogates is now a surrogacy agent). Most of the surrogates and egg donors belonged to a lower socioeconomic caste and class configuration, being either involved in temporary work or managing household responsibilities. Besides being primary earners, most of surrogates’ and egg providers’ spouses were involved in the service sector, including working as drivers for private vehicles or as carpenters. The majority of the surrogates came from remote tribal and rural areas of the state of Telangana (of which Hyderabad is the capital city) and had migrated to the city for work. They had either been scouted by surrogacy agents working at the rural level or had been recruited through local networks of women who had previously worked as surrogates in the city.
The focus on agents within the surrogacy arrangement in India has been an area of limited engagement (Deomampo, 2013; Nadimpally & Majumdar, 2017), so we made a more sustained investigation into the role that agents play within the surrogacy arrangement, as they become important nodes of contact in the field. Deepa et al.'s (2013) research on the surrogacy market revealed intersections of multiple stakeholders in organizing and facilitating surrogacy arrangements. This included pharmaceutical industries, nongovernmental organizations, ex-intended parents, and individuals working at different levels of the IVF industry, the local neighborhood, and in international organizations to source both surrogates and intended parents (IPs; Majumdar, 2017). Within the surrogacy arrangement, agents cater to varied levels of expectations and demands from clientele that includes the IVF industry, intended parents, surrogates, and egg providers. At each level, the agent facilitates a complex choreography of managing relations of kinship and surrogacy facilitators as well as monetary transactions.
Agents belong to different class and caste configurations. Those dealing with surrogates would usually belong to a lower socioeconomic category and would most likely have been surrogates themselves (Deomampo, 2013), while those engaging with IPs and IVF clinics would be middle class and relatively well-off. An agent's class and caste backgrounds can be salient for their agency, as evident in an ethnography of two agents who belong to very different class and caste configurations (Nadimpally & Majumdar, 2017). Surrogacy agents treat their clients—surrogates, clinicians, and intended parents—differently. This has a lot to do with their own position within the surrogacy arrangement hierarchy and the power they wield over the surrogates/IPs/clinicians, as well as their class and caste position. Belonging to an economically stable caste and class often translates into a patronizing treatment of surrogates who belong to lower socioeconomic categories. This includes infantilization, lack of respect, and payment in the form of obligatory largesse, which may not actually be the exact payment promised upon, but less than that. The agent may be either a man or a woman, highlighting the dynamic related to the gendering of reproductive work, wherein women can also reproduce structural inequalities already present in particular forms of care work.
Agents form a tiered set up, with some responsible for hiring surrogates (from rural, semiurban areas), monitoring their preconception medical interventions including embryo transfers, monitoring pregnancy including diets and physical health, upholding the contract signed between the IP and the surrogate, and ensuring safe delivery of the baby to the IP (also see Nadimpally & Majumdar, 2017). All of the surrogates interviewed in Hyderabad were under the care and supervision of an agent. She provided for their housing in a pediatric care nursing home in the city, with access to daily food and clothing. Initial interviews with the surrogates were monitored by the agent, and she would act as intermediary translating questions and answers, as the (second) author conducting the study was not well-versed in the local language, Telugu. However, over a period of time, with frequent interactions, the agent was willing to leave the researcher (second author) alone with the surrogates, who began to open up in the agent's absence and speak in a language common to them, Hindi. This change in interaction points towards the power dynamics between middle-class agents and tribal, Dalit surrogates who are struggling to make ends meet through their participation in the arrangement.
Once freed from the surveillance they were under, the surrogates felt confident to share their experiences with clinics, agents, and IPs. Most surrogates rarely got to meet the IPs and had to deal only with the agent. These relationships were largely exploitative and heightened their vulnerability. Their interactions at the clinic were marked by abuse from nurses and clinicians, who have been traditionally trained to treat Indian women belonging to lower socioeconomic strata with disdain (van Hollen, 2003). Obstetric violence remains an important part of the medical interaction wherein medical personnel are verbally and physically abusive towards women from specific socioeconomic backgrounds due to the perceptions regarding poverty and large families, or ignorance of contraceptive methods. This seeps into surrogacy as most surrogates come from similarly economically and socially disenfranchised backgrounds.
Clinicians and middle-class agents actively propagated misinformation regarding Indian surrogates to be able to continue their surveillance, effectively silencing surrogates into accepting and working with lesser compensation and difficult working conditions. Pande (2014) has previously written about the ways in which a surrogacy hostel in Western India doubled up as a space of surveillance and resistance, where the hostel packed in pregnant surrogates to control their diet and movement, while at the same time surrogates would forge ties of everyday resistance through shared sisterhood in the same space. In Hyderabad, too, similar forms of solidarity were forged amongst the surrogates interviewed, as they navigated their place in the arrangement. The surrogates interviewed activated forms of social interaction mimicking Goffman's understanding of totalitarian institutions wherein inmates would act out different selves to manage power dynamics. Thus, surrogates would have a subservient side that they put forth in front of the agent, while behind the agent’s back, they discussed negotiating proper payment and compensation tactics.
The commercial surrogacy arrangement in India remains dynamic in the ways in which different sets of participants negotiate their position through varied strategies and tactics (Lamaison & Bourdieu, 1986). These strategies provide a more nuanced perspective on how vulnerability is exacerbated while at the same time being managed. The narratives presented in our analysis bring forth the centrality of vulnerability as a trope within surrogacy arrangements, which is an important part of the lived experience of the surrogate and her family, and one that has also recently been used to reject/usurp/grant legitimacy to those “who suffer the most.” Thus, we look at two specific retellings of vulnerability that illustrate how, on the one hand, it can propel individual social mobility while, on the other hand, it maintains systemic exploitative relationships.
From intended parent to agent
G, a middle-class and upper caste former intended parent (IP), suffered from childlessness for 10 years. Her narrative foregrounds her reproductive vulnerability (as understood by Riggs & Due, 2013) associated with her social and economically fragile situation. Socially, she is embedded in a society where infertility is stigmatized (Riessman & Riessman, 2001), as it deviates from meeting the cultural norms of conception, reproduction, and parenthood, inevitably contributing to psychological distress. In fact, in a double bind, opting for assisted reproductive technologies (ARTs) can enhance this stigma as it stands to confirm infertility and a deviation from natural conception—referred to as “infertile motherhood” (Shalev & Lemish, 2013).
She and her husband spent their modest savings on her two IVF treatments. She explains: My husband spent each and every alternate day in the center for a scan or this and that. He is just a government employee, it is not like he is going to get salary for each and every alternate day, right?
Besides the medical expenses, there were substantial time costs involved. G finally birthed her son through IVF, but in the process, she learnt much about how surrogacy works through interaction with IPs who had hired surrogates and through her own IVF doctor, who had been involved in surrogacy arrangements. This prompted her to invest in building a network of surrogates and IPs that would help infertile couples access a surrogate with minimal trouble. Highlighting vulnerability's central role in bioethics, Rogers et al. (2012, pp. 12–13) argue that “an adequate conception of vulnerability … may attend to the ways in which the development of capacities for resilience and the social conditions for promoting agency and autonomy constitute appropriate responses to vulnerability.” In G's case, becoming a surrogate agent was arguably facilitated through the intersections of gender, caste, and class. As a woman, G was able to gain access to other women seeking to be surrogates with relative ease, as opposed to what male surrogate agents experience. The ease of gender-based access was marked by G's upper class and upper caste positionality, wherein she could exert considerable influence upon the economically and socially disadvantaged surrogates. Most of the surrogates under her care were Dalits or scheduled castes, which meant they were expected to adhere to the caste norms of deference and subservience towards upper caste and upper class members of society. These caste-based codes of conduct are not uncommon in India, with parallels seen in domestic care work (Majumdar, 2018). Thus, it was not surprising that G enacted a form of patronizing attitude towards the surrogates—a mixture of paternalism and enforced disciplinarity that demanded deference and obedience.
G's philosophy in wanting to be a surrogacy agent was simple: to aid infertile couples realize their dream of parenthood. She says: This woman waiting with me at the fertility clinic was crying. It seemed the doctor told her to go with the donor egg and she would have to wait for 6 months to be able to find a suitable donor. Considering the time it takes to get a donor, I felt I could help … so, I counselled this young girl in my neighborhood, who was in need of money, especially because she has two kids and her husband is an alcoholic with no or little money. I counselled her to donate her eggs only once—didn’t encourage her to do it multiple times, but just once. It helped that she was reasonably good looking and matched with the IPs’ needs. After I got this donor, the doctor got in touch with me and wanted me to source more donors for them—for which the clinic would pay me. But I didn’t take anything from the hospital, after all, I was a patient and didn’t think that seeking fees would be proper. Finally, the doctor convinced me to start engaging women as donors and surrogates, and what she said to me was particularly thought-provoking. She said, “donors and surrogates should know the pain of IPs as well. They take the money and leave, but don’t understand what IPs go through. As a donor, I can donate in any other center and make easy money instead of working for 30 days. All I do is work for 10 days and walk away with 50,000 rupees.” That was what pushed me to think about becoming an agent.
As an IP and having experienced vulnerability, G was initially prompted to take on the task of sourcing egg donors for the hospital, without receiving any renumeration—as a philanthropic act of piety. This form of philanthropism is a common narrative within commercial surrogacy, as Pande (2011) highlights how surrogacy agencies and IVF doctors continue to create a sense of superiority amongst IPs by positioning them as “saviours” of the poor disadvantaged surrogates. This resonates with our work on transnational surrogacy and adoption, where we suggest that the trope of the “White saviour” is central to both practices (Gondouin & Thapar-Björkert, 2022), an understanding which “obscures the historical and political context … and positions white citizens as rescuers and racial others as beneficiaries, making … the attitude towards the other a question of mercy and compassion” (Gondouin, 2015, p. 106). Such a narrative retains superior–inferior class/caste hierarchy between IPs and surrogate by further conditioning the surrogate to be indebted to her IPs. Arguably, such a paternalistic attitude is meant to erase the surrogate's agency and give more power to the IPs within the arrangement, unlike some open arrangements in the US, where the surrogate and IPs exercise equal choice within the arrangement (Jacobson, 2016); and yet, similar to surrogacy arrangements in Israel and closed surrogacy arrangements in the US, where despite the insistence on the surrogate's value and “sacrifice” in the arrangement, IPs maintain a hierarchical relationship (Berend, 2012; Teman, 2010).
While IPs undergo great hardships in pursuing pregnancy and birthing, chronicled in great detail in academic research on cross-border reproductive care (Riggs & Due, 2013; Stuvøy, 2019), it is true that their vulnerability is not the immediate focus of studies on surrogacy, especially in relation to the surrogate. G's narrative is pertinent in how she positions the IPs in relation to the surrogates. Elsewhere, it has been discussed that in India, lawyers, agents, and clinicians would often deliberately build mistrust (Majumdar, 2017), narratives of benevolence (Pande, 2011), and distance between IPs and surrogates/donors by perpetuating stereotypes of women who would become surrogates as prone to defraud the IPs and run away during the pregnancy. There may have been occasional fraud cases, but this form of “myth perpetuation” has been a ploy to keep information and the finances of the arrangement in the hands of the agent and the clinic. While class and caste were important aspects of control and misinformation (Pande, 2014), this also feeds into a larger picture where the position of intermediary agents can vacillate between being a legitimate facilitator and being part of or upholding a corrupt system (Gupta, 2012).
As G elaborates on “picking” sides: Recipients [intended parents] suffer more than the surrogates. IPs get very emotional, after all, somebody is carrying their kid. They end up giving many things to them, even when they are broke, IPs give money and support to the pregnant surrogate. For instance, this patient has contracted surrogacy as the last attempt to have a baby. She didn’t have much money, but still gave a lot by selling all her gold. She told me one day, after buying incredibly expensive fruits, that she was actually starving so that the pregnant surrogate could eat. IPs constantly spend money on and provide protein powder, vitamins, coolers, etc. When surrogates are contracted, they are weak, but they go back healthy. Everybody will think “poor surrogate, she is ruining her health and giving her baby to somebody else and after that how does she feel?” Nothing like that. They give and run away, they want money immediately and they already have kids, no? There are two sides to everything. See, if they [surrogates] don’t get money, they commit suicide. At the same time, if IPs don’t have kids, they too might be pushed to death. Both the cases are very important cases, and it should come up. She is getting money and they are getting a child, so both problems are solved here.
One of the surrogates employed by G mentioned how she never got the entire amount of money she was promised, a narrative that is repeated by surrogates across India. Systemic exploitation uses “greed” and economic inequality to exacerbate and devalue the struggles of different sets of people involved in the commercial surrogacy arrangement, without doing justice to either. G is the quintessential middle-class Indian surrogacy agent who believes surrogates should be “grateful” for the work and food provided by IPs, just like the surrogates in Pande's ethnography. The vulnerability that G feels resonates with Colen's understanding of “stratified reproduction” (Colen, 2009), wherein socially and economically vulnerable populations, especially women, often support and bolster the lives of privileged (White) families and other socially comfortable majorities such as upper caste Indian women, in the case of India, by sacrificing their own needs and families. This echoes and arguably can be seen as an extension of the jajmani or patron–client system within Indian land-labour relations, wherein the labourer must remain indebted to the patron despite exploitation and receiving less than subsistence wages (Kolenda, 1963). However, as the next narratives suggest, women who become surrogates also become agents—turning the narratives back to questions of systemic exploitation and suffering.
From surrogate and egg donor to agent
Another respondent (AR), who used to be a surrogate and egg donor, decided to become an agent after she felt exploited and cheated in the arrangement. She identifies the mercenary attitude of the agents that she encountered during her time as a surrogate as key to her negative experience of unfair treatment: “at that time, agents were very … their mentality was not good back then.” Drawing on her own experiences enabled her to “feel[ing] the pain” of surrogates, which made her commit to becoming an agent to ensure that surrogates were treated fairly while she would benefit from the process. As an agent, she was successful enough to improve her standard of living and be able to pay for her son's education. The narrative of self-affirmation and growth amongst surrogates who graduate out of their participation in the arrangement to become more active and powerful participants is also chronicled in other ethnographic readings (Deomampo, 2013).
From AR's point of view, the unethical practices one reads about in the media are not inherent to surrogacy arrangements per se, but the result of recruiting surrogates and egg donors from the most disadvantaged social strata: Now many people write in newspapers [about surrogacy] about cheating. But who is getting cheated depends on each individual's position/condition. One can take a person who is completely helpless, which is why donors and surrogates belong to the lowest classes. And coming to surrogacy, I knew that it is painful, but I did it. I knew that there will be an operation. But that doesn’t mean that I will feel bad about this, like how people make it out to be. People say that surrogates feel bad after they give away the baby, but actually, after giving away the baby, we are happy about how the child's future is safe. We do not react much about their baby. They [media, IPs] make it sound very emotional, but there is nothing like that. There are a lot of problems at home. There is no money for even books, what will people in that position do? For some of them [surrogates], their husbands don’t treat them well, and this is a good direction for them. But it is wrong when it is forcefully done. If they choose to come by themselves, then it's fine.
Central to AR's negative experience of being a surrogate and egg donor is the fact that she was cheated in relation to her renumeration. She explains: We do not know who is taking and how much they are taking. Agent takes some and the hospital people take some. We didn’t even know how they took the money. I didn’t know back then. Back then, even a basic amount was a big one for me. I thought that is the amount that will be given and even that felt good. But had I known that the real amount was much higher (INR 25,000) than what was given, I do not know what my opinion would be.
But AR is defiant and unwilling to passively accept such blatant maltreatment: I was cheated a little during my surrogacy. They said I would get 2.5 lakhs, and the mediator would get 50,000. I don’t even know where she is. While I was in the hospital, they said food is free. After I got discharged, they said they will cut money from my payment for food. They said one thing in the beginning and another later. So, I show interest in learning about things. I was there in that hospital for 8 months, and in those 8 months, when they brought the files, when they spoke about payment … I enquired about it all. That is when we got some idea about it. They did not tell us anything then. We thought … it was around the time for me to leave, and we thought they will arrange for giving us full payment without taking some for food. They saw all the records, but they couldn’t do anything. And then I came out and there was nothing for me to fight and take from them. That is when I became an agent. While making the agreement, they write the conditions in small letters. That is not visible, and they ask us to sign. And when they turn over the paper quickly, we do not have the time to check how much money we will be paid. All of doctors are rich and they have so much respect: how do you counter that? So, most surrogates are unable to speak in front of them. The doctor will be present, the agent will be there too, and there will be many others present, and we will be asked to sign. And at that time, if we request to check the agreement (which is in English) once, they make a face and ask us how we can possibly suspect them of cheating us. And there is this fear that people who ask such things might be put through many difficulties. There are a couple of agents who bring people from villages, from very remote villages, and I have seen this. So, when I saw all this happening, I thought to myself, when someone can earn so much from doing wrong, then, why not do something right and make it beneficial for both, us as well as for them. So, I have been a surrogate agent for many people.
Here, the ideal surrogate, as Saravanan (2010) has previously identified, is the submissive woman who will take the contract and its validity as truth, without any questions, overlooking the “conditions in small letters” when signing the contract. In other words, the medical personnel expect nothing less than the surrogate's unconditional trust, refusing to be seen as possible “suspect[s].” Women from rural India carry such meekness and ignorance as a stereotypical badge, unable to engage and counter the devastating impact of urban life and politics. The philosopher Annette Baier (1986, p. 235) suggests that trust acts as a form of asymmetrical vulnerability and points out: Where one depends on another's good will, one is necessarily vulnerable to the limits of that good will … Trust then … is accepted vulnerability to another's possible but not expected ill will (or lack of good will) towards one.
Drawing from her own experience, AR learns fast that being submissive and exposing herself as vulnerable is not the best route forward. Instead, she recalls her late father's advice to protect the surrogates in order for them “not to repeat the pain [she] went through.” She insists that the contract should be in the native language of the surrogate, or at least be read out in the same, while also assuring that the amount to be received by the surrogate should not be tampered with or modified once agreed upon.
The other issue pertains to the logic of keeping IPs and surrogates apart, a practice by agents and clinics to keep financial control over the arrangement. AR changed this in her experience as agent, as she recounts: Actually, I tell them clearly that I will only take how much I have written in the agreement, and I allowed them to see the IP. I did not see any IP when I was a surrogate. Now the people who are there with me can see their IP, can see for whom they are delivering the baby. I keep them in touch with their IPs.
Conclusion
The concept of vulnerability is pivotal for understanding transnational commercial surrogacy and the ethics of reproductive travel. Our analysis highlights how various understandings of vulnerability are set in motion in narratives of surrogacy, and how it becomes a resource and a springboard for agency. Our intention is not to juxtapose surrogates and intended parents, seeing surrogates as embodying vulnerability and intended parents as privileged, as couched in understandings of the latter as exercising their reproductive rights or seen as neoliberal consumers. Instead, we look at two particular retellings that illustrate the complexity of vulnerability; how it can propel individual social mobility and animate attempts to transform an unjust system, but also how such individual agency and empowerment may serve to uphold exploitative relationships. In the first retelling, we analyse the journey of a vulnerable intended parent who becomes an agent, while in the second narrative, we focus on the trajectory of a surrogate and egg donor becoming an agent. In both narratives, the layers of vulnerability across different interconnected circuits of reproduction—of intended parent, agent, and surrogate—are explicated. Our analysis of vulnerability and surrogacy provides room for agency and resistance.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
“From Waste to Profit: Gender, Biopolitics and Neoliberalism in Indian Commercial Surrogacy” was funded by the Swedish Research Council (Diary No. 2016-04078).
