Nurturing an Alien Pregnancy: Surrogate Mothers,Intended Parents and Disembodied Relationships

Doing Ethnography in a Difficult Setting

The ethnographic fieldwork on commercial gestational surrogacy was conducted in the Indian capital city of Delhi from 2010 to 2012, with one-time visits to the neighbouring cities of Jaipur and Ahmedabad. The bulk of the fieldwork was conducted in 2011, for a period of nine months including: visits to IVF clinics; interviews with Indian and foreign couples entering into a surrogacy arrangement or waiting for their babies to be born; and surrogates—pregnant, entering the arrangement, post-delivery and undergoing an embryo transfer. Other informants also included agents who arrange the surrogacy and act as intermediaries, embassy officials, lawyers, relatives of the couple, husbands of surrogate mothers, and women who have had children through infertility treatments. In total, 65 informants were interviewed during visits, and ethnographic observation of IVF clinics and the process of bringing together a surrogacy arrangement.

A majority of the intended parents were foreign nationals (12), while the rest were Indian (3)—pointing towards the growing networks of transnational circuits in reproductive tourism. All the surrogate mothers were Indian (13) as mandated by law (ICMR, 2010).

In this field of investigative and ethnographic research, it was difficult to gain access to people and places where surrogacy arrangements were being organised and carried out. ⁴ The fieldwork progressed by mapping the different steps that couples, surrogates, doctors and agents take to further the process of pregnancy and childbirth. I observed the ways in which agents chose surrogates, doctors negotiated the arrangement with couples and surrogates, how surrogates felt before, during and after a pregnancy. Many of these occasions were dependent upon access and permission to observe.

Entry into IVF clinics was negotiated with the proprietors of the clinic (mostly doctors) who inquired into the research and its goals— and accordingly gave their consent. Out of the 18 clinics approached for the research, only 3 allowed access at varying levels. Entry was granted on the basis of a letter provided by the researcher’s parent institute that listed the objectives of the research and the promise of confidentiality. Conversations with informants were monitored by the clinic staff; and access to aspects of IVF treatment—such as embryo transfer—was denied. The confidentiality clause meant that many informants chose that their responses not be audio-taped, in which case extensive and detailed hand written notes were taken.

Outside the clinics, interviews with informants were mediated through networks of agents, couples and surrogates. Here, informed consent was given without permission to audio tape; in some cases informants wishing to remain anonymous would agree to a telephone interview rather than a face-to-face interaction. Access and consent were denied many times, whereupon an attempt was made to remediate, or move on to seek access elsewhere. In the absence of a recording device as well as when respondents’ anonymity and confidentiality were respected responses were more fluid and open.

Full informed consent was granted on furnishing details of the research and subsequent use of the data. Many of the informants were clear about wanting to participate in an academic research project, but were wary of being part of a media story. ⁵ Understandably, most respondents sought my identity papers and letter of introduction to ascertain the authenticity of the research. Many spoke to me only because I went through a known circuit or had an introduction from a reliable person. In a way the snowball sampling method here involved going through trusted networks of doctors, couples and surrogates. Long-term association happened only where the respondents came to trust me to safeguard their privacy. This happened over a number of meetings, many of which were spent ascertaining my work and involvement.

The stigma attached to the practice of commercial surrogacy meant that one had to navigate carefully in the context of the multi-sided ethnography (Marcus, 1995). In interviewing stakeholders and participants their interests had to be protected (sometimes at the cost of the research). In this sense consent was conditional on safeguarding their identity through pseudonyms and in some cases information on certain essential markers of identity, besides names—such as income, place of residence, profession, and religious, ethnic or caste identity—were withheld. And despite the waiving of the confidentiality clause by many of the informants, I have retained pseudonyms for all.

Disembodied Pregnancies and the Notion of Risk: Socialising the Commercial Surrogate Mother

Pregnancy is envisaged as a stage where a woman is constantly negotiating with her body (Taylor, 2000). Medical discourse constructs her more as a disembodied being—where the foetus is given more importance vis-à-vis the mother (Lupton, 1999). Motherhood is also pathologised so that the foetus is not placed in a subordinate position to the self-mother—as is seen in the way breastfeeding and attachment are eulogised (Kanieski, 2010; Knaak, 2010). Interestingly, this is in keeping with the notion of risk as gendered and sexualised (Phadke, 2007). Within such an understanding the notion of surveillance comes to be the primary responsibility of the woman. Thus, women are both vulnerable subjects requiring protection, as well as embodiments of familial honour and shame that must be protected through self-surveillance (Menon, 2012, p. 142). Embodiment and disembodiment combine in a narrative that leads to patriarchal control and medical surveillance of pregnancies that are ‘precious’ and must be protected by the woman who is pregnant. Medicine is one of the many instruments of control that through subtle coercion and persuasion creates notions of risk that are deeply gendered and centred on the woman’s body (Martin, 2001; Rapp, 2000).

The disembodied risky pregnancy panders well to the clinical discourse on surrogacy and surrogate mothers. In most analyses of the Indian surrogate which place her within the frames of exploitation (Pande, 2010; Qadeer and John, 2009; SAMA, 2012), her position within the arrangement has been constructed in terms of her lack of agency—and as an ‘object’ within a commercial transaction (Qadeer and John, 2009; Sarojini et al., 2011; Shah, 2009). This happens predominantly through her socialisation, carried out by clinics and agents, wherein she is told to internalise the idea of being a ‘vessel’—merely a receptacle with no claims on the child she will give birth to. Vora (2009) notes that surrogate mothers are trained to think of their wombs as ‘rooms for rent’ to help disassociate themselves from the foetus—while Pande (2009b) speaks of how surrogates try to establish a link with the foetus through their role of nurturance, even when they are not connected to it ‘genetically’. In this sense her submissive nature, lack of vices (such as smoking and drinking) become stereotypical as well as sought-after images for the Indian surrogate (Saravanan, 2010). And that she gestates but is not genetically linked to the baby is also a recurring theme of her socialisation.

The commercial gestational surrogacy arrangement involves a nine month ‘vigil’ on the part of all the stakeholders. Surrogate mothers are socialised in particular ways to emphasise the special nature of their pregnancy. The pregnancy, however, does lead to ambiguous, conflicting feelings towards the baby. A sense of ownership is claimed through the nurturance provided to the foetus during the nine months—on the basis of which the surrogates wish to stay in touch with the couple and child (Oza, 2010; Pande, 2009b). Despite socialisation, therefore, surrogates build their own sense of kinship with the unborn child during the pregnancy.

Feminists and reproductive health activists also point out the dangers of ‘artificial’ pregnancy on the surrogate’s health and well-being. Most of the critique has taken the form of highlighting lacunae in the legal guidelines issued by the Indian Council of Medical Research (SAMA, 2010). The risks of assisted reproductive technologies (ARTs) on the surrogate and of illegal abortions or multiple embryo transplants are highlighted. The lack of regulation of the industry means that doctors often indulge in illegal health practices on women who have visibly less rights in the arrangement. A 2012 case of the death of a surrogate mother in the process of giving birth, led to a collective outcry amongst feminists and women’s groups across the country against the arrangement. ⁶ The risk of induced caesarean deliveries and premature births put the surrogate in a situation of life and death. Pregnancy and childbirth in the surrogacy arrangement becomes a risky venture.

However, the disembodied, disempowered body of the pregnant Indian surrogate mother comes to impact the relationships that are implicated within the commercial surrogacy arrangement. Except for a few studies that chronicle the interpersonal relationships amongst the different sets of people within the arrangement (Teman, 2010; Thompson, 2001) academic analysis has been sparse. Teman analyses the ways in which embodiment is constructed and felt within the gestational surrogacy arrangement in Israel, while Thompson focuses on the negotiated ownership of the unborn child during the pregnancy. That intimate relationships may come to embody their own particular form of risk in the act of making kin is the focus of this article.

The Discourse of Risk and Surveillance: How Clinics and Agents Create a Pregnant Mother

From the very beginning the surrogate mother is socialised and constructed for the purpose of a healthy pregnancy, and the eventual relinquishment of the child. The discourse within surrogacy was based on creating ‘owners’ with entitlements. So while the surrogate and her family were persuaded of the asexual nature of the arrangement and the ‘alien’ pregnancy the intended parents were at the same time told of how they are the true owners of the pregnancy and the foetus. In this process the IVF specialist and agents actively propagated mistrust between the surrogate and the intended parents. They discouraged meetings between the couples and the surrogates—and in the case of foreign couples took over the reins of the pregnancy entirely. This meant that couples many times did not meet their surrogate at all. In keeping with the requirements of the contractual nature of the surrogacy arrangement, relationships between the intended parents and the surrogate mother were strictly business-like.

‘Horror stories’ about jeopardised, failed or conned surrogacy arrangements where the surrogate mother cheated the intended parents and the clinic of money and the baby were freely circulated amongst couples, surrogates, doctors and agents to create a sense of precariousness regarding the arrangement. The precarious nature of the relationship was reason enough to enforce strict surveillance mechanisms to monitor the pregnancy. Thus, the recurring need for surveillance of the surrogate pregnancy formed the crux of the medical discourse.

And even though in contemporary medical discourse around pregnancy and the pregnant body, self-surveillance was already an established tradition, often forcing women to subordinate their bodily and emotional well-being for the sake of the foetus (Lupton, 1999), in the case of the surrogate pregnancy it took on a different dimension altogether. Ethnographic analysis of Indian surrogate mothers has pointed towards the practice of ‘housing’ gestational surrogates in hostels that are run by IVF clinics and agents (Carney, 2011; Pande, 2009a; Saravanan, 2010; Vora, 2009). In these hostels the surrogate women follow strict codes of behaviour and nutrition. Many of them feel trapped and imprisoned in the hostel atmosphere (Madge, 2013), unable to move out and participate in any activity beyond the ones mandated by the clinic and agent. Madge notes that the long hours of ‘resting’ that the surrogates have to forcibly undertake tired them out. This pregnancy was unlike their other pregnancies where they actively participated in household activities while carrying their own children.

The delicate balance of nurturing someone else’s pregnancy while implicating yourself and your body in it meant that agents and doctors had a big role to play. Right from screening, selection and the ultimate care of the pregnant mother, the responsibility of nurturing the alien pregnancy as both alien and related lay with them.

In interviews with many IVF specialists the image of the surrogate as a poor, greedy woman who was willing to carry a pregnancy to fund familial needs was the most common. Many of them spoke of the surrogates derisively pointing out to the need for surveillance and control. An IVF specialist running a surrogacy clinic in west Delhi says: ‘It is difficult to interview the surrogates as they are lacking in basic mental capabilities… they come from a lower socio-economic background and do “this” [surrogacy] for the purpose of earning money’.

Monitoring the surrogate pregnancy is based on ideas that regard the surrogate mother as untrustworthy, and on the need to convince the parents-to-be of their parenthood. Agents and doctors constantly try to reaffirm, convince the couples of their genetic links to the unborn child, while at the same time telling the surrogate to treat the pregnancy as not theirs (Menon, 2012). ⁷ To bring such a pregnancy to fulfilment requires a concerted effort on the part of all the stakeholders concerned to bear in mind the basic idea that the pregnancy belongs to the intended parents—those who are funding the arrangement, and connected genetically to the foetus.

Thus, the lack of enthusiasm amongst agents and doctors to house the surrogate with her own family during the period of gestation is based on ideas of hygiene, home atmosphere and proper diet. In Anand, Gujarat and Mumbai where the practice of surrogate hostels is actively endorsed and followed—surrogates’ families are constructed as ‘dysfunctional spaces’ with non-cooperative husbands and in-laws. But in Delhi most of the surrogate mothers lived in their own homes with their families during the pregnancy. A well-known agent remarked how the agency sought women with ‘cooperative families’ to be surrogates.

This involved surveillance of another kind—including surprise visits to the surrogates’ homes to check on their living conditions and whether they were following the prescribed medication plan and diet. Agent Kripa of an overseas agency, Building Futures, remarked:

We make surprise visits and don’t tell them we are coming… basically the idea is to see that they live in hygienic conditions—monitoring it…. I want my surrogates to stay in their own homes, but if there is a request for a separate home… we can arrange it. Tum doosre ka baccha kya karoge [how will you make someone else’s child] if you are separated from your own child? It is exploitation if you keep her away…. We tell the client ki usko ghar mein hi rahne do [let her stay in her own home]—its better that way.

Part of this rhetoric to keep surrogates in their own homes has also emerged from the criticism levelled at clinics and agents for housing surrogates in inhuman, prison-like conditions—where their movements are constantly monitored. But this means that agents have to take on the responsibility of the diet and care of the surrogate, administer medication and give her check-ups from time-to-time while she stays in the ‘dysfunctional’ space of her home. Agent Paromita, who works with Agent Kripa at Building Futures and takes care of recruitment and management of surrogates notes:

We are friendly with them… we joke with them. Unki level pe baat karni padti hain… kabhi kabar unki language mein bhi baat karni padti hain [we have to speak at their level… sometimes we have to speak in their language as well]… we have to explain. They can’t read so we have to explain the medication [in terms of the colour of the medicines] yellow pill, coffee colored…. The condition of their homes is not very good… we have to understand [them] at their level… then they feel that Madam is trying to understand us…. Some days we adjust… some days they adjust. Has to be like this otherwise speaking to them would be difficult.

But Paromita was very clear about the pregnant surrogate and her status vis-à-vis the surrogacy. At one meeting with her pregnant surrogate who was suffering from morning sickness and showed a lack of interest in eating, the advice had been sharp and quick: Embryo ko khana khana hain… usko grow karna hain—is liye khana dena hain’ [The embryo must eat… it has to grow… that’s why you must give it food]. The foetus was important—it was not, however, the ‘baby’ but an organism growing in her body that she needed to nurture because she had undertaken to do so contractually. Paromita wanted to stress the surrogate’s responsibility (towards the pregnancy) without feeling any emotional bonds or sense of ownership of the foetus. When Building Futures suffered a setback with two of its four surrogates suffering an early miscarriage, Paromita was visibly upset. The kind of money that clients/intended parents invested in the arrangement meant that the outcome could not be taken for granted or risked. On the loss of the pregnancy Agent Kripa remarked: ‘Breaking the news to parents of the miscarriage has been the most distressing, especially after they had begun to believe that their surrogate was pregnant.’ Medication was of the essence in such a situation—its correct administration and intake had to be monitored well.

The agents’ primary concern and allegiance are to the intended parents. As SJ of a Delhi agency says:

Our area is surrogacy, therefore as surrogacy agents, we personally supervise the arrangement on a day-to-day basis. Our counselors in different parts of Delhi have proper control, monitor as well as [exercise] leverage with the surrogate mothers in terms of their pregnancy…. All the papers regarding the proper delivery of the baby are handled by us…. We are professional and organised… and this is what is the essence of helping people… from the financial part, the medical part…. To help intended parents avoid the harassment which further adds to their desperation… we provide one-stop shop solutions.

This responsibility was seen differently in relation to overseas couples. Doctors and agents were more in control and took major medical and other decisions (such as choice of donor and surrogate) without always consulting the couple. The couples interviewed had mixed responses to such overriding control. Many were happy to relinquish control and concern to the doctor—including agreeing with the doctor’s decision regarding the number of embryo transfers into the surrogate’s uterus, and ‘reductions’ or abortions in case there were more than two foetuses. ⁸

The foetus was important here—the pregnant body was considered secondary and of transient importance to the unborn child. The risks associated with pregnancies were magnified especially because the foetuses were housed in bodies that did not ‘own’ them. The kind of surveillance that agents and doctors undertook therefore socialised the surrogate to take care of her pregnancy while at the same time they told her that she did not own it. The pregnancy is positioned as a commercial venture of nine months with rewards at the end to ensure the stability of the arrangement.

The [Un]Wanted Pregnancy: Creating a Viable Moral Universe

How do you navigate a pregnancy that is not yours? Surrogate mothers in India conflicted between the opposite ideas of paap (sin) and punya (good deed) ⁹ to understand their pregnancy. Most of them felt that the pregnancy was stigmatising and could not share their feelings with others due to its ‘sinful’ character. Their failed, fallen circumstances had led them to undertake a ‘wrong’ act for the sake of their children and family. Despite its asexual character, it is still a sin—especially for the husband’s kin and family. ¹⁰ Hamare mein toh yeh paap hain—hamare logon mein kharab hain—kisiko pata chal gaya toh zindagi kharab ho jayegi [Amongst our people this is a sin—it’s a bad thing— if anyone comes to know of this then our lives will be ruined] (Rubina, 22, pregnant, later miscarried).

The pregnancy had to be masked by either moving to housing provided by the clinics or by lying about the pregnancy. Yet, despite the visible stigma many women were willing to undertake the task for the obvious monetary benefits, as well as for the merit of having done a ‘good deed’ (punya) that might help overcome the sin of it. After voicing the fear of stigma due to the ‘bad’ nature of the pregnancy, Rubina’s husband Aslam (25) says: Kisiki aulad maar jati hain–… humse bhala toh hota hain. Uski nasl khtm toh nahi ho jati ([If] somebody’s child dies—at least we are able to do some good…. Their lineage does not come to an end]. Ji mere ko bahut accha lag raha hain ki mein ne kisiki goud bhar di… matlab meine punye ka kaam kiya hain. mujhe bahut khushi hain ki hum kissi ke kaam aa paye [Yes, I am feeling really nice that I helped someone have a child… I mean I have done a good deed… I am very happy that I was of use to someone]. (Meena, 25 gave birth to twins for an Indian couple). Unlike the framing of the surrogacy arrangement as a gift relationship (Levine, 2003; Ragone, 1994), which is a euphemism to hide the fact that it is a commercial transaction (Bourdieu, 1977), the configuring of the pregnancy as good and/or bad deed positions itself within a particular moral universe. So while it is a ‘sin’, and has to be hidden from family members (especially the husband’s parents and the family who control the woman’s body, especially her reproductive body), to overcome the negative nature of the act it is positioned as an act of virtue as well. Despite the training given to them, surrogate mothers were unable to fully see the relationship of distant ‘intimacy’ in the light of gift-giving. They also hardly ever met the couples, especially if they were foreigners. At one such meeting between a seven months’ pregnant surrogate and some friends of her Australian intended parent, she asked just one question: why had her intended parent not come to meet her in all the months of her pregnancy?

The cultural-linguistic distance also meant that many of the surrogates were unable to communicate with intended parents who were foreign couples. They were given only very basic information about them. Meetings were postponed till after the birth of the child, when the impending ‘thank you’ by the couples to the surrogate became a matter of discomfort for both. Surrogates expected to be thanked monetarily, or with gifts at this final meeting—while many couples worried about how they would communicate and react to her. The sight of the child also created ambiguous feelings on both sides. Salma recounts her feelings before the meeting with the Italian couple for whom she bore a son, Phir maine kahan tha… ki mujhe gift de ya na de… mujhe ek baar dekna tha… matlab woh jahan bhi rahe khush rahe… sirf mujhe dekhna tha… ki woh kaisa hain… (I had expressed my desire… whether they [the couple] give me a gift or not…. I want to see [them]… I mean may he be happy wherever he (the baby) will be… but I just wanted to see… who they are…).

The need to create a morally obligatory and sustainable (Featherstone et al., 2006) relationship meant that many of the surrogates tried to relate to the couples in some way or the other. This was discouraged by agents and doctors, especially by refusing to share information regarding the surrogate with foreign couples. The cultural context, including the language barrier or class and racial differences, was not the primary deterrent at all times.

However, in the case of Indian couples it was relatively easier to share information and create some form of relationship. A surrogate notes how she would do anything for her bhaiya (brother) as she called the intended father. Phir ek din ghar pe Bhaiya pahunch gaye aur unhone bola ki aap hi ko karna hain—itna toh ek behen kar hi sakti hain. (Then one day, Brother came to our home and said that only you can do this [the surrogacy]—this much as a sister I can do.)

The creation of relationships with strangers and a subsequent sense of kinship was possible only where the couple and the surrogate met and interacted. In the case of the closed surrogacy programmes (Ragone, 1994) that were part of this ethnography, meeting-interacting-relating was screened and discouraged, creating fear and ambivalence. ¹¹ Pande (2009b) notes how many of the surrogates thought of the adoptive mother as their sister who would share their motherhood with them after the child is born. Invoking kinship to overcome an otherwise alienating task was an essential part of the arrangement for the surrogates. This helped surrogate mothers retain some semblance of sanity in an arrangement where the fear of compromising one’s body in return for promised compensation was overwhelming.

On the other hand, planning around the compensation was an important part of the pregnancy that helped to justify and understand why one was undertaking an alien pregnancy at all. Once convinced of the asexual nature of getting pregnant, many of the husbands of the surrogates encouraged/coerced their wives to become pregnant to earn the extra money. Ajay had convinced Kavita, his wife, to become a surrogate. Kavita seemed tentative about the whole procedure even after she found out that she was carrying twins. Ajay was very clear that he was undertaking this for the sake of his two unmarried younger sisters whose wedding was on hold because of the lack of funds. The surrogacy would pay for the weddings—Kavita was helping him fulfil his responsibilities as the eldest son of the family. In addition to the ₹ 2.25 lakhs that they would get for one baby, Ajay had heard (from another surrogate) that in case of twins and triplets every subsequent live child would get ₹ 75,000. This, for Ajay, was unacceptable. Judwe toh do bacche hi hote hain… ek doosre se kaam thodi na hota hain… ki uske liye kaam paise de (Twins are after all two children… one is not less than the other… then why should we be paid less for the second child?)

Similarly Aslam spoke of how he would use the money earned from the surrogacy arrangement to pay off an outstanding loan on their house. The surrogates themselves had plans for how they would spend the money they will earn or had earned. Radha had invested the money she earned in a bank investment for her children, as well as married off a younger sibling.

To say that surrogate mothers were not entering the arrangement for money would be to devalue their economic contribution. The compensation formed an important part of the unwanted pregnancy—the only reason that surrogacy was sought after. Yet, seeking compensation made the pregnancy and the arrangement more risky for the surrogates than for the intended parents. The contract signed by the surrogate laid sole responsibility of protecting the pregnancy and averting risk to the foetus, on her. In a sense the transaction is completely one-sided. The use of the ambiguous term ‘party’ for intended parents meant that the transaction/arrangement was understood as a one-time arrangement, and placed the moral obligation entirely on the surrogate mother rather than on the couple.

The Pregnant [M]Other: Claiming Ownership

The need for ownership drove most of the intended parents to actively ignore or play down the role of the surrogate. Like an albatross around the neck, the surrogate represented the ‘other’ in an intimate relationship. This was a reflection of their fear of the ‘third party’ in the birth of their child (Bharadwaj, 2003). For foreign couples, the Third World surrogate came to represent the desperation of poverty. It was discomfiting for intended parents to enter the surrogacy arrangement and see it through nine months.

The period of gestation was both alien and vital for all the groups involved. Negotiating and tracking the pregnancy in case they did not have everyday access to the surrogate was very difficult for intended parents. In many cases, they never met the surrogate, particularly if they were foreign couples. As mentioned earlier, this may have been on the advice of the IVF specialists or perhaps it was the choice of the intended parents themselves. But there are also cases of couples seeking to create relationships with the surrogates irrespective of their cultural and national background. Xavier, a Spanish single father who had twin girls through the surrogacy arrangement in Delhi, notes:

I didn’t want the birth of my babies to be reduced to a business transaction. It was after all a different, complicated situation—I was going to a place to create life—[I] needed it to feel emotionally well. I’m in touch with her son who always likes to have some news about my babies, but not directly with her. I think the money is helping the education of their son and daughter but she wanted to buy a new house (I’m not sure if she did).

Where the intended parents were of local origin, anxiety regarding the pregnancy would translate into direct supervision and care of the surrogate. One of the respondents took care of the pregnant surrogate in her home for the duration of the pregnancy. The desire to control the arrangement reduced the involvement of the doctor. Udit (35) arranged the surrogacy himself, limiting the role of the doctor to the administration of the ‘treatment’:

Researcher: So… how have you and your wife reacted to the whole process? How was it for both of you for the nine months?

U: Quite exhausting… for me… very emotionally exhausting… the amount of… physical labour that goes into the process… the surrogate needs constant attention … whether she is taking her medication or not… is she taking her meals?… taking her to the doctor… 24 hours—tough conditions… so then as the months progress you are attached to somebody [the foetus]… then you see it as a possibility. Once it crosses one year you feel it’s going to happen now. Then the whole idea of doing it again is emotionally very painful… and you are in constant fear of the woman running away

Researcher: That is a recurrent fear?

U: She is human… and one is unsure, after all she was living in her own habitat…

A: Did you monitor her diet to some extent…?

Researcher: As much as we could… we did provide her regular money for her diet…

Researcher: She was staying at her own place?

U: Yes

Researcher: Did you visit her there or did you see her at the clinic?

U: At the clinic

Udit echoed the lack of trust that many of the couples felt vis-à-vis the surrogate. Amongst Indian couples, this was largely fuelled by issues of class and poverty. It was also fuelled by a discourse that ‘imagined’ the poor surrogate as hungry for money and putting her interests above that of the foetus she was carrying.

Rajat, (34), and his wife Alka’s (32) unfortunate experience with surrogacy had unsettled them. Despite having clarified the doubts of the surrogate’s husband that the arrangement did not involve any sexual relations, the latter had blackmailed them for more money after the surrogate got pregnant. As a result the pregnancy was terminated.

Rajat said:

They are after all illiterate people who don’t understand the technology. The husband had a problem, and his psychology [attitude] was related to making money—which is their primary concern—just like the clinics and the doctors.

The monetary aspect of the intimate relationship posed many problems. Couples wanted committed surrogates who would nurture their pregnancy as their own without staking ownership. They wanted a contractual relationship in the garb of altruism and gift-giving. This is the reason why altruistic surrogacy arrangements seem to be very common in some Indian families when couples inducted their close relatives (sisters-in-law, sisters, mothers and even mothers-in-law) as surrogates persuading them to carry the foetus for love and obligation rather than money.

In one case, Mrs Chadha, the grandmother of twin boys born through surrogacy had nurtured the pregnancy by keeping the surrogate with her, and avoiding too much contact with the doctor and the clinic. However, the premature birth of her grandsons seriously jeopardised their health leading the lady to blame both the doctor and surrogate for not having taken care to fulfil their responsibility. ¹²

The premature birth at 27 weeks had meant that the babies’ lungs and eyes had to be surgically ‘developed’, and they were only a kilogram each in weight. Their stay in the hospital and their precarious condition lasted for some time leading to a harrowing time for the family. Mrs Chadha blamed the surrogate for this. She found the surrogate’s attitude to food, medical examination and medication restrictive.

In Mrs Chadha’s opinion the womb had not fulfilled its role of nurturance because the surrogate did not care for the foetuses and was not attached to them. There was a lack of ‘connect’ as they were not ‘her own’, this was the reason for the surrogate’s indifference to their health. Clearly, for the doctor, the surrogate and the intended parents the nine month period involves an exercise in sustaining an intimate relationship which is marked by fears of risk and surveillance. The distrust is fuelled on both sides and is compounded by intrusive medical practices.

Parents who commission the foetus invoke their rights in unambiguous terms, especially during the pregnancy. Ultrasound scans were regularly posted on social networking websites, such as Facebook, by many of the overseas couples, with their friends ‘participating’ in their pregnancy. The foetal image was effectively used to alienate the carrier from entitlement to the foetus. Foreign couples unable to participate directly in the pregnancy did so through scans and regular updates from the doctor/agent. And even though they recognise the role of the surrogate, her invisibility gives the pregnancy the image of having been ‘artificially inhabited’. Reports of abuse and maltreatment of the surrogate affected couples seeking Indian surrogates—but would immediately be put to rest by the doctors. In reality most foreign couples did not even get to choose the surrogate and left it entirely to the clinic/agent.

The process of claiming and proclaiming ownership of a pregnancy that is housed in an alien body is part of what Thompson (2001) calls ‘kinship work’. She found couples and surrogates unambiguously creating a narrative of biological connected-ness that privileged those who contracted out the surrogacy pregnancy. However, the way in which couples either derecognised or privileged the surrogate’s tie to the pregnancy had a lot to do with perceptions of genetic risk. What the unborn child would or would not inherit was a matter of great speculation amongst intended parents, despite the medical rhetoric assuring them that the surrogate was a mere carrier.

Thus, nurturing the surrogate pregnancy required maintaining a fine balance between attachment and detachment. In trying to make sure that the surrogate did not get attached to the foetus, including not allowing her to breastfeed the newborn, and yet create a healthy child, many of the ideas regarding pregnancy were overturned. Here, the same medical discourse that pathologises the mother who is not attached to the foetus, encourages surrogates to be distant (Kanieski, 2010). For most intended parents this was linked to the fear of the surrogate running away with their child—which is why there was much anxiety regarding breastfeeding of the newborn and possible growth of attachment. In fact, the received ‘medical wisdom’ tended to be about not allowing the surrogate to breastfeed the baby in case she got attached to it (Knaak, 2010). Adoptive mothers tried medicines that would artificially create milk in their breasts, or they borrowed milk from other mothers to be fed through bottles to the newborn. The desperation to create linkages meant that intended parents were constantly dealing with the absent presence of the surrogate mother in their newborn’s life.

Conclusion

The alien pregnancy not only deals with relationships that are risky and marked by mistrust and a high degree of surveillance but also constructs its own notions of risk. In trying to control and nurture the pregnancy, couples, surrogates and doctors create overlapping, conflicting discourses of risk and connectedness. This involves excluding relations and people in an effort to mark ownership.

To feel ‘disembodied’ is both an affectual and physical state within the surrogacy arrangement. It marks the relationships negatively, creating conflicts and ambiguity and superimposes the technology and the medical personnel operating it as supreme.

Owning the pregnancy becomes an important part of the discourse around surrogacy. Often, to the detriment of the surrogate mother, her body is owned by many including her husband, the intended parents, the clinic, the agents—but hardly ever by herself. Risky relationships are formed at the cost of not only shared risk, but in the case of the surrogate, at the cost of her embodied risk.

For couples—whether Indian or foreign—cultural, class, and linguistic differences are exacerbated within a medical discourse that seeks to alienate them from the pregnant mother. Unlike Teman’s (2010) analysis of Israeli surrogate mothers where intended mothers and surrogate mothers come together and are encouraged to come together in birthing a child as well as a mother, in India the state and medical establishment connive to sustain inequitable relationships. This is largely based on creating fears and anxieties about risk. In contemporary, post-modern living where trust is negotiated through surveillance the surrogacy arrangement in India is positioned in a way that favours those who control the arrangement—here, the clinic and the intended parents.