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avafsu · 5 years ago
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Cross-Border Surrogacy, Enacting Change
When the term surrogacy is used, most people think of all parties benefiting because the couple that cannot conceive a child, gets a child, the surrogate mother is compensated for her job, and the company the parties go through gets paid.  However, there are many cases where all parties do not benefit, and ethical concerns are raised.  Cross-border surrogacy is more popular than in state surrogacy because it is cheaper to travel to another country where legally the policies are not as constricted causing the procedure to cost less.  For more background information on cross boarder surrogacy go to the previous blog post attached here.  The exploitation of the surrogate mother from other countries that participate in cross boarder surrogacy is the focus point of this argument because it is unethical. Cross boarder surrogacy should have better, stricter laws to make the process safe and ethical.
It is difficult to say that all cross-border surrogacy should be illegal because there are many places around the world that have laws prohibiting the chance for couples to seek other options for a child.  For example, France, Germany, and Belgium restrict IVF (in vitro fertilization) to same-sex couples.  The United States has no federal laws regarding surrogacy so it is left up to the individual states, so there are many people looking for other options in other places since their home areas prohibit surrogacy options.  However, looking at cases of surrogate women in India it can be determined just how unfair and unethical of an arrangement the practice is without any strict regulations.  Once the surrogate becomes pregnant, she is moved to a “surrogate house” that holds about 40 other surrogate women. The house is set up like a hospital ward with two to three iron-framed beds in each room and the women reside here for the total nine months of the pregnancy.  According to Manasi Mishra, the head director in the Research Division at the Centre for Social Research in New Delhi she says Indian surrogates typically have no more than a fifth-grade education.  The lack of education makes it so the women cannot read a contract drafted in English and makes a mockery of any form of consent.  Many women are told their deliveries will be a natural birth and often undergo a Cesarean section because it is quicker.  Some couples commission for more than one surrogate to boost their chances and the less viable fetuses get eliminated through a pill-induced miscarriage.  Mishra says, “She has been made to believe that is because of her carelessness that she has aborted.”  In this case, the women did not know it was an induced abortion and was not even paid after losing the baby.  It is clear that the companies in India do not care about their workers, the surrogate mothers, the companies diminish the women’s rights and do not communicate effectivity what is happening throughout the course of the nine months.  However, there is a reason why these women put their bodies up for surrogacy, and it is because they are in no position to change their fundamental circumstance of the poverty they are in and the money from surrogacy is a way to help provide for their families.  “The average gestational surrogate carrier in India receives approximately $5000–7000 with the total costs for a surrogacy arrangement estimated between $18,000–30.  If everything goes according to plan, the cost for an Indian surrogacy can be a third of what a US surrogacy arrangement costs.”  The surrogate women are not even making half of what the estimated total cost would be for the entire procedure.  The women are sacrificing nine months of their lives living in a house away from their true families, misinformed consent is being used as consent, uninformed practices of abortion are being performed, and not receiving payments are happening to surrogate women in India.
For the ethics behind cross-border surrogacy to be resolved the industry must be regulated.  In India, there has been some legislation and laws being made to protect the rights of women.  Protections include, having a notarized legal agreement with the surrogate, limiting the age of the surrogate to 35, having a maximum of five pregnancies which include their own children, and requiring medical insurance.  After two years of debate, in December of 2018, an Indian surrogacy law was passed that made commercial surrogacy illegal and only allows surrogacy to infertile Indian couples.  The regulations and laws being passed in India have made groundbreaking progress that hopefully is being transferred to other countries who need to have regulations on cross-border surrogacy as well.
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avafsu · 5 years ago
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Crossing Boards for Convince, Are There Concerns?
Global commercial surrogacy seems to be flying under the radar and more people should be made aware of what is taking place internationally.  Cross-border reproductive care or reproductive tourism is when clients seek advanced technological procedures to impregnate other women to carry the client’s child to term because they typically cannot conceive their own.  The surrogate mothers are from low income nations; India is the leading country that provides commercial surrogacy.  The clients come from high income nations like the United States.  However, there is a large set of unethical questions that have yet to be addressed to protect the rights of low-income surrogate women from other countries.  
Motives for Clients
The information gathered in this article, by a Yale graduate, narrows down eight factors that promote reproductive tourism.
The service is cheaper in another country
Ethical or religious reasons may prevent the specific service in the country
Privacy concerns may lead to some patients traveling 
Due to lack of expertise, donor gametes, or equipment the service is not available 
The country has banned the service because is not considered safe or the risks are unknown
Age, marital status, race, or sexual orientation may not receive the service
There is a shortage problem or risk of being wait listed due to donor gametes (eggs, embryos, sperm)
Patients worry about low-quality medical services
Statistically speaking, it is difficult to have an exact number recorded for all cross-border travel fertility because the international reporting system is not the strongest. At the National Library of Medicine (NCBI), it was found that 5% of all European fertility care involves cross-border travel.  Anecdotal evidence at this same site suggest that hundreds of thousands to several millions of people seek international medical care each year.  Reproductive services are estimated in Europe to be in the tens of thousands and hundreds of thousands in Asia.
Motives for the Surrogate
In low income countries, it is assumed that the “poor and vulnerable” populations are more willing than citizens of wealthier countries to put up their personal health for a small financial award, according to the NCBI.  In Indian, it is believed the soul motive for surrogate women is to gain some financial income and they can make up to $6,000.  To put this statistic in perspective, in the United States a surrogate can make up to $20,000, this study is also from the NCBI.  Religious beliefs may be part of the motive and feelings of altruism are used.  Most data collected found the Indian surrogates to be poorly educated and of low social status, but the clinics do not share much data with researchers.
Risks, Is There Reward?
First, we will look at the ethical issues and the risk the low-income surrogate mothers may have.  All of the information in this paragraph was found in the Journal of Medical Ethics.  Informed consent of the surrogate, which includes the communication of both medical and social risks and benefits to the surrogate.  The clarity of consent to a woman of poor or illiterate background may be challenged when faced with a susceptible neocolonial motivator of medical authority. Quality of surrogate care, the client will probably fund nutritional requirements and the surrogate will be expected for her physical health to be at the proper standards. However, her social and mental health may not be considered, and her domestic familial duties may be affected by her role as surrogate which could inflict stress.  Multiple embryo transfers and abortion, the surrogate is encouraged to accept multiple embryos to maximize successful implantation probability which would reduce the costs to the clients.  The autonomy of the surrogate and informed consent is again put into question at how clearly this was communicated.  The chance of a multiple pregnancy needs to be considered and could turn into a dangerous medical procedure.  The possibility for selective reduction abortion may be used due to the multiple embryo implantation. Coercion of the surrogate may be used to reduce costs.
We will now look at the risks of the clients who travel internationally to acquire the service of cross-border surrogacy may face from the site NCBI.  Typically, these people have great sums of money and have faced biologically infertility, unable to become pregnant, or social infertility, same-sex couples. Disreputable clinics and brokers may promise high success rates, seamless legal procedures, and uncomplicated surrogacy negotiations just to take more of the clients’ money and consume more of their time.  A child may be created with needs that the client was not expecting, for example a baby being diagnosed with Down’s syndrome.  Overall, the greater risks to the clients are acquiring great financially debt on a journey that may not produce the outcomes they desire or are guaranteed.
Thank you for reading this post and I hope you are better informed on cross-boarder surrogacy.
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