Abstract
Intercountry adoption (ICA) has declined significantly since 2004. Now with fewer options for family building with a healthy child or infant via ICA, global surrogacy appears to be replacing the practice in some cases. This article presents a brief history of ICA and ethical dilemmas and human rights concerns and explores global surrogacy, starting with surrogacy practices in India. It then considers the new and emerging practice of surrogacy in Guatemala, with concerns about informed consent in the context of poverty and human rights abuses, including human trafficking and violence against women.
At its peak in 2004, intercountry adoption (ICA) was estimated to have affected approximately 45,000 infants and children worldwide each year (Selman, 2009). Since then, a radical decline, caused by complex ethical dilemmas (Freundlich, 2000; Hollingsworth, 2003; Smolin, 2006), has been under way and is estimated to be at least 50% globally (Selman, in press). Concerns about the ethics of adoption and social work practice, including human rights considerations, have been voiced by a number of social work scholars (Roby, 2007; Roby & Ife, 2009; Rotabi & Bunkers, 2011). One of the earliest articles on the subject of ethics and human rights, “International Adoption: The Exploitation of Women and Children” (Herrmann & Kasper, 1992), was published in
In this article, we present an update on ICA problems, including issues of exploitation and reform in the 20 years since Hermann and Kasper’s (1992) observations. We also discuss the emergent practice of global surrogacy, that is, the globalization of the surrogacy industry, as an alternative to ICA, including new considerations regarding the exploitation of women in the context of severe human rights abuses, such as violence against women and human trafficking.
To anchor this discussion of injustice and oppression as it is related to ICA and global surrogacy, we use Gil’s (1998, p. 10) definition: “Oppression refers to a mode of human relations involving domination and exploitation—economic, social, and psychologic—between individuals; between social groups and classes within and beyond societies; and globally, between entire societies.” As Gil further explained: Injustice refers to coercively established and maintained inequalities, discrimination, and dehumanizing, development-inhibiting conditions of living (e.g., slavery, serfdom, and exploitative wage labor; unemployment, poverty, starvation, and homelessness; inadequate health care and education), imposed by dominant social groups, classes, and peoples upon dominated and exploited groups, classes, and peoples. (p. 10)
Considerations of both oppression and injustice overlay the following discourse on ICA and global surrogacy.
Contemporary Problems With ICA
The top three nations that are engaged in “sending” children to other countries have been Russia, China, and Guatemala, and the significant declines in adoptions from these nations are related to the social policy environment as well as ethical dilemmas. Russia has had a series of ICA scandals, including deaths of Russian children from child abuse in the United States (Rotabi & Heine, 2010). China has made bureaucratic changes and has shifted mainly to releasing “special needs” children for ICA (Dowling & Brown, 2009). Guatemala, on the other hand, had notorious problems with multiple failures of its system related to human rights abuses (Bunkers, Groza, & Lauer, 2009; Gresham, Nackerud, & Risler, 2004; Rotabi & Bunkers, 2008).
In Guatemala, a moratorium on ICA has been put in place, due, in part, to illegal payments to birth mothers and sales of children, which are believed to have been routine in the latter years of that nation’s ICA baby boom (Bunkers et al., 2009). Concerns also included the forcible housing of pregnant women with midwives (Greshman et al., 2004; Rotabi & Bunkers, 2008) and crimes related to the abduction of children (Rotabi, in press). These and other problems were documented by a United Nations (2000) report and subsequent reports by human rights defenders (Casa Alianza et al., 2007).
Social Policy Changes
The Hague Convention on Protection of Children and Cooperation in Respect of ICA (referred to as the Hague Convention) was developed to prevent the sales and abduction of children under the guise of ICA while promoting the best interests of the child (Hollinger, 2004; Rotabi, 2008, in press; Smolin, 2006; The Hague Conference on Private International Law, 1993). Each nation that has ratified the agreement must define its internal processes to ensure the “best interests of the child,” including financial transparency and ethical practices of child welfare and adoption (Rotabi, 2008). The Hague Convention was intended to alleviate some of the social justice concerns related to ICA and to improve practices to protect vulnerable people (Hollingsworth, 2003; Rotabi & Gibbons, 2012). Both official and de facto adoption moratoriums have resulted from the reforms of the Hague Convention, and this is one of the factors that are related to the decrease in the adoptions of orphaned and vulnerable children (Selman, 2009).
Guatemala as a Case Example of the Reforms
The most infamous example of the implementation of the Hague Convention and the moratorium on ICA is Guatemala (Bunkers et al., 2009). The extensive analysis of Hague-related ICA changes in Guatemala by Rotabi and Bunkers (2008) illustrated an adoption system led by a small group of Guatemalan attorneys and recruiters of birth mothers. The resultant problems, some illegal and most unethical and connected to human trafficking, resulted in massive changes in the system as part of implementing the standards of the Hague Convention (Bunkers & Groza, in press; Casa Alianza et al., 2007). As a result, adoptions between Guatemala and the United States declined by more than 80% from 2004 to 2010 (U.S. Department of State, n.d.), and this decrease continued after the United States closed Guatemalan adoptions in late 2007. Currently, the only children who are expected to leave Guatemala as adoptees are a small group of outstanding cases still in process—no new adoptions are expected at this time (Bunkers & Groza, in press).
A new law, passed in Guatemala to regulate ICA, is consistent with the Hague Convention (Bunkers et al., 2009). This law eliminated the private adoption system and prohibited attorneys from handling the cases as a notary process with limited oversight from the family court. Now the government manages the cases, adhering to international standards of child welfare. One of the requirements of the new system is that a child must be considered by Guatemalan families first and may be deemed eligible for ICA only after the child is rejected for adoption by at least two Guatemalan families (Rotabi & Gibbons, 2012). Not all children will be approved to be eligible by the national child welfare authorities, since they must be assessed and determined to be appropriate for ICA.
Market Dynamics
The problems in Guatemala and other nations have been related to the global demand for young, healthy children (Casa Alianza et al., 2007; Freundlich, 2000; Rotabi, in press). When the dynamics of the sale of children for adoption begin to take over an adoption system, the “cost” of adoption reflects an unfortunate reality, creating a price point related to supply and demand (Freundlich, 1998). During the peak of the ICA baby boom in the United States, the fees for adoptions of children ranged from $25,000 (U.S. Government Accountability Office, 2005) to $40,000 or more (Rotabi, 2008) for U.S. families. Consistent with a supply and demand market model, the decline in opportunities for adoption resulted in increased fees—especially for young healthy children—since the waiting times for placing children become more protracted. A child’s value was then based on market economics, and allegations of a “baby market” (Goodwin, 2010) have long been asserted by some academics, the popular press, and advocates for children (Riben, 2007). These conceptions date back to Landes and Posner’s (1978) observations in their seminal article, which discussed public versus private adoptions, applying the most basic principles of market capitalism to adoption, including regulation and price. However, Landes and Posner made “no effort . . . to quantify the social cost of the baby shortage” (p. 335), and in the past 34 years, that social cost has come to bear on women around the world. The women who are the most vulnerable are those in developing or low-resource countries who are living in extreme poverty and under oppressive conditions, with resultant social conditions, such as dismal maternal and child health outcomes, violence, and inequalities related to labor and fair wages (van Wormer, 2005).
The Emergence of Global Surrogacy With In Vitro Fertilization (IVF)
In 2010, the Nobel Prize was awarded to a scientist who was recognized for developing and innovating IVF. The official press release stated, “Robert Edwards is awarded the 2010 Nobel Prize for the development of human in vitro fertilization (IVF) therapy. His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of humanity including more than 10 percent of all couples worldwide” (Nobelprize.org, 2010, p. 1). IVF represents an important advancement in science but also a paradigm shift in reproductive technologies. The Nobel Prize coincided with emerging movements in global surrogacy, shifting the terms of social conscience about conception, family building, technology, and global opportunity and vulnerability.
Solving the problem of infertility is particularly relevant in industrialized nations in which infertility is combined with financial resources and broader notions of
Defining Global Surrogacy
Surrogacy is an arrangement in which a woman agrees to become pregnant and deliver a baby for another couple or individual. In commercial surrogacy arrangements, the surrogate receives payment in exchange for her service. Surrogacy may be traditional or gestational. In traditional surrogacy, the surrogate is impregnated using her own ovum and the intended father’s sperm or donor sperm, usually through artificial insemination. In gestational surrogacy, the intended mother’s ovum or a donor egg is fertilized with the intended father’s sperm or donor sperm and is then transferred to the surrogate’s uterus via IVF. In most commercial surrogacy arrangements, either donor eggs or the intended mother’s eggs are used, and the surrogate is made pregnant through IVF technologies. Global surrogacy is a commercial surrogacy arrangement, in which intended parents hire a surrogate (and often an egg and/or sperm donor) internationally. The reasons for seeking a surrogate outside one’s country vary, but most often are related to the illegality of commercial surrogacy in the intended parents’ country (as in much of Western Europe); the dramatically reduced cost of surrogacy in developing nations compared with the West; limited legal complications and/or governmental interference in surrogacy arrangements in developing nations; the ability of a gay couple to pursue surrogacy and to arrange for a low-cost egg donor and surrogate; and the ability of a couple to complete almost the entire surrogacy transaction via the Internet through an agency with little, if any, personal relationship or continued ties with the surrogate mother, who most likely will not be able to communicate in the language of the intended parents. In fact, if the intended parents use an egg and sperm donor or a preexisting embryo (known as embryo adoption) or have their sperm sent on dry ice to the surrogacy agency, only one trip to the surrogate mother’s country is needed—to pick up and bring home their newborn baby.
We predict that global commercial surrogacy arrangements will become a rising trend in developing nations, where the primacy of the developed nation donor’s nationality is protected and costs are not as much of a consideration. Undertaking a commercial surrogacy arrangement in the United States is a legally daunting process that can cost upward of $70,000, compared to India, where it can be arranged with little legal “red tape” for about $12,000, including medical and surrogate fees (Haworth, 2009).
Most laws that regulate traditional surrogacy were established before IVF was a common practice, and lawmakers did not foresee the implications of a future that included gestational surrogacy. Therefore, gestational surrogacy has little or no regulation in many countries (Ben-Asher, 2009) because it was “off the radar screen” for lawmakers, many of whom consider commercial traditional surrogacy “baby selling” (Ben-Asher, 2009).
Surrogacy Arrangements in India
India legalized commercial surrogacy in 2004, and Indian surrogacy is already reportedly a $445 million per year industry (Haworth, 2009). Carney’s (2010) article underscored troubling issues in the Indian surrogacy market. One of the disturbing practices is the routine use of Cesarean sections for the benefit of the paying couple, who can choose a birth date for their child that best suits their desires or needs, and makes it easier on the clinic because it can “schedule” quick deliveries. In one case, a young mother died after the Cesarean section, and her husband asserted, in the article, that his wife was denied adequate postnatal care by the physician who managed the private surrogacy clinic. The article reported that the young woman was left to die as her husband begged for care in the public medical sector. In contrast, the article also profiled happy customers who quickly returned to the United States with healthy infants.
Another cause for concern is the process that is used to recruit Indian surrogates. The would-be surrogates are impoverished, often illiterate, women who are recruited from rural villages. They are brought to the clinics by “head hunters,” calling themselves social workers, and are required to stay in the clinic’s living quarters in a guarded dormitory-like setting for the entire pregnancy (Carney, 2010). This practice not only allows the clinics to monitor the surrogates’ activities and behaviors during the pregnancy but is seen as protecting the surrogates from ridicule by family members and neighbors; most Indian women who act as surrogates keep it a secret because surrogacy is viewed as dirty or immoral. What is more alarming about the recruiting process is that it is notably similar to the recruitment processes used by human traffickers to coerce rural women into sex work in cities. Also paralleling other trafficking situations, the women have to sign documents (often in English) that they cannot read and are then kept “under lock and key” until the obligations set forth in the contracts are fulfilled (Bromfield, 2010). However, Indian surrogates earn between US$5,000 and US$7,000 plus food, and housing during their surrogate pregnancies, which is the equivalent to about 10 years’ worth of work for rural Indian women (Haworth, 2009); there is certainly no shortage of available women who offer to become surrogates.
In some Indian surrogacy arrangements, especially in cases in which the intended mothers are aged 40 or older, the egg is provided by a “donor,” fertilized with the intended father’s sperm, and then transferred to an Indian surrogate for the 9-month gestation period. Most Indian surrogacy clinics do not allow the surrogate to be a traditional surrogate because of the legal and emotional complications that are involved (van den Akker, 2007). An easy way to avoid these problems is to use the egg of another woman, rather than have the surrogate use her own. Even though two different, non-American women are involved in the creation of the baby, the legal transaction is simple when the child is the offspring (genetically either whole or half) of a U.S. citizen. The American intended parents’ names are listed directly on the baby’s birth certificate, and the American parents exercise a normal route for securing U.S. documents for traveling back to the United States. In other countries, the process is not so straightforward, and there have been multiple cases in which infants who were born through surrogacy arrangements were rendered stateless. Many of these children are genetically linked to Indian genetic/biological mothers, which leads to the need to engage in discourse regarding citizenship, emerging multicultural issues, and human trafficking.
Although not all global surrogacy arrangements are human trafficking cases, the potential for a global surrogacy arrangement to become a human trafficking scenario is startling. Particular concerns about human trafficking are raised when one considers that the latest emergent nation for surrogacy is Guatemala. Guatemala will likely become even more attractive than India to potential customers, especially U.S. citizens, given that it is less expensive and time-consuming to travel to for those who live in North America. However, such a transaction is not simple or without ethical or moral consequences, especially in this socially complicated country.
Implications of Surrogacy in Guatemala
Guatemala is known to have some of the worst human rights abuses in the Western Hemisphere as a result of a number of factors, including civil unrest and a protracted civil war from 1960 to 1996 that has not yet truly resolved peacefully (Recuperación de la Memoria Histórica, 1999). This desperately impoverished nation, which has a significant indigenous Mayan population, which is estimated to be as much as 50% of its total citizenry, was recently determined by the United Nations to have the greatest gender inequality in the Western Hemisphere (United Nations High Commissioner for Human Rights, 2010). This finding was based on a number of variables, including limited leadership of Guatemalan women in the postconflict democracy (Perez, 2003) and attempts to silence women, especially Mayan women, who speak out for social change (Sanford, 2000). In addition and critical to this discourse, Guatemala has the highest incidence of gendered violence in the Americas (Costantino, 2006; Sanford, 2008; see also www.StopFemicide.com), including rape at alarming rates (Fieser, 2009) and femicide. The killings are carried out by men and/or boys to strike terror in the community. Forces of narco trafficking, gang behavior, and other societal-level problems, including familial or domestic violence, underlie this gendered crime (Costantino, 2006; Guatemala Human Rights Commission/USA, 2009a, 2009b, 2009c; Sanford, 2008).
In the global environment of assistive technology and the demand for babies, we contend that Guatemalan women are at risk of human sales of their offspring in global surrogacy schemes—not unlike some of the aforementioned abuses in the ICA system. This is not a new idea. Herrmann and Kasper pointed out in 1992 that women have commonly been called “breeders” in ICA rings, and to exemplify this concept, they provided the following example originally presented by Pastor (1989, p. 19) regarding Honduras: In Honduras, they have paid teenage girls to get pregnant; the merchants then follow the young women throughout their pregnancy to make sure they eat well and receive some kind of prenatal care. Once a baby is born, and if the baby is healthy, the mother is paid $50.00 for the product. This practice is not very different from what we call “surrogate motherhood” in the U.S.; however, it is substantially cheaper.
The term
One Guatemalan Business Model
Little is known about this emerging business in Guatemala, but at least one group, Advocates for Surrogacy, has provided some insights. The following observations are based on the materials posted on the organization’s website (see Advocates for Surrogacy, n.d.) in December 2010, and they serve as an example of the emergent industry. This group began its work as ICA actors in Guatemala. On its website, it claims to be the “first and only agency to successfully complete the surrogacy/passport process through the U.S. Embassy in Guatemala City.” In this same marketing material, it also states that it has “a highly experienced full service team . . . in Guatemala headed up by lawyers who have partnered for many years in international adoption.” Furthermore, the group markets the concept of medical tourism as follows: The idea of deciding to pursue surrogacy in a foreign country may at first seem intimidating; however, medical tourism is a fast growing industry. With excellent medical care available abroad and substantial cost savings, people across the globe are now seeking treatment outside their home countries. Our Guatemalan program offers excellent fertility clinics with well-trained, fully bilingual staff (English and Spanish). Our experienced local program staff led by an attorney will assist you every step of the way upon arrival in Guatemala and throughout your stay with the goal of making your experience a memorable, rewarding and joyful journey to parenthood.
This organization also claims the highest ethical standards of care for surrogate mothers, including a psychological evaluation process, with no details of or attention to the context of oppression in the nation. Specifically, this information—provided in a website marketing pitch—is provided without any mention that Guatemala currently has no regulatory oversight of the process, since the commercial practice is not defined in national laws. There is also no mention of the nation’s horrific track record of human rights abuses and highly vulnerable women. The website reads more like a tourism brochure than an advertisement for surrogacy services, with photographs of scenic landscapes and enchanting indigenous people. It presents Guatemala as an ideal location for surrogacy activities and services and invokes a tone of positivity for all involved in the transaction.
Finally, the fact that this surrogacy business is managed by attorneys who previously worked in the ICA sector is not surprising. Because some of the attorneys became millionaires during the adoption baby boom (Rotabi & Bunkers, 2008), they would easily have the resources to begin medical tourism as a business, and the birth-mother recruiters who worked with them (Rotabi & Bunkers, 2008) would be well suited to carry on the necessary activity of identifying women to become surrogates. From a macrohistorical perspective, this scenario is consistent with repetitive structures of oppression in Guatemala.
It should be noted that no formal ethical or legal violations are known about this particular group. This business example is offered to stimulate thought without any particular evidence of specific wrong-doing on the group’s part.
Choosing the Lesser Evil in Guatemala
Surrogacy is a way for poor Indian women to engage in the global marketplace and provide a much-needed service (Pande, 2009). This sentiment was voiced by Oprah Winfrey in her U.S.-based talk show when she presented surrogacy in India as a family-building strategy that offers economic opportunity to impoverished women (Carney, 2010). Pande (2009) presented surrogacy as social care work, called it a “new form of labour” (p. 145), and noted that it is stigmatized in India and thus classified it as a form of dirty work—occupations that are viewed as degrading to the worker, such as janitorial work. Pande’s interviews with surrogate mothers provide insights into the decision to participate in the practice, including some valuable information about consent procedures and the limitations of illiterate women in understanding the surrogacy contract. This issue is a concern that has been raised about surrogates, even women in industrialized nations who have the benefit of education (Corea, 1986). However, the theme of life improvement—including improving the outcomes of the surrogate’s own biological children because of the income source—was clear in Pande’s research, and it is always involved in discussions about commercial surrogacy (Corea, 1986; Markens, 2007).
Inevitably, an “opportunity argument” will be posited in the discourse about the practice in Guatemala. As Costantino (2006, p. 107) stated, Guatemalan women “face globalizing forces that simultaneously further oppress them yet offer new resources in their individual and collective efforts to alter the reality of their lives.” Freedom to participate in a global marketplace is important, especially for poor and marginalized peoples (Hall & Midgley, 2004), including the women of Guatemala. However, some commercial surrogacy arrangements may challenge notions of self-determination (National Association of Social Workers, 1999) or free will and informed consent in the current social and economic environment in Guatemala. As a result, human trafficking actors, including some who were previously involved in irregular and illegal adoptions, operate with impunity in Guatemala. Ultimately, the legal and law enforcement environment is lacking mechanisms to protect women who may engage in commercial surrogacy. As we stated previously, there is no legal regulation of surrogacy, and even if there were, law enforcement is currently impotent in the postconflict nation that is struggling to reclaim peace (Costantino, 2006; Sanford, 2008).
Self-Determination and Free Will in the Context of Human Trafficking
A further examination of the concepts of self-determination and free will, when considering the dynamics of human trafficking, was explored by Jani (2010). Jani specified that women in India may actually choose to participate in a form of sex work (i.e., barroom dancing in their localities) to avoid being trafficked into more nefarious networks of exploitation—including being taken to other nations where the conditions may actually be worse or more dire than their home country. Applying conflict theory, Jani further interrogated the decisions that women make in context, specifically the social structures that oppress women in traditional and impoverished nations with limited economic options. Exploring individual choices, she also considered the theory of exchange, identifying that it as having “derived its roots from an economic theory that suggests the predominant value that dictates economic behavior is wealth maximization . . . The theory explains how women often get trapped in debt-burdens that eventually force them to consent to the proposal of working in the sex-industry.”
Jani (2010) also applied prospect theory, which “was designed to explain how people make choices in situations where they have to decide between alternatives that involve risk . . . [This] theory suggests that people underestimate outcomes that are probable as compared to outcomes that are obtained with certainty.” This idea, a cost–benefit analysis of the lesser evil, is particularly relevant to the population of surrogate mothers in Guatemala and in India as a “choice” to participate in global commercial surrogacy over other more oppressive forms of work, including sex work. To put it bluntly, the choice between 9 months of being well-fed and medically monitored as a surrogate (even if behind lock and key) is far superior to being forced into prostitution internally or trafficked for sex in other nations like neighboring Mexico or beyond, where women face brutal conditions of sex work/slavery (Risley, 2010). To some women, commercial surrogacy is also superior to working in a textile or other factory where the wages are poor and the commute to and from work is dangerous.
Although research has not been formally conducted on this area in Guatemala, applying Jani’s theoretical perspectives, we assert that the extreme oppression of Guatemala creates a vulnerability that requires complex social exchanges for economic opportunity. In a hopeful prospect, some surrogates will choose to participate in global surrogacy. Then, there may be those who do not have an active choice because the “prospecting” is being carried out by husbands, fathers, brothers, or other family or community members (including recruiters) who may entice and/or coerce the women to engage in surrogacy activity.
Although there may be sophisticated psychological tests—as presented in the Advocates for Surrogacy business model–case example—it is hard to believe that all surrogacy businesses will integrate the highest ethical standards when selecting women for surrogacy. This is especially true if the business moves toward an assembly-line approach and baby farming en masse is the outcome. If evidence in India is any indicator, this industry will soon take hold in Guatemala as social entrepreneurs position themselves for the nation’s next “product” for the global economy, which may be worth hundreds of millions of dollars in the next decade. This “demand” for a service and potential for fantastic profits will be a complicating factor for Guatemalan women in making informed choices and ultimately exercising self-determination to “work” as surrogates. Self-determination of marginalized women requires critical thought and action (Green, 2010).
Conclusion
The rapidly growing global surrogacy industry raises multiple ethical concerns that strike deep at our sensibilities about human need, economics, and human vulnerability, including a power imbalance between consumers and surrogate mothers. This situation is complicated because there are few, if any, protective regulations that are aimed primarily at securing the rights of vulnerable women and their children in developing countries where the highly profitable fertility industry has begun to take root and serve the global surrogacy market. With the exception of India, human rights defenders have not yet begun truly or effectively to focus and organize to address this social justice issue. There is a real need to do so because some of the women who are selling their eggs and their bodies for global surrogacy are among the poorest, most vulnerable, and most oppressed women in the world. The power divide among these women, the sophisticated organizations that are developing the services, and the consumers (relatively wealthy couples and individuals) is such that human protections are an absolute imperative (Elster, 2010).
Because of the undeniable demand for healthy babies (Goodwin, 2010), policies must be developed on an international level above and beyond standards created by the private sector. If and when global surrogacy is practiced, it must be done in a safe, honest, and ethical manner for surrogates and egg donors, as well as the couples who purchase the surrogates’ services. An important consideration is the environment in which such an ethical approach can be guaranteed. We contend that a nation like Guatemala is not one in which such a guarantee can be made, given the current human rights context. Some may argue that the nation will eventually be “ready” for such services, especially with oversight, such as an organizational “accreditation” process with international standards for fertility clinics; however, developing such a system will take time and considerable energy. In all likelihood, the forces against regulation will be such that it will not take place unless an international body becomes involved and develops new human rights protections (e.g., international private law) related to fertility technology integrated with an expanded definition of human trafficking to include coerced surrogacy arrangements.
Fundamentally, a charged debate is building, and it is in its early stages, with wealthy actors, those benefiting from incomes related to surrogacy businesses or those who stand to benefit from purchasing surrogate services, interfacing with human rights defenders. Again, this is a power imbalance, and it is imperative for social workers and other human rights advocates to be aware of the global surrogacy market and the risks that may accompany it for all involved—especially the surrogate mothers and the children who are born from these arrangements. Not only are there social justice implications for the surrogate mothers, there can be lasting repercussions for the children as well. It is possible now for a child who was born out of global surrogacy to have a genetic mother, a gestational (or biological) mother, and a legal mother all from different cultures. Children who are the products of genetic mothers from India and Guatemala, who are then brought to the United States by their families, will have no connection, cultural or otherwise, to half their genetic heritage. This situation may result in identity or other issues, similar to experiences of intercountry adoptees (Crolley-Simic & Vonk, 2008).
Globalization and technology are rapidly changing the world (Singer, 2002) and result in consequences that could not have been fathomed when IVF was introduced in the late 1970s (Goodwin, 2010). Social workers have the responsibility to be aware of emerging issues, including global intersections (National Association of Social Workers, 1999, section VI), and global surrogacy demands our vigilant attention.
Debates will unfold and ultimately what will prevail will be telling as we enter a new frontier of fertility and family building. Wants versus needs will become pushes and pulls, and women in developing nations stand to be exploited. However, when the activity occurs in developing or low-resource nations, it will be discussed and marketed as an “opportunity” for women. It is a complex issue, and ultimately we must be vigilant in weighing the real and human costs and benefits in any discourse about opportunity verses global oppression and exploitation (Gil, 1998). The conception of benefit, including women and men who can afford to pay for surrogacy in high-resource nations, overlays limited opportunities of women in low-resource nations. Ultimately, the cost–benefit equation is complex in the globalized economy.
Challenges lie ahead. Nussbaum (2000), in her discourse on sex and social justice, pointed to the fact that the sale of women’s bodies for sex and other activities is a common phenomenon. This point is consistent with the idea that prostitution is “the oldest profession” in the world, and women’s bodies have been sold by many different actors, not just organized criminal networks, but women’s family members in some cases. The self-determination of women who are involved in the sex industry is never simple, and the underlying decision making or inability to consent varies, depending on the circumstances. And poverty is not a simple consideration when analyzing the situation (Green, 2010). The case of surrogacy—the sale of one’s capacity to reproduce—is undoubtedly complex. As a result, global surrogacy practices require immediate attention so that social work can begin to address the issues at hand and develop an ethical response to the inherent and emerging problems.
Footnotes
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.