Labor in Both Senses of the Word

Wombs in Labor: Transnational Commercial Surrogacy in India
By Amrita Pande
New York: Columbia University Press, 2014, 272 pp., $28.00, paperback

Reviewed by Rajani Bhatia

As the first in-depth, ethnographic study of labor within a commercialized, transnational market for gestational surrogacy, Amrita Pande’s Wombs in Labor is foundational. Pande began her research during an extraordinary moment, at the inception of the use of assisted reproductive technologies (ART) in the global South and across borders. In 2006, when she started her study, there had been only ten surrogate births at her field site, a clinic in a small Indian town. However, the phenomenon was poised to become a media spectacle in the West. Ten months after Pande’s first visit, an episode of Oprah Winfrey’s television show oversimplistically portrayed would-be parents from the US as “brave missionaries” and surrogates from India as lucky lottery winners. Prompted by this distortion, Pande returned to the field twice more to gather data, in order to tell a different, more nuanced and grounded story. Eventually, she conducted extensive interviews with “52 surrogates, their husbands and in-laws, 12 intending parents, three doctors, three surrogacy brokers, three hostel matrons, and several nurses,” during three visits between 2006 and 2011. These conversations revealed the mundane, everyday aspects of this form of labor, which were absent in media stories about “renting wombs.”

Pande’s narrative covers the experience of surrogate labor from recruitment through the establishment of pregnancy; day-to-day life in a hostel during gestation; and birth. Conducting follow-up interviews with several surrogates years post-partum enabled her to assess long-term effects. On its own, a scholar’s exceptional access to the lives of women serving as gestational surrogates, from the market’s inception to its current boom, would promise a richly descriptive account—but the book’s real strength rests with Pande’s analyses. She contextualizes details, invoking meaning in relation to scholarship on surrogacy stemming from global North contexts such as the US and Israel, as well as from feminist theorizations of reproduction, inequality, and globalized regimes of labor, power, and resistance.

Pande frames her study using the concept of labor, but not in a way that automatically condemns surrogacy as objectifying women as wombs or babies as commodities. Rather, she views surrogates as laborers and producers, which enables her to transcend a binary that would cast her study subjects either as agents or victims. Like other recent ethnographers of reproductive practices, she distances herself from the morally definitive condemnations of surrogacy in previous feminist theorizations. For Pande, such arguments assume children are priceless and childbearing is sacred, and ultimately reinforce what she calls “gender-based dichotomies—private/public, nature/social, reproduction/production, and non-market/market.” Instead, she focuses on “how a labor market for wombs is created and how laborers experience this market.” However, she in no way ignores the exploitative aspects of surrogacy across divisions of race, class, and national citizenship.

Attuned to the ways in which some feminist critiques of surrogacy reinscribe an orientalist discourse of “third world women” victims, Pande depicts the surrogates’ everyday resistance strategies, as well as their multiple effects: what she calls “the puzzling dual nature or the aporias of resistance,” which “complicate notions of domination and subversion.” For example, surrogates counter their “disposability,” as workers and as mothers, by resisting the idea that they engage in immoral, “dirty labor”—distinguishing surrogacy from sex work or selling one’s children. Pande points out, however, that this kind of boundary work relies on hegemonic ideas about “women as selfless, dutiful mothers whose primarily role is to serve the family.” This kind of analytic scrutiny, which simultaneously identifies and critiques minute and multiple forms of resistance by the surrogates, who must negotiate layers of oppression within the family, the clinic, and the state, stands out as the strength of this work. Indeed, the surrogates’ resistance, in both body and mind, constitutes the “work” or “labor” at the heart of Pande’s study. It is the glue that binds the story together.

Pande contextualizes surrogacy against the backdrop of an aggressively antinatal state characterized by high surveillance of women’s fertility combined with a low rate of medicalization of pregnancy, especially for poor women, whether they are rural or urban. She characterizes the recent boom in ART as a paradox, given India’s history of population control. Yet, I wondered whether the assumption of paradox might inhibit the apprehension of structural mechanisms that reveal compatibility (rather than irony or contradiction) between pro- and antinatalist mechanisms of reproductive control. After all, during the latest phase of population control in India, the already low average age of sterilization continued to fall from 27 years (in 1992-1993) to 25 years (in 2005-2006), according to National Family Health Survey data (reported in International Perspectives on Sexual and Reproductive Health, 2012). Hypothetically, during a woman’s reproductive lifespan, she could first comply with her family duty to produce children, then with the state’s imperative of permanent family planning—yet still be young enough to provide viable eggs or a womb to the commercial market. Furthermore, the lack of medicalization of childbirth for poor women aids rather than conflicts with the clinic’s informal mandate of cesarean section for childbirth, since most first-time surrogates have likely never had one.

Thus, my interpretation of Pande’s research differs somewhat from hers. Egg donation and surrogacy brokers who have served (or also serve) as sterilization motivators for the state, or nurses who encourage women after undergoing abortion or sterilization to try surrogacy are, in my view, actors within a neoliberal mode of population control—which serves both the state and the commercial market. But my disagreement does not detract from Pande’s perception of paradox; indeed, it highlights the richness of her study, which provides a reliable foundation for a variety of perspectives.

Pande draws on her participant observation at surrogacy hostels, and interviews with doctors, counselors, and hostel matrons, to enumerate the disciplinary mechanisms in force to construct what she calls “the perfect mother-worker.” This figure, Pande argues, is “constantly aware of her disposability and the transience of her identity as a worker and yet loves the product of her transient labor (the fetus) as her own.” The domination of the women’s bodies and minds through counseling and hosteling mold them into perfect surrogates. Throughout the book, however, Pande complicates the view of the hostel as a restrictive, disciplinary space of surveillance. It also serves as shared space among the surrogates, where they form bonds and may even make collective demands for changes in their working conditions.Drawing helpful comparisons with gendered work in global factories, Pande describes mechanisms that naturalize skills (such as positive images of the nurturant mother) and stigmatize labor (such as what Pande calls the “surrogate-prostitute analogy”). These disciplinary techniques keep the women’s labor cheap and under management’s control. Surrogates cannot demand higher wages without facing the stigma of becoming bad surrogates, who are both unfit as mothers and similar to prostitutes.

Ethnographic studies of surrogacy in the global North find that surrogates there often see themselves as angels engaged in divine labor to give the gift of a child. In contrast, surrogates in India tend to view themselves as needy recipients of a God-given opportunity to improve their family’s welfare, while intended parents from abroad see themselves as charitable donors of aid. The extreme gaps in race, class, and national citizenship between global North clients and global South surrogates, Pande surmises, account for the differences in these narratives.

In the conclusion, Pande lays out her conviction that there is nothing inherently immoral about surrogacy, but that surrogacy as it is currently practices exploits and reinforces inequalities, making it undesirable. She rejects the notion of a ban, however, because she believes that would only drive the practice underground. Instead, to improve the rights of surrogates as workers, Pande envisions a national regulatory framework that places the welfare, health, and rights of the surrogate, rather than the interests of the clinics and intended parents, at the center. However, she understands that an improved regulatory framework would not on its own address the huge disparities that lead to exploitation. She reiterates a call for international regulatory principles, as put forth by Casey Humbyrd in a guide to “fair trade” surrogacy (published in Developing World Bioethics in 2009). Pande extends Humbyrd’s vision to demand transparency on three fronts—payment structures, medical processes, and social interactions—to improve the rights and respect the dignity of surrogates and children born through surrogacy.

Pande ends her book with a poignant question: “Do the lives of surrogates, in fact, get transformed?” Her epilogue tells the stories of a few women years after their surrogacy. Comparing their initial aspirations with actual experiences, Pande answers bleakly, if unsurprisingly, that surrogacy is hardly like winning a lottery. Often, surrogacy payments must be used to pay down debts or cover medical emergencies, leading to a repeat cycle of surrogacy for the women and in some cases, for their daughters as well—whose welfare they had intended to improve.

Pande’s extensive research and analysis is poised to have a large impact in both policy and scholarly circles. As she notes in her conclusion, policy proposals to regulate surrogacy seem, thus far, uninformed with respect to the actual working conditions and needs of surrogates in India. Her access to this highly visible site of transnational surrogacy will undoubtedly serve as a foundation for emergent scholarship on reproductive technologies in global South settings. Forthcoming studies on surrogacy from other regions of India, such as one by Sharmila Rudruppa, are already anticipated to diversify this area of literature. However, the value of Pande’s work stems not merely from her extensive and careful research nor even from being at the right place at the right time. Rather, by insisting on labor as a frame for reproductive activity, Pande has skillfully refused to allow the so-called production/reproduction dichotomy to limit her interpretation, as she extends theorizations of globalized regimes of labor as well as of reproduction.

Rajani Bhatia is an assistant professor at the Department of Women’s, Gender and Sexuality Studies at the State University of New York-Albany. Her research interests lie at the intersection of reproductive technologies, health, bioethics, and biomedicine, with recent work on the transnational dynamics of sex-selection practices.

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