How Commercial Surrogacy Became a Massive International Business

In anticipation of the upcoming fourth season of our HBO show, which will premiere February 5 at 11 PM, we are releasing all of season three for free online along with updates to the stories. Today's installment follows up on an episode called Outsourcing Embryos, which investigated the multi-billion dollar industry of gestational surrogacy in India. Watch the episode below:

'Outsourcing Embryos' on Vice HBO

When Rhonda and Gerry Wile had a baby boy in 2009, they did it the new old-fashioned way: with a surrogate. Fertility complications had left the couple in Arizona with few options other than to seek an egg donor and a surrogate, but they quickly learned they were priced out of the market in America, where surrogacy fees can easily soar beyond $100,000 in the seven states where it's legal. So they did what many western couples do: They went to India.

India has become one of the most popular destinations for international surrogacy, where the industry grosses over $1 billion each year: It's relatively cheap (about one-third of the price of a surrogate in America), the medical technology is advanced, and there are an abundance of poor, young women ready to rent out their wombs. But in October 2015, the Indian government announced pending legislation that would ban foreigners from using Indian surrogates or traveling to India on what the government called "reproductive tourism." Within a month, the country's Council of Medical Research had instructed fertility clinics to stop offering embryo transfers to foreign couples; Indian embassies had stopped granting visas for non-Indians looking to make a baby abroad.

Commercial surrogacy—paying a woman for the service of carrying a pregnancy to term—has always been fettered with legal and ethical debates. In 2014, there were only a handful of countries where the practice was legal. And in 2015, months before India reversed its policy, Nepal, Thailand, and Mexico all banned foreigners from soliciting and using surrogates within their borders.

The impetus for these bans isn't entirely clear: The industry is clearly profitable, and there is no shortage of women signing up to act as surrogates. But the industry has been criticized for cases of exploitation against surrogates, and a series of high-profile cases involving foreigners have caused legal headaches regarding the rights and responsibilities of parents who enter into these arrangements: In 2008, the intended parents of a baby born via surrogate in India split up and decided they didn't want the baby; in 2014, an Australian couple, who had twins born via surrogate in Thailand, took one home and refused to claim the other, who was born with Down Syndrome.

But given the growing international demand for surrogates, it's difficult to just put the genie back in the bottle (or the baby back in the womb).

"There's a global demand," said France Winddance Twine, author of Outsourcing the Womb: Race, Class, and Gestational Surrogacy in a Global Market. "More than 160 million European citizens want these services, but aren't able to access them in their own country. If people can't get this service in India, or in Thailand, they'll find another place."

In 2012, after India passed legislation banning single parents and same-sex couples from seeking surrogates, there was virtually zero effect on the the industry—globally, but also within India. For many would-be parents (like this Israeli couple), surrogacy agencies continued to use Indian surrogates, who they would move to neighboring Nepal in time to give birth. In Mexico, even though surrogacy was legal only in the state of Tabasco before it was ultimately banned countrywide last year, but many fertility agencies operated out of Cancún, then relocated their surrogates to Tabasco to give birth, to skirt the law.

This kind of global whack-a-mole makes international surrogacy difficult to police. Where one market closes, another one opens, to keep up with the demand. Twine expects a burgeoning surrogacy industry to emerge in Ukraine, where egg donation is already incredibly common among poor women; other experts expect to see more surrogacy in Greece, where economic turmoil has left more women without good jobs and where the laws on surrogacy are ambiguous.

There's also the United States, which allows commercial surrogacy in some states, like California. Of the top commercial surrogacy markets in the world, the United States and Ukraine are the only ones not to have passed prohibitory legislation last year.

"Surrogacy in the United States increases every year," said Teo Martinez, the CEO of Growing Generations, a surrogacy clinic based in Los Angeles. Martinez has worked at the clinic for 17 years, during which time over 1,000 babies have been born via surrogates. As of last year, over half of his clients come from outside of the United States.

"If people could do this at home, they would," Martinez told me. Still, he doesn't expect to see the fallout from the 2015 bans, because people who go to countries like India and Thailand for surrogates—people like Rhonda and Gerry Wile—do so because it's cheap. "If you can only afford, say, $60,000 and that's the cost of a surrogate in India, you're probably not going to be able to afford $100,000 to $200,000 in the United States."

Still, the demand isn't going anywhere, especially as surrogacy becomes more widely publicized. Leslie Morgan Steiner, who introduced Rhonda and Gerry Wile in her 2013 book The Baby Chase: How Surrogacy Is Transforming the American Family, told me that reproductive technology landscape has changed drastically in the three years since her book was published. "When I wrote the book, nobody knew about egg freezing, nobody talked about surrogates, and uterine transplants were still extremely experimental," she said. These kinds of technological advancements further the idea that "everyone who wants a baby deserves one," which in turn fosters the demand for surrogates.

"There's always going to be more people who want a surrogate than those who are wiling to carry a baby," said Martinez. "There are a number of surrogacy agencies [in the United States] that have no available surrogates, and that's becoming the case more and more. So we'll have to see how this demand plays out."

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Of course, nobody should be economically exploited in order to meet the demand—but banning foreigners from using surrogacy services doesn't exactly solve the problem.

"The industry works the same whether it's foreign clients or Indian clients," said Sharmila Rudrappa, a sociologist at the University of Texas at Austin and the author of Discounted Life: The Price of Global Surrogacy in India. "It seems a bit xenophobic to blame foreigners rather than think through the practice of the industry."

Rudrappa has studied surrogacy in India extensively, and found that while the conditions for commercial surrogates vary per city and agency, the national regulations are specifically designed to support surrogates. "The impetus for legalizing commercial surrogacy [in 2002] was so that women would actually be able to get payment for it," she explained. Before then, "richer families could coerce their maids or poorer relatives to have babies from them and say, 'Look, we're taking care of you financially.' Commercial surrogacy was really the way by which to see that women actually got a fair wage for these services."

And although India is framed as popular destination for western couples seeking surrogates, Rudrappa said only about ten or 15 surrogacy clinics specifically work with international couples. Those clinics, which are situated in bigger cities like Bombay, Delhi, Anand, may lose their international clientele, but she says it will hardly make a dent in the industry at large.

Rudrappa's research also shows that, while hardly a glamorous job, many women specifically seek out surrogacy for its economic opportunity. And because there's no international consensus on surrogacy, its ethical and legal problems skip from country to country.

"It would be fantastic to have an international consensus [on surrogacy arrangements], not just because you could protect surrogate mothers, but because it's very important for the children who are emerging out of these arrangements," said Rudrappa. Numerous high-profile cases have shown confusion over who has parental rights of the child, and to which country the child should be granted citizenship.

"If you think about how much money's at stake here, the fact that [the industry is] unregulated, it breeds a lot of unethical behavior," said Twine. "Even if you're against surrogacy, this industry is not going away. So how can we create an international consensus to make it more ethical?"

As for the Wiles, their son will turn seven this year. Rhonda Wile, who had begun working on behalf of Surrogacy India, the agency that connected her with her Indian surrogate, told me she's saddened by the new legislation. If she hadn't had her surrogate, she says she probably would've remained childless—an alternate reality that she acknowledges, but doesn't elaborate on, as though motherhood has made this a possibility she can't quite wrap her head around.

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