Although surrogacy has existed since ancient times, it does not seem to have been a popular practice among childless couples to formally seek out a surrogate, until medically advanced techniques were introduced, which did not require the actual consummation of the sexual act. Artificial insemination opened the way to traditional surrogacy, where the surrogate mother, who is also the genetic mother, is impregnated with the sperm of the intended father. Similarly, when gestational surrogacy was introduced, it gave hope to the intended parents to have a child, as a couple, who was biologically their own. In gestational surrogacy an embryo is fertilized, known as in vitro fertilization (IVF), from the intended parents and implanted into the surrogate mother who, then, gives birth to the child for the intended parents. Despite the advances in medical technology that have made surrogacy a successful alternative for couples to have children, it remains an ethically complex subject. While on the one hand it can be commended for the altruistic motives it facilitates, on the other hand it can also be condemned because of the potential for malpractice, not only because of possible mistakes by medical personnel but especially because of its commercialization. One wonders how much mismanagement and manipulation have contributed to making surrogacy a Global industry involving billions of dollars. Surrogacy is not an accepted procedure in many countries, although some are more lenient towards altruistic surrogacy, others strictly prohibit commercial surrogacy. India is increasingly becoming a sought after country for surrogate mothers, and it is a fast growing business.
 Surrogacy was legalized in India in 2002, though it became popular in 2003 when Dr. Nayna H. Patel, from Gujarat, India, successfully delivered a surrogate child through gestational surrogacy using the genetic grandmother as a surrogate mother. It has now given way to transnational surrogacy in India, where affluent couples and individuals seeking genetic offspring are being drawn to the practice of surrogacy. In this article, I discuss surrogate motherhood in general while focusing on socio-cultural and ethical matters related to “surrogacy in India.” My approach to “Surrogate motherhood in India” is based mainly on the stories of surrogate mothers, and the critical issues that emerge from those stories. Some of the questions that emerge from those stories are: What is attractive about surrogacy? How does Indian culture treat surrogate motherhood? What are the pros and cons of surrogacy becoming increasingly popular in India? Why and how is that it becoming popular in India, even though it is not traditionally a culturally appropriate practice because it is seen as motherhood happening outside of the boundaries of marriage)? And finally, can surrogacy be affirmed ethically and theologically? Why, or why not?
 Surrogacy could certainly be used to serve altruistic motives, like to help couples who desperately want their own child, offering them a priceless gift and the possibility of happiness. With this as the backdrop, it must be understood that there are healthy and not so healthy possible arrangements between the intended parents and the surrogate mother, even when the surrogate mother is seen as the “giver” of a priceless gift to the intended parents. For instance, Kristin Fabis, writing from the context of the United States, says:
 Words can't describe how I felt when I saw the intended parents catch the first glimpse of their newborn son - nor can they describe the completeness I am sure they felt that day. I am incredibly honored to have been able to help them achieve their dream of bringing a child into this world with gestational surrogacy, and am filled with such happiness every time I get an update or see a new picture of him. There truly is no greater gift a woman can give.
 In the above words, Kristin Fabis considers herself mainly as a “giver” although it is not clear if there was compensation given to Fabis. Even though surrogacy is essentially a giving, fulfilling, and priceless act on the part of a surrogate mother, thus essentially altruistic in its motives, this privilege of feeling as “a giver” is articulated and emphasized in some contexts, but is taken away in other contexts such as India, where a surrogate mother is simply left with a feeling of being just “a receiver.” Surrogate mothers in the first world often seem to speak about the surrogacy experience as a choice, a calling that gives them a sense of fulfillment, and thus enjoying the experience as a giver. For instance, Ivy MaCurtin says,
 I felt so privileged to be able to do this, and in a way I felt kind of like a voyeur into the happiness of another couple — but also I felt in a very real way that I had made their happiness possible. It was a very different feeling from having my own child — I felt like I was simply returning the baby that they had given me to care for nine months. I experienced no sense of regret or “giving up” something. I just felt that I had fulfilled a wonderful responsibility, and there was satisfaction in that.”
 In both Kristin Fabis’ and Ivy MaCurtin’s story there is a clear joy and sense of fulfillment in their experience of surrogacy, which is an indication that there is a privileged status in their experience as surrogate mothers. Thus it is empowering and affirming for women to a large extent. However, there is a clear paradigm shift when it comes to commercial surrogacy in an Indian context. Surrogate mothers from India have a different experience. Apart from the commercial element, if there is gratitude, it is often apparent that they are grateful that, because of surrogacy, they were able to buy a house, or give their children an education, or pay off debts, so on so forth. For instance, Madhu Makwan, an Indian surrogate mother who has been a surrogate for a Canadian couple, affirms how this surrogacy has changed their lives for better in terms of finances. There is a sense of gratitude on the part of Madhu. She says to the person interviewing her that she would like to say “thank you,” and that she does not know anything else to say in English, and she continues, deeming it as an employment opportunity as opposed to the feeling of “fulfillment or joy” as in case of Kristin Farbis and Ivy MaCurtin." When one compares and contrasts the stories of Ivy MaCurtin and Madhu Makwa there is a clear indication in the shift of a perspective, and how their contexts influence their perspective even though both women participate in the same act of surrogacy. As a person who has witnessed poverty at different levels, it is not a surprise that Madhu Makwa sees surrogacy as an opportunity rather than a sacrifice on her part, as her material needs are so intense that she has no luxury to treat her body any different than merely a commodity that can be used to make ends meet.
 Women’s rights activist Rajana Kumari, raises an important question when she asks that if someone needs a child why not someone close to them offer a womb to carry the child for them, and why should it be poor women? From the perspective of a cultural critic, functioning both as an insider and as an observer, it is concerning that there is a huge possibility for the poor women involved that serve as surrogates to be exploited. This happens in mainly two ways: first, by treating them as if they were providing cheap labor instead of helping in the creation of a human life. This is exacerbated by the unfortunate fact that many of these women are illiterate and do not really understand ahead of time what it takes to be a surrogate mother. As mentioned above, from their perspective, it is often seen as an opportunity to earn some income to satisfy their needs. Second, given the oppressed status that women suffer in Indian patriarchal society, these women may be forced into surrogate motherhood against their own choice, and moreover, may not even have the opportunity to be the decision makers on how to use the money that they receive from their work as surrogates,. In this context Indian society is largely influenced by shame and honor dynamics, and one of the strategies in shame and honor societies is keeping secrecy in order to safeguard the family’s privacy. As a cultural critic I cannot help but become suspicious about how that secrecy helps hide the real status and the lack of rights of surrogate mothers in those circumstances. These women who are involved in surrogacy are by and large in a very precarious and vulnerable situation, as we shall see below.
 To recapitulate, surrogate mothers in India are typically poor, mostly illiterate, using surrogacy as a step up opportunity to improve financial status, while either being mostly unaware or in denial of the risk factors that are involved in surrogacy. Even if it is a choice of a woman to be a surrogate mother, she is still forced into taking up surrogacy to financially support her family, if not by people by her social condition of poverty. While it is temporarily empowering for a woman to be able to earn money and help out her family, her reproductive ability is simply objectified for commercial reasons. A surrogate mother is seen as a baby career or an “artificial womb,” resulting in her losing her dignity to be treated as a person. All through history women have been treated as sexual objects. In commercial surrogacy they are endangered as they become objectified for commercial purposes also. Thus, the altruistic notion of surrogacy is completely taken away from surrogate mothers in commercial surrogacy, especially when a surrogate mother lives in poverty. In the so called first world, surrogacy is often treated as a priceless, valuable and virtuous act, while commercial surrogacy can become simply commercial and exploitative. This can be seen, for instance, in the fact that Indian surrogate mothers receive far less payment than the remuneration that surrogate mothers receive in western countries, such as the United States.
 Surrogacy is simply presented as a job opportunity for poor women that will offer quick money in large sums, and thus is seen as a viable, if not altogether attractive alternative. Furthermore, against the Indian cultural understanding of pregnant mothers getting treated with special care, being pampered, if not, completely supported by kith and kin, poor surrogate mothers are expected to move away from home and live in boarding places/hostels. The clinics thus ensure that the product is being nurtured so they can deliver “a surrogate baby” to their customers. The surrogate mothers often leave their families and make commitments to live away from their own children and husbands while living and leading mechanical lives that offer no emotional support. Their hormones, and how they might feel during or after pregnancy are not considered as important in this process, as the commercial element overpowers all other aspects. For instance, Bhavna, a surrogate mother who lives in a hostel for surrogate mothers connected to the clinics, says it is her second surrogacy. She has been living a secluded life, except for seeing those who stop by for periodic checkups, and is looking forward to receiving her check and being done with it. In India, these business places are called “baby factories” simply bringing this down to mere “production” and “delivery of the product” for which laborers simply labor. The dignity of human life and the lives of women is at stake, starting with the words and the language that is being used. In 2002 surrogacy became legal in India, and since then it has been a prospering industry, especially with the affluent west bringing business for the reproductive clinics. Baby factories in India are essentially a business industry that is concerned only about the end product and the profit, and delivering good customer service to the intended customers. Maulik Modi, a father to two children born via IVF, says the Indian system “is literally like a machine factory, for lack of a better word.” He says it’s nearly impossible to connect with the surrogate: “You’ve been shut out from the emotional aspect of it all. It’s probably one of my biggest regrets in life that I have my two IVF children and I never met the surrogate or the donor.” The agencies and intermediaries control the whole process, and they take advantage of language barriers and other hindrances to manipulate the system; the surrogate mothers can be accessible for cheap prices even though agencies charge high amounts from the intended parents.
Surrogacy and Risk Factors
 In India motherhood is traditionally considered a most precious gift from God and is deemed the most fulfilling experience in the life of a woman. Motherhood is also measured as a second birth for a woman, keenly aware of the amount of risk involved in childbearing despite medical advancement and assistance. Just as motherhood is risky, surrogate motherhood is also risky and may have severe complications despite the medical assistance and care that they may receive. Such care is rarely accessible or affordable for them in their natural pregnancies. But then, does the medical assistance assure surrogate mothers a risk-free pregnancy? Consider, for instance, the following case:
 [A] young surrogate named Easwari died after giving birth at the Ishwarya Fertility Clinic in the city of Coimbatore. A year earlier, her husband, Murugan, had seen an ad calling for surrogates and asked her to sign up to earn the family extra money. As a second wife, Easwari was hard-pressed to refuse. The pregnancy went smoothly and she gave birth to a healthy child. But Easwari began bleeding heavily afterward, and the clinic was unprepared for complications. Unable to stop Easwari's hemorrhaging, clinic officials told Murugan to book his own ambulance to a nearby hospital. Easwari died en route. The child was delivered to the customer according to contract, and the fertility clinic denied any wrongdoing. But in a police complaint the husband suggested that the clinic had essentially dumped responsibility for his dying wife. The official investigation was perfunctory. (The clinic did not respond to emailed questions for this story.)
 Surrogate mothers are treated merely as “biological objects” that could be used or abused. The potential feelings and emotions of surrogate mothers, their rights and privileges, are completely undermined particularly in India, as law enforcement is handicapped in the Indian context. Unfortunately, and most importantly, though there may be laws to secure the rights of surrogate mothers, they are not often used to the advantage of poor people.
 In sum, in order to understand surrogacy in the Indian context, it must be kept in mind the fact that the woman who is the potential surrogate is trapped in a situation where and when there is opportunity to help out her family, she feels obligated to do all that she can, even to the point of risking her life, so her family can settle down, in order that she will be seen as a virtuous woman, falling prey to the patriarchal conspiracy that has made women see sacrifice to be a virtue especially for women. Although surrogacy can be beneficial to some extent for some women and under certain circumstances, it is a considerable fact that many surrogate mothers are emotionally deprived, culturally shamed and ethically abused in the process of surrogacy. The lack of awareness and understanding of their rights as surrogate mothers makes them vulnerable to the manipulation of the surrogacy agencies, and also because of the systemic handicap in law enforcement securing rights for the people in lower classes and the marginalized. If something goes wrong, the surrogate mothers, who are poor and marginalized, bear the brunt of an Indian system that treats them as mere objects or tools that carry a surrogate baby, a product needing to be delivered in good condition. Thus, from the perspective of surrogate mothers from India, commercial surrogacy is operated in unethical conditions, even though one might argue that they are better off after their surrogacy. Surrogacy may offer incidental betterment temporarily, but it does not offer an opportunity for empowerment for women. Thus women experiencing poverty are used and abused in commercial surrogacy in India to run the industry that is primarily commercial and corporate in its nature, even though incidentally there are benefits to some in the process.
Surekha Nelavala is a Rostered leader of De-Md Synod, ELCA, serving at Global Peace Lutheran Fellowship, a mission site and at Harmony Community Lutheran Church.
[] Australia, Hungary, Canada, Hong Kong, New Zealand forbid commercial surrogacy but allow altruistic surrogacy. Many states in the United States allow surrogacy with strict laws enforced. Similarly Israel, for instance, allows surrogacy but the all procedures must go through the state. Some countries like Finland, Saudi Arabia, Spain and Pakistan consider surrogacy illegal, whereas India, Ukraine, and Russia legitimized surrogacy opening the door to reproductive tourism.
[] http://surrogacylawsindia.com/legality.php?id=%207andmenu_id=71 (Accessed, May 20, 2015).
[] See Amrita Pande, “The Power of Narratives: Negotiating Commercial Surrogacy in India” in Globalization and Transnational Surrogacy in India: Outsourcing Life, ed. Sayantani DasGupta and Shamita Das Gupta (Plymouth: Lexington Books, 2014), 87-106.
[] http://www.conceiveabilities.com/surrogate_story.htm (accessed April 15, 2015).
[] See for instance, http://www.conceiveabilities.com/surrogate_story.htm (accessed April 15, 2015).
 http://www.artparenting.com/surrogacy-story.html (Accessed May 20, 2015)
[] See http://www.cnn.com/2013/11/03/world/asia/india-surrogate-mother-industry/ (Accessed May 18, 2015).
[] Indian society is a combination of contradicting factors all existing at the same time. On the one hand one can witness Indian women well respected and honored, and on the other hand treated in a demeaning ways, exploited and oppressed. The point here is to present specific cases of the possibility for exploitation rather than offer a general sociological overview of women in Indian society. However, for a general and critical understanding of women’s status in India, see, http://www.bbc.com/news/world-asia-india-17398004, (accessed May 24, 2015), Pamela S. Johnson and Jennifer A. Johnson, “The Oppression on Women in India” in Violence Against Women, Vol. 7 No. 9, September 2001, 1051-1068. These articles just references for instance to provide general information about women’s status in India, while arguing in the context how there is a possibility of women to be forcefully be led into surrogacy and could also be exploited, as many women face gender violence and exploitation.
[] https://www.bu.edu/wcp/Papers/OApp/OAppOzol.htm (accessed on May 23, 2015), also see https://web.duke.edu/kenanethics/CaseStudies/BabyManji.pdf (accessed on May 23, 2015).
[] http://www.iaac.ca/en/commercial-surrogacy-in-india-exploitation-or-mutual-assistance-4 (Accessed on May 23, 2015).
[] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531011/ (Accessed May 22, 2015). For detailed information on structure and procedures of commercial surrogacy in India, see also, http://www.iss.nl/fileadmin/ASSETS/iss/Guests/Adoption___surrogacy/Publications/Amrita_Pande_Pub.pdf (Accessed on May 20, 2015)
[] http://www.conceiveabilities.com/surrogate_story.htm (accessed April 8, 2015).
[] Sayantani DasGupta and Shamita Das Gupta, “Introduction,” in Globalization and Transnational Surrogacy in India: Outsourcing Life, ed. Sayantani DasGupta and Shamita Das Gupta (Plymouth: Lexington Books, 2014), xi.
[] http://www.thedailybeast.com/witw/articles/2014/03/01/the-rent-a-womb-boom-is-india-s-surrogacy-industry-empowering-or-exploitative.html (accessed April 27, 2015).
[] http://www.motherjones.com/politics/2010/02/surrogacy-tourism-india-nayna-patel (accessed April 8, 2015).
© June 2015
Journal of Lutheran Ethics
Volume 15, Issue 6