TV Review: House of Surrogates

I'm not sure how a television documentary manages to be
saddening, heartwarming, uplifting and worrying all at the same time. BBC
Four's House of Surrogates, which focused on one provider of paid-for surrogacy in India, where all the women acting as surrogates for one Gujarati clinic
spent 'their pregnancy away from home in dorms', managed it. I'm guessing the
programme was designed to provoke strong reactions among viewers — and it
certainly did, though I'm not sure all those it provoked in me were the ones
sought.

The title doesn't do the programme justice — from it, I was
expecting more of a focus on the horrible daily lives and grind of Indian women
confined to dormitories while they farmed out babies for Westerners in a kind
of re-imagining of a global Handmaid's Tale. But while there was some focus on
the actual 'house of surrogates' (a 'hostel' where women stay pre- and
post-embryo transfer, and then for the period of their pregnancy, if this was
achieved), the women there seemed happy with their lot, well-treated,
comfortable and looked-after in more ways than one — even if they were (in the
words of some women) a little 'bored'.

Around 100 pregnant or potentially pregnant women can be
housed in the hostel, which is attached (commercially not geographically) to a
clinic run by Dr Nanya Patel - obviously a very successful woman and one I didn't
really expect to like. Surrogates receive on average $8,000 of the clinic's
$28,000 fee — a life-changing sum for her and her family. There are rules: a woman
must already have her own children, may only be a surrogate a maximum of three
times, must stay in the hostel, take her vitamins and enforced rest while
pregnant and — crucially — must hand over the baby. For women where embryo
transfer is not successful, $75 would still be paid. If miscarriage occurs
before three months: $600. If between three and six months: $1,200. After six
months 'whatever happens', the full sum is paid. The interviewer asked 'what if
there are abnormalities?' Even this is taken care of — Dr Patel answered: 'the
contract says that even if handicapped the couple has to accept the baby. The
surrogate has no duty towards the baby'.

So, in among the chaos of daily life in an Indian city,
the whole arrangement is very business-like and organised. Commercial surrogacy
in India is worth an estimated annual £1 billion, so the clinic here was just
one of many such centres. Even the taxi driver at the beginning of the
programme knew that couples came from England, Australia, Africa, Germany… and
we saw or heard of others too, from Canada, the USA and Japan. Which means — as
I already knew — that there is widespread demand for the service offered.

Many of the prospective parents were desperate — none were
what would be called young, and the oldest new mother was 53. All had difficult
fertility histories and evidently, surrogacy was their last resort. I'm pretty
sure that has to be the case —why else would a couple from a part of Australia
where commercial surrogacy is criminalised go to such lengths? Why would the
Canadian woman who assumed, along with her husband, that they would have loads
of kids, who then embarked on a 31 year journey- failing at every step, end up
here? Especially as she had to stay in India without her husband for four
months after the birth of the child while the baby's documentation (to enter
Canada) was sorted out.

So what was saddening? Much of it, but not necessarily the
parts I expected. Obviously, some of the prospective parents' stories were sad,
as were some of the problems encountered after the babies were born and
arrangements being made to take them to the countries in which it is intended
their lives will be. And it's sad that it comes to this — desperate people
travelling the world to get the children they so badly want. And it's sadder
still that the reason for this is largely down to cost, or the avoidance of
home law that prevents them doing this an easier way. What I had expected to be
saddened by was the notional or explicit exploitation of hundreds of Indian
women living in poverty and forced into this 'house of surrogates'. While there
was a little evidence of this (e.g. a small hint of a woman's back-story of an
abusive and feckless husband), it wasn't the general picture conveyed. I also
expected lots of heart-wrenching moments when it was clear surrogates didn't
really want to go through with it. But again this wasn't overwhelmingly
apparent — most seemed to be focusing on the practical side and what it would
mean for them and their families afterwards. Lots of them expressed a desire to
change their own children's lives. One surrogate, who was sad the baby was
(eventually) taken away, had in fact — bizarrely in my view — been employed as
that child's nanny (including nursing) for months after he was born, so had
spent lots of time with the child, getting to know him.

So what was 'worrying'? Well, actually, the thing I worried
about most was the ease with which one intended mother persuaded the clinic to
transfer two of the five blastocysts that had been created with her eggs and
her husband's sperm into the surrogate, not one, as Dr Patel first suggested. I
don't know if that means I've just become hardened to the reality of the
transactional nature of the rest of it or whether, because I already believed
that the intended parents should be the ones who legally become the parents,
that this bit was bothering me less. Still, the fact that you are dealing with someone
else's body, in my view, should mean that their health and safety is uppermost
in your mind (particularly when you would think you would also be concerned
about the safety of any babies being carried) and opting for twins seemed —
when it wasn't your risk to take — a bit reckless and ill-considered.

That leaves 'heartwarming' and 'uplifting': it's not hard to
be heartwarmed when the outcome is happy all round. When the prospective
parents are so clearly happy at the end of their long journey, when the
surrogate has been well looked after in a clean, safe environment while
pregnant, then is able to change her family's life for the better… Even Dr
Patel — who as I said I didn't expect to like — and despite the triteness with
which she dealt with some of the ethical questions posed to her — impressed me.
Her own particular brand of feminism, and her mission to do well by these
women, including providing 'lessons' in embroidery, sewing and beautician
training so they could continue to earn afterwards and by encouraging them to
stand up to husbands and other family members who might demand all/some of
their money was admirable. Though all quite paternalistic, I got the impression
she really meant it — and really wanted to protect these women who she views as
doing a great thing. This was cemented when we saw plans for new future new
clinic/lab/hostel/serviced apartments in one — definitely a one-stop-shop,
where the whole process of the surrogacies — including the 'after-arrangements'
will take place under one roof, and where she intends to employ some of the
women who have previously worked as surrogates.

Don't get me wrong. I know this is a business for Dr Patel,
and for others. I'm not advocating Indian or any other cross-border surrogacy.
I wish there was a better way. But I understand why it's there and why it's not
going to go away any time soon. And on that basis, I hope
that its facilitators are as practically minded and as careful about the
surrogates as Dr Patel is. I do think that everyone should watch this programme
— it was really well made and left me feeling like (at least for one clinic)
they can't have 'anything to hide' if they were prepared for this to go out.
There are still lots of questions about surrogacy, particularly cross-border
arrangements, but given the reality of surrogacy in India, this was no-where
near as bad as I expected it to be.