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Critics of surrogacy point to exploitation of poor people and the commodification of women's bodies, issues that are magnified when couples from wealthy nations can order babies from some of the poorest places on the planet. The average daily wage in Nepal hovers around $2. A surrogate typically makes around $3,500, and an additional $1,500 if she has to have a C-section. She might get around $1,000 in tips from the intended parents too. It’s not a huge sum, but it goes far in Nepal or India.
Hannah Giunta, a bioethicist in perinatal and neonatal medicine at Michigan State University, worries transnational arrangements allow people to view surrogacy as payment for a service or product. Giunta points to the lack of a relationship between many surrogates and families as a key concern. “People get hung up on the genetics,” she says, “but the truth is the person who carries your child for nine months, you should have more than a passing interest in them.”
Another question is whether the surrogate really has the ability to decide whether to use her body in this way. “The woman who’s in front of you may not be consenting because technically in her country she’s not able to consent,” explains Giunta. Consent can be especially muddied where cultural norms and social structure limit women’s decision-making ability in the family.
“The risk of exploitation is extremely high among the women from this part of the world, as they are poor, don’t have pre-informed choice, and are not part of any legal agreement that ensures their rights in the whole surrogacy process,” says Bandana Rana, a Nepali women’s rights activist and chair of the Global Network of Women Shelters.
Giunta says women who choose to perform surrogacy in these situations often do so out of desperation.
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Nur Begum was desperate. She was one of several Indian women impregnated before the legal changes in Nepal who waited to give birth at a shelter for Tammuz surrogates (the agency Stephen and Michael used) outside Kathmandu. Married at 10 to a much older man in Bihar, one of the poorest states in India, Begum and her husband later moved to Delhi, where he drove a bicycle rickshaw and she worked as a maid.
Begum’s husband was sick and they couldn’t make ends meet. “One day at work, I found through my friend that if I lent my womb to give birth to a baby who will not be mine in any sense, I could get enough money to support my family,” the 26-year-old says. “There were no other options left.”
Begum doesn’t know the identity of the parents, and she doesn’t want to. “I just want money, give this baby, and go back,” she says.
“Everyone knows about surrogacy in India,” says Lucky, 37, who was recuperating at the same shelter after giving birth to twins for an American couple, her second time as a surrogate. Also a maid in Delhi, she used the $3,700 she earned the first time to pay for her two sons’ schooling, care for her in-laws, and pay her sister-in-law’s dowry, saving her from abuse by her own in-laws.