“The questions that arise from a close look at for-profit surrogacy are fascinating.” | Mosman Library

Labor of Love

Reimagining global surrogacy

“The questions that arise from a close look at for-profit surrogacy are fascinating.” | Mosman Library
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A few years back, women started foisting babies on to me and then wandering away to do something else—take a nap, cook dinner, watch TV. It had been at least two decades since my last babysitting gig—years during which, by most accounts, I had become something of a “bad influence”—so the string of newborns handed over without query or concern surprised me. I’m not terribly good with babies, so it was stressful too, and I’m not that interested in them, so it was also annoying. But after perhaps the fifteenth swaddled squirmball had ended up in my arms, I also began to think it was nice.

Babies, for the three years I lived in a Bengali immigrant community in Detroit, would simply be slapped to my chest like magnets on a fridge. No words were ever exchanged—I did not speak much Bengali, nor the women I lived among much English—but no nonverbal communication ensued, either. In the minds of my neighbors, I came to understand, an agreement existed a priori: adult women in this community care for the young. I resent, still, the gendered aspects of this presumption, but I came to love the combination of trust and freedom it implied. “Welcome to the neighborhood,” the gesture always seemed to suggest. “Here’s your baby.”

It wasn’t just diaper-clad tykes I suddenly found myself polyparenting, however, and it wasn’t only weary toddler-addled adults that expected me to perform the role. During backyard ball games I, the oldest person within shouting distance, was called on to referee—not the game, but the behavior. During long walks with neighbor girls, I was the one to dispense advice on books or boys, which was always dutifully followed, and outcomes reported back. Even kids on bikes from four or five blocks away who wanted to try something risky would, if I were the only adult in sight, ask my permission. Kids I’d never seen before. “I’m not your mother,” I told one, who looked at me blankly.

“But what do you think?” he asked, awaiting approval before I agreed to let him and his friends play at the skate park.

This is, I am coming to understand, one potential outcome of the argument Sophie Lewis has put forward in her new book, Full Surrogacy Now. Calls for the communization of reproduction and the abolition of the nuclear family might terrify in an age when millennials don’t procreate, families are separated at borders, and recent gains in marriage equality seem once again at risk. From what I’ve seen, however, it’s not so much that “it takes a village to raise a child”; it’s that villages are a hell of a lot more fun if residents respect and care for each other as kin.


“Full Surrogacy Now,” the rallying cry, is a radical demand for the dissolution of notions like “biological parents” and their opposites, (underpaid) (hired) (invisible) gestational surrogates. “We are the makers of one another,” Lewis writes. “And we could learn collectively to act like it. It is those truths that I wish to call real surrogacy, full surrogacy.”

It’s not so much that “it takes a village to raise a child”; it’s that villages are a hell of a lot more fun if residents respect and care for each other as kin.

The problem, in Lewis’s view, isn’t that women are risking their lives and paid shockingly low wages to bear the offspring of others, efforts which are considered “generous” instead of “a job,” before being erased from family histories entirely. The problem is that we haven’t spent any time considering what the fact and endurance of surrogacy from at least the transatlantic slave-trade days to the present might say about unwaged pregnancy.

After all, pregnancy is—well, labor. “It is a wonder we let fetuses inside us,” is how the book opens, later launching into a description of gestation as “a job that never stops, dominates your mood, [and] hijacks your blood vessels and sugar supply, while slowly exploding your anatomy from the inside out.” Kristin Luker’s 1984 Abortion and the Politics of Motherhood lays out a legal justification for abortion on the grounds that if someone broke into your house and lived with you for nine months, forcing you at gunpoint to do what a fetus does via biological means, that you’d have the right to kill the intruder in self defense. That anyone pregnifies at all amazes me, but to agree to it for less than six figures and a 401K seems astoundingly dysteleologic.

The call shouldn’t be confused with a demand for remuneration for aspects of human life previously considered natural or normal, some kind of Wages for Housework for the twenty-first century. Indeed, the real pickle isn’t the lack of wages. It’s that pregnancy kills people, and women of color in particular: in the United States they die at approximately three times the rate of white women, the CDC reported earlier this May, noting that the vast majority of deaths are preventable.

For surrogates, the physical risks of pregnancy are only pieces of the puzzle. Hyper-surveillance of gestational laborers, unnecessary vitamin and hormone injections to sync ovulation cycles, in-vitro fertilization, cesarean sections scheduled around medical convenience and the travel schedules of the contractor are all standard. So is boredom. Emotional risks for gestational workers also run high. In some cases the contractor (or contracting couple) may have hedged their bets and solicited two surrogates through the first trimester, one of whom may be asked to abort (which seems a lot to ask of someone in the moment you are also firing them). In some cases, gestational surrogates bond with the fetuses they carry to term, although requests for visitation rights are rarely granted.

Yet the business of contracted pregnancy remains highly profitable. Lewis suggests that commercial gestational surrogacy pulled in around $2 billion globally in 2017. Fees can run $40,000 to $250,000 per pregnancy, most often paid to a clinic or agency. (The gestational worker would receive only a cut of that.) It’s possible that accounting for informal agreements would push those numbers even higher. “Competitive” industries, business models that also respond to difficulties with DIY fetuses—such as in-vitro fertilization and adoption—can be even more expensive per baby. (These industries respectively raked in over $16 billion globally in 2018 and approximately $16 billion domestically in 2019, although this latter number also includes other child welfare services.)

Any close look at the commerce of gestation will eventually lead to questions about where those profits go if pregnant people in general struggle to remain both happy and alive. That is, unless you’ve already noticed how people with uteruses are treated as if disposable in our present global economy.


So why defend surrogacy at all? On this point, Lewis is both extremely practical and surpassingly unusual: she considers what surrogates themselves say. What they say is that they like the work. Occupational birthers have few complaints about pay rate and, more often than not, continue to sign on for more contracted childbirth. Still, many critics find it too difficult (or boring, or a waste of good resources) to try to improve peoples’ lives, and prefer to decry whole industries that employ women as exploitive—awkwardly, in this case, suggesting we throw the baby out with the bathwater.

Crusades against surrogacy have a lot in common with anti-sex work movements; the rhetoric of both boils down to how bad an idea it is to sell the use of one’s body. Of course these arguments are rarely made against industries that rely on masculinized manual labor, like agriculture or professional wrestling. Nor do cries like “Stop Surrogacy Now” or “End Demand” (for sexual services) appear to have any impact on the need for the work to get done. “As with sex work,” Lewis explains, “the question of being for or against surrogacy is largely irrelevant. The question is, why is it assumed that one should be more against surrogacy than against other risky jobs.”

That anyone pregnifies at all amazes me, but to agree to it for less than six figures and a 401K seems astoundingly dysteleologic.

Despite the fact that pesky human bodies are always sloppily lapping over national borders, the forces that stand against this kind of pregnancy have coalesced into a global movement to ban transnational surrogacy. Yet even these restrictions retain ambiguities. In many places where commercial surrogacy is illegal, for example, “altruistic” surrogacy (read: unpaid) is not, including Canada, New Zealand, the UK, India, and Vietnam.[1] In Austria, Norway, and Pakistan, surrogacy of any kind is illegal, although (presumably) other forms of pregnancy are permitted. But what forms, precisely? Those in which no money changes hands under any circumstances? Those in which emotions are stronger than financial ties? If so, which emotions? Fear? Love? Hate? On what scale are they measured? How do pregnancies resulting from rape or incest fit in? Who is equipped to legislate a pregnant person’s purpose in harboring a fetus, the International Pregnancy Police? What punitive powers might they hold, and how would they operate in places like Alabama?

The questions that arise from a close look at for-profit surrogacy are fascinating, and it’s easy to track Lewis’s desire to banish the commerce but retain the practice. It is in the details of her prescription, however, that things get complicated.

For one thing, no clear picture of what full surrogacy could even look like ever emerges, save some criticism of its opposite, supplied by Amazon in the guise of Margaret Atwood’s The Handmaid’s Tale. (Octavia Butler’s “Bloodchild,” sadly, receives no similarly close read.) Of course it’s impossible, full surrogacy, but I’m perfectly comfortable demanding it anyway. But the radical utopic political demands for love and sex in the face of a rising AIDS crisis that came out of the 1980s and 1990s—cultural products to which Lewis seems to refer, if not precisely emulate—always left me with a vague sense of what I could build toward that I craved while reading this book.

As a self-proclaimed “feminist cyborg,” Lewis downplays the role that biology might play in her argument. Genetics aside, any close reading of microbiology suggests that a pregnant person—regardless of how they earn their living—provides the first batch of flora for a fetus, and therefore does, even without a transfer of genes, become a part of the theoretical, perhaps eventual, child. Proximity, in other words, does matter, both in pregnancy and for an imagined future in which surrogacy flourishes.

There’s also some socialist feminist dog-whistling, as in comparisons of the book’s primary case study, Dr. Nayana Patel of India’s Akanksha Infertility Clinic, to Facebook’s Sheryl Sandberg (as in the chapter “Dr. Patel Leans In”) and megarich media executive Oprah Winfrey, without any explanation of why these figures might be objectionable. Admittedly, Patel seems to deserve the comparison, but she’s not examined terribly closely before being subjected to the harshest of criticisms.

Of course, an academic text—this one appears to be based on Lewis’s dissertation—is not likely to provide the in-person interviews that a deeper look at Patel would require, even if Patel were to grant them to anyone lower on the media totem pole than the BBC. I note my discomfort, however, not to undermine Lewis’s argument, but to strengthen it: I believe—as I imagine many gestational surrogates would, particularly those who seek post-partum relationships with the fetuses they’ve carried—that there’s a value in knowledge based on physical proximity.

Most of all, Lewis’s rallying cry makes evident the need for more such efforts. Lewis describes hers as “animated by hatred for capitalism’s incentivization of propertarian, dyadic modes of doing family and its purposive starvation of queerer, more comradely modes,” but what might a demand for “open-source, fully collaborative gestation” look like that was motivated by care and kindness?

And yes, I’ll watch the kids while you write it.


[1] Recent legislation has responded to some of these concerns, particularly in India, although perhaps not completely.

Anne Elizabeth Moore is currently based in Chicago. Her latest book, Sweet Little Cunt: The Graphic Work of Julie Doucet, has just received an Eisner Award.

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