The latest trend in medical t ourism is surrogate motherhood by Indian women, and reports say that ethical problems include the reinforcement of the local caste system.

Not only are women in the developing world attempting pregnancy for the benefit of client parents in the West, the $200 million-per-year industry has brought dramatic changes to a handful of unskilled poor women, without bringing fundamental changes to their countries’ social structure.

The development has been covered in the United States by CBS and the Los Angeles Times . In Canada, the July 2 Maclean’s magazine cover story documented numerous concerns with one particular practice in Anand, India. But the editorial in the same issue used the troubling facts uncovered in the report to call for reform of Canada’s statutes: “Commercial surrogate contracts of the sort negotiated in India are an important expression of free choice between informed adults. They fulfill a modern need in a civilized way to everyone’s advantage and ensure a loving, stable environment for the child. Canada’s unsatisfactory law on surrogate pregnancies should be reformed to provide these same benefits at home.”

In Canada, the 2004 federal legislation is considered weak by both proponents and opponents of artificial reproduction, since it offers little or no protection to the baby or to the parties involved. Domestic surrogate mothers can legally be compensated with undefined “expenses,” which tend toward the sum of $20,000.

In contrast, surrogates at the Kaival Maternity Home and Surgical Hospital in Anand, India are paid much less – between $3,900 and $6,500, a wide range that depends on their caste status. The fees can be supplemented by grateful client parents.

The hospital is headed by obstetrics and infertility specialist Dr. Nayana Patel.

Since her start in 2003 with a 44-year-old grandmother acting as surrogate, Patel has moved on to a bustling commercial practice. To date, over 70 surrogates – many of whom attempt repeat contracts – have attempted pregnancy for couples from India, Europe, North America and other parts of Asia.

The surrogates are paid only if a baby is born, not for the time and risk if the baby dies at implantation or later in pregnancy. What seems like cheap labour to clientele in developed countries represents many years’ wages for the contracted women. Patel is portrayed as casual about medical confidentiality and shrewd in her recruitment of labour, yet generous in her life-long medical care of former surrogates.

Patel prefers her labourers to have children of their own, so that they are more likely to part with the baby once delivered. Maclean’s featured a photograph of one woman who has already been a surrogate once and is preparing to try again. She was posed with her back turned to her husband and children, one of whom appeared to be crying while looking at the mother. The role of surrogate is considered shameful by the local culture and the labourers live in residence for several months to hide their circumstances from their extended families.

Pro-lifers oppose surrogate motherhood on many grounds. It involves in-vitro fertilization, which disrupts the marital bond in both families; requires masturbation by the father; endangers the health of the client and contracted mothers, risks the life of the transferred child; and involves the death of discarded and miscarried embryos. Further, it harms society through the commercialization of a natural process and exploitation of contracted mothers and discourages authentic care of fertility, as well as adoption. There is precedent for limitation of the practice on moral grounds alone –   on religious grounds, Israel denies surrogacy between family members.

Even non-prolifers have raised numerous objections online. A group blog entitled “The Liberal Avenger” featured a typical reaction:

“I find the ethical implications of this very interesting. In regards to being a surrogate, are prospective parents paying for the baby itself or paying the woman for her service or paying a kind of insurance policy for the woman in case of an unexpected event (death)? Or is it all of the above? In any case, it seems clear that the people who are going to India for this ‘service’ are doing so for financial reasons. Ya might say this ‘outsourcing’ seems to ‘cheapen’ the entire ‘life- giving’ experience.”