Surrogacy as Feminism: The Philanthrocapitalist Framing of Contract Pregnancy

Introducing dr. patel

Surrogate pregnancy "is much better work than a laborer, a construction-worker, or a maid"; so said the star clinician Nayna Patel to the English BBC World talk-show host Stephen Sackur during a 2013 episode of HardTalk.¹ Many viewers, of course, possess firsthand experience of performing nonsurrogate pregnancy to help weigh Patel's claim. She herself has gestated two of her own children, decades ago, unwaged and off-camera. But how does "normal" pregnancy compare to the waged labor of being in labor? The sector Patel pioneers is private contract pregnancy, in which—thanks to the laparoscopic technique of embryo transfer—the gestator and the embryo happen to share no DNA, and the commissioning parents pay a fee (over 70 percent of which goes to her clinic).² Thousands of clinicians perform these lucrative transfers and supervise the ensuing pregnancies in the state of California alone. Patel, a doctor based in Narendra Modi's home state of Gujarat, caters to hundreds of couples resident in India. But her clinic has also become emblematic of "medical tourism" in this global infertility care market: a dynamic Amrita Banerjee calls a "transnational reproductive caste system,"³ whereby couples from the global North come to have their gametes gestated by low-income women at the periphery (at a fraction of the California price).

Western reporters tend to sensationalize—somewhat pruriently and with misplaced pity—the "otherness" of the birth-ontology to which Patel plays midwife, choosing for instance to dwell on her exclaiming about a newly glimpsed newborn: "Pure white! Even when the egg is Indian, you can always tell when it is British … European."⁴ One might remark that in another sense, the truth about surrogacy—however uncomfortable for many—is quite the opposite: since "race" is above all a social relation rather than a medical symptom, you can't ever "tell." Nevertheless, "crossracial reproductive tourism" (Laura Harrison's term) is the most mediagenic aspect of Patel's business. But the "technological" model of "kinship construction" parents are buying into here also relies precisely on an interpretation of gestational genetics as guaranteeing no substantive "crossing."⁵ Certainty—the idea that "you can always tell"—is Patel's public message. Indian surrogates, meanwhile, have described their own conceptualizations of the genetic stranger inside them (behind Patel's back) as their own "sweat and blood."⁶

Alison Bailey cautions rightly against the twin dangers of epistemic imperialism and moral absenteeism when regarding this field, especially (as I am doing) from a distance.⁷ The normative problems in discussing marketized reproduction are legion, and the privileging of "tourists" in coverage of Patel is but one aspect that speaks directly to this. Studying that coverage, as such, carries the risk of reproducing a form of occidentalism rather than making it visible. I do not pretend to be certain I have resolved the difficulty. But I join Bailey in trying to think about surrogacy with the goal of reproductive justice in mind, even though I am turning to the dominant voice of the capitalist in this scenario—not to the people who might overtake her from below and spearhead the progressive transformation of currently "stratified" infertility care.

That surrogacy work (transnational or not) can only entrench injustice rather than trouble it is by no means a foregone conclusion. Not only the selective fascination with "race" in this context, but also the invocation of "feminism," as we shall see, can function to mystify or truncate our understanding of what are, in the end, no more and no less than class relations—mediated by Patel. "Domestic" (Indian) commissioning parents are literally never represented in the Anglo-American representations I have gathered and interpreted in this paper. Moreover, local socio-economic contexts barely figure in these accounts: no mention is ever made of electoral tensions in the area, for example, far less the labor struggles of the workers at the clinic or the feminist movement sweeping through streets nationwide. What an Anglophone person (who watches TV) thinks of as "surrogacy politics" might in theory mean any of these things, but in...