Why I hate "fertility tourism"

Here is a suggestion for NBC--a follow-up to the planned sitcom "Outsourced": a soap opera/drama/reality-show on the agonies and ecstasies of foreign couples going to India to outsource pregnancy and childbirth.  I can guarantee that this will be one hell of a hit. 

Outsourcing pregnancy, which used to be one of my standard jokes in discussions on globalization and outsourcing stopped being funny when it became true.

The reason for this outsourcing is obvious.  For starters, most people are surprised when they find out that the world's second test tube baby was in India.  For some reason, India's medical and scientific community latched on to fertility issues, even though the country has had no problems with population growth.

Surrogacy in India is, like any other outsourcing operation, about a tenth of the costs in America.  It is a labor-intensive process, and India is full of poor labor--female, in this activity--many of whom would gladly rent out their wombs for money. Commercial surrogacy, aka fertility tourism or reproductive tourism, is a fast growing industry in India.  How big is this?  About $500 million a year ... and growing.

The country’s low cost of treatments, lax regulations governing IVF (In-vitro fertilisation) and ART (assisted reproductive techniques) and women who rent out wombs for a modest fee have spawned a US$445mil (RM1.5bil) fertility tourism business. The industry figures are projected to ratchet up to US$6bil by 2012.
According to the private Indian Society for Assisted Reproduction (ISAR), there are over 500 IVF clinics in the country

I hate this economic activity not because it is highly unregulated, or because of how poor women get could, and do, get exploited, or because of the many different legal complications that are inter-national--such as the first ever "surrogate orphan":

In 2007 the Japanese couple Ikufumi and Yuki Yamada came to visit India's "Surrogacy Queen," Dr. Nayna Patel, founder of the Akanksha Infertility Clinic. A donor egg and surrogate mother was found and the embryo was implanted in the surrogate's womb. Before the child was born, however, the Yamadas divorced and Mrs. Yamada no longer wanted the child, which was not biologically hers. Mr. Yamada wanted the baby but could not adopt it due to an Indian colonial-era law that forbids single men from adopting girls. The absence of regulation meant that Baby Manji became India's first "surrogate orphan" until the father was finally able to adopt her several months, after the Supreme Court intervened.  

 All these are serious issues and deserve our undivided attention.  And, as the writer puts it,

These problems are hardly going to stop the phenomena of surrogacy in India from spreading, though. In fact, one might even suggest that India is moving towards a surrogacy-based economy, in which Indians—in call centers and fertility clinics alike—specialize in substituting Westerners in a cheaper, more efficient way.

I hate it because of how much life is then reduced to the crude material aspects.  The factory-like production of life ... I wonder if those children will have on their bottoms a sticker of sorts that says "Made in India" ... I fear we have already rushed too far and too fast without pausing to think about various ethical issues.   

Now, it might seem crazy and contradictory to the atheist in me.  Yes, aren't we all a bundle of contradictions!

And, soon after the product, er, child, is delivered, the parents begin their search to outsource child-rearing.  More on this from America's Finest News Source:

Report: Many U.S. Parents Outsourcing Child Care Overseas

Lower fertility is changing the world for the better

A couple of months ago, I authored an op-ed on falling fertility rates in India.  The rapid decrease in fertility rates throughout the developing world is news to most of the "regular" crowd though.  (Not so to the readers of this blog, of course; you are some of the well-informed people!)

The Economist has a lengthy piece on it, yet again.  A must read because of the implications that demographic changes have on all kinds of public policies.  The conclusion:

This link between growth and fertility raises awkward questions. In the 1980s the link was downplayed in reaction to Malthusian alarms of the 1970s, when it was fashionable to argue that population growth had to be reined in because oil and natural resources were running short. So if population does matter after all, does that mean the Malthusians were right?

Not entirely. Neo-Malthusians think the world has too many people. But for most countries, the population questions that matter most are either: do we have enough people to support an ageing society? Or: how can we take advantage of having just the right number for economic growth? It is fair to say that these perceptions are not mutually exclusive. The world might indeed have the right numbers to boost growth and still have too many for the environment. The right response to that, though, would be to curb pollution and try to alter the pattern of growth to make it less resource-intensive, rather than to control population directly.

The reason is that widening replacement-level fertility means population growth is slowing down anyway. A further reduction of fertility would be possible if family planning were spread to the parts of the world which do not yet have it (notably Africa). But that would only reduce the growth in the world’s numbers from 9.2 billion in 2050 to, say, 8.5 billion. To go further would probably require draconian measures, such as sterilisation or one-child policies.

The bad news is that the girls who will give birth to the coming, larger generations have already been born. The good news is that they will want far fewer children than their mothers or grandmothers did.

It is no longer the young and the restless in India

I am struck by the profound demographic shift in India—very few children, who seem to be outnumbered by senior citizens.

In the India that I grew up, I recall hearing about only person, among all the extended family and friends, who was more than ninety years old. She was 99 when she died, and I was sad she did not live a couple of more months to reach that magical 100.

I was, otherwise, more used to stories of men and women dying in their fifties. When my grandmother died at 67 years of age, well, that was considered then a long and rich life. Now, my father’s uncle is going strong at 94, with quite a few others in their nineties and late eighties. Against such a background, my mother feels too young to complain about aching back; after all, she is only 70!

Meanwhile, in the India of yesteryears, I was almost always tripping over infants and toddlers. What a contrast now— there are very few children around even in the bustling railway stations, where children crying and their mothers yelling at them used to be a constant background noise.

What happened?

Everything in India, including its population structure, is transforming rapidly. The life span, particularly in urban India, has remarkably lengthened thanks to better nourishment and healthcare. At the same time, parents are having fewer children, especially in the southern states in India. So much so that well into the extended family only one cousin has more than two children—he has three. Most of the rest have only one child, and a few are yet to have any, even after a few years of being married. In some cases, even the only child is an adopted one.

Smaller family sizes are not merely anecdotal; the total fertility rate—the average number of children per woman in her childbearing years—in the peninsular India is less than the roughly 2.1 per woman needed to replace the population. In Tamil Nadu, which is where my parents live, the fertility rate is about 1.8. The other southern states of Kerala and Andhra Pradesh also have similar low fertility rates.

I suspect that the fertility rate in the metropolitan areas of these states is considerably lower than 1.8. Such low fertility rates translates to fewer babies, which is why I feel like I have experienced a lot more crying babies in the airports in America, where the fertility rate is 2.1.

The fascinating aspect to this story of decrease in fertility rates is that it has happened without strict government mandates. While public health messages do advocate for smaller family sizes, there is no strict government-imposed one-child policy, a la China.

Such an effect is what development economists have argued for a long time—that economic development is the best contraceptive! As people climb the economic ladders into middle class conditions, they voluntarily decide to have fewer children.

It is also interesting to note that the states with the highest fertility rates, like Bihar, are also the ones that are economic laggards, which then adds more evidence to the idea that economic growth plays an important role in an overall decrease in population growth rates.

Not wanting to wait for economic growth to happen, one federal minister in India recently suggested providing free television to the poor because apparently procreation will otherwise be their only free recreation. I wonder, though, about what will ensue if the television audience watches advertisements for Viagra and the like!

Thus, with low birthrates and simultaneous increases in life spans, it is not any surprise that increasingly people are as concerned, if not more, about taking care of the old as much as they worry about their children’s futures. My parents’ 72-year old neighbor rang the doorbell at 5:15 in the morning to inform us that her mother died, and that she was heading out of town for the funeral and related rites. The deceased was 94, and she leaves behind many in the immediate family including her 100-year old husband to whom she was married for almost 80 years.

Here is to wishing India a lot more of such fantastic demographic and economic transformations.

Babies r us?

In The Nation, Patricia Williams, who is a law professor at Columbia (and a Harvard law alum), writes:

Nadya Suleman's saga, in other words, has highlighted a deep cognitive dissonance about whether children are "assets" or eternal expenditure, divine joy or devilish curse in a time of dwindling planetary resources. When I first heard of Suleman, my immediate thought was of Andrea and Rusty Yates--married, fundamentalist Christian believers in that ubiquitous story line about going forth and multiplying no matter what. After caring for and home-schooling five very young children with no assistance but prayer, and with accumulating signs of postpartum psychosis, Andrea Yates woke up one morning and drowned all her children with quiet efficiency.

And so the specter of psychotic breakdown haunts me when I think of the Suleman abode: one autistic child, plus 2-year-old twins, plus four other kids ages 3 to 7, plus eight newborns ranging from one to three pounds, plus a grandfather who has gone back to Iraq to earn more money for the family, plus a grandmother furious at the medical professionals who "assisted" her daughter, plus a surreally chipper Nadya, who despite the miserable odds remains enrolled as a graduate student in, of all things, pediatric counseling. This situation is undeniably sheer madness, but the public discussion seems fixated on the question of whether she can "afford" so many kids, as though if she was rich, this would be sane. ...

... Suleman takes heart looking at Angelina Jolie. Suleman and Kuczynski represent disturbing emotional extremes. But that should not excuse the rest of us from examining the oppressive competitive natality that seems to have gripped us--the fantasies of "baby bumps" and breeding, always breeding, yet more of "our kind." Our culture's antifeminist backlash and its unrealistic aspirations have bewitched Kuczynski and Suleman, these two young women who are so addled and so suggestible, so endowed and yet so impoverished. All these years after the age of "liberation," perhaps it is time to revisit the myths we still concoct about childless women's worth.

Fertility tourism in India

Life and economics get more and more surreal: here is an example of that from The Guardian.

The fertility tourists
The ads are brazen: 'healthy young women - superovulated exclusively for you!'. The fees are half those of UK clinics ('flights and hotel included!'). And the industry is unregulated, leaving doctors free of legal and ethical constraints. No wonder more and more Europeans are going to India for fertility treatment.

Read more at The Guardian

Paid maternity leave

From: the Economist