Andy Ho, Senior Writer

Surrogacy can work - if it's domestic

In August, scandals involving cross-border surrogacy arrangements erupted in Thailand. In one case, an Australian couple had a Thai woman carry their twins - a boy and a girl - but took only the girl home, allegedly leaving the boy behind because he had Down syndrome.

These cross-border arrangements provide a route for people who can't or won't get pregnant to have their own genetic offspring. The surrogate bears the child but has no genetic ties to the baby as the embryos used to impregnate her are made from egg and sperm of commissioning or intended parents, or their egg and/or sperm donors.

Thus, surrogacy could involve up to five "parents" - genetic mother (egg donor), genetic father (sperm donor), surrogate, intended mother and intended father. If so, the child's nationality could be in some doubt.

As Singapore has neither legalised nor outlawed surrogacy, there is no effective protection for such a child. This grey area needs clarification. But more than that, the surrogate is especially unprotected. While the intended parents are generally affluent, educated folks from advanced economies, the surrogate is usually an uneducated, impoverished Third World woman who is valued only by how much money the services of her womb can make for her handlers.

Such women are often closely controlled and monitored, so they do not form emotional ties with the intended parents, who live overseas and generally remain uninvolved during the pregnancy.

It is ethically proper for us in Singapore not to be party to such human exploitation, so cross-border surrogacy should be criminalised here. This, however, would put paid to the desire of some locals to have genetic offspring. But such ethical positions are abstract, ignoring the empirical human experiences within a surrogacy arrangement.

While surrogacy entails monetary payments and while a surrogate has no genetic link to the child she carries, the intimacy and deep emotions that may develop between surrogate and baby, and between surrogate and intended parents, during pregnancy are not so easily erased.

If these experiences were better understood, especially where there aren't economic, educational, cultural and geographical chasms between intended parents and surrogate, a better system could perhaps be designed.

Here, empirical studies of 30 years of domestic surrogacy within the United States show intended parents and surrogates, who are generally locals, to consistently report being happy with and enriched by the experience. US surrogates tend to be working-class white women, with high school education and annual household incomes of under US$60,000 (S$75,000). Generally in their late 20s and early 30s, they live in the suburbs or small towns and often have several children of their own. They may be lower in economic and educational class than the intended parents but are not in dire circumstances - and thus not vulnerable to exploitation.

Contrary to expectations, most surrogate women do not bond with the babies they carry. That is, they do not generally feel that the babies are theirs, so parting is not very traumatic for them.

What is unexpected, though, is that surrogates tend to report forming kin-like bonds with intended parents instead. Their interactions over 40 weeks of pregnancy lead to deep emotional bonds between the two parties, given the human intimacies involved. Pregnancy, labour and afterwards are experienced in unity, so a kin-like bond transcending friendship forms.

In cases where the bond with the intended parents is kept alive even after the first birth, some surrogate women even refuse to be paid the second time round. Consistently, surrogates say that it is the relationship with intended parents that determines how happy and contented they are with the whole arrangement. If they feel appreciated for their contribution in the creation of the family unit such that the kin-like bond continues long after the baby is delivered, they feel most contented.

Where intended parents keep their distance, the surrogate feels unappreciated. If the relationship essentially ends after the birth, the total experience leaves surrogates disappointed, even devastated, that what they went through was evidently seen by the intended parents as no more than a market transaction. Such surrogates feel that the altruistic aspects of their contribution went wholly unappreciated.

Thus, experts note, surrogacy has both a market aspect, where payment for services is justified, and a non-market side, that of intimacy and emotional connectedness, which must also be managed. Since the market takes care of the commercial aspect, governments should regulate the non-market aspect to protect the surrogate from emotional harm and potential exploitation.

A critical policy move that some advocate is to mandate visitation rights for the surrogate.

The provision for such rights should make intended parents regard surrogacy as more than merely a commercial transaction. It could ensure that they are not overly demanding or crassly exploitative of a surrogate. Instead, they might see it as embarking on a life-long relationship with her.

For this to work, geographic distance will matter. This means that surrogacy ought to be domestic. So, if Singapore legalises surrogacy, it ought to be only domestic - perhaps including surrogates from across the Causeway as well, given the geographical closeness and cultural affinity.

Visitation rights would dissuade some couples, but precisely those who don't care enough about the surrogate's vulnerabilities or her emotional burdens.

A Singapore system of accreditation that takes seriously the real human relationships involved would encourage the right kind of intended parents. These will be people who respect the surrogate's human dignity, so there would be less potential for the kind of exploitation that now commonly plagues cross-border surrogacy.

A sensitively crafted policy of domestic surrogacy would reduce the need for local couples to seek crossborder surrogacy, with all its attendant problems, and make surrogacy more and more acceptable in Singapore over time.

andyho@sph.com.sg