I ring up at least ten different California-based fertility clinics, asking if they had clients who’d be prepared to talk to me about why they chose social surrogacy. They all repeated some version of Sahakian’s line: this is not about vanity, it’s about the pressure women are under to maintain their careers at the same time as becoming parents, and women know it’s not acceptable to admit you’ve used a surrogate for non-medical reasons, so no one will talk.
A more nuanced picture begins to emerge when I speak to people in the industry outside Hollywood. An assistant at a clinic in San Diego tells me their social surrogacy clients tend to be single women in high-powered corporate careers who would risk losing their jobs if they had debilitating morning sickness or were put on bed rest; carrying a baby themselves would not only risk their bodies and health but the livelihood and income their child will eventually depend on. A fertility doctor tells me that 80 per cent of her social surrogacy clients are Chinese, because of a ‘cultural thing’ in China where a uterus is considered to be old after one pregnancy. A fertility psychologist who used to run her own surrogacy agency says she worked with a woman who was campaigning for political office and desperately wanted a child; she had to be out on the campaign trail or risk jeopardizing everything she had ever worked for, so she hired someone else to carry her baby for her.
But what about the surrogates, the uterus-bearers expected to ‘disfigure’ themselves so someone else doesn’t have to? How do they feel about potentially risking their lives to give a baby over to someone who has no medical reason not to carry it herself? Well, generally they have no idea that’s what they are doing. Lori Arnold, a fertility specialist from San Diego who runs both a clinic and her own surrogacy agency to provide carriers for her clients, tells me that ‘the surrogates really don’t know the medical point of why the intended parents are seeking surrogacy. If they asked, if we had permission from the intended parent, we would tell them. But it’s a personal medical decision that I do keep private and confidential.’
* * *
Surrogacy is never the easy option. Even with the most willing surrogate, the most professional fertility doctor and the most fastidious paperwork, surrogacy is the most physically, emotionally and legally messy form of third-party reproduction. But it is the only solution to the problem of baby carrying that humans have ever had.
Traditional surrogacy – where the surrogate is the genetic mother of the baby she carries but gives up her parental rights – has been around from the Book of Genesis to The Handmaid’s Tale. Genesis 16 tells the story of how Sarah and Abraham were having problems conceiving an heir. Sarah told Abraham to go to her Egyptian slave, Hagar, ‘that I shall obtain children by her’. It didn’t end well: as soon as Hagar discovered she was pregnant with a son, Ishmael, ‘she looked with contempt on her mistress’, and when Sarah had her own biological son, Isaac, fourteen years later, she cast Hagar and Ishmael out into the desert.
Although traditional surrogacy has existed for millennia in one form or another, it was usually shrouded in secrecy because of the taboo of infertility, the stigma of illegitimacy and the simple mechanics of what’s involved in making a baby this way. Artificial insemination took some of the ickiness out of traditional surrogacy, but it has its own dark history: the first recorded case took place in Philadelphia in 1884, when Professor William Pancoast helped an infertile man and his wife conceive. Pancoast used a rubber syringe to inject fresh sperm from one of his ‘best-looking’ students into the cervix of the woman after she had been knocked out with chloroform. She gave birth nine months later. She was never told how she had conceived, or that her husband was not her baby’s biological father.
The technique Pancoast pioneered changed what it means to make babies: getting pregnant no longer had to depend on heterosexual sex. This has been great for lesbian and gay couples, although, of course, gay men still need women to carry their babies for them. Traditional surrogacy (as opposed to gestational) still remains an option today; it’s the cheapest way of having a child with a surrogate, and if the surrogate is related to one of the intended parents it allows them to have a further genetic link with their babies.
When Louise Brown, the first baby conceived through IVF, was born in Oldham in 1978, a new era of baby-carrying possibilities was born along with her. Not only was conception no longer dependent on sex, it could happen outside the womb, meaning that it became possible for a woman to be pregnant with another woman’s child. The first baby conceived through egg donation was born in 1982, and in 1985 the first successful case of gestational surrogacy was recorded. There could now be a distinction between a genetic mother and a birth mother. For the first time, motherhood became fragmented.
Since the 1980s we have become gradually more willing to accept that a birth mother can be a different person from a genetic mother. It’s difficult to quantify the rise in gestational surrogacy with any accuracy, but in 2014 the New York Times estimated that three times as many babies were born through gestational surrogacy in the US compared to a decade earlier, and in 2018 it was estimated that in Canada, where only altruistic surrogacy is legal, it had increased by 400 per cent since 2008. The rise of gay marriage has led to a greater acceptance of gay parenting, at a time when fewer babies are being put up for adoption at birth. Single men have begun looking to surrogates in the same way that single women might consider using sperm banks to have children on their own. Surrogacy is increasingly the way that modern families are made for people who can’t or won’t bear their own children, and gestational surrogacy has become far more popular than traditional surrogacy: it is a safer bet, as the embryos have already been created by the time they reach the surrogate’s womb, and many in the fertility field say it is legally and emotionally easier than asking a woman who has just given birth to her own genetic offspring to immediately hand it over.
But all forms of surrogacy come with serious legal and ethical challenges, whether they are traditional, gestational, commercial or altruistic. You might imagine the main issue would be surrogates getting attached to the babies they are carrying and refusing to give up them up, but it’s actually far more likely that the intended parents will change their minds and decide they no longer want an already-gestating child. Surrogates have been asked to terminate pregnancies against their will when intended parents split up, or when anomalies and disabilities are detected in the foetus; they have even been asked to abort ‘surplus’ babies when too many embryos implant successfully. There are far too many documented cases of this.
In 2014, an international scandal erupted when a gestational surrogate from Thailand, Pattaramon Janbua, was trying to raise money to help her bring up a baby she said had been abandoned by his Australian intended parents because he had been born with Down’s syndrome. Pattaramon had been pregnant with boy–girl twins, and a scan at seven months revealed that the boy, Gammy, had birth defects. Her clients, David Farnell and Wendy Li, asked her to abort him. Pattaramon refused, and said the Farnells came to Thailand after the birth to take their daughter, Pipah, but not Gammy. It later emerged that David Farnell was a convicted paedophile who had served time in jail for assaulting two girls under the age of ten. In 2016, courts in Western Australia ruled that the Farnells had not abandoned Gammy; they had wanted to keep both babies, but Pattaramon did not want to give Gammy to them. Pipah is not allowed to be alone with her father but is staying with the Farnells, and Gammy is remaining with Pattaramon. The judge said the case ‘should also draw attention to the fact that surrogate mothers are not baby-growing machines, or “gestational carriers”… They are flesh and blood women.’ Thailand banned commercial surrogacy for foreign parents in 2015.
International commercial surrogacy is fraught with its own special blend of ethical problems. Like any kind of outsourced labour, it’s the poorest and least enfranchised people who bear the brunt of the market. Fertility tourism from the UK used to be a growing industry in India, where poor and often illiterate gestational surrogates
were regularly made to stay under close surveillance in dorms for the nine months of their pregnancy, and intended parents were allowed to dictate what they ate and whether they were allowed to have sex. Complete packages, including the surrogate fee and all medical bills, started from as little as $10,000. When India finally outlawed international surrogacy in 2015 the industry was estimated to be worth $500 million a year. Now Ukraine is the go-to destination for cut-price gestational surrogacy, but it’s not uncommon for Ukrainian surrogates to be abandoned without payment if they miscarry, or subjected to more caesarean sections than is medically safe. Multiple embryos are transferred to maximize the chance of a successful pregnancy, with little thought about how the surrogate might cope with carrying triplets or quads.
No matter how many happy surrogates around the world argue that they are carrying other people’s children in order to give the gift of parenthood to the people who want it most, surrogacy by definition depends on using a woman as a vessel, an incubator, and then expecting her to give up any right she might have to the baby inside her. It depends on exploiting women’s reproductive potential, whether or not they consider themselves exploited. In December 2015, the European Parliament condemned all forms of surrogacy, on the grounds that it ‘undermines the human dignity’ of women, and singled out gestational surrogacy specifically, because it ‘involves reproductive exploitation and use of the human body’.
But banning surrogacy won’t remove the demand for it. It is too late; the possibility of having a genetically related baby without pregnancy has opened up a new world to both men and women, one that cannot just be waved away. And new reasons for demanding pregnancy-free parenthood emerge every year, as Sahakian’s bulging client list shows.
* * *
There is no doubt that the fertility specialists who offer social surrogacy are at the most extreme end of fertility treatment. But those same doctors have led the way when it comes to creating families for older women, same sex couples and single men and women. Could this be another barrier they are breaking down, blazing a trail that the rest of the world will one day follow?
Sahakian likes to think so.
‘You say twenty years ago LA was the Wild West in terms of gay surrogacy,’ I say. ‘Do you think twenty years from now that’s how people will think of social surrogacy?’
‘Twenty? No, a couple of years from now. We’re already almost there. Surrogacy isn’t taboo anymore. In the UK, you are so far behind us. Thank God – it’s good for business! But that’s going to change.’
The strange thing is, the secrecy surrounding social surrogacy makes it more likely that more people will want to have their babies this way. The women who use Sahakian’s clinic are the people who the rest of us are supposed to look at and aspire to be.
‘Aren’t you creating an illusion that it’s possible for these women to have the career and the body and the family, to have it all, when it isn’t?’
He shrugs it off. ‘I don’t think it’s a social problem. I can see both sides, but I’m not going to judge. If you want a baby and have someone else carry it, you are helping two people – you are going to have the kid and the surrogate is going to make money helping you.’
I don’t really buy this. Given a choice, I’m sure Sahakian’s social surrogacy clients would rather not have to go through the messy and complicated business of surrogacy, but if they want a baby and they don’t want to carry it themselves, they will have to put up with it.
For now.
Because the drive to improve the technology that has changed the meaning of motherhood rumbles on. First babies didn’t need to be conceived through sex, then they didn’t need to be created inside their mother’s body. What if we could have babies without anyone being pregnant?
CHAPTER TEN The Biobag
The lamb is sleeping. It lies on its side, eyes shut, ears folded back and twitching. It swallows, wriggles and shuffles its gangly legs. Its crooked little half-smile makes it look particularly content, as if dreaming about gambolling in a grassy field somewhere. But this lamb is too tiny to venture into the outside world. Its eyes cannot open. It is hairless; its skin gathers in pink rolls at the base of its neck. It hasn’t been born yet, but here it is, at 111 days’ gestation, totally separate from its mother or any other animal, alive and kicking in a research lab in Philadelphia. It is submerged in fluid, floating inside a transparent plastic bag, with its umbilical cord connected to a nexus of bright blood-filled tubes. This is a foetus growing inside an artificial womb.
Here it is, two weeks later, at 135 days’ gestation, almost full term. The lamb nearly fills the entire space; its flat nose presses up against the corner of the bag. It is plumper, whiter, fluffier, covered in fine coils of wool, with a puff of a tail: definitely a lamb now, but still a foetus. In another two weeks, the Ziploc bag will be unzipped, the umbilical cord will be clamped and the lamb will finally be born.
When I first see images of the lamb in the bag on my laptop, I think of the foetus fields in The Matrix, where motherless babies are horrifically farmed in pods on an industrial scale: human Cowschwitz. But this is not a substitute for full gestation. California’s booming surrogacy industry can rest easy, for now. The Philadelphia lambs didn’t grow in the bags from conception; they were taken from their mothers’ wombs by caesarean section and then almost immediately submerged in the biobag at a gestational age equivalent to around twenty-three to twenty-four weeks in humans. This isn’t a replacement for pregnancy yet, but it is certainly the beginning of it. Birth may one day be as simple as opening a Ziploc bag.
The team who made these artificial wombs say they are driven only by the desire to save the most vulnerable humans on earth. Emily Partridge, Marcus Davey and Alan Flake are neonatologists, developmental physiologists and surgeons who work with extremely premature babies at the Children’s Hospital of Philadelphia (CHOP). After three years of tweaking and refinement, their latest prototype – ‘the biobag’ – is designed to give babies born too soon a greater chance of survival than ever before.
The biobag was born into public consciousness in April 2017, when the CHOP team published their research, along with images of the lambs, in the journal Nature Communications. The paper describes the four different artificial womb prototypes CHOP tested on a total of twenty-three lambs before settling on the biobag design. (Sheep are the go-to animal models in obstetric research because they have a long gestation period, and their foetuses are around the same size as ours.)
‘In the developed world, extreme prematurity is the leading cause of neonatal mortality and morbidity,’ the paper begins. ‘We show that fetal lambs that are developmentally equivalent to the extreme premature human infant can be physiologically supported in this extra-uterine device for up to 4 weeks […] With appropriate nutritional support, lambs on the system demonstrate normal somatic growth, lung maturation and brain growth.’ They had found a way to gestate foetuses outside maternal bodies; foetuses that would eventually become lambs no different from those which had grown in the wombs of pregnant ewes.
CHOP’s communications department released a very slick short film to coincide with the paper’s release. I imagine this was intended to focus the inevitable international press attention on the therapeutic benefits of the biobag instead of the freaky lamb images. Entitled Recreating the Womb, it looks very much like a corporate video, and there is not a foetus to be seen throughout its entire nine-minute duration. There are neat diagrams of lambs in biobag systems, and some slightly awkward staged B-roll footage of Partridge, Flake and Davey pretending to do lambless lamb research in a pristine lab, set to some twinkly piano music intended to inspire awe and wonder. There are some heartbreaking clips of superpremature babies in CHOP’s neonatal intensive care unit (NICU): impossibly small humans covered in tubes, tiny fingers with cracked, flaking skin, breathing tubes taped to gasping little mouths. And then there are some glossy set-piece interviews with the research team themselves in white lab coats: carefull
y edited, backlit and shot in a studio. A longer version was released at the same time as the shorter promotional film, and includes extended interviews with the team.
‘In the future, we envision the system will be in the NICU and it will look pretty much like a traditional incubator. It will have a lid that will be able to move up and down,’ Davey says, his accent half Australian, half American; he was born in Melbourne and came to CHOP in 1999. ‘Inside that warmed environment will be the baby inside the biobag. We’ll have amniotic fluid next door to the incubator, which will be pumped through the biobag,’ he adds, in the extended video.
The biobags would be kept in a darkened environment to mimic the human womb, but the babies would be visible as never before. ‘Parents would see a lot more than they see during a normal pregnancy. We’d have a dark-field camera in the unit so they can actually look at their foetus in real time, see their foetus move and breathe and swallow and do all the things that foetuses do,’ says Flake, the most senior member of the CHOP team. ‘There will also be an ultrasound unit. That’s really how we’ll do physical examinations on the foetus, since we can’t touch the baby like you can in a preterm infant. We’ll do ultrasound and look at its physiologic well-being at least once or twice a day.’
We do like to monitor our babies. In a world where parenthood increasingly begins with fertility-tracking apps followed by what-to-expect-when-you’re-expecting apps and then apps that track every newborn feed and bowel movement, along with video monitors that measure your baby’s vital signs and stream everything to your phone in all its night-vision glory, this will fit right in.
Sex Robots and Vegan Meat Page 18