Gay Parents and Transnational Surrogacy

Over recent decades, the use of assisted conception techniques by straight, single and gay parents has become increasingly socially acceptable and we have even seen gay and heterosexual celebrities openly using surrogacy to have children. Nonetheless, surrogacy still provokes ethical concerns, not least in the case of transnational surrogacy, with many public commentators expressing fears about the treatment of surrogate mothers by foreign agencies. Transnational surrogacy entails the crossing of geographical, familial, legal, genetic, individual and local ethical boundaries, as well as the expansion of traditional ties of kinship and parenthood. It challenges many conventional assumptions about how we make children, while attesting to the enduring appeal of nuclear families, albeit in postmodern forms.

The second annual Alternative Families Show took place in a conference center in central London in September 2011. This expo of assisted reproductive technology providers aimed at the LGBT community is organized by Stonewall, the national gay rights charity, and the London Women’s Clinic, a private clinic based in exclusive Harley Street, London, which pioneered assisted conception services for gay and single parents.

During a seminar on surrogacy in the United States that I attended during the event, Karen Synesiou, owner of the California-based Center for Surrogate Parenting (CSP)—the agency used by Elton John and David Furnish to have their son—gave a twenty-five minute talk about her agency. The seminar took place in a plush-carpeted, air-conditioned conference room and was attended by around forty people, three-quarters of whom were white, gay and/or single men, while the remainder were heterosexual couples, a number of whom were of South Asian ethnicity.

Synesiou gave a self-assured yet personable presentation. At the outset, she emphasized the shared interests between her and her audience, noting that although she now lives and work in the US, she comes from the UK. This tactic was mirrored by the representative for California Fertility Partners, who outed himself as a gay man within the first few sentences of his subsequent presentation. Synesiou noted that her agency has been established for over 30 years and that it helped its first gay couple become parents 25 years ago. This was likely to be reassuring to prospective intended parents in a blossoming market of providers and with periodic nightmare scenario stories about surrogacy in the press. Synesiou did not skate over the expense of surrogacy in California, nor the many hurdles intended parents must go through. She was also open about the fact that there are disreputable surrogacy agencies and offered advice about how to spot them. While this drew attention to the fact that surrogacy provision is ethically and legally patchy even in the US, it also allowed her to set up a clear contrast between these agencies and her own.

Surrogacy is a Relationship

The key selling points of CSP and surrogacy in California more generally that Synesiou highlighted included the standard of healthcare provision in the US, the “compassionate and professional” staff of the agency who treat surrogacy as a relationship and its reassuring expense. For British intended parents, surrogacy in California can cost between $50,000 and $100,000, but as she put it herself in her mid-Atlantic tones, “you’re gonna get what you pay for.” She made a strong case that high costs were both a sign of quality and necessary in order to ensure a successful experience, implying that each cost—including counseling, legal fees, transatlantic meetings, medical insurance and the surrogate’s fees, treatment costs and life insurance—was a means of protecting the intended parents’ access to their child. Implicit in this is a sense that compensating the surrogate appropriately is an important part of a successful arrangement.

As Synesiou put it, in California, intended parents and surrogates have access to “first world care, like in the UK,” and it seems likely that this is one of the key appeals of US surrogacy agencies for British intended parents. The thinly veiled contrast in this comment was with the new breed of surrogacy agencies currently springing up in India and other less developed countries. Later in the day, I attended the seminar “Affordable Surrogacy in India.” The panel was dominated by Benhur Samson, CEO of Surrogacy Abroad, which is based in Chicago and helps US and British intended parents access surrogacy services in India. Around thirty people attended this seminar. As well as being more ethnically diverse than the earlier one, there were also more heterosexual couples in attendance.

Samson was upfront about the fact that surrogacy in India can be “confusing” for intended parents, not least because it is currently unregulated. As well as the lower cost, he emphasized the fact that his agency is a family business, that he builds personal relationships with surrogates and intended parents and that they “do not outsource anything,” but remain personally involved and in control of each surrogacy arrangement.

This seminar incorporated a substantial question and answer session and audience members asked some probing questions that indicated a sense of mistrust about surrogacy in India. This likely reflects its coverage in the British press, in which many commentators have expressed concerns about the treatment of surrogate mothers in India and the lack of legal protection for all involved, as much as any failings on the part of the seminar panel to convince the audience.

As well as general concerns about cost, legal complications and the ethical treatment of all parties to a surrogacy arrangement, gay people trying to access transnational fertility services must take account of local attitudes towards such ‘alternative’ forms of parenting. While Samson did his best to convince his audience that India was unprejudiced towards gay people, I was left with the impression that he had not been particularly successful in countering attendees’ assumptions that the US offered a significantly more favorable environment for gay parents compared to India.

Reassuringly Expensive

Neither the Indian nor American surrogacy industries have spotless record. The case of Theresa Erickson, a California surrogacy lawyer who pleaded guilty to charges related to her part in a transnational baby-selling ring last year, demonstrates that even with legal regulation, surrogacy can go disastrously wrong. Nonetheless, US agencies have two major assets in selling their services to prospective intended parents in the UK, both of which serve to suggest that they deserve to be trusted: they appear both “reassuringly expensive” and “like us.”

From what I observed at the Alternative Families Show, it seems that gay prospective parents see the US and Britain as having similar levels of support for gay parenting and equivalent standards of healthcare (and it is probably reasonable to assume that many British intended parents who can afford transnational surrogacy have also opted into the private system for their own healthcare). The skepticism about Indian agencies evident in the seminar I observed points to an underlying assumption that US agencies are more likely to be held to equivalent ethical standards to those in the UK. This is despite the fact that the British law was designed to prevent the commercial arrangements offered by agencies like CSP, which is presumably one of the reasons why British intended parents seek their services in the first place.

Karen Synesiou’s point that “you get what you pay for” is apt on a number of levels—the expense of US surrogacy signifies not only quality of service, but also the power to choose and control over the final result. Having such power may be particularly appealing to a group that has historically been marginalized and denied access to traditional forms of kinship and parenting.

Katharine Dow earned a PhD in social anthropology from the London School of Economics (2010). She is an independent consultant and a researcher to the UK’s All Party Parliamentary Group on Population, Development and Reproductive Health. She is also editing a collection that explores contemporary relationships between nature and ethics.