Monday, April 28, 2008

The Life of Surrogates

The Curious Lives of Surrogates
Thousands of largely invisible American women have given birth to other people's babies. Many are married to men in the military.

Jennifer Cantor, a 34-year-old surgical nurse from Huntsville, Ala., loves being pregnant. Not having children, necessarily—she has one, an 8-year-old daughter named Dahlia, and has no plans for another—but just the experience of growing a human being beneath her heart. She was fascinated with the idea of it when she was a child, spending an entire two-week vacation, at the age of 11, with a pillow stuffed under her shirt. She's built perfectly for it: six feet tall, fit and slender but broad-hipped. Which is why she found herself two weeks ago in a birthing room in a hospital in Huntsville, swollen with two six-pound boys she had been carrying for eight months. Also in the room was Kerry Smith and his wife, Lisa, running her hands over the little lumps beneath the taut skin of Cantor's belly. "That's an elbow," said Cantor, who knew how the babies were lying in her womb. "Here's a foot." Lisa smiled proudly at her husband. She is, after all, the twins' mother.

It is an act of love, but also a financial transaction, that brings people together like this. For Kerry and for Lisa—who had a hysterectomy at the age of 20 and could never bear her own children—the benefits are obvious: Ethan and Jonathan, healthy six-pound, 12-ounce boys born by C-section on March 20. But what about Cantor? She was paid, of course; the Smiths declined to discuss the exact amount, but typically, surrogacy agreements in the United States involve payments of $20,000 to $25,000 to the woman who bears the child. She enjoyed the somewhat naughty pleasure of telling strangers who asked about her pregnancy, "Oh, they aren't mine," which invariably invoked the question, "Did you have sex with the father?" (In case anyone is wondering, Lisa's eggs were fertilized in vitro with Kerry's sperm before they were implanted on about day five.)

But what kind of woman would carry a child to term, only to hand him over moments after birth? Surrogates challenge our most basic ideas about motherhood, and call into question what we've always thought of as an unbreakable bond between mother and child. It's no wonder many conservative Christians decry the practice as tampering with the miracle of life, while far-left feminists liken gestational carriers to prostitutes who degrade themselves by renting out their bodies. Some medical ethicists describe the process of arranging surrogacy as "baby brokering," while rumors circulate that self-obsessed, shallow New Yorkers have their babies by surrogate to avoid stretch marks. Much of Europe bans the practice, and 12 states, including New York, New Jersey and Michigan, refuse to recognize surrogacy contracts. But in the past five years, four states—Texas, Illinois, Utah and Florida—have passed laws legalizing surrogacy, and Minnesota is considering doing the same. More than a dozen states, including Pennsylvania, Massachusetts and, most notably, California, specifically legalize and regulate the practice.

Today, a greater acceptance of the practice, and advances in science, find more women than ever before having babies for those who cannot. In the course of reporting this story, we discovered that many of these women are military wives who have taken on surrogacy to supplement the family income, some while their husbands are serving overseas. Several agencies reported a significant increase in the number of wives of soldiers and naval personnel applying to be surrogates since the invasion of Iraq in 2003. At the high end, industry experts estimate there were about 1,000 surrogate births in the United States last year, while the Society for Assisted Reproductive Technology (SART)—the only organization that makes an effort to track surrogate births—counted about 260 in 2006, a 30 percent increase over three years. But the number is surely much higher than this—in just five of the agencies NEWSWEEK spoke to, there were 400 surrogate births in 2007. The numbers vary because at least 15 percent of clinics—and there are dozens of them across the United States—don't report numbers to SART. Private agreements made outside an agency aren't counted, and the figures do not factor in pregnancies in which one of the intended parents does not provide the egg—for example, where the baby will be raised by a gay male couple. Even though the cost to the intended parents, including medical and legal bills, runs from $40,000 to $120,000, the demand for qualified surrogates is well ahead of supply.

Another reason for the rise in surrogacies is that technology has made them safer and more likely to succeed. Clinics such as Genetics & IVF Institute in Virginia, where Cantor and the Smiths underwent their IVF cycles, now boast a 70 to 90 percent pregnancy success rate—up 40 percent in the past decade. Rather than just putting an egg into a petri dish with thousands of sperm and hoping for a match, embryologists can inject a single sperm directly into the egg. The great majority of clinics can now test embryos for genetic diseases before implantation. It's revolutionizing the way clinics treat patients. Ric Ross, lab director at La Jolla IVF in San Diego, says these advances have helped "drop IVF miscarriage rates by 85 percent."

IVF has been around only since the 1970s, but the idea of one woman bearing a baby for another is as old as civilization. Surrogacy was regulated in the Code of Hammurabi, dating from 1800 B.C., and appears several times in the Hebrew Bible. In the 16th chapter of Genesis, the infertile Sarah gives her servant, Hagar, to her husband, Abraham, to bear a child for them. Later, Jacob fathers children by the maids of his wives Leah and Rachel, who raise them as their own. It is also possible to view the story of Jesus' birth as a case of surrogacy, mediated not by a lawyer but an angel, though in that instance the birth mother did raise the baby.

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