Sophie Lewis Full Surrogacy Now: Feminism Against Family Verso Books, 2019. 224 p. £14.99

When the now not-so-novel Coronavirus hit in the Winter/Spring of 2020, global supply chains seized up. Surrogacy arrangements were no exception, as documented in The New Yorker article “The Stranded Babies of the Coronavirus disaster” (July 2020, by Lizzie Widdicombe). The piece centered on Ukraine, a popular destination for international surrogacy. The country is poor (with GDP of about USD 3,000 per capita) and at prices around USD 50,000 per baby, it delivers at a bargain. There is a catch though, married couples only need apply. Singles or same-sex couples have to look elsewhere, the United States, for example, or California to be specific. There are other places, but California offers nontraditional families what Ukraine limits to traditional ones: guarantees that that parenthood will be assigned to the intended parents, singles or couples of any gender combination. This equal opportunity comes with a hefty price tag—somewhere north of USD 100,000. Nevertheless, surrogacy is a growth business. In the United States, the number of births to gestational surrogates almost tripled between 2007 and 2016, to 5,521 according to the CDC (2018). For a business that deals in common ingredients and a mature technology, surrogacy is curiously expensive. Traditional surrogacy (using the surrogate's eggs) can be done with a minimum of medical intervention. Gestational surrogacy uses donated eggs, but assisted reproductive technology (ART) is now in its fourth decade. Nevertheless, the price tag remains high, as do the hoops to jump through, adding to already compelling human drama. What is the point of this book? The book is not a book primarily derived from case studies. Nor, as you've seen, does it argue that there is something somehow desirable about the ``surrogacy'' situation such as it is. It presents brief histories of reproductive justice, anti-surrogacy, and saleswomanship at one particular clinic—but its main distinction, or so I hope, is that it is theoretically immoderate, utopian, and partisan regarding the people who work in today's surrogacy dormitories. The aim is to use bourgeois reproduction today (stratified, commodified, cis-normative, neocolonial) to squint toward a horizon of gestational communism. … Full Surrogacy Now is animated by hatred for capitalism's incentivization of propertarian, dyadic modes of doing family and its purposive starvation of queerer, more comradely modes. Let's bring about the conditions of possibility for open-source, fully collaborative gestation. Let's prefigure a way of manufacturing one another noncompetitively. Let's hold one another hospitably, explode notions of hereditary parentage, and multiply real, loving solidarities. Let us build a care commune based on comradeship, a world sustained by kith and kind more than by kin. Where pregnancy is concerned, let every pregnancy be for everyone. It should be noted that informal and uncompensated (altruistic) surrogacy is perfectly feasible in the United States, where an unmarried mother can in effect chose who adopts her child. Still, altruistic surrogacy is rare, and it is a fair guess that the limiting factor is the availability of surrogates. As for compensated (commercial) surrogacy, Lewis seems to be of two minds. Payment to the surrogate is something Lewis supports. However, having condemned “commodified and stratified reproduction,” justification takes some footwork. Tying herself in knots and Marxist jargon, Lewis settles on arguing that “gestational labor” is work, taking a page from the 1970s’ “Wages for Housework” campaign. Sophistry aside, few would begrudge the surrogate. Pregnancy is physically taxing; giving up a baby sounds soul crushing. But now, the surrogacy contract looks like a contract on persons—can it get more “commodified?” The high cost of surrogacy could be tackled by the surrogate being from a low-cost place, even country, a solution that takes us deep into not just “stratified” but downright “neo-colonial” territory. The book features an Indian “case study” of Dr. Patel and the Akanksha Infertility Clinic. Dr. Patel is named 250 times in the book's 224 pages, but to be clear, the book only contains commentary on secondary material culled from popular outlets such as Oprah, Vice News, or Time magazine. Dr. Patel and her brand of “philanthrocapitalism” is an easy target. A 21st century Madam, rich off the backs of destitute women cooped up in dormitories or a feminist Robin Hood leveraging technology to redistribute wealth from the ultrarich?—discuss. However unseemly, money has not been the main source of controversy. Public outrage has focused on disputes over the fate of the fetus/child. Can the surrogate be forced to terminate the pregnancy? What if there the child does not live up the intended (contracting) parents’ specifications? What if the surrogate wants to keep the child? Disputes over who can do what, when have resulted in some well-publicized cases that have roused national pride and strained diplomatic relations. Since 2015, a number of go-to countries have shut their doors to international surrogacy, including Thailand, India, Nepal, and Mexico. Among the few countries still allowing international, commercial surrogacy, we find Russia. What makes Ukraine more attractive than Russia for surrogacy? (A quick Internet search suggests that the list prices are similar.). The difference comes down to legal motherhood. In Ukraine, the intended parents can be on the birth certificate. By contrast, Russia follows the time-honored doctrine that a child's legal mother is the woman who gives birth—the surrogate's name goes on the birth certificate. The surrogate then surrenders the child for adoption by the intending parents. Why is this important? Imagine if you, the client, is known to be worth millions. The surrogate has borne your baby and is listed on the birth certificate as its mother. The contract says she should give up the baby, but who is to take a baby from its mother? Suddenly, the surrogate's USD 20,000 looks like a pittance … Allowing the intended parents’ names on the birth certificate sidesteps what economists refer to as the hold-up problem. Clearly, surrogacy can be big business. Still, many countries want no part of it, limiting surrogacy to altruistic such for domestic (even kin only) clients. The United States, Ukraine, Russia, and Georgia are among the few countries today that allow surrogates to be paid and to contract with nonnationals. In addition, a number of countries seek to prevent their nationals from using surrogates in another country. So while a couple from Australia can contract with a California surrogate, Australia may not recognize the contractual relationship. An international convention could make cross-border surrogacy easier, but one is unlikely in the offing. Just because two men are allowed to be on the birth certificate in California does not establish them as a family unit in, say, Italy. The legal morass may not be by design, but one would be excused for detecting a lack of interest in clearing it up. The reticence may reflect unease around the matter; a notion that reproductive services should not be commercialized. Maybe such a development would be harmful to children (and by extension, anyone who has ever been a child). Maybe the concern is for women. Could it be that surrogacy, while no means cheap, cheapens motherhood? How could that be? Does the surrogate not provide much-needed relief to the barren woman? Joy to the childless couple? Yes, but unregulated surrogacy can also do something else: provide men with a commercial, and possibly cheaper, alternative to marriage. In the West, until not long ago, a man needed to marry to obtain children, legally speaking. Marriage is still the best a man can do to guarantee fatherhood—a key feature of the marriage contract is the so-called paternity presumption, which states that the father of a child born in wedlock is the husband of mother. Therefore, surrogacy poses direct competition to marriage. The potential for surrogacy to undermine marriage may be one reason many countries limit its use to married couples. In fact, surrogacy operates in a social landscape reminiscent of that of adoption. Heterosexual couples are favored, payments are viewed warily, and there is a notion that it should be reserved for the infertile. Incidentally, adoption has also been viewed as a threat to marriage, and when unregulated as in Roman antiquity, it reduces the status of the wife, as she loses her status as the only way to obtain a legitimate heir. In fact, adoption in the West is relatively recent. The United States was early to recognize legal adoption (Massachusetts Adoption of Children Act of 1851); perhaps out of necessity, as the fraction of orphaned children without any identified relatives to care for them must have been higher than in Europe. In Western Europe, adoption only (re)appeared in the early 20th century, having been banned by the Catholic Church. The Church controlled marriage and wanted to make sure marriage maintained its monopoly on delivering legitimate heirs. Women benefited in the process as the wife stood between men and posterity. She could not be replaced by a concubine, a slave, or be divorced. And she could not be circumvented by the use of adoption. However, the discussion that surrogacy deliberations remind me the most of is that surrounding prostitution. To advocates, it provides a valuable service, and an unparalleled income opportunity to the sellers. No harm, no foul. To opponents, the practice exploits and denigrates women. Clearly, surrogacy is not prostitution. Neither is it its opposite. Arguably, in a Venn diagram of sex and procreation, the two occupy distinguishable but overlapping spaces. Prostitution is sex without children (to the client); surrogacy is children without sex. Marriage sits at the intersection. Lewis touches upon the similarities (p. 42): “As with sex work, the question of being for or against surrogacy is largely irrelevant. The question is, why is it assumed that one should be more against surrogacy than against other risky jobs.” The question is warranted, but unfortunately, treated as rhetorical (de rigueur among prostitution advocates). But prostitution is not just any other job (risk aside). If it were, it would not be well paid. Stigma is what allows a low-skilled and labor-intensive job to be well paid. Stigma is what keeps the profession from being overrun with aspiring interns. Fair or not, without stigma, prostitution would just be another grubby, low-paid job. The book presents surrogacy as a feminist challenge to patriarchy, but surrogacy is about as central to women's status as gay marriage. To be able to rent a uterus is clearly of greatest importance to those lacking one. Incidentally, gay men have surfaced as a key block in the prosurrogacy constituency. If surrogacy poses a challenge, it is not so much to patriarchy as it is to the status of women. While the qualitative direction is clear, the quantitative importance is less so. Women in the West have survived, even found liberation in the reduced significance of the traditional wife role. Still, I do not know what a brand new world of widespread surrogacy would look like for women and children, the groups the least well served by surrogacy. That incertitude, not “capitalism's incentivization of propertarian, dyadic modes of doing family,” may be why many societies have chosen to tread carefully.