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Aug 9, 2019

The Ethics of Surrogate Pregnancy

A review of Sophie A. Lewis’s "Full Surrogacy Now: Feminism Against Family"

When it comes to surrogacy, libertarians and communists may be able to agree more than you might think.

Full Surrogacy Now

I felt compelled to read Full Surrogacy Now: Feminism Against Family, reproductive theorist Sophie A. Lewis’s new book, after seeing the online brouhaha about its controversial thesis. 

Lewis, a communist, believes that “the path to freedom for humanity is a flight from market dependence, and one name for this path is ‘full surrogacy’ ” (33). Now, I’m definitely not a communist, but, deep worldview divisions notwithstanding, I found much of value in Full Surrogacy Now. Even if we (happily) never move towards communal reproduction under communism, there is much to be said about commercial surrogacy and gestation under capitalism. 

First and foremost, I agree with Lewis that pregnancy is work. Having just finished birthing 3 children in less than 4 years, I’m no stranger to the rigors of gestation. Sociocultural baggage around pregnancy, including muddled, uneven, and historically naive claims about maternal altruism, can obscure this truth at times. But, at the end of the day, work is work — though communists and libertarians have much different opinions on what place “work” holds in a just world. 

Whether you think paid labor has no place in a just world or that it should serve as a primary mediator of human interaction, it’d be bad news if pregnancy work were both widespread and miserable. Lewis claims that “pregnancy work is not so much disappearing or getting easier as crashing through various regulatory barriers onto an open market” (5). On the contrary, the volume of worldwide pregnancy work is both shrinking and, for many gestators, becoming easier as well.     

Industrialization, urbanization, and investment in human capital (i.e. education) have combined to drop the birth rate from a grueling and dangerous number of children per woman towards a more humane 1 or 2. In fact, global fertility may have dropped to an even lower number than is socially optimal; and there are women who want to have children but cannot given that access to healthcare remains uneven, childcare is devastatingly expensive, and that childbirth will never be totally risk-free. Still, thanks to advances in obstetrics, and public health more generally, pregnancy and delivery are leaps and bounds safer today than they used to be. 

On top of those demographic changes, brisk markets for consumer goods and services shower pregnant women in developed countries with things that really do make pregnancy easier, like maternity wear, compression undergarments, nausea products, and gear to make caring for and entertaining other children less burdensome. Though these creature comforts won’t seem like a good substitute for cradle communism to a comrade, they are greeted with open arms and wallets by many pregnant women across the rest of the political spectrum.

In other words, economic freedom (i.e. capitalism), and the prosperity that attends it, do seem to be alleviating this oldest of burdens. Meanwhile, countries that have socialized health care appear to deliver worse outcomes during pregnancy and delivery. If improving reproductive healthcare outcomes is the goal, then we have to chalk up another point for capitalism. 

To turn to the realm of ethics, libertarians believe that you should be able to do anything for money that you’re already legally permitted to do for free. This belies common complaints about the “commodification” of certain domains. The principle covers things individuals might choose to do with their bodies: putting things in (sex), taking things out (organs), and incubation (surrogate pregnancy). 

Moreover, libertarians can agree with Lewis that various forms of surrogacy as currently practiced are handled in a deeply unethical manner. The “feminationalism” Lewis decries — laws created to “protect” a “nation’s women [from] nefarious outsiders” — is also objectionably anti-individualist. Libertarianism’s concept of self-ownership strongly contradicts the proposition that a country’s national resources includes women’s uteri and are to be managed through the political process. 

The simple pursuit of profit motivates action from good people and scoundrels alike. But the libertarian vision of capitalism is based on individual freedom and active consent (often explicit and contractual) to commercial transactions. Those surrogates who have been recruited into the industry by dishonest middlewomen, working under “contracts” they literally cannot read, have been unquestionably wronged according to both communist and libertarian standards.

So if libertarians and communists like Lewis are, in some ways, on the same page about surrogacy, what about the radical call for full surrogacy? Well, the details here are sparse. As far as I can tell, Lewis views universal, fairly-paid surrogacy as an intermediate step towards the complete disintegration of the patriarchal, “biological” family. 

The new family will value “motherhood” not as an act of uterine work to produce children-cum-possessions, but as an ongoing practice of generous and kindhearted adults towards various young people with no biological connection necessary. In the meantime, surrogates can and should seize power over their gestational labor through organizational strategies. Although labor negotiations are sometimes a dry affair, surrogates occupy a unique position from which to seize power if they wish. Their strikes and protests might involve absconding from surrogates’ prescribed living quarters or going rogue with fetuses.

I am happy to accept a near future in which surrogacy is more widespread, so long as it is genuinely voluntary. But truly ‘full’ surrogacy would have to be the product of coercion. Even if today’s biological mothers are often alienated from their “natural” pregnancy labor and are brainwashed about what motherhood really means, it’s hard to imagine that nobody in a world of “full surrogacy” would want to do her own gestational work or keep the products thereof. 

Genetic relatedness might not be the most important thing morally connecting caregivers to the children they raise. Still, ordinary genetic parenthood stands as the de facto baseline for human affairs. Perhaps one day every last one of us will consent to a system of invitro-fertilizing our eggs using anonymized pools of sperm and incubating them in disembodied baggies of amniotic fluid (while sterilizing ourselves, lest we accidentally produce a baby the old-fashioned way) and then dispassionately watching them be raised by strangers, all done under the all-seeing, munificient hand of the State. 

But there is no reason to think a government can sort babies and parents effectively, even in the case that everyone wanted this (and they don’t). Coercion on a massive scale would be necessary. In any case, pursuing the Communist full surrogacy vision is already possible on a smaller scale; individuals who do actually want to distribute motherhood amongst themselves communally can already choose to do so. Communes might have a poor track record in general, but I’m happy to live in a society where eccentrics are free to choose to live, work, and raise children however they wish. 

Make no mistake: human reproduction has taken, and continues to take, many different forms. “Leave It To Beaver”-style nuclear families might turn out to have been a flash in the post-World War II pan, so we shouldn’t lean too heavily on that template for reproductive life. I can, with Lewis, at least begin to imagine material and sociocultural conditions under which voluntary surrogacy becomes a widespread norm. 

However, today’s parents seem to feel more strongly than ever that parenting is a value-laden, self-expressive undertaking. So I can’t imagine that full surrogacy would become a step along the path to a radically different future, rather than the product of a radically different future that had already mostly materialized.  How we produce babies would be the last piece of fully automated luxury communism to click into place, not the first.